Ken's Health and Fitness Evaluation

Tim: Prior to the first quarter's exercise program, which we started in December, I put Ken through an evaluation process. The first step was to review his health history. The most important purpose of the health history is to find out what, if any, medical conditions exist that would limit an exercise program. Since I had worked with Ken for so many years, the only thing I needed to do was to update his health history from the previous year. If he were a new client, I would have reviewed his complete health history to determine whether he needed to have a medical exam before proceeding.

The major changes in Ken's health history involved a total replacement of his second hip, which had been done the previous June, and a heart arrhythmia condition. I was very familiar with post–hip replacement limitations but felt that I should call Lee Rice, Ken's doctor, to see whether there were any limitations concerning his heart condition. Dr. Rice told me the arrhythmia situation had been resolved with a successful ablation treatment. (Note: ablation is a technique that essentially “disconnects” the source of the abnormal rhythm from the rest of the heart.)

Fitness Evaluation

I have always adjusted the format of my fitness evaluations to the individual being tested. As Ken mentioned, to monitor progress as the program moves along, it is always a good idea to take objective measurements at the outset. These measurements should be used to compare the fitness level of the individual to their own age group and, again, to establish a baseline on which progress can be measured. The following measurements are ones that I consider important and appropriate.

Body weight. I am not a big believer in stepping on the scale every week, because it is not a good measure of losing the right kind of weight. A good example occurred when I was a young captain at West Point being considered for promotion to major. I received a letter from the promotion board stating that while my service record was exemplary, I was overweight by army standards and might not be promoted unless I lost weight. I was 73 inches tall and weighed 210 pounds. By military standards, my weight should not have exceeded 188. According to those standards, I was 22 pounds overweight. Colonel James Anderson, the head of the physical education department, felt that it was time to get the military to change its standards, and I became the test case. He pointed out that while weighing 210 pounds, I had only 6 percent body fat, would ace every fitness test, and was the example of what a soldier should look like in uniform. The other side of his argument was that many soldiers within the weight standard were poor physical performers with very low muscle content. This experience led to a change of standards—the military would now consider body composition by also measuring the amount of body fat. To my delight, I ultimately was promoted. I believe that the weight scale should be used along with body fat measurement to serve as a marker as well as to determine body composition.

Ken's initial weight: 232 pounds (a bit pudgy). Goal: Below 200

Height. This measurement has many uses. We frequently hear people say, “I'm too short for my weight,” or “I don't need to lose weight—I need to get taller.” Whatever the case, we do accept that as we get older our height diminishes. Every year when I do my annual physical, I tell the nurse, “You're pressing the measuring planer too close to the top of my head”—a poor excuse for the fact that I am getting shorter. The reasons we actually get shorter have to do with joint cartilage wearing thinner, bone loss, and poor posture. While we can't yet replace cartilage, and we can't easily replace bone loss, we can definitely improve posture and stand taller and straighter.

Ken's initial height: 5'8" (Ken says he used to be 5'11". Some of that loss is postural.) Goal: 5'9".

Head distance from wall. This is where I have the individual stand back to the wall and chin level to the ground and measure the distance from the head to the wall. Many people begin to get a “hunched-over” look as they age, and this is the way to measure the severity of this problem. Sometimes it is occupationally driven. I've worked with a lot of dentists, surgeons, and computer operators who have spent years with their heads leaning forward and have subsequent neck problems. Most of these conditions are correctable with proper exercise.

Ken's initial measurement: 3.5" from the wall.
Goal: 2" from the wall.

Neck circumference. Fat accumulates here, sometimes forming a “second chin.”

Ken's initial measurement: 17.0 inches.
Goal: 16-inch shirt rather than 17-inch.

Chest circumference, relaxed. Measured with a tape measure at nipple level.

Ken's initial measurement: 41.5 inches.
Goal: 40.5 inches.

Chest circumference, expanded. Measured in the same manner as above but with the individual inhaling and inflating the lungs with as much air as possible.

Ken's initial measurement: 42 inches. Goal: 41 inches.

Waist. Tape measurement at navel level.

Ken's initial measurement: 45 inches.
Goal: 40 inches. (“Get rid of ‘fat pants.'”)

Hips. Tape measurement at the largest point around the hips.

Ken's initial measurement: 46 inches.
Goal: 42 inches.

Upper arm/bicep, relaxed. Maximum girth measurement at midpoint of upper arm.

Ken's initial measurement: 14 inches.
Goal: 13 inches. (“Smaller guns.”)

Upper arm/bicep, flexed. Maximum girth measurement at midpoint of upper arm.

Ken's initial measurement: 14 inches.
Goal: 14 inches. (“Firmer guns.”)

Both thighs. Measured 7 inches above the knee.

Ken's initial measurement:

Right: 26 inches. Goal: 25 inches.

Left (arthritic knee): 24 inches. Goal: Less pain and 25 inches.

Hamstring flex. Measured with goniometer.

Right: Minus 35 degrees. Goal: Minus 15 degrees.

Left: Minus 45 degrees. Goal: Minus 30 degrees.

Goal: “Ability to do the limbo with younger people.”

Heel cord. Measured with goniometer.

Right: 0 degrees. Goal: Minus 10 degrees.

Left: Minus 5 degrees. Goal: Minus 10 degrees.

Goal: “Ability to tap dance.”—a definite D1 area for Ken!

Basic balance. Stand on one foot at a time; measured in seconds until balance is lost.

Right foot: 2 seconds. Goal: 30 seconds.

Left foot: 10 seconds. Goal: 30 seconds.

BOSU ball: 0 seconds.

Goal: To stand for 60 seconds “and swing a golf club.”

Medical Exam

A medical exam is essential before starting an exercise program. Because exercise places a demand on the body, it is always a good idea to ensure that all systems are functioning normally. If not, you need to know what the limitations are. Dr. Rice has been Ken's primary care physician for the past 25 years and knows Ken's complete medical history. He conducts a physical exam at least once a year for each of his patients. Ken's annual exam was due, so the timing for this startup program was just right.

Dr. Rice's facility, the Lifewellness Institute in San Diego, conducts a very thorough exam that includes but is not limited to the following: family history, personal history, health habits, reviews of all systems, physical exam findings, significant test results, body fat percentage, cardiovascular testing, resting metabolic rate, ultrasound exam of major areas, bone density, pulmonary function, blood pressure, body weight, blood lipid profile, upper-body strength, abdominal strength, flexibility, and diet/nutrition.

The areas we feel are most relevant to Ken's fitness improvement, and his initial scores, are as follows:

Blood pressure: 116/72

Total cholesterol: 153

LDL cholesterol: 86

HDL cholesterol: 46

Cholesterol/HDL ratio: 3.3

Triglycerides: 107

Resting heart rate: 72

Sit-ups: 50 (2 minutes)

Push-ups: 9

Almost all of these areas are affected by a fitness program. Ken's physical exam included every aspect of health and fitness. In addition to what I tested, he had a nutritional analysis with a dietitian and a cardiovascular conditioning assessment by an exercise physiologist.

Although this type of exam is ideal, it can also be expensive—but some find that it is covered by their health insurance. At a minimum, you should visit your doctor and state that you intend to start a vigorous exercise program so that all necessary health areas can be checked.

Exercise coaches and personal trainers can be expensive as well; however, they are a good idea, at least to help you get started in the right direction and periodically check your progress. If your budget is an issue, many gyms and YMCAs offer occasional trainers for modest fees. How much is your health and fitness worth to you? Avoiding injury and sickness is economical in the long run.

Dr. Rice knew that I had worked with Ken for many years as his fitness coach, and he was very happy to learn that Ken and I were making a serious commitment to Ken's fitness program. After the exam he made the following suggestions to Ken, which Ken shared with me:

• Work on a progressive aerobic program as established by Tim. Program intensity should be at a heart rate of 100 to 110 bpm. Include some interval training in your aerobic workout.

• Continue your weight training routine two to three times per week.

• Be sure to do some stretching every day.

• Continue your weight loss pursuit through the Weight Watchers program with advice from nutrition advisor Sabrina Zaslov along with a balanced and regular exercise program.