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Affordable sports science services for athletes and coaches

Affordable sports science services for athletes and coaches

We recognise that the cost of accessing fitness testing can be prohibitive for many athletes and coaches, so we have developed a comprehensive range of affordable portable laboratory testing services for athletes of every level.

Combining expert knowledge with the very latest technology, Cartwright Fitness is uniquely positioned to provide athletes and coaches with the specialist services needed to help them improve their performances.

The mobile nature of our lab allows us to bring elite sports science testing to our customers. Equipment is available to rent or hire on a weekly or monthly basis or on specified days and our team of sport scientists will provide in-depth training for your team. Alternatively, you can hire our expert staff’s services for the day.

Customers can lease or hire the complete lab service or specific market-leading products including the Cosmed Fitmate Pro. The list of available products is increasing daily.

Alternatively, the full range of assessments can be performed in our in-house testing laboratory at our Chester office. The assessments on offer include Vo2 max, lactate profiling, body composition analysis, anthropometric profile, race pace capability, resting metabolic weight, explosive power and strength profile.

From a readymade package of assessments to a bespoke solution tailored to your individual needs, Cartwright Fitness can help.

Our range of assessments includes:

VO2 max assessment – the maximum amount of oxygen your body can utilise at high-intensity exercise. From this, we can determine your anaerobic threshold, heart rate training zones, energy expenditure and fuel source for a given heart rate.

Lactate Profiling – the point before lactate begins to accumulate in the muscles. We can then determine optimal training intensities based on heart rate. This is an excellent way to monitor improvement and progress in training.

Body Composition– assessment of % body fat, % of fat-free mass (lean tissue/muscle) and target body composition for your sport, fitness and health. Speed, agility and power assessments.

Flexibility, anthropometric measures and a host of assessments that can be tailored to suit your needs

Sports science testing enables athletes and coaches to develop an understanding of the physiological components that contribute to and affect performance. This detailed knowledge can then be used to structure your training and enhance your performances.

To find out more about our lab testing services or discuss your specific requirements, please contact a member of the Cartwright Fitness team on 01244 343106.

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Improve performance in 14 days with PowerLung

Here at Cartwright Fitness we’ve gone a bit crazy for the PowerLung and wanted to tell you why!

PowerLung can improve breathing and performance by using it for just a few minutes each day. From those with limited mobility or disability to elite athletes – it benefits all.

Breathlessness can be a real barrier for some people, it can even stop people from exercising. Consider someone who may be overweight who is told to do some exercise for health reasons but because of the weight they carry, they become out of breath before they can get much exercise done.

That sense of breathlessness is when the respiratory muscles do more than they can handle. It is not a nice feeling, and it can put you of walking up the hill to the shop rather than driving. Or at times, pushing yourself on to achieve competitive results and a personal best.

The good news is, there is an easy and inexpensive way to help reduce this breathlessness. What you need is some light weight training on those respiratory muscles! This is where PowerLung comes into play.

PowerLung is a form of light, weight training for the lungs. By using the device twice a day for 10 minutes, you will start to see the results of better breathing.

PowerLung strengthens your lungs, using an adjustable resistance. This trains the respiratory muscles when you inhale and exhale. That’s the same as you would do with weight training in the gym on any other muscle on the body.

This resistance is threshold resistance. The resistance can be increased over time by twisting two cells on the device. You will notice a real difference in two weeks of starting your training program.

As your lungs start to get stronger and the reps completed become easier, you can add more resistance. This is like weights in a gym, it’s the simple principle of overload followed by good recovery.

Here’s how PowerLung works

PowerLung uses something called threshold resistance, these are two clever cells that change the load on the device.

By using PowerLung, you train the lifting and lowering of the weight by inhaling and exhaling.

Powerlung allows you to increase and decrease the resistance as you improve.

In the same way as you would add weights in a gym to strengthen muscles, when considering a respiratory trainer, make sure it can train both inhale and exhale.

PowerLung does feature minor overlap with the TrainerBreatheAir, and AireStream models. For example, the lowest level of resistance is the same as the highest level of resistance on a lower model.

The Sports model is the only PowerLung model that does not overlap. It has an intense range of resistance not like the other models.

By training with the device over time, you will reach the greatest level of resistance. But, you will most likely reach near the end of one but not the other. It is typical to arrive at the highest level of inhaling before you reach the largest level of exhaling

Here’s an example – the greatest resistance on the BreatheAir is similar the lowest level on the Trainer model.

Benefits of PowerLung

PowerLung was the first strength training device with both exhale and inhale adjustable resistance.

Breathing training can yield large improvements with small effort. Athletes and trainers use aerobic exercise as a way to increase breath capacity. Research shows aerobic exercise does little to strengthen the 12 muscles in respiration. A breakthrough in breath training, PowerLung, now raises the cardio-pulmonary bar.

The simple handheld unit employs adjustable resistance. You can build both the strength of your inhale and exhale muscles. This results in increased breath capacity and better endurance.

Here are some respiratory training results from studies conducted with various groups:

  • Athletes were able to move more air with fewer breaths
  • Improved endurance performance in football players
  • 16.7% improvement in endurance performance of sprint athletes
  • 12% improvement in walking treadmill test for elderly women
  • Improved lung function in cross-country runners

PowerLung exercises and how to use it

Improve your lungs and breathe with these PowerLung exercises

The PowerLung device is adjustable for both inhale and exhale functions. Large, and easy to turn dials set your threshold of resistance to each function. Start from a level that you find comfortable and work up as you get stronger.

For optimal training of your breath, perform the sequence below twice a day:

Step 1 – Inhale and exhale through the PowerLung

Step 2 – Repeat repetitions 9x

Step 3 – Take a short 2-3 minute break

Step 4 – Repeat these steps two more times for a total of 27 repetitions

The Science

Breathing plays a significant role in your periphery muscle performance. This means shortness of breath can be the limiting factor in athletic performance.

“Bulking up” and other strength activities can diminish this expansion capability.

Other devices fail to train the full range of respiratory muscles. This limits workouts to either inhale or exhale and force only chest-breathing.

The PowerLung Trainer Model

The Powerlung Trainer is the model of choice for most biohackers. The resistance in the Trainer model is for those in excellent physical condition. This is for those looking to benefit more from their training and exercise regime.

This model is perfect for swimmers, runners, golfers, tennis players or cyclists. Or those who perform at a high aerobic or endurance level.

It’s also ideal for performing artists specialising in wind instruments or professional singers. It will improve endurance and breath control and will also reduce the risk of injury due to muscle strain or over performance.

Athletics – Aerobic vs. Anaerobic

A marathon runner may never breathe hard during his or her race. But, if the breathing muscles fatigue they will shut down the legs. A golfer doesn’t breathe hard during an activity, but if the breathing muscles get tired it can affect their skill level.

Training with PowerLung Improves 12+ Sets of breathing muscles

PowerLung respiratory training enhances the power of your breathing muscles, accessory breathing muscles, and the deep core muscles:

Muscles around the lungs used to inhale: diaphragm, external intercostals, and the interchondral part of the internal intercostals

Muscles around the lungs required for exhaling: internal intercostals, the rectus abdominals, and the external and internal obliques

Accessory muscles: sternocleidomastoid and the scalenes.

Core body muscles: transverse abdominals, pelvic floor muscles, the multifidus, and the lower trapezius.

PowerLung resistance training will not only strengthen your breathing muscles, it will also help you become more efficient at drawing and expelling air.

PowerLung products are for exercise only. PowerLung is not intended to diagnose, treat, cure or prevent any disease. Consult a physician before using PowerLung if you have a medical condition. Ask your doctor before beginning this or any exercise program.

PowerLung V’s PowerBreathe

Some respiratory trainers only train the inhale respiratory muscles. This type of training is okay for starting out and better than doing no respiratory training at all.

But consider people lifting weights in a gym. Most would lift and lower weight, working only the lift or lowering doesn’t work the full range of motion. That’s why we train the inhale and exhale parts of the breathing cycle.

How to get started

When people think about the training, they often think of long and enduring sessions. You can get huge benefits in your health and increase performance in sport in 5-10 minutes a day.

We’re hooked, we practice every day, after all, it only takes 5-10 minutes! Start planning PowerLung into your daily schedule and start seeing the benefits.

To make the most of your device we recommend regular training. The time of day doesn’t matter as long as you get the recommended repetitions in. Research has shown that those who keep a training diary are more likely to continue with a program. This is why we have produced a free one that will allow you to keep track of your progress.

Download this PowerLung training log, and keep track of your progress and improvements.

Cartwright Fitness is the PowerLung UK and Ireland distributor. If you would like advice on choosing the best PowerLung for you, please call us on 01244 343106.

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​Elevating Performance by Improving Mobility

Whether you are training to become a successful athlete or trying to stay in shape and promote a healthy lifestyle, mobility is of the essence in elevating your performance and ensuring long-term health. In fact, mobility training is crucial not only for increasing the range of motion when you exercise specific movements but is also essential for joints, muscle tissue, tendons and ligaments, in promoting their health and strength.

More often than not, people tend to overlook the importance of incorporating mobility drills into their workout routines, deeming them something extraneous or time-consuming, when in reality they are missing out on a world of long-term benefits. Here is how you can easily incorporate mobility exercises into your daily life, elevate your performance, and achieve your goals.

Defining mobility

Mobility is your ability to move freely and with ease according to your natural body composition and predispositions. While you are not able to surpass your physical limits, you can indeed achieve more regarding total body movement and flexibility than you previously imagined.

Mobility plays a crucial role in both aerobic and anaerobic training. Whether you are training for strength, cardiovascular endurance, explosive power or just love to go for a jog in the morning, your mobility (or the lack of it) will define the health of your joints and will affect your future performance exponentially as you age.

Benefits of mobility training

The benefits of practising mobility and corrective movements are numerous. Exercise science emphasises mobility as one of the critical factors in determining the amount of weight a strength athlete will be able to lift, the longevity of their joints, tendons and ligaments. Likewise, endurance athletes such as marathon runners, cyclists and sprinters, to name a few, can prolong the health and lifespan of their knees, hips, and shins, as they are prone to various conditions due to the nature of their sports and the amount of stress they can put on these particular areas.

The joints, more than any other part of the body, are prone to injury over time. While it is essential to strengthen the muscles around the joint for stability and strength, it is also necessary to relieve any accumulated tension in the joint itself and its surrounding tissues to prevent and treat injuries.

The knees, ankle joints, shoulders, elbows, and wrists are all prone to impingements and inflammation over time. Contrary to popular belief, a limited range of motion during exercise will not alleviate pressure from these areas, quite the opposite; it will create unwanted tension at the centre of the joint and strain the surrounding tendons and ligaments. All of this tension can lead to soreness, patellar tendonitis, shoulder impingement and numerous other long-term problems.

Let’s take a look at how to make mobility training a habit, and ensure long-term health, success and well-being.

Incorporating mobility into your workouts

Luckily, organising mobility drills is not time-consuming, they can be done multiple times a day if you need to split them up, and although beneficial, you don’t need to do them every day. The key is in preparation, and you should first make sure you are wearing quality bodybuilding wear that is specially designed for performance, mobility, and functional joint compression. Wearing the right clothes during your workouts is half of the mobility battle already won.

Secondly, you need to assess the state of your mobility levels and divide your body into green, yellow, and red regions, ranging from good mobility to terrible mobility. Naturally, areas with the excellent mobility need to be maintained, while the bulk of your efforts will be directed towards troublesome regions.

Your mobility level will depend on your lifestyle, level and type of physical activity, but for the majority of people, the tightest areas are the hips, shoulders, glutes and hamstrings, due to excessive sitting paired with heavy lifting. Be sure to exercise active mobility before your workouts that will double as a dynamic warm-up, and devote fifteen minutes afterwards towards eliminating any tight areas.

Unfortunately, an ever-growing number of people lack the necessary mobility to execute proper movement patterns during exercise, as well as during their daily routines due to the “comfortable” nature of the modern world. Fortunately, you can quickly avert these conditions and illnesses by incorporating a quick mobility routine into your lifestyle, thus elevating your performance, and reaping its long-term health benefits!

See our flexibility and mobility test equipment. 

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Is BodyMetrix accurate?

In short, YES but lets delve a little deeper. 
Ultrasound was first used to measure body composition in the 80’s, yet studies and validations have taken place since the 50’s.

Measuring fat thickness is an accurate technique to measure body composition. The benefit of ultrasound is that you can also measure muscle thickness too.

BodyMetrix uses fat and muscle thickness to increase accuracy. Several studies have compared the BodyMetrix to DEXA, BodPod, Hydrostatic and Bio-impedance methods.

The studies show good results with these more expensive and non-portable systems.

How it works

If you’ve landed on this page, you may already have an idea of what BodyMetrix is or what it can do. If not then I’ll explain – BodyMetrix is a device that uses ultrasound to track changes to muscle and fat.

It does this by passing a painless sound wave though the body to produce an echo. The echo reflects off tissue structures to determine the thickness of fat and muscle.

On most areas of the body you will see two high signals. The first signal is usually the point where fat tissue and muscle meet. The second reflection is often the point where muscle and bone connect.

This information allows you to see millimeter changes to muscle and fat over time.

Reductions in the fat thickness throughout indicates a reduction in body fat percentage. It is also useful to be able to see that you are not losing muscle when you lose that fat. No other portable device can show this. Devices like BodyStat and Tanita show fat free mass but that’s not the same as a true muscle measurement.

We have seen a growing trend of those who work in rehab want to have the ability track muscle recovery with patients. You can take BodyMetrix anywhere as it plugs into a tablet via USB. Muscle recovery measurements are also non- invasive and quick. 

What people say

BodyMetrix Reviews

Who’s using it? 

  • Pat Divilly – Pat Divilly Fitness 
  • Chris Brown – New Era Fitness 
  • Ben Griffiths – Project Spartan 
  • Gavin Hogarth – Fit Body Farm 
  • Warwickshire Fire & Rescue 
  • Manchester Metropolitan University 
  • University of Glasgow 

An insight from Ben at Fast Way to Fitness

Here is what Ben Owen, head trainer and owner at  Fast Way To Fitness said…  

“At FAST way to fitness we’re quite passionate about finding the RIGHT MEASURES for the individual.

You see, when
your trying to change your body simply weighing yourself is like trying to measure all your debt and all your earnings in one figure.

When undertaking a journey of body transformation
its likely you’re looking to increase the amount of LEAN MASS and decrease FAT MASS…

Sion Pritchard is one Diligent Mo-fo!

taken on board ALL of the coaching I have given him and taken ACTION…

We’ve taken a number of metrics to measure his journey and one is using the
BodyMetrix @intelametrix Ultrasound fat analyser from

The results paint a clear enough picture of how much body fat he lost in just under a month. Both measures were taken after the same amount of water, sleep and food consumed.

This was a HUGE motivation for us as a trainer and client team. We were both made up by his progress.

Thought it was worth sharing as we can ALL sometimes measure the WRONG things… Money for happiness… Scales for progress… Or even measure things that don’t motivate us.

Thought We’d share this with anyone who would like a more dynamic look at their progress than a set of scales and a ‘how are you getting on’…

Feel free to comment, ask questions.

Again… Well done Sion.

Shows what happens when you take action without excuse.

Obsess and practice

But most importantly… Enjoy the journey!!”

Here are the screen shots showing progress before and after:

Compare BodyMetrix Scans

Ben knew BodyMertrix was the best solution for him to track clients body fat and muscle gains.

BodyMetrix validates exercise and nutrition by putting a yardstick in the sand. Collecting muscle data as well as body fat creates a true picture of body composition.

As the saying goes… “what gets measured gets managed” 

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How to perform a basic home fitness test

Chester step testFinding out your level of fitness can often be difficult. Sometimes you may feel fitter. At times you may even improve an aspect of fitness such as how long it takes to run a particular distance.

Some gyms even offer VO2 tests on fitness equipment such as bikes or treadmills. This type of test is one of the most accurate tests of aerobic capacity. Unfortunately, these tests are not always available and can be expensive. Sometimes a local university can provide these services. So if it is something of interest, contact your local facility.

If you would like a simple way to determine your fitness then the basic home fitness test is great.

Research tells us that a good level of aerobic fitness is beneficial to general health. Heart rate watches are useful in giving us a unique insight into our hearts health.

To complete this quick test you dont need one. But if you were performing this test on a semi-regular basis it makes the process a little easier. You dont need anything fancy the very basic Polar FT1 is ideal.

To do this test all you need is a step, you bottom of your stairs is fine and a watch. Then as long as you can complete basic home fitness test and take your pulse, you are good to go. The heart’s ability to recover from moderate exertion is a great sign of fitness. Although the fitness test is not meant to diagnose heart trouble or illness.

They are simple ways that can give you a sign of your current level of fitness. Plus a great way in which you can measure fitness improvements each month. Enter the basic home fitness test This test is sub-maximal. Meaning it doesn’t need all-out exertion. So it’s not designed to test your greatest heart rate. But instead your heart’s ability to recover after exercise.


Please do not attempt this if you have existing heart problems or joint aches and pains. Consult with your doctor before engaging in physical activity if you are unsure.

How To Perform the Fitness Test

All you need to do to complete this test is to step onto and off the bottom step of a flight of stairs for 3 minutes. During the test you will measure your pulse rate. The test is suitable for anyone who is healthy and used to moderate exercise.

If during the test you begin to feel discomfort or distress, then please stop and recover. First using the bottom step of a flight of stairs practice performing the test. You are aiming to complete two up-up and down-down cycles in 5 seconds or 24 steps in a minute.

When you are confident you can do this, then try the 3-minute Step Test. Step at this pace for exactly 3 minutes then sit down. Rest for 30 seconds and find your pulse. Here is how you can take your pulse if you don’t have a heart rate device. Then get your pulse for another 30 seconds and compare your score with the table below: 

Females Males
Number of Beats in 30 Seconds
Excellent 35-38 31-34
Good 39-41 35-37
Average 42-4 38-40
Fair 45-49 41-44
Poor 50-63 45-56

What do the results mean?

Poor or Fair

You need an aerobic exercise program to improve your fitness. Find an activity that best suits your lifestyle and give it a go!


You need to exercise more. Make sure you exercise 20 minutes a day, three times a week.


You are in good shape. Well done!


Keep up the good work.

Test every month or so

You can take the basic home fitness test each month to see improvements in basic health and fitness. The best thing about this test is it only takes 3 minutes. Plus it doesn’t need any expensive equipment.

A more comprehensive assessment of aerobic fitness is the Chester Step Test. Its an affordable and reliable means of testing your aerobic fitness at home.

The Chester Step Test is an easy-to-perform fitness test. Used by many fire and rescue services, police forces and the ambulance services. As well as many large occupational health clinics around the world.

It has been subject to validation studies and is now considered a reliable test. It is a fantastic way to determine your sub-maximal V02 max. The test is also used in health clubs and occupational health departments.

The test is simple to perform too. All that you need to carry out the test is a stepping platform or box at a set height. A basic heart rate device, a CD or Mp3 player and a pen to record your results. There is a software to determine your fitness available or you can use a pen and paper sheet to record the data.

The robust steps are available in a variety of sizes. The full test kits include everything you need to perform the Chester Step Test. This includes a Polar heart rate watch. The test software calculator and audio CD, aerobic resource and instruction manual.

The calculator allows you to estimate your VO2 max reading. This gives you an understanding of your level of health and fitness. These results can assess your current fitness level and set new goals. Doing this helps you to target improvements in aerobic fitness and respiratory health. The Chester Step Test is suitable for people of all ages and levels of fitness.

Give the basic home fitness test a go today and see how you score.

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BodPod vs Ultrasound (BodyMetrix)

BodyMetrix SystemYou may have heard of BodPod. It looks a bit like a space shuttle that measures body composition using plethysmography. Plethysmography measures changes in volume within the body using air displacement. It’s a lot like hydrostatic weighing but using air instead of water.

A metal cylinder goes into the BodPod to calibrate before a measurement, then a swim cap donned, semi-naked individual climbs inside and begins the test.

Considered a Gold Standard, this high tech looking bit of kit has a hefty price tag of about £40,000. Yes, that’s forty thousand British pounds.

What interests me beyond body fat measurement is measuring muscle tissue. There’s plenty of good fat monitors on the market, but few muscle measurement systems. Even the BodPod can’t measure muscle directly. In fact, the systems measure fat-free mass instead shown by the screen shot from the BodPod website.


I talk a lot about measuring muscle as part of body composition measurement. There are many benefits to doing it. Knowing that any weight loss is from fat and not water or muscle is powerful. It can help intervene if needed and then make subtle changes to maximise client progress. The BodyMetrix screenshot below shows actual muscle thickness in millimetres.

BodyMetrix ultrasound

Because Fat-free mass measurements include organs, bones and muscle. The ability to identifying real muscle changes with BodPod is near impossible.

When taking a body fat measurement, I take note of the muscle tissue thickness too. Referring to the measurement, I can confirm weight loss was from fat tissue. At the same time, I can see that there was little to no loss of muscle tissue. Powerful stuff.

Read more here from this study comparing the accuracy of the two systems.

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How to choose the right blood pressure cuff

Upper arm blood pressure monitors use a cuff that inflates when connected to the device.

Omron Cuffs come in 3 different sizes these are:

The size relates to the circumference measurement of the upper arm.

The Omron cuffs work with a range of Omron upper arm monitors. If you’re unsure if the cuff you needs fits with your device contact us and we can help out.

To determine which cuff you need, use a flexible tape measure or piece of paper to measure the circumference of your upper left arm. If using the paper method, you can measure the tape length with a ruler once you’ve done it. After you have your upper arm measurement choose the cuff that matches it below.

If your upper arm size is between 17 and 22cm, then you will need a small cuff. If it measures between 22 and 32cm, then it’s the medium cuff. If your upper arm measurement is between 32 and 42 cm, then you will need a large cuff.

Fitting the Cuff

Once you’ve devised on the right cuff size, then fitting couldn’t be easier.

The first step is to put your left arm through the cuff loop. If the cuff is not in a loop then pass the end furthest from the tube through the D-ring to form a loop. The smooth part fo the cuff should be on the inside of the cuff loop.

Correct arm position

Once the cuff is on your upper left arm, the tube should run right down the centre of your inner arm. This should be in line with your middle finger. The bottom part of the cuff should be about 1 or 2 centimetres from the crease on your elbow.

Apply the cuff to your upper arm so that the red arrow, the one under the tube is at the centre of your inner arm.

Extra Tips

Make sure the cuff is next to the skin and not placed over clothes. If you need to roll up a sleeve, then make sure that it’s not too tight.

Also, make sure that the cuff is in alignments with the heart or breast height. If you need to, pop a cushion below your elbow to raise it to this level.

Once you have the correct position, start the device and follow the instructions.

Check out the cuff range

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​YMCA 3-minute step test normative data

This is a 3-minute step test as the name suggests. The test requires stepping on and off a fixed step at a set speed and can be used as a method of aerobic fitness testing.

Because this is a sub maximal test, it requires a low level of supervision to perform the test safely.

Pre-Test Conditions

Before you begin, ensure that there are no medical reasons that may prevent someone taking a test.

Make sure the person taking the test is ready for exercise. We recommend that they have not eaten, smoked or drunk tea or coffee for at least 2 hours before.

Ensure that the client is also not recovering from illness or has a cold or is taking any medication that may affect heart rate such as beta blockers.

Ensure that you are in a well ventilated room with a temperature of between 18C-20C.

The person tested should fill in the PARQ physical readiness questionnaire. If they answer yes to any of the questions, then the exercise testing should not take place. Medical clearance may also be necessary.

What you need

  • Results table shown below

How to perform the test

  • Practice the stepping up and down on the bench or step to get familiar with the stepping action
  • Explain the pace and rhythm for the test of up, up, down, down as the stepping cycle
  • Set the metronome to 96 bpm (24 steps per minute)
  • Start the watch and get the subject to start stepping
  • Continue stepping for 3 minutes then stop and sit on the step
  • After 60 seconds of being seated record the heart rate

Interpreting results

The results of the test are not given in Vo2 or Mets like other tests such as the Chester Step Test. They are a rating of aerobic fitness based on a test groups performance. Check the resting heart rate after the 60-second rest with the table below. 

Age 18-25 26-35 36-45 46-55 56-65 65+
Excellent 50-76 51-76 49-76 56-82 60-77 59-81
Good 79-84 79-85 80-88 87-93 86-94 87-92
Above Average 88-93 88-94 92-88 95-101 97-100 94-102
Average 95-100 96-102 100-105 103-111 103-109 104-110
Below Average 102-107 104-110 108-113 113-119 111-117 114-118
Poor 111-119 114-121 116-124 121-126 119-128 121-126
Very Poor 124-157 126-161 130-163 131-159 131-154 130-151


Morrow, J.R; Jackson, A.;Disch, J.; and Mood, D. 2005. Measurement and evolution in human performance. 3rd ed. (Champaign, IL: Human Kinetics) 234; adapted from Y’s Way to Physical Fitness, 3rd edition 1989, with permission of YMCA of the USA.

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How is HbA1c testing used to detect diabetes?

Diabetes is one of the fastest growing health problems in western societies and it’s estimated that there are currently more than 3.5 million people living with the condition in the UK. Modern medicine means that the condition can be mostly managed, with most sufferers living long and relatively unhindered lives. However, it is also a condition that often goes un-diagnosed and the later that diabetes is found, the more dangerous it is to the patient. This means that accurate testing is a vital defence against this growing threat.

How HbA1c testing can help

Various tests for diabetes have been available for decades, but have suffered from problems which meant diagnosis wasn’t always accurate. However, a more modern test is now available which solves the biggest problems of previous methods. This test is known as the HbA1c test, also referred to as a1c testing or glycol haemoglobin testing. It has been recommended for use in the diagnosis of type 2 diabetes and – crucially – the condition of prediabetes since 2009.

HbA1c is the shorthand term for glycated haemoglobin, a substance formed in human blood when red blood cells (haemoglobin) become attached to molecules of blood sugar (glucose). This formation of glycated haemoglobin is a natural process which depends on the levels of glucose in the blood – the higher the glucose level, the more red blood cells become glycated. HbA1c is therefore, a proxy measurement for blood sugar level, with obvious implications for detecting diabetes.

However, the crucial point is that once haemoglobin becomes glycated, it stays that way until the cell dies naturally, which typically takes between eight and twelve weeks. This has the effect of providing an indirect measurement of historical blood sugar levels over roughly a 3 month period, as peaks and troughs of glycation will tend to smooth out the aggregate HbA1c count over time.

Why is this important for diabetes diagnosis?

Measuring the level of HbA1c in the blood effectively provides a 3 month average of blood sugar levels, and is expressed as a percentage. The average person has a HbA1c count of less than 6%. Someone with type 2 diabetes has a score of 6.5% or higher. This leaves a gap between 6% and 6.5%, where the patient is said to have prediabetes.

Prediabetes is a risk factor for type 2 diabetes rather than a way point on its development. A person with prediabetes will not necessarily go on to develop full diabetes and does not require treatment in the meantime. However, the increased risk means that further tests at annual intervals are recommended to detect full diabetes as early as possible, should it develop.

Why HbA1c is better than traditional testing

This ability of HbA1c testing to detect the prediabetes condition is one of its great strengths. Previous tests only identified full diabetes, either because of limitations in the techniques used or because they were rarely used unless there was already a strong suspicion, their result would be a definite diagnosis of type 2 diabetes.

HbA1c testing is also more accurate than older testing methods. The measurement is thought to be accurate within half a percentage point of the result, meaning that only borderline cases are likely to be misdiagnosed. In these cases, the second test at a later date will almost always provide a firm diabetes diagnosis or rule it out.

Lastly, HbA1c testing is far more convenient. Previous test methods which measured blood sugar levels directly could be heavily influenced by modern diet, stress levels, fatigue, alcohol consumption and the taking of medication. This inaccuracy meant that either multiple tests were needed for a firm diagnosis, or that the test required to be viewed in combination with other symptoms – which of course, do not tend to show up until diabetes is well established.

The smoothing effect of HbA1c means that a single test is far more reliable, and it’s a simple procedure. A preliminary analysis can be carried out during a routine health care visit, as part of a general test whether the doctor suspects diabetes or not. It is hoped that this convenience and reliability will detect far more people with prediabetes or the early stages of diabetes so that treatment can be given.

Is HbA1c testing perfect?

Unfortunately, nothing in life is perfect and HbA1c testing also has a few drawbacks to go with its certain advantages. Firstly, there is the previously mentioned margin of error which can make diagnosis difficult in borderline cases. However, the margin involved is far smaller than with older testing methods.

Secondly, some people naturally have a slightly different type of haemoglobin, known as a variant, which can interfere with HbA1c test results. This variant haemoglobin is most often found in people of African, Mediterranean, or SE Asian descent or in people with sickle cell anaemia, thalassemia or some other blood disorders. In these cases, HbA1c testing can not be definitively relied upon and subsequent testing using old methods should be used to confirm the results.

Lastly, some underlying health problems can interfere with the normal production of glycated haemoglobin, rendering the HbA1c test unreliable. These conditions include relatively minor problems such as iron deficiency or far more serious ones including reduced kidney function and liver disease.

Nonetheless, despite these drawbacks, HbA1c testing is a giant stride forward in the detection of type 2 diabetes – and just as importantly, the previously under-diagnosed condition of prediabetes.

The Cobas b101 point of care device can determine HbA1c in minutes click here to learn more.

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Hand grip test normative data

Grip strength dynamometers are useful for testing hand grip strength in a quick and easy way. There is plenty of information as to why grip strength measurement is important.

Below you can find the norm values provided for the Takei Handgrip Dynamometer which is produced in Japan. This device is useful for determining grip strength values for a whole range of ages and monitoring improvements with strength training and during rehabilitation.

Why use grip dynamometers?

Handgrip dynamometers are useful for measuring the maximum isometric strength of the hand and forearm muscles. They are also used for testing hand grip strength of athletes involved in strength training programmes or for participants in sports where the hands play a crucial role when throwing, catching or lifting like gymnasts, tennis, golf and rock climbers for example.

There are many methods for measuring handgrip strength and there is a broad range of equipment available on the market.

The first of which was a handgrip dynamometer designed by Edme Regnier (Regnier 1807). Since that time, there have been many different dynamometer designs that have been used to determine grip strength including our personal favourite, the Takei grip dynamometer.

How to perform a test

  • The dynamometer handle is usually adjusted (if possible) to fit the hand or set at the same setting for everyone. When using the Takei dynamometer start by holding the instrument in the testing hand, turn the dial to adjust the starting point until the second joint of your forefinger is bent through 90 degrees. Repeat the protocol again when retesting the same or another arm. The strength of the left and right hand often varies, so the grip test should be conducted on the same side, on the dominant side, or done on both sides and averaged. We recommend 3 or more measurements to determine a good score. 
  • If you are using a digital dynamometer such as the Takei 5401 then it’s possible to continue measurements with the left then right hands for a total of 4 measurements. After which the mean value of the highest values of force is indicated by flashing after 4 seconds. To simply reset the device after each reading rather than turn the central disk as with the analogue device, just press the ON/C button to clear the device. 
  • Before each measurement turn the center dial gently in the direction of the arrow until the indicator is set to zero “0”. The digital version just needs the ON/C button to be pressed. Don’t do this if you want the mean value readings, just move from hand to hand.
  • When you are ready to take a measurement stand upright and relaxed, extend your arms downwards and grip the dynamometer with your hand and exert full force without letting your arm touch your body during the measurement. In order to get the best possible reading try to isolate the hand and forearm muscle. You can do this by not waving the dynamometer about during measurement.
  • After the measurement has been taken read the value displayed on the dynamometer and record it then turn the pulley to set the indicator to zero and repeat the measurement once again.

Hand grip test data

Age  Male Female  Age Male Female Age Male Female Age Male Female
3 6.5  4.4 22 47.8 29.3 41 48.0 30.7 60 40.8 25.7
4 7.2 6.0 23 48.3 29.3 42 48.0 30.6 61 39.7 25.5
5 9.3 8.7 24 48.8 29.4 43 47.3 30.5 62 39.2 25.3
6 10.0 9.7 25 48.9 29.7 44 47.4 30.3 63 38.5 24.7
7 11.0 10.3 26 49.0 30.0 45 47.1 29.8 64 37.5 24.7
8 13.0 12.0 27 49.3 30.0 46 46.9 29.6 65 36.8 24.2
9 15.2 14.0 28 49.3 30.1 47 46.6 29.6 66 36.3 24.0
10 17.3 15.9 29 49.6 30.1 48 45.7 29.0 67 36.0 24.0
11 20.4 19.1 30 49.6 30.8 49 45.6 28.5 68 35.8 24.0
12 24.6 22.1 31 49.8 30.8 50 45.5 28.2 69 35.5 23.6
13 30.7 24.6 32 50.0 30.8 51 45.0 28.0 70 35.0 23.0
14 36.2 26.1 33 50.4 31.0 52 44.9 27.6  
15 39.8 26.5 34 50.0 31.0 53 44.2 27.5  
16 43.3 27.2 35 49.7 30.9 54 43.8 27.3
17 44.6 28.0 36 49.5 30.9 55 43.4 27.3
18 45.2 28.1 37 49.5 30.9 56 42.7 26.9
19 45.8 28.4 38 49.1 30.7 57 42.3 26.9
20 46.5 28.6 39 48.5 30.7 58 42.0 26.4
21 47.1 29.1 40 48.5 30.7 59 41.5 25.9


“Average values of new physical strength for the Japanese II.”

“Physical strength average value study society, Tokyo Metropolitan University.”

Results are often different between male and females and between left and right, your dominant and non-dominant hands. There is also an age-related factor to consider as grip strength often weakens with increased age. However, this is not always the case.

The results can also be affected by the position of the wrist, elbow and shoulder, so these should be standardised.


To wrap up, decide on a dynamometer that best meets your requirements for testing. We have focused on the Takei grip dynamometers today for this post, we know they are accurate and reliable and the choice of many professional sports clubs, academic institutions and the national health service. However, there are other options. If you are interested take a look at Jamar and Camry.

Anther important consideration when deciding whether to choose an analogue or digital display and when data recording is of particular interest, it is worth noting that the digital devices can track mean values for grip strength which can be useful when taking multiple readings.