Once again, as a reminder, your NFPT Certification will not qualify you to administer exercise to persons with one or more Major Health Risk Factor(s) present without the approval of a medical physician.
Personal Medical History
There are several other questions that must also be asked in reference to obtaining more specific medical background information:
Have you ever suffered:
•heart attack
•had bypass surgery
•cardiac surgery
•extreme chest discomfort
•high blood pressure over 145/95
•over 35 and smoke
•serum cholesterol over 240 mg/dcl
•irregular heart beats
•heart murmurs
•rheumatic fever
•ankle swelling
•any vascular disease
•phlebitis
•unusual shortness of breath
•fainting
•asthma, emphysema, or bronchitis
•abnormal blood fat levels
•stroke
•emotional disorders
•recent illness, or hospitalization
•drug allergies
•orthopedic problems, or arthritis
If your prospective client answers yes to any of these questions, you cannot train him/her without a complete physical, or the approval of their personal physician.
Family History of Illness or Disease
Ask if your client has ever had an immediate family member die prior to the age of 50, and the cause of death. With the exception of accidental death, parental and sibling illnesses and diseases, especially cardiorespiratory diseases and bloodsugar abnormalities, are often times inherited. Inform the client of his/her increased susceptibility to these specific disorders and recommend relative lifestyle changes that will help offset the likelihood of your client suffering these family specific disorders. The lifestyle changes to be recommended are discussed in detail elsewhere in this text.
Cardiovascular Risk Profile
The next step is the completion of a "Cardiovascular Risk Profile Questionnaire". Your sample questionnaire is relatively self-explanatory and very objective. A client score of over 32 on this questionnaire would likewise be reason enough not to train this individual prior to the performance of a complete physical and/or the client's physician's approval.
Current Client Medication
If the client is on prescription medication, require that the client contact his/her physician or qualified pharmacist to insure there are no risks involved in starting the exercise program while on this medication.
Chronic Illness, Injury or Limitations
If the client is currently ill, put off starting his/her exercise program until they are over the illness. If the client suffers from a chronic, or recurring illness, care should be taken that the illness is not complicated by exercise. If a client has a chronic injury or a range-of-motion limitation, it should always be advised that he/she see their personal physician, a licensed physical therapist, or an orthopedic physician prior to implementing your recommendations. In the case of range-of-motion limitations, this therapeutic referral need be made only if recommendations involve the articulation (movement) of the injured site(s). You must also avoid recommending movements that aggravate above conditions. Inform the client to stop exercising if he or she experiences relative symptoms or undue pain of any kind, and consult immediately with you, and if need be, with his/her physician.
Contraindications to Exercise
As a personal fitness trainer, you must inform your client of the contraindications (symptoms of overexertion or injury) to exercise, so the client will be able to distinguish the difference between discomfort that is to be expected, and discomfort that could indicate an underlying problem. If a client experiences any joint pain, dizziness, nausea, rapid pulse, excessive sweating, extreme muscle soreness, cramping, or chest pain, he/she should immediately stop exercising, consult with you, and if need be, their personal physician. Contraindications to exercise will be discussed ater in this text as well.
Summary of Physician Assistance
A physician must be directly involved if a Major Risk Factor is present. A physician's consent and/or a complete physical must be obtained when #1) adverse personal medical history symptoms warrant; #2) the client's cardiovascular risk profile score is over 32; #3) there is a significant and restrictive chronic illness or range-of-motion limitation; or #4) contraindica-tions persist.
As initially stated, all clients, even apparently healthy individuals, should be advised up front to visit with a physician prior to starting or increasing the intensity of his or her existing exercise program. You are not however, obligated to require the apparently healthy client to do so.
General Client Information
This may sound a bit cliché, but a quality personal fitness trainer will evaluate a client's total lifestyle not just their exercise needs. There is more to health than just exercise alone. The following is a brief overview of each of the General Client Information topics included in your NFPT Client Screening Questionnaire.
Age - Knowledge of client age is useful in determining health risks, exercise intensity and duration, as well as for computing maximum heart rate (220 - age).
Sleeping Habits - Poor sleeping habits can reduce recovery effectiveness, lower Growth Hormone release, and can cause mental fatigue and inability to concentrate. Sleep is the body's built-in recovery mechanism. A protein builds up in the cerebrospinal fluid during waking hours that can be broken down only during sleep. Moreover, sleeping abnormalities can usually be directly linked to stress and improper diet.
Water Intake - Persons taking in too little fluids are more susceptible to dehydration during exercise. Prolonged low fluid intake can lead to a survival water retention in the body. Refer elsewhere in this text for more information on water ingestion.
Sex - This information is usually needed for demographic reasons. Gender also is a consideration in determining health risks as is indicated on the Cardiovascular Risk Profile Questionnaire.
Weight - Weight is generally a determining factor in first establishing your client's goals. Body composition measurement first requires measurement of total weight. Knowledge of weight is also of obvious re-evaluation benefit in consulting clients. Don't simply ask the client their weight, accurately weigh the client yourself using the guidelines provided in the Diagnostic Testing segment of the Client Screening Questionnaire later in this chapter.
Height - This information is usually needed for demographic reasons. Also, height is a determining factor in setting client goals based on national height & weight standards. These standards have been established by major health insurance companies, as a very general indicator of physical condition.
Occupation - Knowing what type of daily activities your client performs will assist you in determining total caloric intake, meal timing, exercise scheduling, and possible lifestyle change recommendations. Occupational stress may also be a consideration.
Most Recent Exercise Program
In order for you to optimize the results of your client's new resistance exercise program, you must learn as much as possible about their past resistance exercise program. Question your client concerning past resistance exercise, if any, paying special attention to the following questions and the appropriate responses:
•Type of routine - The client should have used a circuit routine for fat loss and aerobic conditioning vs. a split routine for lean weight gain.
•Total sets per muscle group - The larger the target muscle group, the more total sets used.
•Typical number of reps per set - Fewer reps for lean weight increase, and more reps for fat reduction and aerobic conditioning.
•Recovery between sets & workouts - Longer recovery for lean weight increase, and shorter recovery for fat reduction and aerobic conditioning.
•Movements used - Always use compound movements for both lean weight increase as well as fat reduction and aerobic conditioning.
•Length of workouts - Short high intensity workouts should be performed for lean weight increase, and long low intensity workouts should be performed for fat reduction and aerobic conditioning.
•Time of daily exercise - Train later in the day for lean weight increase, and early in the day for fat reduction and aerobic conditioning.
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