Are You Qualified to Work With At-Risk Clients?

Legal & Risk Management
By Sean Riley, MS, JD

Are You Qualified to Work With At-Risk Clients?
Why personal fitness trainers who work with postrehab and special populations are at greater legal risk themselves. Health clubs are becoming increasingly occupied by older clients and those who have special medical needs. This is partly due to referrals from physicians who have begun to appreciate the benefits of exercise in decreasing the risk of disease and in speeding postoperative recovery. While the benefits of exercise for at-risk populations cannot be overstressed, increased physical activity presents risks to all involved. As you will read below, these risks pertain not only to the clients themselves but to the supervising fitness professional as well. experience. Special populations require a greater level of responsibility and, hence, a higher legal duty is owed to them; this means trainers will be held to a higher standard of care when it comes to negligence claims. Again, this higher standard of care is directly based on a trainer’s education and experience. This is problematic if you knowingly or unknowingly accept at-risk clients, since some of you who regularly “train” or “treat” these clients do not possess a physiology-based degree. This is in direct violation of the policy of the American Medical Association, as stated in the “Ethical Opinion of the American Medical Association (AMA), section E-3.04 Referral of Patients” (Strive for Recovery 2002). According to the AMA,”Certified personal trainers who have no formal education in the field of exercise physiology and biomechanics may have a general understanding of normal physiology and even some understanding of abnormal physiology, but certainly do not fully understand either; thereby placing special patients at risk. This includes those with physical education degrees, since these curriculums center around teacher pedagogy, not human or exercise physiology” (Strive for Recovery 2002). Put simply, personal trainers must not attempt to practice those acts that would be beyond their recognized scope of duty and competency. “an organization that offers exercise-based health and fitness programs as their primary or secondary service, or that promote moderate to vigorous recreational physical activity” (AHA 2002). Under this definition, a “fitness facility” is part of a large umbrella that can broadly range from a studio that provides an unsupervised exercise “space” to a health club that offers medically supervised physical activity. Under this broad umbrella, a distinction must be made between personal trainers who work with apparently healthy populations versus “medical” personal trainers who work with “injured” or otherwise health-compromised populations (Morrow 2001). This distinction is necessary as the medical community becomes even more complemented or supplemented by the fitness community. All personal trainers owe a legal duty of competence to their clients, just as all doctors owe that same duty toward their patients. However, fitness clients who are at-risk or health-compromised demand extra supervision, and their exercise programs will require extensive planning and preparation. Consequently, it is strongly recommended that any trainer responsible for at-risk clients should have more advanced education and experience than those who work exclusively with healthy clients. If you work primarily with increased-risk populations, like older adults, you are legally held to a higher standard of care, given your assumed advanced education.

The Emergence of Medical Fitness
Personal trainers who work with postrehabilitative or special-needs populations inevitably invite legal controversy. A distinction must be made between these trainers and those who work with apparently healthy populations. Physicians increasingly refer patients to trainers and fitness facilities; this referral system is often called “medical fitness” (Morrow 2001). In effect, personal training programs are a form of supplemental, preventive health care that complements the efforts of the medical community (Morrow 2001). Whether medical fitness is practiced in a fitness, wellness or sports facility, personal trainers must be competent in recognizing the musculoskeletal, cardiorespiratory and neurological limitations of at-risk clients; this competence is derived from advanced education and

It’s a Fine Line
Fitness facilities are blurring the line between providing medicine and recreation. According to the American Heart Association (AHA), a fitness facility is defined as

What Makes a Trainer Qualified
Seniors and other clients with healthrelated complications must proceed cau-

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