Fitness Assessment Form

Fitness Assessment Data Sheet

Name ______Date ______Age ______Wt ______Ht _____ Medications ______Risk Factor Status ______Resting HR ______Resting BP (1) ______(2) ______

Skinfolds: WOMEN MEN Triceps Pectoral Suprailiac Abdomen Thigh Thigh Estimated % Body Fat Waist to Hip Ratio (divide waist by hip) ______BMI ______Circumferences: Waist ______Hip ______Thigh ______Calf ______Upper arms ______Forearm ______

Step Test (60 sec. HR) ______Rockport Walking Test (60 sec. HR) ______Comments ______

Bench Press 1 RM ______/WT in lbs. ______= ______Crunch Test (#/min.) ______Push-up Test (total #) ______Sit and Reach (inches) ______

Muscle Specific Flexibility Test

Adequate Needs improvement Hamstrings ______Iliopsoas ______Quadriceps ______Calves ______Shoulders ______

Posture Assessments (visual)

Yes No Lordosis ______Kyphosis ______Forward head ______Hip height discrepancy ______Shoulder height ______