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

2. 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

3. 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

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

5. 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) .

6. 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

7. 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)

8. 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

9. 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)

10. 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

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

12. 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!

13. 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)

14. 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’.

15. Figure 3.1

16. Figure 3.2

17. 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)

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

19. 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.

20. 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?

21. Figure 3.3

22. 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)

23. 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)

24. 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

25. 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

26. 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.

27. Table 3.2

28. 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

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

30. Table 3.3

31. 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

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

33. 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

34. 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

35. 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

36. 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

37. 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.

38. 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.

39. 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)

40. 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

41. 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)

42. 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)

43. 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.

44. 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

45. 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

46. 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

47. Table 3.5

48. 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

49. 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.

50. 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.

51. Table 3.6

52. Table 3.6 (continued)