Informed Consent Form

SETON HILL UNIVERSITY
SHU PERSONAL TRAINING PROGRAM

INFORMED CONSENT for FITNESS EVALUATION
1. Purpose and explanation of the tests.

You will be asked to perform a variety of tests to provide an estimation of your health-related fitness. The
health related fitness components to be tested include body composition, flexibility, muscular fitness, and
cardiovascular fitness. The tests are not meant to diagnose diseases.
Body Composition:
Body weight, height, and the circumference around your waist will be measured. You will also be asked to
stand and hold a small device in your hands (bioelectrical impedance analyzer or BIA). The device passes a
weak, electrical signal through the body, but you wont feel anything. This signal is then used to estimate your
percent body fat. Your student trainer may also ask to measure folds of the skin and the fat just under your
skin (skinfolds) to estimate your percent body fat.
Flexibility:
You will be asked to perform flexibility tests for both the upper and lower body. For each, you will stretch as
far as you can slowly without strain, while the student trainer records the measure.
Muscular Fitness:
You will be asked to perform muscular fitness tests for the upper and lower body. These tests may include sit-
ups and push-ups, as well as, exercises using equipment in McKenna.
Cardiovascular Fitness:
You will be asked to perform a submaximal exercise test on a cycle ergometer. The exercise intensity will
begin at low level and will be advanced in stages depending on your fitness level. We may stop the test at any
time because of signs of fatigue or changes in your heart rate or blood pressure, or symptoms you may
experience. It is important for you to realize that you may stop when you wish because of feelings of fatigue
or any other discomfort. You may be asked to perform another submaximal test such as a walking or jogging
test. Your student trainer will explain any tests in detail.
2. Risks and Discomforts

All fitness tests include the risk of injury. There is the possibility of abnormal blood pressure; fainting;
irregular, fast, or slow heart rhythm; and in rare instances, heart attack, stroke, or death. There is also risk of
muscle, joint, or bone injury. Every effort will be made to minimize these risks by evaluation of preliminary
information relating to your health and fitness and by careful observations during testing. Emergency
equipment and trained personnel are available to deal with unusual situations that may arise.
3. Responsibilities of the Participant

Information you possess about your health status, previous injuries, or experiences of heart-related symptoms
(i.e., shortness of breath with low-level activity, pain, pressure, tightness, heaviness in the chest, neck, jaw,
back, and/or arms) with physical effort may affect the safety of your exercise test. Your prompt reporting of
these and any other unusual feeling with effort during the exercise test itself is very important. You are
responsible for fully disclosing your medical history, as well as symptoms that may occur during the test. You
are also expected to report all medications (including nonprescription) taken recently and, in particular, those
taken the day of the test to the student trainer.
4. Benefits to be Expected
The results obtained for the exercise tests may assist in the development of an individualized exercise
prescription and will provide information that will be helpful in tracking your potential fitness changes of time.
5. Inquiries
Any questions about the procedures used in the exercise tests or the results of your tests are encouraged. If
you have any concerns or questions, please ask us for further explanations.
6. Use of Your Results
Your medical history will be treated as privileged and confidential. The student trainer and faculty teaching
the class (Exercise Science Senior Synthesis) will see the forms that you complete. The information obtained
during exercise testing may be used in discussions as part of the class-learning environment.
7. Freedom of Consent
I hereby consent to voluntarily engage in fitness/exercise tests to estimate my health related fitness. My
permission to perform the tests is given voluntarily. I understand that I am free to stop any test at any point if I
so desire.
I have read this form, and I understand the test procedures that I will perform and the attendant risks and discomforts.
Knowing these risks and discomforts and having had an opportunity to ask questions that have been answered to my
satisfaction, I consent to participate in fitness testing.
_________________________________________ _________________________
Signature of client Date
_________________________________________
Client Name Printed
_________________________________________ _________________________
Signature of Witness Date
_________________________________________
Witness Name Printed

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SETON HILL UNIVERSITY

SHU PERSONAL TRAINING PROGRAM

1. Purpose and explanation of the tests.

2. Risks and Discomforts

3. Responsibilities of the Participant

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