Exercise Testing: Practical Exam

Lung Auscultation 

anteriorly- inline with the manubrium on either side; in line with the xiphoid process on either side

posteriorly- concentrically around each scapula, 4 landmarks on either side

BODY COMPOSITION

BODY COMPOSITION

3-Site Skinfold

triceps: vertical fold, posterior midline of upper arm

suprailiac: diagonal fold, in line with the natural angle on the iliac crest, immediately superior to the iliac crest

thigh: vertical fold, anterior midline of thigh

7-Site Skinfold

triceps: vertical fold, posterior midline of upper arm

chest: diagonal fold, halfway between anterior axillary and nipple, above breast tissue

abdomen: vertical fold, 2 cm to the right side of the umbilicus

suprailiac: diagonal fold, in line with the natural angle on the iliac crest, immediately superior to the iliac crest

thigh: vertical fold, anterior midline of thigh

midaxillary: vertical fold, posterior to the armpit on the lateral side of torso

subscapular: diagonal fold, slightly posterior to the inferior angle of the scapula

Circumferences

abdomen: at the level of the umbilicus

arm: mid-upper arm; hands facing thighs

buttocks/hips: maximal circumference of buttocks; feet together

calf: maximum circumference of mid-lower leg

forearm: maximal circumference of mid-forearm; palms facing anteriorly

hip/thigh: maximal circumference of proximal hip/thigh, right below gluteal fold, legs slightly apart

mid-thigh: flex knee at 90 degrees by standing foot on bench or chair

waist: narrowest part of torso, just below the xiphoid process

*waist to hip ratio: waist circumference divided by hip circumference

Waist to Hip Ratio normative values

women 20-29 years old

low risk: <0.71

moderate risk: 0.71-0.77

high risk: >0.77

Bioelectrical Impedance Analysis (BIA)

estimates body fat, lean muscle mass, and hydration levels

enter height, weight, age, gender, and push start

patient stands straight and holds instrument arm’s length away from their chest

MUSCULAR FITNESS

MUSCULAR FITNESS

ACSM Push Up Test

standard “down” position or modified knee push-up form is allowed

subject must touch chin to mat on the down position, stomach should not touch the mat

the maximal number of push-ups performed consecutively without rest is the score

scores for women 20-29 years old

• excellent: 30 or more

• very good: 21-29

• good: 15-20

• fair: 10-14

• poor: 9 or less

Plank Test

perform a straight arm plank for as long as possible

ratings:

• excellent: 6 minutes or more

• very good: 4-6 minutes

• above average: 2-4 minutes

• average: 1-2 minutes

• below average: 30-60 seconds

• poor: 15-30 seconds

• very poor: less than 15 seconds

Partial Curl Up Test

patient must complete as many curl ups as possible in one minute following a metronome set to 50bpm

patient should not curl their neck and raise their torso until they touch their heels

patient should follow the metronome - up one beat, down one beat

ratings:

• excellent: all 25 reps

• very good: 17-24 reps

• good: 12-17 reps

• fair: 6-12 reps

• poor: 6 or less reps

V-Sit Test

flex hips so body forms a “V”

knees can be flexed, keep arms straight at sides

hold as long as possible

Trunk Extensor Test

lie prone on table with torso unsupported, have pelvis lying on table, but not hips

hold as long as possible

examiner holds legs down so they don’t fall

Side Bridge Test

elevate the torso from a side-lying position and support this position on one elbow and forearm

the upper leg should cross in front of the lower leg for additional support and the non weight bearing arm is held across the chest 

patient should hold position as long as possible and maintain a straight line 

Sahrmann Core Stability

pause between positions, use expanded blood pressure cuff under the patient’s back to determine if there is any movement of the spine by watching for pressure changes during movement

Level 1: supine hooklying; flex right hip to 90; flex left hip to 90

Level 2: both hips and knees flexed at 90; plant right foot down; extend right leg slow and controlled

Level 3: flex both hips and knees to 90; lower right leg with knee flexed, but do not let your heel touch the table; extend right leg

Level 4: flex both hips and knees to 90; slowly lower your legs into supine hooklying position until heel rests on table; slide out legs to extend the knees

Level 5: flex both hips and knees to 90; slowly lower both legs into supine hooklying, but do not let your heels touch the table; slide out legs to fully extend knees (feet still do not touch the table); return to flexing both hips and knees to 90

30s Endurance Test

stand with both feet flat on the ground perpendicular to hurdle

timing starts from the first movement

jump off both feet and land both feel on the other side of the hurdle, and back again

continue jumping for 30s and count the number of jumps completed

FLEXIBILITY

FLEXIBILITY

Shoulder flexion and extension

Axis: lateral aspect of greater tubercle

Static arm: perpendicular to the floor

Moving arm: aligned with midline of humerus and referenced with lateral epicondyle

Shoulder internal and external rotation

Axis: Olecranon process of the elbow

Static arm: Perpendicular to the floor

Moving arm: aligned with lateral midline of ulna and referenced with the ulnar styloid

Hip flexion and extension

Axis: greater trochanter

Static arm: midline of body, parallel to floor

Moving arm: lateral midline of femur, in line with lateral epicondyle of femur

Hip abduction and adduction

Axis: located at the anterior superior iliac spine (ASIS)

Static arm: imaginary horizontal line connecting axis point ASIS to the other

ASIS.

Moving arm: anterior midline of the femur, using the midline of the patella as a reference

Sit and Reach - Canadian

at sit and reach machine; set bar at 26cm mark; patient extends legs so plantar region of feet are flat against the machine; patient slowly reaches forward with both hands (parallel) as far as possible, holding this position approx. 2 seconds

Sit and Reach - YMCA

yardstick lays on floor, with 15in mark per; patient sits with the yardstick between the legs, with legs extended at right angles to the taped line on the floor. Heels of the feet should touch the edge of the taped line and be about 10-12 in apart

Trunk Forward Flexion normatives

for women 20-29 years old

excellent: 41

very good: 37-40

good: 33-36

fair: 28-32

needs improvement: 27

BALANCE

BALANCE

Star Excursion 

Patient stands on center point with hands on hips

Reach one foot as far as possible along the individual lines

• Anterior: slight foot straight forward on line

• Anterolateral- slide laterally away from midline of body

• Lateral- slide laterally away from midline of body

• Posterolateral- slide laterally/diagonally away from midline of body

• Posterior- slide foot straight behind you on line

• Posteromedial- slide foot behind standing leg

• Medial- slide foot in front of standing leg, straight to the opposite side (toward midline of body

• Anteromedial- slide foot in front of standing leg anteriorly/diagonally

If patient loses balance, they must start the line over

Mark where their foot stops on each line

Star Excursion normatives

for recreationally trained women

• Anterior: 76.9 ± 6.2

• Anterolateral- 74.7 ± 7.0

• Lateral- 79.8 ± 13.7

• Posterolateral- 85.5 ± 13.2

• Posterior- 85.3 ±12.9

• Posteromedial- 89.1 ± 11.5

• Medial- 90.7 ± 10.7

• Anteromedial- 83.1 ± 7.3

Y Balance

Patient stands on center point with hands on hips

Reach one foot as far as possible along the individual lines

• Anterior: slight foot straight forward on line

• Posteromedial- slide foot behind standing leg

• Posterolateral- slide laterally/diagonally away from midline of body

If patient loses balance, they must start the line over

Mark where their foot stops on each line

Y Balance normatives

anterior: 69.49 ± 7.14

posteromedial: 110.82 ± 7.23

posterolateral: 104.03 ± 6.89

Balance Error Scoring System (BESS)

Have patient complete 20seconds in each pose with eyes closed, both on solid ground and on a foam pad

Errors include: taking hands off hips, opening eyes, stepping, stumbling, abduction or flexion of hip beyond 30 degrees, lifting forefoot or heel off the testing surface

1. Hands on hips, feet touching

2. Hands on hips, one knee slightly flexed so foot is off the ground

3. Tandem gait: hands on hips, one foot behind the other, so toes are touching heel of foot in front

CONCUSSION

CONCUSSION

Tandem Gait

Single-task: Time the patient walking heel-to-toe along the line, turning around, and walking back.

Dual-task: Time the patient walking heel-to-toe along the line, turning around, and walking back. As they walk, they will subtract by 7s. Timer starts when you say the first number

If they say an incorrect number, and subtracts 7 from that incorrect number accurately, then that is still counted as correct

Ex: 84-7=76; 76-7=69; 1 incorrect, 1 correct

JUMPING

JUMPING

Single Hop

you will have the patient start on a single foot as close to the starting line as they can without allowing toes to extend on or past the line.

Patient jumps as far as they can (3 trials, practice trial is allowed)

Patient must maintain balance for two seconds

Single Leg Triple Hop

you will have the patient start on a single foot as close to the starting line as they can without allowing toes to extend on or past the line.

Patient jumps as far as they can 3 times consecutively (3 trials, practice trial is allowed)

Patient must maintain balance for two seconds

Single Leg Crossover Hop

you will have the patient start on a single foot as close to the starting line as they can without allowing toes to extend on or past the line.

Patient jumps laterally over the line 3 times (creating a zig zag pattern)

Patient must maintain balance for two seconds on final hop

Vertical Jump

The first thing to do is adjust the height of the device to standing reach height. To do this have them reach their arm straight up and adjust it so the are barely touching the bottom of the first vane

The person should be instructed to jump as high as possible and try to land on the same spot

Any movement forwards, backwards, etc. will impact results

Jump height is determined by the difference between standing reach and highest vane displaced

Report jump height in inches

Square Hop Test

Put four landmarks on the floor to create a makeshift square.

instruct the client to adopt a stance on one leg, facing the square with their hands on hips.

Once set, instruct the client to first hop into the square, then continuously hop in this fashion, breaking up each direction by hopping back into the square: outside left, outside front, outside right, back to the starting position.

Repeat this test on the opposite side.

Repeat this pattern until you complete 2 circuits around the square if you are able.

Time the trials to assess speed