Skin fold guidelines

• A skin fold test should ALWAYS be presented to a client as optional and never forced upon them.
• ALWAYS ask for a clients consent before performing a skin fold test.
• For obese people, a skin fold test is not likely to be possible due to the inability to apply the skin fold calipers. Also, skin fold testing is highly invasive and is not recommended for this population.
• It is neither necessary, nor recommended that clients completely remove clothing during a skin fold test. All measurements can be taken through clothes or by making small adjustments to them (i.e. rolling a t-shirt up slightly to allow for the abdominal and iliac crest sites to be exposed)
• A skin fold test should be a quick and easy process for the client. If you are not confident in how to perform a skin fold test, then DON’T.
• Practice on friends and family until you are confident you can perform the skin fold test correctly.
• Record the time you performed the skin fold test and when the last time the client ate. Then aim to replicate these conditions for the client’s next skin fold test.
• Exercise increases the extracellular water accumulation in the subcutaneous tissue which results in increased skin-fold thickness. Therefore, a skin fold test should not be measured immediately after exercise.
• All sites should be taken from the right-side of the client’s body. 
• Record not only the skin fold measurements but also the distances of the marked sites, as it allows the skin fold test to be retaken more accurately when the client is due for their next assessment.
  

IMPORTANT: IF you have not built a strong rapport with the client, then DO NOT take the skin fold test and address it at a later date when rapport has been developed.

Skin fold sites

Triceps

Locating the site:

With the client in the anatomical position, measure the distance from the most superior, lateral border of the acromion process (top edge of the shoulder) to the most proximal, lateral aspect of the head of the radius. Once you have measured the distance between the two points, use a pen to mark the halfway point (site A). From site A, measure horizontally to the posterior portion of the humerus and use a pen to mark the site (site B).

Taking the measurement:

On site B, the vertical skin fold is raised with the thumb and index finger (the pinch). While still holding the skin fold, apply the calipers 1cm beneath site B. Remove the calipers, then release the pinch. Take 3 readings from the site and record the average.

Iliac Crest

Locating the site:

With the client in the anatomical position, find the intersection between the mid-axillary line (an imaginary vertical line running downwards from the middle of the armpit) and an imaginary line, lateral from the navel and mark this site with a pen (site C)

Taking the measurement:

On site C, the skin fold is raised with the thumb and index finger. While still holding the skin fold, apply the calipers 1cm beneath site C. Remove the calipers from the site then release the pinch. Take 3 readings from the site and record the average.

NOTE:

The skin should be pinched, so that the skin fold runs diagonally.

Abdominal

Locating the site:

With the client in the anatomical position, measure 5cm lateral from the client’s navel. Then mark this site with a pen (site D).

Taking the measurement:

On site D, the vertical skin fold is raised with the thumb and index finger. While still holding the skin fold, apply the calipers 1cm beneath site D. Remove the calipers from the site then release the pinch. Take 3 readings from the site and record the average.

Front Thigh

Locating the site:

The site for this skin fold is on the anterior surface of the thigh. With the client in a seated position and knees bent at a 90 degree angle, measure from the anterior surface of the iliac crest to the superior border of the knee cap. Once you have measured the distance between the two points, use a pen to mark the halfway point (site E).

Taking the measurement:

On site E, the longitudinal skin fold is raised with the thumb and index finger. While still holding the skin fold, apply the calipers 1cm beneath site E. Remove the calipers from the site then release the pinch. Take 3 readings from the site and record the average. As the skin fold is difficult to take at this site, the client must place their hands under the thigh and apply upward pressure during the skin fold test.