I so agree with JOE.
Often these “high risk” folks are very low to no activity persons so their exercise capacity hence tolerance is really low.
Just getting them to move regularly, more than they have been accustomed to,is a great starting point and they “feel” so much better thereafter which in itself is a great “motivator”.
We may then do all the various fitness assessments etc.etc.as their exercise tolerance improves and evolve in the program.
There are no assessments that I do not do…eventually. The first asssessment I do is to determine the client’s current status. This determines which if any “fitness assessments” will be done at that time. While I do not adhere to a “one size fits all” program design, all new clients initiate their programs with ROM exercises and movement based programming designed to expose a variety of imbalances and issues. Many of which haven’t been noticed by the client, but are already doing damage. Even the most athletic clients are not immune to harmful movement patterns and habits. Most can be corrected before there is irreversible damage. And those that are beyond being reversed, can be slowed or stabilized.
Assessments are tools. Just like using tools to repair a treadmill, you can’t use them out of the order in which they are needed. Which, when, and why are the questions that will guide my process with each client.
When I meet a new client for an assessment, I have already talked to them and thereby have determined whether I will require a physician’s approval. Even if it appears in the conversation that it may not be necessary, I tell people that I may require it after all if anything comes up during the assessment.
For the assessment itself, I have a whole ‘laundry list’ of items that I like to determine and assess. What I always do is taking pictures against a grid, take a video for a gait analysis, take blood pressure and use the Futrex for determining body composition. But even here are already the first modification: if I deal with very overweight clients, they may not be comfortable having their picture taken. I may also forego the body composition because at high levels of obesity it can be inaccurate. There is a piont when it does not add much to my knowledge and only makes a new client feel uncomfortable.
So to summarize my answer: it depends.
As for other assessments: I decide on the spot which to do or not. My rule is to err on the side of safety. I cannot remember the last time I had somebody do push-ups for 30 seconds.
On the other hand: I like to compile as many ‘tangible’ data as possible so that I (and – more importantly – the client) can see measurable progress.