A client may have a wide range of wellness needs, and the Certified Personal Trainer (CPT) is just one member of a team that consists of medical and other allied health professionals and other supporting individuals working with a client to meet those needs.
Clients often think about wellness in terms of physical health, which may include exercise, nutrition, and freedom of disease; however, a client has eight interdependent dimensions of wellness: physical, intellectual, emotional, social, spiritual, vocational, financial, and environmental (Stoewen, 2017).
For a client to be truly well, each dimension of wellness must be maintained, and the client may require additional assistance to meet those needs. Other than the CPT, the team of professionals caring for a client almost always consists of a primary care physician or family doctor but may include physical therapists, registered dieticians, mental health professionals, chiropractors, and massage therapists.
The number of professionals and the degree of skill sets necessary to care for a client will vary based on each client’s need. Some client’s circle of care may also include spiritual counselors, financial advisors, and mentors. This client-centered is becoming more popular, and a team of professionals caring for the client is known as a client’s circle of care (Price, 2016).
The Reponsiblity of a personal trainer
While a Certified Personal Trainer may have a diversity of knowledge and several specializations, such as NASM’s Behavior Change Specialization or Corrective Exercise Specialization, and other credentials such as NASM’s Certified Nutrition Coach, the primary role of the CPT lies within the physical dimension of wellness.
A personal trainer’s primary responsibility is to provide exercise guidance and instruction to help clients attain their health and wellness goals that are both safe and effective (Clark et al., 2018).
Ideally, clients already have a well-established circle of care. They are positioned to leverage the CPT to focus on the physical domain of wellness as a preventive measure to become more resilient to disease and remain physically capable of meeting their lifestyle demands. However, that is not always the case. Sometimes a client may seek assistance from a CPT in reaction to poor health and wellness and may not have a previously established circle of care. The CPT's fitness consultation and use of comprehensive assessment is the perfect opportunity to learn about a client's existing circle of care.
Fitness Assessments
Fitness assessments allow CPTs to continually monitor a client’s needs, functional capabilities, and physiologic effects of exercise. In addition to comprehensive fitness assessments, CPTs are in a great position to maintain ongoing communication with clients that often set them apart from other members of a client’s circle of care. It is due to the CPT’s use of ongoing assessments and communication that allows the observant CPT to recognize a client’s wide range of wellness needs and whether or not they are being met.
A perfect example of a CPT functioning within a circle of care is using a health screening tool such as The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+).
Using the PAR-Q+, the CPT screens a client for general health complications and, when warranted, requires a physician's clearance to begin working with that client. By taking the time to screen and require a physician's authorization when appropriate, the CPT ensures that the client with medical needs has at least one established member within the care circle, their primary physician or family doctor.
The client’s primary physician or family doctor is generally going to be the client’s primary access to medical interventions and an excellent resource for the CPT when navigating exercise contraindications and setting specific health objectives. For example, many physicians recognize fall risks for older adults as a serious problem and are likely to refer their patient to a fitness professional to reduce that risk (Grant et al., 2015).
According to Parkinson et al. (2020), the need to address the underlying causes of medical acute medical risks due to sedentary lifestyles and poor nutritional choices is becoming more popular amongst physicians and more frequently referring their patients to CPTs as well as other allied professionals to meet those needs. Unfortunately, as the CPT and other allied health practitioners' role and skillset are a bit ambiguous to the medical community, establishing direct relationships with individual members of a client’s circle of care may be difficult (De Lyon et al., 2017).
While the medical community’s understanding of a CPTs role is improving, the client’s primary physician will serve as a gatekeeper to more advanced medical care and likely be the CPTs primary referral. So it is essential to establish communication with this primary member of a client’s circle of care.
Because a CPT can build rapport and monitor their client's progress, they may recognize a change in a client’s needs through ongoing assessment. Due to the effects of exercise, client medications may need to be adjusted, or other medical complications may develop.
They will require the CPT to refer their client back to their physician for care or expand their circle of care to meet those needs. In most cases, the referral will be to a client’s primary physician or otherwise previously established care provider depending on the complication.
For example, if a client frequently experiences dizziness during cardiorespiratory training, they would need to be referred back to their primary physician to determine the appropriate course of action.
Leveraging a Client’s Circle of Care
To know when to refer a client to another professional and to know which professional to refer a client to may seem like tricky business, but understanding the CPT scope of practice will help. A CPT must not attempt to diagnose medical conditions, prescribe any medical intervention or diet, provide treatment for any injury or disease, provide acute rehabilitation services, or provide counseling services for clients (Clark et al., 2018). While the CPT scope of practice may seem too limiting, there are many things a CPT can and should do.
CPTs should obtain exercise and health guidelines from other members of the client’s circle of care, such as the client’s physician, physical therapist, or registered dietician. CPTs should screen clients for exercise limitations and identify potential risk factors and refer clients to qualified medical practitioners to address difficulties with risk factors and other complications such as pain. CPTs should design individualized, systematic, and progressive exercise programs and provide general information on healthy eating and basic coaching (Clark et al., 2018).
For anything else, a CPT should make the appropriate referral to another member of the client’s circle of care. Ultimately, the CPT should seek to do no harm. Suppose the CPT lacks confidence or specific knowledge to navigate certain exercise contraindications. In that case, it is appropriate to refer clients to other CPTs with more specific expertise and experience relevant to their needs.
Ideally, a client will already have an established circle of care. So, when an issue arises, such as an ongoing issue of elbow pain or work stress that may be disrupting sleep, the CPT will be able to refer the client back to their already established physical therapist or mental health practitioner, respectively.
While referrals may be medically necessary, some reasons for referral may be preventive. Referrals such as a registered dietician for someone seeking a prescription of a meal plan for better physical performance, a chiropractor for joint maintenance, or a massage therapist for addressing client fascial and soft tissue needs.
It helps to know what professionals may be a part of a client's circle of care. An accurate recommendation may be made, but when in doubt, the client’s primary physician or family doctor will have a more extensive array of assessments and a broader network of professionals to ensure they receive the referral they need.
A CPT should develop a network of allied health practitioners that they easily communicate with and receive guidance in a collaborative effort to help clients meet their fitness objectives and overall wellness needs. A client’s insurance company may influence their decision to meet with a practitioner recommended by the CPT.
If a client refuses a referral to another practitioner for financial reasons, they should be referred back to their primary care physician to assist them with a referral. Whether a client acts on a referral or not, the CPT should always document that the referral was made and continue providing services within the scope with discretion. The responsibility for a client’s health does not rest solely on the CPT’s shoulders. Ultimately, the client should be responsible and their primary advocate to leverage their entire circle of care expertise.
Working with other members of the circle of care does present some obstacles. For instance, due to client confidentiality and personal medical data protection, some details cannot be shared between professionals without explicit written consent from the client without client permission.
Trust is a critical component of an effective circle of care. Due to some allied health professions' ambiguous nature, inconsistencies in regulation, differing paradigms, and education levels, communication and trust may require constant maintenance. For these reasons, a CPT may often feel left out of the circle. Still, ultimately, the CPT has a responsibility to adhere to a client’s medical practitioners' guidelines and operate with a level of transparency.
Because of most practitioners' client-centered nature, with some practice and patience, CPTs can develop effective relationships with other members of a client's circle of care with lasting benefits for both the client's health and wellness and the CPT. A CPT who develops a reputation as a team player, demonstrating the scope of practice adherence, improving program adherence, and achieving results will find other members of a client’s circle of care to be more trusting and more likely to refer their patients in the future.
Summary
A personal trainer’s primary responsibility is to provide exercise guidance and instruction to help clients attain their health and wellness goals that are both safe and effective. Considering the eight interdependent dimensions of wellness: physical, intellectual, emotional, social, spiritual, vocational, financial, and environmental, the client may require several medical and allied health practitioners to meet their needs. Because a CPT can build rapport and monitor their clients progress through ongoing assessment, they are likely to recognize potential deficits in a client's wellness.
This gives them the ability to refer clients to the appropriate medical or allied health practitioner for care, therefore playing a critical role within the client’s circle of care. A CPT must develop a network of allied health practitioners to communicate easily or leverage a client's existing circle of care to receive guidance in a collaborative effort to help clients meet their fitness objectives and overall wellness needs.
References
Clark, M. A., Lucett, S. C., McGill, E., Montel, I., & Sutton, B. (Ed.). (2018). NASM Essentials of Personal Fitness Training. Jones & Bartlett Learning.
De Lyon, A. T. C., Neville, R. D., Armour, K. M. (2017). The role of fitness professionals in public health: A review of the literature. Quest, 69(3), 313-330. https://doi.org/10.1080/00336297.2016.1224193.
Grant, A., Mackenzie, L., & Clemson, L. (2015). How do general practioners engage with allied health practitioners to prevent falls in older people? An exploratory qualitative study. Australasian Journal of Aging, 34(3), 149-154. https://doi.org/10.1111/ajag.12157.
Parkinson, M. D., Hammonds, T., Keyser, D. J., Wheeler, J. R., & Peele, P. B. (2020). Impact of physician referral to health coaching on patient engagement and health risks: An observational study of UPMC’s prescription for wellness. American Journal of Health Promotion, 34(4), 366-375. https://doi.org/10.1177/0890117119900588.
Price, M. (2016). Circle of care modelling: An approach to assist in reasoning about healthcare change using a patient-centric system. BMC Health Services Research, 16(546), 1-10. https://doi.org/10.1186/s12913-016-1806-7.
Stoewen D. L. (2017). Dimensions of wellness: Change your habits, change your life. The Canadian Veterinary Journal, 58(8), 861–862.
