NUTRITIONAL TEST - BMI
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- Randolph Conley
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1 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) NUTRITIONAL TEST - BMI How to Calculate Your BMI: Formula: weight (lb) / [height (in)] x 703Calculate BMI by dividing weight in pounds (lbs) by height in inches (in) squared and multiplying by a conversion factor of 70Example: Weight = 50 lbs, Height = 5 5 (65") Calculation: [50 (65) ] x 703 = 4.96 Or go to the bottom of and use the BMI calculator. USE CHART BELOW BMI BMI Values Below: If your BMI is 30.0 and above score yourself a your score is a give yourself a 30.0 and Above DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR BMI TEST
2 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) NUTRITIONAL TEST - BM Bowel Movements: Many people believe that the definition of a normal bowel movement is having movement each day, but that is not true for everyone. There is no rule for frequency of bowel movements, but the general range is from 3 times a day to 3 times a week. Less than 3 movements a week may indicate constipation, and more than 3 watery stools a day could indicate diarrhea. A bowel movement should be soft and easy to pass, though some people may have harder or softer stools than others. Stool should be brown or golden brown, be formed, have a texture similar to peanut butter, and have a size and shape similar to a sausage. Number of Bowel Movements a day: Type: If your BM is absent, loose, watery or abnormal score yourself a. Normal but not every day your score is a. Normal bowel to 3 times a day give yourself a Abnormal Normal not everyday Normal everyday 30 DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR BM TEST
3 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) NUTRITIONAL TEST - Balance Body Chemistry Assessment. Fill out Balance Body Chemistry Outcome Assessment Form and turn in to be scored by computer: Drop off or mail to: Back to Life Chiropractic Fax: W Highway 46 Crestwood, KY backtolifeky@att.net Write Results from Balancing Body Chemistry Test: TOTAL If your total scores add up to 0-5 score yourself a 6- your score is a. 3 and greater give yourself a. 3< DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR Balance Body Chemistry TEST
4 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) NUTRITIONAL TEST - Nutritec Symptom Survey Form. Fill out Nutritec Symptom Survey Form. EACH SECTION REPRESENTS A SYSTEM OF THE BODY Write Results from Nutritec Symptom Survey Form: SD PD SR CV LBIL DIG HT ht HP hp HA ha FEMALE MALE TOTAL If your total scores add up to 0-5 score yourself a 6- your score is a. 3 and greater give yourself a. 3< DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR SP Outcome Assessment TEST
5 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) NUTRITIONAL TEST - PH BALANCE Urinate or spit in a cup. Tear off a strip of PH paper or take a PH strip and dip into urine or saliva. Read results and compare to chart. Record results. PH One test can be done at our office. Strips can be bought at Back to Life Chiropractic, health food stores or online. Urine ph is used to classify urine as either a dilute acid or base solution. Seven is the point of neutrality on the ph scale. The lower the ph, the greater the acidity of a solution; the higher the ph, the greater the alkalinity. The glomerular filtrate of blood is usually acidified by the kidneys from a ph of approximately 7.4 to a ph of about 6 in the urine. Depending on the person's acid-base status, the ph of urine may range from 4.5 to 8. Secretion of an acid or alkaline urine by the kidneys is one of the most important mechanisms the body uses to maintain a constant body ph. PH If your PH is score yourself a your score is a give yourself a DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR PH TEST
6 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) NUTRITIONAL TEST - ZYTO Schedule a time to be scanned at Back to Life Chiropractic or other ZYTO owner. Get scanned. Take report and score yourself below. Circle areas, below, that were indicated on your test. (use the Zyto biosurvery information sheet to eliminate foods that could be causing inflammation) Total Circled: If your ZYTO has no results score yourself a. to results your score is a. 3 or greater give yourself a 3 or greater results to results No Results 30 DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR ZYTO TEST
7 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) CARDIO TEST - BP Blood Pressure: / Blood Pressure can be done at our office. See graphs about BP below: Blood Pressure Category Systolic (top #) (mm Hg) Diastolic (bottom #) (mm Hg) Normal less than 0 and less than 80 Prehypertension 0 39 or High Stage or Stage 60 or higher or 00 or higher If your BP is greater than 40/99 score yourself a. 0-39/80-89 your score is a. Less than 0/less than 80 give yourself a Greater than 40/ /80-89 Less than 0/80 30 DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR BP TEST
8 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) CARDIO TEST - THR SubMax Test with a step Figure out you Maximum Heart Rate (MHR) by doing 0 your age= Cardiovascular with a Heart Rate Monitor with a Step: The SubMax Step Test. Use a 6" to 8" step (almost any step in your home or in a club will do) and perform a 3-minute step test. After your warm-up, step up and down in a four-count sequence as follows: right foot up, left up, right down, left down. Each time you move a foot up or down, it counts as one step. Count "up, up, down, down" for one set, with 0 sets to the minute. It is very important that you don't speed up the pace--keep it regular. After minutes, you'll need to monitor your heart rate for the last minute. The SubMax Step Test now can be used to predict your MHR for your current condition if you were in excellent shape. Add to your last minute's heart rate average the following number: Excellent Shape: +75 bpm. Poor Shape: if you are over your THR by +5 bpm. Average Shape: if you are over +0 bpm Excellent Shape: less than 0 bpm off THR Your result should be pretty close to your Max HR. Your SubMax Result: 75 + = If your SubMax test is 5 bpm over your THR score yourself a. SubMax test is 0-5 bpm over your MHR score is a. SubMax test is less than 0 bpm off give yourself a Poor Shape Average Shape Excellent Shape 30 DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR THR-SubMax with a step TEST
9 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) CARDIO TEST - THR Mile Test Cardiovascular (without heart rate monitor): The Cooper Institute in Dallas recommends using this method for those who take medication that affects heart rate or those who don t want to use a heart-rate monitor. This really is one of the easiest ways to test your cardio fitness. Measure a mile on an athletic field track (usually four laps) or on one of your neighborhood streets (use your car s odometer to clock the distance). Using a stopwatch or watch with a second hand, walk the mile as fast as you can without running. Note the time and compare your results with the chart to right and record results: Track time: Excellent Under 40 Over 40 Men Women Men Women 3:00 or less 3:30 or less 4:00 or less 4:30 or less Good 3:0-5:30 3:3-6:00 4:0-6:30 4:3-7:00 Average 5:3-8:00 6:0-8:30 6:3-9:00 7:0-9:30 Below Average Poor 8:0-9:30 8:3-0:00 9:0-:30 9:3-:00 9:3 or more 0:0 or more :3 or more :0 or more If your score in below average to poor score yourself a. Good to Average score is a. Excellent give yourself a Below AVG to Poor Good to Average Excellent 30 DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR THR-Mile TEST
10 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) Flexibility of Neck, Mid and Low Back: FLEXIBLITY TEST - ROM Do by eyeball, get measured by ROM diagnostic equipment or Back to Life Chiropractic. Write results in box next to normal values. Graphs to be filled out BELOW: Option of Flexibility of Mid Back: Keep knees locked and touched the ground with your hands. Record results: Hands flat, fingers touching, or inches from the floor. Flexion (head forward) Neck Range of Motion Normal 50 Extension 60 (head back) Left Rotation 80 Actual Impairment Mid Back Range of Motion Flexion (knees locked-touch Left Rotation (bend forward and to the left) Normal Impairment Actual Low Back Range of Motion Flexion (knees locked-touch Extension (bend back) Normal Impairment Actual 60 5 Right Rotation 80 Left Lateral Flexion (ear to shoulder) Right Lateral Flexion (ear to shoulder) Right Rotation (bend forward and to the right) Option : 30 Left Lateral Flexion (bend to left) Right Lateral Flexion (bend to right) 5 5 Actual divided by normal=impairment Inches from floor: Touch the floor: 3 Wellness 5 inches or less: Average 5 inches or more: Crisis If your ROM is full in all 3 regions score yourself a Less than 0% impairment in any region score yourself a. Greater than 0% impairment in any region give yourself a. < THAN 0% LESS THAN 0 OFF FULL ROM 30 DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR ROM TEST
11 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) STRENGTH TEST - MRULFB Strength UPPER AND LOWER BODY: Lift MINIMUM RESISTANCE: weight (0lbs) or elastic band (blue Synergy at our office) 8 times (reps) and check if performed every week ( to 3 times a week). Bench Press: Biceps Curl: Triceps Curl: Reverse Fly: Quadriceps: Hamstrings: Calves: each to 3 X a week Neck Muscles: Using a cm Synergy ball (or comparable size) available at our office do minimum (3 times) amount of reps to 3 times a week: to 3 X a week STRENGTH FRONT: Abdominals: Do minimum (0 times) sit-ups at one time without rest to 3 times a week. Check if performed. Sit Ups: to 3 X a week STRENTH BACK: Back Extensors: Do minimum (8 times) back extension exercises to 3 times a week. Check if performed. Superman Exercise: or Elastic Band Back Extension Exercise: to 3 X a week See Rehab Sheet for Picture of Exercises in Strength Category of website If you performed all upper, lower, front and back exercises, MRULFB, with minimum resistance to 3 times a week score yourself a MRULFB once a week score is a. MRULFB less than every week or can not do minimum resistance score yourself a. MRULFB not performed weekly MRULFB > than to3 week MRULFB Performed 30 DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR MRULFB TEST
12 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) STRENGTH TEST - SEMG. Have a SEMG scan from a diagnostic center or clinic that has capability or make an appointment at Back to Life Chiropractic for scan. OPTION : ( PRINTED) Write Results from SEMG Scan: OPTION : (NO PRINTED) CHECK RESULTS FROM SCAN: Score BLACK/RED: CRISIS BLUE/GREEN: WHITE: WELLNESS MARK BELOW If your total score adds up to score yourself a score is a score yourself a. 30 DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR SEMG TEST
13 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) POSTURE TEST - VISUAL Posture: Posture simply refers to the alignment of your body. If you had perfect posture the forces of gravity would be distributed equally throughout your body and there wouldn t be too much stress on any one joint, ligament or muscle. Stand with your feet shoulder width apart, toes pointing straight to the front. Your knees should be aligned with your ankles, keep a slight bend in the knee and avoid locking them. Your hips should be in line with your knees and your pelvis should be in a neutral position. If you were to imagine that your pelvis was a bowl of water, neutral would be the place where the water wasn t spilling out to the back or to the front. Keep your abdominal muscles tight and draw your shoulders back so that they are also in line with your hips. Your ears should be over your shoulders and chin parallel to the floor. Visually check ( ) if your posture is like the Posture Charts: Side Posture: Head Shoulders Pelvic Knees Ankle Front Posture: Eyes Shoulders Pelvic Knees Feet If you need help seek the help of someone who evaluates posture or make an appointment at our office to be evaluated. If you checked all the regions above score yourself a If you left one to two regions unchecked score is a. If you unchecked more than regions give yourself a. > Regions Unchecked to Regions Unchecked All Regions Checked 30 DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR VISUAL TEST
14 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) POSTURE TEST - X-RAY EVALUATION 5 Lateral and AP X-Ray Analysis 0 Have X-Ray Analysis of any region of interest to see if in normal range (lateral and AP views). Score yourself: Cervical Radiographs: Lateral and AP. Check if normal: Thoracic Radiographs: Lateral and AP. Check if normal: Lumbar Radiographs: Lateral and AP. Check if normal: If you checked all the regions above score yourself a If you left one region unchecked score is a. If you unchecked more than regions give yourself a. > Region Unchecked Region Unchecked All Regions Checked 30 DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR X-RAY TEST
15 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) NERVOUS SYSTEM TEST - Nutritec Symptom Survey Form. Fill out Nutritec Symptom Survey Form. SD is for Sympathetic Nervous System and PD is for Parasympathetic Nervous System Write Results from Nutritec Symptom Survey Form: SD TOTAL PD Normal is no results. If your total scores add up to 0-5 score yourself a 6- your score is a. 3 and greater give yourself a. 3< DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR SP Outcome Assessment TEST
16 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) NERVOUS SYSTEM TEST - THERMAL SCAN. Have a thermal scan from a diagnostic center or clinic that has capability or make an appointment at Back to Life Chiropractic for scan. OPTION : ( PRINTED) Write Results from THERMAL Scan: OPTION : (NO PRINTED) CHECK RESULTS FROM SCAN: Score BLACK/RED: CRISIS BLUE/GREEN: WHITE: WELLNESS MARK BELOW If your total score adds up to score yourself a score is a score yourself a DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR THERMAL TEST
17 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) NERVOUS SYSTEM TEST - PULSE WAVE. Have a PULSE WAVE PROFILE scan from a diagnostic center or clinic that has capability or make an appointment at Back to Life Chiropractic for PWP test. Write Results from PWP test: Autonomic Activity Index: Autonomic Balance Index: Total Score If your total score adds up to score yourself a score is a score yourself a DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR PULSE TEST
18 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) ARCHES TEST - SCAN Arches of Feet: Feet have 3 normal arches: Your feet are the foundation of your body. They support you when you stand, walk, or run. And they help protect your spine, bones, and soft tissues from damaging stress as you move around. Your feet perform better when all their muscles, arches, and bones are in their ideal stable positions. The foot is constructed with three arches which, when properly maintained, give exceptional supportive strength. These three arches form a supporting vault that distributes the weight of the entire body. If there is compromise of one arch in the foot, the other arches must compensate and are subject to additional stresses, which usually leads to further compromise. A lose of the arch of the foot causes the knee and hip to rotate internally leading to knee, hip and back problems. FOOT SCAN: Have foot scanned at a center that has diagnostic equipment. Schedule a time to be scanned at Back to Life Chiropractic. Results of SCAN: RIGHT FOOT: Normal or Abnormal LEFT FOOT: Normal or Abnormal Both feet are normal score yourself a 3 or if you wear custom made orthotics everyday. One foot normal score yourself a or if you wear some type of generic orthotic or arch support everyday. Both feet abnormal score yourself a and wear no type of orthotic or arch support. Both Feet Abnormal One Foot Normal Both Feet Normal 30 DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR SCAN TEST
19 40 Madison Corinthians nd St. Madison, 6:9-0 IN HEAL (435) ARCHES TEST - VISUAL Arches of Feet: Feet have 3 normal arches: Your feet are the foundation of your body. They support you when you stand, walk, or run. And they help protect your spine, bones, and soft tissues from damaging stress as you move around. Your feet perform better when all their muscles, arches, and bones are in their ideal stable positions. The foot is constructed with three arches which, when properly maintained, give exceptional supportive strength. These three arches form a supporting vault that distributes the weight of the entire body. If there is compromise of one arch in the foot, the other arches must compensate and are subject to additional stresses, which usually leads to further compromise. A lose of the arch of the foot causes the knee and hip to rotate internally leading to knee, hip and back problems. VISUAL CHECK: CIRCLE ANY OF THE RED FLAGS TO RIGHT Results of VISUAL CHECK: RIGHT FOOT: Normal or Abnormal LEFT FOOT: Normal or Abnormal Both feet are normal score yourself a 3 or if you wear custom made orthotics everyday. One foot normal score yourself a or if you wear some type of generic orthotic or arch support everyday. Both feet abnormal score yourself a and wear no type of orthotic or arch support. Both Feet Abnormal One Foot Normal Both Feet Normal 30 DAYS 45 DAYS 90 DAYS 0DAYS / YEAR YEAR Visual TEST
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