On initial contact, the assessment worksheet is completed, which includes the following information:

1. Diagnoses
2. Current medications
3. Allergies
4. Most current lipid panel (if available)
   • Total Cholesterol
   • Triglycerides
   • LDL Cholesterol
   • HDL Cholesterol
   • Total Cholesterol/HDL Cholesterol Ratio
5. Age
6. Weight (in pounds)
7. Height (in feet and inches)
8. Percent body fat (by hand-held fat analyzer) or BMI
9. Fat mass (in pounds by hand-held fat analyzer) or BMI
10. Condition of feet/shoes
11. Blood pressure (pre- and post-exercise)
12. Resting heart rate (RHR) (with Polar heart rate monitor) following 5 minutes of sitting prior to exercise
13. Cool-down heart rate (CDHR) - taken 5 minutes after exercise while client is resting

We make every effort to introduce ourselves to the client and start things off on a positive note. The room has music, a VCR and TV, and a client/staff ratio of 1:1. We first record weight and height and then strap the heart rate monitor around the client's chest. The participant sits down and relaxes for 5 minutes while we review the medical chart. We record resting heart rate, blood pressure, and body composition. At this point, the therapist must make a judgment about the amount of support that will be required by the participant. If the client has no history of seizures or aggressive behaviors and has a near normal gait pattern, we may attempt to use only a gait belt. However, if there is any question about how the participant will perform, the harness system allows us to test the individual without risking a fall. This allows the therapist to devote his or her attention to monitoring the person and determining the most appropriate parameters for exercise (rate, grade, time).

During the evaluation period, we identify a comfortable stride. Walking either too slowly or too quickly may cause an abnormal gait pattern. The ideal rate allows for a comfortable gait while getting the heart rate into the target range and keeping it there for between 20 and 30 minutes. We use the Karvonen formula (American College of Sports Medicine, 1991) to calculate the target range:

Individuals with physical limitations or movement disorders that cause stress on one or more joints due to biomechanical considerations may not tolerate higher speeds without experiencing risk of injury or pain. To increase the workload for these individuals, increasing the incline may be the preferred alternative. While someone might only tolerate exercise in his or her target range for 5 to 10 minutes initially, time should increase with training and improved cardiovascular endurance. The objective of the evaluation is to determine a starting point for exercise parameters (speed, incline, and time) that are safe, well-tolerated, and provide a workout in the target heart rate range. Frequent checks of the heart monitor are taken so that adjustments in speed and incline can be made to maintain the individual in his or her target range. Adjustments are recorded along with the maximum heart rate. When the client has either completed the 30-minute protocol or demonstrates signs of distress or fatigue, the program is terminated. A 2-minute cool-down is recommended. Having completed the evaluation, the client is removed from the treadmill and asked to rest for 5 minutes. The recovery heart rate is documented and used to set a baseline for training as well as to ensure that the participant returns to a near-baseline heart rate. The worksheet used for monitoring the client can be found in Appendix A, and the process is repeated a minimum of 3 times over a 1- to 2-week period.