QUEST, 1997,49,315-321
O 1997 American Academy of Kinesiology and Physical Education
Use of Technology in
Health-Related Fitness Programs
B. Don Franks and Robert H. Wood
This paper describes how technology can be used in health-related screening,
testing, exercise prescription, and program evaluation. Technology can assist
the healthlfitness professional in these elements of a fitness program by saving time and space. But because many of the devices lack adequate validity
and calibration, fitness professionals are encouraged to make careful decisions concerning what specific tasks can be more effectively accomplished
with the aid of technology.
Key Words:Fitness, Health-related, Technology
In noting the changes created by the use of technology, Morrow (1992) said:
Computers have transformed many aspects of everyday life, and they
can significantly influence the health fitness instructor's work. Tasks
that previously were arduous, time consuming, confusing, and laborious can now be accomplished in a matter of minutes or seconds. The
variety of convenient forms of output (e.g., on-screen, printed, or plotted) can be a great help in communicating with clients and supervisors
and can generally enhance your services and relations with others.
Technology is an integral part of life and will become increasingly so in the
future. However, this element of life also evokes strong positive and negative responses
from individuals, with some swearing by technology while others swear at it!
Although there are a few individuals who can operate independentlyof technology (e.g., the man in Baton Rouge who adds up the cost of produce by hand),
most of us will be faced with deciding in what ways we will use technology.
The purpose of this paper is to describe how technology can be used in the
typical activities of a health-related fitness program, including screening, testing,
exercise prescription, and program evaluation. We begin with some ethical issues
and will conclude with some observations about the future.
Ethical Issues
The fitness professional needs to be aware of the ethical issues related to the
use of technology in health-related fitness programs, including:
B. Don Franks and Robert H. Wood are both with the Department of Kinesiology at
Louisiana State University, Baton Rouge, LA 70803-7101.
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Bells and whistles;
Communication regarding data and its limitations; and
Over- and underutilization of technology
While it is tempting to make decisions about the use of technology based on
the ease of data measurement and attractiveness of equipment, the validity of the
data and the meaningfulness of the variables should also be considered.
Technology allows us to gather a lot of information on individuals. Regardless of the general purpose of a test, the fitness professional has the responsibility
of communicating the results of the test to the client. Not only does this responsibility involve interpreting the findings, but it also includes an explanation of the
limitations of the test and the testing situation. For example, in the screening situation, health fitness instructors must be careful to explain that the results are not
definitive diagnoses and that screening tools are often not the most sensitive nor
specific indicators of the presence or absence of clinical or preclinical symptoms.
Therefore, among the ethical concerns for fitness professionals is knowing the
limitations of new techniques and new equipment in an effort to provide the most
accurate information to their clients and community. Furthermore, the explanation
of results also should include goal-setting, such as referring the client for medical
evaluation (in the case of a positive screening result) or to encourage continued
awareness of preclinical signs or symptoms of disease (as in the case of a negative
result). In the evaluation setting, the prescribed intervention should reflect the results of the evaluation. For example, the plethora of nutritional assessment programs often tempts health fitness instructors to evaluate a client's nutritional status; however, unless the wellness program addresses specific recommendations,
modeling, and follow-up for nutritional care, health fitness instructors should not
evaluate the nutritional status of their clients. Rather, in the absence of a detailed
nutritional program, health fitness instructors should screen clients for nutritional
status and refer those who are "at risk" to a registered dietitian for evaluation and
treatment.
Finally, there is a tendency to go to extremes, using technology for everything, even when not needed, or refusing to use it when it would enhance efforts.
For example, a lot of information may be gathered on individuals as part of the
screening process, but it goes unused. There may be an excellent nutritional analysis, but feedback or referral fails to reach the individuals in the program. Even with
the results of a graded exercise test, exercise intensity is often prescribed as if
nothing was known about an individual's response to exercise. At the other extreme, some of the exercise equipment is so extensively programmed that it takes
half of the workout time just to set the variables to get started, when ail that is
needed is a 5 minutes warm-up, the resistance set so that it feels fairly difficult,
carry on a conversation for 20 minutes, then cool down for 5 minutes.
Screening
The first goal of screening is the prevention or early detection of disease.
Health-related fitness programs also use screening to determine the appropriate
type of exercise program for an individual. This screening can range from the
quick and dirty-Are you severely ill and hurting?-to a comprehensive examination of health history, signs and symptoms, behavior, and fitness-testing results.
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Simple screening can be used to determine if the person can begin exercise-lite
activities without medical referral. More comprehensive screening, however, is
needed prior to prescribing more vigorous activity or for older individuals or those
at higher risk.
Simple pencil and paper screening tests (e.g., PAR-Q, Thomas, Readin, &
Shephard, 1992) are available, as well as HeartCalc (InnovaTech Software, Dallas, TX) which has a series of three risk assessment software packages:
Coronary risk (risk factors)
Health risk (safety, nutrition, preventive exams, and self-care)
Fitness assessment (includes PAR-Q)
Any of these assessment packages would be sufficient to screen for the lowto moderate-intensity physical activity recommended for sedentary individuals.
However, none of these programs provides the specific information needed for
vigorous exercise screening, as found in Howley and Franks (1992), such as whether
to refer an individual for medical care, suggest a supervised program, or provide
recommendations for unsupervised exercise.
In addition to being a part of screening, testing also is used to assess physical
activity level, health-related fitness components, nutrition, and stress management
to provide appropriate recommendations for individuals and to determine the effectiveness of different types of life-style interventions.
Physical Activity, Fitness, and Nutrition Assessment
Perhaps the most obvious arena in which technology has enhanced opportunities for the fitness instructor is that of testing. However, attractive new developments may make deciding on which technology to use more difficult. Consequently,
health fitness instructors may, at times, be tempted to make decisions based on the
ease of data measurement and the attractiveness of the equipment, rather than on
the validity of the data and the meaningfulness of the selected variables.
With regard to both the selection of variables and method of measure, perhaps the most important issue health fitness instructors must address is identifying
the purpose of the test. Is the testing situation meant to serve as a mechanism for
screening, or is it for the purpose of evaluation prior to some intervention, or to
obtain data solely for its empirical value as in the case of an observational study?
Having considered the above conditions, the health fitness instructor may
wish to select a method of measurement that is easy to use and nonobtrusive while
perhaps sacrificing some reliability. For example, some methods of determining
body composition are very easy to use but do not present the same reliability as
other more cumbersome methods.
However, an evaluation demands a valid and reliable measure of the variable of interest. Furthermore, if some period of intervention is to follow the evaluation, then follow-up measures should be made to detect changes in risk status. In
this situation, health fitness instructorsmay wish to select measurement techniques
that provide high intertester reliability. Finally, if the purpose of the testing is to
describe a sample of some population, the health fitness instructor must find a
balance between maximizing the validity of the test and minimizing any risk involved in the procedures, as well as the investment of time and money.
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Physical Activity Assessment
There are many techniques for determining an individual's level of physical
activity (see Montoye, Kemper, Saris, & Washburn, 1996), including self-report
questionnaires, observation, movement-detectingdevices such as Caltrac (Muscle
Dynamics Fitness Network), and for measuring some physiological variable, such
as oxygen uptake or heart rate. The major use of technology at the current time
seems to be to reduce the data, by scanning questionnaires, estimating caloric expenditure, and providing the instruments to record movement. Technology can
assist with measuring oxygen uptake and heart rate, however, these are indirect
ways to determine the amount of physical activity.
Health-Related Fitness
There is general agreement that health-related fitness includes the following
components:
Body composition
Cardiorespiratory function
Muscular strength and endurance
* Flexibility
There has been an evolution of health-related test batteries, especially for schoolaged children and youth. A good example of a current health-related test is the Fitnessgram
(CooperAerobic Research Institute, Dallas, TX).This program is useful for mass testing,
school programs, and large communityprograms and is relativelyinexpensive.One drawback is that feedback cannot be provided on the same day the test is taken.
Increasing emphasis has been placed on health fitness criteria standards,
rather than comparison with population norms (e.g., percentiles), and the
Fitnessgram does include computer-derived feedback with a range of health fitness criteria scores for each test component. Other tests with limited technology
are available, such as a video that shows how to administer a functional fitness test
to the elderly (AAHPERD, Reston, VA)
Body Composition Assessment
Body composition assessment is one area that has been advanced by technology. A minicomputer now can calculate the percentage of fat (e.g., Futrex 5000,
McLean & Skinner, 1992).The bioelectric impedance (Lohman, 1992) also has the
promise of quick and efficient readings, as well as the DEXA-2 (Lohman, 1992)
which has the possibility of becoming the gold standard. However, all of these need
to have careful validation work done so that the quick and easy reading is, in fact, as
accurate as possible for the specific individual.
Cardiorespiratory Assessment
Another major advance is in the calculation and estimation of maximal oxygen intake (e.g., Biopac System, Santa Barbara, CA; Oxycalc, Brentwood, NH;
Quinton, Bothell, WA), so that the answer is seconds rather than hours away. In
addition, exercise equipment can now be programmed to estimate oxygen uptake
and calories expended, as well as allow a variety of automatic workout patterns.
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Once again, fitness professionals need to be careful about the calibration and the
equations used so that the information is accurate. Students in the lab at Louisiana
State University, under the direction of Hugh Welch, showed some major errors in
one of the popular metabolic carts. One has to question some of the data that have
been published by individuals who assumed that the readout was correct without
an independent calibration.
Muscular Strength and Endurance
While some weight-lifting machines hold the weights with easy adjustment
for different amounts (e.g., Universal Gym), other apparatuses try to match the
strength curve so that an individual can work at the same percentage of maximal
force through the range of motion (Nautilus, Cybex). And, of course, there are
machines that allow the exertion of maximal force in both concentric and eccentric
contractions.
Flexibility Assessment
Very little new technology has been introduced in the flexibility area, with
no new developments emerging beyond the Leighton Flexometer, goniometer, and
the inclinometer (Liemohn & Sharpe, 1992).
Nutrition Assessment
The link between nutrition and physical activity is growing stronger as evidenced by the Dietary Guidelines now having a recommendation for physical activity. The Center for Disease Control and Prevention (Atlanta, GA) also has a new
unit combining physical activity and nutrition. Suffice it to say that there are numerous computer programs to analyze diet, such as Dine Healthy (AAHPERD,
Reston, VA). In addition, information such as the Dietary Guidelines and Food
Guide Pyramid are available on the World Wide Web (Center for Nutrition Policy
and Promotion, Washington, DC).
Exercise Prescription
In this area, technology seems to be part of the problem and can be used as
part of the solution. One of the reasons that regular physical activity has to be
promoted as a conscious choice for individuals in technological societies is that
technology has removed physical activity as a normal part of the daily round.
When people relied on their own physical movement to walk to places, move
objects, and use simple equipment, then everyone did a certain base level of activity as part of human existence. Now with cars, elevators, electric appliances, remote controls, and so forth, it is possible to live, eat, work, and be transported with
exerting little physical activity. Yet to maintain healthy bodies, regular physical
activity is essential.
Therefore, partly because of technology, we are less active. However, technology can be used to assist us to be active, such as workout machines, treadmills,
stationary bicycles, rowing machines, and weight-lifting equipment. In addition,
technology can help us determine the total workout in terms of how much and at
what intensity by programming the equipment to work at constant paces or at
higher and lower intervals.
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To measure physical activity, Kirkpatrick (1995) conducted research incorporating the use of heart rate monitors at schools. Students monitored their heart
rate throughout the physical education class, and then the data were feed into a
computer that provided the duration and intensity of the student's class participation. There also are other sources that combine technology with a variety of exercise possibilities (e.g., Multimedia Workout).
Monitoring workouts is useful to those individuals who need to exercise at a
certain level or are interested in determining what benefit they are receiving from
their exercise program. However, the data collected from the monitored exercise
might be considered overkill by some who do not need all the information that is
provided and could be confusing for others, such as the elderly.
Program
It is difficult to imagine operating any type of data management program
nowadays without the use of computers and other technology. InnovaTech (Dallas, TX) has two software programs that are aimed at health-related fitness
(MemberTrack and HealthCalc). There are numerous other ways that technology
is used to make data more manageable, such as keeping personnel and budget
records, as well as schedules and evaluations, on file in a computer.
Improvements in data management have frequently focused on two of our
most precious resources: time and space. The speed with which one can access information has enhanced the health fitness instructors' ability to receive and transmit
medical information. Facsimile machines and modems have made it possible to receive client records days earlier than conventional mail. Timeliness is particularly
important when one considers the sometimes small window of opportunity during
which a client in the "contemplation" stage of change may be motivated to act.
Consider how many potential clients have been lost to delays because of paperwork.
Not only are we presently moving at the speed of light (fiberoptics), but
present research on the use of secondary light sources for fiberoptic computers
shows promise for lowering operating costs.
Space is always a cost concern for any business. The technology revolution has
afforded the health fitness industry the opportunity to devote more available space to
client services and less to storage of files and other paperwork. Furthermore, the health
fitness instructor has a wealth of resources that are available through multimedia programs and through the Internet; a volume of material that 10 years ago would have
required several dozen square feet to store. Finally, libraries of information can now be
obtained on disks. Some fields provide a years' worth of relevant journals and texts on
one compact disk. Some insurance companies provide lower rates for liability insurance if documents are stored via Document Imagery Processing (DIP).
Future
Our future will include rapid change with the development of new technology that will be primarily beyond our control. It is up to us to decide how and
under what conditions we will interact with technology.
Every indication is that the development of technology is more like an exponential curve than a linear trend. It is exploding, making it difficult to keep up with
the latest developments. Many examples of technological improvementsmentioned
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in this issue of Quest will have been upgraded or replaced by the time the papers
are published.
Recommendations
Our recommendations are not original, yet they bear repeating. Neither the
embracing of every new gadget nor the exclusion of all technology is recommended.
The question is not what can technology do, but what should technology do in a
particular situation. Thus, individuals have to decide what they want technology to
do for them, then select what works best in their situation by careful evaluation
and keeping in mind possible future upgrades.
We are glad that we no longer have to compute ANOVA tables by hand and
that VO,, percentage of fat, and nutrition analysis can be estimated quickly. We
don't long for the old days when manual labor was a part of life. We're glad that
our children and grandchildren don't have to walk 5 miles uphill in the snow to
and from school and that we have many time-saving devices.
Yet the important decisions still require the best of our human intelligence
and that intelligence is needed in deciding on the use of technology for enhanced
health-related fitness.
References
Kirkpatrick, B., & Buck, M. (1995). Heart adventures challenge course: A life-style education activity. Journal of Physical Education, Recreation, and Dance, 66(2), 17-24.
Liemohn, W., & Sharpe, G. (1992). Muscular strength and endurance, flexibility, and low
back function. In E.T. Howley & B.D. Franks (Eds.), HealthJitness instructor's handbook (chap. 10, pp. 179-196). Champaign, IL: Human Kinetics.
Lohman, T.G. (1992). Advances in body composition assessment: Current issues in exercise science, [Monograph] Number 3. Champaign, IL: Human Kinetics.
McLean, K.P., & Skinner, J.S. (1992). Validity of Futrex-5000 for body composition determination. Medicine and Science of Sports and Exercise, 24,253-258.
Montoye, H. J., Kemper, H., Saris, W., & Washburn, R. (1996). Measuringphysical activity
and energy expenditure. Champaign, IL: Human Kinetics.
Morrow, J.R., Jr. (1992). Computer software for the health fitness instructor. In E.T. Howley
& B.D. Franks (Eds.), Healthfitness instructor's handbook (2nd ed., chap. 18, pp.
329-337) Champaign, IL: Human Kinetics.
Thomas, S., Reading, J., & Shephard, R.J. (1992). Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Canadian Journal of Sport Science, 17,338-345.