Client Consultation and Health Appraisal

scope of practice

Personal trainers are health/fitness professionals who use an individualized approach to assess, motivate, educate, and train clients regarding their health and fitness needs. They design safe and effective exercise programs and provide the guidance to help clients achieve their personal goals. In addition, they respond appropriately in emergency situations. Recognizing their area of expertise, personal trainers refer clients to other health care professionals when appropriate

symptoms of chronic cardiovascular, pulmonary, metabolic, and orthopedic

The most important principle underlying the client consultation and health appraisal process is to screen participants for risk factors and , , diseases to optimize safety during exercise testing and participation.

Credentials of the personal trainer, Site of delivery, Specific population served, Legal statutes

four factors that dictate implementation for the client consultation and health appraisal mechanism:

first step

Even though no recognized uniform process of administration appears to exist, there is agreement about the value of an initial interview as the , , in the client consultation to obtain and share essential information associated with the program delivery process

initial interview

is a scheduled appointment intended as a mutual sharing of information with the expected outcomes of assessing client–personal trainer compatibility, discussing goals, and developing a client–personal trainer agreement.

the services available

As the first step in determining personal trainer–client compatibility, the personal trainer provides a detailed description of

mission statement, success rate

Important information to convey to the potential client includes an explanation of the personal trainer’s formal education, professional experience, certifications, and expertise or specializations, as well as the , , and unique features of the program delivery system.

suitability and appropriateness

The last step in determining compatibility is to assess

goals

If compatibility and suitability are established, the next step may be a discussion of

provide and define direction

The main function of identifying objectives is to , , as it relates to purpose and motivation.

specific, measurable, action oriented, realistic, and time sensitive

Developing goals that are , , (SMART) is a vital element of the training process.

services, parties involved, expectations of those parties, timeline of delivery, cost structure, and a payment process

Components of a contract include written documentation describing the

cancellation policy, termination of contract, and circumstances

Language of the contract should also cover the , , that would render the document void.

legal age and competency

The contract becomes valid when signed by both parties, assuming appropriate

facility

After the personal trainer and the client have entered into the client–personal trainer agreement, they must then enter an agreement to validate the safe use of the

liability

Also discussed in this form (safe use of the facility) is the explanation of , , between the personal trainer, the client, and the facility itself.

preparticipation health appraisal

The purpose of the , , is to identify known diseases and risk factors associated with cardiovascular disease, assess lifestyle factors that may require special considerations, and identify individuals who may require medical referral before starting an exercise program.

complete relevant forms

The first step in the preparticipation health appraisal screening process is to ask the client to

collected and evaluated

Health appraisal instruments are tools by which information is , , to assess appropriateness for various levels of exercise and referral.

Physical Activity Readiness Questionnaire for Everyone (PAR-Q+)

is a tool developed in Canada that consists of questions requiring self-recall of observations and signs and symptoms experienced by the client, in addition to confirmation of diagnosis by a physician

cost-effective, easy to administer, and sensitive

The advantages of the PAR-Q+ are that it is , , in that it identifies individuals who require additional medical screening while not excluding those who would benefit from participation in low-intensity activity

risk for cardiovascular disease

The PAR-Q+ appears to have limitations in that it was designed essentially to determine the safety of exercise and not necessarily the

health/medical questionnaire

is an effective tool for assessing the appropriateness of moderate and vigorous levels of exercise in that it can identify positive coronary risk factors associated with cardiovascular disease, sudden cardiac death risk factors, existing diagnosed pathologies, orthopedic concerns, recent operations, personal history of suggested signs and symptoms, medications, supplements, and lifestyle management.

Lifestyle questionnaires

vary in their format, substance, and depth. However, they usually consist of questions to evaluate personal choices and patterns related to dietary intake, management of stress, level of physical activity, and other practices that may affect the person’s health.

valid and reliable

Most of the existing standard lifestyle questionnaire assessments were developed for the average, apparently healthy population. Persons with existing health-related conditions who have been previously diagnosed by a physician may not obtain , , information from the results of the questionnaires and therefore should rely on diagnostic information from their physicians for guidance.

informed consent form

gives clients information about the content and process of the program delivery system.

a confidentiality clause, responsibilities of the participant, and documentation of acknowledgment

The essential elements of an informed consent include a detailed description of the program, the risks and the benefits associated with participation , , and acceptance of the terms described within the form.

assumption of risk or waiver

is an agreement by a client, before beginning participation, to give up, relinquish, or waive the participant’s rights to legal remedy (damages) in the event of injury, even when such injury arises because of provider negligence

potential risks

An assumption of risk agreement needs to identify the , , associated with participation and establish that the potential client understands those risks and voluntarily chooses to assume the responsibility.

preparticipation physical evaluation

form has been approved by the American Academy of Pediatrics and the American Academy of Family Physicians as well as other organizations. This form may be helpful in determining whether a child should visit and get the permission of a physician before participation in a physical activity program.

children

Regarding assumption of risk or waiver agreements, parents do not have the right to execute such waivers on behalf of their

collect, organize, and store

The personal trainer needs to develop a strategy to , , the vital information and materials obtained through the initial interview process.

record-keeping system

to verify the completion and receipt of forms, along with other documentation concerning the status of the client, is instrumental in allowing one to move on to the next step of the preparticipation health appraisal screening process.

HIPAA protocols

The personal trainer needs to follow , , with sensitive client material pertaining to personal and private health information.

Atherosclerosis

is a progressive degenerative process associated with CVD through which the endothelial lining of the arterial walls becomes hardened and the walls consequently lose elasticity.

myocardial infarction

Atherosclerosis can lead to

positive risk factor

may be defined as “an attribute or exposure that is associated with an increased probability of a specified outcome, such as the occurrence of a disease”

positive coronary risk

Epidemiological research suggests that a person’s potential risk for developing CVD is associated with the , , factors the person possesses.

greater

The greater the number and severity of those risk factors, the , , probability of CVD

The eight identifiable positive CVD risk factors

relate to age, family history, cigarette smoking, physical inactivity, body mass index and waist circumference, blood pressure (i.e., hypertension), blood lipid levels, and blood glucose levels

negative CVD risk factor

suggests a favorable influence that may contribute to the development of a protective cardiovascular benefit

High-density lipoproteins

appear to provide a protective mechanism against CVD by removing cholesterol from the body and preventing plaque from forming in the arteries.

Pain or discomfort due to ischemia, Dizziness or syncope, Breathing difficulties, Ankle edema, Palpitations or tachycardia, Intermittent claudication, Known heart murmur, Unusual fatigue or shortness of breath with usual activities

major signs or symptoms suggestive of cardiovascular and pulmonary disease are

transport oxygen

Various pulmonary diseases affect the respiratory system’s ability to , , during exercise to the tissue level via the cardiovascular system.

exercise tolerance

The systematic breakdown that occurs because of inadequate oxygen supply creates a greater than normal demand on the cardiorespiratory system, in some cases markedly reducing

Chronic bronchitis

is an inflammatory condition caused by persistent production of sputum (a mixture of coughed up saliva and mucus) owing to a thickened bronchial wall, which in turn creates a reduction of airflow.

Emphysema

is a disease of the lung that affects the small airways. An enlargement of air spaces accompanied by the progressive destruction of alveolar-capillary units leads to elevated pulmonary vascular resistance, which in most cases can contribute to heart failure.

Asthma

is mostly due to a spasmodic contraction of smooth muscle around the bronchi that produces swelling of the mucosal cells lining the bronchi and an excessive secretion of mucus.

Sudden cardiac death

related to exercise is caused by cardiac arrest that occurs instantaneously with an abrupt change in an individual’s preexisting clinical state or within a few minutes of that change.

Chest pain or discomfort with physical exertion, Excessive exertional dyspnea, Syncope, Family history of sudden and unexpected death before age 50 in more than one relative, Family history of disability from heart disease before age 50 in a close relative

Identification of one or more of the following conditions should warrant a referral for a cardiovascular examination.

Diabetes mellitus

a metabolic disease, affects the body’s ability to metabolize blood glucose properly. The disease is characterized by hyperglycemia resulting from defects in insulin secretion (type 1), insulin action (type 2), or both.

type 1 diabetes

are insulin dependent, meaning they require insulin injections to metabolize glucose.

type 2 diabetes

in most cases can produce insulin, but the tissue is insensitive to it, and consequently glycemic control is inadequate.

heart rate, blood pressures, cardiac function, and exercise capacity

Various medications may alter

rating of perceived exertion

monitoring intensity of exercise by using heart rates may be inappropriate because of the masking effect of the medications on heart rates, and therefore , , would be a more effective mechanism for regulating intensity levels of exercise

saturated fat and cholesterol

The most evident connection is between dietary , , and the development of atherosclerosis, although this relationship remains a topic of controversy

atrial fibrillation

Alcohol consumption has also been associated with an increased risk for

systolic blood pressure

diets high in sodium can lead to chronic elevation of , , or, more importantly, can result in worsening of heart failure

risk for CVD

Epidemiological studies provide evidence that stress is related to the

depression, social isolation, and chronic stress

Type A behavior pattern characteristics include , , produced by situations involving high demand and low control

preliminary step

Classifying risk for potential health-related concerns is a , , in determining the appropriateness of activity and identifying clients who require referral before beginning an exercise program.

PAR-Q+ results

To meaningfully interpret the results obtained through the screening process, the personal trainer should use the , , to identify people who have a greater potential for risk and may require referral and a clearance from a physician.

appropriateness of activity

The PAR-Q+ provides direction based on interpretation of the results and specifies recommendations as to the , , and the referral process.

ACSM preparticipation screening algorithm

determines a person’s preparedness to begin an exercise program using current exercise status, known cardiovascular, metabolic, or renal disease, and personal signs and symptoms

physician’s referral form

includes assessment of the individual’s functional capacity, classification of ability to participate based on the evaluation, identification of preexisting conditions that may be worsened by exercise, prescribed medications, and fitness program recommendations.

concerns and needs

The physician recommendations provide the personal trainer with guidance and directions regarding what , , the individual has and which programs are appropriate.

unsupervised program

is commonly recommended for people who are apparently healthy or presumably healthy with no apparent risks. This type of program recognizes the positive health-associated benefits that regular activity provides in relation to the relatively low risk involved in participation. These programs may be designed and initiated with the support of a personal trainer, the intended long-term eventual outcome being a combination of consistent weekly training sessions conducted by the personal trainer and other sessions that are self-directed and unsupervised.

supervised program

may be recommended for people who have limitations or preexisting conditions that would restrict involvement but not limit participation. These programs are usually directed by a certified fitness professional, such as a certified personal trainer, who monitors intensity and modifies activity to meet the special concerns of the participant.

medically supervised program

may be recommended for individuals who present a higher potential risk because of a predisposed condition, multiple risk factors, or an uncontrolled disease. These programs are directed and monitored by allied health professionals in clinical settings with immediately accessible emergency response capabilities.