Many trainers, let alone clients, do not fully understand the importance or purpose behind exercise testing. Many clients wonder, “why do I care what my body fat percentage or VO2max is?” These values, among others, allow a well-informed trainer to create an individualized and effective exercise program. Without knowing these parameters, a trainer is playing a guessing game trying to determine what their client needs, which can lead to missing a key area of potential improvement. Goal setting, both long-term and short-term, is nearly impossible without knowing where your client is starting and where they can reasonably progress in a given period of time. If a trainer makes the assumption that their client can look like they did in high school without taking into consideration their current fitness level, it can be a recipe for disappointment. These testing procedures also allow the client to see their progress over time, which is both a major motivational tool for the client and it gives the trainer the opportunity to see what is and is not working. If you can see your improvements aesthetically, internally, and quantitatively, you should be more inclined to stick with an exercise program.

So, what’s involved in the testing?

This is far from an all inclusive reference, but is meant to be more of a brief overview of the basics that should be involved. Other tests may be included or excluded based on the client’s preliminary goals (athletic performance, weight loss, muscular strength, ect.).

1. Resting Vital Signs

Included in this section are primarily resting measures of cardiovascular function. This typically includes resting heart rate and blood pressure. Heart rate is measured by palpating the radial artery and counting the number of beats felt during a one minute time frame. This can be used to identify abnormal heart rhythm or excess/diminished pumping of the heart. Blood pressure refers to the pressure exerted on the blood vessel walls during contraction/pumping (systolic) and rest/filling (diastolic) of the heart. This is the determining factor in diagnosing hypertension, which increases the risks of several serious conditions (stroke, retinopathy, heart disease, diabetes, ect.). Hypertension is defined as a systolic BP > 140 mmHg and/or a diastolic BP > 90 mmHg. These two assessments are typically the most simple to obtain, but their importance in determining an individual’s cardiovascular fitness and health cannot be overlooked.

2. Body Composition

Body weight, BMI (Body Mass Index), girth measures (hip and waist), and percent body fat are all components of a thorough body composition assessment. BMI is determined by comparing an individual’s body weight with their height. While this is a viable option for categorizing large groups of people, it is not a valid option for determining the composition of one individual because it does not take into consideration muscle mass or bone structure. For example, someone can have a body fat percentage of 5%, but be classified as obese because of their increased body weight due to muscle mass. The primary purpose for recording girth measurements is to determine an individual’s waist to hip ratio, which shows the proportion of body fat distributed in the abdomen. The greater the amount of relative body fat distributed in the upper body leads to a greater likelihood of developing hypertension, metabolic syndrome, type 2 diabetes, dyslipidemia, and coronary artery disease. The most telling measurement for body composition is percentage of body fat because it takes into consideration all aspects of an individual’s physical makeup. In general, the most practical way to determine body fat percentage is the use of skin fold calipers. This is because the proportion of sub-cutaneous (directly below the skin) fat directly correlates with total body fat.

3. Cardiovascular Fitness

Testing procedures will typically involve the use of a treadmill (walking or running), stationary bike, or step testing. The determination for mode of testing will be based on the client’s comfort with a specific activity, musculoskeletal limitations, or what is most readily available to the trainer. Regardless of the specific test, the purpose remains the same, to determine the maximal oxygen uptake of the client (VO2max). This measure is calculated by finding the relationship between a client’s heart rate and the specific workload at which it was elicited. This value represents an individual’s ability to utilize oxygen during exercise and is the “gold standard” for determining an individual’s cardiorespiratory endurance. This value can be obtained directly in a clinical graded exercise test that most accurately measures the physiological responses of the individual’s body. The direct measurement of maximal oxygen uptake is based on the equation VO2max = Q(A-VO2 diff). Q refers to cardiac output, which is the total amount of blood pumped through the body in one minute. While A-VO2 is the difference between arterial and venous oxygen content. While the direct measurement is the more accurate, it is not always practical due to the excessive cost and time requirement for client and patient alike. In most cases, a trainer will elect to use a field test to predict their client’s cardiovascular fitness. These tests can include running a predetermined distance/time at the client’s own pace or using a submaximal graded exercise test, which increases the intensity or speed at consistent intervals.

4. Muscular Endurance and Strength

Muscular endurance refers to an individual’s ability to lift a predetermined amount of weight as many times as possible while maintaining proper form and rhythm. This is typically achieved by performing as many push-ups, sit-ups, or repetitions of a specific weight for bench press or leg press. Whereas, muscular strength is the ability of an individual to lift the maximal amount of weight that they can for a predetermined number of repetitions, which is often called their one repetition max (1-RM). This value can be predicted using various equations/tables if an individual cannot physically handle the stress of a 1-RM test or adequate weights/equipment are not available. Both endurance and strength values are used to determine areas of weakness and in order to predict proper load for their resistance training program. This is typically determined based on a percentage of their 1-RM and is the most accurate prediction of proper training load. While determining the proper load based on 1-RM is not a perfect science, it does eliminate a lot of the trial and error involved in finding the appropriate weight for resistance training exercises.

5. Flexibility

Flexibility is an often-neglected area of an individual’s exercise program, however its importance cannot go unnoticed. Flexibility is an individual’s ability to move a joint through its complete range of motion (ROM). When one thinks of this measure, they typically are drawn to the vision of a ballet dancer or hockey goaltender, however it also has implications in everyone’s activities of daily living. Limited ROM can predispose an individual to musculoskeletal injury and disability with even the most simple of everyday tasks. Regardless of age or starting point, anyone can improve or maintain their flexibility with a safe and effective stretching routine. Base-line measures can show areas of impairment and needs for improvement, which allows for the creation of the most appropriate program.

Typical measures included in most flexibility testing include both the sit and reach for an assessment of general flexibility and goniometric measure for a more joint specific test. Both of these measures should be used for a thorough appraisal of flexibility.

The use of an exercise testing regimen gives both personal trainer and client a snapshot into all aspects of an individual’s physical fitness. By having this information in hand, a trainer and client can sit down and most efficiently improve any areas that may be deficient. Also, when routinely reassessing these measures, you can see first hand the progress that you are making during your exercise program. All of these measures are highly modifiable with proper exercise programming and nutritional counseling regardless of age, sex, or baseline level. When you can see a numerical value to work towards, it gives you more confidence and a sense of pride once your goal is achieved.

References:

1. Ehrman JK. ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription. 6th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2010.
2. Thompson W. ACSM’s Guidelines for Exercise Testing and Prescription. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2010.
3. Reynolds M, Gordon T, and Robergs R. Prediction of One Repetition Maximum Strength from Multiple Repitition Maximum Testing and Anthropometry. Journal of Strength and Conditioning Research, 2006, 20(3), 584–592.
4. Wilmore JH, Girandola RN, Moody DL. Validity of skinfold and girth assessment for predicting alterations in body composition. Journal of Applied Physiology, 1970, 29 (3), 313-317.

About the Author John Snyder, PT, DPT, OCS, CSCS

I am a Physical Therapist, a Board Certified Orthopaedic Specialist, a Strength & Conditioning Specialist, an Educator, and a Research Junkie. My goal is to provide resources for orthopedic and sports medicine clinicians to keep up to date with the current literature and allow them to translate it to their practice.

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