Assessment of Musculoskeletal Fitness

Anna Howery and Kathryn Webster

Carroll University

Assessment of Musculoskeletal Fitness

Data
Upper Body Strength. The correlation between grip strength and 1-RM bench press for
males and females are shown in Figure 1.

FIGURE 1Mean values of force produced in kilograms (kg) for grip strength and 1RM bench press for males (blue bars) are females (red bars).
Upper Body Endurance. The correlation between weight lifted for bench press and the
number of repetitions performed for males and females is shown in Figure 2.

FIGURE 2Mean values for the weight lifted in pounds and the number of repetitions
performed for bench press for males (blue bars) and females (red bars).
Upper Body Endurance Battery. The correlation between the weight lifted and the
number of repetitions performed for males and females are shown in Figure 3. The battery
exercises include: arm curl, bench press, lateral pull down and triceps extension.

FIGURE 3Mean values for the weight lifted in pounds for males (blue bars) and
females (gold bars) and the number of repetitions performed for each battery exercise for
males (red bars) and females (green bars).
Lower Body and Core Endurance. Mean repetitions for the squat endurance test and
the one-minute sit-up test for males and females are shown in Table 1.
TABLE 1. Mean SD repetitions of lower body and core endurance.
Male

Female

Squat Endurance Test

55 0

50 0

1-min Sit-up Test

37.5 6.36

32 4.24

Lower Body Endurance Battery. The correlation between the weight lifted and the
number of repetitions performed for males and females is shown in Figure 4. The battery
exercises include: leg extension and leg curl.

FIGURE 4Mean values for the weight lifted in pounds for males (blue bars) and
females (gold bars) and the number of repetitions performed for each battery exercise for
males (red bars) and females (green bars).
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Upper Body Range of Motion. The correlation between back scratch and shoulder
circumduction tests for males and females are shown in Figure 5.

FIGURE 5Mean values for back scratch test and shoulder circumduction test measured
in inches for males (blue bars) and females (red bars).
Core Range of Motion. The correlation between the active back range of motion and the
skin distraction tests for males and females are shown in Figure 6.

FIGURE 6Mean values for the active back range of motion test and the skin distraction
test measured in inches for males (blue bars) and females (red bars).
Thoracic and Sacral Range of Motion. The correlation between the thoracic and sacral
range of motion tests for males and females are shown in Figure 7.

FIGURE 7Mean values for the thoracic and sacral range of motion tests measured in
degrees for males (blue bars) and females (red bars).
Lower Body Range of Motion. The correlation between the Thomas test and the sit-andreach test for males and females are shown in Figure 8.

FIGURE 8Mean values for the Thomas test measured in degrees and the sit-and-reach
test measured in centimeters for males (blue bars) and females (red bars).
Evaluation of Protocols
Upper Body Musculoskeletal. Upper body musculoskeletal protocols are used to assess
the strength and endurance of the muscles in the upper body. Results of these tests can be used to
identify an individuals general overall fitness of the upper body. Upper body musculoskeletal
protocols include: the grip strength test, YMCA bench press, five repetition maximum (5-RM)
bench press and dynamic muscular endurance test battery which includes arm curl, bench press,
lateral pull-down and triceps extension.
Grip strength. The grip strength test is used to assess the isometric muscular strength of
the upper body, focusing specifically on the muscles of the forearm. The purpose of measuring
an individuals grip strength is the ability to compare an individuals results to normative data.
According to Roberts et al. (2011), grip strength measurements are recommended in the
diagnosis of sarcopenia. Grip strength is also used in assessing upper body impairment and work

capacity following an injury or illness (Allen & Barnett, 2011). Measuring grip strength is also
the simplest method to use in a clinical setting as only a hand dynamometer is needed and little
technique is required by the individual. Grip strength tests should not be performed when a client
has active arthritis due to the motion used during the test could further aggravate their symptoms.
This test should not be performed when an individual has a current upper extremity injury (Allen
& Barnett, 2011). A study performed by Allen and Barnett (2011), studied the grip strength of
forty-nine university students. Grip strength values were collected using a computerized
dynamometer along with a non-computerized hand dynamometer. Results of the study found that
there was concurrent validity in using both the computerized dynamometer along with noncomputerized hand dynamometer for both right and left hands. When comparing test re-test
reliability, the computerized dynamometer obtained more accurate results than the noncomputerized hand dynamometer. Therefore, an advantage of using a computerized
dynamometer is that digital readouts can be obtained, which increases inter-rate reliability and
decreases manual reading errors.
YMCA bench press. The YMCA bench press test is used to assess the muscular
endurance of the upper body. The YMCA bench press test protocol selects an appropriate
submaximal level of resistance and measures the number of repetitions that can be performed
before fatigue (American College of Sports Medicine, 2014, p. 99). The purpose of measuring an
individuals muscular endurance using the YMCA bench press is that it is used to compare an
individuals results to normative data as a way to classify an individuals fitness level. For this
protocol, males are tested using an 80 lb barbell, while females are tested using a 35 lb barbell.
Throughout the test, standardized repetitions are performed at a rate of 30 lifts per minute.
Individuals are scored based on the number of repetitions they can complete before fatigue.
According to ACSM, the YMCA bench press test is an excellent test in that it controls for both
repetition duration and posture alignment, therefore making the test highly reliable (American
College of Sports Medicine, 2014, p. 99). A study performed by Barfield, Channell, Pugh, Tuck
and Pendel (2012) tested an individuals upper body muscular endurance using the YMCA bench
press before and after participating in a resistance training program. Results of this study found
that both before and after participating in a resistance-training program, the YMCA bench press
was a reliable predictor of upper body muscular endurance. Based on ACSM guidelines,
individuals with contraindications to resistance training should not participate in the YMCA
bench press test. Examples include: individuals with unstable CHD, uncontrolled arrhythmias
and severe pulmonary hypertension (American College of Sports Medicine, 2014, p. 103).
Five-resistance maximum bench press. The 5-RM bench press is used to predict an
individuals overall upper body strength. The purpose of predicting an individuals overall
strength is that it can be used to prescribe a resistance training program based on a percentage of
the individuals maximum muscular strength (Materko & Santos, 2009). Although the best
method for assessing strength is through measuring the 1-RM capacity, this is contraindicated for
untrained lifters as it could cause muscle soreness or musculoskeletal injury (Materko & Santos,
2009). The ACSM also recommends using a multiple RM approach when assessing maximal
muscle strength in individuals who are classified as high risk for or with known cardiovascular,
pulmonary or metabolic diseases (American College of Sports Medicine, 2014, p. 96). In a study
performed by Reynolds, Gordon and Robergs (2006) seventy individuals participated in a 1, 5,
10 and 20-RM bench press. Results of this study found that for bench press, the most accurate
prediction of an individuals 1-RM occurred from a 5-RM. Accuracy in predicting 1-RM
worsened with increasing repetitions to fatigue. For this study, twenty individuals were used for

test-retest reliability. Testing was done using the 5-RM bench press. The test-retest correlations
for bench press were 0.999. Therefore, the 5-RM bench press is a reliable predictor of an
individuals 1-RM and thus an individuals overall upper body strength.
Dynamic upper body muscular endurance test battery. The upper body dynamic
muscular endurance test battery includes arm curl, bench press, lateral pull-down and triceps
extension. The amount lifted in each of these exercises is based off of a percentage of an
individuals body weight. Percentages differ based on an individuals gender. The purpose of
performing an endurance battery test is that the number of repetitions an individual is able to lift
(up to 15 repetitions) based on a percentage of their body weight can be used to classify an
individuals fitness level. According to ACSM, individuals with absolute contraindications to
resistance training should not participate in this fitness test. Examples of contraindications
include: individuals with unstable CHD, uncontrolled arrhythmias and severe pulmonary
hypertension (American College of Sports Medicine, 2014, p. 103). A study performed by
Koehuis, Veenstra, Van Dijk and Delleman (2009) studied whether percent body weight would
be a reliable predictor of muscular endurance. In this study, bench press and shoulder press were
used to assess upper body dynamic muscular endurance. The results of this study indicate that
using a percentage of an individuals body weight can be used to predict the upper body
muscular endurance of an individual. Therefore, muscular endurance can be reliably predicted
based on a percentage of an individuals body weight and thus used to predict an individuals
overall fitness level.
Lower Body and Core Musculoskeletal. Lower body and core musculoskeletal
protocols are used to assess the endurance of the muscles of the lower body. Results of these tests
can be used to identify an individuals general overall fitness of the lower body. Lower body and
core musculoskeletal protocols include: the squat endurance test, one minute sit-up test, and
dynamic muscular endurance test battery which included leg extension and leg curl.
Squat endurance test. The squat endurance test is used to assess dynamic lower body
muscular endurance. Individuals who have back or knee injuries, should not perform a squat
endurance test as it could further aggravate their injury or cause increased pain. Individuals who
have a difficult time balancing without an assistive device are also not recommended to
participate in this test. According to Tew (2010) body weight squats are usually a sufficient
challenge for the average individual to perform, but they avoid the risk of injury that could occur
with an inexperienced individual trying to use a weighted bar to perform squats. A study
performed by Myer and Wall (2006) assessed various squatting techniques in young athletes. Of
the various squats performed, a squatting technique similar to that used in the squat endurance
test was used to assist the individuals in gaining confidence in their squatting form. Therefore,
according to these researchers, body weight squats are can be effectively used for technique
acquisition. Once an individual develops the proper technique, the squat endurance test can be
used as an appropriate measurement of dynamic lower body endurance when individuals are
compared to normative data based on age and gender.
One-minute sit-up test. The one-minute sit-up test is used to assess dynamic abdominal
muscular endurance. Individuals who have suffered a back injury, experience back pain or have a
difficult time getting on the floor should not participate in this test. Also, individuals with central
adiposity may be unable to properly perform this test. According to Jackson et al. (1998), the situp test is not a test that should be used in determining low back pain, but instead should be used
for determining ones muscular endurance as musculature is the needed factor in order to
properly perform this abdominal specific test. In study performed by Schilling, Murphy, Bonney

and Thich (2012), untrained individuals were randomly assigned to core isometric endurance
exercises and core isotonic strength training exercises. Core endurance tests including the sit-up
test were used to assess these individuals. Results of the study indicate questionable validity, as
the study was only performed using untrained individuals. Therefore, the results of this study
indicate that the one-minute sit-up test can only be used to assess dynamic abdominal muscular
endurance when both trained and untrained normative results are obtained.
Dynamic lower body muscular endurance test battery. The dynamic lower body
muscular endurance test battery is used in assessing lower body dynamic muscular endurance.
This lower body battery test consisted of leg extension and leg curl. Weight lifted for each of
these resistance training exercises was determined based off on an individuals body weight and
gender. Ratios based on gender were multiplied by body weight to determine amount of weight
lifted up to 15 repetitions. Individuals with lower leg injuries or contraindications to resistance
training as outlined by ACSM, should not participate in this test battery. In a study performed by
Neeter et al. (2006) a test battery consisting of knee-flexion, knee-extension, and leg-press tests
had a high ability in testing and determining any discriminating strength performance between
sides of the body, either injured or uninjured. It was also determined from this study that the test
battery can contribute to the decision of whether an individual can or cannot safely return to
strenuous physical activities after an injury or surgery.
Upper Body and Core Range of Motion. Upper body and core range of motion
protocols are used to assess the flexibility of the upper body and core. Results of these tests can
be used to identify an individuals general overall range of motion of the upper body and core.
Upper body range of motion protocols include: the back scratch test and the shoulder
circumduction test. Core range of motion protocols include: the active back range of motion test,
the skin distraction test and the thoracic and sacral range of motion test. The purpose of
measuring an individuals upper body flexibility is that results can be compared to normative
data based on an individuals age and gender.
Back scratch test. The back scratch test is used to assess upper body flexibility focusing
specifically on the shoulder girdle. Individuals with shoulder injuries should not participate in
this test as it could create further injury. Results from this range of motion test are a component
of a senior fitness test battery. This test will measure the ability to perform activities of daily
living such as combing hair, dressing, and reaching for a seat belt. A study performed by
Cicioglu (2010) used the back scratch test as part of a senior fitness test battery in determining
independence of elderly patients between the ages of 60-80 years of age. It was found that as the
patients aged, their range of motion scores decreased. Milanovi, Panteli, Jorgi (2012), also
found that as an individual ages, their upper body range of motion decreases due to muscle
atrophy and sarcopenia. This study also found that if an individual participates in regular
physical activity and functional fitness activities, the aging process of muscle atrophy can be
reduced or slowed. Therefore, the back scratch test is a reliable test used to assess upper body
range of motion.
Shoulder circumduction test. The shoulder circumduction test is used to assess the
dynamic range of motion of the upper body, specifically focusing on the range of motion of the
shoulder joint. Individuals with musculoskeletal injuries to their shoulder should not participate
in this test as they could further aggravate their injury. A study performed by Lemmink, Han,
Greef, Rispens and Stevens (2001), assessed 458 individuals upper body flexibility. The shoulder
circumduction test was administered twice to individuals with one week between sessions. When
individuals are participating in this test, it is necessary that they follow strict guidelines as a way

to obtain accurate and reliable results. For example, the movement over their head must be made
with extended arms and individuals must keep their arms from fanning out. The purpose of
performing two trials was to test for interrater reliability, intrarater reliability and trial-to-trial
reliability when conducting a shoulder circumduction test. Results from this study indicate that
the shoulder circumduction test is a reliable test as individuals who participated in the test had
similar measurements for both of their trials. Therefore, when conducting a shoulder
circumduction test, it is necessary for strict measuring guidelines to be in place, so that similar
results are obtained from trial to trial.
Active back range of motion test. The active back range of motion test is used to assess
the dynamic muscular strength of the back muscles. Individuals with musculoskeletal injuries to
their back should not participate in this test as they could further aggravate their injury. A
systematic review was performed Williams, McCarthy, Chorti, Cooke and Gates (2009). These
researchers assessed studies focused on intraobserver and interobserver reliability when using
various measuring devices. Forty-six studies were analyzed for reliability with only 19 articles
reporting both intraobserver and interobserver reliability. Various devices were used to measure
active back range of motion within these research studies. For the test conducted in our
laboratory, a yardstick was used to measure the distance an individual could lift their core region
off a mat, while keeping their arms and legs completely flat on the mat. It was concluded by
Williams et al. (2009) that sophisticated measuring methods did not appear to offer greater
reliability than more simple measuring methods. Therefore the active back range of motion test
using a yardstick to measure flexibility is a reliable method, when strict measuring guidelines are
followed.
Skin distraction test. The skin distraction test is used to assess lower back flexibility,
focusing specifically on lumbosacrial flexion. Spinal mobility tests are frequently performed to
diagnose ankylosing spondylitis (Cidem & Karacan, 2011). Individuals with severe
musculoskeletal injuries to their spinal region or individuals who are unable to stand and bend
forward should not participate in this test as they could further aggravate their symptoms.
According to Hayward (2010), the skin distraction test is a reliable measure when compared to
radiographic measurements of spinal flexion and extension. A study performed by Cidem and
Karacan (2011), assessed the skin distraction of 1,982 Turkish males. Measurements were then
compared to the norms of other populations. As this study was only performed on males from
one ethnic population, this study did not produce reliable results that can be used for comparison.
Therefore, this study indicates that skin distraction tests must be performed on a variety of
individuals in order to produce accurate normative data.
Thoracic and sacral range of motion test. The thoracic and sacral range of motion test is
used to measure the flexibility of the core region, focusing specifically on the flexibility of the
lumbosacral region. This test uses a double-inclinometer technique, which is placed on the distal
end of the body segment and measures the angle between the long axis of the moving segment
and the line of gravity (Hayward, 2010, p. 271). Individuals with severe musculoskeletal injuries
to their spinal region or individuals who are unable to stand and bend forward should not
participate in this test as they could further aggravate their symptoms. A study performed by
Brooks, Patterson, Wagner and Hardigan (2012) took 232 individuals through a series of lumbar
bending motions and recorded their range of motion using a double-inclinometer technique.
Strict guidelines were put in place in order to increase the reliability of this study, as this study
was conducted to test for interexaminer reliability. Studies prior to this study had poor
interexaminer reliability. The results of this study found that when strict protocols are followed,

reliable results can be obtained and therefore results can be used in determining an individuals
flexibility of their core region.
Lower Body Range of Motion. Lower body range of motion protocols are used to assess
the flexibility of the muscles of the lower body. Results of these tests can be used to identify an
individuals general overall range of motion of the lower body. Lower body range of motion
protocols include: the Thomas test and the sit-and-reach test. The purpose of measuring an
individuals lower body flexibility is that values can be used to compare an individuals results to
normative data based on an individuals age and gender.
Thomas test. The Thomas test is used to assess iliopsoas flexibility of the lower body.
Individuals with musculoskeletal injuries to their iliopsoas should not participate in this test as
they could further aggravate their injury. Results from this flexibility test are one component of a
musculoskeletal screening. A study performed by Harvey (1997) assessed 117 athletes who
participated in tennis, basketball, rowing and running to determine their flexibility. Two trials
were performed on both the left and right legs. The length of the iliopsoas was determined by
measuring the angle of hip flexion. Results of the study found interclass correlations throughout
the two trials. Rowers and tennis players had less iliopsoas flexibility than runners. According to
Peeler and Anderson (2008) when Thomas tests are conducted using a goniometer, only
moderate levels of reliability are observed, as tester error can be quite high. Therefore, when
conducting a study using a goniometer it is necessary for strict measuring guidelines to be in
place as a way to increase reliability of the data obtained.
Sit-and-reach test. The sit-and-reach test is used to assess the flexibility of the lower
body, focusing specifically on the hamstring muscles. Elderly individuals or individuals who
have a difficult time getting down on the floor should not participate in the sit-and-reach test.
Also, individuals with musculoskeletal injuries of the lower body should not participate in this
test as they could further aggravate their injuries. Sixty individuals participated in a study
performed by Mier (2011). A sit-and-reach box was used to assess an individuals lower body
range of motion, focusing specifically on the hamstring muscles. Two trials were performed and
the average of the two trials was used to assess hamstring flexibility. Similar values for sit-andreach were also obtained when tests were performed on a different day. Therefore this test had
test-retest reliability. A possible error associated with the sit-and reach test is limb length
discrepancy. Individuals who have short legs relative to trunk and arm length may have an
advantage when performing the sit-and-reach test (Hayward, 2010). Therefore the modified sitand-reach test was designed to take limb length into account and thus, the most accurate results
can be obtained using the modified sit-and-reach test.
Case Study
Cathy Carroll is a 42-year-old female who works in a factory and is required to perform
repetitive lifting tasks throughout the day. She was referred to an exercise physiologist to reduce
her non-specific lower back pain (NSLBP). Cathy has a BMI of 26 kg/dL and a waist
circumference of 35 inches. She also does not perform any regular leisure time activities.
According to Cathys symptoms the following protocols would be recommended to further
determine a proper exercise program to reduce NSLBP. These protocols include: the grip
strength test, the YMCA bench press, the repeated trunk flexion, repeated sit-to-stand and the 50meter walk.

10

Grip Strength Test. The grip strength test is a general measurement of upper body
isometric strength. This test specifically focuses on the muscles of the forearm. This test would
be helpful in assessing Cathys isometric strength in the forearm as she works in a factory. Part of
her job description requires her to carry objects a certain distance throughout her day. Grip
strength is important, as she will need to be holding onto the objects, preventing them from
falling and moving them to the next location. The grip strength test is not a timed test. Three
trials will be administered for both the left and right hands to determine the isometric strength of
the upper body. A completed trial will be recorded as Cathy squeezes the hand dynamometer as
hard as possible in one motion as shown in Figure 9. According to Roberts et al. (2011), the
Jamar hand dynamometer is the most widely cited instrument in the literature, and is accepted as
the gold standard due to having the most normative data. In a study performed by Allen &
Barnett (2010), the grip strength test was found to be not only reliable but also a valid test in
measuring the isometric strength of the upper body. Therefore, if Cathy does not score well and
needs improvement it would be recommended that she begin resistance training exercises as a
way to assist in increasing her strength.

FIGURE 9Hand Grip Dynamometer.

YMCA Bench Press. The YMCA bench press test is used to measure dynamic upper
body muscular endurance. For Cathy, upper body endurance is important when lifting, holding,
and carrying objects during everyday activities at work. Poor upper body endurance could be one
contributing factor in Cathys low back pain. In a study performed by Barfield et al. (2012), the
YMCA bench press is used to specifically assess upper body muscular endurance. The study also
scores the test as the total repetitions completed on cadence until fatigue develops. According to
the ACSM, the YMCA bench press test is performed using free weights; for Cathy she will use a
35 pound weighted bar. There is a cadence of 60 beats per minute or 30 repetitions per minute.
Beginning in the down position, Cathy will extend her elbows are far as possible and flex back
down until the bar touches the chest as shown in Figure 10. This will be classified as one
repetition if she remains in sync with the cadence. The test is terminated if Cathy cannot stay
within the cadence, maintain form, bar becomes unbalanced, or she can no longer perform any
more correct repetitions. If Cathy scores poorly during the YMCA bench press test, it could be
recommended that she begin a resistance training program in order to increase her strength.

11

FIGURE 10YMCA bench press

Repeated Trunk Flexion. The repeated trunk flexion test is used to measure the speed of
the flexion movement of the trunk (Aluko, DeSouza, Peacock, 2011). For Cathy, this repeated
motion of flexion of the trunk is used everyday while she is working in the factory. Due to this
repetitive motion along with having to carry heavy load, poor performance could be a
contributing factor to Cathys NSLBP. The repeated trunk flexion test is a timed test. Two trials
will be administered to determine how long it would take Cathy to complete ten flexion
movements at the trunk. A complete flexion movement includes bending her trunk forward,
reaching for her toes from the upright positions and then returning to a standing upright position
(Teixeira, Lima, Guimares & Leite, 2010). The motion used for this test can be seen in Figure
11. It is important during this test that the individual goes at a pace that does not aggravate their
low back pain (American College of Sports Medicine, 2014, p. 214). In a study by Teixeira et al.
(2010), seventy-two individuals took part in the repeated trunk flexion test. Individuals with low
back pain were matched with healthy individuals. According to the results of the study,
individuals with low back pain took almost double the amount of time to complete the repeated
trunk flexion test compared to healthy individuals. According to ACSM, the repeated trunk
flexion is both reliable and valid test used for physical performance measures in individuals with
low back pain (American College of Sports Medicine, 2014, p. 214). The reproducibility of
scores obtained by Teixeira et al. (2010) is similar to those obtained by other researchers.
Therefore, if Cathy receives results similar to the individuals in the study with low back pain, it
would be recommended that she begin resistance training and flexibility exercises as a way to
assist in reducing the pain she experiences while at work.

FIGURE 11The repeated trunk flexion motion.

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Repeated Sit-to-Stand. The repeated sit-to-stand test is used to measure the muscular
endurance of the lower body. For Cathy, when she is lifting objects at work, it is necessary for
her to bend down and pick up the object using her legs to assist her in lifting the object. The
repeated sit-to-stand test requires individuals to sit in a chair with their feet shoulder width apart.
Individuals are timed how long it takes them to complete five sit-to-stand maneuvers. Starting in
a sitting position, individuals stand as quickly as possible, without using their hands (Ryan,
Gray, Newton & Grant, 2008). Two trials are recorded and results are averaged. The motion used
for the test is shown in Figure 12. In a study by Ryan et al. (2008), thirty-eight participants with
chronic low back pain took part in the sit-to-stand functional test. Each individual self-reported
functional ability before participating in the tests. Results from the study indicate there was a
relationship between self-reported function and an individuals results from the sit-to-stand test.
Therefore, this test provides reliable and valid data, which can be used as a physical performance
measure when assessing an individuals low back pain (American College of Sports Medicine,
2014, p. 214). Reliability of this test was also found in a study performed by Teixeira et al.
(2010). In this study, individuals with low back pain were matched with healthy individuals.
Results of this study indicated that individuals with low back pain took 17.39 seconds to
complete the test compared to healthy individuals who took 11.37 seconds to complete the test.
Therefore, this test provides reliable information regarding muscular endurance of the lower
body in individuals with low back pain and can be used when determining resistance training
and flexibility programs that individuals can participate in as a way to reduce their low back
pain.

FIGURE 12The repeated sit-to-stand motion.

Fifty-Foot Walk. The 50-foot walk test is used to measure the gait speed of individuals,
focusing specifically on the agility and balance of an individual. For Cathy, when she is moving
objects at work, she may need to carry an object from one area of the factory to another.
Therefore, this test is important in measuring her speed, agility and balance while walking a
distance without carrying an object. The 50-foot walk test requires a walking course, which
consist of 25 feet out from the start line and 25 feet back to the start line. Individuals are asked to

13

begin walking on the command go and walk as quickly and safely as they can to the 25 foot
mark and then back. Individuals are timed as to how long it takes them to complete the walk
(American College of Sports Medicine, 2014, p.214). The course used for this test is shown in
Figure 13. In a study by Teixeira et al. (2010), individuals with low back pain were matched to
healthy individuals. On average, individuals with low back pain took 12.23 seconds to complete
the 50-foot walk, while healthy individuals took 10.18 seconds to complete the 50-foot walk.
Therefore, it took on average two more seconds for individuals with low back pain to complete
the 50-foot walk test compared to healthy individuals. These results indicate that the 50-foot
walk test is a reliable test that can be used to assess the functional ability of individuals with low
back pain. Similar to the results of this study, ACSM also suggest that the 50-foot walk test is
both a reliable and valid test used for physical performance measures in individuals with low
back pain (American College of Sports Medicine, 2014, p. 214). Therefore the results obtained
by Teixeira et al. (2010) are similar to those obtained by other researchers and therefore have
high reproducibility. If Cathy obtains results similar to the individuals in the study with low
back pain, it would be recommended that she begin a resistance training program along with a
flexibility program as a way to decrease her low back pain and increase her efficiency while at
work.

FIGURE 13The 50-foot walk course.

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