ACE Personal Trainer Manual 5 th Edition Chapter 6: Building Rapport and the Initial Investigation Stage Lesson 6.1.

ACE Personal Trainer Manual 5th Edition

Chapter 6: Building Rapport and the Initial Investigation StageLesson 6.1

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• After completing this session, you will be able to: List and discuss the components of a successful

rapport-building client interview Demonstrate the components of the transtheoretical

model of behavioral change and motivational interviewing

Assess clients’ readiness to change, utilizing motivational interviewing

Understand the purpose and process of health-risk appraisal, including ACSM risk factor stratification

Utilize the different types of evaluation forms used by personal trainers

Identify health conditions that affect physical activity (cardiovascular, respiratory, musculoskeletal, metabolic, and others)

LEARNING OBJECTIVES

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• Additional attributes to a successful client–trainer relationship: Empathy – experiencing another

person’s world as if it were one’s own Warmth – unconditional positive

regard for another person Genuineness – authenticity, or the

ability to be honest and open • Trainers must also distinguish between

verbal messages that reflect cognitive and affective content of the communication: Cognitive messages are more factual Affective messages are composed of

feelings, emotions, and behaviors

BUILDING RAPPORT DURING THE CLIENT INTERVIEW

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• Listening effectively is the primary nonverbal communication skill and occurs at different levels: Indifferent listening: A person is

not really listening and is tuned out

Selective listening: A person listens only to key words

Passive listening: A person gives the impression of listening by using minimal noncommittal agreements (e.g., head nods or “uh huhs”)

Active listening: A person shows empathy and listens as if he or she is in the speaker’s shoes

BUILDING RAPPORT DURING THE CLIENT INTERVIEW

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• It is important to use a variety of interviewing techniques to understand a client’s message, such as: Probing: Asking additional

questions in an attempt to gather more information

Clarifying: Verifying an understanding of the content of the client’s communication

Informing: Expanding upon shared information with facts

Questioning: Directing both open-ended and closed-ended questions to a client

INTERVIEWING TECHNIQUES

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• Personal trainers should also select a communication style that matches the client’s needs and personality style, and the situation:An educating style is informational,

providing relevant information in a concise manner.

A counseling style is supportive, utilizing a collaborative effort to problem-solve.

A directing style is more instructive, in that the trainer provides instructions and direction.

INTERVIEWING TECHNIQUES

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Finding out as much information as possible about each client’s lifestyle, habits, and physical-activity history will facilitate the program-design process.

Sample questions:•Tell me about a typical week in your life. •What types of physical activities are part of your daily routine?•Do you participate in consistent business activities, such as travel or entertaining, that extend the hours of your workday or week? •How do you spend your time away from work? •When was the last time you engaged in an outdoor activity, such as walking or bicycling? Was it a leisurely pace or a vigorous intensity?

ASKING THE RIGHT PRE-EXERCISE INTERVIEW QUESTIONS

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• Once a trainer has developed a foundation of rapport, the next step is identifying the client’s readiness to change behavior and stage of change.

• Motivational interviewing helps: Determine the client’s level of readiness,

or current stage of change The client learn more about the reasons

for change The client participate in the behavioral

change process

FACILITATING CHANGE AND MOTIVATIONAL INTERVIEWING

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READINESS TO CHANGE QUESTIONNAIRE

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THE HEALTH-RISK APPRAISAL

• While moderate levels of physical activity promote numerous benefits, there is an increased risk for those individuals who are: Unhealthy Have an existing disease At risk for disease

• Pre-participation screening includes identifying: The presence or absence of known disease Signs or symptoms suggestive of disease Medical contraindications At-risk individuals who should first undergo

medical evaluation Those with medical conditions who should

participate in medically supervised programs

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THE HEALTH-RISK APPRAISAL

• The Physical Activity Readiness Questionnaire (PAR-Q) is a minimal, safe pre-exercise screening measure for low-to-moderate training: A minimal health-risk appraisal prerequisite Quick, easy, and non-invasive to administer Limited by its lack of detail and may overlook

important health conditions, medications, and past injuries

• The process for health-risk appraisal: Review the client’s health information,

medical history, and lifestyle habits Risk stratification Need for medical examination/clearance or

supervision Recommendations for lifestyle modification Strategies for exercise testing and

programming

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RISK STRATIFICATION

• Risk-stratification determines the presence or absence of: Known cardiovascular,

pulmonary, and/or metabolic disease

Cardiovascular risk factors Signs or symptoms suggestive of

cardiovascular, pulmonary, and/or metabolic disease

• Risk-stratification is categorized as: Low Medium High

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ACSM RISK-FACTOR STRATIFICATION

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RISK STRATIFICATION EXAMPLE

Joe is a 49-year-old male who stands 5’11” (1.8 m) and weighs 240 pounds (109 kg). He currently smokes one pack of cigarettes a day and indicates no history of regular physical activity over the past 10 years. He also has a sedentary occupation and travels frequently for work. His latest physical examination revealed the following information:•Blood pressure (repeated twice): 136/88 mm/Hg•Total cholesterol 208 mg/dL; HDL cholesterol: 41 mg/dL; low-density lipoprotein (LDL) cholesterol: 134 mg/dL•No medications•Fasting blood glucose (last medical exam): 98 mg/dL•Family history:

Father diagnosed with CAD at age 62 Mother diagnosed with type 2 diabetes at age 50

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EVALUATION FORMS

• Informed consent: The client acknowledges having

been informed about the risks associated with activity

Discloses the purposes, procedures, risks, and benefits associated with the assessments

• Agreement and release of liability: Releases a personal trainer from

liability for injuries resulting from a supervised exercise program

Represents a client’s voluntary abandonment of the right to file suit

Does not necessarily protect the trainer from being sued for negligence

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EVALUATION FORMS

• Health-history questionnaire:Past and present exercise and

physical-activity informationMedications and supplements Recent or current illnesses or

injuries, and chronic or acute pain

Surgery and injury historyFamily medical historyLifestyle information (related to

nutrition, stress, work, sleep, etc.)

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EVALUATION FORMS

• Exercise history and attitude questionnaire: The client’s previous exercise history and

behavioral and adherence experience• Medical release:

The client’s medical information Explains physical-activity limitations

and/or guidelines as outlined by the physician

Deviation from these guidelines must be approved by the physician

• Testing forms: Used for recording testing and

measurement data during the fitness assessment

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HEALTH CONDITIONS THAT AFFECT PHYSICAL ACTIVITY

• Injuries related to physical activity usually come from: Aggravating an existing condition

(either known or unknown by the client)

Precipitating a new condition• The cardiovascular, respiratory, and

musculoskeletal systems all experience stress during physical activity.

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CARDIOVASCULAR DISEASE

• Atherosclerosis: Accumulation of fatty cholesterol and calcium deposits on artery walls causing

hardening, thickening, and loss of elasticity When this process affects the arteries that supply the heart, it is called coronary

artery disease (CAD).• Myocardial infarction or heart attack:

May result from atherosclerosis when the blood supply is limited and the increased oxygen demand cannot be met

• Angina: May also result from atherosclerosis Described as pressure or tightness in the chest, arm, shoulder, or jaw May be accompanied by shortness of breath, sweating, nausea, and palpitations

• Coronary artery disease: A history of CAD or chest pain should have a physician’s release Many people with CAD have no known symptoms.

• Hypertension: Prevalent among elderly and African-American individuals The risk of CAD, stroke, and kidney disease increases with higher levels of systolic

and diastolic blood pressure.

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RESPIRATORY SYSTEM DISORDERS

• Respiratory system disorders will interfere with the body’s ability to provide enough oxygen for the increasing demand that occurs during aerobic exercise: Bronchitis Asthma Chronic obstructive pulmonary disease

(COPD) • Any client with a respiratory disorder

should have physician’s clearance: These conditions may result in dyspnea. Regular exercise may aggravate the

condition for some people. Conversely, exercise may improve it.

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MUSCULOSKELETAL DISORDERS

• Clients should be referred to an appropriate healthcare professional and have a physician’s clearance to exercise if they suffer from issues such as: Minor sprains and/or strains Runner’s knee/swimmer’s shoulder/tennis

elbow Iliotibial band syndrome (ITBS) or shin splints Spine disorders, such as herniated discs Bursitis Tendinitis Arthritis Significant muscle weakness or joint laxity Recent orthopedic surgery, and any disuse

atrophy

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METABOLIC DISORDERS

• Diabetes: A client’s situation and exercise program should be discussed

with his or her physician before working with a personal trainer. Requires physician approval before starting an exercise program,

especially if receiving insulin• Thyroid disorders:

Hyperthyroid individuals have an increased level of thyroid hormones and a higher metabolic rate.

Those with hypothyroidism have a reduced level of hormones and require thyroid medication to regulate their metabolism.

Require physician approval before starting an exercise program

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OTHER CONDITIONS

• Hernia: A protrusion of the abdominal contents into the groin or through the

abdominal wall May be further aggravated by the Valsalva maneuver Is a relative contraindication for resistance training unless cleared by a

physician• Pregnancy:

Important to maintain a good fitness level, instead of maximum fitness goals

A client should have physician’s approval until three months after delivery.• Illness or infection:

A recent history may impair a client’s ability to exercise. Moderate exercise may be appropriate during a mild illness. Generally not advisable to start a new exercise program during an illness

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SUMMARY

• Personal training is about behavioral change, which is the true measure of a successful client–trainer relationship.

• Perhaps the most crucial factor for determining a positive climate for the working relationship is the trainer’s repertoire of communication skills.

• By determining the client’s needs and desires, personal trainers can appropriately respond at various stages of the client’s readiness to change.

• It is important to conduct a thorough health-risk assessment utilizing appropriate health-risk appraisals and risk stratifications.