PHRE 3043 – Data Submission Data Collection - PHRE 3043 Client Info Sex * Male Female Body Weight (kg) * kg Height (cm) * cm Age * Activity Readiness Screening Get Active Questionnaire Complete Yes Resting HR (bpm) bpm Systolic BP mmHg Diastolic BP mmHg PIN Assessment Data Push Up - Raw Score (#) Push Up - PIN Score Sit and Reach - Raw Score (cm) Sit and Reach - PIN Score Back Extension - Raw Time Back Extension - PIN Score 1.5 Mile Run - Raw Time 1.5 Mile Run - PIN Score Total Did you meet the PIN Fitness Award standard? No Yes 1.5 Mile Data RPE (1-10) Average HR (bpm) HR at the end of the run (bpm) Time (min) Convert your seconds to a decimal. VO2 max 1 ml/kg/min VO2 max 2 ml/kg/min PREP Circuit Data Time for Circuit (sec) sec Did you meet the 157s circuit standard (wearing 18 lbs) Yes No Peak RPE for Circuit (1-10) Peak HR for Circuit (bpm) bpm Average HR for Circuit (bpm) bpm 20M Shuttle Run Data 20M shuttle run stage: Did you meet the PREP standard Yes No Peak RPE for 20M shuttle run (1-10) Peak HR for 20M shuttle run (bpm) bpm Average HR for 20M shuttle run (bpm) bpm PREP Assessor Were you a good assessor for the PREP I am pretty good I need some practice Movement Screening Overhead Squat Score Dowel Hinge Score Scapular Wall Slide Forearm Plank Hold Excellent Good Needs Improvement Poor FMS Scores Deep Squat Final Score Hurdle Step Raw Score (Right) Hurdle Step Raw Score (Left) Hurdle Step Final Score Inline Lunge Raw Score (Right) Inline Lunge Raw Score (Left) Inline Lunge Final Score Shoulder Mobility Raw Score (Right) Shoulder Mobility Raw Score (Left) Shoulder clearing test (Right) + - Shoulder clearing test (Left) + - Shoulder Mobility Final Score Active Straight Leg Lift Raw Score (Right) Active Straight Leg Lift Raw Score (Left) Active Straight Leg Lift Final Score Trunk Stability Pushup Raw Score Extension clearing test + - Trunk Stability Pushup Final Score Rotary Stability Raw Score (Right) Rotary Stability Raw Score (Left) Flexion clearning test + - Rotary Stability Final Score FMS Total Score & Weakest Link FMS Total Score (0-21) Your 'Weakest Link' Active Straight Leg Raise Shoulder Mobility Rotary Stability Trunk Stability Pushup Inline Lunge Hurdle Step Deep Squat No weak link Modern Burpee Number of Burpees (with proper form) RPE (1-10) HIIT prescription Training modality Treadmill Bike Rowing machine Prescription time for work (seconds) s Prescription time for rest (seconds) s Prescription intensity for work (% HRR) % Prescription for intensity for work (bpm) bpm HIIT Actual (what you did in training) 1 - time (work; seconds) s 1 - HR (work; bpm) bpm 1 - RPE (work; 1-10) 1 - time (rest; seconds) s 1 - HR (rest; bpm) bpm 2 - time (work; seconds) s 2 - HR (work; bpm) bpm 2 - RPE (work; 1-10) 2 - time (rest; seconds) s 2 - HR (rest; bpm) bpm 3 - time (work; seconds) s 3 - HR (work; bpm) bpm 3 - RPE (work; 1-10) 3 - time (rest; seconds) s 3 - HR (rest; bpm) bpm 4 - time (work; seconds) s 4 - HR (work; bpm) bpm 4 - RPE (work; 1-10) 4 - time (rest; seconds) s 4 - HR (rest; bpm) bpm 5 - time (work; seconds) s 5 - HR (work; bpm) bpm 5 - RPE (work; 1-10) 5 - time (rest; seconds) s 5 - HR (rest; bpm) bpm 6 - time (work; seconds) s 6 - HR (work; bpm) bpm 6 - RPE (work; 1-10) 6 - time (rest; seconds) s 6 - HR (rest; bpm) bpm 7 - time (work; seconds) s 7 - HR (work; bpm) bpm 7 - RPE (work; 1-10) 7 - time (rest; seconds) s 7 - HR (rest; bpm) bpm 8 - time (work; seconds) s 8 - HR (work; bpm) bpm 8 - RPE (work; 1-10) 8 - time (rest; seconds) s 8 - HR (rest; bpm) bpm Save
