NASM CPT Client Assessments: Intake, PAR-Q, Vitals, and Body Composition

The NASM CPT assessment sequence, from paperwork to performance

Domain 3, Assessment, is 16% of the NASM-CPT exam. Its first task is subjective: use questionnaires and interviews to assess a client's medical history, needs, and readiness. The physical tests come after. A practical order is below. The blueprint lists these assessments without fixing a sequence, so treat this as a teaching order in which each step can stop or reshape the next.

1. Subjective screening. A readiness questionnaire, plus personal, occupational, and family medical history and a lifestyle questionnaire covering sleep, stress, tobacco, and alcohol use.
2. Physiological measures. Resting heart rate, blood pressure, and waist-to-hip ratio.
3. Body composition. Skinfold calipers, circumference measurements, or bioelectrical impedance, and the fat-mass and lean-mass math that follows.
4. Posture and movement. A static postural assessment, then movement assessments such as the overhead squat, single-leg squat, push, pull, and gait.
5. Performance. Cardiorespiratory, strength, power, and speed tests chosen for the client's goals and limits.

One rule sits above the sequence. NASM's Code of Professional Conduct says a certified professional must not begin training a client before receiving and reviewing a current health-history questionnaire signed by the client. If step one is not done, nothing else starts.

Screening with the PAR-Q, the PAR-Q+, and a health history

The blueprint names the Physical Activity Readiness Questionnaire (PAR-Q). Its current successor is the PAR-Q+, published by the PAR-Q+ Collaboration, which offers a 2025 fillable version on its site. As checked on October 17, 2026, the PAR-Q+ works like this:

• Page 1 has seven general health questions. A client who answers no to all seven is cleared for physical activity, signs the participant declaration, and should start slowly. The form adds that anyone over 45 who is not used to vigorous exercise should consult a qualified exercise professional before working at that intensity.
• A yes leads to follow-up questions about living with a chronic medical condition. No to all of those means the client is ready to become more physically active, starting slowly at low to moderate intensity, and the form advises working with a qualified exercise professional on the plan.
• A yes on the follow-up pages points the client to the ePARmed-X+ and/or a qualified exercise professional, and higher-risk results may require healthcare clearance.

Your job is to administer the form, read it, and follow the path it sets, plus your facility's policy. You are not interpreting the medical condition behind a yes.

The health history fills in what a questionnaire cannot. The blueprint lists personal, occupational, and family history, and it names medical risk factors such as pregnancy, eating disorders, hypertension, and the client's age. Occupational questions are often the most useful for program design: hours spent sitting, repetitive lifting, or footwear worn all day can all show up later in a movement assessment.

Resting heart rate and blood pressure: what a trainer records

Resting heart rate. The American Heart Association (AHA) describes a normal resting heart rate as 60 to 100 beats per minute when a person is sitting or lying, calm, and well. Trained people can sit lower, and medications such as beta blockers slow the heart rate. To measure it, find the pulse on the inner wrist with the index and middle fingers and count the beats for 60 seconds.

Blood pressure. The AHA categories, from its page last reviewed August 14, 2025, are below. The trainer column is Passy's suggestion for staying inside scope. Check it against your facility's policy and NASM's course.

The AHA adds that only a doctor or other medical professional can confirm a high blood pressure diagnosis. A single reading in the trainer's office is information to pass on, not a verdict.

The blueprint also lists "applicability of assessments from other health professionals," such as blood pressure, cholesterol, glucose, and BMI. If a client brings recent results from a physician, they add context. Interpreting lab values is the physician's job.

Body composition methods the blueprint names

For adults, the CDC's categories are underweight below 18.5, healthy weight 18.5 to less than 25, overweight 25 to less than 30, and obesity 30 or greater.

The blueprint expects you to calculate fat mass and lean mass. The math is short. A client who weighs 180 pounds at an estimated 25% body fat carries 180 × 0.25 = 45 pounds of fat mass and 180 − 45 = 135 pounds of lean mass. If a later test shows 22% at 176 pounds, fat mass is about 38.7 pounds and lean mass about 137.3 pounds, so the client lost fat and kept lean tissue even though the scale moved only four pounds.

A worked intake with a fictional client

Janelle, 47, is fictional. She wants to run a 5K.

1. Questionnaire. She answers yes to the general PAR-Q+ questions on high blood pressure and on prescribed medication. You follow the form to its follow-up pages instead of guessing what the yes means.
2. History. She works long shifts standing, sleeps about six hours, and does not smoke. Her physician manages her blood pressure.
3. Resting measures. Seated and calm, her blood pressure is 134/86, which falls in the AHA's stage 1 range. Her resting pulse is 58 beats per minute, and she mentions her medication is a beta blocker.
4. Decision. Training waits until the PAR-Q+ path and any clearance it calls for are complete. NASM's code says a certified professional should not train a client with a diagnosed health condition unless trained to do so, following procedures prescribed and supervised by a licensed medical professional, or licensed to do so.
5. Test selection. Because her medication slows her heart rate, heart-rate-based fitness estimates will mislead you. The performance and cardio assessments guide explains the alternatives, such as ratings of perceived exertion.

Notice that the most important decision in Janelle's intake happened before any physical test. Once you can walk through her case without the list, test the same screening judgment in a mixed NASM CPT set →; one of its 20 questions is a chest-pain screening decision.

When an assessment result means referral or a retest

The blueprint asks you to recognize "indicators that a client's condition requires a medical release/clearance or is out of scope and requires referral to another professional." NASM's code gives the minimum list. Refer the client to the appropriate medical practitioner when you become aware of:

• any change in the client's health status or medication
• an undiagnosed illness, injury, or risk factor
• unusual pain or discomfort during a session that warrants professional care, in which case you stop the session immediately

Reassessment is the other half of the domain. The blueprint's criteria are time elapsed, a client plateau, a change in goals, a change in health, a change in phase, and weight loss or gain. Each one is a reason to repeat the relevant tests, not the whole battery.

Where the physical assessments go next

Movement assessment has its own guide: the overhead squat assessment guide covers the kinetic chain checkpoints and how compensations shape a program. Clients who are pregnant, older, young, or managing a clinical condition need modified assessments, which the special populations guide covers.

To check this section of Domain 3 under time pressure, work through 20 mixed NASM CPT questions →; one turns on a client whose progress has stalled. If the reassessment triggers keep slipping, list all six from memory until you can name them without looking.