One of your regulars starts feeling lightheaded during a workout and their heart rate doesn’t come down with rest. Do you modify the workout or stop it and refer them out? While this sounds like a test question from your CPT exam, it’s a real-life situation that could happen in one of your sessions.
So, when do you refer a client to someone with more training and expertise?
As fitness professionals, we encounter client symptoms every day, ranging from mild asthma attacks to life-changing heart attacks. Knowing what to do when you find yourself in these circumstances is a matter of safety, professionalism, and liability. Referring a client to another professional doesn’t mean you aren’t a capable trainer. It means that you care for your clients and that you’re doing your job right, acting within your scope of practice and professional limitations.
In this article, we’ll address what that scope of practice is, as well as when and how to refer a client to a health professional who can provide additional help.
What is the Scope of Practice for Fitness Professionals?
The American Medical Association describes scope of practice as “activities that a person licensed to practice as a health professional is permitted to perform.” Each of our work activities each day should fall within those allowances in order to keep our clients safe and protect ourselves from liability.
Each fitness and medical profession has different scopes of practice. They are primarily dependent on two things, the certification itself and the location in which you are practicing.
Personal trainers are typically licensed to plan and administer exercise programs for apparently healthy individuals. If your certification included training on special populations, such as pregnant women or individuals with chronic diseases, such cases would fall under your scope of practice.
A bit of a hot take, and regulated in some states, is nutrition coaching by personal trainers. In most states, specific and individualized nutritional advice and meal planning falls outside of a personal trainer’s scope of practice. However, if a trainer is a registered dietitian or has other nutritional credentialing, it may be within their scope to practice.
Group fitness instructors generally provide less individualized instruction and focus on group activity. Health coaches provide direction and guidance toward healthy behaviors, but would not provide specific exercise programming or nutrition advice without other certifications. Strength and conditioning coaches can provide greater direction and programming for athletes and teams.
While each of these careers can vary greatly, they all have limitations. Specific services outside the scope of practice for all of these certifications (unless an individual has the training and license to do so) include:
- Diagnosing health conditions;
- Prescribing treatment for health conditions;
- Offering individual pharmaceutical or nutritional advice related to health conditions.
These activities are reserved for healthcare providers with additional training and licensure. While we want to offer advice and help our clients however we can, we need to stay within the bounds of our certification. When we are certified, we are expected to adhere to those boundaries. They keep us safe from potential liabilities and lawsuits that could arise from providing misinformation or advice. They also ensure that our clients can receive proper care from trained individuals.
For specific information on your scope of practice, refer to the organization through which you are certified.
Red Flags That Require Medical Referral
There are obvious times when we should make a referral to a medical provider, such as the services previously mentioned. They’re often much easier to spot than less obvious, but equally as important red flags that occur in our sessions.
A common misconception is that if someone has been cleared by their doctor to exercise, they will always be safe doing so. We are not off the hook when it comes to monitoring our clients for warning signs that something may be wrong.
Many red flags and exercise contraindications can be taken care of through the PAR-Q+ and other health screenings that take place before a client begins an exercise program. Following their guidelines, you can screen clients who need to be referred to a medical provider. Sometimes, those clients may be sent back to you, often with helpful considerations and restrictions. Others may be sent to a facility that offers medically supervised exercise for additional care and support.
If you have a client that returns to you after being cleared by their healthcare provider, be vigilant in watching for any changes and take their providers’ notes seriously, even if a client seems fine.
Red flags to watch for before, during, and after your clients sessions include:
- Chest pain
- Dizziness or fainting
- Blood pressure outside of typical or safe range
- Unexplained shortness of breath or lack of recovery
- Joint instability
- Disorientation
These are just a few of the most common concerns to look for. If your client has any known health conditions or a family history of such, get to know the symptoms associated with them so that you know what to look for. While we ourselves aren’t doing the diagnosing, we may be the first to spot a symptom and start someone on the path to care. If a client does exhibit a symptom of a known or anticipated health condition, a referral is always warranted to ensure proper treatment.
Which Healthcare Professionals Should You Refer Clients To?
Just like a single exercise program won’t fit every client, referring every client to a single source is not the best practice. Knowing which type of healthcare or medical provider to refer a client to is important for several reasons. It directs the client to someone who can provide the help they need, and it also helps them get assistance more quickly than if they waited around for their yearly check-up or for symptoms to get out of control. By making the referral in a timely manner, your clients can get the additional help they need and continue on their path toward better health.
When you refer a client to a healthcare professional, match their health concerns to qualified professionals who can provide appropriate treatment.
Primary care providers, such as doctors, physician’s assistants, and nurse practitioners all provide care for general health concerns, pain, systemic symptoms, and medication needs. They are generally the first place we would refer a client to. Primary care providers can make referrals to other healthcare providers as needed.
Physical Therapists work in the same vein of the health industry as personal trainers. They have a more extensive education and can provide a higher level of care and treatment, including many treatment styles that are not generally available to personal trainers. They aid in pre- and post-operative care, injury prevention and recovery, chronic conditions, and movement restrictions.
Registered dietitians are one of your most valuable allies as a personal trainer, and make up the other half of a well-rounded fitness plan. We all know that movement and diet go hand-in-hand, but there is only so much we can do as trainers when it comes to food and diet. Dietitians have a broader scope and can address more complex eating concerns. They can also go more in depth and dive into specific nutrients. They can provide dietary planning for chronic health conditions, athletes, and others with unique needs.
Mental health providers can include counselors, psychologists, mental health coaches, and more. They vary greatly in what they can address depending on certifications, but can address the mental and emotional parts of wellness. They are a great resource for individuals dealing with anxiety, depression, emotional distress, or other mental health conditions. Once heavily stigmatized (and in some communities, still are), mental health providers can unlock many doors for clients facing mental challenges keeping them from better physical health.
Each of these providers can be valuable resources for you and your clients. As you become the type of trainer who uses all available resources, your clients will come to respect you. Remember that you are there to encourage, train, and assist clients, not to diagnose or treat them. When you refer a client to an appropriate healthcare provider, you’re not giving up on them, you’re helping them take another step toward better health.
How to Refer a Client and Document the Necessary Paperwork
Once you have made the decision to refer a client to another professional, what do you do next?
Who Should You Refer Clients To?
Start by determining which healthcare professional the client should be referred to. Do they need to see their doctor, a dietitian, or someone else? Once you know the type of professional to refer them to, the next question is who to actually refer them too.
If it’s a physician they need to see, their own primary care provider is a good choice. If they need to see a dietitian or other specialty provider, you can go about it two ways. You can refer them to their primary care provider, who can make a referral of their own. This is 9 out of 10 times the best way to go about making a referral. They have a much greater network of medical professionals than we usually do, so they can make a better judgement call. The weight of a doctor’s referral also goes a lot further than that of a personal trainer.
The one exception that I’ve found that sometimes works is with a dietitian. Having a dietitian you know and trust can be a valuable asset to you as a trainer. For simple cases, you may be able to refer a client straight to a dietitian. This is usually an exception to the rule though, and depends greatly on the population you’re working with. I like to think big picture with my clients, and realizing that I don’t see everything (and that’s okay!), and send almost everything through their primary care provider first.
How To Refer Your Client to Another Provider
Once you know who you’re sending your client to, prepare and practice how you’ll address this with your client. Be ready to explain your reasoning to the client in a way that gets them to take action and go see the provider. Of all the steps you take, this might be the most important one. Let me tell you why.
If your client needs help beyond what you can legally and ethically give them, you should make a referral. But just because you encourage them to see someone else, doesn’t mean they’re going to follow through on it.
A referral, when made without sensitivity and care, can push people away, from you and from other healthcare professionals. It can make them feel less than, broken, and like something is wrong with them. People may see it as “That trainer just doesn’t want to work with me,” or “I’m not going to go see someone else, because I just keep getting bounced around.”
However, when you approach the referral from a place of genuine care for the individual, it can open doors they might never have found. Make sure your clients feel seen and heard. Clarify that referrals are made to best meet their needs and to honor your scope of practice.
You might say something like: “I want to see you improve and get the most out of your training, and this is outside my role as a trainer. I recommend checking with your doctor before we continue to ensure we’re doing everything safely and effectively to get you on the road to better health.”
Documentation and Next Steps After a Referral
If needed, you may want to address next steps with the client. Some may just need a doctor’s clearance and then can continue working with you. Others may need to see a more qualified professional or receive alternative treatment. You may not know what all that entails, but you can offer encouragement and support as they move to the next stage of their journey.
Once you’ve discussed the referral with your client, document the exchange and referral for your own records (and to help with liability). While not required, you may choose to document your findings for your client to take to their referred provider. This could include red flags from intake forms, observations from sessions, or symptoms and concerns you have noticed.
The referral process enables clients to get the help they need, opens communication between you and healthcare providers, and helps you maintain professionalism and boundaries to keep you and your work safe and legal.
Referrals Help but Liability Insurance Still Matters
Referring a client to someone else does not indicate in any way your failure as a trainer or your client’s inabilities. It is standard professional protocol to be followed before an incident occurs whenever possible, not as a worst-case fallback.
It helps you avoid the legal claims that can result from missed symptoms, poor documentation, or failure to act on client disclosures. Liability insurance is still essential, even when referrals are made correctly, because each of us carries risk, whether we’re employees, solo trainers, or group instructors.
If you haven’t already, take a few minutes to review your intake and assessment forms, and develop your own protocol for referrals. Referring a client protects their health. The right insurance protects your work.
Explore liability coverage made for certified fitness professionals with Insure Fitness.
