Certified personal trainers (CPTs) wear many hats; but above all, they serve as critical advocates for health, wellness and fitness. Through their commitment to exercise education, improved health, goal-setting and overall wellness, CPTs foster the promotion of healthier individuals and communities. However, just as important as their skill sets and abilities to pass their knowledge on to their clients, CPTs must likewise understand the scope of their practice as defined by law. In this article we delve into what a CPT can do for clients, as well as where they must draw the line and begin to guide clients towards other more qualified allied health professionals.
Excel, But Within Boundaries
A personal trainer’s primary responsibility reigns supreme within the confines of the gym/fitness center/community center. While other professionals may provide general guidelines for physical activity—typically heard in a physician’s office as “just try to move more” — the certified personal trainer (CPT) excels at developing specific exercise programs for individuals to help improve and maintain their health and fitness goals. Certified personal trainers might even consider themselves the bridge between the medical community and their clients. While some physicians and other allied medical personnel may recommend physical activity to their patients, only 30% of patients report hearing this advice from their family doctor.
Ideally, perspective personal training clients who come to the gym seeking guidance on their fitness journey already have a well-established medical team. They have typically sought out the services of a trainer to help them focus on the physical domain of wellness as a preventive measure. However, we also see exceptions. Sometimes a client may look to a CPT to remedy their poor health, often in the absence of or as a substitute for a true medical professional. The CPT’s fitness consultation/comprehensive assessment provides the perfect opportunity to learn about a client’s existing level of health care.
Knowing When to Refer
Sometimes clients have issues beyond the CPTs’ scope of practice. Many personal trainers choose to develop referral networks. Key professionals in the network may include physicians, physical therapists, nutritionists, mental health professionals, chiropractors, massage therapists, and occupational therapists.
How can a CPT identify when to refer a client to another professional, and how can he ascertain they exact type of professional to best address the client’s needs? Understanding the CPT’s official scope of practice will help. By law and/or definition, a certified personal trainer may not attempt to diagnose medical conditions, prescribe any medical intervention (including diet), provide treatment for any injury or disease (aside from RICE in the case of a gym-related incident occurring during a training session), provide acute rehabilitation services, or provide counseling services for clients. While this seems limiting, a CPT does wield some power and bears some responsibility, which can easily get accomplished as follows.
When faced with a client who presents with a multitude of challenging health issues, CPTs might consider obtaining exercise and health guidelines/records from other members of the client’s circle of care, such as the client’s medical team (physical therapists, physicians, dietitians, etc.). If upon screening a new client, the CPT identifies exercise limitations and/or potential risk factors associated with a training protocol, he must refer clients to qualified medical practitioners to address these challenges prior to commencing a regular workout program.
Forging a Trusting Alliance
Trust, critically important for an effective circle of care, does not come easily for everyone. Many allied health professions often present with ambiguous structures, inconsistencies in regulation, differing paradigms and education levels; as such, communication and trust may require time and patience. While this may render a CPT somewhat powerless, even feeling left out of the circle, he nonetheless bears the responsibility of adhering to medical practitioners’ guidelines and operate with a level of transparency.
It may take some legwork, but with patience and dedication, CPTs can develop effective relationships with other members of a client’s medical team, which can have lasting mutual benefits. A CPT who leads as a team player, demonstrating superior scope of practice adherence and achieving results, will find other members of a client’s medical team more willing to extend a trust bond, and may even refer other patients in the future.
When a potential new client arrives at the gym with a physician’s referral, a CPT must obtain permission from the client to communicate with his doctor, in an effort to keep the doctor abreast on the client’s progress vis-à-vis the medical professional’s recommendations. Physician’s orders will always take precedence over the suggestions of a fitness professional; therefore, a trainer must remain cognizant of his important yet limited role in order to avoid any legal problems, providing only the types of services allowed under his national certification(s).
Knowing Our Limits
While every national certifying body most likely comes up with its own set of parameters outlining a CPT’s scope of practice, certain basic tenets hold true across the board. Below we list some of the more common legal allowances for a certified personal trainer:
- Training healthy individuals with a goal of improving cardiovascular endurance, cultivating lean muscle mass/strength and increasing flexibility
- Using behavior-change strategies to improve health and fitness
- Training individuals with certain physical limitations in accordance with their physicians’ orders
- Training 1-on-1 or in small groups
- Coaching clients on developing, setting and achieving realistic health, fitness, and behavior-change goals
- Designing unique and appropriate fitness training programs to meet each client’s specific goals
- Teaching and monitoring safe exercise technique, proper movement progressions and regressions with demonstration, explanation, proper cueing and safe spotting
- Conduct health-history interviews and preparticipation health screenings in order to determine the need for referrals
- Periodically assessing parameters such as body weight, heart rate and body mass, if desired
- Providing general nutrition information/guidance
- Protect client confidentiality as directed per HIPAA regulations
- Act with professionalism, respect, and integrity at all times
- Be prepared for emergencies and know how to respond appropriately (CPR, AED, first aid, etc.)
Similarly, all certifying bodies prohibit CPTs from engaging in the following behaviors:
- Diagnosing/treating an illness
- Prescribing medications/supplements
- Making specific meal plans or dietary recommendations
- Attempting to serve the role of a physical therapist
Maintaining Records and Safeguarding Confidentiality
Very often, during an initial assessment with a trainer, a client will disclose personal information that will have to figure into his training program. This may include past surgeries/rehab, ongoing conditions (hypertension, diabetes, cardiac issues) or even a temporary situation that merits attention (recently broken ankle, pulled muscles, etc.). Therefore, the need for confidentiality remains of utmost importance. Some gyms ask their CPTs to keep client files in a locked cabinet or secured in a personal locker, to ensure that this information remains away from the public eye.
Similarly, records of training sessions and payments made/due must stay in a secure location. In the rare case of any litigation, trainers may need to reproduce documentation to prove that they performed appropriately and well within their professional scope of practice. Experts suggest that trainers to hold onto these personal client records for a minimum of four years, should the need to access them arise.
Final Thoughts
As a CPT, I understand the passion for helping others succeed; we strive to guide clients on their journeys to better health and fitness, often wanting to do everything we can to help them meet their goals. It often proves frustrating when, for example, I possess the knowledge to help improve clients’ nutrition but must apply the brakes just shy of writing them a meal plan. The best thing we can do sometimes involves simply offering suggestions regarding other professionals and even providing them with contact information for these individuals, if we have that networking ability.
By prioritizing professional standards, ongoing education and ethical practices, CPTs not only enhance but protect their careers, all while improving the lives of their clients.
References:
ACE Chapter 1: Role and Scope of Practice for Personal Trainers
Chapter 29: Legal and Professional Guidelines for Personal Trainers
CPT’s Role within a Cricle of Care
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