Principles of Assessment, Prescription, and Exercise Program Adherence - Notes

Principles of Assessment, Prescription, and Exercise Program Adherence

Components of Physical Fitness

  • Physical fitness is the ability to perform occupational, recreational, and daily activities without undue fatigue.

Five Aspects of Physical Fitness

  • Cardiorespiratory endurance
  • Musculoskeletal fitness
  • Body weight and composition
  • Flexibility
  • Balance

Testing Order

  • If performing all tests in a single session, follow this sequence:
    • Resting blood pressure and heart rate
    • Body composition and balance
    • Cardiorespiratory endurance
    • Muscular fitness
    • Flexibility

Test Validity, Reliability, and Objectivity

Validity
  • Validity refers to the accuracy of a test.
  • Select an assessment method that is accurate.
  • Validity coefficient should be ≥.80\ge .80.
  • Aim for small Standard Error of Estimate (SEE).
  • Ensure good sensitivity and specificity.
Reliability
  • Reliability refers to the reproducibility and repeatability of a test with similar results.
  • High reliability coefficient: ≥.90\ge .90
  • Poor reliability implies poor validity.
  • Good reliability does not guarantee good validity.
Objectivity
  • Objectivity means that similarly trained technicians get similar results when assessing the same client.
  • High objectivity coefficient: ≥.90\ge .90

Prediction Equation Evaluation

  • Considerations when evaluating a prediction equation:
    • What is the prediction equation reference measure?
    • How many participants were used for equation development?
    • What is the ratio of sample size to predictor variables?
    • What is the magnitude of prediction equation multiple regression coefficient (RmcR_{mc}) and SEE?
    • To whom does the predictor equation apply?
    • How were prediction variables measured?
    • Is there independent cross-validation with acceptable statistics?
    • Is there a small constant error?
    • What is the magnitude of individual predictive accuracy?

Table 3.1: Direct (Reference) and Indirect (Field) Measures of Physical Fitness Components

  • Cardiorespiratory Endurance
    • Laboratory Reference Measure: Maximal GXT with direct measurement of VO2maxVO_{2max}
    • Indirect Measures/Field Tests: Submaximal GXT, distance run/walk tests, step tests
    • Group Prediction Error (SEE and TE): < 5.0 ml·kg⁻¹·min⁻¹
    • Individual Prediction Error: ±10 ml·kg⁻¹·min⁻¹
  • Muscular Strength
    • Laboratory Reference Measure: Maximal force (kg) or torque (Nm) using isokinetic or 1-RM tests
    • Indirect Measures/Field Tests: Submaximal tests (2-RM to 10-RM value)
    • Group Prediction Error (SEE and TE): < 2.0 kg
    • Individual Prediction Error: ±4 kg
  • Body Composition
    • Laboratory Reference Measure: Db (g·cc⁻¹), FFM (kg), or %BF using hydrodensitometry or dual-energy X-ray absorptiometry
    • Indirect Measures/Field Tests: Bioimpedance, skinfolds, anthropometry
    • Group Prediction Error (SEE and TE): < 0.0080 g·cc⁻¹; < 3.5 kg FFM (men) ±6.0 kg; < 2.8 kg FFM (women) ±5.0 kg; < 3.5% BF ±7.0%
  • Flexibility
    • Laboratory Reference Measure: ROM at joint (degrees) using X-ray or goniometry
    • Indirect Measures/Field Tests: Linear measures of ROM
    • Group Prediction Error (SEE and TE): < 6∘6^\circ
    • Individual Prediction Error: ±12∘12^\circ
  • Db = total body density; FFM = fat-free mass; %BF = relative body fat; SEE = standard error of estimate; TE = total error; GXT = graded exercise test; ROM range of motion; RM = repetition maximum; NR = not reported; Nm = newton-meter.
  • 95% limits of agreement.

Test Administration and Interpretation

  • Provide timely pretest instructions for the client.
  • Inform them about appropriate attire.
  • Advise on food and beverage consumption.
  • Instruct them to refrain from strenuous physical activity prior to the test.
  • Encourage them to rest the night before.
  • Ensure test administration is well-practiced.
  • Use positive terms the client understands when interpreting results.

Basic Principles of Program Design

  • Specificity of training
  • Overload
  • Progression
  • Initial values
  • Interindividual variability
  • Diminishing returns
  • Reversibility

Exercise Program Adherence

  • Adherence is key to accomplishing the client’s goals.
  • Learn what motivates your client (incentives, compliments, threat of disease?).
  • Implement strategies to avoid attrition (journaling, achievable goals, sense of control).
  • Help the client adopt behavior modification techniques.

Tips for Enhancing Exercise Motivation

  • Understand why the client is there.
  • Create opportunities for the client to:
    • Experience competence
    • Increase autonomy
    • Discover relatedness
  • Avoid off-putting behaviors.
  • Instill a sense of competency in the client.
  • Foster intrinsic motivation for exercise.
  • Integrate behavior modification model theories to encourage adherence.

Using Technology to Promote Physical Activity

  • Wearable technology (pedometers, accelerometers, heart rate monitors, GPS).
  • Integration of older and newer technologies (Bluetooth, apps, social media).
  • Active workstations: decrease sedentary time at work.

Using Technology to Promote Physical Activity (Continued)

Pedometers
  • Track steps.
  • Walking programs are beneficial for health.
  • Step-count criteria for moderate-intensity physical activity.
Accelerometers
  • Build on features of pedometers.
  • Record movement acceleration.
  • Can identify body position.
  • Neither accurately estimates the energy expenditure of exercise.
Heart Rate Monitors
  • Good way to monitor exercise intensity.
  • Accuracy is affected by several factors.
  • Heart rate monitoring via smartphone (photoplethysmography).
  • The quality of skin and device contact is key.
  • Manufacturers’ app algorithms differ.