The must-do for personal trainers, first and foremost, is a new client screening and consultation. When you start working as a personal trainer, the screening process will become second-nature after you’ve done it several times. But first, learn how to screen clients effectively in a step-by-step way that assures you don’t miss any major risk factors. Learn how to do this first, and the rest will fall into place (because you’re doing what you love!)
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Knowing what questions to ask during the first client consultation appointment is key to successful training for the long term. Some of these questions will help you identify major risk factors, and others will cue you in on present exercise experience and expectations when working with you. It’s always a good idea to recommend that your new client get clearance from his or her physician before starting or increasing the intensity of an exercise program, but it is not required in order that you start training the apparently healthy client.
Reminder: an ‘Apparently Healthy Client’ is one with no significant disease or physical condition or impairment which prevents them from engaging in physical fitness activity.
Inform your new client, right up front, that the answers to any and all questions during the client screening are strictly confidential. It is part of the professional codes of conduct for trainer:client information to remain confidential, you are responsible for your end of this agreement. So emphasize to the client the importance in answering all questions as specifically and honestly as possible because the more you know the less likely they are to experience injury and the more likely they are to have positive results.
Reminder: For client safety, and for professional and liability reasons, you should always maintain current CPR Certification. It is always possible, even if you are only training apparently healthy individuals, that there will be a need for the performance of CPR. If you extend your service to medical fitness clients (requiring additional education and specialty certificate) then this will be required of you. As a qualified and conscientious personal fitness trainer, it would be both professional and appropriate to maintain CPR Certification at all times. In most cases it is required for employment and for liability insurance purposes.
Fitness Assessment Variables are Broken up in to 2 Types:
- Non-Performance Variables
- Performance Variables
These are the variables that are viewed as not a measurement of the physical fitness level, or specifically the performance, of your client. Of course these do impact the outcomes of the performance variables and ‘weigh’ heavily in the ultimate design of the exercise program, but they are not measuring performance directly. For example, your client’s weight and height is not a measure of their actual performance, it is simply a measurement of their frame or current condition.
First, before moving into actual performance of movement, you have to screen and assess the Non-Performance Variables. Starting with Major Risk Factor Identification.
Major Risk Factor Identification
The first official step when on-boarding a new client (after all the business ‘stuff’ is nailed down and you understand their fitness goals and they understand your hourly rate) is to assess their current medical condition. Step 1: identify “health risk factors”. You are not qualified, as a NFPT-CPT (or with most standard issue Personal Trainer Certifications) to design and implement exercise programming to persons with one or more Major Health Risk Factor(s), UNLESS you have the direct involvement and approval of a medical physician. The following are Major Risk Factors that should first be identified as being present, or not. Here are a few of the questions that you will ask as part of your new client assessment and screening:
- Do you have diabetes?
- Is body composition interfering with the performance of the simple of daily tasks? (i.e. clinically obese?)
- Do you have a history of high blood pressure?
- Do you have a family history of coronary disease prior to age 50?
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Personal Medical History
As part of the health risk factor assessment, you’re going to ask these questions in order to obtain specific information about medical history and/or current lifestyle behavior risks.
Have you ever had?:
- a heart attack
- cardiac surgery
- extreme chest discomfort
- high blood pressure (over 140/90)
- heart murmurs
- ankle swelling
- any vascular disease
- unusual shortness of breath
- fainting spells
- asthma, emphysema, or bronchitis
- smoke (and over the age of 35)
- drink excessively (more than 1-2/day)
- have poor sleeping habits (less than 8 hrs/night regularly)
Not all of the questions for client screening are listed here, these are examples. As a NFPT Certified Personal Trainer, you will be provided the step-by-step questions, forms, and sample waivers to complete as you walk through this process with each client.
Cardiovascular (CVD) Risk Profile and PAR-Q
Step 2 in assessing health risk is completing the “Cardiovascular Risk Profile Questionnaire” and PAR-Q & You Form. A ‘PAR-Q’ is a ‘Physical Activity Readiness Questionnaire’. Both of these questionnaires are easy to use, self-explanatory and very objective. For the CVD Risk Profile, a client score of over 32 would be reason enough not to train this individual until you have a signed Physician’s Release. The PAR-Q is a quick and simple 7 question survey that asks ‘YES/NO’ questions to identify red flags (any ‘YES’ to one or more questions is a red flag).
Current Client Medication
If the client is on prescription medication, require that the client contact his/her physician or qualified pharmacist to ensure that there are no risks involved in starting the exercise program while on this medication.
Chronic Illness, Injury or Limitations
If the client is currently ill, put off starting the exercise program until they are over the illness. If the client suffers from a chronic, or recurring illness, then additional care should be taken that the illness is not complicated by exercise. If a client has a chronic injury or a range-of-motion limitation, it should always be advised that they see their personal physician, a licensed physical therapist, or an orthopedic physician prior to implementing your recommendations. In the case of range-of-motion limitations, this therapeutic referral need be made only if recommendations involve the articulation (movement) of the injured site(s). You must also avoid recommending movements that aggravate the condition. Inform the client to stop exercising if they experience relative symptoms or undue pain of any kind. They should be reminded to consult immediately with you when/if they start to feel any pain at all; then, if needed, they should consult with their physician.
Contraindications to Exercise
As a personal fitness trainer, you must also inform your client of the contraindications (symptoms of overexertion or injury) to exercise, so the client will be able to distinguish the difference between discomfort that is to be expected, and discomfort that could indicate an underlying problem. Make sure that they understand the importance of informing you should any of the following occur: joint pain, dizziness, nausea, rapid pulse, excessive sweating, extreme muscle soreness, cramping, or chest pain.
Has Client Been Advised Against Exercise If the client has ever been instructed by a physician not to exercise for any reason not already covered in the Client Screening Questionnaire, you need to know. Ask this question specifically.
Physician’s Release and Informed Consent: Summary
You are responsible for making sure that your client, if a Major Risk Factor is present, gets an approval from their physician to start or increase the intensity of exercise. A Physician’s Release is a signature document that the client/patient will provide to their doctor in order to get their doctor’s okay and approval to exercise. We recommend getting this Physician’s Release when #1) when there is adverse personal medical history and/or symptoms; #2) the client’s cardiovascular risk profile score is over 32; #3) there is a significant and restrictive chronic illness or range-of-motion limitation; or #4) persistent contraindications
Though you are not obligate to require a Physician’s Release of your apparently healthy clients, it still isn’t a bad idea to have one on file. If your client does show risk factors, then you are putting your client and yourself at risk by not having a Physician’s Release. For all clients, it is imperative that you inform them of the inherent risk to injury that comes with exercise, and require that they sign an Informed Consent and Liability Waiver prior to starting the exercise program. Basically, an Informed Consent Waiver states that you, the personal trainer, has informed the client of potential risks and that they agree and understand that you have informed them and they are willing to take on the risk. The Liability Waiver is a signature document that releases your from liability should any injury occur (injury that is not considered negligent on your part).
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General Client Information
This may sound a bit cliche, but a quality personal fitness trainer will evaluate a client’s total lifestyle, not just their exercise needs. There is more to health than just exercise alone. The following is a brief overview of each of the General Client Information topics. These are included in the NFPT Client Screening Questionnaire and respective forms.
Age – Knowledge of client age is useful in determining health risks, exercise intensity and duration, as well as for computing maximum heart rate.
Gender – This information is usually needed for demographic reasons. Gender also is a consideration in determining health risks as is indicated on the Cardiovascular Risk Profile Questionnaire.
Sleeping Habits – Poor sleeping habits can reduce recovery effectiveness, lower Growth Hormone release, and can cause mental fatigue and inability to concentrate. Sleep is the body’s built-in recovery mechanism. A protein builds up in the cerebrospinal fluid during waking hours that can only be broken down during sleep. Moreover, sleeping abnormalities can usually be directly linked to stress and improper diet.
Water Intake – Not drinking enough water leaves the client susceptible to dehydration during exercise. Also, prolonged low water intake can lead to a survival water retention in the body.
Occupation – Knowing what type of daily activities your client performs will assist you in determining total caloric intake, meal timing, exercise scheduling, and possible lifestyle change recommendations. Occupational stress may also be a consideration.
These are measurements of the human body, its frame and measurements that factor in to equations like BMI (Body Mass Index) and others.
Weight – Weight is generally a determining factor in first establishing your client’s goals. Body composition measurement first requires measurement of total weight. Knowledge of weight is also of obvious re-evaluation benefit in consulting clients. Don’t simply ask the client their weight, accurately weigh the client yourself.
Height – This information is usually needed for demographic reasons. Also, height is a determining factor in setting client goals based on national height & weight standards. These standards have been established by major health insurance companies as a very general indicator of physical condition.
Body Composition – Without question, this is the most valuable re-evaluation tool at the personal fitness trainer’s disposal. This is the measure of body fat versus lean muscle and it requires that you know the accurate total body weight and how to use the proper body composition measuring device (e.g. skin-fold caliper)
Circumference Measurements – Accurate circumference measurements are extremely valuable regardless of your clients’ goals. Circumference measurements will be altered regardless of the type of resistance activity and relative desired adaptation. Take measurements at the following sites can be helpful later to assess progress: neck, chest, upper arms, waist, hips, forearms, thighs, and calves.
These variables include factors that determine the readiness and current fitness level of your client. There are specific assessments that are performed for each of these variables which will determine the starting place and the modifications needed for your client.
Cardiorespiratory Condition: assessing your client’s current cardio condition gives you a predictive maximum aerobic capacity that your client can comfortably handle. Using a simple 3 minute step test, for example, can let you know if your client is within an ‘Average’ to ‘Above Average’ range for their gender and age.
Muscular Endurance: Your client’s muscular endurance should be tested for their upper body, lower body and core. Proper form and full range of motion are required in order to successfully perform these tests and get accurate projections for placement from ‘Poor’ to ‘Excellent’ muscular endurance.
Muscular Strength: muscle strength tests are useful for determining initial strength/lean tissue of the fat loss client, and for determining initial strength/lean tissue of the weight gain client. In either case, the strength test is easily applied and extremely useful in continued lean weight monitoring for all client types and goals.
Power: this is a combination of how fast and how much resistance can be moved. It is a more common assessment for athletes.
Speed: also a common athletic assessment, speed tests are as much about acceleration as they are actual speed.
Agility: this is a very important skills tests for most sports. Basically, agility is the capacity to move the body in different directions in rapid succession.
Blood Pressure Screening
Your ability to take a blood pressure reading will help you to determine the ‘at-risk’ client. It is important that you know how to take it, and read it. Your ability to offer blood pressure screening is a skill that you should consider a requirement, especially if you intend to perform sub-maximal pre-exercise testing. This testing calls for the client to perform aerobic activity usually in the form of ergometer cycling. At three (3) separate stages, blood pressure measurements are taken. Ideally, the Systolic (above) reading should rise slightly while the Diastolic (below) reading should not change dramatically. You should be able to take blood pressure readings during the initial training and then again during more intense training in order to compare readings.
With the influx of hypertensive persons needing to monitor blood pressure on their own, the medical supply industry provides battery operated, digital display, blood pressure testing kits for self-testing. These kits can easily be applied by the personal fitness trainer in taking supine, seated, and standing blood pressure readings. Without proper certification or training in blood pressure screening, you are not qualified however, to perform sub-maximal pre-exercise testing. Should you be interested in performing sub-maximal exercise testing, this certification is not a complicated process. While attending class, ask detailed questions concerning sub-maximal exercise testing procedures.
Optional Diagnostic Tests
Consider acquiring appropriate diagnostic skills enabling you to perform tests lending to the efficiency and professionalism of your personal fitness trainer services. The ability to competently perform diagnostic tests will make your services more marketable, more unique, more effective, and attractive to prospective clients/members. The following is a list and explanations of the various types of diagnostic testing you can perform with a minimal amount of education and required skills. For clarification on requirements involved in offering the below services, contact the appropriate health professionals in your area.
Blood Sugar Analysis – The 12-hour fasted use of “Glucostix” or a “Glucometer” will effectively reveal to you any abnormality in blood sugar. The average adult’s normal 12-hour fasted blood sugar ranges from 70-110 mg/dcl. A lower reading may indicate Hypoglycemia where a higher reading may indicate a Diabetic problem. Pre- and post-exercise blood sugar monitoring may also prove valuable in adjusting dietary intake around training. The NFPT recommends that these tests be performed by the appropriate health professionals to assure the use of universal precautions in the handling and disposal of blood products or body fluids.
Ketone Testing – Initial client Ketone testing is usually unnecessary in the apparently healthy individual. It is during periods of starvation dieting and/or extreme overexertion that this test should be applied on a re-evaluation basis. This test is discussed later in this chapter.
Personal Training is Personal: Know Your Client
It’s important to get to know your client, they’re not just what you collect on a piece of paper. Over time, you will know what works best for them and what training methods or environments that they enjoy and are more productive in. But first, before you get to know them over time, know them over conversation…ask them about:
Stress Levels – solicit answers to questions such as…”Do you feel you are under a lot of stress at work?” “Are you easily frustrated?” “Would you say you are always trying to do two or three things at once?” “Do you enjoy an active social life?” Answers to these types of questions along with the answers to occupational, sleeping habits, and other questions, may point towards a need for a future referral to a stress management professional or therapist. On a smaller scale, stress can sometimes be effectively controlled through proper dietary consideration, increased physical activity, and improved sleeping habits.
Long & Short-Term Goals – the client’s long and short-term goals are invaluable. In order for you to effectively design an exercise program and implement your recommendations, you have to know what the client wants and needs in order to feel successful in their mission.
Client Eating Habits – ask the client about their normal eating habits, what do you notice? When you on-board a new client, you should advise that they keep a food log to track their daily eating routines. As a personal trainer, you can give general recommendations for healthy eating, and you should. Eating and exercising go hand in hand when it comes to seeing positive outcomes in health and fitness levels. Don’t be afraid to discuss this topic with your clients.
Most Recent Exercise Program – in order for you to optimize the results of your client’s new exercise program, you must learn as much as possible about their past exercise experience. Ask your client about their past exercise, especially resistance exercise. Pay special attention to the following and be taking notes about what they did and what they should have been doing:
Type of routine – The client should have used a circuit routine for fat loss and aerobic conditioning vs. a split routine for lean weight gain
Total sets per muscle group – The larger the target muscle group, the more total sets used
Typical number of reps per set – Fewer reps for lean weight increase, and more reps for fat reduction and aerobic conditioning
Recovery between sets & workouts – Longer recovery for lean weight increase, and shorter recovery for fat reduction and aerobic conditioning
Movements used – Always use compound movements for both lean weight increase as well as fat reduction and aerobic conditioning
Length of workouts – Short high intensity workouts should be performed for lean weight increase, and long low intensity workouts should be performed for fat reduction and aerobic conditioning
Time of daily exercise – how does this work within your clients past and present schedule? How to incorporate into your schedule?
Even if your client does not have any prior resistance experience at all, you will still need to know what type of past exercises have been performed so that you have a baseline for their starting exercise intensity and duration. This topic is discussed in much greater detail in the NFPT Personal Trainer manual.
Periodic Re-Evaluation and Program Modification
This is another key factor in success as a personal fitness trainer. On predetermined dates (and times) the goals should be re-evaluated (because you need to know if your client isn’t feeling the goal or feeling like they’re moving towards it) and you need to repeat your assessments. It is crucially important to accurately assess and re-assess so that comparisons can be made which point to client progress and/or a need to readjust.Program modification is necessary along several points of progress. All factors in the F.I.T.T. principle, used on some level to create an exercise program to begin with, will be adjusted according to your re-evaluation.
These are all factors which you could and should address and modify according to your findings over time. Personal training is a ‘team sport’ in that you and your client are a team and it is required of all team members to be involved and put forth their best effort in order to win. Fortunately, for the personal trainer, these steps in the screening and assessment processes are step-by-step laid out for you with very little guess-work involved. You can get to the heart of why you started training in the first place, and make it more productive, if you use the steps and the tools to accurately design a program that will get your clients results. Then, once they’ve been at it for awhile, you use these same steps and assessments to re-evaluate and prove how successfully your exercise program has been as they make strides to their goal. Reinforce to your clients that you’re not running a ‘get skinny quick’ scheme, you’re a professional trainer who works for long term results that last.