Fi t ness Assessment- Results Form

Dat e:
s/?-r /f,_,,
Assessor:
Participant:
I
Pre-calculated Values:
Age Predicted HR max: 19\ BPM
Target Heart Rate Range ( (,) - ) % HR Max): BPM
I le)
Resting Values
Pre-exercise HR {i t
BPM Pre-exercise BP l?-8/60
Body Mass Index
Height:
79
";:1
107. 9 G <-r-
BMI: /_7 kg/m
2
Weight : 21S-

Classification: r ,r , \..t Risk Category:
TABLE 4-3
Underweight
Norma Ii
Overweight
Obesity, cl ass
I
II
ill
BMI, kg/m
1
<18.5
18.b-24.9
25.0- 29.9
30 0-34.9
:15.0-39.9
>4.J
Disease Ri skt Relative to Normal
Wei ght and Waist Circumf erence+
Men, s 102 cm;
Women, :S88 cm
Increased
ll igh
Very
l: xtrcwcly '11gh
Men, >102 cm;
Women, > 88 cm
Hi gh
Very high
high
i:xtremeiy higr'
mm/Hg
Waist to Hip Ratio CWHR}
WHR , )-:>
TABLE4-4
Men
Age
20-2:)
30 30
40-119
50--58'
3(}59
20-29
38-'.W
50--59
60-59
Low
'.(083
<'.'.l.8
<D.8R
-<0.90
<0.91
<.:(I 7!
< C.72
<:G. 7.1
<0.74
C0.76
Modera1c
0.83-0.38
0.84-0 91
0 880 95
0.90-0.3()
0.91 0.09
07 1-CU /
0.?2-0. 7(3
o n -n 79
0.74-0.8'
1
0. 7&-0.83
Risl1
fligh
OS9- 0.94
092-0. 8ti
0 SXH 00
097-1 02
0.99-1 C3
S2
0.79-0.24
0.80-0.87
D.B2-0.88
0.8t, 0.90
>Cl.94
> 1 .. 00
"" ( '""
> . UL
>UiJ
.>0.82
>0.87
88
> 0.*10
ptrrni!':son f,::.;n1 Heyvvard V.i , L }\pph3d C1Jnip:>$i;:or f\ s-s essrnent
\.hampa;gn, ff , HumM' KL!C('Cs 1
Waist Circumference Conly}
Waist Circumference (cm) q Risk Classification
-----
Table 4.3. Risk Criteria for Waist Circumferences in Adults
Waist Circumferences cm (in)
Risk Women Men
Very low <70 cm(< 28.5 in) < 80 cm ( 31.5 in)
Low 70-89 cm (28.5-35.0) 80-99 cm ( 31.5 - 39.0)
High 90-llOcm (35.5-43.0) 100-120 cm (39.5-47.0)
Very High > 110 cm ( > 43.5) > 120 ( >47.0)
Skinfold Assessment s
Chest: 10
Women: Triceps: __
Body Fat )f 1).. ?-
0
10
Percentile ___ _
n . 25
tb -1.<;
1-3 1
32- 3.4
35 -."!,7
:.:.$ - (j()
.q .. \J.
44 - 46
47-4"1
SO -
:>J - 55
56 .58
59- 61
62-M
t/5. o7

7f.7J
77-79
e;o . a2
&3. 1}.'

il'l -9' !
'1"2-9.\
95 -'17
96 -!00
f O!.i(l'.}
IC4 - IC6
; 07- l ('f/
:. o.;i ::
l U - i 15
l l&-l 18
i IS-t2l
112-\ 24
9.7
11 0
12;)
IJ 6
1 l .5
l i>D
17. 2
!8'.J
19.5
11.7
1i7
1.1.7
14 7
25.7
'26.6
17 5
29 . .J
J(J .

3D
.31.5
.1.}. 2
JJ,9
'.R o
:>.5 J
351:!
3r. :.
:1 70
t
C}i"'<
' 1
i 11.
11..5
D.a
l '.i. O
16.3
193
l OIJ
2!.9
'l3.0
Abdomen: /) Thigh :_ f_3_
Supraili um : _ _ 'l\ Thigh: _ _ _
Classification
G-cv."
6-'.U .:U- 37 4J... 47 l,S.57 Sj.>7 (>..;, 57
10 :2
r i.:,,
12 8
14()
15.l
1(1, ;i
17. 7
f M
200
If !
:; ; I
) J. ;
27 l
0
'.:! 3.9
29' 5
;';(16
JI i1
J'l'.!
3JO
337
3.:.4
.35 ;
35.i
ili .3
I l
31 .7
:i. .:;
3 . . I
.13,9
34.6
101 ro.."f 11.2 11.o\
I '.l. 0 123 I 2.S 1
133 135 13.8
14 5 t .\ f 5.0 ! :. J
15,8 16.() lb.3 I (:,,
17.0 l 7.2 I i .5 ! U
rs.2 1e,.1t 1.s.7
1q1 i 6 1ia 2Qf
W5 20.7 /1.0 21.2
21 h 2r .a nr 22.l
:n 229 23 I 2: ..
7 23.<) 24.
24-.7 15.0 251 1.'i.5
25.7 26.0 26 7 'Jt: .1;
20.1 '26.9 11.2 ::n..1;
270 27.9 :213. ! 2M
1$5 w.a 2? 0 "n3
l<f . .l. 29.7 9 J0 .. 7
J0.3 .!Vo 3!.0
:;q I 3iA JU> 31?
:>i .9 n i :i2.h 32.7
32,.q- 3J.2
JJ.) 33.7 J'.l... .J4.2
. .4 l 4.7 J1',9
34 9 J5.I< 35 <i
JS.3 .36.0 J6 3
Jo.2 JM J.t\ ? 36.9
3,,S n 1 J 7.J 37.S
..37 i ; 37. 3/.9 3-5 I
1t,i,t1
180
F:t1
.W.3
i.1
22.1.ic
23.6
2-\."l
2'i7
"16.1
TJ.7
18'6-
29. S
30A'
31.3
32. 1
32.'1
41 ll
11 .e.
.:. . 10
11-l.'l
14 16

10. 2
J.J.
21.: -21l
79-31
35 . ;;7
35-40


1\7 \ <f
5'.) - 5)


6?
66 _t:. .r
I ..)

ZS J.1
; J
53
67.
n
ll .i
'9 l
10.0
...- f
.Lt
3.7
9.11
d.J
9..
f(/ 2
I .

ll.:i
55
1;;.1,
7.4
!U
9 4
: C 3
t 1.3
/ "'\"';
. .:.. ....
I {!.:;
1r1A
;:{) 2
]LI
2! '!
n7
2J.6
2> .. 4
.2.'.> .2
?!i.9
-:!-b. 7
21:,s
..
J.Yl)
'J!:U
.;.1 ' "

23.3
2i .A
22.1
7.} I
:.:Vi
1il.I
<S:i
6 .l
Zl I
27.9
Rockport Fi t ness Walking Test ( 1 mile)
1 mile time: lO' \S Steady state HR: \ Y S bmp
REP: Location: Surface Area: ___ _
Calculate V02:
Females: V0
2
(ml/kg/min)= 132.853-(0.1692 x Weight in kg) - (0.3877 x
age) - (3.265 x walk time, expressed in minutes to the nearest l OOt h) -
( 0.1565 x HR)
Males: V0
2
(ml/kg/min) = 139.168- (0.1692 x Weight in kg) - (0 .3877 x
age) - (3.265 x walk time, expressed in minutes to the nearest l OOth) -
( 0.1565 x HR)
Age: 'LS
Time: tO . \S

t h<: \Y/olkittg.Te:i.t
_,_,..,.. . '"' ".,,
ll;.,t"li !l.Jhl CA.1T .}(). 69)

Go:,.oJ
;fXY>:io:
l;:.t .... J-'9-''-"1"'
N;,
I.loo<
10%
10.1 2
lCdJ- 11:1;').
l !:43-i J 1:1

:23
> f6:24
1 l:JB
I f .'\2
12:3.".
! 3:::.8
l7

!
11 :l;i. 13,f.)1;;
13.09-l IJ':J6
111-:.:}i. j 6 C4
! t.:IJ.5-i 7<.l l
17:32
(1\".)> 11',.Ji))
ff 45
12:49
Stork-Stand Balance Test
Time: sec Rating :A,Jc'<j f
-f .Yl" l1"f:'O't2sn: t t:! ... f'1( tt'.";1 fo..r
::.:in1,9cr.r: turcH et' rf} ....
J!3 tv"n) !:e.s:t ;,.f)lf, th-.: n:f -.'!o"'l t,;n):-t; to ...
fr:thnJ.,.$19 b.i:p:;- US.JC e.,Jtt\.'' ....
l 0 "1".-S-7.$ S."Llt k C<l r"i ret;.: 1; iJ rrcdf;.:.Q tt:i;cl
f'lt".tft..,\. 'f.
r :.Vji_

Ai l. t!i: .. lh<: hp.;,.
;\1'1l4t{.;(t to <rr-e '(;qt r/ i <.f'ld to tr.i<.1:11
k1vj.e v:f tfi: }tar-<A: li<ljl.ht kfr":: i: <}
1

.,r 1lw..;ti?;:t".t r:11.Ht r'1 :St< ot tfa7 t;rn_rKi:: :,:fl on me t;.)J cf

foo1 12 l iYr
./" ' !)'. HME <}hY\1 f;r if
.,,., Jq "'1 "ri:--ute ,.vtH:t.cr:- t.1.r1ls.
t V: p-atti:c 1 Hlt: H'-"" It

..,,itih ,'\}.
4.1s,
.. r1l"t :i tJ cl t ft_)'f;,.",'r.;J i.:
/" ii',i::l 1.1t'di'};{(Hf'.,C{ft1W .
./ Th--. C.:" ' o::.f. i.J: in- ,.rq rh e<t-<>O
./' il.ny . n cd tkH!' t C{ ':L1Ct ..... S!$Htt' :t;9
" :rn: S"l.l:ti.:t.'i
1
k).Oi.
,., n-, .. 1ri:.:-::
Curl Up Test
Total Score:
Curl-up Ti:Jt
Tk C\(Jl-up t;.-:,,.r rs I C alx1.i) fU1-
11;J >.11.;ngth .<i"ld t".'.Htforj rn:t'. Llki: .Ji.: poJih- vp
Cc)t, dll:: &.t: diem tu pi.:r!"i.inn !O
fati !)'UC. The is pre:"crrOO O'IC: :ht full
i: is a 1000; rdi;ililc
;r.hdDm:u.:;J stre!"4,rth a.nd cmhlr.tnc:: 2nd h mU<.."h
iOr the ' fhc foll
a.dd.irion.U m.-miu1H:nt cf' ::he hip wimh
i 'll"r'("..l$td [1)l<i\ ri-K. ht'lh1r
i\:l;iny dicot$ a1c al:'l) i.ndi ''*i h p>.1r on rhr.
,l si1-1.ip. (J L'-ler:t.faliy tl:c fo1
in du: r<'pm, \ fr )!.t will
l>c" :ibk. (TJ txd;"nn the cu.rl-11p !dt' 1nk:st they
1'1.t ffi:t fivn1 JW.Jbl('..: 11:>.. TI).('n1rh 1p
tf'fi.t is im ("'.:isy and mc? l11d (lf c::'<.lh1
!.!ti ng .1hd111nin:.il -:.:1".l
Conlraindications
< fhe shout-0 be cimid
.
ered pmir tc U.e p:-fwn.nce of abtj;minJ!
5lH!flllh
Cho:rts wtl\ l;:JH hrl C\Xl:t:ms
cl'.tcl: Yilfh trc>tr j'.)lysicians P't:lf h
l
attempt in' test
Clll!irts " iti ctirVt:al naci. m.ce.! ma
find tha! th1:. txH'd:S.e
cam. All ci il!<Jts tE .l 41?d to
it1e f'\ff'X anJ 1ef'j-00 tlle1r abQ..irn inel
5J 0-J tM '


!\fnt
Pr<
Afic:r <-'1,Ja3ni11g d\C pUfl)l.):'C of :he uuiup
irsr, c;trhi1l :md dt."fflOfhfr.u.:c pnpcr hody
on i ncl t<.-chr.iqJc. Tu
i.1:ining \'<:
5'.1pinc, with S:ct tkt <.!n ?h.; Jh:r.
kut:n bait ro" 9(.i...dcgree
(Fibi\UC :;\ - Ji).
Cth'. rlu: d ien: ct.i 1>crfnm\ A cr.n:rn!lcc!
Cl1ri\JO to life 1.he
0
lnulrlcr hhdc:s Jlf
rhc rn; t {;1ppl-;uou:ely JO of
tni nk :iml tht11 to IO'>t:f 1!1 c
bai'.:k down rl) the .dt:)ukkri
O)r::p'.ttdy on the 1nat (rht
not ntcd to wuch Llh m.at).
Ranking: AErctge_
_)
Cll1f-up tlffit: Up ?QBifion
the diem to exhale on the w-ay
up inbak on the w.1y <low!!.
th<: .:!km to f"w
pnctice o: ttpetiL4.:i:u pri.'.'.1 :- 10
l t'f i .
TtJI pr()((!({!/ .twf
Tiic i;.licm in !.he "dcw11" pm:tlon
;\n:i hcgin!i- a n ;h: mintt\ i:1:.tnKt;011.
Counr e-J.:-:h ,..,mtl<.tCL'\td-up ur: tiJ t1 1e
client
M;i,kc SI.Ill!- the diem is not holding his ot
hcf brc-.lth Juring cl>< toest.
The client m u.Si uot 11t..'< the c<r.--iwl
,.pine by turling the
R<oo:d d:<- diem';. $('(;.X on the tC$tin.g
fonu in t.hc inx...imnm nu:nh:: o( ..:u rl-
up;; rompl!!'tt'.d.
rl:c dit'nl's "-.-Un:
Table. S-13 1n 8-.N. Por e;.; ;unple.
ifu 27-..-'C;,1.t-oki mak .:!km cumr.ie:(':)
a ttl';\ ] J.6 rnd uJ-*. ht w0-..uld j'I(:
das.::ifa:J :11 the1:ppcr r:mgc of"bdow
dgnlfying that h:s
c:n>iurincc nci:ds
Figure B 17
C.i. 1t ut> to::1
MLE 12.10 FITNESS CATEGORIES BY AGE GROUPS AND SEX FOR PARTIAL
. CURLUP .
Age
..--- ..
Pcn.:cntile. 20-29 30-39 40-49 S0-59 60-69

M w M w M w M w M w
---------
._ ..__________
90 75 JO 7; 55 75 :i.S 74 45 SJ 51)
A\-t til gt
so
r\bO'oft'
S6 -' S 69 1:i
75 \1 bO 30 3:J 30
70
A ... .,
.;i .;.s 3'1 67 33 5 23 16 24
61) ,;d 31 36 is 51 n
;o 16 19 19
5;)
r\'.i'::':t :. t; r
27 27 31 11 :,9 25 27 16 n
!O

21 26 15 Jt 20 lJ 9
.., ...\....
J-0 ' 2Q . 17 !9 11 26 14 19 0
2: ;;
1
S d ! l3( lo>o-;
13 12 13 o n 13
lC

0 u v 0
\.(, .. _J,., ......
f1w" S.-.,.""'., b br."f .... fof,t \1<l141". :-, 11(.:0:/..- W'lld. (:e_;.t+hti. .\ F'1tt-,h >('
.. ":: r-ii; $ ' ..t.-;:1 J"1 :> c .... .,.J .v1 :."!l () f<<'
Push Up Test tb !)._
Total Score:_--""-
1
2'? -'-- /
t:,
11
,ipmir.:;
1' ht (c';>tiona.Q
Tcwd or fu.-un bkidt
u;r pf(Xtd:tr(:
A .. d:c puqx,i;c. (I f 11.<.:
e.\:phtin a1t.:!
the i:omxt pu.h up ('rnuda11! m
n lnJificd) digur<: 8--\ 6 ).
"i1ic \l:ooki i.--.:oi nr for'\,;ud tn<l
be ?'->siriorll:d shoulikl"wldt b :ipJ..f'\.1
dirt"crlv tmdcr the sh1.wklcr..._ hipi
:md wouldm 'lmnld he aligned (i.e .. rigid
tnlnk} tl1c rCJ.oJll'I in a
neutral tu c<l'endcd ymm.
The go;llof the tc-.r is tv :>S nt.1ny
c.oMc.;...urivc :tiul oxnplcte fHJ.<li'"'\.lpc. :t.i
fX'SSibk before ,-.lchiug a point o.f falih'\IC.
Figure 8-16

Ranking
The O\ ltSt be s:c:idy. w\thout
an}' rcsr ln between the. rcpcri t:i ,;ns.
r:,:p!ain tfoH only (<)rrc.ctly performed
push-ups arc wuntcd. , .
the d it nt to pcr :orm f('\\'
praccicc trials before the tt$l begins.
1;.1! prot.-xo/ ,md adminfrlmtirm:
The \c,st mm.s in "down" pos-i tki n
and h<: dienr begin the t t :; t
whenever he or is
Crnrnt c-:1ch pnm-\:p unlil
the fut !;;i.1e. t\
require$;
.I Fuli elbow extension wi th a '1fr'light
back rigid ttllso in rhe "up
positiou
/ The touching the. :r;ti ncr's a
roil ed rowd , or ;1 foom block, withr>11!
rc;;t1ng thotoff1 ,1ch or body on the
mJ.t in the "J own* po<it\on
The ls tcrrnirnitcd when the cli<mt is
un3blc to cmnplctc a repctitiou or fail
to rn.iitrniin pror.cr ttdiniquc for two
conscc:.aivc repetitions.
Rt._; ord the: s.;orc on the tt':Sring fom1.
TABLE 12.9 . FITNESS CATEGORIES BY AGE GROUPS AND SEX FOR PUSHUPS
Ag .. yr

20-29 30-39 40 49 S0 - 59 W- 69
------
- ------
M F M f M F M M F

--------------- ----- -
------
&all ent 36 30 30 27 25 2J 2l n lR
35 ' 29 29 26 2-S 23 20 20 17
\';,tygo<>.i
l? 21 22 20 17 15 13 1i 11
28 20 21 19 16 H
' O
' .
10 10
Coo.:!
22 17 13 13 1! 10 s
21 "f4 1() 12 1'2 10 9 6 7

17 10 ! ;? 10 7
imprlWC-mc.ut 16 9 11 1 9 6
F, '!:nak. ,\l, -W:..
IN,,. th ( .. 1 ..;. rl 1.ln (a C.>if.l.$i'v rhf1.-. i, ! .. \ .!. :if"' ' :)'t! ('SP' Hr.- hi1 Si
..i.w;t1 td A ( t fl' , tl f r't Y.PM ;;y . t-1. 0 ?(, .. .JJ, C..1.->t,t. !} .. .. Sc-.; -f l J' h;r Pti,,, i.'Ci>
17
16
12
11
I
2
-