chapter 3

1. chapter3 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 • 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.