PHRE 3043 – Data Submission Data Collection - PHRE 3043 Client Info arrowup6 Sex * MaleFemale 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 arrowup6 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? NoYes 1.5 Mile Data arrowup6 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 arrowup6 Time for Circuit (sec) sec Did you meet the 157s circuit standard (wearing 18 lbs) YesNo Peak RPE for Circuit (1-10) Peak HR for Circuit (bpm) bpm Average HR for Circuit (bpm) bpm 20M Shuttle Run Data arrowup6 20M shuttle run stage: Did you meet the PREP standard YesNo 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 arrowup6 Were you a good assessor for the PREP I am pretty goodI need some practice Movement Screening arrowup6 Overhead Squat Score Dowel Hinge Score Scapular Wall Slide Forearm Plank Hold ExcellentGoodNeeds ImprovementPoor 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 arrowup6 FMS Total Score (0-21) Your 'Weakest Link' Active Straight Leg RaiseShoulder MobilityRotary StabilityTrunk Stability PushupInline LungeHurdle StepDeep SquatNo weak link Modern Burpee arrowup6 Number of Burpees (with proper form) RPE (1-10) HIIT prescription arrowup6 Training modality TreadmillBikeRowing 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) arrowup6 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
