The undersigned hereby gives informed consent to engage in a series of health and medical evaluations including an exercise test. The purpose of this test is to determine my physical fitness and health status.

    Exercise testing may be performed in a health and fitness center setting by a variety of means. Individuals trained in administration of the tests will conduct the voluntary Target Fitness Program Assessment. The assessment will include the following:

1. Blood Glucose Level and Cholesterol Level will be determined by blood analysis. The blood will be collected by either venipuncture or capillary finger prick. A blood pressure cuff will determine Blood Pressure.

2. Body Composition will be determined by a variety of assessment methods:

• The Electrical Impedance device involves using a small portable instrument and placing four electrodes on the skin to measure conductance of a very weak electrical current.

• Body weight and height will be measured on a standard medical scale.

• A Waist to Hip Ratio will involve measuring the circumference of the hip and waist with a tape measure and determining their relationship.

• A Skin fold Caliper Device will be used to measure the thickness of substantial fat stores under the skin. Three sites will be taken to estimate the over all body fat.

3. Cardiorespiratory Screening will be done to provide an estimate of the cardiorespiratory fitness of the individual. Cardiorespiratory fitness is defined as the ability of the heart and lungs to provide oxygen to the muscles. The tests below are not valid nor should they be administered to individuals taking medications that affect heart rate. Cardiorespiratory screening will be done by any of the following methods:

• A 3-Minute Step Test will be used as one method. The purpose of the Step Test is to measure the heart rate in the recovery period following three minutes of stepping. The results of the Step Test provide an indication of the cardiorespiratory fitness of the individual. The test is a tool that can be used to demonstrate an individual's progress during a training program. The recovery heart rate becomes lower, indicating a more efficient heart.

• Ergometer with Robobike Attachment will be used to measure cardiorespiratory fitness as the individual pedals the bike at a moderate intensity for a specified time period as their heart rate and blood pressure are monitored.

• The One-Mile Walk Test is another method. The purpose of the One-Mile Walk Test is to measure the heart rate in the recovery period following a one-mile walk and comparing it to the time it takes to walk the one mile. The test provides the individual with a general assessment of cardiorespiratory fitness. The tester or the tested may stop any of the tests should symptoms of pain, fatigue, breathlessness, or other symptoms dictate.

4. A Maximum Chest Press and Leg Press Test, and a One-Minute Push-Up and Sit-Up Test will be used as screening devices for measuring muscular strength and endurance, respectively. The chest press and push-up tests measure the strength and endurance of the chest, shoulder, and upper arm muscles. The leg press test measures the strength of the thigh and buttock muscles. Muscular strength is defined as the amount of tension that a muscle can generate in one maximum-effort contraction. The sit-up test measures the endurance of the abdominal and hip flexor muscles. Muscular endurance is defined as the ability to contract a muscle repeatedly over a period of time. If you should have back, shoulder, or knee problems, please make the tester aware before beginning the tests. The tester or the tested may stop the test should symptoms of pain, fatigue, breathlessness, or other symptoms dictate.

5. The Sit and Reach Test will be used as a screening device for measuring flexibility of the muscles in the back of the legs and trunk. Flexibility is defined as the range of possible movement in a joint or group of joints. The test may be stopped by the tester or the tested should symptoms of pain, fatigue, or other symptoms dictate.

The entire testing procedure should take no more than one hour of my time. I realize that I may withdraw from the program at any time at no prejudice to me.

    The benefits of such testing are the scientific assessment of physical fitness and the appraisal of health hazards, which may facilitate prescription of my exercise and other lifestyle habits. All records and results from this testing will be held in strict confidence unless my written consent is obtained.

    I understand that trained health promotion specialists will Supervise, directly or indirectly, the Targeting Fitness Program in which I will participate. There may be some slight risk associated with the exercise program, there is a chance that some cardiovascular problem could develop, and in very rare instances a heart attack could occur. Excessive exercise in hot, humid conditions can lead to heat injury such as heat exhaustion or heat stroke. This danger can be reduced by altering my exercise program during hot and humid weather, by drinking plenty of water, and by recognizing the early signs of heat injury. Careful medical screening prior to entering the program minimizes these risks. If further diagnostic or therapeutic care is needed, I understand that it is my financial responsibility.

    There are numerous benefits to participation in the wellness program. I will learn how to improve my diet, lose weight, manage stress, and how to exercise safely and effectively. Improving these health practices is thought to improve my overall health status and functional ability.

    I have had a chance to have my questions answered to my satisfaction about this program. I understand that if I have additional questions, I may contact my Coordinator.

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