NASM CPT Podcast

NASM-CPT Podcast: CPT 7 Professional Development and Responsibility– Part I

National Academy of Sports Medicine
National Academy of Sports Medicine
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In the first episode of this two-part series, NASM Master Instructor Rick Richey examines evidence-based practice to help you make the best decisions when it comes to client care.
Topics discussed include the global state of health, maximizing your client experience, scope of practice, code of conduct, and much more.
Let the “NASM-CPT Podcast” help educate and guide you through the sixth, and final, domain of the new CPT 7 program!

Rick Richey is a NASM-CPT, CES, PES, and Master Trainer.


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Rick Richey:

Hello, and welcome to the NSM CPT podcast. My name is Rick Richey and we are starting to wrap things up. We have gotten now towards the end of a series that we've been working on for a study guide, basically an overview supplemental material for those of you who are studying for your CPT seven. And for those of you who are not studying for it, who have already taken and become an ni, SMC PT, this is an excellent review for you. It is not just for the new people that are coming in, it is nice to be reacquainted with some of that material that you studied so long ago, and realize maybe that there are some things that you've forgotten about that you may want to start implementing back into your programming or back into your what we're going to talk about today, professional development and responsibilities. So this will be a two part series. So we're gonna go professional development responsibility. And as we do this, this is the final section for our testing domains. For those of you studying this is domain six, and 10% of the weight of the final exam will be coming from this. So this is that first section that you'll look at in your textbook, chapters one and chapters two. So let's get into some of the material. We're going to look at this. First of all, just like we did in the science portion of it, we need to look at this as evidence based practice. So it's not just the science of human movement, or assessments or implementation or program design. But this is about how NASM recommends that we start focusing on evidence base at the highest levels of success. So evidence based practice is is really a part of current best evidence and making decisions about client care. And it's defined as any practice medical or non medical that relies on scientific evidence for guidance and decision making.

But we're going to look at this now regarding our professional development. Can we use this to first of all, develop some individual expertise? Can we use an evidence based practice to do so I think we can. And as we build this, this individual expertise, are we staying current and the best sources of external evidence evidence is coming outside of us not just our own experience and our experience with our clients. But what does some of the science saying we'll look at that in regard to building best practices around professional development, and then prioritizing clients values and expectations, and I've known throughout the years, as I start to work with clients, I get some pretty lofty, and not necessarily attainable expectations that people may want. I've literally had people come in with photographs of celebrities and say, This is who I would like to look like. And I said, I am a personal trainer, not a plastic surgeon meaning like the what you want from what I'm trying to do are not the same thing. So how do we manage those expectations, and also have it fall within our values when we work with clients so that they feel comfortable with us. But we also maintain a relationship that we are not crossing any bounds with their values. And we are working with them on what they find to be important what they value and how they prioritize things. So let's look again, at an overview of integrated training in the OPC model. We know that there's an integrated approach, there are three levels in the OPC model stabilization, strength and power.

There are five phases stabilization, endurance training, phase two, strength, endurance training, phase three muscular development, phase four, Max maximal strength, and phase five power training. So that's what we look at, particularly in regard to our resistance training. But there are many other things that fall within that like flexibility and mobility, core strength and stability, cardio respiratory training, balance, plyometrics, speed, agility, and quickness. And then we talk about resistance training. All of these are components of the integrated training that we look as we start to experience train program people through the NASM  OPT model. Now, as we look through this And we think about the OP t model initially being a performance based model. That's actually what it means the optimal performance model. So, performance training models. So when we look at this, there's actually a larger scope that I think we need to prioritize with our clients. And that is really about the global state of health. It is not just about bigger, faster, stronger, it is about quality of life and living longer and positive health experiences. So we look at this by defining health and disease and identifying whether that is acute versus chronic disease. So they have an acute disease, they have a chronic disease, is it something that is short term? Or is it something that is longer term and progressive, and then there comes a spectrum of health. And health is a dynamic phenomenon. transition is often gradual, between different stages, and that spectrum of health. And where one stage ends, another begins, and it's usually a matter of judgment. So you might see in that spectrum of health, starting at the top, this highest level of positive health, and then we have better health, better than most, but not in the most positive sense. So we go positive health, better health, freedom from sickness, I'm not sure how healthy I am, I'm just not that sick. And then underneath that is unrecognized sickness. And then mild sickness, severe sickness and death, being that spectrum of health in this global state of health. So from the bottom to the top, it would look like death, death, severe sickness, mild sickness, unrecognized sickness, freedom from sickness, better health, and then positive health. And when we tend these things, suddenly, when I start looking at this, maybe my PR and benchpress, or squat is not the most important thing, the most important thing is increasing maybe physical activity, getting our clients to come in regularly to take care of their health and their wellness, not just trying to hit prs. And that those nothing, none of these are wrong goals. But the global state of health really depends that we focus more on providing and being a part of the health care continuum, which we will talk about momentarily. So there's physical inactivity, and there's a relationship to that and chronic disease. We know that physical activity has a relationship with chronic disease with things such as being overweight, and obesity. And those aren't necessarily chronic diseases.

But those certainly are risk factors that are highly correlated with other chronic diseases. So physical activity has a role to play and overweight and obesity has a role in heart disease, hypertension, cholesterol, diabetes, cancer, respiratory disease, and even stress. So when we look at physical inactivity, we need to realize how hand in hand they can go with chronic diseases. Now, what does that mean for me as a fitness professional? Well, first of all, it doesn't mean that everyone necessarily needs to, quote, work out. Now, if they're coming to see you, and you're a personal trainer, I'm pretty sure working out is on the table for these clients. But when it comes to working with clients and working out, there's 168 hours in a week, let's say they visit you for two. Right? So that's 166 hours, it doesn't seem like a big section. And it's not however, every little bit helps, and a little bit of somethings better than a whole lot of nothing. But what needs to be done within that training session isn't just Am I setting you up for your workout for their two times this week? But are you coaching them on physical activities that they can engage in throughout the week, multiple times in a day, going for walks, walking the dog, taking the stairs and not the escalator, things that seem very simple, almost so simple, in fact, that people don't do them. But it is the aggregate of all of those small things that build up to significant change in people's lives. And we need to encourage physical activity, not just the workouts that they're doing with us.

Alright, when we talk about muscular dysfunction, and muscular dysfunction can lead to things Like increased injury as well, there's foot and ankle dysfunction. There knee dysfunction lumbo, pelvic hip, shoulder dysfunction, head and neck dysfunction. So we look at things like foot and ankle just function and then the skeletal muscle development and maintenance. It's vital to ensure optimal health and well being across the lifespan of individuals. So when we look at things like foot and ankle dysfunction, there can be things that affect your physical activity like sprained ankles. And I don't know about you, but spraining an ankle, it seems like First of all, it can be acute, it can be chronic, but it can be repetitive. It's like eating and biting your cheek and then like five more times that week, you bite your cheek again. What well, because it's swollen, it's in the way well, ankle dysfunction. ankle sprains like maybe rolling an ankle would be very similar. It's it is it's hard to say I've just done that one time. It's one of those things that seems to get in the way and if you're not careful, then it can happen repetitively, and that acute sprain can lead to a chronic issue. There are also other issues at the foot and ankle like plantar fasciitis, and that's one that I had dealt with years ago, it was not enjoyable. So the very front of the heel, it just feels like especially first thing in the morning when you step out of bed, it's like who which of my kids left the Legos or an icepick right at the bottom of my bed when I stepped out of my bed Who did that? And it is plantar fasciitis can be incredibly painful, a sharp pain, especially upon getting out of bed. Well, that's good for you to know. Because if you ever hear a client complain of having a sharp pain when they step on the bottom of their foot when they especially when they get out of bed in the morning. Wow, that's likely plantar fasciitis, also, not for us to diagnose.

So what do we do, we suggest that they go see a physician or a physical therapist, somebody that can address that directly. Because we don't address pain, we address movement with knee dysfunction. The three most common things that you're going to see are patellar tendonitis, so it is the tendon that goes along with the kneecap where the quads attach into patellar tendonitis, that that can be one of the major things that people see usually pain on the front of the knee. Then the ACL, the anterior cruciate ligament tears and the mcpl, the medial cruciate ligament tears, which I had years ago, when I was doing a tumbling routine, and tore my ACL and then had to have a couple of meniscus surgery. So I fall well within that category for knee dysfunction. lumbo, pelvic hip complex dysfunction, the lphc. This is important for improvements in health, sports performance prevention of injuries, because an unstable core limits the ability of the limbs which attached to your core to properly produce force and predisposes an individual to back in hip pain. And we know that there's a lot of low back dysfunction, that a high percentage of the population will experience debilitating low back pain at some point, maybe only once, but at some point in their lives. And we want to look at and see how can core stability, how can managing core strength, and movement dysfunctions, which we as fitness professionals can attend to support those people. And what we can't do is just say, Oh, you've had back pain in the past, let me turn you away, because there would be no clients left.

But if somebody is experiencing an acute back pain, we want to be aware of that if somebody has chronic back pain, then we would likely send those people out to a pain management professional. So whether that we send them initially to their physician, or a recommendation towards a physical therapist, then we would move them from our training catalog and into somebody else's. What about shoulder dysfunction? A lot of things that we see with shoulder dysfunction, the major things we see are going to be shoulder impingement syndrome. And impingement just means pinching. And so if you usually happens when you raise your arm over your head, and there's a pinching sensation in the shoulder, that's shoulder impingement syndrome, and then there's some instability in the shoulder joint. Well, again, if they're experiencing pain, we can help them work through movement but not work through pain. If there's shoulder joint instability, then we can certainly be a part of the management of that, but I would suggest that being Under the supervision and guidance of maybe a physical therapist, as we continue to work with somebody, especially with pain, and then head and neck dysfunctions, things like regular headaches, neck pain, posture, tech neck, and this forward head position that we all get from being on too many zoom calls and sitting and doing maybe some virtual training or studying for your nsmc pt seven, as your head juts forward, maintaining that relative chin tucked position. Also to add one to this, for those that are nursing something called nursers. Neck, it's like technic. But it's usually happens from a nursing mother as she looks down at her child lovingly until at some point, it becomes fairly painful, very painful to do so. So that can be a challenge. Great. Let's talk briefly about the healthcare continuum. The healthcare continuum represents a systematic way to view the healthcare industry through various entry points. So that being like why health care is needed. So there are types of health care provided, which professional Am I supposed to choose? They're all taught now all sorts of health care that had been provided, where, where do I fit in as a fitness professional? And where does my client start to go when it comes to their health care? And there are some intended outcome. So what does the individual want to accomplish? So let's look at a few things. One, let's start at the healthcare continuum at hospitals, hospitals, the emergency clinics and trauma centers. So if you ever have something wrong, and you call your doctor and your doctor says if this is an emergency, go to the hospital or call 911. So hospitals, those are going to be for emergency care, then their ambulatory care centers. And those are personal physicians, those are specialists that work with people. And then the therapist. therapists can include physical therapist, cardiac rehab professionals, athletic trainers, Barry attrex, specialist, and those types of therapists are vital to what we were talking about momentarily. A moment ago, when we talk about physical therapists when they were dealing with physical pain and pain management. There are ancillary facilities, such as a dentist or ophthalmologist. Then there are behavioral health specialists, psychiatrists, psychologists, addiction specialists, social workers fall under this behavioral health specialty, alternative medicine practitioners could be chiropractors, acupuncture massage therapist fall under the fall under the alternative medicine, long term care. So things like home health, or hospice. And then I know what you've all been waiting for, this is what we're trying to get to. In the health care continuum, the last one to be addressed here, health and fitness specialists, specialist. Those are personal trainers, those are you are what you're training and studying to be performance specialist, nutrition coaches, group exercise instructors, those are the health and fitness specialists that fall under this health care continuum. And this isn't what's called the allied health care. But in a general health care continuum, we're there, we are a part of that process for so many people. And for many instances, we have more contacts, we have more touch points with a client or a patient, then a physician or a therapist ever has. So our influence is huge. And we need to take that role and that responsibility. We need to take that into account as we work with people. And we affect their lives, how they live their lives, and how we influence what they do in their lives. So one of the things that I wanted to continue talking about with not just the moments that they spend with you, how are you influencing them? How are you encouraging them to maintain to increase to continue with their physical activity throughout the day, little things that add up to big things when they're not with you. I think that is an important part of what we need to address as fitness professionals in any situation whether your group fitness or personal trainer or a nutrition coach. Alright, we've kind of led up to this. So let's address this right now which is scope of practice and Code of Conduct.

Now I've, I've hit up the scope of practice regularly. You've heard me say multiple times, if they're in pain, they're not for you. We are not pain management specialists and you go, Well, why don't we talk about back pain? Why do we talk about plantar fasciitis and sprained ankles? Well, because you need to know about it. You are a personal trainer working with people's bodies. And how else are you going to know that that's not a person that you're going to be working with, you have to know enough about it to know when to refer out. Now it doesn't mean that people with sprained ankles cannot work with personal trainers are people with plantar fasciitis cannot work with them, but cannot work with you to help fix the sprained ankle, or the plantar fasciitis. And the most important thing that you should pay attention to as a fitness professional is that you don't exacerbate what's already wrong. That's what's important in referring out so that they can be taken care of. So I refer people out all the time. I refer people out all the time. What that means that I'm not going to be making money. Well true for that short term while they're seeing that professional, but you know, when else you're not going to be making money, when they no longer train with you, because either they got hurt worse while they're with you or their injury progressed, as opposed to sending them to a professional that facilitated the recovery of that injury so they could get back to you. So don't think so short term, think about what's important to your client, not just whether or not you're getting those sessions. And so here we go, the code of conduct, let's talk about four things in general, one professionalism, to confidentiality, three, legal and ethical, and for business practice, which all fall under that code of conduct. So the scope of practice represents all the things are given professional can do within the legal boundaries of their job title. And because of personal trainers are it's not a licensure, we are not under we have a lot of opportunities to work in different ways. But anything that's protected like people that deal with pain, and that could be physical therapists, chiropractors, even massage therapist, those are all people we can refer out to a certainly their physician, they're in Certified Personal trainers are fitness professionals who perform individualized assessments and design safe, effective and scientifically based and individualized exercise and conditioning programs for clients who present with no medical special needs, or who have been medically cleared for exercise. That is your scope of practice. One more time Certified Personal trainers are fitness professionals who perform individualized assessment. So we have assessments as a personal trainer, we can do design safe, effective and scientifically based individualized exercise programs, and conditioning programs. So that could be resistance training, flexibility, training, core balance, reactive speed, agility, and quickness, plyometrics and cardio respiratory. So those are programs for clients, no medical special needs, or if they've been cleared to exercise medically by their medical professional. So that is our scope of practice. That's where we come in. And that scope of practice is important for us. Because it does address professionalism and confidentiality, we're we're not just saying, hey, my client, Jerry, Jerry has got a lot of medical issues. Let me as a heart disease and diabetes and this and that. And so I just want to talk that out with another fitness professional. And now we maintain confidentiality, because it is not for us to share somebody else's medical things going on. We have a ethical responsibility for that legal responsibility for that. And then there are also best practices that we fall under.

And those best practices as a fitness professional go back to that kind of professional description that we talked about what are best practices well, engaging in assessments, engaging in safe, effective and efficient program designs that take into account individual needs to ensure best practices that there are no special medical needs that I'm working with somebody that I'm ill prepared to work with. All right. Well, let's talk about what where do we go like, I know that you're studying for this and trying to figure out well, what's my next move? Some of you have that in mind. Some of you already know what commercial health club you're going to be going into it. Yeah, you planned on this. You have a great idea. So let's go through several commercial health club market. So there A low cost market mid market premium and non profit. So low cost. Let's talk about low cost. These are facilities that offer a low price membership. And they often include very few amenities other than access to exercise equipment, and access to amenities or programs like group fitness classes, small group workouts or personal training for extra cost, if the services are offered at all, so in low cost, commercial facilities, you may not have personal training. If you do then their add on. And I think that add on market if that could work for you, you could potentially increase the volume how many people you were training at a single time then there are mid market health clubs and these are health clubs and a category that provide all features of low cost clubs with additional amenities like a higher end locker room, they may have snacks and supplements for sale at the front desk or machines there might be group fitness workouts included in the price of the membership that you can engage in. So as a mid market, and certainly personal training would likely fall in there as an additional price to add on. Then there are premium health clubs and your health clubs. The ones in this category typically feature multiple group Fitness Studio options like indoor cycling, mind body options, traditional group fitness programs, they also have frequent these high end amenities like towel service, nice, plush fluffy towels, and complimentary personal hygiene products. So when you go into the locker room, they may have cafes to provide post workout nutrition pools, full service spa salons, sports courts, in house childcare services, and personal training. A lot of these things are add on so they may be relatively higher priced, then Well, certainly higher price than the mid and low markets. But then a lot of add on services would be included in there as well. And now the nonprofit many of the nonprofit organizations, things like places like the YMCA, they operate fitness facilities, and they use the revenue from the fitness programs and membership to cover operational costs to improve the facilities and to fund a wide range of community based initiatives. That is why I love YMCA is and JC sees these community based facilities, because they really do support outreach for the community. And that is greatly appreciated. And a nod towards them. Does that mean that that's where you need to work? No, that's not what that means. But that may be what is right for you.

All right, a few more things before we close up this particular one. Let's talk about the independent professional. So we know we're just talking about somebody that wanted to go work at a corporate facility. But what about independent professionals, you have options now where you can work at especially because studio and boutique fitness has blossomed. And all of these places have taken a hit throughout the pandemic. But these have blossomed quite a bit. So there are studio and health clubs that you could go to these are fitness professionals, they may be able to pay rent at a studio or health club to use the facility, as long as they have their own liability insurance and adhere to establish guidelines and operating procedures. I love these things. Because I have four of them. I own several of them in New York City. These are things that are important to me that weren't really that available. And so I was trying to build my business and my brand in New York. So I could be a place where people once they decide to become independent, have a place to train their clients. So it's kind of like a we work for fitness professionals. Then there's the traveling trainer. This is a traveling to clients home, it's a fitness professional that goes to a home provides services. services could also include access to a facility if the client lives in a house into housing development with a fitness center, but it might be going to their house it might be going to their garage to work with people could also be Park based, go into the park, meaning outside boot camps in the park, different things like that. There's online coaching, which has definitely definitely blossom since the beginning of the pandemic. And there are different options for delivering training services online that could include selling pre packaged programs. So you write programs out you say you want an eight week program, then it costs this much to get access to it provide coaching to a group of remote clients with similar goals like preparing for a marathon. You're working with several people at a time, you can do one on one and personalize your services like this remote one on one coaching. That is, like I do with many of my traveling clients, when they leave, then they keep using their package, and they're training with me and they just do it and we do it on a FaceTime or zoom or Skype, whatever way that we can reach that communication while they are on work or on vacation. And then there's organizational wellness, employers may contract with a fitness professional to provide wellness or fitness classes to help keep employees healthy and free from disease as best as they can. And this service requires a liability insurance to use the employer's facility, but this kind of corporate wellness concept and organizational wellness is something that many personal trainers, these enterprising and entrepreneurial trainers, have done outreach with organizations and go into you know, the banking organizations or the in a place of industry and offer fitness services where that is supplemented oftentimes by the the, the organization, the company. Alright, last one we're going to talk about today is career development. So, what's my what's next and at Optima, 2021, I'll be talking about this in in several in one specific manner. But this is what we're gonna talk about in general, for career development. And the first one might be you could you get ready to say, let me let me get away from as much training and maybe start to become a manager. And that's where a fitness manager may come in. That might be the first step fitness managers duties include maintaining and staffing the schedule, providing mentorship to fitness professionals, and really, that's enough my focus at Optima is mentorship. So what's next for training becoming a mentor to other fitness professionals, fitness manager may hold regular meetings with the entire fitness team. And all while still responding directly to members needs when necessary. And it doesn't exclude you from still engaging in some personal training it probably not a lot, because your hours at work are going to be pretty elevated. But you may have a client or two that you just can't get rid of.

So you may still be doing some off our training, then there's a general manager. So oftentimes that fitness manager could be promoted up. And from a department manager position. This General Manager is responsible for all the business operations of the club from sales and repairs and maintenance. they oversee multiple departments and individual employees. Well, there is a facility owner, I know a lot of people listening to this, they're like one day I want to own my own gym, uh, highs and lows, I definitely say that so you want to think that one out. But facility owners, there are different models for this. And what you could do is instead of doing what I did, which is try to figure it out and lose a lot of money in the process, you may want to consider franchising instead of starting a business from scratch, or you may want to do what I do now, which is create partnerships with my facility and other people that want to open a facility. So it's an expansion of my business and my brand, by people who want to do it, but they don't want to go at it alone. So there are opportunities to partner with people and open fitness facilities that may allow you to be a bit more comfortable. And then there are adjacent careers. So there's things like master instructors, which educate SM there's a blog post, I think conditioning coaches, social media, influencer, college or trade school instructors, many of my friends that have gone on and become trade school instructors. So they teach exercise for personal trainers at trade schools, obviously many connections throughout the years that have gone on to do all of the things that we just mentioned. And there are a lot of opportunities for now want to bring that up so that you know that there are things in your future that this CPT course is going to lead you to and if you're already CPT certified I hope this maybe elevated inspired made you think about things they you may want to do any your what's next.

If you have questions about your what's next or about what we're doing here, feel free to reach out to me. You can reach out to me on instagram where I'm most active at Dr. dot Rick Ritchey or you can reach out to me on email Rick dot Richey Thank you so much. Stick around for part two. This has been the NASM CPT Podcast."

The Author

National Academy of Sports Medicine

National Academy of Sports Medicine

Since 1987 the National Academy of Sports Medicine (NASM) has been the global leader in delivering evidence-based certifications and advanced specializations to health and fitness professionals. Our products and services are scientifically and clinically proven. They are revered and utilized by leading brands and programs around the world and have launched thousands of successful careers.


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