Chapter 5 - Fitness Assessments for the Active Older Adult

Question 1

Fill in the blank: According to the National Council on Aging (2021), the average older adult is diagnosed with ___ chronic medical conditions.

Answer 1

3

Such as osteoarthritis, heart disease, osteoporosis, cancer, hypertension, diabetes, and pulmonary disease.

Question 2

Pre-participation screening should include the following:

Answer 2

Medical Clearance to Exercise, PAR-Q+, Medical History, and Liability Release.

Question 3

What does ‘PAR-Q+’ stand for and what is it?

Answer 3

Physical Activity Readiness Questionnaire.
A questionnaire used as a screening tool by Senior Fitness Specialists to determine if a new client needs to seek medical clearance prior to beginning an exercise program.

Question 4

A health history questionnaire typically contains the following information about a client, which is considered private and confidential:​​​​​​​

Answer 4

Demographics
Name/Age/Gender/Height/Weight
Contact Information
Physician’s Name and Contact Information
Emergency Contact Information
Lifestyle Habits
Exercise/Diet/Sleep/Stress
Occupation/Recreational Pursuits
Medical History
Family History
Past and Present Injuries, Surgeries, and Medications

Question 5

The Stages of Change Model (SOCM), also known as the Transtheoretical Model and some ways the Senior Fitness Specialist can interact with clients in each stage:

Answer 5

Precontemplation: Educate clients about the benefits of being more active; have the person imagine their quality of life if their physical health improved.

Contemplation: Share success stories of others who have become more active and seen improvements in well-being; continue the education process.

Preparation: Schedule sessions, construct programs, and discuss goals for training. In addition, educate clients about other supportive behaviors (e.g., good sleep, relaxation, stress management, and healthy eating) that may reduce discomfort from starting an exercise program.

Action: Deliver safe, enjoyable, and appropriately dosed exercise programming. Provide encouragement and support. Facilitate introduction to other clients who can support and mentor the new client.

Maintenance: Focus on both the progress and outcomes. Help clients to recognize the transformation that has been made and seek to engage the client in a mentoring role for newer clients.

Question 6

The general format of motivational interviewing follows the O.A.R.S. process:

Answer 6

Open-Ended Questions
Affirmation
Reflection
Summarize

Question 7

What is the decisional balance sheet (DBS)?

Answer 7

The decisional balance sheet (DBS) helps to provide a road map for this discussion and gives the Senior Fitness Specialist powerful information about the client that can be utilized to develop the best training program possible.

The DBS is a diagram that consists of four categories: Advantages of Change, Disadvantages of Change, Advantages of Not Changing, and Disadvantages of Not Changing.

Using open-ended questions and reflective listening skills associated with motivational interviewing, the DBS will quickly reveal the current mindset of the client related to their upcoming work

Question 8

The Two most appropriate physiological assessments a Senior Fitness Specialist can integrate into the assessment process:

Answer 8

Resting heart rate
Blood pressure

Question 9

Where to measure a clients heart rate and why:

Answer 9

NASM recommends that Senior Fitness Specialists measure RHR at the radial pulse versus the carotid pulse (which is located at the neck just to the side of the larynx), because the vagus nerve lies adjacent to the carotid artery. Applying too much pressure to the vagus nerve can inadvertently slow a client’s heart rate response.

A client’s resting heart rate should be measured for 60 seconds in either the sitting or supine (lying on the back) position after the client has been resting for several minutes.

Question 10

Why is are there two numbers when measuring blood pressure?
List the normal ranges for each.

Answer 10

BP is not consistent within each heartbeat—the pressure fluctuates between a peak and a low pressure in the bloodstream during each beat. This explains why two numbers are measured.

Systolic - pressure produced by the heart as it pumps blood to the arterial tree of the body.
Normal systolic pressure is below 120 mm Hg.

Diastolic - the minimum pressure within the arteries while the heart is filling with blood.
Normal diastolic pressure is below 80 mm Hg.

BP is traditionally measured using an aneroid sphygmomanometer

Question 11

Blood Pressure Classification Ranges:

Answer 11

Normal:
Systolic <120 mm Hg
Diastolic <80 mm Hg

Elevated:
Systolic 120–129 mm Hg
Diastolic <80 mm Hg

Stage 1 hypertension:
Systolic 130–139 mm Hg
Diastolic 80–89 mm Hg

Stage 2 hypertension:
Systolic ≥140 mm Hg
Diastolic ≥90 mm Hg

Hypertensive crisis:
Systolic >180 mm Hg
Diastolic >120 mm Hg

Question 12

Define anthropometry:

Answer 12

The field of study of the measurement of living humans for purposes of understanding physical variation in size, weight, and proportion.

Question 13

Steps to recording blood preasure:

Answer 13

To record BP, instruct the client to assume a comfortable seated position and place the appropriate-sized cuff on the client’s arm just above the elbow. Next, either rest the arm on a supported chair or support the arm using the specialist’s arm and place the stethoscope over the brachial artery, using a minimal amount of pressure. Continue by rapidly inflating the cuff to 20 to 30 mm Hg above the point at which the pulse can no longer be felt at the wrist. Next, release the pressure at a rate of about 2 mm Hg per second, listening for a pulse. To determine the SBP, listen for the first observation of the pulse. DBP is determined when the pulse fades away. For greater reliability, repeat the procedure on the opposite arm.

Question 14

BMI
What does it stand for?
What are the equations?
What is the range with the lowest risk for disease?

Answer 14

Body Mass Index
Metric formula: BMI = weight (kg) ÷ [height (m)]2
Imperial formula: BMI = 703 × weight (lbs.) ÷ [height (in.)]2
lowest risk for disease: 22 to 24.9 BMI

Question 15

BMI Ranges with disease risk and classifications:

Answer 15

BMI: <18.5
Disease risk: Increased
Classification: Underweight

BMI: 18.5–24.9
Disease risk: Low
Classification: Healthy weight

BMI: 25.0–29.9
Disease risk: Increased
Classification: Overweight

BMI: 30.0–34.9
Disease risk: High
Classification: Obese

BMI: 35.0–39.9
Disease risk: Very high
Classification: Obesity II

BMI: ≥40.0
Disease risk: Extremely high
Classification: Obesity III

Question 16

Define visceral fat:

Answer 16

Fat deposited within the abdominal cavity surrounding the organs.

Question 17

Define gynoid fat patterning

Answer 17

Characterized by the accumulation of excess fat around the hips, buttocks, and thigh regions.

Question 18

WHR classifications of health risk for men and women:

Answer 18

Health risk: Low
Men: 0.95 or lower
Women: 0.80 or lower

Health risk: Moderate
Men: 0.96–1.0
Women: 0.81–0.85

Health risk: High
Men: 1.0 or higher
Women: 0.86 or higher

Question 19

What does WHR stand for?
What is the equation?

Answer 19

Waist to Hip Ratio (WHR) = Waist Measurement ÷ Hip Measurement
The hip circumference measures the widest circumference around the hips or buttocks region, above the gluteal fold, where the buttocks join the back of the thigh.

Question 20

Method of measuring waist circumference:

Answer 20

Stand alongside the client and use a flexible cloth measurement tape to wrap around the location of the LARGEST circumference between the base of the sternum (xiphoid process) and the navel. Ensure that the tape is level to the floor and fits snugly without indenting the skin. Record the circumference to the closest 0.5 cm or 0.25”.

Question 21

Method of measuring hip circumference:

Answer 21

Stand alongside the client and measure at the location of widest circumference at the hip/buttock region. Again, ensure that the tape is level to the floor and fits snugly without indenting the skin. Record to the closest 0.5 cm or 0.25”.

Question 22

Should you use skin fold measurements on older adults?
Why or Why not?

Answer 22

Skinfold measures are generally not appropriate for older adults due to the change in relationship between distribution of fat beneath the skin (subcutaneous fat) and fat within the abdominal cavity (visceral/internal fat).

Because skinfolds can only measure subcutaneous fat and not visceral fat, skinfold equations will typically underestimate body fat percentage in older adults and the measurement error can be more than 5%.

Question 23

Define muscle imbalance:

Answer 23

When muscles on each side of a joint have altered length–tension relationships and force-couple relationships.

Question 24

Define length–tension relationships:

Answer 24

A change in the resting length of the muscles surrounding the joint

Question 25

Define force–couple relationships:

Answer 25

The ability of joint muscles to be activated by the nervous system at the right time, with the appropriate amount of force.

Question 26

What are the kinetic chain checkpoints?

Answer 26

Movement assessments require observation of the kinetic chain. The five kinetic chain checkpoints refer to major joint regions of the body, including the following: - Feet and ankles - Knees - Lumbo-pelvic-hip complex (hips and lumbar spine) - Shoulders/scapulae - Head/cervical spine

Question 27

Overhead squat (OHSA) starting position:

Answer 27

Have the client stand with their feet shoulder-width apart and pointed straight ahead. The foot and ankle complex should be in a neutral position. Have the client raise their arms overhead with their elbow fully extended. The upper arm should bisect the ears:

Question 28

Overhead squat (OHSA) movement and views:

Answer 28

Movement: - Instruct the client to squat to the level of a typical chair height and return to the start position. - Have the client repeat the movement five times from each view. Views: - View the feet, ankles, and knees from the front. - View the lumbo-pelvic-hip complex (LPHC) and shoulder and cervical complex from the side. - View up to five repetitions before resetting the client’s position.

Question 29

Overhead squat (OHSA) movement compensations:

Answer 29

Feet Flatten: - The arch of the foot will appear flat and pronate. Feet Turn Out: - The client will squat with feet externally rotated. Heel of Foot Rises: - The client’s body weight will shift forward and the heels will rise off of the floor. Excessive Forward Lean: - The trunk falls forward so the lower leg and trunk line are not parallel. Lower Back Arches: - The low back will appear overly arched (extended). Lower Back Rounds: - The lower back and buttocks will appear tucked under.

Question 30

Overhead squat (OHSA) foot and ankle flatten: - Viewpoint: - Movement Impairment: - Possible Muscle Imbalances:

Answer 30

Viewpoint: Anterior Possible Muscle Imbalances: - Overactive - Fibularis (peroneal) complex Gastrocnemius (lateral head) Tensor fascia latae - Underactive - Anterior tibialis Gastrocnemius (medial head) Gluteus maximus/medius Intrinsic foot muscles Posterior tibialis

Question 31

Overhead squat (OHSA) foot and ankle turn out: - Viewpoint: - Movement Impairment: - Possible Muscle Imbalances:

Answer 31

Viewpoint: Anterior Possible Muscle Imbalances: - Overactive - Gastrocnemius (lateral head) Soleus Biceps femoris (short head) - Underactive - Anterior tibialis Gastrocnemius (medial head) Gluteus maximus/medius Hamstring complex (medial) Posterior tibialis

Question 32

Overhead squat (OHSA) foot and ankle heel rise: - Viewpoint: - Movement Impairment: - Possible Muscle Imbalances:

Answer 32

Viewpoint: Lateral Possible Muscle Imbalances: - Overactive - Quadriceps Soleus - Underactive - Anterior tibialis Gluteus maximus

Question 33

Overhead squat (OHSA) knee: - Viewpoint: - Movement Impairment: - Possible Muscle Imbalances:

Answer 33

Viewpoint: Anterior Possible Muscle Imbalances: - Overactive - Adductor complex Biceps femoris (short head) Gastrocnemius Soleus Tensor fascia latae Vastus lateralis - Underactive - Anterior tibialis Gluteus maximus/medius

Question 34

Overhead squat (OHSA) Lumbo-Pelvic-Hip Complex (LPHC) low back arches: - Viewpoint: - Movement Impairment: - Possible Muscle Imbalances:

Answer 34

Viewpoint: Lateral Possible Muscle Imbalances: - Overactive - Adductor complex (anterior fibers) Latissimus dorsi Psoas Rectus femoris Erector spinae Tensor fascia latae - Underactive - External obliques Gluteus maximus Hamstrings complex Local core stabilizers Rectus abdominis

Question 35

Overhead squat (OHSA) Lumbo-Pelvic-Hip Complex (LPHC) excessive forward trunk lean: - Viewpoint: - Movement Impairment: - Possible Muscle Imbalances:

Answer 35

Viewpoint: Lateral Possible Muscle Imbalances: - Overactive - Adductor complex (anterior fibers) Gastrocnemius Psoas Rectus abdominis Rectus femoris Soleus Tensor fascia latae - Underactive - Anterior tibialis Gluteus maximus Hamstrings complex Local core stabilizers Erector spinae

Question 36

Overhead squat (OHSA) Lumbo-Pelvic-Hip Complex (LPHC) arms fall forward: - Viewpoint: - Movement Impairment: - Possible Muscle Imbalances:

Answer 36

Viewpoint: Lateral Possible Muscle Imbalances: - Overactive - Latissimus dorsi Pectoralis major/minor Teres major - Underactive - Infraspinatus Lower/middle trapezius Posterior deltoids Rhomboids Teres major

Question 37

To correct each muscle imbalance identified during the Overhead Squat assessment, it is important to stretch the client’s overactive muscles and strengthen their underactive muscles. Typically, the Senior Fitness Specialist should choose one to three overactive muscle groups to stretch and one to three underactive muscles to strengthen. This is accomplished through the following steps:

Answer 37

1) Perform the Overhead Squat assessment and notate all of the client’s movement compensations. 2) Using the OHSA Solutions Chart, list all of the clients overactive and underactive muscles. 3) Stretch one to three overactive muscles using a combination of stretching techniques (typically self-myofascial techniques and static stretching). The overactive muscles that are repeated the most on the list should take priority in programming.​​​​​​​ 4) Strengthen one to three underactive muscles using light, low-intensity core, balance, or strength training exercises. The underactive muscles that are repeated the most on the list should take priority in programming.

Question 38

The two of the most common clinical assessments of older adult function:

Answer 38

Short Physical Performance Battery (SPPB): The SPPB is a series of lower body strength and mobility assessments intended to detect older adults at risk for losing their independence. Berg Balance Scale (BBS) The BBS has become a primary balance evaluation tool for physical therapists and other clinicians to evaluate many different older patient’s balance capabilities. These assessments are outside the scope of a Senior Fitness Specialist to administer. However, it is important for Senior Fitness Specialists to be aware of these assessments when speaking to their client’s healthcare provider.

Question 39

The Senior Fitness Test consists of six assessments:

Answer 39

Flexibility Assessments - Chair Sit and Reach Test - Back Scratch Test Strength Assessments - 30-Second Chair Stand Test - Arm Curl Test Agility and Dynamic Balance - 8-Foot Up and Go Test Cardiorespiratory Assessments - 2-Minute Step Test

Question 40

Chair Sit and Reach Test - Purpose: - Required Equipment: - Instructions:

Answer 40

The purpose of the Chair Sit and Reach Test is to measure lower body flexibility and range of motion. It is a variation of the standard sit and reach test. Required Equipment: - Ruler or tape measure - Chair (with no arms and 17” seat height) Instructions: 1) Instruct the client to sit in the chair with their feet flat on the floor and hip-width apart. 2) The client extends one leg fully with the ankle dorsiflexed. 3) The client overlaps their hands with the tips of the middle fingers even, as shown. 4) Instruct the client to inhale, and then, as they exhale, reach forward toward their toes by flexing at the hip. The client reaches forward toward their toes as far as possible (or past their toes, if possible). Avoid bouncing or quick, jerky movements. 5) The client holds the position for 2 seconds while the Senior Fitness Specialist takes the measurement to the nearest 0.25”. The distance is measured between the tip of the fingertips and the toes. If the client touches their toes, then the measurement is zero. Use a positive (+) score if the client reaches past their toes and a negative (–) score if the client reaches short of their toes. 6) Measure the client's results on both sides. One or two practice trials on both sides are permitted before conducting the test.

Question 41

Back Scratch Test - Purpose: - Required Equipment: - Instructions:

Answer 41

The purpose of the Back Scratch Test is to measure upper body flexibility and range of motion. Required Equipment - Ruler or tape measure Instructions 1) Instruct the client to stand with their feet hip-width apart and flat on the floor. 2) Instruct the client to reach one arm up and over the shoulder and as far down their back as possible. At the same time, the client reaches their opposite arm around the back and as far up as possible, as shown. 3) The client will reach their fingertips toward each other as far as possible without hooking the fingers. 4) Instruct the client to hold the endpoint. The Senior Fitness Specialist will measure the distance of the client’s middle fingers to the closest 0.25”. If the fingertips touch, then the client’s score is zero. Use a positive (+) score if the client reaches past their fingertips and a negative (–) score if the client reaches short of their fingertips. Measure the client's results on both sides. One or two practice trials on both sides is permitted before conducting the test.

Question 42

30-Second Chair Stand Test - Purpose: - Required Equipment: - Instructions:

Answer 42

The purpose of the 30-Second Chair Stand Test is to measure lower body strength and muscular endurance. Required Equipment - Stopwatch - Chair (no arms, 17” seat height) Instructions 1) Instruct the client to sit in the middle of the chair with their feet hip-width apart and flat on the floor. Their arms are crossed in front of their chest. 2) The Senior Fitness Specialist gives a “Ready, Set, Go” command. 3) The client must fully stand up and sit back down into the chair. This movement pattern is conducted for 30 seconds. 4) Count the total number of complete movements out loud (up and down equals one) and provide positive encouragement. If the client has completed a full stand from the sitting position when the time is lapsed, the final stand is counted in the total. Practice trials of a few repetitions are permitted before conducting the test.

Question 43

Arm Curl Test

Answer 43

The purpose of the Arm Curl Test is to measure upper body strength and muscular endurance (Figure 5.22). Required Equipment: 8-pound dumbbell (men), 5-pound dumbbell (women) Chair (no arms, 17” seat height) Stopwatch Instructions Instruct the client to sit on the dominate side of the chair with their feet hip-width apart and flat on the floor. This test is conducted with the client’s dominant arm. The Senior Fitness Specialist gives a “Ready, Set, Go” command. The client starts with the weight at their side in a neutral position. Next, the client performs a biceps curl, bringing the weight up to their shoulder by flexing their elbow and supinating their forearm, as shown. Their upper arm must remain motionless. The Senior Fitness Specialist can hold the client’s upper arm in place if necessary. For a period of 30-seconds, count the total number of complete movements out loud (up and down equals one) and provide positive encouragement. Practice trials of a few repetitions are permitted before conducting the test.