FITNESS ASSESSMENT FORM (PE 4)

Name: ___________________________________ Class Schedule: _____________________

Goal: ____________________________________

Static Postural Assessment

Anthropometry: Girth Measurement
Kinetic Movement 6th RE 7th RE
View Chain Observation 6th RE 7th RE
L R L R Chest
Checkpoint
s Right Upper Arm
Head Forward head*
Right Forearm
Shoulder Protracted*
Retracted Waist
Lateral Lumbo- Anteriorly Hips
pelvi-hip tilted*
Right Thigh
Posteriorly
tilted Right Calf
Adducted Waist and Hip Ratio:
Anterior Knees Abducted
Internally
rotated*
Externally rotated
Feet Flat*

Dynamic Postural Assessment: Overhead Squat Cardiorespiratory Endurance: Step Test

th th
View Kinetic Chain Movement 6 7 60-sec HR CV THR
Checkpoints Observation RE RE Efficiency
L R L R 6th RE
Feet Turns out Interpretation
Anterior Moves inward 7th RE
Knees
Moves outward Interpretation
Lumbo- Excessive forward
Lateral pelvic-hip lean
Low back arches
Anaerobic:300-Yard (274m) Shuttle
Low back rounds
Shoulder Arms fall forward Trial 1 Trial 2 Average
th
6 RE
Feet Heel of foot rises
Interpretation
Foot flattens
Posterior 7th RE
Lumbo- Assym. Weight
Interpretation
pelvic-hip shift
Shoulder Shoulder elevated
Agility: Hexagon Test
Flexibility: Sit-and-Reach Test Trial 1 Trial 2 Trial 3 Average
th
6 RE
Trial 1 Trial 2 Trial 3 Best (cm)***
th
6 RE Interpretation
Interpretation 7th RE
th
7 RE Interpretation
Interpretation

Aerobic: 12-Minute Run

Speed: 40-Yard (37m) Sprint
Laps Distance Result (m)
Trial 1 Trial 2 Average th
6 RE
6th RE Interpretation
Interpretation 7th RE

7th RE Interpretation
Partial Curl Up
Interpretation Repetitions
6th RE
Interpretation
7th RE
Interpretation
 Strength
1 RM=

Criterion Scores and Normative Values

Cardiovascular Endurance: 3 Minute Step Test

Duration of Exercise (sec) x 100/
Recovery pulse x 5.6
=CV Efficiency
Zone One MHR x 0.65
MHR x 0.75
Zone Two MHR x 0.76
MHR x 0.85
Zone Three MHR x 0.86
Poor Zone One MHR x 0.90
Fair Zone One
Average Zone Two
Good Zone Two
Very Good Zone Three

Aerobic: 12 Minute- Run (Male) Speed: 40-Yard (37m) Sprint

Age 13-14 15-18 17-20 20-29 30-39 40-49 >50 Rating Men Women
Excellen >2000 >2800 >3000m >2800 >2700m >2500 >2400m Very good <4.80 <5.30
t m m Good 4.80-5.29 5.30-5.59
Above 2400- 2500- 2700- 2400- 2300- 2100- 2000- Average 5.10-5.29 5.60-5.89
Average 2700 2800 3000m 2800m 2700m 2500m 2400m
Fair 5.30-5.60 5.90-6.20
Average 2200- 2300- 2500- 2200- 1900- 1700- 1600-
2399 2499 2699m 2399m 2299m 2099m 1999m Poor >5.60 >6.20
Below 2100- 2200- 2300- 1600- 1500- 1400- 1300-
Average 2199 2299 2499m 2199m 1999m 1699m 1599m
Poor <2100 <2200 <2300m <1600 <1500m <1400 <1300m
m m Anaerobic: 300-Yard (274m) Shuttle
Excellen Above Average Below Poor
t Average Average
<50 50-52 52-53 53-55 >55
secs secs secs secs secs
Aerobic: 12 Minute-Run (Female)
Age 13-14 15-18 17-20 20-29 30-39 40-49 >50
Excellen >2000 >2100 >2300m >2700 >2500m >2300 >2200m Waist-to-Hip Ratio
t m m Formula: Waist measurement/Hip
Above 1900- 2000- 2100- FLEXIBILITY:
2200- Sit and Reach
2000- 1900- 1700- Measurement=Waist to Hip Ratio
Average 2000 2100 2300m 2700m Men 2500m Women
2300m 2200m Men Women
Average 1600- 1700- Superior
1800- 1800- >42 1700- 1500- >45 1400- Prone to Chronic >0.95 >0.80
1899 1999 Excellent
2099m 2199m
32cm-411999m
cm 1899m
36-44 cm1699m Diseases
Below 1500- 1600- 1700- Good 1500- 1400- 1200- 1100-
21cm-29cm 26cm-35cm
Average 1599 1699 1799m 1799m 1699m 1499m 1399m
Average 15cm-20cm 16cm-25cm
Poor <1500 <1600 <1700m <1500 <1400m <1200 <1100m
Partial
Fair Curl
m Up8cm-15cm m 7cm-15cm
Age 18-25 26-35Poor 36-45 46-55
1cm-2cm 56-65 5cm-6cm
65+
Excellent >43 >39 Very poor
>33 >27 >24 >23
<1cm Agility: Hexagon
<5cm Test
Good 37-43Gender
33-39 Excellent
27-33 22-27 18-24
Above Average 17-23
Average Below Average Poor
Above 33-36Male 29-32 <11.2 23-26
secs 18-21 13-17
11.2-13.3 secs 14-16 secs
13.4-15.5 15.6-17.8 secs >17.8 secs
Average Female <12.2 secs 12.2-15.3 secs 15.4-18.5 secs 18.6-21.8 secs >21.8 secs
Average 29-32 25-28 19-22 14-17 10-12 11-13
Below 25-28 21-24 15-18 10-13 7-9 5-10
Average
Poor 18-24 13-20 7-14 5-9 3-6 2-4
Very Poor <18 <13 <7 <5 <3 <2