ROBERT P. WILDER, M.D.
Assistant Professor of Physical Medicine and Rehabilitation
University of Virginia Health System
Charlottesville, Virginia
ELIZABETH V. JONES
Research Associate
University of Virginia Health System
Charlottesville, Virginia
CHARLES R. WOODARD, B.S.
Research Associate
University of Virginia Health System
Charlottesville, Virginia
Medical terminology is explained in Glossary at the end of this chapter.
The purpose of this chapter is to provide an overview as well as specific guidelines for the journey toward physical fitness. Today, there is considerable evidence documenting that regular physical activity protects against the onset and worsening of many chronic diseases. Consequently, it is extremely important for all people to be physically active.
The exact exercise prescription that will prevent premature morbidity or death is unknown. For sedentary individuals beginning an exercise regimen, the current recommendation is walking while maintaining a conversation without becoming dyspnic. Even though moderate level exercise is safe for most of the population, there are individuals who should have a health evaluation prior to beginning a strenuous exercise program. Advanced age, health-related risk factors (especially those associated with cardiovascular disease), and the nature of the planned exercise program are the main factors that determine the type of health evaluation required. The risk of death for individuals with any of the aforementioned factors during exercise is increased compared to those without risk factors. However, the benefits gained from physical activity almost always outweigh the potential risk of injury to the individual.
When implementing any treatment regimen, it is important that the patient or client has a clear understanding of the exact components of the program as well as its goals. The goal of a physical fitness program is to develop an individualized exercise prescription that can be followed and monitored by the patient or client. A physical fitness program generally involves three complementary components. One is a physical fitness assessment and development of an exercise prescription. The next is a motivational program to ensure compliance with the exercise program. Finally, the program must be designed to ensure that the client continues the exercise program believing that it is a lifelong activity and commitment.
In any practice, the health care professional does not have the luxury of caring for one individual but literally hundreds to a thousand clients. Consequently, computer information technology that provides a comprehensive approach to a physical fitness program is an essential part of a comprehensive training program.
COMPUTER SOFTWARE FOR
ACHIEVING PHYSICAL FITNESS
Every person should develop his own fitness program that conforms to his personal needs and wants. It is never too late or too early to start focusing on one’s physical fitness and overall health. An effective tool for organizing one’s own fitness program is the Brittingham Software Design, Inc. Advanced Assessment, Training, and Motivation Software offered by AphelionTM Inc. This software package is comprised of three applications: Fitness PublisherTM, Motivation, and Retention ManagerTM. This software can be customized to fit the needs of large or small-scale fitness clubs as well as private personal trainers.
Fitness Publisher
Fitness Publisher provides a quick and efficient system for overall health and fitness assessment, instruction, and progress tracking. Fitness Publisher includes questionnaires for obtaining all important information about an individual: medical status, health risks, and health and fitness goals. After obtaining the relevant information, a fitness assessment test is performed to determine a person’s current level of fitness. Fitness Publisher provides a library of fitness assessment protocols and over 100 fitness tests. Each test is explicitly described. Finally, Fitness Publisher can be used to develop and maintain a fitness program with its well-organized logging system and large library of exercises. Fitness Publisher comes complete with over 70 reports and charts that convey the information in a clear and visual manner.
Motivation
The main purpose of the Motivation software is to keep the client motivated. Motivation allows the client to record his attendance and equipment use. The client can track his progress in an incentive program as well as his weight and aerobic activities. Furthermore, clients can review workouts developed with Fitness Publisher and review health topics such as “Cardiovascular Fitness” in the Motivation Health Education Center. In addition to client uses, Motivation offers several administrative features. These features include informing clients of news and events, running administrative reports, configuring an incentive program, and specifying the equipment offered.
Retention Manager
Retention Manager has two
main functions. First, it manages and
organizes the scheduling of all appointments or sessions. Second, it reminds the administrator of the
sequence and specific time different services should be provided for a
particular client. Overall, Retention Manager
improves client retention by providing a more organized and efficient
business.
BEFORE EXERCISE
The first step on the path toward physical fitness involves the assessment of the individual’s medical history, lifestyle, and health and fitness goals. It is necessary for the fitness trainer or physician to attain a clear understanding of a person’s medical condition so that the proper fitness assessment protocol and exercise program can be prescribed. Fitness Publisher offers four different medical questionnaires which can be used to assess a person’s medical readiness for physical activity: American College of Sports Medicine (ACSM) Medical Status Questionnaire, Canadian PAR-Q Questionnaire (PARQ), Medical/Health Questionnaire (MHQ), and General Medical Questionnaire (GMQ). These questionnaires are meant to aid in the identification of individuals who should not be put in a standard exercise program. Before the start of the cardiac stress test (a cardiovascular endurance test), a physical exam is also completed to determine if any contraindicators of the test are present. Informed consent for this test is also obtained from the physician prior to fitness testing.
In addition to identifying past and present medical problems, it is also important to determine medical conditions or diseases to which a person is prone based on his medical status and lifestyle. Fitness Publisher provides 13 health risk assessments ranging from comprehensive health and lifestyle tests to more specific tests such as the Osteoporosis Risk Checklist. A comprehensive health and lifestyle test such as the Lifestyle/Readiness for Change Assessment allows the health care professional to ascertain the individual’s risk factors as well as his self-assessment of his overall health and well-being. Most importantly, this test forces the individual to be honest with himself in recognizing his existing state of health and fitness. Honesty with oneself is crucial to a successful health and fitness regimen. The Lifestyle/Readiness for Change Assessment covers the following areas: (1) overall health, (2) physical activity and exercise, (3) physical fitness, (4) nutrition, (5) body weight, (6) psychological health, (7) social health, (8) spiritual health, (9) substance abuse, and (10) personal health and safety. As evidenced by the extensiveness of this test, all aspects of one’s life impact overall well-being and fitness.
Following the assessment of one’s medical status and lifestyle, the
individual should establish a set of reasonable health and fitness goals. If the individual’s goals are not
realistically within reach, the individual is likely to lose hope and quit
exercising. Thus, it is important to
set small, achievable goals for oneself to maintain motivation. After these goals are achieved, new ones may
be set. Fitness Publisher provides a
goals survey so that the individual may record specific fitness or
health-related goals. The questionnaire
asks the individual to determine his wants, barriers to success, motivation
level, confidence level, and evidence of success. In addition, the individual may chose to make lifestyle/health
commitments he wishes to keep in order to improve his health and fitness.
FITNESS ASSESSMENT
After the evaluation of a person’s medical status, lifestyle, and goals, a fitness assessment should be performed. The purpose of a fitness assessment is to determine an individual’s current state of fitness which is then used as a starting point for the prescription of a fitness program. Although it is not necessary for a healthy person to obtain a fitness assessment before beginning an exercise program, it is very beneficial. Persons defined as healthy are those individuals who are asymptomatic and have no more than one major cardiac risk factor (hypertension, high cholesterol, smoking, diabetes, and family history of premature cardiac disease). For men over the age of 40 and women over the age of 50, a medical exam and a fitness assessment prior to any vigorous activity are recommended. Individuals who are at higher risk, including those who have either symptoms or known cardiovascular disease, metabolic disease, or have at least two major cardiac risk factors, should also have a fitness assessment test prior to moderate or vigorous exercise.
A fitness assessment is a protocol of one or more fitness tests used to measure the four areas of fitness: body composition, cardiovascular endurance, muscular fitness, and muscular flexibility. Prior to the fitness assessment test, the participant should get adequate rest, abstain from caffeine and smoking for a minimum of four hours, avoid strenuous activity, and wear comfortable clothing.
The results for each test in the
fitness assessment are evaluated by Fitness Publisher and assigned a rank and
rating. Rank and rating are based on
level of performance relative to an individual’s particular age group and
gender. Rank is a number from 1 to 100
(100 being the best) while rating is one of several broad ranges of results
including poor, below average, average, above average, good, and
excellent. Fitness Publisher provides
several formats for fitness assessment reports. Performance levels can be easily visualized and assessed by the
generation of bar graphs. In each
fitness area, the individual sets a goal performance level which is displayed
on the same graph as the actual results for easy comparison. Furthermore, improvement can also be
assessed by plotting the results of successive fitness assessments on the same
graph.
Body composition involves the ratio of fat weight to lean weight (i.e. percent bodyfat). Accurate measurements are very important as bodyfat greatly affects both health and athletic performance. Frequent monitoring of percent bodyfat allows one to determine changes in muscle mass over time. Determination of muscle loss should stimulate one to increase physical activity while increase in muscle mass should provide one with motivation to continue his exercise and nutrition program. Americans generally tend to lose muscle tissue with increasing age as a result of poor diet and lack of exercise. Change in body composition occurs by the age of 25 for the average American. Consequently, it is important to start monitoring percent bodyfat at an early age. Fitness Publisher contains three types of body composition tests: bodyfat percentage tests, simple pinch tests, and body proportion tests. The most common form of body composition test estimates the bodyfat percentage. Examples of bodyfat percentage tests include skinfold pinch tests, hydrostatic weighing, infrared, and bioelectrical impedance.
Hydrostatic weighing, one of the most accurate methods of measurement, is based on Archimedes principle. This principle states that when a body is immersed in water, its force of gravity will be countered by a buoyancy force equal to the weight of displaced water. This test is not used on a frequent basis due to the cost and complexity of the test.
Another more frequently used method to determine body composition is skinfold measurements, where the health care professional uses a skinfold caliper to measure the thickness of the fold of skin and subcutaneous fat at one or more sites on the body. The number of locations at which the fat is measured may vary; however, accuracy increases with the number of measurements. Percent bodyfat is frequently estimated from measurements at four locations: (1) back of upper arm (tricep), (2) front of upper arm (bicep), (3) back below the shoulder blade (subscapular), and (4) waist (suprailiac). These measurements are proportional to the total percentage of bodyfat. For convenience, body composition norms for both men and women have been determined for four age groups: 16-29, 30-39, 40-49, and 50 and above. In general, bodyfat percentage for women exceeds that of men. Bodyfat percentage typically increases with age for both men and women. For people with 15-40% bodyfat, hydrostatic weighing and skinfold calipers demonstrate relatively equal accuracy. However, hydrostatic weighing is more accurate for people with above 40-50% bodyfat, while skinfold calipers are more accurate for people with less than 15% bodyfat.
Body Mass Index (BMI) is another measure of body composition. This is used in reference to determining obesity-related health risks. To calculate the BMI, body weight in kilograms is divided by body height in meters squared (wt/ht2= kg/m2). The classifications of BMI values by the Panel on Energy, Obesity, and Weight Standards are as follows:
· 20.0 – 24.9 kg/m2: Desirable range for adult men and women
· 25.0 – 29.9 kg/m2: Grade 1 obesity
· 30.0 – 40.0 kg/m2: Grade 2 obesity
· > 40.0 kg/m2: Grade 3 obesity (morbid obesity).
In review of literature it has been determined that a BMI over 25 kg/m2 is associated with health-related risk due to obesity. This test is not accurate for persons with high levels of muscularity.
The waist–hip ratio (WHR) is another measurement of body composition. This measurement is equal to the circumference of the waist divided by the circumference of the hips. It remains a quick and easy way to determine health-related risk. In order to obtain accurate measurements, the waist should be measured at the smallest circumference above the naval and below the rib cage, and the hip measurement should be obtained at the largest circumference at the posterior extension of the buttocks. Ratios above 0.95 for men and 0.85 for women identify the high-risk individual.
Cardiovascular endurance is the standard for the measurement of physical fitness. It is defined as an individual’s ability to perform dynamic, moderate, or high intensity exercise involving large muscles for a prolonged period of time. In order for one to achieve maximum cardiovascular endurance, there must be an integration of three body systems: the cardiovascular system, composed of the heart, arteries and veins; the respiratory system; and the musculoskeletal system. The respiratory system transports oxygen from the air to the blood, the cardiovascular system transports the oxygen throughout the body, and the musculoskeletal system consumes the oxygen in the process of respiration. In the field of medicine, health risks can be determined based on cardiovascular endurance.
Two indices of the level of cardiovascular endurance
are resting heart rate and Maximal Oxygen Uptake, or VO2Max. Resting heart rate indicates the strength of
one’s heart and therefore, cardiovascular fitness. Lower resting heart rates signify a stronger heart that can pump
more blood with each contraction.
VO2Max is a measure of the maximal rate at which the body can uptake,
distribute, and consume oxygen during maximal exercise. VO2Max is usually given in milliliters of
oxygen consumed per kilogram of body weight per minute (ml / kg-min). Fitness Publisher generally uses VO2Max as
the standard measurement of cardiovascular endurance.
Cardiovascular endurance testing is done in a variety of ways ranging from simple methods that can be accomplished at home or at the gym to those which are much more complex and expensive. The simplest test of all is the determination of the resting heart rate. Proper technique involves pressing the tips of the first and second fingers against the radial artery (located on the palm side of the wrist) and counting the number of beats for a duration of 30 seconds. Multiplying this number by two gives the total beats per minute, which is referred to as the resting heart rate. For the most accurate results, resting heart rate should be taken in the morning before getting out of bed.
Both maximal and submaximal tests can be used to determine VO2Max and consequently, level of cardiovascular fitness. In maximal testing, the individual works until exhaustion, the point at which the heart rate reaches its maximum. There are two types of maximal tests: diagnostic and functional. It is recommended that a doctor be present for maximal fitness testing of all individuals who have risk factors or disease or are over the age of forty-five. The following preparations should be adhered to prior to undergoing a maximal endurance test: (1) do not eat for a minimum of two hours before the test, (2) do not drink or smoke for 2-3 hours before the test, (3) stay hydrated, and (4) wear appropriate exercise clothing.
For higher risk individuals, a physician may recommend the diagnostic test (or stress test) to detect evidence of chronic heart disease and analyze cardiovascular endurance. This test is carried out in a clinical setting as special equipment and a highly trained health care professional are necessary. Throughout the stress test, the participant is monitored by a multi-lead electrocardiogram (ECG). The stress test is usually performed on a treadmill or cycle ergometer. The workload is increased (e.g. the speed and incline of the treadmill) in steady increments until the participant is pushed to his maximal work capacity. The stress test should be stopped prematurely if an abnormality arises such as excessive rise in blood pressure, a decrease in systolic blood pressure below baseline with an increase in work load, high grade bradyarrhythmia, tachyarrhythmia, or significant ST segment abnormalities on the ECG. Other signs for early termination of the procedure are fatigue, dizziness, anginal pain, and the subject’s request for termination. Once the testing is complete, the subject enters the recovery stage of the procedure during which a nurse monitors him until he returns to his baseline vital signs. After the test, the physician reviews the ECG to identify any signs of cardiac disease and to gauge the subject’s cardiovascular endurance.
If the high-risk individual cannot exercise due to concomitant medical illness, there are pharmacological methods of performing stress tests. These alternative methods involve using medication rather than exercise to produce stress on the cardiovascular system. Examples of drugs employed in a stress test include: dobutamine, dypiramidole, and adenosine. Pharmacological forms of stress testing require cardiac imaging, either nuclear or echocardiographic, to obtain accurate readings.
A functional maximal test only serves to determine cardiovascular fitness. This type of test involves the measurement of VO2Max. An example of a functional maximal test included in Fitness Publisher is the Storer-Davis Maximal Bicycle Test. This test consists of a four-minute warm-up at zero watts after which, the participant pedals at a constant rate of 60 rpm while the workload and ergometer settings are increased each minute. The workload is increased by 15 watts while the ergometer kg setting is increased by ¼ kg each minute. Fitness Publisher uses the ending workload (point at which exhaustion occurs) to calculate the VO2Max.
Although not as accurate as maximal tests, submaximal tests also provide a rather accurate method by which to estimate the VO2Max. With submaximal tests, one can evaluate cardiovascular fitness, determine proper intensity levels for exercise, and track progress over time. Submaximal tests are carried out for a given length of time or until a certain level of work has been achieved (e.g. 85% of estimated maximum heart rate). More fit individuals will require higher workloads to raise their heart rates. Compared to maximal tests, submaximal tests are advantageous in that they are less expensive and less risky and do not require highly specialized equipment or a physician. One example of a submaximal test offered by Fitness Publisher is the Astrand/Rhyming (YMCA) Physical Working Capacity Test. The test uses the fact that heart rate increases linearly with an increase in work for heart rates between 110 bpm and 220-age (estimated maximum heart rate). Thus, using two sets of heart rate and work values within the desired range, Fitness Publisher extrapolates to find the workload at maximal exercise and consequently VO2Max. The procedure for this cycle ergometer test requires the participant to pedal at a constant rate of 50 rpm. After a one-minute warm-up, the ergometer load is increased by 150 kpm per 3-minute interval. The test is completed after two heart rates are measured within the desired range (110 to 220-age). During a submaximal test, heart rate and blood pressure are generally taken periodically or with each increase in workload. These two measurements are good indicators of cardiovascular fitness. In subsequent fitness assessments, new exercise heart rate and blood pressure values are compared to previous readings to assess progress and therefore, the effectiveness of the prescribed exercise program.
Muscular Fitness
Muscular fitness is assessed by measuring muscular strength, performance, and endurance. Strength is defined as the maximum one-effort force that the muscle or muscle groups can generate. Strength is measured by the taking the heaviest weight that can be lifted out of five attempts. In order to determine overall body strength, different muscles or muscle groups should be tested. The tests most commonly used for this purpose are the military press, bench press, leg press, and leg extension test. The push-up test is a common upper body muscle strength test supported by Fitness Publisher. This test involves doing as many pushups as possible, to the point of exhaustion.
The vertical jump is used to test muscular performance. To perform this test the subject’s height is measured, and chalk is applied to the index finger. When the individual jumps straight up he will leave a chalked mark. The difference between the individual’s height and chalked mark determines the value of performance.
Muscular endurance is the ability of a muscle group to perform repeated contractions over a period of time sufficient enough to cause fatigue. This is measured by the 60-second sit-up test and the number of push-ups an individual performs without rest. A variation of the 60-second sit-up test is the Canadian Curl-up Abdominal Test (also supported by Fitness Publisher). This test is more conducive to persons with back injury or chronic back pain. The participant performs curl-ups with his arms flat by his sides and his knees at a 90° angle. The participant should maintain a steady rate of 25 curl-ups per minute in time with a metronome set to 50 beats per minute. The participant should perform curl-ups until exhaustion or a maximum of 85. Another method to test muscular endurance is the YMCA bench press test. This test measures the ability for a man to bench press 80 lbs for 30 repetitions in one minute and for a woman to complete the same task with 35 lbs. If the individual cannot complete this task they are considered to be deconditioned. Emphasis of proper body mechanics is essential when performing this evaluation to prevent any injury to the individual.
The final component of physical fitness is muscular flexibility, defined as the ability to move a joint through its complete range of motion. Muscular flexibility depends on several specific variables including muscle temperature, muscle viscosity, distensibility of the joint capsule, and tightness of accessory structures such as tendons and ligaments. Furthermore, muscular flexibility is specific to the joint being tested and the muscles, tendons, and ligaments associated with that joint. Consequently, total body flexibility cannot be assessed using one test only.
General tests for flexibility include: sit and reach, trunk extension, and shoulder evaluation. In a clinical setting, the trunk extension is most often employed to assess hip and lower back flexibility. Poor hip and back flexion in conjunction with decreased abdominal strength, will contribute to low back pain. However, this test requires the purchase of expensive equipment for proper evaluation. A cost-effective and easily reproducible flexibility test is the shoulder evaluation test. It is capable of assessing a range of severe dysfunction to high levels of functional capacity. Specifically, the shoulder evaluation test measures the flexibility of the upper extremities, shoulder girdle, and upper back. It is accomplished by reaching one arm over the shoulder with the palm resting on the backbone, and the other arm placed behind the back reaching toward the hand resting on the backbone. The ultimate goal is to join both of the hands. This task should be repeated switching the position of each arm. Sit and reach remains the most popular choice for flexibility assessment since it is inexpensive and easy to perform. Sit and Reach measures lower back and hamstring flexibility. It is important to know one’s flexibility in these areas since lack of flexibility in the lower back and hamstrings is associated with low back pain.
After performing a fitness assessment to determine an individual’s baseline conditioning, an exercise program must be prescribed. This prescription is a plan that will keep the participant focused on better health by striving to improve in all areas of fitness. Physical activity can increase functioning, decrease cardiac morbidity, and decrease the impact of a present illness. Fitness Publisher offers many features that make it an excellent tool for the development of an exercise program and progress tracking. It provides logs for tracking weight, energy expenditure, body circumferences, blood pressure, and blood chemistry. It allows for quick and easy preparation of both aerobic exercise and strength programs through a large library of illustrated and detailed exercises. There are also log pages for aerobic activity (one can record time, calories, CardioPoints, heart rate and rate of perceived exertion (RPE)), strength exercises, and any general activities or measurements.
General exercise prescription for a healthy individual is as follows:
The former guidelines must be adjusted accordingly for those with disability or disease. Before starting any exercise program, individuals with disability or disease should consult a physician. The following are physicians’ exercise recommendations for populations with a specific condition or disease:
Angina- For this population, only those patients who have been diagnosed with stable angina should begin an exercise program. It is important for these patients to understand their anginal symptoms, with cessation of exercise if any are present. If these symptoms do occur, then it is important to note the location, duration, and precipitating factors at the time of onset. This information remains valuable to the physician. It is important to note at what heart rate ischemic changes took place during a previous stress test. The maximum heart rate for this population is 10-15 beats/minute less than the heart rate at which the change was observed:
Percutaneous Transluminal Coronary Intervention (PTCI)- These patients are encouraged to pay close attention to any anginal discomfort, as this may give early detection of restenosis. In addition, individuals with this condition must not smoke.
Pacemaker- For this population it is important to know the type of pacemaker implanted. There are types of pacemakers that allow the ventricular response to increase with an increase in workload. The target heart rate should be 12 beats below the upper limit of the pacemaker.
Cardiac Transplant- During the transplant procedure the nerves are cut, therefore the heart rate will not increase with increased workload. It is important for this population to gauge their workouts with regard to the work of breathing, or dyspnea. If the individual finds it difficult to carry on conversation then the intensity should be decreased.
Congestive Heart Failure (CHF)- This population has a limited exercise capacity due to the decrease in skeletal muscle aerobic metabolic capacity and an increase in pulmonary pressure. Owing to a decrease in oxygen availability, the dyspnea scale should be utilized. The prescription for this population is altered due to the decrease in available oxygen.
Pulmonary disease (COPD)- Breathing techniques are taught to this population to help expel carbon dioxide. These techniques are important during physical activity. The oxygen requirement must be determined during physical activity because supplemental oxygen can be supplied. The dyspnea scale is used here for maximum work effort.
Hypertension – The treatment of hypertension is done by weight control, exercise, and decreasing sodium intake.
Peripheral Vascular Disease (PVD)
Diabetes Mellitus- This population has an increased risk for Coronary Artery Disease (CAD). Since there are two classifications for this disease we will consider them separately.
Insulin Dependant- The amount of required insulin will be less with physical activity; therefore it is necessary to check blood sugar levels periodically during the day. It is important for diabetics to have proper foot wear. Sneakers that do not fit tightly, where friction occurs causing red areas, must be avoided.
· Warm-up: 5-10 minutes
· Cooldown: 5-10 minutes
· Intensity: 45-85 % of maximum heart rate
· Duration: 20-30 minutes
· Frequency: daily
· Type: aerobic—weight bearing or non-weight bearing
· Warm up: 5-10 minutes
· Cool down: 5-10 minutes
· Intensity: 40-60 % of maximum heart rate
· Duration: 40-60 minutes
· Frequency: 5 times/ week
· Type: aerobic—weight bearing or non-weight bearing
Obesity- For those individuals who
are obese, the goal of physical activity is the same for healthy persons with
the addition to decrease body weight.
In order to do this effectively, there needs to be a greater expenditure
of calories than are consumed. This
requires both a change in physical activity as well as dietary habits.
exercise. Jogging should be avoided, to prevent injury to joints
Hyperlipidemia- Treatment for high cholesterol includes weight loss, dietary changes (decreasing daily fat intake), smoking cessation, decrease quantity of alcohol consumed, exercise, and medication.
Arthritis- Exercise for this population is limited by joint pain and should only be done in the absence of pain. It is important for these individuals to preserve function by maintaining range of motion of all joints.
End Stage Renal Disease- Exercise training for this population will increase endurance, increase muscle strength, and may improve hematocrit, decrease blood pressure, and improve lipid profiles.
minutes over a period of 6-8 weeks
Organ Transplant- The benefit of physical activity is to counteract the loss of muscle strength and to increase functional capacity.
Cancer- The benefits of exercise include counteracting the effects of bed rest, psychological benefit, and possible improvement of immune function. It is important for these patients to partake in an exercise program in the absence of fever.
and high repetitions.
Moore GE, Roberts SO. Exercise Management for Persons with Chronic Diseases and Disabilities, 5th ed. Champaign, IL, Human Kinetics, 1997. This book provides specific exercise recommendations for individuals with disease processes or disabilities.
Pate RR, Blair SN, Durstine JL, Eddy DL, Hanson P, Painter P, Smith LK, Wolfe LA. Guidelines for Exercise Testing and Prescription, 4th ed., RR Pate (ed). Philadelphia, PA, Lea & Febiger, 1991. This book is a comprehensive review of physical fitness testing and the physiology behind these tests.
Yoke, Mary. A Guide to Personal Fitness Training, Laura A. Gladwin (ed). Sherman Oaks, CA, Aerobics and Fitness Association of America, 1997. This book provides a comprehensive overview of fitness training.
Ergometer- an apparatus for measuring the work performed
Hyperlipidemia- a general term for elevated concentration of fats in the plasma
Maximal Oxygen Uptake (VO2Max)- a measure of the maximal rate at which the body
can uptake, distribute, and consume oxygen during maximal exercise
Skinfold Caliper- instrument used to measure percent bodyfat