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Rick Richey 0:03
You're listening to the NSM CPT podcast with Rick Ritchie, the official podcast of the National Academy of Sports Medicine. Hello, and welcome to the NASM-CPT Podcast. My name is Rick Richey. And for those of you who are watching today and not just listening to the podcast, you will see my background looks a little bit different. I got to be honest, it's a lot more professional. And that's because I am visiting family home in Alabama, which I haven't been to in a while. So it's good to be back here. And I have my dad's background in the area that he does his work, which has books and things that are really nice and makes you look astute. And therefore, if you're watching this, I probably come across as a little bit more astute today. With that being said, you also see a picture of me and my bow tie my graduation picture in high school. So if you're not on the Facebook stream or on YouTube, then you may want to check out that right there. All right, y'all, let's get into talking about what we're going to talk about today. We've got the CPT domain number three in our webinars. So what we've been doing recently is a basically a CPT, seven contents of certified personal trainer course, from an ASM and there is that we're in the seventh edition right now. And we're doing a webinar and the webinars, the podcast, it's like a study guide for the content. Now, with that being said, I don't want to chase anybody off that says, hey, I, I'm already certified. So I don't need to listen to this. And in fact, one of the things that happens after certification is you forget majority of the things that you did and studied within your certification for for those of you who are studying, this will be a nice study guide. It's not going to get you there as I'm going to answer all your questions. But it's an excellent audio Study Guide to support you in the process of your study. For those of you who are not who are already certified, it's a great refresher. It's excellent content, it's the kind of stuff that I like to sit through and listen to other people do, because I forget about these things sometimes. So it's really nice to hear. So let's talk about what we're going to be talking about today. This is domain three. In the testing domains, it is the domain of assessments. So this is Section four, and your book chapters 11, and 12. And let's get into what we're going to talk about now. So this particular episode is going to be on health, wellness and fitness assessments. And then we're going to follow up with another episode, which will be about movement assessments. So let's talk about what we're going to talk about. First of all, let's go over a few guidelines, what fitness professionals should not do. And the first one on the list, there is going to be fitness professionals should not diagnose medical conditions. You need to obtain exercise and health guidelines from a physician, a physical therapist, a registered dietitian, and so forth. But we're not diagnosing anything. So if it has something to do with a medical condition, we don't do that. Now, it happened to me one time, and it was a great example of what not to do. I'd gone to a water fountain, I was a manager at a sports club in New York City and my low back was bothering me. So I walked over to the water fountain, and I leaned over to get water and it actually felt kind of nice. But when I tried to stand up, I couldn't stand up. So I immediately thought, Well, what felt better bending forward. So I've bent forward more tried to stand up, bent forward more and tried to stand up until eventually I was lying flat down on the floor under the water fountain at the gym.
Just so you know, that's an embarrassing place to be as the manager of the gym lying under the water fountain unable to move. I had something going on with my back and I don't know what it was. But I probably had about five trainers give me their opinion in a diagnosis of what they believed was wrong with my back. You know what, I ended up being taken out on a stretcher taken to a hospital. And you know what the doctor said? We don't know. So the physician who was trained in this information, who took care of me, did not give me a diagnosis, but I had five different trainers provide me with five different diagnosis sees. Don't know how to conjugate that. And the I guess the moral of the story here is don't diagnose medical conditions because we don't know. We just don't know. Also, let's add to that. You cannot you should not prescribe a treatment. Refer clients to a qualified medical practitioner for medical exercise prescribed And if they've got something going on, we don't do that that's for a physical therapist and the like to support people in prescription of treatment even if that treatment is exercise. We don't prescribe diets or recommend specific supplements unless qualified. So refer the quote clients to a qualified dietician or nutritionist. for specific diet plans, we do not and should not provide treatment of any kind of injury, or disease, aside from basic first aid, refer the clients out to medical practitioner for treatment of an injury or disease, we do not provide or should not provide rehabilitative services for clients. Like design exercise programs for clients after they're released from rehabilitation, we don't design it and we don't support them before. If they need to help medical attention, orthopedic issues, send them out to somebody else, our job is to work out to look at movement, and to provide healthy individuals a healthy means of progressing their fitness. We also should not provide counseling services for clients. And I know if you've been a trainer for any amount of time, and if you're studying for this, you will experience this that it will feel as if you are accounts where sometimes as if your clients are on a couch, telling you their stories. So try to shift away from that and focus more on what we can do, and what needs to be focused on as a fitness professional. So those are some guidelines to review and go over. And I hope that you found them beneficial. Now let's move into the pre the pre participation screening. And this is the health risk assessment sometimes referred to this as the par q or the physical activity readiness questionnaire. And that's going to do, it's going to provide a health history questionnaire, it's going to review lifestyle habits and medical history. And there are guidelines and standards that we go through with the Parkview. So it's a screening tool, right, it's not used to evaluate the benefits and the risk associated with starting any type of exercise that is strenuous in nature. It's just a DC tailed questionnaire designed to assess an individual's physical readiness and to encourage this structured exercise program that we're going to be going through. So in the park Q is the updated version of the park view. Part One of the questionnaire consists of seven questions if a client answers no to all seven of them, then the survey is considered complete. However, if the client answers yes to any of those initial seven questions, they must go into part two of that survey. And that will clarify a little bit more. And what that may also do is require a physician's clearance in order to move forward. And this is important, I've worked with several personal trainers throughout the years who have worked with people referred them out, and the physician caught some really serious things based on the referral out. So keep that in mind, we are not punishing them for issues that they may have. That is not what we're doing. We are trying to protect them from exercise that may not be supportive for them. Alright, let's move on to the next let's get into some fitness assessments. And we're gonna start with definitions and definitions come in handy when you are preparing for exams. So here we go. definition. What is a fitness assessment? First of all, we'll define a fitness assessment as a systematic problem solving method method that provides the fitness professional with a basis for making educated decisions about exercise and the acute variable selection. What it is not, it is not designed to diagnose any condition. But rather, it's to observe each client's individual structure and functional status, creating a starting point from which to work. So what happens a lot of times is that people will use a fitness assessment as almost a selling tool. And I think that's valuable because we want to be able to sell personal training. But the thing is, you might go through a series of fitness assessments and when it's all over, you say great. Let's do Monday chest today, and it doesn't really support. It's just what you were going to do anyway, as an example. So what does that mean? That means that you did the fitness assessment, you maybe got them intrigued with fitness and with using personal trainer services, but you didn't actually utilize any of the content. So what we do is we create fitness assessments in order to have a starting point to work with our clients and to progress them from where they start based on what we find in those assessments. And we like to do several types of assessments. So when you start conducting health and fitness assessments, here's some considerations, you have to look at assessment considerations. Are the assessments relevant? What's the relevance of the assessment that you're doing? Is the assessment relevant for the client's goals, their needs and their abilities? All right, is the assessment appropriate? what's appropriate? Well, this is as the assessment appropriate for the client, for example, is the is it appropriate to form to do a skinfold measurement, or a one rep max test for an obese client. Now that that's a good example, where you might say, hey, these are the list of things that we're going to do in our workout or in our assessment list. But you have a client that comes in and you on your list have skinfold measurements, and you have one rep maxes, and that may not be appropriate for that client. And that's just an example. So what this means is, the assessments are good, having the assessments there are good to have and having standard assessments are good to have. But they may not be right, they may not be appropriate for every client. And you have to understand that this is something that you work with, and sometimes you work around. Next on the list is validity. And validity refers to the degree that a test specifically measures what they are intended to measure. For example, if you do a sit and reach test, which is often limited by tight hamstrings and calves, it may not always be a valid test to assess overall body flexibility. So that's not a valid test. It's not testing, what is that measuring what you're intending to measure necessarily? Alright, what about the final one here, which is reliability. And reliability refers to the ability of a test to produce consistent and repeatable results. For example, we talked about skinfold assessments earlier. So skinfold assessments may have a poor reliability, if the test administrator administrator hasn't properly learned how to locate and grasp skinfold cites correctly.
What also happens with that, too, is that you lose some of the reliability, it's called
the inter user reliability, which means I have I might do a skinfold assessment, somebody else might do a skinfold assessment. And they do it, they perform it a little bit differently, they grab a little more, they grab a little less, they don't measure in the exact same place. So intrapersonal and interpersonal reliability is very important. And what does that mean? It means Usually, the same person will do the assessment over and over again, and you practice enough that you were doing it the exact same way, every single time. And we'll get into skinfold assessments a little bit more. So let's have a look also, at assessment, sequencing, assessment sequencing is there's a physical exertion that if you do that, first, it can skew results for other things. So don't work out if but first, if you're going to try to figure out what's the resting heart rate, or what's the blood pressure, or body fat testing, because that's going to skew those numbers. So what needs to be done prior to work out versus what can be done during an after workout, be aware of some safety and legal implications. And what that means is that we need to be very careful when we work with people and what we have them do. And so if I'm training somebody, and I haven't progressed to them appropriately than they can get injured, and you and the facility could be held liable for any of the things that go on. All right, exercise test, termination criteria. And what we're looking at here is when when do I, when's it appropriate, when I'm working out with somebody to say, Hey, this is where we need to stop. But the first line of defense there is sometimes they'll tell you, and if it's a new client, you're working with somebody new and your job is to push them, I get it. But you don't know what they feel they know what they feel. So we can encourage them to move forward. But when we're working with a new client, we haven't figured out their capabilities yet. pushing them is not maybe the right initial steps to take. If if they are lagging behind, and they're saying I'm not ready for that. They would have a better idea of that than you. So to err on the side of caution, say Hey, take a break, grab a sip of water, we'll come back and we'll try something else or we'll try it again after a little respite. What else? Well, obviously, they start to look clammy, their countenance, the way that their face look starts to change in a way that you look at you go and look right, then be aware that that might be time to terminate the exercise and then you have some previous Assessment instructions. And that's just being very clear with individuals about what the assessment is what it's designed to measure, if you're going to need to touch them, then to ask permission to do that first and all of this pre assessment instruction that goes along with preparing them for the assessments. Alright, well, let's talk about some fitness assessments. First of all, there's subjective information, that's general information that you're going to get from them, including their medical history, the subjective stuff is the stuff you ask them, and they tell you the answers to, but then we're going to get into up jected information. And those are things that we measure, a lot of times, it's things that we can measure, and we can quantify. So they might be physiological assessments, body composition, cardio respiratory assessments, static and dynamic postural assessments, and then performance assessments. Well, let's break those down a little bit more. And we'll start with physiologic assessments. And what these do is, they're going to provide some valuable information regarding the status of the client's health. And we might do something like a resting heart rate, I get a resting heart rate. And you may want to do this and teach them how to do this as well. So a good resting heart rate is to take it first thing in the morning before you get up. And that allows them to truly be at rest, and find out what their resting heart rate is, as long as the first thing they hear is an alarm that that's blaring
in their ear, because of that might alter the resting heart rate a little bit. And then we also do things like blood pressure. And, you know, when I early on when I started training, we would actually use a blood pressure cuff and would use the bulb and we'd use the stethoscope and this big moment ometer to measure the blood pressure, you know, they have, they have machines that do that, that are much less expensive and pretty accurate, and they're pretty reliable, and they're pretty valid. So a blood pressure cuff might be beneficial. And what you can do with that blood pressure cuff is find out again, where they are safety wise with a physiologic assessment prior to getting into the workout. Alright, so those are examples of physiologic assessments, when it comes to measuring heart rate, and we want to measure their heart rate. Or they can either wear a heart rate monitor. And that's an easy way to do it. But when we manually do it, we're going to do this from the radial pulse, the radial pulse is on the thumb side of the wrist. And the reason it's called the radial pulse is because it goes along the radius bone in the forearm. So to take the radial pulse, it's right below, just proximal to the bend in the wrist and you'll see two tendons in the wrist, it's going to be a little lateral side of the lateral tendon, you can take your two fingers, and put it right there on that pulse. And what you're going to want to do is you're going to want to sit or live comfortably for several minutes prior to testing. And you lightly placed those two fingers directly over the radial artery. Once the pulse is identified, start counting pulses for 60 seconds. You can also do this with exercise heart rate. And that can be measured for 10 seconds, and then multiply that by 610 times six is 60 seconds. So multiply that number by six and it will give you a relatively good exercise heart rate. There are some things in there obviously, if you're not taking it for an entire minute, that will change the way things are done. All right. So we've got the exercise heart rate, the resting heart rate were to measure it, you can measure that from the radial pulse, you can measure that from the radial pulse. All right, blood pressure. All right, let's talk about blood pressure for a moment. Blood Pressure is the outward pressure exerted by blood on the inside of the arterial wall. So if I've got blood going through my vessels through my arteries, when it pulses, it pushes out on the arterial walls, but also when it says at rest, the blood has pressure that pushes out against the arterial walls, just not as much as when the heart beats. And so every time the heart beats, it comes out of that left ventricle in the heart, and you'll feel a gush of blood. And that's what the pulses are. But even when it's not pulsing, it has an outward pressure against the wall, the systolic blood pressure, which is the top number when we say things like 120 over 80, right? The systolic number is the top number. It's the force of the blood pushing against the arterial walls when the heart is contracting. And normal systolic pressure is less than 120 millimeters of mercury. So we have that example of 120 over 80. So that no Normal is 120 or below for that millimeter of mercury. The next one is the diastolic number. And the diastolic number is the force generated by blood in the arteries when the heart is relaxed, so when the hearts relaxed, there's still blood that pushes out against our arteries. Normal diastolic pressure is less than 80 millimeters of mercury. So these are blood pressure numbers that you would look at. And part of the way that we would measure someone's blood pressure and what those outcomes would look like. When we look at other anthropometric and body composition things, we can look at body mass index, and a lot of times people because body mass index is used in large studies, because it's a very easy way for us to calculate height versus wait until a body mass index is taking that it's taking a number of your height versus your weight, and it gives you a body mass index. And it is not the best number for individuals. Because you could have somebody that is a and I hear this argument regularly about body mass index. Well, what about bodybuilders? They have a lot of weight compared to their height. And so that number is not true. And I say yes, you're absolutely right. But the problem with this country isn't all the bodybuilders we have. And so the bodybuilders are not the ones skewing and great numbers, our body mass index, what it's used to do is to take large swaths of people, large population studies, body mass index gives us a good idea of what somebody's body composition is. And we can calculate that easily when you having 1000s of people being measured. Because that's a lot easier than doing circumference measurements, which would be the next one, where you might just say, let's take a measuring tape and measure around somebodies chest and their abdomen and their hips and their thighs and their calves and their neck. And you have body comp, you have circumference measurements that allow us to do that. They're also skinfold measurements. skinfold measurements are a way of measuring body fat that can be skewed when working with obese clients. But skinfold measurement is grabbing a pinch of skin. And then you would use a caliper to measure how thick that skin fold is. And there are certain places that you'd measure the skin folds. There's also bioelectric impedance and hydrostatic weighing. So let's go into a little bit of what these are. So the the body mass index formula, the number for getting your body mass index, if you're using the Imperial formula, that is weight and height in pounds and inches, then that's going to be 703 times the person's body weight in pounds, divided by their height in inches squared. And if you're using the metric formula, it's kg divided by height in meters squared. And so you have a chart that you can look up and it gives you an idea. So what's my body mass index, what is good, what is low, what's high, what's extremely high, what would be considered obese, and it gives you some correlations with what your classification is, and the disease risk. And that's how these were done your disease risk. Based on these large population studies, there's a correlation with body mass index, and weight, and the diseases, the disease risk associated with that or what's called a relative risk ratio. When you work in large population studies. circumference measurements are a good way to measure the girth of the body segments. And it serves to identify body shape and changes and an x as an important indicator of health risk for diseases such as heart disease and diabetes. And our goal, I would suppose if we're working with weight loss clients is to do weight circumference measurements, and measure if that gets a little bit smaller. And we can quantify that and track that. But one of the other things that you can do, just from a practical point of view is you can have people have pants that fit them well or that are the skinny pants, the pants that they used to could fit into and they can't quite fit into anymore, and see if they're getting closer to getting into those pants. Now I think circumference measurements can be tricky, because we pull a little bit tighter sometimes we don't necessarily find the exact place and it's not such an objective measurement as we would think based off of that.
So I like to use a measuring tool that is mechanical. And so you can wrap a circumference measurement around you slide a the end of it back into the base and it anchors it and then you push A button and it shrinks around them. And it pulls the same amount of tension at every location for every time you measure. So it's not whether or not I'm pulling the appropriate way. Now, with that being said, sometimes it just takes practice, and you can get good and efficient at it, and you can get some valid and reliable results.
Alright, skinfold measurements, there are several types of skinfold measurements that can do and this is just to estimate body fat with calipers while pinching the skin standard sites for that are triceps, biceps, chest, abdomen, mid axillary, which mid axial areas between the axillary line, the anterior axillary line, which is the bend where the arm and the chest meet. And so mid axillary would be between the bend where the arm and the chest meet. And the line of the nipples would go right in between that that's mid axilla subscapular below the scapula Supra iliac, above the ilium. And then thigh or mid thigh, which would be where that would be taken from. So that seven point site, that protocol is called the Jackson and Pollock site. Yes, you got it right, as if it was the artist, that would splatter paint on canvas, except these are two researchers that would measure these skinfold measurements. And so Jackson Pollock seven point site, and then there's a little easier one, which is a Jackson Pollock, three site protocol. And then there's a four site one called the Durnan Warmsley protocol. And so be familiar with the three different types of protocols with their Jackson Pollock seven, Jackson Pollock three and the Durnan Warmsley protocol for four sites. All right. Next one for body fat measurement is something called bioelectrical impedance. And it estimates your body fat percentage by measuring the resistance to the flow of electrical currents introduced to the body. So what you do is, a lot of times it might be a handheld device, sometimes you put your feet on it, sometimes they were really advanced devices that you stand on, and you hold your hands on. And what it does, it sends an electric current through your body, and it tasers you. So I'm just kidding, you will not feel this at all, you don't feel the electric current going through your body. And what it does is it goes out one side, and it travels around until it connects back to the other side. So you have to hold on, you have to have two points of your body touching, it usually might something you would have your hands or your feet on or both. And the more fat you have, fat is not conductive. So it's going to have a high resistance to that bio electrical pulse that goes through the body, it's going to impede that result. And that's why it's called bioelectrical impedance, but muscle and water and the body on the other hand is more conductive. So it's gonna have a low resistance to that jolt, which you don't feel. Remember, you will not feel this. So the electrical current that's going through their body, and it has a low impedance, so the faster that current gets around, then the less body fat someone may have, the more fat they have in their body, the more impedance it takes, the longer it takes for that current to get from one hand or one foot to the other. And it gives an estimation on body fat based off of that. Alright, I think the last one we're going to talk about is hydrostatic weighing, which is underwater weighing, and is founded on the principle that bone and muscle and connective tissue are denser and heavier in comparison to fat tissue, which is less dense and it's lighter, and it floats. So a person's weight on land is compared to their underwater weight to determine their fat percentage based off of Archimedes principle, a physical law of buoyancy. And so what you do is you would displace this fluid, you would go underwater you had do have to hold your breath, it's complete, submerge underwater. And usually, these are only found at universities, and they can be pretty expensive to do but they are considered very, very accurate. So with that said, That's hydrostatic weighing. And that is that for those physiological body fat assessments, let's get into cardio respiratory assessments. Now cardio respiratory fitness, let's define it. The ability of the circulatory and respiratory systems to provide the body with oxygen during activity. That's a cardio respiratory fitness, a cardio respiratory assessment, let's define it. protocols intended to measure the aerobic fitness of an individual so we're measuring somebodies fitness with this then we are Looking for an assessment? And it'd be aerobic fitness is just measuring how much provide the body with oxygen during activity.
All right, what are some of the assessments you could do? Well, there's the YMCA three minute step test. And I do like this one, it's an assessment for aerobic fitness for de-conditioned clients, it looks at your resting I sorry, your recovery heart rate. So what you do is you do a three minute step test, by having the client perform 96 steps per minute, up, up, down, down, that's four steps, by the way, so up, up, down, down, then measure the client's pulse after the three minutes, you can have him sit down, measure the client's pulse for 60 seconds at the radio pulse, and record the number as the recovery pulse. So you locate the score in the chart provided in your textbook. And that gives you an idea of where they are in their cardio respiratory fitness. So let's say you can move to the next one, you can do a if you don't want to do a step test. Then there is a walk test. And this is called the Rockport block test. It's a one mile walking test that predicts your vo two max and the vo two is the max volume of oxygen consumed, maximize the max amount of oxygen that you can consume. We all breathe in the same amount of oxygen, the same amount in the air. But how much do you utilize? Once you bring that in? That's vo two max. So the one mile walking test will give a prediction of the vo two Max and what you'll do, you'll have a client walk one mile as fast as he or she can on a treadmill, you're going to record the time it takes for the client to complete the walk, immediately record the client's heart rate and beats per minute at the one mile mark. And they use the formula listed in the textbook to calculate the corresponding vo two max that's the Rockport walk test. And then the last of these tests, and we've shifted towards this test. In particular, it's the one in the half mile run test. And it's used to measure a client's aerobic endurance. And the goal of this test is to complete a one and a half mile distance as quickly as possible. And sometimes pacing may be necessary. And you may say, I'm not a runner. As a personal trainer, I might do some things but I don't run well. Pacing may be necessary. But you may not be the person to do it. Working with somebody, if they're on a treadmill, you can do that. Preferably we like these to be done outside, but you do what you can and you'd work with what you can work with, you take that one and a half a mile run. And you compare that time back to the results chart in the textbook and find out where they are. The great thing about comparing this to is that you're just getting a time for one and a half mile run. And if we're using this as a benchmark, the only thing you have to do is see if they're getting better. See if they're getting faster at that one and a half mile run test. In fact, I've been running quite a bit lately, I would say at this point, I'm in the maintenance phase of regular running, but I haven't done a one and a half mile run test. And I'm going to do that today. Follow up with me on it, see if I did it. Here we go. Top Test. Now this is interesting.
And it's gonna start to get us into our last components we're going to talk about in this episode, which is we're moving towards the ventilatory threshold, more than we are focusing on heart rate and things like that. So there's a talk test the aerobic test that measures the participants ability to talk or hold a conversation during an activity at various intensity levels. And that top test is going to provide us some feedback that feedback can give us let us know whether or not they're at their ventilatory threshold one. So that vt one test. And what that is it's an incremental test performed on any device. So you can do it on an elliptical trainer. You can walk, you can step it doesn't matter. Whatever you've got is what you can use. And you can gradually progress, increase the intensity level, and it relies on the interpretation of the way a person talks. So we use the talk test, and to determine a specific event at which the body's metabolism undergoes a significant change. So here we go. Let's do a brief talk through vt one. We're going to talk about with our client, we're going to discuss the protocol and answer all the questions and we're going to provide a warm up that's going to help support them in the process which might be stretching or recovery work before starting the test. And then we're going to begin the test at an intensity considered light and easy and gradually progress them through incremental stages. We'll perform the continuous talk test. So having them talk towards the end of each stage. And then once we find a steady state heart rate, we're going to check that out steady state heart rates, we're still check a heart rate, heart rate is good as a consistent measure. So what we can do is we can do the talk test, and identify where they are in their heart rate. And that way, instead of having them talk to themselves, when they're training on their own, which they could do, we can then correlate that to a heart rate that we want them to train through, we can repeat this continuous talk test until the talk becomes challenging, but not difficult. Right? It's challenging, but not difficult for the client to perform. It's a sign that the client has reached their ventilator ventilatory threshold one vt one at this moment, you're going to record the client's heart rate, the speed, the grade, the wattage, depending on whatever type of equipment they're using, you're going to record that. And then you're going to evaluate the challenge of continuous talking. So you should observe the ability to speak continuous continuously at a conversational pace. It's going to be smooth, streamlined, continuous, versus choppy, and interrupted, in a little disjointed. You're going to ask the client to rate the challenge. Is it easy? Is it small challenge? Is it uncomfortable? Is it difficult? Is it nearly impossible? vT one is marked as uncomfortable or challenging, and you're gonna listen to the breathing sounds. vt one occurs when breathing becomes clearly audible with fairly visible signs of rib cage elevation. So consider continuing one stage beyond the suspected vt one stage to validate the assessment. So go a little bit farther. And then if they start working a little bit harder, gasping for more air, you're gonna move them back, you know where that vt one took place? ve t to venturi threshold to test you're gonna same thing initially, but by giving them a warm up talking to them about the protocol, what we're going to do answer any questions, but this test is going to require the client to maintain their highest sustainable pace for 20 minutes. A fitness professional is going to record the client's heart rate and marker of the performance. And then it's going to markers of performance might be rate of perceived exertion, Wantage speed, that kind of stuff. Over the last five minutes of that training. The body relies heavily on the anaerobic system during vt, two, if you start to increase the intensity to a predetermined pace, some careful programming couldn't be required to determine what this pace would look like, but allow for some minor adjustments as needed during the first few minutes when you're doing this workout or this workout bout. And remember that the client will need to hold this pace for 20 minutes. So it should be the most intense pace that they can safely do for that amount of time. Record the individual's heart rate and marker for performance again, speed wattage RP during the last five minutes of the bout, and you're going to use the average heart rates collected over the last five minutes, and then correct them by using a 95% estimate of the client's vt two and that 5% correction is needed because the 20 minute pace is usually more intense than when a client is performing a 30 to 60 minute test. And that is that the venti alarie thresholds to or vt two. All right? Well, this wraps up our health, wellness and fitness assessments, and that particular chapter. So this is part one of two parts of this particular domain domain number three assessments. And as we continue into our following assessment, we'll get into posture movement and performance assessments. I'll be jumping a little bit later on this week and you join us for those. With that being said thank you for your time today. I appreciate you listening and learning and continuing your education with us. My name is Rick Richey, you can reach out to me directly on Instagram where I'm most active at Dr. dot. Rick Richey, I forget what it is sometimes, or you can email me at Rick.email@example.com I'd be happy to answer any questions that I can. Thank you so much. This has been the NA SM CPT podcast.