ASSESSMENT DONE PRIOR TO FITNESS & WELLNESS PRESCRIPTION

For general health and fitness purposes, there are certain tests that are also required prior to
prescribing exercise programme and these are considered the starting point for designing an
appropriate exercise program. These tests are meant to ensure that the person is not at risk of
health hazards and provide the trainer with the insights needed to establish clear and effective
fitness goals.

1) Non-Exercise Data Collection

Health Status Questionnaire-

The first step when working with a client on their health and fitness is to conduct a consultation
with them to establish their exercise readiness and to ensure all relevant health issues are
identified and considered before a training prescription occurs.  Before starting a fitness
program, it is important to discuss medical history with the trainer and to get the necessary
approvals from the doctor to proceed. Most fitness specialists will use one or more screening
tools to help determine baseline health. This may include obtaining vital sign measurements such
as height, weight, resting heart rate, and resting blood pressure and getting health and medical
questionnaire filled.

HEALTH & MEDICAL QUESTIONNAIRE-Sample

Name: _________________________ Date of birth: _____________________

Date: ________________
Address:________________________________________________________________
Street City State Zip
Phone (Cell): __________________ (Work): _________________
Email address: ___________________
In case of emergency, whom may we contact?
Name: _________________________ Relationship: _______________________
Phone (Cell):_________________________ (Home):___________________________
Personal physician
Name: _________________________ Phone: _______________________
Fax: __________________
Present/Past History
Have you had or do you presently have any of the following? (Check if yes.)
______ Rheumatic fever
______ Recent operation
______ Lung disease
______ Heart attack or known heart disease
______ Fainting or dizziness
______ Diabetes
______ High Cholesterol
______ Orthopnea (the need to sit up to breathe comfortably) or paroxysmal (sudden,
unexpected attack) or nocturnal dyspnea (shortness of breath at night)
______ Shortness of breath at rest or with mild exertion
______ Chest pains
______ Palpitations or tachycardia (unusually strong or rapid beat)
______ Intermittent claudication (calf cramping)
______ Pain, discomfort in the chest, neck, jaw, arms, or other areas
______ Known heart murmur
______ Unusual fatigue or shortness of breath with usual activities
______ Temporary loss of visual acuity or speech, or short-term numbness or weakness
in one side, arm, or leg of your body
Cancer
Family History
Have any of your first-degree relatives (parent, sibling, or child) experienced the
following conditions? (Check if yes.) In addition, please identify at what age the
condition occurred.
______ Heart attack
______ Heart operation (Bypass surgery, Angioplasty, Coronary Stent placement)
______ Congenital heart disease
______ High blood pressure
______ High cholesterol
______ Diabetes
______ Other major illness: _____________________________________
Activity History
1. How were you referred to this program? (Please be specific.)
2. Why are you enrolling in this program? (Please be specific.)
3. Have you ever worked with a personal trainer before?
Yes _____ No _____
4. Date of your last physical examination performed by a physician:
____________________________
5. Do you participate in a regular exercise program at this time?
Yes _____ No ______ If yes, briefly describe:
5. Can you currently walk 4 miles briskly without fatigue? Yes ______ No
6. Have you ever performed resistance training exercises in the past?
Yes ______ No _______
7. Do you have injuries (bone or muscle disabilities) that may interfere with
exercising? Yes ______No ______ If yes, briefly describe:
 8. Do you smoke? Yes ______ No ______ If yes, how much per day and what was your
age when you started? Amount per day _______ Age _______
9. What is your body weight now? _______What was it one year ago? At age 21?
_______
10. How tall are you?
11. Do you follow or have you recently followed any specific dietary intake plan and, in
general, how do you feel about your nutritional habits?
12. List the medications you are presently taking.
13. List your personal health and fitness objectives.

PAR Q (Physical Activity Readiness Questionnaire)

The PAR-Q, or physical activity readiness questionnaire, is a simple self-screening tool that can
and should be used by anyone who is planning to start an exercise or fitness programme. It is
typically used by fitness trainers or coaches to determine the safety or possible risk of exercising
for an individual based on their health history, and current symptoms and risk factors. It also can
help a trainer design an ideal exercise prescription for a client based on these results.

The PAR-Q was created by the British Columbia Ministry of Health and the Multidisciplinary
Board on Exercise. The questions aim to uncover heart, circulatory, balance, medication,
emotional, and joint problems that could make exercise difficult, or even dangerous for some
people. The most serious potential risk of intense exercise is that of a heart attack or other sudden
cardiac event in someone with undiagnosed heart conditions.

As useful as these questionnaires are, some underlying cardiac issues, particularly those in young
athletes, can only safely be diagnosed by more invasive testing, including
an electrocardiogram (ECG) and an echocardiogram. Still, the simple questionnaire has a place
in screening most adults for obvious exercise safety risks.

Physical Activity Readiness Questionnaire-Sample

Being physically active is very safe for most people. Some people, however, should check with
their doctors before they increase their current level of activity. The PAR-Q has been designed to
identify the small number of adults for whom physical activity may be inappropriate or those
who should have medical advice concerning the type of activity most suitable for them.

Answer yes or no to the following questions:

1. Has your doctor ever said that you have a heart condition and that you should only do
physical activity recommended by a doctor?
 2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem that could be made worse by a change in your
physical activity?
6. Is your doctor currently prescribing drugs (for example, water pills) for your blood
pressure or heart condition?
7. Do you know of any other reason why you should not do physical activity?

If you answered yes:

If you answered yes to one or more questions, are older than age 40 and have been inactive or are
concerned about your health, consult a physician before taking a fitness test or substantially
increasing your physical activity. You should ask for a medical clearance along with information
about specific exercise limitations you may have.

In most cases, you will still be able to do any type of activity you want as long as you adhere to
some guidelines.

If you answered no:

If you answered no to all the PAR-Q questions, you can be reasonably sure that you can exercise
safely and have a low risk of having any medical complications from exercise. It is still
important to start slowing and increase gradually. It may also be helpful to have a fitness
assessment with a personal trainer or coach in order to determine where to begin.

When to delay the start of an exercise program:

 If you are not feeling well because of a temporary illness, such as a cold or a fever, wait
until you feel better to begin exercising.
 If you are or may be pregnant, talk with your doctor before you start becoming more
active.

Keep in mind, that if your health changes, so that you then answer "YES" to any of the above
questions, tell your fitness or health professional, and ask whether you should change your
physical activity plan.

Informed Consent

Informed consent is the process of obtaining the client's signature to confirm that they
have read and received a satisfactory explanation of the benefits, limitations and risks of
engaging in the fitness programme. Informed consent must be obtained from a client
 prior to beginning any fitness or wellness programme. This is taken when a personal
trainer collects a client’s personal information, conducts fitness assessments, provides
lifestyle advice, designs an exercise programme or instructs exercise.

The normal method for obtaining informed consent is to provide the client with a form
and to explain its content, giving the client the opportunity to ask questions prior to
signing the form. This signature represents their consent for the collection of personal
information and participation in the services offered. The informed consent form is a
legal document that contains personal information belonging to the client. It must
therefore be treated confidentially according to the organizations information governance
policy.

Body Composition

Body composition describes the different components that make up total body weight,
including your muscles, bones, and fat. The most common methods for estimating body
composition include:

Body mass index (BMI), a generalized calculation of body fat based on your height and
weight

Skinfold measurements in which calipers are used to estimate how much body fat there is
in a fold of skin

Bioelectrical impedance analysis (BIA) in which electrical signals are sent from
electrodes through the soles of your feet to your abdomen to estimate your body
composition

Blood Chemistry

The blood test is one of the most important diagnostic tools. Checking blood can help
identify a range of issues from infections to our overall state of health. It can establish if vital
organs such as the kidneys or liver are working well, whether we have markers for certain
cancers, or if we are susceptible to some genetic conditions.

Trainers can also use blood tests, such as fasting blood tests and full blood count
tests to measure hormone levels, and nutritional deficiencies or excesses.

One of the most common tests is for levels of cholesterol in the blood. High levels of
cholesterol, can be an indicator of heart disease or stroke. Testing for C-reactive protein
(CRP) can help doctors spot inflammation in the body which can be a sign of disease. Thus,
blood is analyzed for nutritional deficiencies, metabolic health, kidney, liver, and
reproductive health, and inflammation, among other things.
Risk analysis for Diabetes

Risk analysis of heart disease

Warning Signs to Terminate Exercise

Pain and other symptoms that occur during exercise can be warning signs that something
is wrong. Client should stop exercising right away if he:

 feels pain or pressure in the left or middle part of chest, or in the left side of the neck, left
shoulder or left arm
 Feels dizzy or sick
 Breaks out in a cold sweat
 Has muscle cramps
 Feels sharp pain in joints, feet, ankles, or bones
 Notices that heart starts racing or beating irregularly

If Client starts to experience these problems during high intensity aerobic exercise, it is
best to immediately slow down. Allow heart rate to drop gradually before stopping
completely, since an abrupt stop can cause problems with blood circulation and fainting.
 However, in cases of severe and sudden pain, stop immediately, seek help, and follow up
with the doctor.

Resting and Exercising ECG

An ECG Electrocardiogram is used to determine whether or not the heart is receiving

enough oxygenated blood to perform optimally while under stress. As the heart is taxed
during exercise or exertion, it requires increased blood flow to support the rest of the
body however, this flow may become compromised due to cardiovascular problems.

The ECG Electrocardiogram produces a wide range of results and insights into heart rate,
blood pressure and ECG (heart rhythm). This information is valuable in helping the
doctor determine the following:

 The health and performance of heart

 Determine the efficiency and taxload of the heart
 Determine if the heart is enlarged
 Diagnose coronary artery disease
 Use test results to locate arterial blockages and make diagnoses
 Efficacy of a particular treatment program - Determine whether the program is
working well or if adjustments are required

The standard ECG test is performed in a professional medical setting such as doctor’s
office, clinic or hospital. The doctor, nurse or trained technician places adhesive electrode
patches on several areas across the chest and shoulders to permit ECG measurement. The
electrodes transmit electricity from heart to the ECG testing system where they are
tracked, monitored and recorded. Patient also wears a conventional blood pressure cuff to
extract blood pressure data.

For the exercise component, the person will be instructed to carefully step onto the
treadmill then begin stepping. The exercise will begin gradually then the speed and
intensity will slowly increase. This increase in intensity causes heart rate to go up.

The technician will be present throughout the entire procedure, monitoring the person
both visually and verbally. Additionally, the ECG system will be continuously monitored
to track and respond to any issues as quickly as possible. Should any abnormal symptoms
arise such as pain, extreme fatigue, shortness of breath or dizziness, these issues have to
be reported immediately to the technician.

The test concludes when the person reaches his target heart rate or if he is physically no
longer able to perform the exercise due to significant symptoms. Once the exercise
 component is complete, person will be instructed to step off the treadmill and rest on a
chair or bed where his heart rate, blood pressure and ECG will continue to be monitored.

The entire test takes approximately 45 minutes to one hour to perform. This total time
includes preparation, exercise and recovery.

The Results

Typically, the doctor will review the images at a later time and prepare a report detailing
his findings.

Normal Results

In normal test subjects, exercise produces a typical increase in heart rate and blood
pressure. This indicates that blood is flowing properly and allowing the heart to pump
effectively therefore, the coronary arteries are presumed healthy and normal. These
results are dependent on age, medical history, health conditions.

Abnormal Results Mean

Since the Exercise ECG test is performed in order to determine how well a heart
functions, abnormal test results indicate the heart is not performing to its maximum
potential. This may be due to reduced blood flow to the heart typically caused by arterial
blockages or narrowing. It may also be caused by scarring from a prior heart attack.
Based on the test results, follow-up treatment may include the following:

 Heart medication treatment or changes to the current exercise program

 Heart bypass surgery
 Coronary angiography
 Angioplasty and/or stent placement

Pulmonary Functions

Pulmonary function tests (also called lung function tests) are used to measure how well lungs are
working. They can also be used to diagnose conditions like asthma, chronic obstructive
pulmonary disease (COPD) or pulmonary fibrosis or to measure the damage done by conditions
like pulmonary fibrosis (it is a chronic and progressive lung disease where the air sac in the
lungs (alveoli) becomes scarred and stiff making it difficult to breathe and get enough oxygen
into the bloodstream.).

To do this, pulmonary function tests measure:

 How much air you can breathe in

 How much air you can breathe out, and how fast you can breathe it out
 How well your lungs are delivering oxygen to your blood
  How strong your breathing muscles are

To measure these things, doctors use different breathing tests:

 Spirometry: measures how much air you can breathe in and out and how and how fast
you can breathe air out
 Body plethysmography: measures how much air is in your lungs after you take a deep
breath and how much is left in your lungs after you breathe out completely
 Lung diffusion capacity: measures how well oxygen passes from your lungs to your
blood

To measure the amount of oxygen in your blood, doctors use:

 Pulse oximetry: uses a sensor attached to the finger that measures the amount of oxygen
in the blood
 Arterial blood gas test: determines how much oxygen is in the blood by examining a
blood sample

Exercise testing is done to allow doctors to see how well lungs perform during exercise. Exercise
tests involve measuring heart rate, carbon dioxide and oxygen levels in the blood, blood
pressure, breathing patterns, and overall physical condition while exercising. There are three
main types of exercise tests:

 Six-minute walk: involves walking on a treadmill at own pace for six minutes

 Rest and exercise test: involves mild exercise at different speeds to evaluate a patient’s
oxygen requirements with everyday exertion
 Incremental exercise test: involves exercise that is gradually increased in intensity to
determine a patient’s maximum exercise capacity
 Exercise tests are usually performed using a treadmill or stationary bicycle. The doctor
will ask the person to walk or pedal for different amounts of time and at different
intensities depending on what tests are being performed. Some exercise tests require only
mild exertion, while others require exercise as hard as the person can.

Nutrition Information

General nutritional data is taken. The person is asked to record his dietary intake for 3 days
and then it is analyzed for dietary habits and nutritional deficiencies and excesses. Along with
any exercise program, nutritional habits are important to be modified for better results.

Risk Factor Assessment

Factors to be considered when assessing exercise risk
There are modifiable factors (things we can change) and non-modifiable factors (things we can’t
change) that need to be considered when assessing risk.

 Modifiable factors to consider Non-modifiable factors to consider

Smoking Age

Inactivity Personal health history

Poor nutrition Gender

Stress Family health history

Excess body fat.  

All increase the risk of the common  Higher risk for older, history of poor health, male,
diseases mentioned within this folder. history of related family members with similar
disease.

Generally a combination of risk factors significantly increases the overall risk of disease (for
example being overweight, smoking, being inactive and being stressed will greatly increase
disease risk).

The non-modifiable risk factors

Age
In general, a persons risk for heart disease increases as they grow older. Specifically age is a risk
factor for:

 Men older than 45 years

 Women older than 55 or with premature menopause without oestrogen replacement therapy
Gender
Women in general run a lower risk of developing heart disease than men, until menopause. After
that, the hormonal changes brought on by menopause cause the heart disease risk to increase at a
much faster rate. Of course, women who smoke have just as great a chance as men for
developing heart disease.

Personal health history:

If the client has a history of risk factors like high blood pressure, high cholesterol and being
overweight he has a much higher risk of developing diseases like diabetes, cardiovascular
disease and stroke. If he has already been diagnosed with any of the following this increases risk
of more serious complications:

 Cardiovascular disease 
 Pulmonary disease including asthma
 Metabolic disease including diabetes
Personal health history is a non-modifiable risk factor as past cannot be changed. One can give
up smoking now and reduce the risk, but the risk will still be higher than someone who never
smoked.

Family health history

Research has shown that a person’s risk of developing heart disease is higher if they have a close
relative (grandparents, parents, siblings) with a history of heart disease or stroke at an early age.
While genetics are thought to contribute, a family's lifestyle (lack of exercise, being overweight,
smoking, eating large amounts of saturated fats and cholesterol) contributes significantly to heart
disease.

The specific risk factors to look for are:

Myocardial infarction, coronary revascularization, or sudden death

 before 55 years of age in father or other male first degree relative (i.e. brother or son)
 before 65 years of age in mother or other female first degree relative (i.e. sister or daughter)

The modifiable risk factors

Smoking
Smoking is the single most important risk factor for many diseases. People who smoke run twice
the risk of developing heart disease compared to their non-smoking peers. Smoking speeds up
the development of arteriosclerosis by damaging the inner lining of the blood vessels' walls. It
constricts the coronary arteries, the blood vessels which supply oxygen and nutrient-rich blood to
the heart, causing an increase in heart rate and blood pressure.

Smoking also reduces the amount of oxygen available to the heart and other parts of the body.
Smoking is a risk factor for someone who is currently a smoker or quit in the last 6 months.

Poor Nutrition
Poor nutrition such as a diet high in saturated fat and sugar contributes directly to high
cholesterol, high blood pressure, obesity, diabetes and heart disease.  Signs of a poor diet can be
measures like high cholesterol and triglyceride levels and high blood sugar levels.
Some of the high risk levels are total cholesterol above 200 mg/dL, triglyceride levels above 150
mg/dL and fasting blood glucose levels above 100 mg/dL

Sedentary Lifestyle
A sedentary lifestyle or a lack of exercise is a major risk factor for heart disease.  Exercise helps
to reduce risk factors including lowering blood pressure, lowering cholesterol, reducing stress,
achieving and maintaining a healthy body weight, helping to quit smoking and improving your
blood sugar levels. Low exercise levels are a risk factor if someone is:

 Not accumulating 30 minutes or more of moderate intensity physical activity on 5 - 7 days

of the week

Obesity
Obesity or being very overweight causes the heart to work harder to pump blood throughout the
body. Consequently, it is a risk factor in the development of heart disease.

Obesity raises blood pressure, raises blood cholesterol and triglyceride levels, lowers HDL and
contributes significantly to developing diabetes as well.

How a person’s weight is distributed is also important. People who carry their weight in the
middle have a greater risk of developing cardiovascular disease, compared to people who carry
their weight in their arms and legs. Guidelines for obesity as a risk factor are: 

 Waist hip ration greater than 1.0 (men) and greater than 0.85 (women)
 Waist circumference greater than 102 cm (men) and greater than 88 cm (women)

Excessive alcohol consumption

Excessive use of alcohol has been shown to have a number of negative effects on the circulatory
system, including the heart.  Alcohol in moderation may not be harmful, but any positive effects
have yet to be proven conclusively.  On the other hand, too much alcohol has been shown to
raise blood pressure, promote weight gain, raise triglyceride levels, produce irregular heart
rhythms and lead to heart failure, in addition to causing diseases of the liver, pancreas and
nervous system.

High blood pressure

High blood pressure or hypertension is sometimes called the silent killer, since there are usually
no specific symptoms or warning signs. Uncontrolled hypertension adds to the workload of the
heart, causing it to enlarge and become weaker. Without treatment, the risks for heart failure,
heart attack, stroke, kidney failure and reduced eyesight increase.

Normal blood pressure is generally between 90/60 mmHg and 120/80 mmHg. When high blood
pressure is combined with risk factors such as obesity, smoking, high cholesterol or diabetes, the
risk for developing heart disease increases several times. If the client is with blood pressure at or
above the risk threshold then proceed to exercise with caution and if other risk factors are also
present then refer them to a doctor before starting an exercise programme.

 Systolic blood pressure: 140 mmHg or greater

 Diastolic blood pressure: 90 mmHg or greater
 Using antihypertensive medication

Cholesterol level
High lipid (fat) or cholesterol levels in the blood have been shown to speed the development of
arteriosclerosis and heart disease.  Cholesterol can't be dissolved in the blood, so it is carried via
two types of lipoproteins:

 LDL (low-density lipoproteins), or ‘bad’ cholesterol, can build up fatty deposits and clog
arteries. A good LDL reading is less than 100 mg/dL (mg/dl means milligrams per 100
millilitres of blood).  A high risk level is more than 130 mg/dL.
 HDL (high-density lipoproteins), or ‘good’ cholesterol, helps remove bad cholesterol from
the body. A good range for HDL is greater than 60 mg/dL.
 Total cholesterol is a risk factor above 200 mg/dL. Lowering cholesterol can decrease or
stop the build-up of fatty deposits on the artery walls and decrease the risk of heart attack
and stroke.
 Triglycerides are another form of fat. High levels of triglycerides contribute to high
cholesterol levels and heart problems. A good level for triglycerides is less than 150 mg/dL.
 

Stress
Stress, both physical and emotional, is dealt with differently by every individual.  Some stress
has a positive effect on the body however continual stress is a risk factor for disease.
In a normal stress response situation the levels of the hormones adrenaline and cortisol are
increased causing increased blood flow to the muscles and brain, accelerated respiration and
heart rate. These hormones also stimulate the release of stored energy sources into the blood.
This prepares the body for fast or demanding movement. If the person is under too much stress
or is under stress too often, the normal stress responses such as increased heart rate, respiration,
and blood pressure put more physical stress on bodily organs (they have to work harder all the
time). Long-term stress can be a contributing factor in heart disease, high blood pressure, stroke,
enlarged adrenal glands, and other illnesses

2) Exercise Data Collection

Cardiorespiratory Endurance

Cardiovascular endurance testing, also known as stress testing, measures how efficiently your
heart and lungs work to supply oxygen and energy to your body during physical activity.

Among the three most common tests used:

 12-minute run tests are performed on a treadmill and compare your pre-exercise heart and
respiration rates with your post-exercise heart and respiration rates.
 VO2 max testing is performed on a treadmill or stationary bike and uses a breathing
device to measure your maximum rate of oxygen consumption during an activity.
 Exercise stress testing is also performed on a treadmill or stationary bike and involves the
use of a heart monitor and blood pressure cuff to measure your vital signs during
exercise.

Some trainers will incorporate exercises such as sit-ups or push-ups to get a qualitative
measurement of how you respond to specific exercises. These baseline results can be used at a
later date to see if your health and fitness levels have improved.

Muscular Fitness

• Strength testing measures the maximal amount of force a muscle group can exert at one
time. Muscle endurance testing, by comparison, measures the length of time a muscle
group can contract and release before it fatigues.

• The exercises standardly used include the push-up test and core strength and stability test.
In some cases, a trainer will use a metronome to see how long can you keep up with the
rhythm. The results are then compared to people of your same age group and sex
to establish your baseline levels.
 • Strength and endurance tests are valuable as they help the trainer pinpoint which muscle
groups are stronger and which are vulnerable and in need of focused attention.

Flexibility / Balance

Measuring the flexibility of joints is vital in determining whether person has postural imbalances,
foot instability, or limitations in range of motion.

There are a variety of tests used to measure flexibility. Among them:

 Sit-and-reach testing is used to measure tightness in lower back and hamstring muscles.
The test is performed while sitting on the floor with legs fully extended. Flexibility is
measured by the number of inches hands are from feet when reaching forward. 

Exercise Test Environment

• Stress free environment to combat client pre-test anxiety

• Ambient Temp = 21 to 23o C

• All equipment should be calibrated and prepared

• Conversation and attention should focus on the client