Clients who voluntarily agree to participate will pay (or have arranged payment by their employer) a one-time fee of $35.00 which will cover the cost of an initial assessment, an individualized exercise prescription, and two follow-up visits (likely at 4 week and 8 weeks from the date of the initial assessment). All clients agreeing to participate will sign an informed consent explaining in detail the risks and benefits of this program. A summary of the wellness assessment follows:
Clients will meet with the physical therapy student where they will be asked questions about their past medical history (surgical, illness, medications, family history, etc.), previous and current exercise history, and other pertinent health history. Part of this standard interview will involve completion of a Physical Activity Readiness Questionnaire ("PAR-Q") and a cardiovascular risk assessment. In the event that significant risk factors are identified, the findings will be discussed with the client, physical therapy student, and supervising faculty. The assessment may be streamlined, modified, or placed on hold until medical clearance is obtained from the client's personal physician.
Posture is an important component that contributes to the overall well-being of an individual. The following is a definition of posture:
Posture is usually defined as the relative arrangement of the parts of the body. Good posture is that state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity irrespective of the attitude (erect, lying, squatting, stooping) in which these structures are working or resting. Under such conditions the muscles will function most efficiently and the optimum positions are afforded for the thoracic and abdominal organs. Poor posture is a faulty relationship of the various parts of the body which produces increased strain on the supporting structures and in which there is less efficient balance of the body over its base of support.
The above definition is from the Posture Committee of the American Academy of Orthopaedic Surgeons (1947) and while seemingly dated, many might agree that "good posture never goes out of style." Postural alignment and muscular balance are the basic foundation for all training. We refer to a standard postural grid (REEDCO Research, Auburn, New York) and will examine standing posture from anterior-posterior and lateral views, reporting the results numerically out of a possible score of a 100 which is considered "ideal" posture.
Mortality rates from heart disease, cancer, and diabetes increases with increasing fatness. In addition, the distribution where excess fat is deposited may also indicate those who are most vulnerable to diseases and early death related to obesity. Our screening includes body compostion assessment (skinfolds, Body Mass Index) and assessment for the distribution of fat (Waist-to-Hip (W:H) ratio). Skinfold measurement is the most widely used method for determining obesity. The procedure includes measuring the thickness of a fold of skin and the fat just below the skin at 3-7 different sites on the body. Body mass index (BMI) is another form of body composition assessment that takes into account the relationship between your weight and height. The Waist-to-Hip ratio is a measure of the circumferences of these sites which will provide information on whether you store fat primarily in the upper or lower body.
Cardiorespiratory Endurance (CR) is defined as the ability to perform large-muscle dynamic exercise for prolonged periods at moderate-to-high intensities. Performance of this type of exercise depends on the functional state of the cardiovascular, respiratory, and skeletal muscle systems. CR endurance is considered health related because: a) low levels of fitness have been associated with markedly increased premature death from all causes and specifically from cardiovascular disease; b) higher fitness is associated with greater abilities to perform physical activity with less fatigue.
Submaximal CR endurance testing consists of performing one or a series of submaximal workloads to a steady state exertion level. CR endurance testing will provide information regarding:
- the physiological response during submaximal physical work
- the design of a safe and effective exercise program to improve CR endurance
- the ability to perform specific work intensities (functional capacity)
Protocol: If the resting tests (PAR-Q, Body composition, HR, BP, Posture) reflect normal values, the submaximal test is administered. We may use either a stepping type protocol that requires repeated stepping up and down at a constant rhythm, a stationary cycling protocol (YMCA), or a timed walk-run protocol. Physiological response will be monitored by such means as: HR and BP measurement before, during, and after the testing, and a subjective rating of perceived exertion (RPE).
Sit and Reach Test: This test is a general measure of lower back and hamstring flexibility. While controversy exists over the reliability and validity of this particular component of the assessment, the sit and reach test is commonly used in many fitness appraisals as a "gross" measure of flexibility. Good joint range of motion and muscle flexibility are thought to be important for the prevention of injury. Normative values for age and gender have been reported and will be used for comparison.
Muscular Strength Assessment:
Grip Strength: Grip strength is another important measure commonly used in general fitness appraisals and physical assessments. It is used to evaluate an individual's strength relative to normative standards, assess a client's ability to return to employment, or to establish a baseline from which to assess treatement effectiveness. Recently, grip strength has been reported to have some predictive value of functional limitations and disability later in life. A standard procedure involving a handheld dynamometer is used for repeated trial testing for both hands.
Isometric Lift Strength: A Back-Leg-Chest Dynamometer is used to accurately measure the isometric force produced by the musculature of the back, leg, chest, and shoulders. Several testing protocols have been developed for appropriate job-specific tasks to establish baselines and for comparison to normative values.
Sit-Up and Push-Up Endurance: Sit-ups and push-ups are commonly used to assess muscular strength/endurance. These tests are selected on the basis of their practicality and appropriateness for use in adult fitness programs. Both of these "field" tests have normative values based on age and gender. The sit-up endurance is the total number of sit-ups completed in one-minute, while the push-up performance is based on the total number completed consecutively.
This is an important aspect of functional mobility and is dependent upon a number of factors that include visual acuity and function, vestibular function, and what is known as the somatosensory system which involves the small nerve endings (mechanoreceptors) found in the joint capsule and ligaments of the joints. Dysfunction in any of these primary systems may affect balance performance. Gross measures of balance performance used in this assessment include timed single leg standing with eyes open, and eyes closed. Impaired performance may warrrant some simple intervention with home balance exercises, or may require a more detailed examination and referral.
Results: Individualized Exercise Programs
Following the completion of the above assessment, individualized goals will be discussed and set for each client, based on personal desires, schedule, availability of exercise equipment, etc. Clients will return approximately one week later to receive a written copy of their exercise prescription, and necessary instructions and any specific details.
ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription, 3rd ed. Williams and Wilkins, Baltimore, MD, 1998.
Howley ET, Franks BD: Health Fitness Instructor's Handbook, 2nd ed. Human Kinetics, Chaimpaign, IL, 1992.
Nieman DC: Fitness and Sportsmedicine: An Introduction. Bull Publishing: Palo Alto, CA, 1990.
Rantanen T, et al: Midlife hand grip strength as a predictor of old age disability. JAMA 281(6):558-560, 1999.