Individuals who seek personal trainers or fitness instructors come with
a variety of goals — as well as medical conditions and experiences. In
order to provide the safest, most effective training program, a
person’s medical history, not just current medical issues, must be
considered. Doctors spend a great deal of time in medical school and in
residency learning how to take a medical history in a succinct and
efficient manner, gathering all the important information that can
affect a patient’s diagnosis and treatment. When establishing a
training program, a personal trainer or fitness instructor can use a
similar, though less detailed approach to help him or her provide a
safe and effective training program for his clients.
Begin in the present with the client’s current medical problems. Be
sure to inquire about any medications they are taking. Ask about their
social history, including their occupation, if they smoke, how much
alcohol they drink, and if they use any illicit drugs. Although these
may be sensitive questions, it can help to get a better understanding
of an individual’s physical abilities when you learn how well they take
care of their body. Then touch on their family’s medical history.
Finally, go through a thorough Review of Systems (ROS) to see if there
is anything that either of you may have missed. A ROS consists of
asking general questions about major organ systems, and symptoms or
problems within that system. This is best organized from head to toe.
For example, ask about headaches or dizziness, blurry vision, recent
changes in vision, etc.
Importance of a Medical History
There are many physical and psychological benefits to exercise.
Although these benefits have been well-understood and accepted in the
medical community for quite some time, only in the last 20 years or so
has the general public begun to understand and participate in a regular
fitness routine. As a result, increasing numbers of fitness-naïve
individuals are participating in fitness activities, be it playing
sports, taking classes, joining a gym, or hiring a personal trainer —
all with various goals.
There are a large number of individuals with various medical conditions
and vastly different levels of physical ability that will seek your
help in reaching their fitness goals. It is vital when designing a
training program to consider the individual’s athletic and medical
history, as well their current physical abilities and goals. Major
determinants of success and satisfaction with a fitness program include
how appropriate it is to a specific individual and their goals, and how
well it takes into account their medical and physical abilities. A
client’s medical history may not seem to have much relevance to their
training program, however, taking a few extra minutes to gather this
information at the initial intake can help give real insight as to what
type of program will work for them — and which programs they’d do well
to avoid.
A medical history can be very long and complex, especially as the
client’s age increases. Doctors spend a great deal of time in medical
school and residency learning how to take a succinct, efficient medical
history that helps them gather all the important information that can
affect a patient’s diagnosis and treatment. When establishing a
training program, a personal trainer or fitness instructor can use a
similar — though less detailed — approach to help design a safe and
effective training program for the client.
An individual’s medical history can have small — or dramatic — effects
on an individual’s fitness plan. If the client is on a blood-thinning
medication, for example, a fitness professional needs to be more aware
of potential fall risks. If the patient has episodes of hypoglycemia,
they need to tailor nutrition more carefully into their exercise
routine. Lastly, any recent surgeries may require a more gradual return
to physical activity. There are many different potential confounding
factors, and each needs to be assessed on an individual basis.
How to Take a Detailed Medical History
There are many different parts to a medical history, and it can be very
overwhelming for both the interviewer and interviewee. As a result, a
systematic approach is required. It is best to begin broadly, then to
focus more on specific topics that may be of importance. It is easiest
to work backwards from the present, to help keep the history in
chronological order.
Begin in the present with any medical issues the client is currently
facing. Also keep in mind that many individuals take medication for
chronic conditions such as high blood pressure, and as a result, no
longer consider these conditions problems. However, even if a condition
is being treated, it still exists as a current medical issue for the
individual. So be sure to inquire about all current medications, to
help assess these underlying medical conditions.
Ask also about any supplements or herbal/homeopathic substances they
may take on a regular basis. Many people do not think of these as drugs
or medications; it’s possible, however, that they can have serious
side-effects. Ask about any allergies as well, so that you can avoid
recommending a nutrition or fitness routine that could be potentially
problematic.
At this point, you can begin to reach farther back into their history.
Begin by asking about any major illnesses or hospitalizations, as these
will stick out most prominently in people’s minds. Ask about any
long-term effects of these illnesses. Ask about any past surgeries they
may have had, as well as why, if appropriate.
Ask about their social history, including their occupation, their
smoking habits, how much alcohol they consume, and if they use any
illicit drugs. Although these may be sensitive questions, they can help
you get a better understanding of an individual’s physical abilities
and how well they take care of their body. Then begin to touch on their
family history: Ask about medical problems common in their family,
including any major medical problems that their blood relatives,
particularly their parents and siblings, may have.
Finally, run a thorough Review of Systems (ROS) to see if there is
anything that either of you may have missed. A ROS consists of asking
general questions about major organ systems, and symptoms or problems
within that system. This is best organized from head to toe. Begin by
asking about headaches, dizziness, blurry vision, and any recent
changes in vision. Then move on to difficulty swallowing or sore
throat. Ask about chest pain or pressure, difficulty breathing,
wheezing, or trouble catching their breath. Then ask about stomachaches
or pains, as well as any trouble with digestive or excretory functions.
Inquire about easy bruising or bleeding. Ask about generic symptoms
such as fatigue, unintended weight loss, difficulty sleeping or
sleeping too much. Lastly, ask about any musculoskeletal pain or
problems; although these issues may have been covered somewhat in the
earlier history, it is important to ask once more in case anything was
overlooked.
Remember to remind your clients that they should consult their doctor
for medical advice or services, including seeking advice prior to
undertaking a new diet or exercise program. Advance consultation with
their doctor is particularly important if they are under eighteen (18)
years old, pregnant, breastfeeding, or have health problems. In
starting a fitness program, clients should never disregard professional
medical advice.
Sample Medical History
Mr. Jones is a 48 year-old man who has been physically active in the
past, but he now has difficulty keeping up with his kids. He wants to
get into better shape for his health, and to better enjoy his time with
them. Mr. Jones reports that he has high blood pressure and high
cholesterol, (for which he takes medication), had surgery for some
“bowel problems” several years ago, and has some minor musculoskeletal
aches and pains. Otherwise, he considers himself relatively healthy —
just “out of shape.” However, after a thorough medical history, you
learn that several members of Mr. Jones’s family have had heart
attacks, and that some family members have asthma. You also learn that
he sometimes experiences tightness in his chest or has trouble
breathing when he tries to keep up with his kids.
These are some major red flags; Mr. Jones needs to see his doctor prior
to beginning any fitness regime. Although these symptoms could be
caused by exercise-induced asthma, a relatively benign, albeit
irritating condition, they could also signal underlying heart disease,
and could be signs of an impending heart attack.
If you’d been content with Mr. Jones’s opinion that he was “just out of
shape” instead of looking more closely at his medical history, these
red flags may have been overlooked, which could have resulted in an
ineffective and potentially dangerous training program. Even “out of
shape” clients like Mr. Jones can benefit from giving a thorough
medical history.
Your Role
Many types of fitness professionals can take part in helping a person
reach his or her fitness goals. It is important for everyone on the
client’s fitness team to know how best to operate within that support
system. Taking a medical history will help each member of the team know
when to seek the others’ advice and opinions. If any part of the
client’s history raises concerns, it is best to have them consult their
doctor before beginning a training regimen. It is also important to
know your own limitations and to seek expert input and advice when
necessary. A medical history will help you better assess your client’s
ability to engage in a fitness routine, as well as guide you to make
the most of his or her physical abilities.
Topics:
Pre-Workout, Research, Skills, Brain Function
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