"Physical-Fitness Assessment Results Form - American Council on Exercise"

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PhYsICAl-fItness
Assessment resUlts
Name:___________________________________________________________________________________________________________
HEART RATE
DATE: __________________
Resting heart rate: _______________ bpm
Exercise heart rate: _______________ bpm
BLOOD PRESSURE
DATE: __________________
Resting blood pressure: ____/_____ mmHg
VENTILATORY THRESHOLD TEST (TALK TEST) USING A TREADMILL
DATE: __________________
Pre-exercise HR: _____ bpm
Pre-exercise BP (if necessary): ____/_____ mmHg
stage 1
HR: ______ bpm
Client assessment of discomfort _______________
stage 2
HR: ______ bpm
Client assessment of discomfort _______________
stage 3
HR: ______ bpm
Client assessment of discomfort _______________
VT1 HR: _____ bpm
BALKE & WARE TREADMILL EXERCISE TEST
DATE: ________________
Pre-exerciser HR: ______ bpm
Estimate of submaximal target HR (Maximum heart rate x 0.85): _____ bpm
Calculate estimated V
O
max:
2
Minute 1
HR: _____ bpm
RPE: _____
BP: _____ mmHg
For men: V
O
max = 1.444
2
(time in minutes) + 14.99
Minute 2
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 3
HR: _____ bpm
RPE: _____
BP: _____ mmHg
For women: V
O
max = 1.38
2
Minute 4
HR: _____ bpm
RPE: _____
BP: _____ mmHg
(time in minutes) + 5.22
Minute 5
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Estimated V
O
max: ______________
2
Minute 6
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 7
HR: _____ bpm
RPE: _____
BP: _____ mmHg
To calculate METs, divide V
O
max
2
Minute 8
HR: _____ bpm
RPE: _____
BP: _____ mmHg
by 3.5 mL/kg/min
Minute 9
HR: _____ bpm
RPE: _____
BP: _____ mmHg
METs: _______________
Minute 10
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 11
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 12
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 13
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 14
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 15
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 16
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Time until completion ______ minutes
©2014 American Council on Exercise®
PhYsICAl-fItness
Assessment resUlts
Name:___________________________________________________________________________________________________________
HEART RATE
DATE: __________________
Resting heart rate: _______________ bpm
Exercise heart rate: _______________ bpm
BLOOD PRESSURE
DATE: __________________
Resting blood pressure: ____/_____ mmHg
VENTILATORY THRESHOLD TEST (TALK TEST) USING A TREADMILL
DATE: __________________
Pre-exercise HR: _____ bpm
Pre-exercise BP (if necessary): ____/_____ mmHg
stage 1
HR: ______ bpm
Client assessment of discomfort _______________
stage 2
HR: ______ bpm
Client assessment of discomfort _______________
stage 3
HR: ______ bpm
Client assessment of discomfort _______________
VT1 HR: _____ bpm
BALKE & WARE TREADMILL EXERCISE TEST
DATE: ________________
Pre-exerciser HR: ______ bpm
Estimate of submaximal target HR (Maximum heart rate x 0.85): _____ bpm
Calculate estimated V
O
max:
2
Minute 1
HR: _____ bpm
RPE: _____
BP: _____ mmHg
For men: V
O
max = 1.444
2
(time in minutes) + 14.99
Minute 2
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 3
HR: _____ bpm
RPE: _____
BP: _____ mmHg
For women: V
O
max = 1.38
2
Minute 4
HR: _____ bpm
RPE: _____
BP: _____ mmHg
(time in minutes) + 5.22
Minute 5
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Estimated V
O
max: ______________
2
Minute 6
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 7
HR: _____ bpm
RPE: _____
BP: _____ mmHg
To calculate METs, divide V
O
max
2
Minute 8
HR: _____ bpm
RPE: _____
BP: _____ mmHg
by 3.5 mL/kg/min
Minute 9
HR: _____ bpm
RPE: _____
BP: _____ mmHg
METs: _______________
Minute 10
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 11
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 12
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 13
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 14
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 15
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Minute 16
HR: _____ bpm
RPE: _____
BP: _____ mmHg
Time until completion ______ minutes
©2014 American Council on Exercise®
ROCKPORT FITNESS WALKING TEST (1 MILE)
DATE: __________________
1-mile time: _______________
Steady-state heart rate: _______________bpm
RPE: _______________
Weather: _______________
Location: ___________________
Surface area: _______________
Other: _________________________________________________________
Calculate V
o
:
2
Females: V
O
(mL/kg/min) = 132.853 – (0.1692 x Weight in kg) – (0.3877 x Age) – (3.265 x Walk time,
2
expressed in minutes to the nearest 100th) – (0.1565 x HR)
Males: V
O
(mL/kg/min) = 139.168 – (0.1692 x Weight in kg) – (0.3877 x Age) – (3.265 x Walk time,
2
expressed in minutes to the nearest 100th) – (0.1565 x HR)
V
O
: _______________
2
Performance rating: _______________
Note: Refer to page 336 to determine performance rating.
STATIC POSTURAL ASSESSMENT
DATE: _________________
Notes: ___________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
STORK-STAND BALANCE TEST
DATE: _________________
Time to completion: _______________
Reason for stopping: _______________
Performance rating: _______________
Note: Refer to page 343 to determine performance rating.
SHARPENED ROMBERG TEST
DATE: _______________
Time to completion: _______________
Reason for stopping: _______________
©2014 American Council on Exercise®
MCGILL’S TORSO MUSCULAR ENDURANCE TEST BATTERY
DATE: _________________
Trunk flexor endurance test:
Time to completion: _______________
Trunk lateral endurance test:
Right side
Left side
Time to completion: _______________
Time to completion: _______________
Trunk extensor endurance test:
Time to completion: _______________
Flexion/extension ratio: _______________
Right-side bridge/left-side bridge ratio: _______________
Side-bridge (either side)/extension ratio: _______________
MODIFIED BODY-WEIGHT SQUAT
DATE: __________________
Depth of squat: _______________degrees
Number of repetitions: _______________
Where does the client report feeling the muscles working the most? ______________________________________________________
Knee alignment from anterior view:___________________________________________________________________________________
FRONT PLANK
DATE: __________________
Time to completion_________________
Where does the client report feeling the muscles working the most?_______________________________________________________
OVERHEAD REACH
DATE: __________________
Do the thumbs touch the floor? _______________
Does the client arch the back? _______________
Analysis of shoulder flexibility (adequate/inadequate): __________________________________________________________________
©2014 American Council on Exercise®
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