Exercise Testing and Prescription: Exam 1

ADIME

• used as the client care process, or long term process when seeing client

• Assess, Diagnose, Intervene, Monitor, and Evaluate

Assess (ADIME)

• gather the data (screening, history, tests)

• needs analysis

• initial meeting

Diagnose (ADIME)

• within our scope of practice

• name problem you can act on

Intervene (ADIME)

• design and deliver the program (FITT-VP)

Monitor (ADIME)

• track clients response over time

• reassess or adjustments if not working

• follow up

Evaluate (ADIME)

• judge whether it worked then loop back.

• Continue adjust and conclude

SOAP Notes

• occurs after every session with client

• documentation important for formal record, liability, and professionalism

• concise wording but important to provide details

• Subjective, Objective, Assessment, Plan

Assessment Process steps

1. intro to screen/test

2. explain the protocol

3. demonstrate the screen/test

4. subject demonstrates screen/test to check for understanding

5. administer screen/test to protocols

6. explain results

7. record data

6 components of exercise

• frequency (how often)

• intensity (how hard)

• time (how long per session or sets/reps)

• type (which mode of exercise or RT)

• volume (total dose = frequency x time x intensity)

• progression (how does changes over time)

two clients same goal different starting points- what do we change?

• the volume and progression of the exercise

ACSM algorithm: Three questions

• current activity level: regular planned PA for at least three months

• Known disease: does person have known cardiovascular, metabolic, or renal disease

• signs or symptoms: is person currently experience signs or symptoms

Needs Analysis

• Individual analysis

• movement analysis

Individual analysis (needs analysis)

• purpose, concerns, goals

• health status

• psychological readiness

• training status and experience

• movement ability

• testing

Movement analysis (needs analysis)

• biomechanics

• physiological focus

• injury inherent to desired movement

Purpose, concerns and goals (individual analysis)

• details to help you create SMART(EST) goals

• explore with the client general ideas

Health status (individual analysis)

• may need further details on HSQ information

Psycological readiness (individual analysis)

• stage of change, self-efficacy, decisonal balance, outcomes

• identify what. supporters and barriers are present

• meet client where they are

• design personalized program for the client

• readiness will help how you introduce the program and pace of it

Supports/barriers (individual analysis)

• time, access, other roles

Training status (individual analysis)

• important marker for goals, testing and prescription

• listen for current activity (FITT and how long its been occurring), Training history (tried, worked and why quit), familiarity with technique (competence)

Experience (individual analysis)

• current activity, trining history, techniques, and equipment

screening and testing (individual analysis)

• movement screens

• exercise tests

Reliability

• consistently across repeated administrators

• same client, same push up test, two different days

• training needed

• not enough if test isnt valid

Objectivity

• consistency accross different administrators

• two lab instructors score same grip strength trial

• not enough if test isn’t valid

Validity

• does test measure what it claims

• established against an already validated standard

how to maximize reliability

• client preparation: rested, hydrated, nourish, appropriate clothing

• environment: calibrate equipment, Control temp

• test administrator: explain procedure, ensure correct form and technique

How to use initial consult and fitness testing results

1. screen and identify risk

2. establish baselinen

3. compare norms or criteria

4. identify straths and weakness

5. set SMART goals

6. perscribe exercise

7. motivate and educate

8. monitor progress

Serial test results

• repeat measure or self comparison (pre vs post)

• ex: day 1 lift 100lbs and on day 60 lift 120 lbs

normative reference (test results)

• compare with established % rankings for that test

• ex: push up count vs. age/sex categories

criterion reference (test results)

• “health” or “fitness” standard

• ex: blood pressure being <120/80

ego orientation

• “able” only when performing better than others

• belief that people achieved based on ability

• social status is a primary purpose of sport participation

• “I do well when I perform best”

task orientation

• “able” when they learn and improve

• progress indicates competence that can sustain motivation

• belief that hard work can lead to success

ego and task orientation with competence

• ego orientation, task orientation with high competence = motivated

• task oriented with low competence = motivated

• ego oriented with low competence = maladaptive

aim for mastery oriented climate to emphasize serial comparison

how to give feedback on assessment results

• accuracy and honesty

• plain language

• client centered (serial vs norm)

• forward looking

• scope of practice

movement ability (individual analysis)

• neuromotor (functional) fitness

Mobility (neuromotor functional fitness)

• ROM, body position specific

• flexibility: capacity to move joints freely through normal ROM

• symptoms of poor mobility → stiffness or tightness

Stability (neuromotor functional fitness)

• posture and control during movement

• maintain control through the available range

• symptoms of poor stability → poor strength, coordination, or balance

general factors affecting neuromotor fitness

• age and sex

• activity level and training history

• posture

• injury

• disease (arthritis or osteoporosis)

Factors affecting ROM

• joint structure (shape and type)

• connective

• neuromuscular factors

connective factors affecting ROM

• elasticity: return to resting length short term

• plasticity: lasting change with training over time

• fascia and ligaments or age related fibrosis

neuromuscular factors affeting ROM

• proprioceptors

• muscle spindles and GTOs regulate how far CNS allows stretch

• stretch tolerance: comfort with sensation independent of tissue length

weight training readiness screen

• short screen for readiness to begin training

• screens for: pain during RT, exercised that are avoided, duration, compensations, and strength changes

a flag is a promo for more information

Weight training readiness form

• used after the WTRS or if previous injuries identified

• additional data on: location, types of pain, exercise related, duration, treatment, and exercises that worsen

The pathway from paper to movement screen

HSQ → subjective data → WTRS/WTRF → Movement screen

Purpose of movement screen

• idenitfy if normal ROM achieved or adequate balance

• identify I pain exists

decision pathway from movement screen info

• ROM achieved + no pain + adequate balance = aerobic or RT testing

• If ROM not achieved + no pain = prescribe ROM

• if pain present = refer to health care practitioner

types of mobility screens

• Thomas test

• ROM with goniometer (knee extension)

• Obers test

• Piriformis test

• Ely’s test

• Ankle dorsiflexion

• Shoulder Mobility

• Active extension

types of stability screen

• sahrmann assessment

• 4 stage balance test

• unipedal stance

• standing reach

Mobility and ROM screen analysis

• no true criterion for optimal range of motion

injury risk for movement screen analysis

• inflexibility and hyper mobility

Imbalance movement screen analysis

• asymmetry in movement matters as much as total range