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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 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.

Disclaimer:
The scientific information found on the powerbar.com website is derived from the following sources unless otherwise stated:

American College of Sports Medicine, Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain SJ, Stachenfeld NS. American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exerc 2007;39:377–390.

American College of Sports Medicine; American Dietetic Association; Dietitians of Canada. Joint Position Statement: nutrition and athletic performance. American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada. Med Sci Sports Exerc 2000;32:2130–2145.

Burke L, Dean V, eds. Clinical sports nutrition. McGraw-Hill Companies, Australia, 2006; 415–453.

Currell K, Jeukendrup A. Superior endurance performance with ingestion of multiple transportable carbohydrates. Med Sci Sports Exerc 2008;40:275-281.

Jeukendrup AE, Moseley L, Mainwaring GI, Samuels S, Perry S, Mann. CH. Exogenous carbohydrate oxidation during ultraendurance exercise. J Appl Physiol 2006;100:1134-1141.

Asker Jeukendrup, Michael Gleeson: Sport Nutrition, An Introduction to Energy Production and Performance, Human Kinetics 2004

Expert Panel:
Trent Stellingwerff PhD, BSc, Senior Research Scientist – Performance Nutrition, Nestlé Research Center
Christopher D. Jensen PhD, MPH, RD Nutrition & Epidemiology Researcher
Tricia L. Griffin RD, CSSD, POWERBAR Sports Nutritionist

Topics: Research

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