Form 3
DON BOSCO TECHNICAL COLLEGE-CEBU, INC.
Pleasant Homes Subdivision, Punta Princesa
PO Box 271, Cebu City 6000
Tel. Nos. 2732301; 2731127& 2731128 Fax Nos. 2721161 & 2732302
_______________________________________________________________________________
PHYSICAL FITNESS TEST (PFT) SCORE CARD
S.Y. 2019 - 2020
NAME: Senador, Louie Victor GRADE/SECTION: 11- Quadrio AGE: 17 SEX: M
SCHOOL: DBTC BIRTHDAY: 7/5/2004
PART I. HEALTH – RELATED FITNESS TEST
PARAMETERS ACTIVITIES PRE-TEST POST-TEST
( 09-02-2021 ) ( )
Body Mass Index (BMI) ● Height (meters) 1.70m
A. BODY ● Weight (kilograms) 55kg
COMPOSITION BMI = Weight (kg.) ● BMI 19
Height (m)2 Classification Normal
● Waist Size 81cm
Waist Circumference (Centimeter/Inches)
Interpretation low
Heart Rate Per Minute 79bpm
B. CARDIOVASCULAR 3 – Minute Step Test ● Before the Activity
ENDURANCE Heart Rate Per Minute 129bpm
● After the Activity
Heart Rate Recovery 127bpm
C. STRENGTH 90 Degrees Push-Up ● Number of Push-Up 24
Basic Plank ● Time (00:00) 1:18.15
seconds
Zipper Test Overlap Gap – Right Arm
D. FLEXIBILITY (cm)
Overlap Gap – Left Arm
(cm)
● First Try
Sit and Reach (cm) ● Second Try
● Best Score
PART II. SKILL – RELATED FITNESS TEST
PARAMETERS ACTIVITIES PRE-TEST POST-TEST
( ) ( )
A. COORDINATION Juggling ● Score: Number of Hits
● Clockwise Time (00:00)
B. AGILITY Hexagon Agility Test ● Counter Clockwise Time
C. SPEED 40 Meter Sprint ● Time (00:00)
● First Trial (cm)
D. POWER Standing Long Jump ● Second Trial (cm)
(distance in cm) ● Middle Score (cm)
Stork Balance Stand Test ● Right Foot Time (00:00)
E. BALANCE ● Left Foot Time (00:00)
● First Trial (cm)
F. REACTION TIME Stick Drop Test ● Second Trial (cm)
● Third Trial (cm)
● Middle Score (cm)
___________________/___________________ _________________/_________________
Name of Partner Name of PE Teacher
Form 4A
PHYSICAL FITNESS TEST STANDARDS
PART I. HEALTH – RELATED FITNESS TEST
A.BODY COMPOSITION: B. CARDIOVASCULAR ENDURANCE
BODY MASS INDEX:
Formula:
Weight(Kilograms)
Height(Meter)2
Ex. 30 = 30 = 20.83
(1.20)2 1.44
20.83 (Normal)
Classification:
Below 18.5 Underweight
18.6-24.9 Normal
25.0-29.9 Overweight
30.0-Above Obese
WAIST CIRCUMFERENCE
Men:
Risk Centimeter Inches
Very High >120 >47
High 100-120 39.5-47
Normal 102 40
Low 80-99 31.5-39
Very Low <80 <31.5
WAIST CIRCUMFERENCE
Women
Risk Centimeter Inches
Very High >110 >43.5
High 90-109 35.5-43
Normal 88 34.6
Low 70-89 28.5-35
Very Low <70 <28.5
3-MINUTE
STEP TEST
Formula:
RHR=
count the
pulse for 10
seconds x 6
MHR= 220-
age
HRR=
MHR-RH
PUSH-UP:
MEN
Classification:
<4 Very Poor
4-10 Poor
11-18 Below-Average
19-34 Average
35-46 Above average
47-56 Good
>56 Excellent
WOMEN
Classification:
0-1 Very Poor
2-5 Poor
6-10 Below-Average
11-20 Average
21-27 Above average
27-35 Good
>35 Excellent
C. STRENGTH
BASIC PLANK:
MEN
Classification:
<25s Poor
63-90s Below Average
91-121s Good
>121 Excellent
WOMEN
Classification:
<77s Poor
77-108 Below Average
107-128.5s Good
>75 Excellent
ZIPPER TEST
Standard:
0 Did touch fingertips
1 Just touched fingertips
2 Fingers overlapped by 1-2cm
3 Fingers overlapped by 3-4cm
4 Fingers overlapped by 5-7cm
5 Fingers overlapped by 8cm and more
D.FLEXIBILITY
SIT AND REACH:
MEN
Classification:
<17.0cm Very Poor
17.0-26.5cm Poor
27-37.5cm Average
38-46.5cm Good
<46.5cm Excellent
WOMEN
Classification:
<20cm Very Poor
20-28.5cm Poor
29-37.5cm Average
38-45.5cm Good
<45.5cm Excellent
Form 4B
PART II. SKILL– RELATED FITNESS TEST
A.COORDINATION:
Standard Excellent Above Average Average Below Average Poor
Classification >50 30-50 15-30 10-15 <5
B AGILTY
GENDER Excellent Above Average Average Below Average Poor
MALE <11.2 secs 11.2 - 13.3 secs 13.4 - 15.5 secs 15.6 - 17.8 secs >17.8 secs
FEMALE <12.2 secs 12.2 - 15.3 secs 15.4 - 18.5 secs 18.6 - 21.8 secs >21.8 secs
C. SPEED
GENDER Excellent Above Average Average Below Average Poor
MALE <11.2 secs 11.2 - 13.3 secs 13.4 - 15.5 secs 15.6 - 17.8 secs >17.8 secs
FEMALE <12.2 secs 12.2 - 15.3 secs 15.4 - 18.5 secs 18.6 - 21.8 secs >21.8 secs
D.POWER
GENDER Excellent Very Good Above Average Below Poor Very Poor
Average Average
MALE > 250cm 241-250cm 231-240cm 221-230cm 211-220cm 191-210cm < 191
FEMALE > 200cm 191-200cm 181-190cm 171-180cm 161-170cm 141-160cm < 141
E.BALANCE
Standard Excellent Above Average Average Below Average Poor
Classification > 50 40 - 50 25- 39 10 - 24 < 10
F.REACTION TIME
Standard Excellent Above Average Average Below Average Poor
Classification <7.5cm 7.5 - 15.9cm 25- 3915.9 - 20.4cm 20.4 - 28cm >28cm
PICS:
Checking pulse:
Checking weight:
Waist size:
Height check:
Planking:
Push ups:
