Fitness assessment training manual. Version 2.0 / Last Updated January For internal use only. Not approved for use with clients.

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1 Fitess assessmet traiig maual. Versio 2.0 / Last Updated Jauary 2010 For iteral use oly. Not approved for use with cliets.

2 For iteral use oly. Not approved for use with cliets. 2 :: Fitess assessmet traiig maual Cotets. 1 :: Our fitess assessmets 3 Itroductio 3 How members book 3 Equipmet checklist 4 Paperwork 4 Preparatio: prior to participat arrival 4 Cotraidicatios to exercise 4 2 :: The assessmet compoets 5 Returig forms to PruHealth/PruProtect 5 The health survey 5 The results sheet 5 Data collectio 5 Body mass idex 6 Waist to hip ratio 6 Weight measuremet 6 Height measuremet 6 Blood pressure 7 Electroic devices 7 Maual devices (see above) 7 Norms ad vitality score 7 YMCA step test 8 Procedure 8 Timig ad the metroome 8 Idicatios for stoppig exercise 10 3 :: Appedices Miimum qualificatios Heart rate (hr) calculatig mthr 11 Takig heart rate hr moitor method 11 Exercise heart rate 11 Maximum theoretical heart rate (mthr) Health survey ad your results form What is Vitality? Bradig available for fitess assessmet room 14 BMI chart Doctor letter cofirmatio 15

3 For iteral use oly. Not approved for use with cliets. 3 :: Fitess assessmet traiig maual 1. Our Fitess Assessmets. Itroductio 1. All PruHealth ad PruProtect members are eligible for 2 of our specific Fitess Assessmets, eve if they are ot a member of your or ay other Health Club. 2. Results must be captured o Coect so PruHealth ca receive ad allocate poits to the members. 3. Our Fitess Assessmet icludes Blood Pressure (BP), Body Mass Idex (BMI), Waist to Hip measuremet ad YMCA Step Test, which takes miutes i total. 4. Members ca obtai poits whe completig their fitess assessmet tests. The member will eed to go to the member zoe for further details: pruhealth.co.uk/member Members are allowed to have a maximum of two free fitess assessmets durig their policy year or two subsidised health screes or oe of each. 5. Each club should have at least 3 staff that are competet i providig our Fitess Assessmet ad all staff should kow if it differs from your usual Fitess Assessmet (See appedix 3.1). How Members Book PruHealth or PruProtect members do ot have to be a member of the gym to book i for a Fitess Assessmet. Our members ca cotact their preferred club to arrage their bookig with frot of house. They eed to provide their ame ad PruHealth or PruProtect membership umber foud o their membership cards. Upo bookig, members should be advised the followig: Food cosumptio should be avoided 90 miutes before streuous exercise Smokig should be avoided 30 miutes prior to blood pressure beig measured pruhealth.co.uk Alcohol cosumptio should be avoided for 24 hours before participatio i exercise Clothes suitable for exercise should be wor Showerig facilities are available for them after PruHealth, Customer Services, Stirlig FK9 4UE

4 For iteral use oly. Not approved for use with cliets. 4 :: Fitess assessmet traiig maual 1. Our Fitess Assessmets cotiued. Equipmet checklist Equipmet Height measurig device or Scales Calculator Pe Blood Pressure Sphygmomaometer Blood Pressure Stethoscope Stop Watch Heart Rate Moitor Metroome 30cm high, sturdy step Paperwork This maual which icludes results tables Hadouts for members Your Results Doctor's Letters (see appedix 3.6) Preparatio: Prior to participat arrival All uecessary equipmet, chairs, stools, clothig, briefcases etc. must be cleared well away. The ecessary apparatus must be kept to a miimum ad must be checked i advace to miimise malfuctios. There must be sufficiet space for the member to be laid o the floor if they feel fait at ay time durig or after exercise. The members must have the situatio ad protocol fully explaied. For example; There are 4 steps ivolved i the PruHealth/PruProtect Fitess Assessmet. Firstly, you ll be required to complete the Health Survey, the you will have your blood pressure take, measure body compositio (bmi/waist to hip ratio) ad fially you ll complete a short step test. Cotraidicatios to exercise Members ca t perform the Step Test if they aswer yes to ay of the Health Survey questios, if they are classified as hypertesive or with extreme obesity If the member falls ito ay of these categories, please provide them with a Doctor s letter (refer Appedix 3.6) ad advise them to retur oce they ve received the doctor s cofirmatio to cotiue Doctor s Cofirmatio Requestig a Doctor s letter from a member acts as a prevetative tool for us to esure we do t put members at uecessary risk ad also highlights potetial egative health treds. I completig the Doctor s letter, you will eed to specify the health coditio which has bee highlighted as a problem. This esures that we act i a prevetative way for this member s health. If the member has either; ticked oe or more yes boxes o the Health Survey form, bee categorised as havig Hypertesive blood pressure, bee categorised i extreme obesity, Esure the member does ot do the YMCA test without writte coset from their doctor, if they have a coditio outlied above.

5 For iteral use oly. Not approved for use with cliets. 5 :: Fitess assessmet traiig maual 2. The Assessmet Compoets. Who completes? Who keeps What to sed to PruHealth/PruProtect Health Survey Member Club ad the member 3 Results Sheet Fitess Assessor Club ad the member 3 The member always keeps the origial copy of their results. Returig forms to PruHealth/PruProtect Iput the results via Coect. If the perso is ot a member of the club, you will eed to load them as a prospect before iputtig their results. To re-order Fitess Assessmet forms cotact the Vitality Team o or vitality@pruhealth.co.uk The Health Survey The Health Survey (appedix 3.5) should be completed by the member prior to ay assessmet compoet beig performed. The Health Survey is crucial for the member to complete ad sig for the followig reasos: Acts as iformed coset from the member Protects you by excludig high-risk members from participatig. Reduces the risk of a exercise iduced icidet (e.g. member with high heart health risk, akle ijury, etc) Stadardises all PruHealth/PruProtect exercise exclusios The Results Sheet Please esure you complete the results sheet i its etirety. You are required to keep a copy o your records as well as submittig a copy to us ad providig the member with their copy. Data Collectio Submittig the results to us will esure: your club is credited for the Fitess Assessmet the member receives their Vitality poits the member s results are kept o file at PruHealth/PruProtect Provides credibility to the assessmet Data Protectio. By sigig this documet, the member agrees that the health club ca forward their results to PruHealth/PruProtect As such, it is essetial that you keep a copy of the siged Health Survey for the member o your files as well as faxig ad providig the member with their copy. Please ote: If the member does ot sig this documet, do ot proceed with the Fitess Assessmet ad do ot fax the forms.

6 For iteral use oly. Not approved for use with cliets. 6 :: Fitess assessmet traiig maual 2. The Assessmet Compoets cotiued. Body Mass Idex I order to compesate for differeces i weight i adults of differet heights, this weight-for-height idex was devised for better assessmet of obesity. Body Mass Idex (BMI) is determied as the weight i kg divided by the height i metres squared. For example, a idividual weighig 80kg, with a height of 1.68m would have a BMI of BMI = [Weight (kg)] / [Height (m)2] 80kg / [1.68m]2 = 28.4 Waist to hip ratio measuremet Measuremets should be take with the idividual wearig thi layer of clothig. Measure hip circumferece at its widest part. Measure the waist circumferece at the belly butto or just above. Divide the measuremet of the waist by that of the hips. For example, if waist measuremet is 80cm ad hip measuremet is 105cm, divide 80/105= For me, a ratio should ideally ot be over For wome, that figure is The higher the ratio above these values, the greater the risk of heart disease. Weight measuremet Weight should ideally be measured o scales that ca be calibrated with a kow weight. The scales should be placed o a firm, flat surface, ad ot o a carpet or rug. Idividuals should be barefoot ad remove ay heavy outer clothig such as jackets. The idividual must stad freely o the scales without holdig o to a wall or ay other support while the measuremet is take. After stadig still util the scales stabilise, a readig should be take to the earest 0.5kg. Height measuremet I order to measure height accurately, a straight wall ad eve surface are required. The perso must stad barefoot, with his/her back agaist the wall. The feet must be together with the heels placed firmly o the groud ad touchig the wall. The legs ad back should be straight ad the back of the head must rest agaist the wall. The head should be straighteed, so that a lie draw from the corer of the eye to the top of the ear is at right agles to the upright wall. All hats, hair combs, hair bads, clips or pis should be removed prior to the measuremet. BMI Ratig Special otes <20 Uderweight Healthy Overweight Obese 40+ Extreme Obesity No step test Doctor s cofirmatio required prior to step test

7 For iteral use oly. Not approved for use with cliets. 7 :: Fitess assessmet traiig maual 2. The Assessmet Compoets cotiued. Place a headboard or some other straight edge with the flat (horizotal) part firmly agaist the top of the head, ad at right agles to the wall. A mark ca be made where the headboard or straight edge meets the wall. A tape measure may be used to measure the height by achorig the tape measure from the floor ad extedig it upwards. Alteratively, commercially available height charts may be secured to a wall, or a portable stadiometer may also be used. Blood Pressure Esure you take three Blood Pressure readigs with every member. Disregard the first readig ad take the average of the secod two. Electroic devices The member should have rested for at least 5 miutes ad ideally should ot have eate or smoked for 30 miutes. The room should be quiet ad comfortably warm. The member s arm should be restig, free of clothig. Whe the member is seated, restig the arm o a table a little above the member s waist is suitable. The lower border of the cuff should be about 2.5cm above the atecubital crease (elbow crease- frot). Secure the cuff sugly. Positio the member s arm so that it is slightly flexed (bet) at the elbow. Tur the device o. Maual devices The member should have rested for at least 5 miutes ad ideally should ot have eate or smoked for 30 miutes. The room should be quiet ad comfortably warm. The member s arm should be restig, free of clothig. Whe the member is seated, restig the arm o a table a little above the member s waist is suitable. The lower border of the cuff should be about 2.5cm above the atecubital crease (elbow crease- frot). Secure the cuff sugly. Positio the member s arm so that it is slightly flexed (bet) at the elbow. Esure the stethoscope is o the member s ski over the brachial artery pulse. Pump the sphygmomaometer up to 180mmHg. Read both the systolic ad diastolic levels. Norms ad Vitality Score Systolic Diastolic Ratig Special otes <130 <85 Normal Elevated risk >140 >89 Hypertesive No step test Doctor s cofirmatio required prior to step test

8 For iteral use oly. Not approved for use with cliets. 8 :: Fitess assessmet traiig maual 2. The Assessmet Compoets cotiued. YMCA Step test 3-Miute Step Test (Aerobic Assessmet) The purpose of the Step Test is to measure the heart rate i the recovery period followig three miutes of steppig. The results of the test provide a idicatio of the cardiorespiratory fitess level of the member. Cardiorespiratory fitess is defied as the ability of the heart ad lugs to provide oxyge to the muscles. The advatages of this test are the ability to test members i large groups ad the brief amout of time to admiister the test. If the member caot fiish the test, or scores at the Very Poor level, he/she should obtai medical clearace before further testig. This test is ivalid for ad should ot be admiistered to idividuals takig a beta-blocker medicatio (or ay other medicatio affectig heart rate). Procedure Esure the heart rate moitor strap is securely fasteed aroud the member s chest ad that a readig is evidet o the watch, or esure you ca fid a pulse if maual readigs are beig take. OR The member should warm-up with appropriate stretchig exercises. Member steps up ad dow at a rate of 24 steps per miute (metroome settig of 96) for 3 miutes. After the three miutes of steppig, the member sits dow o the bech ad fids pulse (at eck). The 60-secod heart rate is take five secods after completio of steppig. Heart Rate Moitor method; the member sits dow o the bech. The 60-secod heart rate is take five secods after completio of steppig ad to esure cosistecy with the m aual method, take a average of the 30-secod ad 60 secod readigs to obtai the 60-secod recovery heart rate. Example 1:00 3:00 miutes: Step Test 3:00 3:05 miutes: Member sits dow 3:35miutes: Note 30 secod recovery readig (e.g. 175 BPM) 4:05 miutes Note 60-secod recovery readig (e.g. 149 BPM) Average of 175 ad 149 = 162 BPM for 60 secod recovery Example is based o heart rate moitor method. This recovery heart rate is the score. Cosult the tables o the followig page to determie the member s fitess level. Timig ad the metroome: Without a metroome, use your stopwatch or clock with a secod had. Esure the member steps (up ad dow) six times every 15 secods, to reach 24 steps for the 60 secods. Most metroomes will ot set as low as 24 i order for the member to step up o every beep. We recommed you set the metroome to 96 (beeps per miute), ad guide the member to take oe footstep every beep. Example Metroome settig: 96 Beep 1, step up left foot. Beep 2, step up right foot. Beep 3, step dow left foot. Beep 4, step dow right foot.

9 For iteral use oly. Not approved for use with cliets. 9 :: Fitess assessmet traiig maual 2. The Assessmet Compoets cotiued. Me Age (heart rate i bpm) Ratig Special Notes <79 <77 <77 <83 <78 <82 Excellet Beats Per Miute (BPM) Good Above Average Average Below Average Poor >119 >121 >124 >126 >128 >126 Very poor doctor s letter doctor s letter Wome Age (heart rate i bpm) Ratig Special Notes <82 <81 <85 <92 <93 <93 Excellet Beats Per Miute (BPM) Good Above Average Average Below Average Poor >131 >129 >132 >132 >135 >133 Very poor doctor s letter doctor s letter

10 For iteral use oly. Not approved for use with cliets. 10 :: Fitess assessmet traiig maual 2. The Assessmet Compoets cotiued. Idicatios for stoppig exercise These iclude: member ca t sustai pace for 30 secods member's volitio, sustaied 80% of Maximum Heart Rate (MHR). Refer to appedix 3.2 for istructios o calculatig the member s MHR. Durig the exercise the member must be watched at all times for sigs of iattetio or tiredess. Distractios by others must be preveted. At the cessatio of exercise, the test situatio requires a sudde ed to a bout of exercise. This ca cause faitess, dizziess or collapse. ay pai i the chest pai i the feet or legs sigs of impedig collapse pallor, cold moist ski, cyaosis, staggerig, ad cofusio. If the member faits or feels dizzy or disorietated they must be placed i the recovery positio.

11 For iteral use oly. Not approved for use with cliets. 11 :: Fitess assessmet traiig maual 3. Appedices. 3.1 Miimum Qualificatios PruHealth/PruProtect Fitess Assessors must be at least a REPS Traier, Level Heart Rate (HR) Calculatig MHR Takig Heart Rate HR Moitor Method A heart rate moitor ca be used to get a more accurate heart rate measuremet. This is recommeded for our Fitess Assessmet. To esure cosistecy with the maual method, take a average of the 30- secod ad 60 secod readigs to obtai the 60-secod recovery heart rate whe usig a heart rate moitor. Exercise Heart Rate It is possible to use the maual method for heart rate measuremet durig exercise, though better results ca be obtaied usig a heart rate moitor or similar device. The heart rate durig exercise is a idicator of itesity. As the member gets fitter, their heart rate should decrease for ay give exercise workload. Maximum Heart Rate (MHR) Maximum heart rate is the highest umber of heartbeats per miute (bpm) whe exercisig maximally. This ca be measured durig a maximal exercise test. As the heart rate will begi to decrease as soo as exercise is completed, max heart rate is best measured usig a heart rate moitor. Maximum Heart Rate Maximum heart rate ca also be predicted usig a formula, this predicted maximum is referred to as the member s Theoretical Maximum Heart Rate. To predict the member s theoretical MHR, take their age away from 220. This figure is oly a estimate, ad is usually withi 10 beats of their true maximum heart rate. You ca use the percetage of maximum heart rate as a idicator of exercise itesity. May exercise programs use percetage heart rates to set traiig loads. We recommed you cease the step test if the member has a sustaied heart rate of 80% of their theoretical MHR. If this member sustaied a HR of >151 for more tha 30 secods, cease the test For example, the followig is for a 32-year old = 188 (theoretical MHR), of which 80% =

12 For iteral use oly. Not approved for use with cliets. 12 :: Fitess assessmet traiig maual 3. Appedices cotiued. 3.3 Health Survey ad Your Results Form Your fitess assessmet results. Staff otes: Results to be iput ito Coect ad this copy of results to be give to member. Member's details Assessmet details Name Date of assessmet D D M M Y Y Y Y PruHealth/PruProtect Assessmet locatio e.g. Virgi Active Wadsworth membership umber Telephoe Assessor's ame Date of birth D D M M Y Y Y Y Are you a gym member? YES NO Health survey Has your doctor ever said that you have a heart coditio ad that you should oly do physical activity YES NO recommeded by a doctor? Do you feel pai i your chest whe you do physical activity? YES NO What your results mea. For further iformatio o poits classificatio, please check your Vitality poits statemet i the Member Zoe at pruhealth.co.uk/member BMI Blood Pressure Result Classificatio Systolic Diastolic Classificatio <130 <85 Normal <18.5 Uderweight Elevated Healthy risk >140 >89 Hypertesive Overweight Obese Blood pressure classified as hypertesive requires doctor's referral. Your assessor should issue a doctor's referral letter to 40+ Extreme obesity take to your GP. BMI of 40+ should be referred to the doctor. Your assessor Category based o highest result, e.g. 120/96 is hypertesive. should issue a doctor's referral letter to take to your GP. I the past moth, have you had chest pai whe you were ot doig physical activity? YES NO Do you lose your balace because of dizziess or do you ever lose cosciousess? YES NO Do you have a boe or joit problem (for example, back, kee or hip) that could be made worse by participatig i physical activity? Is your doctor curretly prescribig drugs (for example, water pills) for your blood pressure or heart coditio? YES NO Do you kow of ay other reaso why you should ot do physical activity? YES NO If you aswered yes to ay of the above questios, you should: Talk with your doctor by phoe or i perso BEFORE you participate i physical activity. BEFORE participatig i the step test compoet of the Fitess Assessmet, tell your doctor about this form ad which questios you aswered YES to. To complete the PruHealth/PruProtect Fitess Assessmet you will require a siged doctor s referral letter with cofirmatio from your doctor you are ok to complete the assessmet. Declaratio I agree that PruHealth/PruProtect shall ot be held liable for ay loss or damage caused directly or idirectly by my participatio i this fitess assessmet to be carried out by the health club amed above. I uderstad that if I suffer from a medical coditio or have ay cocers about my health I should cosult my doctor before participatig i this assessmet. I hereby authorise the health club amed above to provide PruHealth/PruProtect with these Vitality results for the purpose of awardig Vitality poits i coectio with my PruHealth or PruProtect policy or medical scheme. I also authorise the subsequet processig ad storage of the iformatio o this form by PruHealth/PruProtect i accordace with the relevat data protectio legislatio. I have read, uderstood ad completed this survey. Ay questios I had were aswered to my full satisfactio. Member's sigature Fitess assessor s sigature Assessmet results Height Metres Blood pressure e.g. 120/80 Weight BMI e.g. 23 Kilograms BMI of 40+ requires doctor's cofirmatio before step test. YES NO Blood pressure results classified as hypertesive will require doctor s cofirmatio before step test. YMCA step test e.g. 80 Waist to Hip Ratio e.g YMCA step test Me Age (heart rate i bpm) Ratig Special Notes <79 <77 <77 <83 <78 <82 Excellet Good Above Average Beats Per Average Miute (BPM) Below Average Poor doctor s letter >119 >121 >124 >126 >128 >126 Very poor doctor s letter Wome Age (heart rate i bpm) Ratig Special Notes <82 <81 <85 <92 <93 <93 Excellet Good Above Average Beats Per Average Miute (BPM) Below Average Poor doctor s letter >131 >129 >132 >132 >135 >133 Very poor doctor s letter PRUHB15465_Virgi 12/2009 PruHealth ad PruProtect are tradig ames of Prudetial Health Services Limited, which is registered i Eglad ad Wales. Registered office at Laurece Poutey Hill, Lodo EC4R 0HH. Registered umber Prudetial Health Services Limited is authorised ad regulated by the Fiacial Services Authority.

13 13 :: Fitess assessmet traiig maual For iteral use oly. Not approved for use with cliets. 3. Appedices cotiued. 3.3 What is the Vitality programme? The Vitality programme is our uique way of rewardig our members for lookig after their health, whether they are youg or old, a fitess faatic or just ejoy livig a healthy lifestyle. There are three stages to Vitality: Uderstad their health status ad goals The jourey begis with our olie health assessmet the Health Review. This gives members a idea of how much or how little they eed to do to improve their health ad fitess, ad helps them set goals. They ca moitor their progress through our Vitality parters' health screes ad fitess assessmets which we subsidise. Gettig ad stayig healthy Exercise is key to health, so to help get members movig we offer them gym memberships ad trackig devices ad heart rate moitors at discouted rates. We also have parters to help them quit smokig ad eat healthily, ad they ca track their progress olie to see how well they are doig. Ejoy the rewards Beig healthy should be its ow reward, but the truth is that most of us eed motivatio to get started. So everyoe who takes part i the Vitality programme is etitled to rewards, ad the more they look after themselves, the bigger those rewards could become. We have the followig reward parters who all offer discouts. * * Saisbury's is ot available as a Vitality parter to PruProtect members. This is for your kowledge oly, please direct the member to our Customer Service Cetre for detail aroud their specific policy o: PruHealth PruProtect

14 For iteral use oly. Not approved for use with cliets. 14 :: Fitess assessmet traiig maual 3. Appedices cotiued. 3.5 BMI Chart Body mass idex. PRUHM /2009 CALCULATE BMI = Weight (kg) Height (metres) 2 BMI CATEGORIES <20 Uderweight Healthy Above Weight Obese 40+ Extreme Obesity HEIGHT iches cetimetres WEIGHT ft' iches'' 4'10" 4'11" 5'0" 5'1" 5'2" 5'3" 5'4" 5'5" 5'6" 5'7" 5'8" 5'9" 5'10" 5'11" 6'0" 6'1' 6'2" 6'3' 6'4' Kilograms Total pouds Stoe Pouds PruHealth is a tradig ame of Prudetial Health Limited which is registered i Eglad ad Wales. Registered office at Laurece Poutey Hill, Lodo EC4R 0HH. Registered umber Prudetial Health Limited is authorised ad regulated by the Fiacial Services Authority.

15 (please prit) have examied ad cofirm that For iteral use oly. Not approved for use with cliets. 15 :: Fitess assessmet traiig maual 3. Appedices cotiued. 3.6 Doctor Letter Cofirmatio PRUHEALTH SERVICING CRAIGFORTH STIRLING FK9 4UE PruHealth Tel: PruProtect Tel: Doctor Cofirmatio I, Dr Date: Dear Dr Commets (please prit patiet ame) ca safely udertake the Fitess Assessmet. Re: Thak you for agreeig to see this patiet, who would like to participate i a PruHealth/ PruProtect Fitess Assessmet. Through the process of our Health Survey, we have idetified the followig coditio(s) that places this patiet i a category that requires medical clearace prior to participatig i the fitess assessmet performed by oe of our parter fitess professioals. The Fitess Assessmet comprises: Blood Pressure Body Mass Idex 3-miute YMCA Step Test (30cm height) Sigature of Doctor Date Cotact Telephoe umber Please cofirm that this member ca safely perform the fitess test by completig the sectio overleaf. Yours sicerely Fitess Professioal cotiued overleaf PruHealth ad PruProtect are tradig ames of Prudetial Health Services Limited, which is registered i Eglad ad Wales. Registered office at Laurece Poutey Hill, Lodo EC4R 0HH. Registered umber Prudetial Health Services Limited is authorised ad regulated by the Fiacial Services Authority. PRUHL18199a 01/2009

16 PruHealth is a tradig ame of Prudetial Health Limited ad Prudetial Health Services Limited which are registered i Eglad ad Wales. Registered office at Laurece Poutey Hill, Lodo EC4R 0HH. Registered umbers ad respectively. Prudetial Health Limited ad Prudetial Health Services Limited are authorised ad regulated by the Fiacial Services Authority. PRUHM /2010