In order to design a personalised exercise programme the trainer should conduct a comprehensive consultation with the client (Earle and Baechle, 2004). This is usually a face to face discussion with the client and provides an opportunity to build rapport as well as gather specific information.
The general way of life and habits of a client will impact on their health, body composition, fitness levels, energy levels, motivation and ability to adhere to an exercise programme. This information along with agreed SMART goals will form the basis on which the trainer can design a programme that will effectively progress towards the clients objectives.
It is the legal and professional responsibility of a fitness instructor is to gain informed consent and collect information about the client before planning or instructing any physical activity programme. Once the information has been gathered, the fitness instructor must analyse the information to plan, instruct and evaluate safe and appropriate gym-based exercise sessions based on the clients goals and likes.
The first stage of gathering information is ensuring that you have obtained informed consent.
Informed consent or by a parent or guardian:
Informed consent is a legal procedure to ensure that the participants knows the risks involved in the activity they are about to perform or undergo. For it to be valid, the client must be competent and the consent given voluntarily. If they are not, competent, then a guardian must be present. Individuals who may be deemed as not being competent include, children under 16 years, people with learning difficulties, dementia and participants suffering from mental ill health. The informed consent informs the participant of the nature of what is going to happen, possible alternatives and any potential risks and benefits. It must be given voluntarily.
The second stage of gathering information is the pre-activity screening and the client interview. The purpose of pre-exercise screening is to establish an individual’s suitability to participate in an exercise programme and to evaluate an individuals’ health status and identify any existing medical conditions or risk factors that could be made worse by an increase in physical activity. It is not designed to diagnose new health issues.
When carrying out health screening, the following areas should be considered;
- The medical status:This will identify if the client suffers from any conditions or diseases and whether they are on any medication which may affect their heart rate response to exercise.
- Risk Category:the likelihood of the client falling into a risk category, such as special attention or medical referral. E.g. if a client has a family history of heart disease, a sedentary lifestyle and is overweight, it would indicate that they may be prone to hypertension
- Contraindications to Exercise:A ‘contraindication’ means that if a client has particular medical condition then they should not exercise unless they have written medical clearance. Even then they may need more specialist supervision than a fitness instructor can provide. Contraindications to exercise include: High blood pressure readings, Tachycardia (abnormally fast heart rate) or bradycardia (abnormally slow heart rate. If you are unsure about a medical condition then additional questioning may be required. Also if the instructor or participant has any other concerns regarding their readiness to exercise then play safe and refer them to a medical professional for more advice.
- Past Surgery:highlight any past surgery that may have resulted in a weakness that would make certain exercises high risk. E.g. a client who had surgery to fuse vertebrae in the lumbar spine would be at high risk from exercises such as plyometric hopping or lifting heavy weights, due to the increased pressure in the spine.
- Injury: identify any former injuries that have had little or no rehabilitative treatment. Pain often causes people to alter their general movement patterns to keep away from the pain. For example, if somebody suffers with an ankle injury, they can change their movement patterns by shifting their body weight away from the injured side during walking.
- Goals and Aims:The pre-activity screening will provide an opportunity for the fitness instructor and the client to explore their goals and aims for their physical activity programme.
- Lifestyle:This includes whether they smoke or drink alcohol, how stressed they feel, the quality of their diet, and so on.
- Motivation and barriers to participation:If the client identifies any barriers it may be possible to suggest simple strategies to overcome them
Take some time to gather information from your client; it will help you select the most appropriate exercises for them. It also helps to build rapport, and can also help you to more fully appreciate your client’s motivation to exercise. There are a variety of methods for gathering information, but at level 2, you only need to be aware of 3 main methods:
- Health / Physical Activity Readiness Questionnaire PAR-Q (written)
- A client interview(verbal)
- Observations of physical measurements (visual)
This is a simple, valid and time efficient document used for assessing the client’s state of readiness to exercise. PAR-Q are appropriate Assessment of fitness should always start with medical screening, to ensure that your client is not placed under any undue risk from the testing procedure. The Physical Activity Readiness Questionnaire (PAR-Q), originally developed by the Canadian Society for Exercise Physiology, provides a quick and easy method of identifying any individuals that may be at risk from an increase in physical activity. Completion of the PAR-Q should be seen as providing a basic screening of existing medical conditions and/or symptoms of medical conditions. Once completed the PAR-Q should be kept on file and may be useful in providing protection from future legal action.
How does a PAR-Q work?
It is easy to use, if the client ticks ‘yes’ to any question on the PAR-Q, then they need to be referred to the appropriate specialist for advice prior to exercise. If the client ticks ‘no’ to all the questions, that person can proceed into the exercise programme.
The PAR-Q is a good starting point for gathering personal background information.
|It provides a permanent record|
Enable a quick response (yes, no)
It helps to identify the apparently healthy individual
It assists in identifying persons who need special attention or who should not be exercising until they have obtained written clearance from their doctor
There is an opportunity for the Instructor to ask open questions to gather more detailed information
It can help protect instructors against potential legal problems
|Records may change, and information needs to be updated|
Records must be confidential, therefore must be stored in a secure environment
Note; when a client ticks ‘yes’ to any question on the PAR-Q, it is classed as a positive response.
The client must then be referred to their doctor as they may have a condition or risk factor that could be aggravated by physical activity.
Here is a downloadable example of a PARQ. Click HERE
Before starting any session planning, it is important to take time to get to know the client. This helps you gather a wide variety of information along with the motives to exercise and the barriers that might be preventing exercise adherence. It also allows you to develop a rapport with the client and a positive connection. You can then help to educate/motivate the client to make improved lifestyle choices based on the evaluation of the client’s current lifestyle behaviors e.g. stress, occupation, eating habits.
The structure of the interview can take different forms. You can follow a set structure or script that the employer wishes you to follow or complete a questionnaire and ask questions while taking notes. Which method is chosen is dependant on the experience and confidence of the instructor, the company policies and procedures and the type of client you are dealing with.
Types of Question
There are a number of ways of asking for information. It is important to use the right kind of question at the right time:
- Open questions.These allow the client to answer in their own words, and are most useful when opening a dialogue. The test for an open question is that it does not allow a simple ‘yes’ or ‘no’ answer. For example: ‘What types of exercise do you enjoy?’
- Closed questions. These only allow a ‘yes’ or ‘no’ answer, or a single piece of information. They are good for focusing on specific information, but not effective when trying to encourage the client to talk and say things in their own words. For example: ‘Do you like running?’
- Leading questions.These manipulate the client into answer the question in a certain way, and for that reason they should be avoided. For example: ‘I expect you would like to lose some weight?’
- Clarifying.A clarifying question usually follows a client answer and simply asks for more detail. For example: ‘You say you enjoy doing exercises classes. What type of classes in particular?’
What Information Do You Need?
It is important to collect as much information as possible when trying to build a complete picture of the client.
The following details are important:
- Previous activity history?
- Activity likes and dislikes?
- Current fitness level?
- Lifestyle – This includes whether they smoke or drink alcohol, how stressed they feel, the quality of their diet, and so on?
- Medical history – This can be done using a health questionnaire?
- Motivation and barriers to participation – If the client identifies any barriers it may be possible to suggest simple strategies to overcome them (see ‘managing change’ later)?
- Functional ability – This means their ability to carry out daily functions such as lifting, carrying, climbing stairs, etc?
Some examples of basic questions about their personal background can provide a wealth of facts e.g.
- What has your experience of exercise been like in the past?
- What do you want to achieve from starting an exercise programme?
- What are the reasons for you wanting to start an exercise programme?
- Do you have any hobbies that are exercise related?
- Do you have any past injuries that still affect you today?
|It is immediate and up to date,|
It allows a rapport to be built up.
It allows further questioning to clarify information or to gather further information.
|Some people might find it invasive and hold some information back from you.|
Special arrangement needs to be made to record this information.
It takes up time as it is personal and can only be done one at a time to maintain confidentiality.
As a Gym Instructor you will need a system of record keeping. This usually involves standard screening questionnaires, a contract for services, programme cards, electronic files and so on. Record keeping is perhaps the least interesting part of the job, but it is essential for reasons of legality and professionalism. Note that when you have access to any personal information then you must abide by the data protection act.
Data Protection Act
The data protection act (1998) tells us of our legal responsibilities when we hold other people’s personal information. It is important that the instructor respects their client’s right to confidentiality. This means that any information should be treated as privileged, and not divulged to anyone else, including friends and family of the client. It also applies when you are chatting informally to other instructors – be mindful of how you talk about your clients.
Personal information should be stored safely in a locked cabinet, accessible only to staff who need to know that information to carry out their job. Any records stored electronically should be password protected as a minimum. Ideally, a firewall and data encryption should also be used.
If you feel that, in the client’s own interest, information should be shared with another professional, it is essential that you seek their permission first. If they refuse, that is their right.
Go to: http://www.ico.gov.uk/for_organisations/data_protection.aspx to obtain detailed guidelines of your responsibilities.