When Should A Personal Trainer Refer Clients To Another Professional?

The question ‘when should a personal trainer refer clients to another professional?’ is difficult to answer. As a PT, your clients' wellbeing is paramount and, in some cases, a referral is a necessity.

In this article, we’ll explain how and when personal trainers should refer clients to another professional, and provide you with example scenarios to follow.

But first, if you’d like to advance your own personal training career, check out OriGym’s range of specialist Level 5 courses. Through enrolment, you could develop a sought-after specialism, supporting clients in areas such as Advanced Nutrition and Diabetes Management.

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When Should You Refer Clients to Another Professional as a Personal Trainer? 

In this section, we’re going to run through 9 hypothetical scenarios where you should refer your client to another professional, such as:

• Medical professionals 
• Specialist dieticians 
• Strength and conditioning coaches 

As a golden rule, we recommend that these referrals should occur as soon as you have any concerns regarding a client's safety and wellbeing, or if they require something that falls out of your jurisdiction.

#1 - As A Direct Response To A PAR-Q Form

If you selected this article in the hopes of learning when personal trainers should refer clients to another professional, this process can begin with the distribution of a PAR-Q form.

PAR-Q stands for Physical Activity Readiness Questionnaire and is used to ensure that clients are in good physical health prior to the start of their exercise programme. 

You should hand these forms out as part of a personal training consultation session, as this will provide immediate insight into a client's health, prior to any commitments being made. 

These questions relate directly to the client’s current health, and any recurring family medical issues. To understand what this PAR-Q form should look like, check out the example we’ve created below:

Here we can clearly see that clients are given multiple questions relating to their overall physical health, alongside a section where they can elaborate on their answers

Following this, there are two separate sign up options one for clients who check no boxes, and those who have selected yes to one or more of the proposed questions:

As evident from the ‘If Answered No’ section, clients will be deemed low-risk and can therefore immediately begin their personal training programme.

However, if they answered yes to one or more of the questions on the PAR-Q, they are clearly advised to consult a physician prior to signing up for training. 

Depending upon their condition, they may have to see specific professionals. For example, those with cardiac issues will need to see a cardiologist, or those with serious joint issues will be referred to an orthopaedic surgeon.

#2 - When A Client Has Injuries That Exercise Could Aggravate Or Worsen 

This is a fairly straightforward example, but if there are any existing injuries or medical conditions that will prevent personal trainers from working with a client, then a referral should be made to assess their health and wellbeing. 

Injuries like this can include:

• Severe lower back pain
• Stress fractures 
• Achilles tendonitis 
• Hamstring strains
• Knee injuries (such as Patellofemoral Pain Syndrome)

If any of these injuries are recurring, then the client should note them down on their PAR-Q form, and you should keep note of them in your personal training software. 

According to the HSE, if someone is suffering from a sprain or strain of any kind, you should stop exercise immediately, and follow these recommended guidelines:

Exercising on a strain or sprain can lead to an aggravated injury, and if a client is reporting continuous pain, it’s your responsibility to cease all training until they have been cleared by a medical professional or doctor.

Following this referral, the client will be able to receive an examination from a professional, who can then decide on the appropriate treatment program

Making this referral is essential for the health and safety of your client. For example, if they suffer from an ankle sprain that becomes aggravated through exercise, this could result in:

• Chronic pain
• Instability 
• Swelling 
• Arthritis

In severe cases, an untreated ankle sprain could even result in ligaments becoming stretched, leading to prolonged stability issues.

Therefore, if a client is continuously reporting discomfort throughout or after this time period, we’d advise you to begin the referral process. 

This recommendation can be made in two ways. You could make the referral on the client's behalf, in which case you will be responsible for booking the initial appointment and relaying the appropriate information to the client.

Alternatively, you can discuss the injury with the client personally, and stress that you believe it’s in their best interest to receive a medical examination before continuing with their sessions.

#3 - If A Client Is At Serious Risk Of Cardiovascular Disease 

According to Laya Health Care, over 10,000 people die from cardiovascular disease in Ireland every year.

Cardiovascular disease can describe a range of conditions including:

• Blood vessel disease 
• Heart defects that you’re born with
• Heart rhythm issues
• Heart valve disease
• Heart infections

If left untreated, these issues can cause heart attacks and strokes, so it's crucial to ensure a client receives the correct form of assessment from a medical professional, followed by the appropriate treatment. 

As always, when looking to explain how and when personal trainers should refer clients to another professional, this process should occur as soon as possible. 

The faster clients receive an appropriate diagnosis, the sooner you can work towards creating a beneficial training programme.

Some clients may be aware that they are at higher risk of developing CVD through hereditary conditions, which they should mention on the PAR-Q form. 

However, this does not mean that everyone is in the same boat, and as a PT you should be aware of some of the early symptoms in order to spot them in your clients. These include: 

• Chest pains
• Shortness of breath 
• Pain throughout the body
• Feeling faint
• Recurring nausea

Should you notice these symptoms occur within your clients, be sure to have a discussion with them in order to share that you believe they may be at risk of developing CVD. 

At this point, all training should cease until a proper medical assessment can be made.

Following this, you can either set up an appointment with a cardiologist on their behalf or strongly advise them to do it on their own accord. 

Upon completing this referral, you may need to make necessary adjustments to a client’s workout programme to ensure that they’re not exerting their heart too much.

However, if a healthcare professional determines that regular training would be too strenuous on a client’s heart, they’ll be recommended to train under the instruction of a qualified Exercise Referral Specialist, rather than a personal trainer.

#4 - If A Client Finds Out That They’re Pregnant 

Whilst discussing medical conditions that will prevent personal trainers from working with a client, not every circumstance will be pre-existing.

Instead, clients may discover that they’re pregnant over the course of their training, which will prompt a brief pause in their workout programme, until they receive medical clearance. 

In this instance, you should make an immediate referral to an obstetrician or maternity team, in order to determine whether their pregnancy is high-risk. 

Please note that it is very much possible to train pregnant clients, and the HSE recommends that all those who were active prior to pregnancy should remain active.  

The HSE goes on to say:

If you were active before becoming pregnant, keep up your normal exercise routine for as long as you're comfortable. Slow down as your pregnancy progresses.

Should the obstetrician determine that it’s unsafe for a client to continue working out, then naturally all training sessions should be immediately halted. 

However, if the pregnancy is deemed safe, then the programme can continue with a few necessary amendments. 

This will all be determined through the completion of a PARmedX, a required form that acts in a similar fashion to a PAR-Q. This is simply used to evaluate whether a pregnant client can safely engage with physical activity. 

An example of this can be seen below, created by the Canadian Society of Exercise Physiology:

Note, as a PT you cannot distribute a PARmedX form - this should only be done by a medical professional only!

Furthermore, even if clients do receive medical clearance from the PARmedX the work doesn’t stop there, as you can’t continue the regularly scheduled workout programme.

Amendments will need to be put in place to take the client’s condition into account. For example, it’s strongly advised that pregnant clients avoid:

• Laying flat on their backs for prolonged periods, due to the fact that the bump will pass the main blood vessel bringing blood back to the heart. 
• Exercises that involve them getting hit - Kickboxing, wrestling, rugby, etc.
• Hiking/Walking/Running above 2,500m sea level - Both expecting parent and baby are at risk of altitude sickness.

As a trainer, you also want to ensure that clients remain safe and comfortable throughout the course of their pregnancy.  

As such, their bespoke exercise programme can (and should) be adapted several times to ensure the safety of both parent and unborn child.

#5 - If You Wish to Work With Older Clients 

The answer to the question ‘when should a personal trainer refer clients to another professional?’, can also be influenced by the age of the client.

For example, if you wish to specialise in personal training for older clients, you will need to make routine referrals in order to assess the health and wellbeing of said customers.

When we use the term ‘older’, we are referring to clients who are over the age of 65, as this is the point that individuals receive geriatric healthcare.

Now, please be aware that, despite many misconceptions surrounding this topic, older clients can still exercise. In fact, the HSE recommends those over 65 should:

• Get at 150 minutes of moderate aerobic activity every week such as walking, dancing or even pushing a lawnmower
• Perform muscle-strengthening exercises 2 or more days a week — for example, digging, step aerobics, hand-held weight exercises and yoga
• Take part in daily chores such as cooking or housework to break up periods of sitting

Wondering when a personal trainer should refer clients to another professional based on age? The answer is simply to refer to them prior to the commencement of the training programme, following an initial consultation.

As with many other examples on this list, you should refer said individuals to a medical professional who will assess their health and fitness, in order to determine their existing physical capacity. 

This process helps medical professionals to determine the intensity at which older clients should be exercising at. The HSE's advice on this are simple, and laid out in this leaflet for older clients:

The reason why this needs to take place prior to the commencement of the exercise programme is that it provides you with an opportunity to craft a workout routine that is specific to that client.

For example, if you know that an elderly client can't exercise at a high intensity, you can craft a plan filled with light to moderate workouts. 

Should you ignore this referral process, an elderly client could overexert themselves and become injured during the workout programme. Therefore, you should make an effort to stress the importance of this referral. 

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Support your expertise, and learn more with these 3 related articles:

• The Pros and Cons of Being a Personal Trainer
• Top Personal Trainer Specialities for 2022
• 9 Tips for Training Disabled Clients

#6 - Based On Client’s Personal Preference Or Doubts About Their Own Health

While medical conditions are hugely important in the referral process, the opinion of your client should hold the same weight as your own. 

This means that, if they personally believe they need medical advice/attention, then you should encourage them to receive it. 

For example, a client who intends on training for a marathon may state they’d like to see a doctor in regards to chronic knee pain.

Should you ignore or disagree with this request, the client’s injury could become aggravated even further due to the high-impact nature of long-distance running, resulting in torn ligaments or tendon tears.

In this instance you may need to use your own judgement to determine whether you’d personally recommend a medical referral, or whether the injury is minor enough to receive alternative forms of home treatment such as:

• Rest - Taking longer rest periods and avoiding using said body part
• Ice - Applying ice to the injured area
• Compression - Wrap bandages around the injured area for support 
• Elevation - Keep the injured area raised on an elevated surface such as a pillow 

However, in the instance that you deem your client’s injury to be severe, you should agree with their request and encourage them to receive medical attention immediately. Severe cases of chronic knee pain can result in:

• Swelling on the knee
• Being unable to put weight on their knee
• Hearing or feeling a ‘pop’ when you bend your knees
• A continuous feeling of buckling or instability 

Determining when you should refer clients to another professional as a personal trainer is difficult, especially in this instance. 

However, remember that your clients know their own bodies better than anyone else, and if they feel that something is wrong, you should typically agree with them. 

For this reason, you should encourage them to make the referral of their own accord. That way, they can describe exactly what pain they’re experiencing to the appropriate medical professional, who will then be able to determine an appropriate course of action.

In order to assess how clients are feeling at all times, we would encourage personal trainers to develop their communication skills, in order to create a friendly working environment that encourages conversation and open dialogue.

#7 - If A Client Wants to Receive Specialised Dietary Advice

As a qualified personal trainer, you can provide nutritional advice to anyone you wish, but this will merely act as a suggestion rather than a piece of concrete guidance for clients to follow. This means that Level 4 Personal Trainers cannot give prescriptive nutritional advice or develop bespoke meal plans for individuals. 

Here’s what REPs (now known as CIMSPA) have to say about the matter:

PTs should only provide general advice on healthy eating, rather than give specific, prescriptive advice. If PTs start giving nutrition advice to alleviate real or suspected medical conditions, then they are operating outside of their professional boundaries and may find themselves in trouble if problems with clients occur.

As such, if a personal trainer is ever giving nutritional advice to their clients, they should stress the following phrases:

• I Recommend...
• I Advise...
• I Suggest...
• I Propose...
• I Endorse...
• I Urge…

In order to explain how and when personal trainers should refer clients to another professional for dietary advice, we need to discuss the different roles of dietitians and nutritionists.

The main difference between dietitians and nutritionists is that dieticians can prescribe diet plans for clients with specific needs or medical conditions.

Dietitians generally have extensive training in higher education, which is what qualifies them to work and treat clients suffering from such issues.

This is why dieticians can prescribe diet and meals, rather than having to phrase it as general advice (like a PT or nutritionist would).

For example, a client who suffers from high cholesterol may wish to pair their bespoke exercise routine with a diet that is low in the likes of sodium and saturated fats. 

In this instance, the client and trainer can work together to find a dietitian in a hospital or GP setting that specialises in the treatment and management of high cholesterol. 

Without specialist dietary advice to accompany a tailored workout programme, clients may fail to achieve their end goals, whereas others could see their medical conditions worsening due to repeated consumption of harmful foods.

#8 - If A Client Is Engaging in Extreme or Harmful Eating Habits 

According to the health organisation The Priory Group, over 3.4 million people in the UK and Ireland suffer from eating disorders of varying intensities.  

Some clients won’t even be aware that they are engaging in harmful eating habits, but these can include:

• Over- or undereating 
• Skipping meals 
• Removing or limiting specific food groups 

As a personal trainer, you should try to observe a client's eating habits whenever possible. This can be done through simple conversations about what foods they are eating, or by asking them to keep a food diary. 

Should you believe that they are engaging in harmful eating patterns, you should intervene and have a discrete discussion about referring them to a dietician who specialises in this area. 

This may not be an easy conversation to have, so approaching this referral from a place of sensitivity is an absolute must.

If you have no experience dealing with dangerous eating patterns, then this referral process should not be rushed.

Prior to this conversation taking place, you need to take time to do research into said patterns, before determining how harmful it could potentially be for the client. 

If you are still struggling to obtain the proper resources or information required to assist your client, you could contact a dietitian yourself and ask for their professional opinion on the matter. 

This conversation will provide you with vital information that could have otherwise been overlooked.

Following this research process, you can then begin to have a conversation with the client regarding their matter, before finally making the referral to the dietitian. 

Remember, you don’t want a client to feel intimidated or hurt by the suggestion of this referral. If they are suffering from any kind of eating disorder, a lack of sensitivity and care on your behalf could result in negative consequences for the client.

Furthermore, during this referral process, you should stress to a client that a professional medical dietitian will be able to assist with these eating patterns in a more effective way than you can as a PT.

You can assist in this process by:

• Encouraging clients to fuel their body correctly, with the likes of complex carbohydrates and 3.7 litres of liquid every day
• Stressing the negative consequences of fad diets and food restrictions 
• Conducting research into how various eating disorders and disordered eating presents itself 

But please keep in mind that the referral to a medical professional is for the benefit of your client’s health. 

Without the proper care and support, these dangerous habits could prompt medical conditions that could prevent personal trainers from working with a client. Anyone looking to read further into this topic can check out article on offering personal training to clients with eating disorders.

#9 - Client Requires a Higher Level of Training Than You Can Provide 

Finally, as a personal trainer, you can only do so much for your clients, as you will naturally have your own limitations and capabilities as an athlete. 

At some point in time, you may work with a client who exceeds even your expertise, and as a result, you may need to make a referral to another professional who can assist them in reaching the next level of their athletic career.

But when should you refer clients to another professional as a personal trainer? 

A client could potentially come to you with a request of wishing to pursue a specific sport professionally. 

In this instance, you would refer them to a strength and conditioning coach, who can support them through this process.

Strength and conditioning coaches specialises in working with professional athletes, with the primary goal of developing:

• Speed 
• Strength 
• Endurance 
• Agility
• Power 

All of which will enhance an athlete's performance in a specific sport. From this referral, a client will be able to professionally pursue their desired sport. 

Often, this is a positive reflection on your as a PT - clients will appreciate this referral, as you are helping in their professional and personal development. 

If you fail to provide this, clients may become bored of your training, viewing it as regressive, and leaving your practice of their own accord. In worst-case scenarios, you could personally overexert yourself trying to keep up with the client, resulting in an injury of your own.  

To make this referral successful, you can help your clients make industry connections with strength and conditioning coaches. 

In this instance, you will have to vouch for said client’s capabilities and skills, ensuring the specialist coach that they are ready for this niche training. 

Alternatively, you can help said client conduct research into their chosen sport, assisting them in finding a specialist coach or training facility. 

Whilst it's never easy watching a client move on and train somewhere else, this referral process will only better your image and reputation within the wider industry. 

In exchange for this referral, the client could spread how beneficial your training was in their fitness journey to other athletes and trainers alike. This will help to attract new customers to your personal training business, as it spreads a positive message through word of mouth.

What Should You Do If Your Clients Ignore Your Advice? 

Throughout this article, we have explained how and when personal trainers should refer clients to another professional and have done so by presenting 9 hypothetical situations in which you may have to intervene.

However, just because you make these referrals does not mean that clients will automatically follow your recommendations.

Some may choose to ignore the service you have recommended, but still, wish to continue training under your supervision. 

In this instance, you can always refuse to train a client altogether if you believe they are in serious danger of hurting themselves. 

Be sure to explain your reasoning behind this decision carefully, once again stressing the importance and severity of the referral. If they continue to resist this advice, politely let them know that you can no longer train them.

Regardless of the advice that your client ignores, you should always protect yourself with personal trainer insurance. 

The following policies should protect you in any of the following incidents:

• Public liability and professional indemnity - If a client is injured and brings your training into question
• Personal accident - If you are personally injured during a training session 
• Loss of earnings - If you are unable to train for prolonged periods and can therefore not make money from your clients
• Loss, theft or damaged equipment - Protects your property, ensuring you have the finances to replace things should any of the three situations take place

You can receive quotes from sites such as Hiscox who cater to those in the fitness industry.

Better yet, you can specifically pay for the coverage your business needs, meaning that you won’t have to pay additional fees for services you don’t require.

We strongly encourage you to get personal trainer insurance. Without it, you could be held accountable for a client’s poor health, resulting in fines, a loss of earnings, and potentially even the closure of your business.

Before You Go!

This article has dissected the question ‘when should a personal trainer refer clients to another professional’ and has posed various hypothetical scenarios to support our claims.

As a PT you are responsible for the health and safety of your clients, and everything you do in such a role should be in their best interest. As such, you should always strive to refer them to an appropriate specialist who will be able to provide them with the appropriate care.

Remember, enrolling in one of OriGym’s specialist Level 5 PT courses can help to advance your career allowing you to work with and assist multiple different types of clients. 

You can also check out our free prospectus to view all of the courses we have to offer.