Hi Jo. This is a great question because it’s one that I’m sure faces us all at some point in our careers. In my opinion, since you (or I) are the exercise expert in that relationship, you must take charge of the situation and do what you are comfortable with, and what is in the best interest and safety of the client. The answer to your question all comes down to a couple of factors (the severity of the medical condition, and its effect on your client’s ability to safely and effectively exercise). First and foremost should be the seriousness/severity of the medical condition. While in my own practice if a client has any condition that will effect their ability to safely or correctly exercise, I would insist that they see their physician, I recognize that not all medical conditions are ‘created equal.’ Quite frankly, there are some conditions (especially chronic ones) that our clients and doctor’s patients simply have to learn to live with. That being said, if I as the trainer have ANY doubts or hesitation about the client’s medical condition I would INSIST that they obtain medical clearance before training with me, and would make it a prerequisite to our working together. “No clearance, no training” is my rule. While some clients may initially be taken aback by my insistence, in the long run they quickly recognize that here is a trainer who considers their clients health first and foremost, above training dollars. It also helps establish that in the trainer-client relationship you are being hired for your expertise and knowledge and that you have certain guidelines that must be followed in order for your client to safely navigate the road to health and fitness.
I hope that this helps.