Enhancing Clinical Fitness Skills
Brian D. Johnston
The initial interview conducted with a client serves several purposes: To build trust, to elicit information through history
taking, and to determine the mental status (motivation and desires) of the individual. Interviews are conducted
thereafter, and like the first interview, they serve to guide proper fitness prescription. However, the clinician must bear
in mind that there is some give and take when conducting interviews – namely, client information cannot be trusted
100% and without contention. Certainly most clients will do their best to be as accurate as possible, although some will
forget important information, such as having an operation a few years back that would influence current choice of
exercise implementation. Other clients simply skew the details to avoid shame or embarrassment.
In regard to the latter point, some people have difficulty in overcoming denial, e.g., “I don’t eat much,” or “I tried so
hard in the past.” Similarly, many clients will not admit to making mistakes or an offense, such as cheating on a diet,
which is why quality body composition is vital when working with the overweight client. If it can be demonstrated that
a particular food plan guarantees 1.5 pounds of fat loss per week, and two weeks later there is no fat loss, then there can
be no other answer except over-eating1 – the evidence of the nutrition plan coupled with the body composition testing is
However, not all clients will deny when they do something wrong, but will minimize its meaning or importance (e.g.,
“it was only one donut”), claim that it was unintentional (e.g., “I had to go to this party”), justify the cause (e.g., “I
deserve it for being so good this past week”), or blame someone else (e.g., “my husband was eating and told me to have
The reason for enlightening the reader on some of the psychological tricks used by clients is that conducting an
interview for purposes of acquiring information is not always foolproof. You depend on the quality of the data
available, whereas historical recollection or divulgence may be suspect or incomplete. Nor is there an instrument that
will predict when a client will fall off the wagon and eat more or less than he or she should, or conduct training sessions
behind your back. And then, when you consider all the possible influencing and intervening variables (e.g., stress at
work, a quick holiday at the last minute) it becomes even more difficult to predict what will or could happen.
Therefore, the data you collect from the initial interview and every interview thereafter must be utilized as a means of
guidance or recommendation, and must not be held on its own.
‘Informed consent’ refers to an approval for treatment or to undertake exercise; to participate in a fitness program and to
share information (through means of assessment) with a competent clinician in order to facilitate such a program. The
agreement or consent also is based on being informed of the reasons for assessments, the intended uses of the data, and
possible risks and benefits of exercise.
Based on the above, consent refers to three distinct areas. The first is that the client is undertaking the process
voluntarily, without any coercion, duress, or unjustified excitement or influence (e.g., increased motivation through
exaggerated or unrealistic outcomes). Second, the client must be considered legally competent to grant consent. In the
case of the mentally challenged or children, an adult or guardian must assume liability in providing consent. Third, the
client must have the requisite information to consent, i.e., the client can make an informed decision regarding his or her
participation in assessment and exercise. Although any number of situations may arise, such as sudden death, a broken
Some individuals will have such sluggish metabolisms that very little you do will have an impact, but they are far and few between.
Enhancing Clinical Fitness Skills 89
limb, skin abrasions, overuse injuries, etc., sufficient information must be disclosed as to any risks that may occur, so
that the client feels comfortable and competent in choosing fitness services. Other information should include what
tests will be taken and how the information will be used, full disclosure of assessment results, the right to refuse any
types of assessments (e.g., many overweight clients will refuse before and after photographs unless their value are
explained properly and in a professional context) or training methods, and the right to discontinue exercise sessions at
Disclosure of assessment data is an important factor, for two reasons. Primarily, it allows the client an opportunity to
respond to perceivably incorrect or misleading conclusions. For example, a body composition test may indicate a loss
of 2 pounds of lean tissue, but if it is relayed that body water is down by one liter (which is equivalent to 2.2 pounds or
1 kilogram), then the client will come to understand that the loss of lean mass was nothing more than a fluctuation in
body water. Remember that body composition is based on a ratio between fat and lean, and that a decrease in water
while stabilizing fat will indicate a higher body fat percentage! Second, feedback discussions can be therapeutic for
clients (particularly those requiring significant weight loss or rehabilitation), and through means of symptom reduction,
to improve confidence, and the rapport shared between the two parties.
Various consent forms exist, and clinicians can develop their own, but they should be written at a grade 7 or 8 level,
using straight-forward, everyday language and terms. No terminology or sentence structuring should be confusing,
particularly to serve as a means to bewilder the client in order to provide greater legal protection for yourself. The
client then should be allowed to review the document and ask any questions, and the clinician should volunteer
information, as to explain each section of the document. As important, sessions must not begin until a consent/waiver
form is signed and witnessed.
Lastly, consent forms are more than legal protection for the clinician, and to facilitate a client’s understanding of what is
required of him or her and any possible risks. Professional forms serve to increase a client’s positive perception of the
clinician, as well as an indication of the clinician’s experience, trustworthiness, and ethics. Part of this involves the
issue of confidentiality, a term that refers essentially to the general standard of professional conduct that obliges a
professional not to discuss information about a client with anyone2, unless the client provides consent.
Competence is an important ethical issue, in that one can be competent without being ethical, but one cannot be ethical
without being competent. Competency in the fitness profession means a person has the requisite knowledge, training
and understanding to determine and conduct appropriate assessments and to prescribe and supervise fitness accordingly.
It may be asked how ‘competent’ most fitness professionals are if taking a certification based on a weekend course and
multiple-choice questions, and how ethical the certification companies are in offering such courses – likely knowing full
well the (lack of) standards in which they support.
Some may view weekend certifications as sufficient, merely to get a personal trainer’s foot in the door, whereby hands-
on experience is acquired while in the field and working. Taking that into consideration, it is only ethical that one offers
services within the boundaries of one’s competence, based on education, training, supervised experience (e.g., in-field
apprenticeship work), study and overall experience. Hence, what kind of service should be provided by someone whose
experience is limited to a multiple-choice exam and a half-hour practical?
The other problem is one of assessment, a vital aspect that helps to govern proper fitness prescription. There are so
many tools and methods available, that a person cannot be tested in all of them, or be expected to carry out all of them.
A person who has reliable body composition equipment, such as the BioAnalogics system (www.bioanalogics.com),
likely could not perform skinfold measurements very well, since he or she lacks the practical ability to do so. On the
other hand, a person who is skilled in skinfold measurements likely will not achieve the accuracy and consistency of
Koocher, G.P., Keith-Spiegel, P. (1998). Ethics in Psychology: Professional standards and cases (2nd ed.). New York: Oxford
University Press. P. 116
90 Enhancing Clinical Fitness Skills
using a BioAnalogics system, nor would that person know body water content (an important consideration in the body
dynamic), a factor determined by use of the BioAnalogics.
Now, it makes sense that monitoring (the collection of data) and evaluating a client’s progress is done relative to a
person’s goals, which is objective in one sense, i.e., either a person is achieving what he or she desires or that person is
not. However, the method of evaluation is both diverse and difficult in exactness, and this is where the issue of
assessment instruments rears its ugly head once again. A clinician may use nothing more than a tape measure and
weight scale, sometimes as a result of budget constraints or being frugal (cheap!), whereas another clinician will have
access to elite equipment to pinpoint what is and is not happening to a more accurate degree. In the latter instance, a
product may claim to be accurate in determining body composition or metabolism, but is it? There always will be a
margin of error in a device for measuring biological changes, with that error increases as a person deviates from normal
(since most testing of such devices are conducted within a section of the population that may not have [knowable]
access to the outlying individuals considered below or above average).
Hence, there is a fine line that converges with competency and ethical practice when it comes to using instruments of
assessment. If a fitness professional does not invest in proper equipment, is he or she considered unethical, thus
preferring to use inexpensive devices that are less accurate and that provide less information to conduct one’s job more
competently and fully? As it stands, fitness professionals, and possibly with backing of the certification institutes, are
left to address the matter of ‘measurement’ on the basis of awareness and knowledge of what is and is not accurate. It
then is their responsibility to take the appropriate steps and to make the appropriate investment if the goal is to be both
competent and accountable.
It should be obvious that competence is not dependent on the type of certification obtained, or the ‘reputation’ of the
company, but on relevant training and supervised experience. This is true of any trade, such as plumber and electrician,
or in more exacting occupations of medical surgery. This is not the case with nearly all certification institutes. The
I.A.R.T., and a few others of which I am aware, do incorporate client case studies, and stringent requirements in hands-
on practical work. Our standards certainly are not as ‘high’ as they could be, since we are unable to supervise on-site
and directly, but it is a struggle to entice and certify individuals as the I.A.R.T. certifications currently exist. Until the
industry changes as a whole, it is impractical to make certification more challenging than it is – at least from our
perspective and relative to our testing methods.
Nonetheless, let’s continue with the issue of assessment. Again, what is assessed and how it is assessed varies
significantly. There are so many products and instruments available, all of which vary in reliability, validity, and
consistency that how does a certification organization test this ability? What we have found to be effective and relevant
is to have students account for their tools and methods within a client case study. For instance, if body part
measurements are going to be taken with a cloth measuring tape, then how does one know the tape is accurate – that it
has not stretched or shrunk? It would be necessary to compare the cloth tape to a known measurement that is resistant
to change, such as a steel measuring tape, and this comparison process would be described within the case study report.
Moreover, measurements are made at specific sites, in order to maintain consistency. For example, measurement of the
upper thigh could be made at one inch below the gluteal fold, and would need to be made at that point every time. As
well, and this is the crux of the matter when addressing measurements, changes in a body structure can occur at one
point more so or entirely than at another point. In regard to the thigh, the area just below the gluteal fold could remain
the same, and yet increases or decreases could occur elsewhere along the length of the muscle bellies. Hence, it would
be practical to measure the lower or mid thigh and this, again, would be measured from a landmark position –
determined best by measuring from a bony process or possibly from a fold in the skin that is not apt to change (such as
the gluteal fold).3
For video explanation and demonstration of proper landmarking and measurement taking (tape, calipers, etc.), refer to the DVD
Anthropometry Technique, by Rosscraft Innovations at www.rosscraft.ca.
Enhancing Clinical Fitness Skills 91
Now, it should be obvious that supervision of a fitness practitioner be continued until the supervisor judges the mastery
of the practitioner’s competency and ability. With the I.A.R.T., most of the exam process, of in-field assignments is
based on subjective interpretation, in that the practitioner needs to be accountable by means of explaining ‘how’ and
‘why’ with any recommendations.4 When the case study and other assignments are graded, they are done in a manner
that is left to the competency of the teacher, viz., if something is not up to (I.A.R.T.) standards then the assignments
need to be redone or reworked. This does not bode well with most certification institutes, or how schools prefer to mark
exams in a more ‘objective’ manner, via psychometrics (i.e., multiple-choice exams). However, by limiting the
education process to multiple-choice or easy answer questions, it becomes an issue of memorizing information or trivia,
rather than demonstrating competency in a field that is highly diverse and which involves living beings with unique
needs and goals. Although the I.A.R.T. does incorporate two multiple-choice exams, it became a necessary practice to
establish practical work in the real world, something that most companies dare not incorporate since it makes
certification a more daunting and time-consuming endeavor, thus limiting enrollment and student investment.
It is not a coincidence that the manner in which a certification institute tests or assesses its students’ competency is the
same in which a fitness practitioner is to apply his or her methods to assess the changes of clients. These steps include:
1. Any test must be psychometrically sound. Even if this does not include multiple-choice questions, the testing
method must be based on known principles. In the instance of certification, questions can be very broad, but
they will incorporate the underlying principles of intensity, volume, frequency, specificity, (over)load,
diminishing returns, and individualism. In the instance of client assessment, specific numbers are desired
and/or achieved, e.g., a client is 14% body fat, whereas the goal is to achieve 12% body fat.
2. The test must be reliable and validated for its intended purpose. For example, one would not measure height
and weight to determine body composition (this is the major downfall of the Body Mass Index, in that very
muscular people will measure ‘obese’). And if body composition is to be measured, there must be some
comparison of the tool with what is considered the ‘gold standard’ at that time. The tool very well may be the
gold standard, such as DEXA imaging to ascertain lean vs. fat tissue. With the BioAnalogics, it was compared
to hydrostatic weighing, with the former demonstrating equal accuracy and greater consistency, and both of
which have a margin of error of approximately 2.5% (but even with the margin of error, both are consistent in
terms of tracking changes accurately as a person loses or increases fat or muscle).
3. To ensure the first two points, fitness clinicians should follow standardized administration guidelines in all
instances. This means that how you measure something should not alter from one client to the next. If
skinfolds are to be taken with the individual standing, do not have other clients sitting or lying down, or the
same client standing in one instance and sitting in another.
4. Tests conducted should be relevant to the client. If a person is lean, and coming to a clinician for purposes of
shoulder rehabilitation, then a body composition test is irrelevant (although it may interest the client). More
specifically, strength and range-of-motion, and general function tests would be considered applicable to such a
person. Hence: 1) Assessment methods correlate to a client’s goals; 2) Assessment methods are as diverse as
possible within the assessment framework (various tests conducted so that one set of data supports and/or
corresponds to another); 3) The clinician identifies any problem solving obstacles to assessment (e.g., client
reluctance to be measured because of shyness and embarrassment), and; 4) The clinician evaluates whether
assessment procedures are generating useful, valid, and reliable information.
Unfortunately, being able to give a reason may not be a good or valid reason, depending on one’s knowledge and understanding of
92 Enhancing Clinical Fitness Skills
Enhancing Clinical Fitness Skills 93
Competent assessment practice includes the integration of any or all related data, rather than reliance on the test results
only. A body composition test may indicate that a client has not lost any fat, but that data should be assimilated with
other details, such as nutrition logs and psychological tests of motivation to control eating habits. Strength testing can
provide important data, such as individual improvement, but it has greater meaning if it can be compared to normative
values, in both absolute (compared to others of the same age and sex) and relative (based on body weight) terms. MedX
and the University of Florida Center for Exercise Science went to the pains to provide such details for the muscles of the
lumbar spine; unfortunately, little information exists of this nature for other body areas.
By applying the above points, a clinician is able to answer specific questions about a client, which helps to facilitate
proper fitness prescription (or changes needed for better results), and to generate confidence in a clinician’s findings and
perception of what is happening. This, in turn, better qualifies and quantifies problems (e.g., inability to lose fat), and
maintains greater understanding of a client’s predicament and within his or her context. But this can be done only if it is
known what a test can do (i.e., its function), what diagnostic conclusions can be drawn with what degree of certainty,
and the influence and ability the data will have on influencing future fitness prescriptions. If those three things cannot
be answered, then the test has little value. Similarly, certification companies must employ the same standards of rigor,
in that a fitness practitioner must be tested relative to the environment in which they intend to work, and if there exists
no hands-on application of exercise communication, prescription, interpretation of accumulated data, and supervision,
then the certification testing procedures are flawed.
You do not know it all, and don’t pretend that you do. Be confident in what you do
know, but realize that it is only the tip of the iceberg. Consequently, realize your
limitations in knowledge, understanding and ability, and seek to research those areas
that will help in your professionalism. There always is room to be better, always
deficiencies that need improvement, and you never will be good enough insofar as
being flawless in your fitness prescription and instruction abilities.
The term function has received bad press as of late, not because of the word itself, but how it is used. Some experts or
fitness enthusiasts do not believe ‘bodybuilding’ is functional exercise, since it (apparently) develops useless muscles.
Perhaps this misconception arose because of overly-developed bodybuilders who have taken so much growth-enhancing
drugs that they truly have become excessively massive and have not retained a good size-to-strength ratio, nor a high
degree of agility, quickness, etc. Nonetheless, and apart from this small group within the total population, the most
functional form of exercise is bodybuilding.
To explain, if a person wanted to maximize biceps brachii strength, then various curls at various angles would prove
beneficial. After all, to affect a specific muscle, one would mimic the actual function of the muscle, target it as much as
possible, and train it intensely. Moreover, an increase in muscle girth means an increase in cross-sectional area, which
further means greater force production since muscle fibers are larger. Hence, a muscle that is larger will be stronger, the
joint surrounded by said muscle more stable, and the added tissue serves as a shock-absorbing medium in the event of
falls and other accidents; thus, the body becomes more functional. This is exercise physiology at its most basic, and
was explained merely to support the notion of using the term ‘functional’ in its proper context.
94 Enhancing Clinical Fitness Skills
The term ‘functional analysis’ is not new, and has been used in psychology for several years. Its intent and meaning
refers to the process of identifying important, controllable, and causal environmental factors, and then using that data to
affect the intended prescription (in this case, fitness). In psychology it would mean a strategy used to initiate an
appropriate behavioral intervention, and that is true in fitness as well, since the control of one’s diet and ability to
exercise hard is motivation and behavioral based. However, in fitness we also must look toward the influence that a
particular training program has on a person’s mind and body, and that is where an analysis of the various aspects of the
program comes into play. In effect, this means what is and is not working relative to the client’s individuality (needs,
goals, abilities, and limitations).
Strategies for conducting such analyses include client interviews, observations of how the client responds to the
exercises and methods implemented (both mentally and physically), and how manipulation of the fitness prescription
brings about changes in response. This supports some form of daily monitoring, which then integrates into weekly or
monthly monitoring, such as altering an exercise and nutrition program and measuring the outcome by way of body
composition testing. In this regard we have the body comp test, which would occur every 2-4 weeks, which then is
correlated to the observations we make each time a person exercises. It is not coincidental that when a client enjoys a
program most, and feels his or her muscles best (based on exercise selection and the method of performance) that
progress either is fastest or most efficacious relative to time investment.
Your focus must be about results. Promoting and speaking about the quality of your
equipment, the cleanliness of the environment or any other factor is secondary at best. You
must direct your attention to achieving the necessary change, in order to appease the
client’s needs and desires in order to sustain motivation. If that does not occur, having the
world’s best equipment or any other facet is meaningless and retention rates will be low.
Types and Purposes of Assessment
The function of assessment in a fitness clinic varies significantly and can include any and all of the following objectives
(some of which involve psychological components):
• Determine and evaluate a client’s reason for seeking fitness/nutrition counseling.
• Case conceptualization, i.e., the client’s psychological and habitual background, and how he or she will sustain
a fitness lifestyle.
• Program planning, i.e., what will be done or can be done relative to the individual, and how will the
information be used and by whom.
• Regular monitoring and evaluation of a client’s progress.
• Change in a client’s behavior and frame of reference through increased self-awareness of body image and
accountability outside the facility.
There is an immense variability in how any of the above is carried out. How we interview and the questions asked are
very subjective, and this ties into an individualized case conceptualization. In effect, how you treat or question one
person may not be the same as with other clients, and although some of the questions asked may be part of a prepared
form, as you get to know the client you may need to ask customized questions in order to learn more about the person,
which then allows you to develop a fitness program better.
Enhancing Clinical Fitness Skills 95
Hence, program planning must heed the Principle of Individualism, but just what a program will entail is highly diverse,
based on the myriad exercise and nutrition philosophies that exist and how they reflect a person’s physical and mental
The initial interview is the most commonly practiced form of assessment. This usually includes the collection of
physical data, such as diseases, previous exercise history, fitness goals, nutrition status, prescription medications, etc.
However, and often this is a neglected part of the interview, psychological data should be collected as well.
Understanding a client’s psychology will disclose such things as mood, thought processes, potential risk issues, ability
to concentrate, and knowing whether the person is based firmly in reality or fantasy in regard to expectations. The
interview provides the clinician other useful details, such as how the client has coped with injuries, being overweight
and trying to lose fat, or a number of other scenarios. This is not to suggest that a fitness clinician’s role is to analyze a
client’s psychology, but to understand the person in a broad context, since how one communicates and motivates must
be relative to the person in which you are communicating and motivating. How you speak to a competitive athlete with
dogged determination is far different than how you would speak to a person who is obese and has failed at dieting all his
or her life, for example.
A good way to have a client disclose his or her personality and thought processes is to ask open-ended questions. Allow
the client to divulge information. Consequently, a very structured question within the interview may be “what methods
of exercise have you attempted before and what were the results,” whereas after a client answers you may begin probing
into relative areas, such as “after being disappointed with the last exercise program, what did you do in regard to
activity and nutrition?” The result of such questioning will be emotional data that will help direct you toward
prescribing an individualized exercise and nutrition program so that you can avoid some of the mishaps experienced by
Unfortunately, in typical gym settings fitness professionals are in a rush to conduct the initial meeting and interview,
since they operate on an hourly schedule – and spending too much time with a new client means not making money
from other clients. However, such premature closure is a fundamental error among clinicians, since rushing to
summarize who a client is and what he or she needs will ignore all the possible data available, and reduces the rate of
success when working with the client.
Moreover, observation of a client during the initial interview then extends itself to the sessions conducted in the gym.
One needs to do more than to count reps and motivate, but to observe the client’s behavior patterns toward the exercise
methods, thus digging for psychological clues that will help direct how you treat, communicate, prescribe, and supervise
future workouts (viz., fitness prescription is more than reps, sets, and exercises, but also involves a psychological
component). What further must be integrated into the equation is the environment in which the client reacts and
experiences. The person’s response to your manner of communication, the effect of gym music or noise, and the
influence of other gym patrons (e.g., peer pressure) all must be factored in the psychological evaluation. This last point
should not be under-estimated, since some people join different types of gyms for different reasons: Very aggressive
men want competition and may look toward a hard-core gym; introverts may prefer a 1-2-1 setting; obese women with
low confidence may prefer a women’s only club that has like members; and some clients will seek the services of
specific fitness professionals (because of reputations) regardless of the environment.
As a supporting point, how clients feel about their relationships or bonds with their instructors has a close affiliation to
the positive or negative outcomes of the sessions. If there is tension or dislike, the environment will change and be
strained. If there is camaraderie, although not too much over-friendliness (since such will increase an unprofessional
environment and the client will take advantage of situations when possible, like canceling appointments at the last
minute), then there will be far more joy and positive emotions going into the workouts. The relationship and feelings a
client and clinician will have often are established immediately, upon first impressions and within the first few sessions,
and so for this reason clinicians must make an effort to create a positive bond in order to ensure successful workouts. If
the client does not feel good about the workouts, the tasks to be completed, goals to be achieved, or in spending time
with you, then either progress will slow or the client will discontinue the sessions.
96 Enhancing Clinical Fitness Skills
In regard to the above, success in training also is influenced by the clinician’s accuracy in the ability to assess the
client’s motivation, desire to change, and intent to train aggressively. These would include expectations, changes in
habit, and motivation in general, based on questionnaires or broad questioning. It is not unusual for a client to appear
passionate about wanting to change, but which may not be the case. A rehabilitation client, for example, can express as
much, but the person’s body language reluctance to exercise with vigor suggests something quite different. An obese
client may claim to want to lose fat, but lack of changes in body composition supports the notion that extra calories are
being consumed and that the preference to eat is greater than the desire to reduce fat.
It is because of the contradiction in what a person wants and what he or she does in an ‘attempt’ to achieve a goal that
the best laid plans can go awry. Similarly, even when a person is motivated highly and does everything correctly will
plans need to be rectified regularly. In this regard, clinicians become detectives, looking for clues in how things appear
and how they actually are, in order to re-strategize an appropriate plan of action relative to a unique individual. And
part of that plan of action involves the assessment protocol, of what it consists and the manner in which it is executed
(more so when dealing with the much diverse psychological aspects than those pertaining to the physiological).
Hence, the original protocol may need to be changed even before fully implemented. Many times I thought a certain
strategy would fit a client, but the more often the client was interviewed, the more I began to see deviations in how I
needed to coach, monitor and prescribe exercise and nutrition. And sometimes this may not be the case until after 2-3
sessions, when you acquire a more concrete sense of how a client is responding mentally and physically. The client
may be enjoying the sessions, but is not producing the physical effects desired. Conversely, the changes may be on cue,
but the client dislikes the process. Based on the data, not only will the protocol need to change, but even the measures,
i.e., the goals and objectives, so that both protocol and goals coincide once again. This is easier to understand and
coordinate once it is determined what the purpose of the protocol is, the ways in which it is to be administered, and the
manner in which you are to collect data and its interpretation.
When there is a clear understanding of the client’s psychology, and how that factor integrates and influences the training
sessions, the data can help the clinician to identify areas whereby interventions can be applied or modified to improve
training productivity. It may be discovered that something as simple as a dislike for particular exercises or methods of
training is what is holding a client back from being as aggressive as is necessary to achieve the desired results. After
all, when a person is challenged and finds exercise interesting and enjoyable, greater quality of effort is expended both
mentally and physically.
Part of this assessment process includes ‘exit interviews,’ which may involve one-on-one discussions, surveys, or a brief
written statement by the client. How often these are administered would depend on the client and the nature of the
questioning and to what the questions pertain. These exit interviews would assess whether the client is satisfied with
the clinician and his or her methods of communication, teaching and guidance, what the client liked and disliked about
the training protocol, the degree of progress made, and how hopeful the client was/is about making and sustaining
changes. As a guideline, such questioning should take place about once a month, since if things are not going right with
the client and his or her perception of what should be happening, you do not want to wait too long before rectifying the
The difficulty with administering a psychological questionnaire is in knowing what to ask. Simply put, clinicians need
to know what data is applicable and helpful in their work, and that will help direct what questions should be asked in
prepared forms. As important is the process involved in asking questions, i.e., you are evaluating a client’s perspective
and how he or she answers as much as the answer itself. A person may answer yes to a question, but did he hesitate;
was he sincere; did he answer in the way he thinks you expected him to answer?
Avoid being too friendly and take charge of sessions. If a client speaks too much about pains,
emotional problems, etc., then that person needs to seek professional help within the disciplined area
(e.g., medical doctor, massage therapist, etc). Otherwise, you will spend much of your time consoling
and trying to be everything to this person, which not only is time consuming, but likely outside your
scope of expertise, which can create legal problems.
Enhancing Clinical Fitness Skills 97
The ability to supervise your ability, to self-assess how good of a fitness clinician you were, are, and could be is no
different than what occurs when you train in the gym. In sum, similar to directions taken in sport psychology, it is
common to evaluate how well you have done based on interest, motivation, desire, and how these facets interconnect to
the practical and physical actions during workouts. When you feel and know that your training is not as it should be, or
that you are not tuned into a session mentally, then you do something about it, such as psyching yourself up, taking a
layoff, altering the program, etc. Likewise, if something is not up to par with your professional standards, or when
behavior is not as good as it should be with clients, you determine where the weakness lies, problem-solve solutions,
implement those solutions, and re-evaluate accordingly – and this happens continuously over time and should be broken
down into six distinct phases:
1. Determine an area for improvement (e.g., exercise technique communication).
2. Analyze your strengths and weaknesses within that area.
3. Determine what may have worked in the past (if done so) and combine those with other potential courses of
action that seem both appropriate and promising to improve the area.
4. Implement a direction for action in a non-threatening environment, such as with a colleague or a client with
whom you feel comfortable.
5. Log the steps taken and the outcome; determine what was effective and what was not, while problem-solving
6. Discuss the strategies with other fitness clinicians to receive feedback and ideas; similarly, athletes rely on
their coaches for input and at times you will require help to check your blind spots.
The issue of self-supervision and assessment with clients is akin to the individuality of each client, and what is best for
that person when in the gym. Each person is unique, and how you work with that person will involve unique
interactions and directions for action. Any workout can be unpredictable, and this aspect must be considered when
working with people, in that anything can happen and you need to be focused in order to catch the real-time nuances of
how you work with clients and their responses/feedback. For example, this could refer to adjusting loads and ranges of
motion of an exercise, but also the manner in which you communicate and relay instruction. You then evaluate or
assess your professionalism on the spot with quick decision-making, but also after a session with a more methodical
approach, e.g., report writing/journaling. (Keep in mind that self-report supervision is the least effective form of
supervision and is much different than having a peer or respected mentor do the supervising; nonetheless, it is better
than no supervision.)
In effect, you manage your resources (abilities) to meet the need of each client best. This follows a process of knowing
what needs to be done with clients (interviews, assessments, report writing, technical communication, motivation, etc.),
how well you can accomplish those tasks, and setting personal goals to improve your ability in any specific task. You
also must be aware of any resource that could help you become better (e.g., books, Internet, colleague, mentor,
technology/tool, etc.) and the desire to acquire improved skills and to monitor those skills accordingly.
Suppose you were weak in a particular area, such as the initial interview with clients. The first step is to set a goal to
become better at interviewing. If you do not set a goal, just as in athletics or running a successful business, you will not
improve, or will be unable to measure the extent to which you are improving and how much further you need to grow
your skills toward optimizing the improvement. Goals must be clear in regard to what you want to achieve so that you
can select appropriate steps or interventions to determine an end point or time line in which to make changes.
98 Enhancing Clinical Fitness Skills
The measure of goals then is based on creating a standard for comparison. In weight training, standards are very clear,
in regard to target heart rate or loads lifted from a previous session. In self-evaluation of professional skills,
benchmarks are more abstract, and the best way to evaluate would be through a scaling system of questions posed to a
client, e.g., “on a scale of 1 to 10, how would you rate my ability to motivate you during intense exercise?” Another
method is to use feedback from past task-oriented mistakes, in that a clinician would keep track of mistakes or errors in
judgment, then determine what an ideal course of action would have been in those instances, thus implementing
problem solving into future actions.
What Is to be Evaluated?
1. Identify skills, knowledge and understanding deficits.
2. Recognize difficulties relative to those deficits and as they arise in sessions.
3. Notice reoccurring themes and unresolved issue patterns, but also as they transpire in real time.
4. Become aware of deficiencies that interfere with client progress.
5. Remain passionate and curious about fitness science, which factor is enhanced by being creative in your
application of fitness.
TIP: As with sport psychology, using methods of self-talk and mental imagery can help clarify problem areas and
solutions. Rehearse in your mind how you want to be (the area for improvement), and replay actual sessions… how
they occurred and how you prefer they were to have occurred.
Mutual support and analysis is important. When feeling inadequate or frustrated, we tend to rationalize those emotions
rather than accepting them and doing something about it. However, if limited to our own devices, we need to ask
ourselves key questions to allow for some self-reflection, as presented on the following page.
100 Enhancing Clinical Fitness Skills
Questions for Supervision
1. Do I distort or exaggerate my client’s results or lack of results?
2. Do I have a bias for or against my client, e.g., are there personality conflicts, lack of passion, or personal issues
that are preventing me from doing the best I can with this client?
3. What have I been doing that has been most and least helpful for my client to achieve his/her goals?
4. What ineffective training, nutrition or motivational strategies am I reluctant to let go of in favor of something
that might work better?
5. Are there issues of power or control in regard to myself or my client that are getting in the way of progress?
And am I allowing arrogance to prevent me from being at my best?
6. Are there ways in which working too hard or taking on too many clients or too much responsibility is getting in
the way of optimizing this client’s results; if so what can be done?
7. How are my self-doubts and fears of failure affecting my client’s outcomes?
8. What mistakes or misjudgments have I made in working with this client?
9. How am I blaming my client for being uncooperative or not taking responsibility, rather than looking at our
shared responsibility to achieve desired fitness goals?
10. How could a colleague, supervisor or other fitness professional help me to work through any of the above
As stated, the idea is to determine your weaknesses and to reflect upon the answers to understand better your
capabilities and what needs to be improved upon. This helps us to discover what is working best and what we can do to
assist clients better. This can be done only by forcing yourself outside a comfort zone. In doing so, you learn to think
outside the box and to discover/invent new ways in which to conduct yourself with your client, to think of new ways in
which to apply fitness science and to grow as a fitness clinician. Similarly, an adventurous person will try new exercise
gadgets, machines, handles, and exercises, while a very reserved person will cling to the ‘same old,’ and likely will fail
to grow as a result.
It helps greatly to discuss clients within a group setting (peers at the gym in which you work) or with other professionals,
in order to confirm one’s understanding, and to get feedback in case something is missed. However, you must feel
confident in order to expose any vulnerabilities and inadequacies, although it is normal to feel confused or inadequate at
times. We are not infallible and there always is something new to learn. There will be instances when you feel as though
what you did was not fully effective and that things could have been done differently. What makes it difficult is that we
are viewed as professionals and, consequently, thought to no longer require supervision. This is the reason for peer
feedback and being supervised by someone with greater knowledge. Fitness professionals are in the position to make
positive changes in others’ lives, and this can be amplified by allowing input of other professionals. This is one reason
for doing client case studies, to demonstrate one’s understanding and, at the same time, one’s weaknesses, thus
providing direction in areas in which to improve. Unfortunately, in the personal trainer industry there are so many people
going through the motions and doing only what is expected in order to meet minimal requirements.
Enhancing Clinical Fitness Skills 101
Self-Monitoring within the Self-Supervision Model
You are bound to make mistakes; not always because of incompetence, but because of lack of self-monitoring, viz., the
process of being aware of one’s actions to maintain a point of reference during fitness practice in order to avoid self-
deception (e.g., affecting objectivity as a result of a poor memory, thinking one client can do as well as another,
believing that a particular method of training is best because it works for you, etc.). To explain it in other terms, self-
monitoring refers to observing and mentally processing the connection between events and your subjective responses
with the goal to increase desirable thoughts and to decrease undesirable thoughts, feelings, and behaviors. Each person
and how he or she operates in the work force, at school, or socially is affected by values, life stressors, peer pressure,
personality, and many other factors. You want to understand the nature of your environment and individualism since
this will allow you to understand the nature of your actions as a fitness professional, rather than becoming defensive
through rationalization of why you act and think as you do. In sum, you not only want to learn about your clients, but
about your work and yourself, both of which affect how you interact and work with clients.
The purpose of the I.A.R.T. case study component of the Fitness Clinician apprenticeship module is to force the student
to track as much pertinent detail, to be accountable for his or her actions, and even to develop reports on one’s strengths
and weaknesses, all of which serve as a means of self-monitoring and self-reflection. However, once certified, such a
process rarely is maintained, mostly because it is not required by law or even as part of an ethical code in the personal
trainer industry. But it is through self-monitoring that we learn about ourselves and become better clinicians.
How do you know when to self-monitor? To answer that question best, consider any number of negative situations that
could arise as red flags or cues. For example, and some of these can be inter-connected:
• You are bored with the client and merely ‘exist’ during your sessions with little interest or intensity.
• You allow yourself to become emotional and to have a ‘tone’ when speaking.
• You get involved in a client’s private life, through discussions in the gym or socially (if a client has a problem
that has a bearing on his or her fitness regimen then some action needs to take place, but it must be done within
your professional means and boundaries).
• You dislike a client for whatever reason, which sometimes means unresolved issues affecting your work with
the person; you do not ‘connect.’
• You lose patience with the lack of results a client is achieving and try some excessive training or dieting
regimes that could end up injuring or harming the client.
• You would rather implement the same program continuously since it suits your agenda and makes things
easier, rather than focusing on any evolving needs of the client, or the client’s need for change to maintain
• You take a client for granted since he or she has been with you for so long, and you become relaxed in your
critical thinking of how to help this person best.
• You avoid receiving client feedback to help you fine-tune the program or to make appropriate change.
• You experience negative emotions (for whatever reason, such as the sense of being unable to help) including
anxiety, fear, guilt, or anger, and you then redirect those emotions toward how you work with a client.
There are several ways in which we can self-monitor our behaviors and actions. The most common is self-talk,
whereby you verbally speak out about your feelings, thoughts, biases, etc. This is not done in your head, but aloud as if
to develop a solution to problem with another person. This method works only if the clinician is critical enough to carry
through with the process.
102 Enhancing Clinical Fitness Skills
Some feel awkward in carrying on a dialogue with them selves, but are able to put words down on paper.
Consequently, a more practical method of self-monitoring is by way of journaling. This method supports the idea of
developing client case studies, in that the clinician can include notes of concern while writing out the client’s daily
workout observations. And just as a clinician would include regular assessment reports on the client’s improvements,
so too would the clinician include regular assessments on his or her professionalism, level of skills, weaknesses, etc.
What makes this method of self-monitoring effective is that it slows down thinking as each idea is considered fully
before moving onto the next sentence or idea, whereas self-talk sometimes can allow us to skip over ideas or trivialize a
When journaling, write down random ideas about subjective matters, such as your feelings or emotions when working
with a particular client, and then develop your notes more toward the objective factors, such as your skills and abilities
and how they differ or are constrained with this client. From there you need to develop solutions to rectify any negative
As mentioned previously, whether implementing self-talk or journaling, you can utilize visual imagery to enhance the
experience. Imagery is the same as it is when training, in that you see yourself completing an exercise movement
successfully, and the same is true when developing notes or speaking aloud about an experience with a client. A
relaxed state is necessary for imagery to work effectively, as you replay key moments in your fitness coaching, recalling
any dialogue, feelings, images, etc. Using imagery, and remembering clearly the events of the day or of a session will
help in clarifying ideas in your head for self-talk or journaling.
A point that should be made is that anything can be overdone, including self-monitoring. You do not want to become
obsessive about your feelings, methods and interaction with clients, to the point of ruminating and devoting more time
than is necessary. If you become excessive in your thoughts and actions toward a client, and you cannot stop, that may
be a signal that you require outside assistance from a peer or respected personal trainer or health care professional
(depending on the nature of the problem). After all, if you determine a problem and cannot come to an answer quickly,
or after some modest research, then it’s time to move on or take care of it through means of assistance. Know and
understand your limitations!
Keys and Method to Self-Supervision
Fitness Clinicians should have a set of procedures in place, to maintain quality standards of practice and to improve the
flow of operations. The basis for this section is to offer practical guidelines for self-supervision within your practice,
with an obvious benefit toward maintaining and/or enhancing your work by way of observation and problem-solving.
This is done by means of following an independent on-going systematic process to monitor and direct professional
development when working with a client, and both mentally and through journaling thereafter (the set-aside time must
be scheduled like an appointment that is part of your professional mandate; otherwise, it is far less likely you will
devote the time for this process).
When critiquing your professional ability, take on two roles of supervisor and supervisee. Imagine that you are the head
fitness clinician in a state-of-the-art facility and you are overseeing the actions of a newly employed personal trainer
(which also happens to be you). As supervisor, look for any holes or weaknesses, and bring them to the supervisee’s
attention. Aspects that should be considered include:
• Quality of Communication that reflects the personality of the client, clarity of instruction, explaining concepts,
and tone of voice.
• Quality of motivational coaching, including exciting the client, making the client feel at ease, and helping the
client to focus while reducing anxiety.
• Quality of program development throughout the entire process of the case study, from one session to the next,
and how it best meets the individuality of the client.
Enhancing Clinical Fitness Skills 103
• Quality of knowledge and skills (such as hands-on training, information gathering and interviewing, and
physical assessment) relative to the needs and constraints of a client.
• Quality and adherence to professional ethics and standards (such as issues of confidentiality, disclosure,
legalities, competency, etc., as set out by the I.A.R.T. or another fitness professional education body).
• Nature of the personal trainer’s demeanor and attitude toward the client, such as friendliness, apprehension,
• Quality of report writing and program development outside a session.
Many of the above factors can be reviewed and considered by way of video taped sessions, which is common practice in
some pre-graduate studies, including clinical psychology. Of course, you must receive a client’s permission before
videotaping, and by way of a signed release, and that the tape(s) will be held confidentially. When doing so, make
certain to inform the client that you are videotaping the session to analyze the quality of his or her training, rather than
saying that the taping is to review your clinical skills (which brings into question your credibility and qualifications).
Tapes then should be viewed once all the way through, for a general overview, and then reviewed a second time while
journaling – extracting specific concerns, including your patterns of discourse, habits and methods of relaying
information, technique, motivation, etc., as well as how you interact and understand a client.
It then must be determined what methods and procedures are to be in place if you were to write a report on yourself, the
objectives and areas of analysis, etc. From the perspective of the supervisor, you need to consider the following:
• What are the needs of the client during your one-to-one interaction and throughout the development of the
client’s program? What are you trying to achieve with this client? For instance, a clinician’s skills, demeanor
and communications would need adjustment and variation with clients who range from one extreme to another,
e.g., attention-deficiency symptoms, a medical surgeon, a brain injury victim, and an athlete.
• Your self-report must be a systematic review of a session in question and in the context of the entire case study
of that client. This is important since how you conduct yourself from one session to the next could change,
such as becoming too relaxed and joking with a client or developing an aversion toward the client.
• Investigate and deliberate alternative ways in which a session in question could have been conducted or how
the case study could have been developed (or needs to change). It is obvious that program requirements
change as a client changes, but the ability of a clinician and his or her attitude, communication skills, and
knowledge may need to change as well.
Based on this, a rating system in various areas of performance evaluation can be developed. The reader is encouraged
to develop these forms so they are more customized, but simple examples of self-evaluation and client evaluation are
presented on the following 4 pages, both of which can be compared to determine how you think about your performance
and how a client thinks of your performance.5 However, the next step, as indicated in the last bulleted item above
necessitates possible solutions to increase professional conduct and ability.
Lastly, do note that self-evaluation is not to be conducted with every client in mind. Rather, self-analysis should be
done regularly when you can schedule about a half-hour to one-hour, although devoted toward troubled cases to
determine where problems lie.
It may be necessary to have a client complete an evaluation anonymously through the mail; otherwise, that person may be
apprehensive to disclose what he really thinks or the client may grade you higher than he would under anonymous conditions.
104 Enhancing Clinical Fitness Skills
Enhancing Clinical Fitness Skills 105
Fitness Instruction/Prescription Evaluation
Your feedback and input is important to the continued success and improvement of our Personal Training Services.
Please take a moment to complete the following evaluation and return to:
___________________________________________________________________________. Thank You!
The instructor was knowledgeable,
professional and punctual. 1 2 3 4 5 N/A
The instructor showed enthusiasm, 1 2 3 4 5 N/A
approachability and promptness.
My program met my goals and objectives 1 2 3 4 5 N/A
My questions and concerns were
adequately addressed. 1 2 3 4 5 N/A
I would recommend this instructor to a
friend or coworker 1 2 3 4 5 N/A
The value of my training was in line
with the cost. 1 2 3 4 5 N/A
Fitness Clinician’s name:
Date(s) of session(s):
Client name (optional):
Client email address:
Additional comments or suggestions:
106 Enhancing Clinical Fitness Skills
Performance Appraisal Form – Client Case Study Specific
Instructions: This form is to be completed within four to six weeks of a case study
completion. It will be added to the employee’s personnel file, and become a component of
the year-end review.
Employee Name:________________________ Client Name:_______________________
Employee Title: ________________________ Client #:____________________________
Goal of Study: _______________________ Study Started:________________________
# of Hours Spent:______________________ Study Ended:________________________
Evaluator Name:____________________________Evaluator Title:_____________________
Date of Evaluation: ___________________________
Case Study Description & Objectives
What was the overall scope of the case study, and what were the objectives of this client?
Enhancing Clinical Fitness Skills 107
Please rank the individual’s performance for each metric on from one-to-ten (1-10) using
the scale below as a guide. If the metric is not applicable for this particular project, fill in
the blank with “NA” (Not Applicable):
1 5 10
Did not Meet Expectations Met Expectations Exceeded Expectations
1. Overall Case Study Performance: _________
2. Completion of Client's Objectives: _________
3. Client Satisfaction: _________
4. Quality of Case Study Deliverable: _________
108 Enhancing Clinical Fitness Skills
5. Leadership Capabilities: _________
6. Teamwork: _________
7. Communication Skills: _________
8. Team Impact: _________
9. Problem Solving & Knowledge: _________
10. Personal Qualifications: _________
Enhancing Clinical Fitness Skills 109
Limitations of Self-supervision
There are several limitations to self-supervision. The most notable is that a person may be unable to identify
weaknesses, and this could prevent a fitness clinician from rectifying the situation or seeking external consultation (to
obtain different perspectives of a client’s dilemma and the clinician’s ability). If you do not know there is a problem,
why seek a solution? However, this becomes more of a scapegoat or excuse since even the best clinician must make an
effort to undertake some degree of self-supervision, whether you think there is a problem or not.
As a first step, in order to prepare for self-supervision, the clinician must be competent at conceptualizing his or her
client and how that person relates to the fundamentals of fitness science. If it is unclear as to how the fundamentals
exist in regard to a unique individual, then it is impossible to critique one’s ability in applying those principles, and this
becomes an issue of needing to investigate exercise theory more intimately.6 Once the fundamentals are understood, it
is vital that the clinician ask questions during sessions, since doing so is required to learn and understand a client’s
unique individuality. When this is done, and the right questions are asked, then it is easier to self-supervise since you
have a frame of reference from which to do so. Without a frame of reference, you have no context in which to supervise
and analyze your ability.
Whenever self-supervising, it becomes an issue of competency, a topic discussed previously. This means knowing
where one’s strengths and weaknesses lie, and it certainly does not take much mental effort to know where you are
weak. In effect, several abilities must be analyzed, such as technical instruction, gathering and interpreting data, regular
assessments of client change, etc. Once a weakness is discovered, the next step is to investigate how it can be improved
upon, which may mean research in the appropriate area, but also, more importantly (since others often can see flaws or
problems more clearly), consultation with a trusted peer. Failure to acknowledge and rectify a weakness (and to model
appropriate behavior or actions) may result in lackluster changes for the client, or possible legal action resulting from
incompetence. This last point must be realized from a broad perspective, in that bad habits can be hard to break if
carried on for too long, and that they can be passed down to other less experienced fitness clinicians working in the
More than once I mentioned the importance of outside consultation to help rectify weaknesses once discovered.
However, often a person does not realize the degree to which a weakness exists, and this is where consultation of a
supervisor or peer becomes valuable. Periodically, and when possible, every fitness clinician should have a peer or
outside professional observe training sessions and the development of fitness programs (which programs are to include
full reasoning to establish a proper context of ‘how,’ ‘why,’ and ‘when’). This can be done on site and live, or by way
A limitation at this juncture occurs when clinicians become too obsessed with the content of a fitness prescription (at the
time of implementation) rather than the process, of what is to happen over the ensuing weeks or months. This trap is
common among most trainees, in that they try to find the ideal training prescription rather than looking at the big picture
of strategizing. Similarly, self-supervision becomes difficult when one’s frame of reference is so narrow, and some
trees within the forest become more of a concern than what is and may be happening in a broader framework.
Unfortunately, most personal trainers haven’t a clue as to what those principles are or how they need to be applied
relative to any particular person. Consequently, it is little wonder that something as abstract as self-supervision is both
ignored and not given any consideration in this industry.
110 Enhancing Clinical Fitness Skills
As will be discussed later in this article, burnout is another limitation to self-supervision as fitness professionals take on
too many clients to make more money, thus reducing the quality of work. It is tempting to take on a few more clients,
to make a few hundred dollars more per week, but as time becomes constrained in dealing with more clients, there
becomes less desire, interest, and energy to focus on competency and quality. This was evident among some I.A.R.T.
instructors who already were certified, but who had to undertake a client case study in order to demonstrate continued
competency relative to the organization’s improved standards. Many of these instructors dropped out quickly with
many excuses. One instructor indicated that his clients “don’t want to be part of a case study,” which is as obtuse an
excuse as they come, since clients are unaware that they are part of a case study… all actions by the clinician are done
behind the scenes, including any report writing or problem solving. Nonetheless, it speaks volumes of individuals who
claim they want higher standards but are unwilling to demonstrate as much when it comes down to the crunch, which
further signifies the state of the personal trainer industry.
Understand that in order to evaluate one’s skills, it is vital to go through the pains of a client case study, to produce
videos of training sessions and possibly to seek outside advice on these assignments. Failure to do so make it difficult
to determine strengths and weaknesses since the process becomes relegated to brief reflection – and often rationalization
to accommodate one’s ego and pride. Sufficient time must be devoted to evaluate how effective your work is with each
client. If not, the result eventually will be inferior client service and results. Even if you use yourself as a case study,
the result is that you seek your own professional services, and this helps to prove competency to some extent based on
the results produced physically and also through the mental process involved during report writing.
Professional Fears and Incompetence
It is necessary to understand how people evolve in fitness. Seeing patterns and how things change, it is possible to
know where they have been and where they are headed. This much is obvious, but a fitness clinician’s career
development also can be plotted with accuracy. Failure to complete a client case study, lack of investing in new
learning materials, all signifies the quality (or lack thereof) of work and the idleness taking place among I.A.R.T. fitness
clinicians (if still certified) and their clients. Never must you rest on your laurels, since once certified, the journey has
One problem may be lack of structure, but also too much structure can produce negative consequences. Without
sufficient structure, a clinician will proceed haphazardly without consistency. This does not mean standardizing what is
done for a client (e.g., same workouts over and over), but standardizing the procedures of how and when things are done
in daily operations, assessments, etc. On the other hand, being as clinical as possible can provide a sense of too much
structure, which frightens some personal trainers. In this instance, structure must be viewed as a means to remain
organized and accountable, which is what any of us would want from our doctors, mechanics, or accountants.
Clinicians with low-level skills will lack self-confidence, a feeling of incompetence, and will set limits in how they
work with clients. In this regard, attempting to create structure in their professional practices adds gasoline to the fire,
as it causes them to feel even more inadequate and incompetent.
The issue of competence is a major factor that permeates the fitness profession and one that frustrates those who are
competent and who are compared with those who know little about fitness prescription beyond a weekend course of
study. As stated, for some trainers the issue of competence brings about fear, whereas others it is a challenge toward
mastery of one’s profession. Some individuals have unusual determination and nothing will stand in their way, whereas
others often will ask “do I have what it takes to be a personal trainer?” There likely are several reasons why a person
does not feel confident in prescribing fitness.
Enhancing Clinical Fitness Skills 111
One reason (problem) is the quality of testing and educating. Similar to school, fitness examinations are limited largely
to multiple-choice challenges, whereby people learn that the correct answer is somewhere among four choices. Rather,
in the field, there could be several choices from which we must problem solve and select, and often we cannot be certain
if we are choosing the right or best course of action until it is implemented, and that can be scary to those who do not
like to take chances, no matter how educated the guess. The result is that people will keep quiet, pick the easiest
solution (even if it means lesser results), and rarely investigate and try alternatives (not only for reasons of fear, but
The second problem is that answers are not found in books, as if the truth can only be found within the vacuum of the
state of reference in which the facts are told. Throughout the I.A.R.T. materials we provide ways in which to think
about fitness, how to problem solve, etc., but with very few solutions. The reason being is that the best solution for any
person is relative to his or her individuality, needs, goals, constraints and limitations, all of which can change based on
the moment and dynamics of the client’s mind and body. Moreover, and after all, the best learning will come from
direct experience with clients and not from any teacher or book. The purpose of learning in school or through a fitness
certification program is to establish a base from which to apply one’s knowledge and understanding, whereas relevant
details can only surface through direct experience with a unique individual. Unfortunately, the base established through
most programs involves nothing more than memorized trivia.
The third quandary is that personal trainers feel incompetent as a result of the vagueness of the profession. People come
to us for solutions to their problems, whether dealing with obesity, injury, the wanting of more muscle, etc. However,
we still are not clear on the best way to address any of these issues, again because of the uniqueness of any individual,
but also the range of poor to mediocre tools at one’s disposal to measure change or lack thereof. And then each of us is
in competition with the latest book or television guru who really doesn’t know what they’re doing for the most part, but
who have sufficient charisma and confidence to pull it off. (In that regard, I have found the most successful fitness
professionals are those with the charm rather than the ability.)
The fourth problem is that you never will be good enough or feel good enough. When first starting on a career, personal
trainers cling onto the myth that some day, by studying hard, reading books, going to seminars, and working with
clients that they finally will know enough to feel competent. It won’t happen. No matter how much you know (and, in
fact, the more you know), the less competent you feel simply because you realize how much more there is to know.
And, of course, the more you know the more you realize how little you knew; therefore, how much more is there to
know that will affect your self confidence?
A fifth problem, associated with the fourth, is summed best by the saying ‘physician, heal thyself.’ As a result of
genetics, or not knowing ‘how,’ many personal trainers do not look the part (no thanks to all the steroid bodies that have
raised the bar in physical development to exaggerated extremes). Many do not take control of their own training as they
do with their clients; however, you know your body most intimately, and if you are constantly confused as to what
works best for yourself, then how good of a job are you doing with your clients? Most importantly, the inability, desire
or fear to experiment has held many fitness enthusiasts back, as they cling to biases and hypothetical arguments as to
why their program ‘should’ work best. But when a person does not appear to be in shape or athletic, then something is
amiss. I have worked with some people who have very poor genetics to develop the body, and still I give them
muscular shape and size, so that their exercise enthusiasm no longer remained in question. They may not be very large,
and never will be, but the shape and separation among their muscles make it evident that they exercise seriously. Often
the ability to produce change in these subjects was the result of regular experimentation, of changing and fine-tuning the
variables in order to play catch-up to their bodies’ highly resilient and adaptive natures.
112 Enhancing Clinical Fitness Skills
A sixth issue of competency is that personal trainers rarely see how they are, as opposed to what they do. When
working with a person, how you coach, motivate and relate to a client can be as important as what is done in and out of
the gym. It is the influence and interaction of your coaching and motivational skills that enable a client to sustain
intensity, a strict diet, and regular sessions. It is not always about the science of lifting, and what repetition scheme is
best, but the vigor you instill within each client’s psyche. If you do not feel good about your capabilities, this will
reflect in your coaching, thus suggesting the importance of self-confidence, whether communicating with a client or
taking educated chances with a different training protocol. However, most of us put too much emphasis on learning
new techniques or buying the latest and greatest fitness equipment, rather than developing and reshaping our
personalities and communication skills.
Finally, no matter what you do, some clients simply will not improve, or improve much. It is unrealistic to think you
can change everyone and do so significantly, although that is a common conception among rank personal trainers.
There are limits to what anyone can achieve, but the clients that do poorly for whatever reason(s) tend to stick out in the
clinician’s mind, and this can have an effect on confidence and evaluating one’s competency.
When you combine all these factors, what we have are a lot of self-doubts and fears of failure. This brings us to the
primary issue of fear; the most prevalent being not knowing what to do with a client. Personal trainers new to the
industry likely are most concerned about hurting people, and being reluctant to strive toward greater challenges as a
result of that fear. They don’t want to motivate or push clients too hard, or to try new exercises that may seem foreign
in the fear of causing an injury. It is the lack of understanding of proper exercise that holds a person back, and this
results in pretending to know more than you actually do, a façade you maintain particularly since your peers seem to be
more confident and knowledgeable. Such a predicament is common even among well-experienced fitness professionals
as they cling to the traditional or tried and true, as they keep quiet about how unprepared they feel. Fake it just long
enough to gain more experience so that you, one day, will feel like you know what you’re doing. You then begin
rationalizing any feelings of incompetence as a means of reassurance. After all, you know people far less capable and
they’re doing just fine.
The most challenging part is when you have to face a client who wants and needs your help and you are unclear as to
where to start or the long-term process of how to help. You have a general idea, but the details escape your knowledge
and understanding. You confirm your expertise and persuade the client that you can help, and in so doing you convince
yourself. And this is where we face a catch-22, in that you may be skilled sufficiently, or should be smart enough to
investigate assistance through other professionals or learning materials to determine how to proceed best with an
individual but, at the same time, we all lack skills to some degree and there always is something new to learn. One
merges into the other and this is what generates frustration.
As a personal trainer gains experience, eventually it no longer is an issue of faking it, but worrying about being caught
screwing up or looking incompetent. Whether it is during a session or shortly thereafter, you will think of several things
you should have done or said differently or better; you will begin second-guessing your actions. It usually only takes a
client to complain of a sore wrist or an aching back for a personal trainer to realize that what is being done may serve
more to aggravate or hurt a client than to make him or her more functional, although the problem may have been the
result of something outside the gym. The trainer then confirms to himself that he is not in control.
The trainer then wonders if he’s even doing anything worth the time, trouble and client investment (mentally,
physically, spiritually, and financially). This is not always within your control. Certainly each of us has to look closely
at a client and determine what is best or what can be tried to make change beyond the current state. If there is
something left to try, then you should consider trying it. However, as stated, not all clients can produce ‘remarkable’
change, and even when great change is possible, there still is a limit to what can be achieved. Other clients will lie and
deceive in regard to their activities and habits outside the gym; they will tell you what you want to hear or what they
think you want to hear.
Enhancing Clinical Fitness Skills 113
From the above discussion we can extrapolate an inevitable result… the fear of failure, of not being able to do enough;
or worse, doing the wrong thing. Clients come to you feeling helpless and overwhelmed, and as you probe deeper into
their psychology, habits, physical problems, you feel as helpless and overwhelmed as the clients. You believe there is a
‘right’ way to do personal training, but can’t seem to grasp it (nor does it exist). You perceive all the things you say and
do, believing that you are inept and inadequate. You feel guilty that you get paid for what you do, but fail to realize
your limitations and that what you do may not meet your expectations; which is a good thing since it means you want to
better yourself. Improving your professionalism through self-supervision is about becoming aware of things that could
be done better or differently; assessing the relative strengths and weaknesses of your coaching, implemented strategies,
and methods; and determining the impact that your work has on each client.
Being over-critical, however, can lead to a fear of mediocrity. Every personal trainer is in competition to some degree,
with other personal trainers, with television fitness gurus, and with the latest diet or exercise book. As a result, we make
comparisons of ourselves to others. Unfortunately, many personal trainers are inept and even dangerous in what they
recommend, and still they attract a following for reasons of personality and charisma, and those who can convince
clients they have been helped or are doing well when such may not be the case or nearly to the extent believed. In the
meantime, you struggle to hopefully, one day ‘make it.’ Worse yet, every time you see someone do or say something
you think you never could, it reinforces the fear of mediocrity, and you feel average or below average. And every time
you slip up, the fear grows even more until it becomes a reality.
Next level: A fear of your limitations grows. No matter how good you become, you never will do everything as you
would prefer. Errors will occur because you are not omniscient – you have weaknesses that will get in the way. The
best way to confront this fear is to take inventory (write it down!) of your most significant weaknesses as a fitness
clinician, e.g., consider what gets you in trouble most or prevents you from doing the best job possible, and what don’t
you do that well. It may not be specific to working with clients, but could be the quality or habit of report writing,
spending time learning new methods and investing in your education, etc. It could be a personality dilemma, such as
being impatient or abrupt when speaking to clients who are sensitive about their bodies. Now, what can you do about
any of these weaknesses… what are your options?
The irony is that in order to produce the best results for any client and with your client base as a whole, you must take
risks and experiment with new strategies and methods, whether in the gym or in problem-solving outside the gym. In
doing so, you and your clients are trying to reach beyond what has been done in the past, and this inevitably will result
in occasional failures. As the saying goes, however, the idea is to view failures as opportunities for further growth and
As stated, full competency can never happen; you always will have something new to learn and you will, now and
again, question your ability. Again, this is a good thing since a few butterflies in the stomach helps to keep us on edge
and more objective in our actions. What we should be looking for is a stage in development whereby the distress is
reduced to a tolerable level. This means abandoning the quest for the one correct answer or one perfect program that
will fit an individual or group of clients. Rather, at any particular moment, determine what is the best choice among the
possibilities available, even if this means reaching out beyond what was done in the past or what you have tried in the
past. In other words, there may not be any right answer, but a choice that is better than others at the time.
This process also may involve the client, whereby choices in strategy, exercise selection, etc., are presented and
discussed, with the client making the final decision. However, this must be limited to a client who has a grasp of what
has happened and could happen, since neophytes need your direction in what to do for obvious reasons of lack of
understanding and knowledge about fitness. Whether this is done or not, in the end we must recognize that alternatives
and choices must come from the needs of the client, and not from our own needs of how we want to prescribe fitness.
114 Enhancing Clinical Fitness Skills
In the Face of Adversity
Clients go through hardships, and this can affect fitness goals, outcomes and possibilities for change and prescription.
Likewise, a fitness clinician can experience abrupt or on-going adversity, such as divorce, a death in the family,
weddings, accidents and illnesses, and a multitude of other factors that will serve to challenge professional abilities.
However adverse, when things go wrong in your personal life, they need to stay in your professional life.
One of the most common instances of adversity is the strain of constant work. After all, we need to make money in
order to pay bills, and that often means avoiding vacation and down time. As stress builds over time, and the risk of
burn-out increases, a clinician may be apt to work even more to prove competence and that “the stress of work cannot
possibly be a match for my fortitude.” This is part of our culture, in that we must be seen always to be in control, rather
than vulnerable and needy.
Taking care of one’s self not only relates to the mental state of a person, but also the physical. I’m aware of several
fitness professionals who work such long hours that they have neither the time nor the energy to train hard, to produce a
healthy, developed body. And yet, they expect their clients to do just that. Eventually the clients look and feel better
than the trainer, which is a more serious problem than simply being ironic.
Whatever the problem that may arise to affect one’s professional conduct you need to ask yourself if loved ones or
clients are noticing your change in behavior or quality of services. If such is the case, then it’s time to take action in
separating personal problems from professional life, and possibly to seek appropriate help, whether through medical
intervention, taking a vacation, or whatever solution best fits the situation or problem. When something negative
happens in your personal life, and it will, there are various steps and suggestions to consider:
• Be realistic in your abilities and consider how much workload you can maintain.
• Based on your level of coping and the nature of your problem, it may be best to take time off, to limit your
caseload, or to refer new clients to another fitness professional.
• If you continue to handle the same workload through adverse times, be critical for your reasons. The problem
may not warrant a change in work conditions; however, it may serve as an escape to your problem, as a
financial motivator, or you could be underestimating your ability and denying the full extent of the problem.
• Use your personal life as a benchmark as to how your clients perceive you. If loved ones can see and
experience a change, then likely your clients have, too.
Lack of action may hide shame and fear, but it can result in a loss of clients. In some instances, and this must be
considered case-by-case, it may be necessary and prudent to disclose your situation in brief with clients, so that they can
understand any possible changes in your conduct or services, and temporarily be forgiving. Certainly this does not give
a clinician license to provide bad services indefinitely or for long periods, but that discloser clarifies that the problem
will be rectified as soon as possible. Clients will understand this, since they are aware you are only human, as are they.
The decision to disclose may be relative to the extent to which the adversity is affecting one’s job; and if the decision to
do so is made, the clinician will need to decide how much disclosure is too much.
In the end, you must be aggressive with self-care and listen closely to any feedback. Often a person cannot see the
problem clearly, and recommendations from loved ones or other health care professionals will reflect reality more than
how each of us perceive our needs. Consequently, accept the support of friends and loved ones, whether it’s to help in
meal preparation, running errands, or simply to spend time together. Being aggressive also means knowing how you
could be affected by adversity (e.g., taking on too much caseload) and doing what is necessary to remain within your
boundaries of tolerance (e.g., getting a flu shot to avoid downtime and transferring illness to clients).
Enhancing Clinical Fitness Skills 115
Every client deserves your utmost attention, both in regard to program design and motivational coaching. However,
training clients can become tedious and downright boring, i.e., aversion caused from a dislike from some aspect of an
experience. Some clients have the energy to keep trainers on their toes, whereas other clients complain, are lethargic,
and this can have an effect on how interested we become in working with such individuals. And if we become bored,
this can have an effect on the energy of our clients, which then affect us further.
Many other jobs offer a bit of mental respite, such as taking a washroom break when desired, grabbing a drink of water,
or even staring out the window and letting the mind drift momentarily. That is not the case always with fitness
instruction, since one’s job not only is to motivate, but to make certain there are no injuries, which means maintaining
very tight standards in mechanics at all times, whether the client is working out or stooping to pick up a barbell plate.
And this is required client after client, session after session of every week over the course of years. This can make
clinical fitness repetitive, monotonous, boring and sometimes overwhelming, as we look for distractions to redirect the
The key is to recognize when boredom sets in and to take steps in rectifying a problem that could have an effect on
client safety, results, and finances. This is necessary since if a person is bored, it means there is no intensity or tension
happening with the sessions to maintain interest and excitement… no peaking of curiosity to explore (doing the same
things over and over, e.g., ‘one size fits all exercise program’)… no discovered answers to problems… and no shared
sense of accomplishment between trainer and trainee. When any of these things are lost, it is a good sign and easy to
recognize that you are becoming bored and complacent. We need to look for these things since it is so easy to fall into a
despondent daily routine and not even know it, unless we compare the emotions and feelings with those at the opposite
end of the spectrum, i.e., if you’re not feeling excited to work with a client or any of your clients, then lack of
excitement and interest means boredom; and boredom means reduced quality of work.
Many things can cause us to become bored in this profession:
• There could be personality clashes between trainer and trainee;
• A client may have a laid-back attitude and show little excitement (and if the trainer has a boring life outside
work, then there is little stimulation at work);
• The atmosphere of the training center may be lackluster;
• When a trainer is stressed and allows outside problems or lack of sleep, etc., to be more important than the
• The inability to be creative (which could be a problem associated with the trainer’s personality or the
philosophy of gym management); and
• Feeling withdrawn when a client does not meet expectations.
The list could go on, but the reader gets the idea. However, let us look a bit more closely at a few of these points. The
clinicians in greatest danger of becoming bored are those who require or are in need of a high level of excitement and
mental stimulation and, on the opposite end, those who are excessive when it comes to safety, sameness, and
standardization. With a very excited personality type, few clients will be able to give back as much as the clinician can
give, and this makes the trainer bored. With those who become too ‘cold’ in their clinical methods, they create their
own boredom that eventually will have a trickle down effect to clients (besides limiting the results produced as clients’
bodies become too adapted to the same protocol). The ideal direction and environment is somewhere in the middle,
whereby there needs to be certain rules of operation in place, to standardize how we function in order to remain
organized and objective, but at the same time we need to experiment and research with our clients, in order to pose new
challenges to maintain motivation and, hopefully, to discover new things about individual response.
116 Enhancing Clinical Fitness Skills
The latter point must be controlled appropriately, since only the most experienced fitness clinician will be able to alter
and adjust an exercise environment significantly with seemingly random abandonment or chaos, and still be able to
track and decipher responses. The problem is, if the clinician is not well experienced, skilled or creative, then change
comes much slower to clients and this can create boredom and frustration for both parties. And those who are not
creative in general tend to be anxious, rigid, lack spontaneity, and are over-reliant on conventional attitudes and beliefs,
all of which are predictors of boredom. They become complacent and predictable in what they do and how they do it.
In some instances we have little choice but to remain limited in how we apply exercise, because of the limitations and
very specific needs of a client (rehabilitation falls under this umbrella). Such situations limit a clinician’s opportunities
to reach out and try new things, which can limit learning new things, and boredom sets in. Too much mundane
paperwork can have a similar effect, which is why client case study reporting can become wearisome if not done
properly7. And because we have limited time to introduce new facets to our jobs, since certain things need to be done
daily, we are restricted further as to how exciting we can make fitness instruction and still pay the bills.
One solution of many problems associated with boredom on the job is to learn to appreciate and enjoy the people with
whom you are working. This does not mean we should get involved in their personal lives, but to share information on
fitness and nutrition, discuss aspects of hobbies each of you have, etc., examples that can have a positive influence on
how you communicate and respond to each other. Furthermore, your frame of reference is vital. If you reflect on how
important your job is, as the lives of your clients are changed, your attitude and interest will change significantly.
And if the relationship is open enough, and you understand your client’s needs sufficiently, become active with the
client. Introduce different exercises, equipment, techniques, and routines in which the client can participate in the
decision-making process. In that regard, you work as a team, rather than merely ‘follow the leader.’ Another way to
elicit client involvement is to have the person complete questionnaires, quizzes or other types of ‘homework’ to provide
more structure, information for analysis, and stimulus for thought and discussion.
As important, you need to have social relationships with people, hobbies, and interests not affiliated with fitness. This
could be stamp collecting, painting, playing a musical instrument, going to the movies or out for dinner, or any number
of hundreds of other activities. Breaking yourself away from your profession can provide renewed vigor when
returning to the job. Moreover, having interests in areas outside fitness can increase your knowledge and understanding
of fitness, as Arthur Jones, inventor of Nautilus and MedX machines can attest. Although he had a passion for exercise
years before selling Nautilus machines, his background in general mechanics, interest in animals and flying, and
experience in operating businesses all integrated to create examples and analogies when he wrote or thought about
If you begin to feel bored, whether you still want to be a fitness clinician or not, then you have to ask yourself some
important key questions:
1. What would you rather be doing if not fitness instruction and prescription? If you enjoy doing your job for the
most part, then read further.
2. Do you need to change your venue (e.g., a different gym, laying out the gym differently, etc.), or perhaps
redecorate with visually stimulating photos and decor?
3. Do you want to work with a different type of client (e.g., rehab vs. weight loss vs. athletes), or perhaps more
Once you do a case study for a rehab, weight loss, bodybuilding, competitive athlete client, etc., save each as a file template and use
the general format and basic information and then fill in the blanks regarding the specifics of the client. Starting from scratch each
time is both time consuming and, in the very real sense, boring and unnecessary; however, developing reports and detailing your
actions and assessments can provide some very challenging and exciting tasks that are over and above simple coaching and
Enhancing Clinical Fitness Skills 117
4. In what way can you change what you’re doing to make it more exciting, whether speaking of a particular
client (e.g., change in equipment or exercise approach) or all clients in general (e.g., outdoors boot camp
training vs. HIT circuits on machines)?
5. How have you educated yourself and expanded your fitness vision in the past few years? For example, even if
you find a particular exercise method of little value, dangerous, or pointless, learning new ways to do things
sharpens your critical thinking skills and even may provide a few helpful tips when least expected.
6. Do you need to take a vacation, longer lunches, or have a reduced client load in order to have more time for
yourself? If so, how must you budget and re-organize your personal life to pay for what you need and/or want?
‘Clinician, Heal Thy Self’ Revisited
It seems reasonable that if so many people are helped by fitness professionals that the professionals should be able to do
equal or better work with themselves (since it is easier to know and understand one’s body and mind better than that of
another person). However, fitness professionals are like anyone else, in that they can become overwhelmed with
problems to be solved when trying to develop and change their bodies. The dilemma is because we are expected to be
experts, and to look the part, there can arise a situation of over-analysis, to the point that we become frustrated with
anxiety to be ‘the best.’ This not only refers to what we do with our bodies, but how effective we are in helping others.
And it can be equally frustrating when clients make good changes and yet we do not.
That latter aspect can be multi-faceted. Perhaps a person has very average or below average genetics. Perhaps a person
has trained for so long and developed so much that further change is near impossible. Perhaps it is easier to look into
the minds and bodies of others and to problem-solve than to self-analyze situations. If that is the case, then the fitness
professional needs to investigate the services of a peer, which relationship rarely seems to occur because of the nature of
the ego and pride in the physical fitness industry, stemming all the way back to “how much can you bench press,” to lies
about one’s arm measurements. Others take on so many clients that time is not scheduled for a workout. Ironically, this
is what we condemn our clients for when they claim they are too busy to exercise or to eat properly.
You need to ask: “how can I help myself?” “Can I help myself by those same means that I help my clients?” And if
what you preach is not helpful to you, how helpful is it to your clients in regard to optimizing their bodies? Everyone
has different needs, but your application and strategies should be equally as effective for your individuality as it is for
118 Enhancing Clinical Fitness Skills