NSCA CPT Chapter 9 – Client Consultation and Health Appraisal

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Chapter Objectives:

• Discuss the structure and function of skeletal muscles.
• Do initial client interviews for the assessment of compatibility, development of goals, and the establishment of a client to trainer agreement.
• Know the process of preparticipation health appraisal screening.
• Find positive coronary risk factors associated with cardiovascular disease.
• Stratify and evaluate the health statuses of potential clients.
• See individuals that need a referral to other professionals.

Purpose of Consultation

The scope of practice for personal trainers is this: Personal trainers are health and fitness professionals that use individualized approaches to motivate, assess, educate, and train people in their needs for health and fitness. Personal trainers design safe and effective programs and guide people to help achieve personal goals. They also respond to emergency situations. Personal trainers will refer people to other professionals when something is outside of their scope of practice.

Personal trainers MATER

• Motivate performance and compliance
• Assess health status
• Train clients effectively and safely to meet objectives
• Educate people to be informed, consumers
• Refer clients to health care professionals when needed

Delivery Process

Four factors dictate implementation:

• Credentials of the trainer
• Site of Delivery
• Specific populations served
• Legal statutes

Client Consultation

In the first interview, the trainer and client assess compatibility with each other, develop goals, and establish an agreement.

Steps of the client consultation and health appraisal

• Schedule interview appointment
• Conduct interview
• Make and complete health forms
• Evaluate risk factors and lifestyle
• Assess and interpret results
• Refer to other health professionals if needed
• Get medical clearance and recommendations for programs.

Assessing Client Trainer Compatibility

The trainer gives details on the services they offer. 

The trainer evaluates the client’s readiness by assessing the individual’s motivation and commitment.

The last part is assessing suitability and appropriateness.

Discussion of Goals

If the client and trainer are compatible and suitable, they will start discussing and setting goals.

Establishing the Client Trainer Agreement

The next step is finalizing the agreement. Contracts have written documents describing the services, parties, timelines for delivery, cost structure, and payment process. Other things covered are the cancellation policy, contract termination, and circumstances where the document is made void.

Preparticipation Health Appraisal Screening

PAR-Q

This physical activity readiness form is a tool that was made in Canada. It consists of a questionnaire and requires the person to fill it out to recall observations and signs and symptoms that the person has experienced. It also needs confirmation of diagnosis by a physician. 

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These forms are easy to give and are sensitive documents. 

It does not consider risk factors for coronary artery disease, medications, or any exercise contraindications. 

It mainly assesses how appropriate moderate and vigorous levels of exercise are.

Additional screening

Lifestyle inventories

These consist of questions for evaluating personal choices and patterns related to dietary intake, stress management, physical activity level, and other personal health practices.

These inventories are mostly made for the average and apparently healthy population. 

Informed Consent

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

It includes a detailed description of the program, the risks and benefits that are associated with participating, a clause for confidentiality, the responsibilities of participants, and the documentation of the client’s acknowledgment.

Release / Assumption of Risk Agreement

An assumption of risk, also known as a waiver, is an agreement the client makes before the begin participating. It relinquishes rights to legal remedy in the event of injury, even in the event of negligence.

Children and Preparticipation Documents

Since there is a rise in the number of overweight children, the number of children receiving personal training is rising also. Because of this, the parents of the children will fill out forms on behalf of the child, and then there are more requirements for medical clearance. It is also imperative that the trainer put forth the most effort into teaching form and effective training methods,

Evaluation of Coronary Risk Factors, Disease, and Lifestyle

Coronary Artery Disease Risk Factors

This is the leading cause of death in western societies.

Atherosclerosis is a progressive degenerative process that is associated with CAD. The endothelial lining of the arterial walls gets hardened and the walls lose their elasticity.

These factors, and mainly atherosclerosis, could lead to a heart attack, also known as a myocardial infarction.

Positive Coronary Risk Factors

Age – Men ≥45 years; women ≥55 years

Family History – Myocardial infarction, coronary revascularization, or sudden death before 55 years of age in biological father or other male first-degree relatives, or before 65 years of age in biological mother or other female first-degree relatives

Cigarette Smoking – Current cigarette smoker or someone who quit within the previous six months, or exposure to environmental tobacco smoke

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Sedentary Lifestyle – Not participating in at least 30 min of moderate-intensity (40-60% V O2Reserve) physical activity on at least three days of the week for at least three months

Obesity – Body mass index of ≥30 kg/m2 or waist girth of >102 cm (40 in.) for men and >88 cm (35 in.) for women 

Hypertension – Systolic blood pressure ≥140 mmHg and/or diastolic ≥90 mmHg, confirmed by measurements on at least two separate occasions or on antihypertensive medication 

Dyslipidemia – Low-density lipoprotein cholesterol (LDL-C) ≥130 mg/dl (3.37 mmol/L) or high-density lipoprotein cholesterol (HDL-C) of <40 mg/dl (1.04 mmol/L), or on lipid-lowering medication. If total serum cholesterol is all that is available, use ≥200 mg/dl (5.18 mmol/L 

Prediabetes – Impaired fasting glucose (IFG) = fasting plasma glucose ≥100 mg/dl (5.50 mmol/L) but <126 mg/dl (6.93 mmol/L) or impaired glucose tolerance (IGT) = 2-h values in oral glucose tolerance test (OGTT) ≥140 mg/dl (7.70 mmol/L) but <200 mg/dl (11.00 mmol/L), confirmed by measurements on at least two separate occasions 

Negative Coronary Risk Factors

High Serum High Density Lipoprotein Cholesterol – > mg/dl (1.55 mmol/L)

Identification of Medical Conditions and Diagnosed Disease

Coronary Artery and Pulmonary Disease

Signs and symptoms: 

• Pain in the chest, arms, jaw, neck, or other body areas due to ischemia. 
• Shortness of breath when at rest or only mild exertion.
• Dizziness or syncope
• Orthopnea or paroxysmal nocturnal dyspnea
• Ankle edema
• Palpations or tachycardia
• Intermittent Claudication
• Known heart murmur
• Unusual Fatigue or shortness of breath with your typical activities

Risk of Sudden Cardiac Death

This is related to exercise caused by cardiac arrest, which happens when an abrupt change in a preexisting state is immediate.

Sings and conditions to look for:

• Chest pain or discomfort with some physical exertion.
• Unexplained dizziness or fainting.
• Excessive and unexplained shortness of breath.
• Recognition of a heart murmur.
• Rise in blood pressure.
• 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.
• Family history of hypertrophic cardiomyopathy, long QT syndrome, Marfan syndrome, or heart arrythmias.

Metabolic Disease

Impaired fasting glucose levels may lead to the development of diabetes. 

Diabetes mellitus is a metabolic disease that affects the ability of the body to metabolize blood glucose.

There is type one and type two diabetes.

Exercise and activity pattern

We look at specific activities as well as frequency, volumes, and the level of intensity of those activities. Any joint pain or chronic discomfort is identified here too.

Stress Management

Stress can lead to increases in heart disease.

Interpretation of Results

Initial Risk Stratifications

This uses age, health status, personal symptoms, and coronary risk factor info to classify people into three risk categories.

Low Risk – Asymptomatic men and women who have ≤ one CVD risk factor 

Moderate Risk – Asymptomatic men and women who have ≥ two risk factors 

High Risk – people who have…

known cardiac, peripheral vascular, or cerebrovascular disease; chronic obstructive pulmonary disease, asthma, interstitial lung disease, or cystic fibrosis; or diabetes mellitus (type 1 and 2), thyroid disorders, renal or liver disease, or

one or more of the following signs or symptoms: -Heart murmur
-Unexplained fatigue
-Dizziness or fainting -Swelling of the ankles
-Fast or irregular heartbeat
-Unexplained shortness of breath
-Intermittent lameness or pain in calf muscles
-Breathing discomfort when not in an upright position or interrupted breathing at night -Pain or discomfort in the jaw, neck, chest, arms, or elsewhere that could be caused by lack of circulation 

Referral Process

Medical Examinations

These are recommended for everyone when they begin a new program or activity. 

PAR – Q 

If a client answers yes to any question on the form, they will be suggested to contact their physician and discuss the question that got the answer. 

Recommendations for Current Medical Examinations and Exercise Testing

Low risk: These clients do not need medical exams or exercise testing before participating in moderate and vigorous activity. Physicians also do not need to do Submax or max exercise testing.

Moderate Risk: It isn’t necessary to have current medical exams for moderate intensity exercise, but it is highly suggested for vigorous ones. Physician supervision is recommended during Submax testing.

High Risk: Current medical exams are recommended for exercise, and physicians should supervise any Submax or max exercise testing.

Medical Clearance

When needed, the trainer must encourage medical clearance as a reasonable and safe course of action. 

It should be seen as a concerted effort to obtain valuable information and professional guidance to ensure safety and protection for the client’s health. 

Physician Referral

The physician referral form given to the client to give to their physician has info regarding health status, physical limitations, and restriction that should be made for future programs.

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