The first session with a new client (or as a new trainer) can be daunting. How do you start the session? What do we talk about? Should I refer them to a physician based on certain answers? What assessments should I perform?
In this episode, Dr. Rick Richey takes us through his first session and what he talks about, why he talks about it and discusses how much time he spends engaging in discussion and assessment versus exercise in the first session. He also takes us through the Physical Activity Readiness-Questionnaire (PAR-Q) that NASM uses with clients prior to exercise.
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You're listening to the NASM-CPT Podcast with Rick Richey, the official podcast of the National Academy of Sports Medicine.
Welcome to the NASM-CPT Podcast, my name is Rick Richey, and I may sound a little different today, for a couple of reasons. One, I'm on a new microphone, and two, I've been talking a lot and so my voice may sound a little off. I'm on a new microphone because I'm not in the Everlast Studios recording. I am actually in a hotel room in Seoul, South Korea after I had just gotten done finishing five days of speaking at a conference in Bangkok, Thailand. So I've got another conference coming up in Seoul I'm looking forward to, but I am on the road and I am in a hotel room, so if the sound quality on this doesn't come across as well as I hope it will, then I apologize for that in the advance part of this particular episode.
This particular episode, we're gonna talk about the first session. This is what you're gonna do with a client on the first session or what I might do with a client on a first session, and it's gonna have less to do about the exercise and more to do about the beginning part of the session. Now when I first start training a client, I actually do spend a little more time talking than I do spend working out with somebody for one primary reason. I don't know what their goals are, I don't know what they like or dislike yet, I don't have a lot of information, so I can't just jump straight into the workout.
So I think that's a good place to start is number one, get to know your client. Find out why they're there, what their goals are, what they're trying to do, what they wanna do, what the outcomes that they think that they wanna get, and balance that with a rational outcome that they may or may not be able to get.
So for instance, somebody says, "Hey, I'm getting married. I would like to lose 30 pounds before my wedding," and you say, "Okay, well, when's your wedding?" and they say, "Week after next," alright, pump the brakes. This isn't how it's going to work. I had a woman come in probably 15 years ago with pictures basically of the cast of "Friends" saying that this is what she wanted to look like, and there was no way for that to happen for this particular person, because she wasn't even built in that way.
There are a lot of issues that people will come in and talk about and want trainers to help them fix, so what I like to do is I like to find out what it is that they're looking for, what it is that they think that they want. A lot of people are gonna come in with weight loss goals, they want to get into shape. You have to suss that out and figure out what "get into shape" means for them. Usually people will bring a story along with it, like for instance, "I was walking up the stairs in the building and I was winded after the first half flight of stairs." Well, that's important, that's important that they see that in themselves and that they need to rectify that and make changes with it.
So these are opportunities for you to really commiserate with what people are doing, or at least empathize with what's going on in their lives. They wanna get into shape, they wanna live a better life, they wanna live their best life, their activities of daily living, they're not able to do what it is that they want to do, or used to could do. So what can they do now and how can you get them where they want to be?
Also with exercise, I wanna find out, what's your previous experience with exercise? Particularly if you've had a trainer in the past. If you've had a trainer and you no longer have a trainer, why do you no longer have a trainer? What happened to that trainer? What was that relationship like? What did he or she do that you liked? What did he or she do that you disliked? When it comes to exercise, what do you like? What do you dislike? And if they did something that they didn't like, you need to take note of that! And that needs to be a very important consideration for you as you train this client, 'cause clearly, they're no longer working with that trainer, so if you wanna continue helping them and working with them, find out what they didn't like, and then also try to keep an open line of communication with your clients and find out what is this ongoing thing that they like or dislike?
And some people are just ball-busters, and they're just gonna say, "I hate everything, "I hate exercise," and they're gonna come in and they're gonna work every single day. And that's gonna happen, you're gonna have those clients. But some people are gonna be much more difficult. For those people, you need to find out, what do you like? What do you like, and then capitalize on the things that they enjoy. And also, don't make the things that they enjoy miserable.
We as trainers tend to find things that our clients like, and then push them so hard at it that they no longer like the thing that they used to like. So make sure that there's a home base, like a safety for your client, an exercise that you can always go back to that you know that they love, that you can do with them or support them in their process. But you should also let your clients know that they're going to be challenged. And you're gonna start off low and you're gonna increase with time, and it's gonna be progressive and it's gonna be systematic, and through that systematic process, we look at things like the OPT Model, and methods of periodization.
But it's going to be a systematic approach. And with that systematic approach, then we have to get into the PAR-Q. The PAR-Q is the Physical Activity Readiness Questionnaire, and you're gonna get questions like, actually, I'm just gonna go through it. So NASM has a PAR-Q on their website, so if you go to NASM.org, you can find our PAR-Q.
And it says, has your doctor ever said that you have a heart condition or that you should only perform physical activity recommended by a doctor, yes or no? Excellent question, glad that one's on there. Do you feel pain in your chest when you perform physical activity? That's a big deal too, so we're looking at potential, obviously heart conditions in both of these, and in the past month, have you had chest pain when you're not performing any physical activity? Again, that could be potentially something like angina pectoris.
Angina pectoris is a chest pain. It's not a heart attack, it's a significant chest pain. But I will say that if a heart attack is the silent killer, then angina pectoris is the alarm that lets you know that you've got heart disease. And I love angina pectoris for that, because it saved my dad's life many years ago. And it's because he had angina that he went to the doctor instead of going with my mom to pick up my brother at the airport and bring him home. And he had a triple bypass surgery the following morning first thing in the morning.
So when people say yes to any questions like that, it is really important that you don't work out with that person, that you send 'em to a doctor and you get 'em checked out, that they get themselves checked out. And then, once they're under control with their heart disease or whatever they may have, if it comes to that and they're controlled via medication, then they can exercise and it's controlled, and then find out from their doctor what it is that you can do with 'em.
Also, if you lose balance because of dizziness or you ever lose consciousness, that's something that if they check yes to, you've got, you've got to send 'em to a doctor and let 'em get checked out before they come in and work out. Also, bone and joint problems that may worsen with physical activity. So for instance, some people are gonna come in and they've had surgeries and things like that, and they're not gonna wanna answer this question, because they don't want you to tell them that they can't work out.
I've had a couple of knee surgeries, so I would be that same person, where I would say, "Hey, I work out regularly. I've got arthritis in my right knee, I've had it for years,"but I'm totally good to work out." If somebody's been working out on a regular basis, and you're not changing their activity level really, you're just refining their activity or working with them in different ways, then that doctor's clearance wouldn't be indicated, but if you've got somebody that has a bone or joint problem that could be made worse with physical activity, because they don't currently exercise, but when they go out for a walk their knee swells, then they need to go to a doctor and get checked out. And it might be something that you simply just work around. It might be something that you work around, but it might not be, so send 'em to their doctor and make sure.
And is your doctor currently prescribing any medications for blood pressure or a heart condition that we need to know about? One of the reasons, another example would be, there was a friend of mine years ago that was teaching a cycling class, and there was a woman in there that was just pumpin' away, man, she was workin' really hard and he kept comin' back by and checkin' her heart rate. She had the strap on her chest. He had a device on his wrist so he could check people's heart rates, and he kept comin' by her and she was at a really low heart rate, like 110, but her face was absolutely white, she was working hard, she was sweating, and he found out that she was on medications that were limiting her heart rate! And so here she is, working at this incredibly high level, but her heart's not able to keep up with the expenditure.
Well, if you don't know that going in, especially into a one-on-one session, then that could be really dangerous. And it was also very important that my friend, who was teaching that class, sent this person to a doctor and then followed up with the doctor, with the client's approval, of course, on what should be done and what are the levels of intensity that could be worked at.
And then ask 'em just, do you have any other reason that we need to know about, that you shouldn't be doing any physical activity? And if they say yes, find out what that reason is, and then send 'em to a doctor if they need it. But the goal of this conversation is not to be fear-mongering right now, so I don't wanna jump in and say, "Hey, here are all the scary things that could happen," but here are all the scary things that could happen! And you could be responsible for some things if you don't ask the right questions, and if they give you an answer and you're just not paying attention to it. So you wanna be very understanding of what's going on.
And then you wanna know like occupationally, what's going on in their lives. So what do they currently do? Does it require sitting, does your occupation have repetitive movements, are you constantly bending over or turning or twisting or reaching overhead or lifting something or pulling something? Or are you just wearing shoes with high heels all the time, right? And then one of the other questions is, does your occupation cause you anxiety or mental stress? And you could probably just check that off for most people. Work can be stressful, and what does that mean for us? It means that exercise, for us, can be very helpful, but make sure that your client is a client that is in a controlled state of stress, not something that they feel like they're overwhelmed by, because at that point, you have to refer them to somebody else.
And then recreational questions, and that goes back to what we were talking about before. Like what do you like to do? What is your love, man? Like if you wanna exercise, then let's exercise, but tell me some things that you like doing, like what are your recreational things? Do you like playing golf, do you like rugby, do you like playing tennis, skiing, wonderful things like that? And you find out a little bit more about that, then what you can start doing, and I find this really interesting, it can be really helpful, is we can have, instead of these morphological goals, which we're gonna pay attention to, which they're things like weight loss. But we also look at things like performance-based goals. And a performance-based goal is not necessarily what is your new bench press or squat PR, but a performance-based goal might be something like a Spartan race or a Tough Mudder or a 5K or a 10K. So that we're just putting something to do out in the ether, and then finding out what it is that they feel like they could participate in, and then you work towards something.
Because working towards something like that, versus working towards weight loss, is a lot more invigorating for the client, to have something to do to work for. Not just an outcome that says, hey, did I lose weight? Because the problem is, if people don't lose weight in a short term, then they're disappointed, you know? They feel let down from it, and of course, when that happens, then they start exercising, but a lot of times, weight loss is certainly a byproduct of activity. And of course, diet and many other things, but if you can be more active and enjoy activity, and activity becomes part of the lifestyle, and you've planted that seed because of these performance-based outcomes, then your clients are gonna L-O-V-E you, and even if they're not working with you anymore, they're your billboards.
They're the ones that are out there talking to other people about you saying that you are the one that inspired them to do what they do, as they're out there, you know, people that are cycling around, they look like they're professional cyclers, they got the whole outfits that they put on, they are doin' their thing, and now you've got a client that's dressed up like those cyclists, out there doing those rides because you inspired 'em to not just exercise, but to find an activity, a recreational activity that they can really take part in, and make it be part of your activity lifestyle. That you do something for you that you like to do that is activity, so that we stop focusing on simply industrialized fitness, and relying on the gym to be the only way for us to get our activity answers. That's not true, and that's a fallacy.
And that's coming from somebody who owns several gyms in New York City. I sit back and I say, "I wish that they weren't as necessary," and they're not necessary, that's the thing. But we've put the gyms in a place where that's where we have to go to exercise, and people think that they have to go to gyms to exercise, and y'all, you know it's not true.
So inspire activity outside of the gym. Inspire activity in the gym too, and things that they can do on their own, but what can they do that doesn't include the gym? It's unnecessary, you don't have to have it, so if it doesn't have to be there, then move on! Get them moving, just get 'em moving.
And then find out if they've got joint pains, find out if they've had surgeries, if they've ever been diagnosed with a chronic disease, like coronary heart disease, coronary artery disease, hypertension, high cholesterol, diabetes. And the thing is, maybe they have been, and it's under control and this is all wonderful, but the good news is that they've done these things! Exercise is really good for them, but what kind of exercise?
So you may wanna cater your exercise specifically to people who have specific pathologies, because some people, you don't want them lying down or standing up back to back in certain ways. Some people, you wanna be very careful, depending on what type of pathology they have. Do you have food around, do you have an inhaler around, right? So find out where they are and what's currently going on, and then find out if there are any prescription medications, more so on what that might be doing for your exercise heart rate, for your heart, what effect that has, and then you can go into the assessment process, and once you get into the assessment process, now you're up and moving a little bit. And even though you don't spend much time working out in this initial process, and this doesn't take long, it doesn't take long to do what I just talked about, but then you can go in and take assessments, and you wanna take certain types of assessments before you do any activity. So that would be like if you wanna do a weigh-in.
Find out what their weight is, and use the same scale, and use the same clothing, right? So if they're just gonna be wearing their underwear, great, or if they don't wanna just wear underwear, make sure they're wearing the same clothes when they come in to weigh in again, or the same type of clothes, like shorts and a t-shirt. But it's not something that's gonna be heavier and more weighty, or lighter than the previous time that you weighed in. So you can do your weight, but you can also do things like, and these are all for baseline, right? So you wanna benchmark where they start, so we can track their progress. And the other thing would be something like body fat. And body fat can be done in multiple different ways in the gym environment.
Some of the gym environments are having these wonderfully fancy body scans, the InBody or Fit3D, and I think within the next year or two, you probably just have an app on your iPhone that you can have somebody just stand there and spin around, and it'll do measurements just from your phone. It's on its way, I think, I think it's on its way. But there are simple handheld bioelectric impedance devices where you hold onto it, and they're relatively, relatively decent at measuring body fat. And you just kinda hold it and it sends a bioelectric pulse that goes through your body. You can't feel it, but muscle is a conductor, and fat is an insulator, so the more fat you have, then the more it insulates how that current moves through your body, and the slower it is, then it measures body fat that way.
And then there are the skin fold measurements, which I used to teach when I was working for a large chain, and all trainers would come in and we would teach them how to do skin fold measurements, and there are multiple different types of skin fold measurements that you would do with calipers. And then there are girth measurements. Not a body fat measurement, but a girth measurement is just using a tape measure and measuring around certain areas in the body, and there are very specific areas in the body that you would measure around. And when you do those measurements, you wanna make sure that you have exactly where you're measuring, and it's the same place each time that you measure, and you're not pulling the tape measure harder when you reassess them, so that you can say, "Hey, look, you've lost a half an inch around your thigh." You don't wanna do that, you don't wanna cheat yourself. I've seen trainers do that with their clients, and the clients get excited, but I'm like, after a year of training with this trainer, and you continue to lose half an inch around your thigh every single week, and you haven't lost any size around your thigh, but according to that you should've lost seven, eight, 12 inches.
So just be aware that anything that trainers can do that's not completely objective, there's always a means of skewing, which is why I like to use other means of data for doing that. And so one of my favorite measures of girth measurement is the "how do your pants fit?" method. So I think that probably a lot of people have some skinny jeans, and they've got some things that fit them well that will become baggy on them. Those are things that have an emotional component too, so it's not just an objective component, that these are now fitting better, but there might be an emotional component for people wanting to fit into those specific things.
And then you get into your movement assessments, like your overhead squat assessment, single leg squat assessment, push-up assessment, shoulder assessment, pulling, pushing, rotating, any movement, every movement, it's all assessments, and you want to assess, and you don't want to assess and not follow up with these assessments. All of these assessments are to set a benchmark, and they should be revisited. They should not just be a sales technique for your client. They should not just be a sales technique for your client. You should be able to do these, assess, reassess, move back to it, and then see if progress has been made.
And here's the thing, if progress hasn't been made, then you gotta do a couple things. You need to check your measurements again, but then you need to check your strategy again. And are you doing what you need to do, and is your client doing what they need to do? And then at that point, it is time to have a conversation. It is time to talk, it is time to discuss. Not time to work harder, but time to work strategy together. Don't just develop a strategy and say, "This is the way it's gonna be." Work with your clients to find out what strategy is gonna work best for them.
Do they need more support when they are not with you? Do they need the NASM Edge app so they know something to do when they are not training with you? Are they working toward something, are they having trouble with their diet, is certified nutrition counselor specialty, is that something that you need to add to your repertoire?
There's so many things, guys, there's so many things. And then once all of this is done, that's when the exercises start, that's when the exercises begin. And sometimes I only have a few minutes to work out with them towards the end, and I'll take 'em through a nice core balance reactive short resistance training workout. And it's short, but it's sweet and it's to the point, and at the end of it, they had a good workout, and then I say, "Hey, based off the information that you shared with me, "based off of what we just did together, "even if it's just for five minutes, "if we were to spend an hour together, "how do you think that that would work for you?" And put it back in their court. "How does that work for you? "Do you see yourself being able to be inspired "to work out more on your own, do some exercise on your own, "do some exercise with me to help you reach your goals?" And let them sell themselves on you as a personal trainer.
That's fantastic, guys. Thank you so much for listening. I'm gonna put a series of programming together soon, so we'll talk about periodization, cycles, and how you get the exercise programming that needs to be in place, in place now that you've gone through your first and introductory session. So thank you so much for listening. This is the NASM-CPT Podcast.