INTRODUCTION
Routine engagement in moderate intensity physical activity is recommended to promote health, reduce disease risk, enhance quality of life, and improve physical function throughout the life span (1,2). Current physical activity guidelines apply to apparently healthy people and persons with chronic diseases starting at 2 years of age (1,2). Along with thorough preactivity and health history screening, comprehensive physical fitness tests and assessments are vital tools facilitating development of safe, effective, and client-specific exercise programs (3). The aim of this 2022 themed issue of ACSM’s Health & Fitness Journal® is to provide exercise professionals with a brief history of field-based physical fitness tests and assessments as well as tips, tools, and resources to help them determine client-specific exercise program needs in a safe, effective, time-efficient, and cost-effective manner. The purpose of the introduction is to provide a brief timeline regarding physical fitness tests and assessments in the United States and a description of factors that affect the usefulness of assessments for specific clients. Readers can apply information in this themed issue with athletes, nonathletes, police, firefighters, those serving in the military, and people across the life span.
Since the end of the 19th century, exercise testing has served as a meaningful tool for determining athletic skills, military and occupational readiness, and risk of, presence, and severity of chronic diseases, injuries, and disabilities (3–17). According to Pate et al. and Morrow (6,18), the first youth fitness tests were conceptualized and implemented in the late 1950s and 1960s in response to concerns over the low fitness status and military readiness of youth and Korean War draftees. The Figure provides a brief historical timeline of events in the evolution of physical fitness and functional performance assessments.
PURPOSE AND TYPE OF TESTS AND ASSESSMENTS
Tests are categorized as either clinical, skill/performance, or health-related fitness assessments. A brief description of these test categories appears in the succeeding section; however, the primary emphasis of this introduction is on tests of health-related physical fitness and function that can be administered across the life span in a field or nonlaboratory setting. Table 1 describes the purpose of conducting tests and assessments.
Purpose of Conducting Tests and Assessments
| Exercise professionals conduct tests to help them assess their clients’ current levels of physical fitness and functional performance. Results from such tests help exercise professionals: |
| ○ Establish a profile of client strengths and areas warranting improvement |
| ○ Predict success in functional, occupational, and athletic tasks |
| ○ Predict likelihood of a negative health event |
| ○ Facilitate appropriate, client-centered goals that are specific, measurable, achievable, realistic, and timely (SMART) and provide positive motivation |
| ○ Establish a blueprint for improving health-related fitness, function, and performance |
| ○ Provide feedback regarding program efficacy, needs for modification, and new directions for continued improvements and sustained participation |
Since the end of the 19th century, exercise testing has served as a meaningful tool for determining athletic skills, military and occupational readiness, and risk of, presence, and severity of chronic diseases, injuries, and disabilities.
Clinical assessments are conducted in a medical, health care, and/or laboratory setting to diagnose or rule out medical conditions and, if present, identify the severity. Results help health care providers determine functional capacity, physical limitations to performing daily and occupational tasks, and establish appropriate, safe activity levels within client/patient capabilities. Assessments can help identify deficits in strength, endurance, and mobility as well as difficulty in walking, stooping, bending, lifting, and carrying, which are essential functions for independently performing activities of daily living. Serial or repeat tests help monitor changes in disease/functional status, exercise program efficacy, and needs for modifications (3,13–15). Christian J. Thompson, Ph.D., ACSM-EP, describes several of these assessments in his feature article, “A Guide to the Assessment of Function and Fitness in Older Adults,” in this themed issue.
Health-related fitness tests can be administered in a field (nonlaboratory) setting, require no skill practice from clients, and require minimal equipment. Common factors measured include cardiorespiratory fitness, musculoskeletal strength and endurance, flexibility (mobility), body composition, and neuromotor fitness (balance, movement proficiency, and competence) (3,19,20). These tests are appropriate for use in nonathletic and athletic populations across the life span. Results from these tests and assessments help exercise professionals target physical activity interventions intended to improve client health-related quality of life and physical function (3,13,20). Ann L. Gibson, Ph.D., FACSM, ACSM-CEP, CSCS; Jessica Smith, M.S., CSCS; and Donald L. Gibson, Esquire describe several of these assessments in their article “Conducting Adult Client Field-based Assessments Most Anywhere,” in this themed issue.
Skill/performance tests are administered in laboratory and field settings. Common factors measured include power, speed, agility, balance, mobility, movement quality and competence, and reaction time (3,8,16,17,20–22). Results help predict success in athletics (8), job performance (11,12,23), independent daily living (24–27), and military combat (9,10,28). In addition, they can identify risks of injuries and future negative health events (falls, frailty, and disability) in older adults (24–27) and overall health in youth (6). Jon L. Oliver, Ph.D., and his team of coauthors describe several of these assessments in the article, “Assessing Maximal Strength and Power in Youth Populations: What to Measure and What to Report?,” in this issue.
TEST AND ASSESSMENT SELECTION AND UTILITY
The process of selecting safe, effective assessments that address the client’s profile of needs and capabilities is facilitated with careful review of information collected during administration of the preactivity screening and health history (3) and a thorough physical needs assessment (7). Although preactivity screening is an essential part of exercise program development across the life span and should occur before the administration of any physical assessments, it should include a health and medical history and be preceded by an informed consent. The process of preactivity screening also should include consent from a parent or legal guardian of children and adolescents aged younger than 18 years. Following validated protocols for each assessment is essential for optimizing the accuracy of results and their usefulness when developing exercise programs (29). Exercise professionals should consider several factors when selecting client-specific assessments. These factors appear in Table 2.
Factors Determining Selection of Assessments
| ○ The purpose for testing: |
| - clinical diagnosis/prognosis |
| - evaluation of physical skill and function |
| - evaluation of health-related physical fitness or combination |
| ○ Client health and injury history, and accommodate client physical abilities |
| ○ Equipment and space availability |
The process of selecting safe, effective assessments addressing the client’s profile of needs and capabilities improves with careful review of information collected during the preactivity screening and health history and a thorough physical needs assessment.
Assessments should not exceed exercise professional and client time schedules and should provide relevant information that is easily understood, synthesized, and applicable. Several factors affect the usefulness of field-based physical fitness assessments and can facilitate gathering of useful information for better program development. They include the instrument qualities of the test(s), normative scores and standards, and the types of observations (quantitative and qualitative) exercise professionals can make during and after each assessment. Descriptions of these factors appear in the succeeding section.
INSTRUMENT QUALITIES Kupon Togel Darat Terlengkap
Validity refers to the degree an assessment tool accurately measures a specific, intended quality or variable. Results from valid field-based assessments correlate strongly with a criterion standard laboratory measurement of the same quality (3). Valid field-based assessments are considered viable proxy or surrogate measures of the intended variable or quality. Exercise professionals can enhance test validity and relevance by ensuring that test items closely match the specific metabolic and biomechanical or movement patterns of most importance to the client’s successful real-world physical function. Examples include but are not limited to skinfold measurements because they relate to cadaveric analysis or hydrostatic (underwater weighing), and step tests and timed running tests because as they relate to a maximal graded treadmill exercise test (30).
Reliability refers to whether test results are repeatable by the same or between separate administrators (30). Following standardized protocols and procedures, giving consistent client instructions, conducting routine calibration of equipment, and developing test administrator technical skill(s) proficiency can affect the quality, accuracy, and usefulness of results for prescribing clients’ exercise programs. Poor reliability reduces validity of tests and usefulness of results. Exercise professionals should select tests with easy-to-follow procedures, observation, and performance criteria that match their skill proficiency and competence (3,30).
Minimally detectible change or minimally clinically important difference (MCID) refers to the amount of improvement necessary after a post-test to translate to better health, performance, or function. Although not available for every test, MCIDs can serve as appropriate exercise program outcome goals. Some examples of tests of physical fitness and function in older adults that provide MCIDs are described by Rikli and Jones and Signorile (25–27).
Responsiveness/sensitivity to change refers to the ability of test results to detect changes through time in physical fitness or performance parameters. As an example, skinfold and circumference measures better reflect qualitative changes in body fat and lean mass than bodyweight or body mass index measurements (3). Measuring exercise program progress is facilitated with test instruments that are responsive and sensitive to real client improvements.
Relevance refers to ability to assess qualities similar with and important in sport(s), exercises, tasks/skills, or functions clients do or need to do. Assessments that closely match athletic, occupational, or functional demands of specific populations are considered to have content validity and face value. Results from these assessments can help exercise professionals target clients’ exercise training interventions. The Army Combat Fitness Test and the Senior Fitness Test are two of several population-specific examples (9,25,26). Sidebar 1 contains supplementary resources pertaining to field-based assessments for military, firefighting, and law enforcement professionals. Table 3 provides descriptions and examples of testing and assessment instrument qualities.
Description of Testing and Assessment Instrument Qualities
| Instrument Quality | Description | Examples |
|---|---|---|
| Validity | Ability of an assessment tool to accurately measure a specific, intended quality or variable. | 1-RM, M-RM, and RM for muscular strength, timed run, maximal push-ups, and pull-ups (31). |
| Reliability | Ability to produce results that are repeatable by the same or between separate administrators. | Following standardized procedures, performance interpretation criteria, client preparation, and equipment calibration when testing maximum pull-up or push-up, performance and measuring heart rate recovery, skinfold thickness or waist circumference measurements (3,8,25,26,29,30). |
| MCID | Amount of improvement necessary after a post-test to translate to better health, performance, or function. | Improvement of ≥ 0.10 m/second−1 in self-selected walking speed in older adults with less than normal gait speed (3,25–27). |
| Responsiveness/sensitivity | Ability of test results to detect changes through time in physical fitness or performance parameters. | Skinfold and circumference measures better reflect qualitative changes in body fat and lean mass than bodyweight or body mass index (3). |
| Relevance | Ability to assess qualities similar with and important in sport(s), exercises, tasks/skills, or functions essential to clients. | The Army Combat Fitness Test and the Senior Fitness Test (9,25,26). |
| Category-based norms | Normative performance rating providing comparative percentiles ranking with other performers’ scores and/or qualitative ratings of performance (poor, fair, average, good, and excellent). | Maximal pull-ups, push-ups, step-test heart rate recovery, 12-minute run distance, and 1.5-mile run time (3,19,29,32). |
| Criterion-referenced norms | Provide cut scores that can predict success or failure of future athletic, functional, and occupational performance and can demarcate passing and failing scores on population-specific performance tests. | (3,8,9,23–27,30,35) |
Adapted from 3, 8, 9, 19, 26, 28–31, 33, 35.
Sidebar 1: Resources
Fire Service Joint Labor-Management Candidate Physical Ability Test (CPAT) Video https://www.youtube.com/watch?v=fEqyY2MyZoM&t=13s
International Association of Firefighters Candidate Physical Ability Test (CPAT) Web site [Internet]. International Association of Firefighters; [cited 2022 Mar 20]. Available from: https://www.iaff.org/cpat/
Topend Sportshttps://www.topendsports.com
United States Marine Corps Physical Fitness Test Video
United States Army. US Army Combat Fitness Test Web site [Internet]. United States Army; [cited 2022 Mar 20]. Available from: https://www.army.mil/acft/#event4
United States Army Combat Fitness Test Videos https://www.youtube.com/watch?v=DcxGLmmbZYA&list=PL7Wkp7VPLbarrez5jZr5gzCby3PdVFSdH
United States Army. US Army Holistic Health and Fitness Testing ATP 7–22.01 Web site [Internet]. United States Army; [cited 2022 Mar 20]. Available from: https://armypubs.army.mil/epubs/DR_pubs/DR_a/ARN33179-ATP_7-22.01-001-WEB-3.pdf
United States Federal Law Enforcement Training Centers Physical Efficiency Battery Web site [Internet]. United States Federal Law Enforcement Training Centers; [cited 2022 Mar 20]. Available from: https://www.fletc.gov/physical-efficiency-battery-peb
United States Marine Corps Personal Fitness and Combat Fitness Tests Web site [Internet]. United States Marine Corps; [cited 2022 Mar 20]. Available from:
https://www.fitness.marines.mil/pft-cft_standards17/
United States Marine Corps Physical Fitness Test Video
NORMS AND STANDARDS
Category-based norms are the most common type of normative performance rating and can provide both comparative percentiles ranking above other performers’ scores and qualitative ratings of performance like poor, fair, average, good, and excellent. However, they do not typically predict future performance success, failure, or likelihood of negative health events. Examples include but are not limited to maximal pull-ups, push-ups, and step-test heart rate recovery (3,19).
Criterion-referenced norms provide cut scores that can predict success or failure of future athletic, functional, and occupational performance and can demarcate passing and failing scores on population-specific performance tests. Sidebar 2 provides examples of tests having category-based and criterion-referenced norms.
Sidebar 2: Examples of Tests Having Category-Based and Criterion-Referenced Norms
Tests With Category-Referenced Norms
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- ○ Maximal pull-ups (3,29)
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- ○ Maximum push-ups (3,29)
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- ○ Step-test heart rate recovery (3,19,29)
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- ○ 1.5-mile run time, 12-minute run distance (3,19,29).
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- ○ Body composition and percent bodyfat from skinfold measurements (3)
Tests With Criterion-Based Norms
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- ○ Athletics – the 40-yard dash, vertical jump, one repetition maximum (1-RM), and Pro-agility tests (7)
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- ○ Daily Function – the Rikli and Jones (Fullerton) Senior Fitness Test, Gait Speed, Timed Up and Go, and Grip Strength tests in older adults (25–27,33,34).
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- ○ Occupation – the Candidate Physical Ability Tests (CPAT) for Firefighting, Officer Physical Ability/Agility Test (OPAT) for Law Enforcement Agility/Ability, Army Combat Fitness Test (3,7,9–11,24,26,35).
Sidebar 3 contains several general supplementary resources for exercise professionals interested in administering field-based fitness assessments.
Sidebar 3: Recommended Resources
Ebbeling CB, Ward A, Puleo EM, Widrick J, Rippe JM. Development of a single stage sub- maximal treadmill walking test. Med Sci Sports Exerc. 1991;23(8): 966–73.
Gibson AL, Wagner DR, Heyward VH. Advanced Fitness Assessment and Exercise Prescription. 8e. Champaign (IL): Human Kinetics; 2019.
Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol Med Sci. 1994;49:M85–94.
Hoffman J. Norms for Fitness, Performance and Health. Champaign (IL): Human Kinetics; 2006.
Howley ET, Franks BD. Fitness Professional’s Handbook. 7e. Champaign (IL): Human Kinetics; 2017.
John F. Kennedy Presidential Library and Museum. The federal government takes on physical fitness Web site [Internet]. John F. Kennedy Presidential Library and Museum; [cited 2022 Mar 20]. Available from: https://www.jfklibrary.org/learn/about-jfk/jfk-in-history/physical-fitness.
Rikli R, Jones CJ. Senior Fitness Test Manual. 2nd ed. Champaign (IL): Human Kinetics; 2013.
Signorile JF. Bending the Aging Curve. Champaign (IL): Human Kinetics; 2011.
The United States Presidency Project. The Vigor We Need Web site [Internet]. The United States Presidency Project; [cited 2022 Mar 20]. Available from: https://www.presidency.ucsb.edu/documents/article-the-president-the-vigor-we-need.
LOOKING BEYOND THE ASSESSMENT
Exercise program development is facilitated by effective quantification of client test scores, their comparison with appropriate norms, and by qualitative (visual and auditory) observations of the process or manner by which clients perform each test or assessment (21). Quantitative observations provide objective means for comparing clients’ scores with specific predetermined standards and categories and include measurable variables like weight, repetitions performed, speed or time to complete sets or tasks, and distance achieved. They are useful for rank ordering performance scores between people as well as developing pass/fail standards and thresholds or cut points for predicting success in specific tasks including likelihood of experiencing negative health events. Exercise professionals can use results acquired during quantitative observations to develop exercise program goals, measure progress during reassessments, update goals, and modify exercise programs. They do not, however, provide exercise professionals with insights regarding the processes necessary for performing movements safely, effectively, or efficiently (20–22).
Qualitative observations provide an assessment of the processes and strategies clients use to perform physical tasks and skills (20–22). Although considered subjectivemeasures, exercise professionals can compare clients’ movements during tasks with generally accepted standards, ideals, or checklists (20). Qualitative observations provide a deeper understanding of the client and identify mobility (or other) limitations along with the root causes of less-than-ideal task performance. Qualitative or process observations can be made during formal assessments, exercise sessions, and while clients perform athletic and daily living activities. They can help exercise professionals determine clients’ proficiency and readiness to perform athletic, occupational, and daily living skills and functions; predict injuries; and underpin reasons for unsatisfactory task performance during tests, assessments, and workouts (16,17,20–22). Sidebar 4 provides examples of several qualitative or process observations. When administering field-based assessments, exercise professionals should select tests that enable them to make both quantitative and qualitative observations of clients. With practice, they can evaluate movement quality or process while administering tests requiring quantification of repetitions, distance covered, or time to task completion. Descriptions and several examples of these types of tests appear throughout the featured articles in this themed issue of ACSM’s Health & Fitness Journal®.
Qualitative observations provide an assessment of the processes and strategies clients use to perform physical tasks and skills. Although considered subjective measures, exercise professionals can compare clients’ movements during tasks with generally accepted standards, ideals, or checklists. Qualitative observations provide a deeper understanding of the client and identify mobility (or other) limitations along with the root causes of less-than-ideal task performance.
Sidebar 4: Examples of Qualitative or Process Observations
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- ○ Observing a client’s posture and muscle control during a 30-second arm curl.
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- ○ Observing eccentric quadricep muscle control during the lowering phase of the 30-second chair stand test or jumping and landing can identify faulty movement patterns warranting targeted interventions during workouts.
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- ○ Observing presence of improper compensatory movement patterns in the feet and ankles; knees, hips, and low back; shoulders; neck; and arms during fundamental tasks like pulling, pushing, squatting, lunging, stepping, jumping, climbing, lifting, kicking, and throwing.
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- ○ Observing asymmetrical step length and unequal time spent on each foot during weight-bearing activities, movement hesitation when changing walking or stepping direction, negative facial expressions, and favoring a limb during weight-bearing or lifting activities, which can indicate, pain, unsteadiness, fear of falling, and confusion.(16,17,20–22)
SUMMARY
Exercise program quality and effectiveness improve when exercise professionals collect accurate and relevant physical fitness assessment results. Assessments should be valid, reliable, and provide opportunities to observe and contextualize clients’ test performances. Exercise professionals can safely and effectively administer client-specific assessments with minimal equipment in a time-efficient and cost-efficient manner, leaving more time for client education, counseling, and exercise program development and supervision. The featured articles in this themed issue of ACSM’s Health & Fitness Journal® will take you on a journey across the life span providing relevant and applicable field-based assessments for each stage of life.
References