chapter 3 chapter 3 Principles of Assessment, Prescription, and Exercise Program Adherence Author name here for Edited books

Chapter Objectives Understand the role and responsibilities of health and fitness professionals Understand the components of fitness testing Evaluate test validity, reliability, and objectivity and prediction equations Understand the basic principles of exercise program design Understand how behavior change models relate to program adherence Appreciate the need for certification and licensure

Responsibilities of Fitness Pro Education: benefits of exercise, do’s, don’ts Screening: pretest evaluations and stratification Selection: administration, interpretation Design: individualized program Lead: exercise sessions Critique: technique, performance Motivate: continued adherence, improvement

Physical Fitness Ability to perform occupational, recreational, and daily activities without undue fatigue. Components: Cardiorespiratory endurance Musculoskeletal fitness Body weight or composition Flexibility Balance

Cardiorespiratory Endurance Aerobic capacity Ability of circulatory and pulmonary systems to work together to deliver O2 and nutrients to working muscles and those muscles’ ability to use them! Maximal aerobic capacity (VO2max) Can be measured or estimated Commonly requires a GXT (max or submax) .

Musculoskeletal Fitness Ability of muscles and skeleton to do work Three aspects: 1. Muscular strength (maximal force or tension) 2. Muscular endurance (ability to maintain submaximal force over extended periods of time) 3. Bone strength (maximal force or tension produced by bone) Relates to bone mineral content and bone density

Body Weight and Body Composition Body weight = mass of individual Body composition = body weight in terms of amount of muscle, bone, and fat Absolute amount: weight of that specific component (ex: 15 pounds of fat) Relative amount: weight of that specific component in relation to total body mass; a percentage (ex: 10% body fat)

Flexibility Ability of joint(s) to move through entire range of motion (ROM) Limited by bony structure of joint size and strength of related musculature, ligaments associated connective tissue

Balance Ability to keep body’s center of gravity (COG) within base of support when maintaining a static position, performing voluntary movements, or reacting to external disturbances. (continued)

Balance (continued) Functional balance = ability to perform daily movement tasks requiring balance Examples: Picking up an object from the floor Dressing Turning to look at something behind you

Physical Fitness Test Sequence and Environment Test sequence matters. Resting BP and HR Body composition Cardiorespiratory endurance Muscular fitness Flexibility (continued)

Physical Fitness Test Sequence and Environment (continued) Stabilize room temperature and humidity. Provide some privacy. Keep all equipment calibrated and in good condition. Prepare the area in advance!

Test Validity Assesses accuracy of measurement Comparison against reference or criterion method Direct (reference) versus indirect (field) measures Prediction equations, conversion formulas Validity coefficient (ry,y') is the correlation between criterion score (y) and predictor score (y'). ry,y’ at least .80 is good. (continued)

Test Validity (continued) Standard error of estimate (SEE): a measure of prediction error the smaller the better Line of best fit: shows relationship between criterion and predictor values The tighter the cluster of data points around the line of best fit, the smaller the SEE and higher the ry,y’.

Figure 3.1

Figure 3.2

Test Reliability Assesses repeatability of measurement Looking for consistency and stability of scores Comparison of multiple measures Reliability affects validity Poor reliability is poor validity Good reliability is not always good validity (continued)

Test Reliability (continued) Reliability coefficient (rX1,X2): correlation between score 1 (X1) and score 2 (X2) rX1,X2 at least .90 is good.

Test Objectivity Intertester reliability Comparison of scores by multiple technicians Influenced by training, practice, standard procedures Objectivity coefficient (r1,2): correlation between tester #1 (1) and tester #2 (2). r1,2 at least .90 is good.

Prediction Equation Evaluation What reference method was used? How large was the original sample? What is the ratio of sample size to variable? What is the size of RMC and SEE? To whom does the prediction equation apply? How were measures made? Was the prediction equation cross-validated? How do well to cross-validation statistics replicate original statistics? Are the limits of agreement acceptable?

Figure 3.3

Administering and Interpreting Tests Pretest instructions: Tell your clients how to prepare! Appropriate clothing Hydration for preceding 24 hours No eating, smoking, alcohol, or caffeine 3 hours prior No strenuous PA on day of test Lots of rest the night before (continued)

Administering and Interpreting Tests (continued) Test administration: Get the best answers for your clients. Prepare setup in advance. Follow standardized procedures. The more practice you have, the more confident you will be, and the more at ease the client will be. (continued)

Administering and Interpreting Tests (continued) Test interpretation: Explain the results to the client. Use established normative values Use language the client understands (K.I.S.S.) Explain using a positive point of view Maintain confidentiality

Basic Principles of Program Design Specificity: muscle group, intensity, contraction Overload: increase workload to make gains Progression: gradual, systematic Initial: lowest starting point equals biggest gain Individuality: account for individual differences Diminishing returns: closer to goal, change Reversibility: use it or lose it

Basic Elements of Exercise Prescription Mode: How is exercise performed? Run? Walk? Lift? Ride? Rate of progression: Change one variable at a time. How quickly do you change variables? Frequency: How many sessions? Influences intensity and duration. Intensity: How hard? What percent of max? Duration: Time; how long per session? Inversely related to intensity.

Table 3.2

Stages of Progression Initial conditioning Improvement Maintenance Usually 4 weeks, familiarization, low intensity Increase duration first May skip for one with high initial values Improvement Usually 4 to 5 months, faster progression Maintenance Usually starts at 6th month Lasts the rest of your life Cut back on main activities; add variety

Adherence Almost half of those who start exercising drop out in the first year! What influences adherence? Biology Psychology Behavior Social support Environment

Table 3.3

Who’s Likely to Drop Out? Overweight Low levels of self-motivation Anxiety about exercise Lack of partner support Inconvenience of access Workout too hard Lack of social support during and after exercise

Behavior Modification: Your Task Three pertinent theories: 1. Behavior modification theory 2. Social cognitive theory 3. Stages of readiness theory

Behavior Modification Theory Clients are actively involved in the process: Goal setting Strategies to attain goal(s) Contract Reassess, review, revise Helpful techniques: journaling, incentives, celebrating the successes

Social Cognitive Theory Based on client’s self-efficacy and outcome expectation How confident am I that I can do this? 70 percent confidence score equals high self-efficacy. Help your client recognize and overcome barriers. Helpful techniques: skill mastery, modeling, positive reinforcement, education

Readiness to Change Theory Change comes when client is intellectually and emotionally ready to change. Five stages Precontemplation: not even thinking about it Contemplation: thinking about it, intends to do it Preparation: starting to do something, exercising Action: been exercising <6 months Maintenance: been exercising ≥6 months

Decision-Making Theory People decide to engage in a behavior by weighing the behavior’s perceived benefits (advantages) and costs (disadvantages). If benefits > costs, then client is likely to exercise. Position in stages of motivational change influences perceptions of benefits and costs. Early stages: perceived costs outweigh benefits Later stages: perceived benefits outweigh costs 16-item self-report tool available

Theory of Reasoned Action Intention is the most important determinant of behavior and is highly influenced by one’s attitudes and subjective behavioral norms. Belief that exercise yields positive outcomes is a favorable attitude about being physically active. Subjective behavioral norms are perceptions about what others think or believe about exercise.

Theory of Planned Behavior People intend to perform a specific behavior (e.g., exercise) if they evaluate it positively, believe that others think it is important, and perceive the behavior to be under their control. An extension of Theory of Reasoned Action, it considers the client’s perception of behavioral control.

Self-Determination Theory Describes how presence or absence of specific psychological needs (i.e., autonomy, competence, and relatedness) impacts behavior through a continuum of motivation (continued)

Self-Determination Theory (continued) Four levels of motivation Amotivation: no intention or desire to engage in exercise Other-determined motivation: exercise motivation from outside factors (e.g., rewards, guilt, fear, or pressure); long-term adherence is unlikely Self-determined extrinsic motivation: person values exercise; extrinsically motivated by factors like improved health or fitness gains; one freely chooses exercise without a sense of outside pressure Intrinsic motivation: exercising for sheer enjoyment and satisfaction brought to sense of well-being; enjoying exercise for its own sake leads to adherence

Using Technology to Promote Physical Activity Pedometers: step counter; accuracy varies; proper placement is critical Accelerometers: minute-by-minute tracking of acceleration; can monitor frequency, duration, intensity, and patterns of movement Combined pedometry and accelerometry: improves energy expenditure prediction Heart rate monitors: assess and monitor exercise intensity; more suitable for certain exercising subgroups (continued)

Using Technology to Promote Physical Activity (continued) Global positioning system (GPS): uses satellites, ground-based stations, and physical location of the signal origin (the exerciser) to track altitude, distance, time, and average velocity during activity Geographic information system (GIS): computer system that stores information about location and the surrounding environment Interactive video games: increase energy expenditure; may produce positive health benefits; well suited for solo or group play; requires little training or skill; good exercise alternative during bad weather; may help transition to actual participation in sports and physical activities (continued)

Using Technology to Promote Physical Activity (continued) Persuasive technology: a computer system, device, or application intentionally designed to change one’s attitude or behavior through use of tools, media, and social interaction Experts suggest that clinicians should use internet-based physical activity interventions to promote and change exercise behavior.

Accreditation, Certification, and Licensure Indicates high degree of professionalism Increases employment opportunities ($$$) Increases awareness of issues pertaining to safety of clientele during exercise sessions May reduce liability lawsuits against you Tailor your certifications toward your professional goals

Accreditation Awarded to organizations and programs that meet or exceed standards established by an independent, third-party accrediting agency In 2009 the number one trend was having more fully accredited educational programs and certification programs for health and fitness and clinical exercise professionals

Certification Obtained by passing examinations developed by professional organizations Certifications are generally good for 2-year period and maintained through continuing education Numerous certifications currently available No governing entity overseeing development of certification examinations and eligibility requirements Inequalities exist among the preparatory rigor required and certifications available to exercise science professionals

Table 3.5

National Boards Standardized tests assessing the knowledge, skill, and competence of professionals Most medical and allied health professions use National Boards National Board of Fitness Examiners (NBFE): currently defining scopes of practice for all fitness professionals and determining standards of practice for them

Licensure May be better for protecting consumers and for enhancing the credibility and professionalism of exercise science and fitness professionals Determined at the state level Louisiana was the first U.S. state requiring licensure for clinical exercise physiologists. More U.S. states are considering requiring licensure for clinical exercise physiologists and personal trainers.

Statutory Certification Regulates usage of titles (e.g., exercise physiologist, personal trainer) and qualifications needed to obtain the titles Only certified professionals with the required credentials are allowed to use the specific title. Professionals without necessary credentials may still practice in the state but under a different title.

Table 3.6

Table 3.6 (continued)