Pre-Screening

To kick-start this sub-topic watch this video tutorial where Ben discusses the purpose of the pre-exercise consultation 

As a personal trainer, it is essential to have a comprehensive understanding of your client's health and fitness levels before starting any exercise programme. Pre-screening plays a crucial role in identifying potential risks and limitations that may impact the safety and effectiveness of the exercise programme.

This topic will explore the consultation process, including health and fitness questionnaires and goal-setting tools. We'll discuss how to interpret the results of these assessments and use them to design customised exercise programmes that cater to your client's unique needs and goals.

Throughout the topic, you will participate in activities that will enhance your knowledge and skills in pre-screening and health assessments, enabling you to become a competent and confident personal trainer.

In this topic, we’ll cover:

• Consultation
• Documentation
• Pre-screening tools
• Goal-setting tools

It's your responsibility to provide accurate and safe information to clients from diverse backgrounds. The consultation is a chance to learn about clients' goals and medical history through open and closed questions, so you can ensure the information you provide is accurate and safe.

The safety of your client and other gym members is at the core of all you do.

Uphold professional standards

The Code of Ethical Practice states that registered personal trainers will always “respect the rights and dignity of every participant regardless of gender, age, disability, ethnicity, sexual orientation, religious or political affiliation, or any other legally prohibited grounds of discrimination” (REPs, Code of Ethical Practice, 2018).

Remember, you will work with a wide range of people from different backgrounds. Clients may include:

• People of all ages, including senior citizens
• People of all genders and sexualities
• People from different cultural, language, and social backgrounds
• People who may have limited English language, literacy, and numeracy skills
• People with disabilities (including sight, hearing, mobility, and intellectual)

You must not discriminate because of disability, ethnicity, culture, language, age, gender, sexual preference, religion, political beliefs, or socio-economic status. Not only is this specified in the Code of Ethical Practice, but it’s also just doing the right thing and being a kind and inclusive person.

This may mean adjusting a programme and your communication skills when appropriate. It's important to demonstrate an awareness of culturally appropriate practices when interacting with clients. New Zealand is culturally diverse, and practices may vary depending on your client's cultural background.

Successful consultation

A successful consultation leaves the client feeling comfortable, with dignity, and having confidence in your abilities. A successful consultation provides the personal trainer with key information to design a great programme and help the client reach their goals.

Things you can do to increase the chances of a successful consultation:

• Make your client feel comfortable. Explain why you are collecting the information and what will be done with it.
• Break the pre-screen into subtopics. Subtopics like training goals, are best discussed verbally so you can ask follow-up questions. For other subtopics, such as medical screening, you may find it sufficient to have the client tick boxes.
• If the client is busy writing, stay quiet and don’t talk to them. It can be hard to concentrate on 2 things at once.
• Observe non-verbal communication such as hesitation when answering questions.
• Ask follow-up questions for “yes” responses to medical or injury questions. E.g., Which shoulder? How did you do it? When? Did you get treatment? What did the physio suggest?
• Don’t presume. Let the client tell you.

Consultation provides the opportunity to create and build rapport while taking the client through a series of questions to obtain personal information. Clients may not want to share their personal history with someone they have just met. So, within the initial consultation process, try to build trust, establish professional credibility, and determine compatibility and trust between yourself and your client as this will help the client feel comfortable and allow them to feel a sense of genuine interest and connection. 

The personal trainer/client relationship is close, and ideally, long-term. It’s important that you spend some initial time building rapport. ​You may find the SMILE technique helpful for this.

Effective questioning

The consultation is an opportunity for a personal trainer or coach to get to know the client better and figure out their values, beliefs, and goals. The best way to gather the client's background information is by asking open-ended and closed questions.

Examples of open-ended questions:

• What objectives do you have?
• How do you feel about beginning this fitness journey?
• What type of exercise activities do you enjoy?
• What are your top 3 goals?

Examples of closed questions:

• Is increasing your muscles your key objective?
• Have you ever attended a gym before?
• Do you have any physical conditions that affect you using weights or other equipment?
• Have you ever used a rowing machine?

Open and closed questions help you to:

• gather detailed medical and exercise history
• create specific and measurable goals
• determine any weaknesses or barriers to exercises
• find out about lifestyle factors such as nutrition, stress, and support
• build rapport and find common ground with your client

Importance of pre-screening

Pre-screening is a preliminary process of identifying any potential risks or reasons for exclusion before starting an exercise routine. This is done to ensure that the exercise program is safe and appropriate for the individual. You pre-screen your client to determine:

• If your client is medically and physically safe to exercise and if so, determine the appropriate intensity and other variables within the FITT principle
• If medical referral and/or clearance is required
• If you are a suitable professional to safely, and effectively, meet their medical and exercise needs

It’s important to provide an initial screening of all potential clients to determine risk factors and discuss limitations prior to starting an exercise routine. This is to ensure the safety of the clients during exercise testing and to help you produce a specific, individualised, safe and effective programme.

Pre-screening is a 2-way process. You should use this stage to determine if your client is a suitable candidate for exercise and if the needs of your client fall within your scope of practice. Are you qualified to safely guide them through their exercise and health needs? If not, ask for further advice from your gym manager, a more experienced personal trainer, or refer to the appropriate health professional such as a general practitioner or a clinical exercise physiologist.

All health and fitness professionals conduct pre-screening sessions to:

• optimise safety
• develop sound and effective exercise prescription
• identify individuals with disease symptoms and risk factors for disease development who should receive medical clearance before starting an exercise programme
• identify and exclude individuals with medical contraindications to exercise
• identify individuals with other special needs

Your gym will require you to complete documentation recording the consultation. These are sometimes called screening forms. Each gym has its own paperwork and processes for recording and filing the records. Confidentiality and client privacy are important, so ensure any completed paperwork is stored safely.

Pre-screening forms

REPs have an online pre-screening tool for REPs registered exercise professionals and facilities, and offline pre-screening forms.

Pre-screening forms may have the following sections:

• Important medical information
• A diagram to label areas of the body that may be adversely affected by exercise
• Programming information, including exercise goals, exercise history, and client availability
• Monitoring progression
• Proposed schedule

Why do you think it’s important to accurately and fully document client consultation?

Documenting pre-screening is helpful for:

• Legal protection: Documentation provides legal protection to both the client and the personal trainer. If there are disputes or claims, detailed and accurate documentation can help support a trainer's position and provide evidence of the services provided.
• Personalised service: Detailed client documentation allows personal trainers to create personalised training programmes that consider the client's individual needs, goals, and health status. This can help ensure that the training is safe and effective for the client.
• Tracking progress: Documenting client consultations allows personal trainers to track the client's progress over time. This can help in adjusting the training programme and setting new goals to help the client continue making progress towards their fitness goals.
• Communication and collaboration: Documented consultations can be shared with other health and fitness professionals, such as general practitioners or physiotherapists, to ensure a collaborative approach to the client's care. This can help the personal trainer work more effectively with other healthcare providers to help the client achieve their goals.

Pre-screening tools can vary but the main premise and outcomes are always the same. You want to create a good relationship with the client, keep your client safe, and protect yourself from liability.

First, you want to get to know the client. Have a chat and make them feel comfortable. Next, you want to establish the following:

• Personal details
• Medical history
• Injury history
• Exercise history
• Capacity to exercise
• Goals and motivation
• Informed consent and commitment statement (signed)

You may also include lifestyle, movement screening, exercise and biometric testing.

Medical information

You should require your clients to complete a comprehensive medical information and history questionnaire that includes questions about personal and family health history. When reviewing medical history, focus on conditions that require medical referral. If any of these conditions are noted, refer your client to their GP for medical clearance before exercise testing or starting an exercise programme.

The purpose of medical screening is to:

• Identify and exclude individuals with medical conditions
• Identify individuals with clinically significant disease - medical personnel referral/clearance
• Identify individuals who may need further medical evaluation – GP referral
• Identify individuals with special needs (pregnancy, elderly persons, asthmatic)

Keep a copy of this in the client file, confidentially, for your own records to refer to.

Medication

It’s also important to note any medication the client is using and determine what effects (if any) these will have on their ability to train. Drugs such as digitalis, beta-blockers, diuretics, vasodilators, bronchodilators, and insulin may alter the individual’s heart rate blood pressure, ECG, and exercise capacity, you should be aware of these and incorporate this knowledge into your programme and progression approach.

If your client reports a medical condition or drug unfamiliar to you, consult medical references or a GP to obtain more information before conducting any exercise tests or allowing the client to participate in an exercise programme.

Exercise history and capacity

Exercise history and capacity to exercise are important aspects that contribute to an individual's overall fitness journey. Exercise history is essential as it helps to determine fitness goals and provides an insight into their capabilities and programme adherence. E.g., if a client has a history of running, they may be able to perform high-intensity cardio exercises with ease compared to someone who has never exercised before.

You can also establish their preferences – what exercises they like, dislike, or want to try out. 

Questions to establish exercise history:

• What they’ve done in the past
• To what extent
• How long ago was it
• Why they stopped
• What they enjoyed and why
• What did they not enjoy and why
• Anything they want to try

Similarly, understanding an individual's capacity to exercise is crucial as it helps to design an effective workout plan that fits their lifestyle and fitness level, and will aid with programme adherence.

• How often (frequency)
• How intense (intensity)
• How long (time)
• How advanced (type)
• Days and times (fit)

These insights will help you create a personalised programme tailored to your client’s needs and abilities. This approach can help clients achieve their fitness goals, stay motivated, and enjoy their exercise routine.

Age

The client’s age will influence programme design, including the types of exercises, weights, and reps selected, as well as the order of the exercises and the focus of the programme.  

Along with being goal-orientated, the programme may focus on improving quality of life or increasing the functionality behind daily living activities (DLA’s). It’s also important to consider the developmental stages of the human body and the stages of progression of any disclosed diseases or medical conditions. Children, adolescents, and the elderly are all special populations. 

Lifestyle evaluation

Planning a well-rounded fitness programme requires that you find out information about your client’s lifestyle habits, including:

• Work
• Hobbies
• Nutrition and hydration
• Stress, alcohol, and smoking
• Possible barriers
• Support from family and friends
• Mentor and inspiration

Factors such as smoking, lack of physical activity, and diets high in saturated fats or cholesterol increase the risk of cardiovascular diseases (CVD) and hypertension, increasing the risk of participating in vigorous activity. These factors may also influence blood pressure readings, RPE, or lung capacity, making exercise more demanding on these clients.

The lifestyle evaluation component should also gather information on drug and alcohol use, past and present physical activity levels, and the psychological stress levels of the individual. These factors can be used to pinpoint patterns and habits that need behaviour modification and to assess the likelihood of the client’s adherence to the exercise programme.

From a practical standpoint, knowing the client's weekly schedule regarding work and other commitments is essential, so you know what you’ll have to be programme around. Exercise type and location preferences are also worth noting as these will aid you in making the programme engaging and achievable for your clients.

Physical Activity Readiness Questionnaire (PAR-Q)

The Physical Activity Readiness Questionnaire (PAR-Q) is a form used to identify if it is safe for a client to start unsupervised exercise.

It is a simple self-administered questionnaire commonly used by fitness professionals to determine an individual's readiness to participate in physical activity or exercise. It consists of several questions relating to health status and medical history and is designed to identify any potential risks or limitations that may affect someone’s ability to exercise safely.

If a client answers "yes" to any of the questions on the PAR-Q, they are required to get medical clearance from a GP before starting exercise.

PAR-Q was created by the British Columbia Ministry of Health and the Multidisciplinary Board and Exercise, adopted directly from the American College of Sports Medicine (ACSM) Standards and Guidelines for Health and Fitness Facilities. It has been adapted by many fitness organisations into their own templates, including REPs.

A PAR-Q form is not intended as an alternative to a full pre-screening form because it doesn’t provide the detail needed to develop a personalised exercise assessment and prescription. It’s designed for quick, easy, and independent completion by a facility user. It is specifically and exclusively intended for the following situations:

• Unsupervised exercise facilities for users to sign prior to entry
• Casual visitors to an exercise facility who will otherwise receive no further individual attention from a registered exercise professional.

Pre-exercise screening form

Many pre-screen tools focus exclusively on risk stratification. These tools will not provide you with all the necessary information to create a safe and effective exercise prescription. The New Zealand Pre-Screening Guide from REPs combines 4 sections to provide a template for a complete exercise pre-screening. The 4 sections are:

1. Identify key risk factors
2. Identify other key medical/physical condition information
3. Determine information that informs programme design
4. Fitness assessment results that may influence programming (programme information)

The REPs core pre-screening form includes only 2 sections: Important medical information and other important conditions.

The pre-screening form with additional programming information and monitoring progression sections includes additional sections to outline specific programme and progression content with clients. These additional sections are not part of the core pre-screening process but are helpful for exercise adherence and client retention.

Informed consent

Before conducting any physical fitness tests or exercise programmes, you should see each participant sign informed consent. This is part of the pre-screening forms.

Informed consent explains the purpose and nature of each physical fitness test, any inherent risks in the testing, and the expected benefits. Client awareness and consent are essential.

If your client is underage (under 18 years of age), a parent or guardian must also sign the informed consent.

It’s important to find out why your client has decided to start an exercise programme. What was the catalyst or motivation behind engaging a personal trainer?

Think back to the Stages of Change Model from Behaviour Modification. Clients engaging with a personal trainer may be in the preparation, action, or maintenance stage. How you communicate with your client depends on where they are at in the model.

In the pre-screening consultation, you want to find that emotional driver. You need to find out exactly what your client wants from their training with you.

Goal-setting tools are resources that can help you and your clients define, plan, and achieve goals. These tools may include forms, mobile apps, worksheets, or templates. They provide a structured approach to goal setting. Some examples of goal-setting tools include SMART goal worksheets, habit trackers, vision boards, mind maps, and to-do lists.

These tools can establish both short-term and long-term goals, track progress, identify barriers, and make adjustments to achieve desired outcomes. Goal-setting tools can be valuable aids for individuals who want to improve their health and fitness.

Set staircase goals

Staircase goals are a type of goal-setting strategy that breaks down a larger goal into smaller, more manageable sub-goals. Each sub-goal represents a step towards achieving the overall objective, like climbing up a staircase one step at a time.

This approach can be helpful for several reasons. First, it makes the larger goal less overwhelming by breaking it down into smaller, achievable steps. This can help to prevent procrastination and increase motivation. Second, by focusing on achieving each sub-goal, you can track your progress and see how far you've come, which can also help to boost motivation.

Staircase goals can be a useful strategy for health and fitness goals. By breaking down larger goals into smaller, more manageable sub-goals, clients can make steady progress towards improving their health and fitness.

By focusing on these smaller, achievable goals, the client can build momentum and make steady progress towards their larger health and fitness goals. Plus, achieving each sub-goal can help to boost their confidence and motivation, making it more likely that they’ll continue to stick with the plan over time.

Goals should be a combination of outcome goals (results-orientated), process (attendance-based), and lifestyle.

SMARTER goals

By this stage, you should be feeling comfortable with SMART goals. Here, we introduce 2 more elements to make goals SMARTER: Evaluate and Re-adjust. These 2 steps ensure the goals remain relevant and effective as circumstances change.

Note - there are a few variations of the acronym SMART. The main thing is that SMART goals provide a clear road map for the goal setter and the person monitoring their progress.

To revise SMART goals, expand the accordions.

Let’s focus on these 2 new elements: Evaluate and Re-adjust.

Evaluate

After setting a SMARTER goal and taking steps towards achieving it, it's important to evaluate progress periodically. This can involve tracking metrics like time, frequency, and progress towards the goal and analysing the effectiveness of the actions taken to achieve it. Evaluating progress can help to identify areas where the plan is working well and where it may need to be adjusted.

Goal setting is not a one-time task. Things change and you may realise that a goal requires adjusting. E.g., some of the FITT principles need to change due to lifestyle changes, such as school holidays or changing work hours. Goals and sub-goals should be evaluated to ensure your client stays motivated and has achievable and relevant goals.

Questions to ask your client (or have them ask themselves):

• Are my goals still SMART goals?
• Have any factors within or outside my fitness routine changed since these goals were set?

Re-adjust

Based on the evaluation, it may be necessary to re-adjust the plan to stay on track towards the goal. This could involve changing the action plan, the timeline, or the metrics used to measure progress. Re-adjusting can help keep the goal relevant and achievable, especially if circumstances change or progress has stalled.

Questions to ask your client (or have them ask themselves):

• Do I need to make any adjustments to continue the path to achieving my goals?
• What adjustments do I need to make?
• What adjustments can I make?

Discuss your client’s goals and record them following the SMARTER process.

Goal setting

Goal setting is a combined effort between the client and the trainer:

• Record goals and ensure both parties have a copy
• Regularly remind your client of their goals (especially when they backslide)
• Encourage your client to share their goals with others
• Encourage your client to place a copy of the goals somewhere prominent

 

Check out this short video tutorial where Ben summaries client goal setting