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Research Update: Assess For Success

Fitness assessments serve as a baseline for exercise prescriptions, and help to track progress and motivate members. The YMCA of Greater Kansas City shares its indepth assessment program, its results and lessons learned.

Fitness assessments provide an objective way to measure physical improvements in exercisers. Specific categories include resting heart rate, resting blood pressure, body composition, muscular strength, joint flexibility and cardiovascular endurance. As important as these fitness parameters are to most exercise professionals, the majority of people who begin an activity program evaluate their success by subjective standards, such as general physical appearance, or imprecise measurements, such as body weight. Therefore, it is important for fitness professionals to explain the importance of assessments to members and clients, and to administer them regularly and appropriately.

Why Assessments Are Essential

Bodyweight and body mass index (BMI) measurements are referred to as imprecise because they do not indicate what was lost or gained from a body composition perspective. For example, a client who reduced her scale weight by 6 pounds could have lost 3 pounds of fat and 3 pounds of muscle (undesirable), or she could have lost 9 pounds of fat and added 3 pounds of muscle (desirable). While these examples represent major differences in the effects of a diet or exercise program, the average American seems most concerned with the amount of weight lost, regardless of whether it is fat weight or lean weight. Herein is an essential reason for performing body composition assessments: Namely, the opportunity to educate a largely uninformed public on the importance of maintaining or gaining muscle during any weight-loss initiative. When people understand the essential role of muscle in metabolism and chronic disease prevention,2,3,5 as well as functional capacity,1,4 they appreciate regular assessments of body composition.

Muscle strength testing goes hand-in-hand with body composition assessments, and clearly reinforces the training efforts of both new and long-term exercise participants. Although there are numerous ways to measure muscle strength (e.g., bodyweight resistance such as the push-up test, or external resistance such as the bench press test), the key is consistency. Strength assessments should be both valid measurements of muscle force production, and reliable with respect to replication accuracy. That is, clients must perform the strength test in exactly the same manner at every assessment.

Whereas most strength tests examine a muscle's ability to contract and shorten against resistance, flexibility assessments examine a muscle's ability to relax and lengthen. In terms of muscular fitness, strength and flexibility are two sides of the same coin, and both capacities play important roles in functional performance such as sports, exercise and activities of daily living. As with tests of muscle strength, assessments of joint flexibility (muscle stretchability) should be conducted under the same conditions and in the same way every time.

Cardiovascular endurance, also called aerobic capacity, is a more complex issue when it comes to valid and practical assessments. Valid evaluations of aerobic capacity require a maximum effort stress test (with gas collection), which is beyond the scope of most fitness centers. Physician supervision further complicates the ability for non-medical facilities to conduct maximum stress testing.

Sub-maximum assessments of cardiovascular endurance, such as step tests, cycle tests, treadmill tests and walk/run tests, are more practical to perform, but typically compromise the validity of the results. From a practical perspective, the submaximum assessments don't require expensive equipment, medical supervision, lengthy testing sessions or high levels of participant discomfort.

However, submaximum assessments are based on predicted, rather than actual, maximum heart rate, which is typically estimated as 220 minus the participant's age. As an example, a 50-year-old man or woman would have a predicted maximum heart rate of 170 beats per minute. Because there is a 10-beats-per-minute standard deviation from the mean in this formula, a perfectly normal 50-year-old individual could actually have a maximum heart rate between 140 and 200 beats per minute (three standard deviations from the mean of 170 beats per minute). This potentially large variation in predicted versus actual maximum heart rate affects the validity of sub-maximum cardiovascular assessments. Nonetheless, if the assessment conditions and procedures are carefully controlled and replicated, sub-maximum testing can provide useful information about a client's change in cardiovascular fitness.

The YMCA of Greater Kansas City

The benefits of qualitative and quantitative fitness testing are both educational and motivational. Properly conducted fitness assessments enable instructors to design more appropriate training programs, encourage participants to perform regular physical activity and provide objective reinforcement for their exercise efforts. The Kansas City YMCAs (with 19 locations) offer fitness assessments to every member, which has had a major positive effect on membership and retention. This practical assessment system can serve as an effective model for all fitness centers.

The Process

Scheduling. The YMCA of Greater Kansas City strives to help all new members achieve their health and fitness goals. To ensure this, it schedules health assessments for all new members. When new members join, as much value and emphasis is put on making sure they are scheduled for a health assessment as is put on collecting their billing information. The YMCA of Greater Kansas City includes the PAR-Q with all new member paperwork; so, if physician clearance is needed, the process can be started immediately. This also allows staff members to have a background on each member before their first meeting, which allows the fitness staff to be prepared, and to have a basic medical history so they will not cause more unintended problems.

To accommodate as many members as possible, health assessments are scheduled in 30-minute increments. Depending on staffing, multiple appointments can be scheduled concurrently. Staff members use Microsoft Outlook to schedule all appointments. A color-coded scheduling system in Outlook simplifies the scheduling process, while creating accountability for all appointments being scheduled.

Collection tool. Y staff members use the BSDI Fitness Analyst V10 software program to capture members' assessment information. This software stores all member information on a server, and allows staff to access each member's assessment information at a later date or from any facility in the association. Because the software is server-based and password-protected, information can be pulled up on any computer in the association in a safe and secure environment. And, also because the software is server-based, the more than 30,000 health assessments that the Y has performed since 2003 can all be stored.

Assessment protocol. The YMCA of Greater Kansas City has developed and trained staff to follow a set protocol during every health assessment, ensuring the highest level of accuracy possible. Each appointment begins with the staff capturing demographic information, setting goals with the member, exploring activity interests and completing a more indepth medical history questionnaire. Once this section is completed, the staff member performs the following tests: resting heart rate, resting blood pressure, height/weight, BMI, seven-site skinfold measurement, girth measurements, three-minute step test, one-rep-max (1 RM) upper-body strength test, 1 RM lower-body strength test and a sit-and-reach flexibility test.

After completing the tests and entering the results into the software, the staff member reviews a 17-page print-out of results and basic recommendations with the member. The test results and recommendations are gender- and age-specific. By completing the assessment and reviewing the results, the staff member is able to determine the member's baseline level of fitness, and identify areas needing attention in order to develop the most appropriate exercise program.

Follow-up/next step. After reviewing the health assessment results, the fitness staff member helps the member plan out the next steps. Based on the results and the member's interest, the staff member offers a beginner exercise program, takes the member through an equipment orientation, or directs the member to the appropriate group exercise class or personal training package that will help achieve his or her goals. Since 2003, the YMCA of Greater Kansas City has increased its overall personal training revenue by over two-fold, using the health assessment results as a talking point to springboard members into personal training. This "soft sale" approach takes the uneasiness of the personal trainer asking for the sale out of the picture. When they are reviewing the results of the health assessments, trainers can provide various paths for the member to choose, offering personal training as an option.

Reassessment. After completing the initial health assessment, each new member is encouraged to schedule a 90-day reassessment to track progress. The reassessment is critical in ensuring member retention. This is the point when the member's successes can be highlighted as a result of the exercise program. Health-seekers, as they are called by the YMCA of Greater Kansas City, often do not see success as an increase in strength, a decrease in body composition, an increase in cardiovascular endurance or an increase in flexibility. They often become frustrated because they do not always see the immediate weight loss they anticipated. It is the job of the fitness professionals to relate to these health-seekers that the improvements in physical changes will lead to the weight-loss goals for which they are striving.

Testing Outcomes

Staff training process. To ensure that all health assessments are conducted and administered with a high level of professionalism and accuracy, the YMCA of Greater Kansas City created a training program for all new fitness staff. The training program is designed to teach all fitness staff how to use the assessment software, how to go through the proper order of a health assessment, and how to find the resting heart rate, blood pressure and the appropriate locations of the seven-site skinfold test. Fitness staff are also taught the proper protocol for the strength tests, cardiovascular test and flexibility test.

Just as important as understanding and mastering the protocols for each test, all fitness staff must understand how to interpret the results and convey the proper message to the member. Initial staff training takes six to eight hours, and is followed up with practice health assessments on other staff members to ensure that the new staff members are ready to perform an accurate health assessment on a member.

Y Achievements

Retention effectiveness. In its 2007 report to the United Way of Kansas City, the YMCA of Greater Kansas City reported completing 6,178 health assessments. Member retention was tracked during the first 90 days after completing an assessment to determine success. The findings showed that 96 percent of members who had a health assessment were still members 90 days after the assessment. Member retention was also tracked over 12 months, and showed that 76 percent of members who completed a health assessment maintained their membership 12 months after the assessment.

2008 goals. Out of all the health assessments the YMCA of Greater Kansas City performed in 2007, only 39 percent of new members were captured in a one-on-one consultation. Based on these results, a more concerted effort has been made to increase the one-on-one consultations with fitness staff. For 2008, a goal was set to make a one-on one-consultation with at least 50 percent of new members through a health assessment or an equipment orientation. To achieve this, appointments were adjusted from a one-hour to a 30-minute schedule. This has allowed staff to get twice as many appointments completed in a day.

With January through March being months for large membership growth, the YMCA of Greater Kansas City was still able to meet the needs of its members. It decreased scheduling wait time to less than half of what it was in January through March 2007. From January through March 2008, the Y had approximately 7,800 new units. It completed 5,057 one-on-one appointments (health assessments or equipment orientations), giving it a 65 percent "connection rate." Based on previous success with retention rates, this could lead to an increase in member retention, an increase in fitness department revenue and, most importantly, an increase in the quality of life for the Y's communities.

Assessments Lead To Success

As the example from the YMCA of Greater Kansas City shows, fitness assessments not only help to motivate members, they can lead to better fitness results, and increased revenue for your facility. When done consistently, with the right tools and with follow-up, members can see that regular exercise is beneficial for more than just weight loss.

References
1. Frontera, W., C. Meridith, K. O'Reily, et al. Strength conditioning in older men: Skeletal muscle hypertrophy and improved function. Journal of Applied Physiology 64(3): 1038-1044, 1988.
2. Hurley, B. Does strength training improve health status? Strength and Conditioning Journal 16:7-13, 1994.
3. Nelson, M., M. Fiatarone, C. Morganti, et al. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. Journal of the American Medical Association 272(24): 1909-1914, 1994.
4. Westcott, W., M. Richards, G. Reinl and D. Califano. Strength training elderly nursing home patients. American Senior Fitness Association www.seniorfitness.net, 2000.
5. Wolfe, R. The underappreciated role of muscle in health and disease. The American Journal of Clinical Nutrition 84(3): 475-482, 2006.
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