Fitness Assessment

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

General Information

• Name

• Age

• Wt

• Ht

• Medications

• Risk Factor Status

• Resting HR

• Resting BP (1)

• Resting BP (2)

• Skinfolds

  Men

  Women

• Pectoral

• Abdomen

• Thigh

• Triceps

• Suprailiac

• Thigh

• Estimated % Body Fat Waist to Hip Ratio (divide waist by hip)

• BMI

• Circumferences:

• Hip

• Waist

• Thigh

• Calf

• Upper arms

• Forearm

Step Test

• Step Test (60 sec. HR)

• Rockport Walking Test (60 sec. HR)

• Comments

Abdominal Strength

• Bench Press 1 RM

• Weights (lbs)

• Total Bench Press

• Crunch Test (#/min.)

• Push-up Test (total #)

• Sit and Reach (inches)

Muscle Specific Flexibility Test

• Hamstrings

  Adequate

  Needs Improvement

• Iliopsoas

  Adequate

  Needs Improvement

• Quadriceps

  Adequate

  Needs Improvement

• Calves

  Adequate

  Needs Improvement

• Shoulders

  Adequate

  Needs Improvement

Posture Assessments (visual)

• Take a photo

  Media

• Lordosis

  No

  Yes

• Kyphosis

  No

  Yes

• Forward head

  No

  Yes

• Hip height discrepancy

  No

  Yes

• Shoulder height

  No

  Yes

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• Prepared by

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