Medical-Fitness Technician
Certification Course
Part C: Assessing Medical-Fitness
Learning Modules: 25-34
Learning Module 30:
Aerobic Fitness - Shuttle
Study the Learning Module and take the Quiz.
Learning Objective:
  • Properly conduct the Shuttle Test.
  • Calculate the Aerobic Fitness Score.
​For Participants with BMI < 35
Another standardized Aerobic Fitness Test for individuals with a BMI < 35 and otherwise fit enough to participate in calisthenic type exercises is a 4-minute Shuttle Test during which the participant tries to cover as much distance as possible by walking/jogging a 50-meter (55-yard) course back-and-forth until time runs out.

The Shuttle Test Course:
  • Practice taking multiple 1-yard strides or measure off 11 yards (10 meters) and count how many regular strides it takes you to walk that distance.
  • Set a large safety cone at the start of the course.
  • Drop a smaller safety cone every 11 yards (10 meters) for the first 44 yards (40 meters).
  • Drop a large safety cone at the 55-yard (50 meters) mark for the "turn-around" point of the course.
  • Make sure the course is straight, level, and clear of any debris or potential hazards.
  • The course may be set up on a grass or dirt field or a smoothly paved asphalt or cement area.
  • Alternatively, use the "MapMyWalk" app to measure your distance as you slowly walk the course, dropping the cones every 10 meters accordingly.
​Explain the testing procedure to your client:
  • (Inform your client in advance to wear appropriate clothes and shoes for the test.)
  • Your Aerobic Fitness Test involves walking/jogging for 4 minutes.
  • You will slowly warm-up by taking a practice lap or walking/jogging in place.
  • You will tell me when you are ready for me to start the Timer.
  • I will start the Timer when you take your first step and will announce "Timer Started."
  • Both your feet must go beyond the large cone each time you turn-around.
  • You may adjust your speed -- walk, jog, run -- any time as you feel comfortable.
  • Try to cover as much Distance as you comfortably can during the 4 minutes.
  • Give it your best effort, but pace yourself to not over-do it.
  • I will count the laps out-loud as you continue shuttling back-and-forth.
  • I will announce when the Timer stops.
  • You are to stop forward movement when the Timer stops, but continue walking/jogging in place.
  • Do you understand how the test works?
  • Do you have any questions?

Test Protocol:
  • Explain the test and confirm your client's understanding.
  • Start the test when your client indicates he/she is ready and takes his/her first step.
  • Observe your client at all times.
  • Count the laps as your client completes each one.
  • Watch for signs of distress.
  • Do not allow your client to become over-exerted and out-of-breath.
  • Do not inform your client how much time has elapsed or remains.
  • When the Timer stops (alarms), announce, "Stop!."
  • Mark the spot where your client was when the timer stopped.
  • Encourage your client to walk/jog slowly in place as his/her heart rate recovers.
  • Estimate and add the distance in meters past the last turn-around cone to the counted laps.
  • Record the Total Distance in meters.

Calculation of Distances:
  • 1 lap (out and back) = 100 meters
  • 1/2 lap (out) = 50 meters
  • Each cone interval = 10 meters
  • Estimate in meters (full steps) any partial distance past the last cone.
  • Example: 7 full laps (100) + 1 half-lap (50) + 1 cone (10) + 5 steps (1) = 765 meters

Calculation of Aerobic Fitness Score:
  • Divide the Total Distance by 800 and then multiply that number by 100.
  • Round off to the first decimal.
  • Example: (Total Distance 765 / 800) x 100 = 95.625 = 95.6

Aerobic Fitness Score Interpretation:
  • Use the Score Interpretation chart below.
  • A score of 100 (or more) indicates a Very High Fitness Level in relation to health benefit.
  • A score below 100 indicates "room for improvement."
An “average” fitness level for an unfit and unhealthy population, which is at increased risk for sedentary-related chronic disease resulting in premature disability and death, is not satisfactory. A score of 100+ is an appropriate goal for most individuals, no matter how de-conditioned and unhealthy he/she might be.

Encourage all your clients with a score < 100 to try an Aerobic Fitness Training Program for 1-3 months and to return for a Follow-Up Medical-Fitness Assessment. If they follow your Exercise Rx (Learning Module 35), even with only 50% adherence, they will see significant improvement.
Note: The standardized, healthy level for aerobic fitness is being able to jog 800 meters (880 yards, 0.5 miles, 0.8 km) in 4 minutes. This pace is 7.5 mph (12 km/h). The Treadmill Test (previous Learning Module) is 0.05 miles (80 meters or 88 yards) longer than the Shuttle Test. The extra distance on the continuous Treadmill Test is to compensate for the more demanding stop-and-go format of the Shuttle Test. This makes the Fitness Scores between the two formats more comparable.
​For Participants with BMI 35+
The Aerobic Fitness Test for individuals with a BMI > 35 or otherwise not fit enough to participate in calisthenic type exercises is a 10-minute Shuttle Test during which the participant tries to cover as much distance as possible by walking (no jogging) a 50-meter (55-yard) course back-and-forth until time runs out.
Why are Obese (Class 2 & 3) participants tested differently?
  • Medical-Fitness Training that includes jogging and calisthenic type exercises is inappropriate for individuals with a BMI > 35 due to an increased risk of injury and the lower efficiency of calisthenic exercises to burn calories compared to walking.
  • Testing muscle strength is not critical and may even be contraindicated when the BMI is 35 or greater.
  • Medical-Fitness Training is limited to Aerobic Fitness in order to: a) Condition the cardio-pulmonary-vascular system (heart, lungs, and blood vessels), b) Condition the joints, c) Avoid injury, and d) Maximize/accelerate weight-loss.
  • As body weight decreases and the heart and joints are conditioned, walking/jogging speeds can be increased as tolerated.
  • When the BMI is < 35, muscle strength can be assessed and calisthenic type exercises can be added to the fitness training program when appropriate.

​The difference in the Fitness Test parameters for obese clients is because the Medical-Fitness objective for individuals with a BMI > 35 is cardiovascular fitness and weight loss, not muscle development.
The Test Instructions and Test Protocol for participants with a BMI > 35 are the SAME as those above for participants with a BMI < 35, EXCEPT;
  • The Timer is set to 10 minutes (instead of 4 minutes)
  • The client is instructed to WALK at a slow, moderate, or brisk pace as tolerated, but to NOT jog.
  • This is for heart and joint safety, fitness training, and weight-loss purposes.
Calculation of Distances:
  • 1 lap (out and back) = 100 meters
  • 1/2 lap (out) = 50 meters
  • Each cone interval = 10 meters
  • Estimate in meters (full steps) any partial distance past the last cone.
  • Example: 5 full laps (100) + 0 half-lap (50) + 3 cones (10) + 4 steps (1) = 534 meters

​Calculation of Aerobic Fitness Score (1600 meters = 1 mile):
  • Divide the Total Distance by 1600 and then multiply that number by 100.
  • Round off to the nearest first decimal.
  • Example: (Total Distance 534 / 1600) x 100 = 33.375 = 33.4

Aerobic Fitness Score Interpretation:
  • The initial Aerobic Fitness Goal for obese clients is to jog 1 mile in 10 minutes (6 mph) for a Score of 100.
  • Your client's Aerobic Fitness Score (33.4) can be compared directly to the initial Goal of 100.
  • When your obese client achieves a Score of 100 (and/or a BMI < 35), he/she can be transitioned to the regular Aerobic Fitness Test (if otherwise appropriate) as part of a full Medical-Fitness Assessment.