Olivia A. Gallucci

In a society where nearly ⅔ of adults are overweight and not physically active enough, and where youth may have shorter lifespans than their parents, the role and scope of practice of personal trainers has never been more important. 

This blog post contains my notes for chapter 1 of the American Council on Exercise (ACE) Certified Personal Trainer (CPT) exam. 

All content in this post should be attributed to ACE and the research cited in Chapter 1.

American Council on Exercise. (2020). Role and scope of practice for personal trainers. In The exercise professional’s guide to personal training study companion (pp. 2-23). 

Further reading: ACE Chapter 1 Lesson Summary. 

Personal training careers

• CPTs have diverse career opportunities
  • Full or part-time trainers, fitness directors, teachers, business owners, or contractors.
  • Work settings may include virtual, face-to-face, or hybrid environments.
• CPTs aim to:
  • Enhance individuals’ fitness levels.
  • Reduce disease risk factors.
  • Improve overall health through tailored physical activity programs.

Future of personal training

• U.S. Department of Labor
  • Federal agency 
  • Oversees labor laws, workplace safety, and employment standards
  • Ensures fair treatment and working conditions for American workers.
• Bureau of Labor Statistics
  • Unit of the U.S. Department of Labor
  • Collects and analyzes economic data related to employment, wages, and inflation.
  • Role of Personal Fitness Trainers (BLS, 2018)
    • Design and implement
      • Create workout routines tailored to clients’ needs.
    • Client types
      • Individual clients or group classes.
    • Sales
      • Often sell training sessions to gym members.
    • Evaluation
      • Assess clients’ current fitness level, personal goals, and skills.
    • Program development
      • Develop personalized training programs.
    • Monitoring
      • Track and monitor clients’ progress.

Job projection 

The employment of fitness trainers and instructors is anticipated to grow by 10% between 2016 and 2026.

This rate of growth is faster than the average growth rate of 7% for all occupations, driven by several factors, including:

• Businesses and insurers encouraging employee physical activity.
• Ongoing emphasis on physical activity to enhance health and fight obesity.
• Active baby boomers aiming to prevent injuries, illness, and chronic disease.
• Older adults seeking low-impact exercises for arthritis relief and other conditions.

Career development

• Pathways to becoming certified:
  • Self-study
  • Preparatory courses
  • Internships
  • Formal education programs
• Program implementation involves:
  • Designing tailored exercise programs
  • Providing clear instructions
  • Monitoring client progress
  • Adapting programs to ensure client safety and success.
• Continuous education is essential for CPTs to stay updated with industry trends, improve their skills, and advance their careers.
  • Specializations are the best way to differentiate themselves from other CPTs. 
  • Continuing Education Credits (CECs)
    • Units earned by fitness professionals through approved educational activities to maintain certification and stay updated with industry standards.

(Source) 

Networking 

Building a strong referral network

• Ask questions and find common ground
  • Interact with colleagues, fitness professionals, and potential clients by asking thoughtful questions and identifying shared interests.
• Script and practice fitness elevator pitch
  • Develop a concise and compelling elevator pitch highlighting expertise, specialization, and unique selling points.
• Follow-up
  • Consistently follow up with contacts and prospects to demonstrate dedication and increase the likelihood of referrals or job offers.

Effective networking strategies

• Attend industry events
  • Participate in fitness conferences, workshops, and networking events to connect with industry professionals, potential employers, and clients.
• Utilize social media
  • Leverage platforms like LinkedIn, Instagram, and YouTube to promote expertise, engage with a broader audience, and network with professionals and clients.
• Join professional associations
  • Like NASM or ACE to network with peers, access resources, and stay updated on industry trends and opportunities.

Certifying bodies 

• Prescription for Activity Task Force (ACE PfT)
  • Group establishing physical activity guidelines for health promotion.
• National Commission for Certifying Agencies (NCCA)
  • Non-profit organization 
  • Accredits certification programs that meet established standards of excellence in various industries, including fitness and exercise.
• Coalition for the Registration of Exercise Professionals (CREP)
  • An alliance of organizations 
  • Committed to ensuring quality and consistency in the certification of exercise professionals.
• United States Registry of Exercise Professionals (USREPS)
  • Registry that lists qualified exercise professionals who meet specific certification standards. 
  • To be listed as a personal trainer on the USREPS, one must hold a current NCCA-accredited certification as a personal trainer from a CREP member.
• Medical Fitness Association (MFA)
  • Organization dedicated to promoting medically integrated fitness programs and advancing the profession of medical fitness.
• American College of Sports Medicine (ACSM)
  • A leading authority in sports medicine and exercise science, offering education and research to improve physical performance and health.
• Commission on Accreditation of Allied Health Educational Programs (CAAHEP)
  • Ensures the quality and consistency of educational programs in allied health disciplines through accreditation.
• Committee on Accreditation for the Exercise Sciences (CoAES)
  • Evaluates and accredits academic programs in exercise science to ensure they meet established standards of quality.

Health benefits of physical activity 

• Health benefits from regular physical activity
  • Enhanced cardiovascular health.
  • Weight management.
  • Improved mental well-being.
  • Overall enhancement of quality of life.
• Factors underlying chronic disease
  • Tobacco use
  • Poor nutrition
  • Lack of physical activity
  • Excessive alcohol use
• Researchers Dunstan, Thorp, and Healy suggest that prolonged sitting or sedentary behaviors are expected to join common modifiable risk factors for noncommunicable diseases (NCDs) in the future.

Health benefits associated with regular physical activity

Table 1-1 in ACE Guide. 

Children and adolescents

• Improved
  • Bone health (ages 3 through 17 years)
  • Weight status (ages 3 through 17 years)
  • Cardiorespiratory and muscular fitness (ages 6 through 17 years)
  • Cardiometabolic health (ages 6 through 17 years) 
  • Cognition (ages 6 to 13 years)
• Reduced risk of depression (ages 6 to 13 years)

Adults and older adults

• Lower risk of
  • All-cause mortality
  • Cardiovascular disease mortality
  • Cardiovascular disease (including heart disease and stroke) 
  • Hypertension
  • Type 2 diabetes
  • Adverse blood lipid profile
  • Cancers of the bladder, breast, colon, endometrium, esophagus, kidney, lung, and stomach
  • Falls and fall-related injuries (older adults)
• Improved
  • Cognition*
  • Sleep
  • Bone health
  • Physical function
  • Quality of life 
• Reduced
  • Risk of dementia (including Alzheimer’s disease)
  • Anxiety
  • Risk of depression
  • Slowed or reduced weight gain
• Weight loss, particularly when combined with reduced calorie intake 
• Prevention of weight regain following initial weight loss

Professional responsibilities and ethics

Personal trainers must uphold high ethical standards, prioritizing client safety, well-being, and confidentiality. 

They need to understand and follow intellectual property laws, employment regulations, and copyright guidelines to ensure legal compliance in the fitness industry. 

Maintaining client confidentiality is essential for building trust, fostering positive client-trainer relationships, and protecting sensitive information shared during training sessions.

Scope of practice 

• Definition
  • Legal range of services professionals in a given field can provide.
• Settings
  • Specifies where the services can be provided.
• Guidelines and parameters
  • Outlines the rules and standards that must be followed.

Factors determining scope of practice:

• Education
• Training
• Certifications or licenses to work in a given field
• The laws and organizations covering that specific profession, and
• The laws and organizations covering complementary professions within the same field.

Laws

• Determination and regulation
  • State regulatory agencies define and regulate laws for professions, including licensure.
• Variation
  • Scope of practice for licensed practitioners can differ between states.

Guidelines 

The ACE scope of practice for CPTs outlines their responsibilities and guidelines, focusing on promoting fitness, health, and an improved quality of life through physical activity interventions (ACT Guide, Figure 1-2):

• Use a client-centered, evidence-based approach by creating personalized exercise programs and using behavior-change strategies to improve health and fitness.
• Develop and implement safe, effective exercise programs for individuals and small groups, whether healthy or with medical clearance.
• Conduct health-history interviews and preparticipation health screenings to determine the need for referrals and identify exercise contraindications.
• Administer appropriate assessments for cardiorespiratory and muscular training based on the client’s health history, current exercise, lifestyle, and goals, using research-backed protocols.
• Help clients set and achieve realistic health, fitness, and behavior-change goals.
• Teach correct exercise techniques and proper movement progressions and regressions with demonstration, explanation, and proper cueing and spotting.
• Empower clients to stick to their exercise programs with guidance, support, motivation, and effective feedback.
• Design structured exercise programs for one-on-one and small-group training.
• Educate clients on fitness and health to help them adopt healthy behaviors and succeed in their exercise programs.
• Protect client confidentiality (HIPAA) and other relevant laws.
• Act with professionalism, respect, and integrity at all times.
• Recognize the scope of practice and refer clients to other healthcare professionals when necessary.
• Be prepared for emergencies and respond appropriately.

Documentation and communication 

• Written permission from clients
  • Necessary for CPTs to communicate with healthcare providers.
  • Ensures collaboration and understanding of the client’s health status.
• Physician clearance form
  • Required for obtaining medical clearance.
  • Especially needed for clients with pre-existing health conditions or risk factors.
• Progress reports
  • Requested periodically to track and evaluate clients’ fitness journey.
  • Frequency and format determined by individual goals and needs.

General scope of practice for personal trainers

Actions outside scope of practice	Actions within scope of practice
Diagnosing, illness, or disease	– Following accepted guidelines for exercise programming for diseases and disorders as presented by the appropriate governing body (e.g., American College of Obstetricians and Gynecologists and American Diabetes Association) – Assessing for exercise limitations – Identifying potential risk factors through health screening and fitness assessment – Referring clients to appropriate healthcare professionals as needed – Adhering to guidance and limitations outlined in a medical release form provided by a client’s physician or other healthcare professional
Prescribing diets or nutritional supplements	– Referring clients to a registered dietitian for meal planning or a specific diet plan – Providing general information on healthy, evidence-based nutrition (e.g., Dietary Guidelines for Americans)
Treating injury or disease or rehabilitating clients following injury	– Using exercise programming to help clients improve overall health – Helping clients adhere to advice from a physician or physical therapist – Designing an exercise program after a client has been released from rehabilitation – Referring clients to appropriate healthcare professionals as needed
Monitoring clinical progress for medically preferred clients	– Documenting progress and reporting it to the appropriate healthcare, professional or physician after receiving the clients permission to do so – Following recommendations from a physician, physical therapist, registered dietitian, or other healthcare professional
Counseling clients	– Using coaching techniques to support clients through behavior change (e.g., Increasing physical activity and adopting healthy eating habits) – Providing general health and wellness information – Referring clients to appropriate healthcare professionals as needed

Appropriate scope of practice 

Client scenario	Inappropriate for an ACE CPT	Appropriate for an ACE CPT
Client stands with an exaggerated lordotic posture	Diagnosing the cause of the clients exaggerated lordosis	Implementing a care conditioning program to improve strength and flexibility and balances and muscles acting on the hips and spine
Client wants to lose weight by trying the latest commercial diet	Helping the client to understand and implement the diet	Helping the client to make more health choices, using dietary guidelines and tools
Client is cleared for exercise following physical therapy for rotator cuff impingement	Continuing with physical therapy exercises to treat shoulder impingement	Implementing exercises to improve stability and building work physical therapy
Client has tight iliotibial (IT) bands	Providing deep tissue massages to relieve tightness in the IT bands	Teaching client self-myofascial Release techniques for the IT bands, using a foam roller
Client has soreness following a weekend, tennis tournament	Recommending use of over-the-counter anti-inflammatory medications	Discussing proper techniques for performing, dynamic, stretching activities for the affected areas
Client tells you they are depressed due to problems with their spouse	Listening to the client and providing them with recommendations for improving the situation	Listening to the client with empathy and maintaining their confidentiality

Healthcare continuum

• Integral members of the allied healthcare continuum
  • Collaborate with healthcare professionals: physicians, physical therapists, nutritionists
  • Promote overall health
  • Contribution to preventive healthcare
• Importance of understanding roles
  • Effective collaboration through knowledge of various healthcare roles
  • Provides holistic care to clients
• Sometimes clients have issues beyond the CPTs scope of practice
• Hence, some trainers develop referral networks.
• A referral network includes
  • Healthcare professionals, fitness experts, and wellness practitioners.
  • Collaborate to offer comprehensive care and support.
  • Key professionals in the network may include
    • Physicians, physical therapists, nutritionists, mental health professionals, chiropractors, massage therapists, and occupational therapists.

If a CPT needs clarification about the physician’s exercise guidelines, they should feel confident reaching out to the physician’s office with the client’s written permission with any program related queries.

Referral network components

Physicians

• Provide insights into clients’ health conditions, medications, and restrictions.
• Offer medical clearance for exercise programs.
• Doctor of Medicine (MD)
  • Trained in the allopathic tradition of medicine.
  • Diagnoses and treats diseases using medications, surgeries, and other conventional medical techniques.
• Doctor of Osteopathy (DO)
  • Historically: emphasizes a holistic approach to patient care.
  • Focuses on the musculoskeletal system and the body’s ability to heal itself.
  • Utilizes osteopathic manipulative treatment (OMT) in addition to traditional medical interventions.

The allopathic tradition of medicine, also known as conventional or Western medicine, focuses on treating diseases “with remedies that produce effects different from those caused by the disease itself” (Wilson, 2017).

Physical therapists

• Expertise in rehabilitation, injury prevention, and movement analysis.
• Assist in designing exercise programs for musculoskeletal issues and injury recovery.
• Physical Therapist (MPT)
  • Assesses and treats patients with physical impairments or disabilities.
  • Aims to improve mobility and overall function.
• Physical Therapy Assistant (PTA)
  • Supervised by a physical therapist.
  • Assists in providing therapy interventions and exercises.
• Doctor of Physical Therapy (DPT)
  • Qualified to diagnose and treat patients independently.
  • Focuses on rehabilitation and movement science.

Nutritionists and dietitians

• Guidance on dietary strategies and meal planning.
• Complement fitness goals with nutritional counseling.
• Registered Dietitian (RD or RDN)
  • Healthcare professional trained in nutrition science
  • Assess, educate, and counsel individuals/groups
  • Focus on nutrition and dietary choices for health promotion and medical condition management
• Nutritionist
  • Specializes in food and nutrition study
  • Provides advice on diet and lifestyle
  • Term not regulated, qualifications and scope vary by region
  • NOT regulated term 

Nurses

• Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN)
  • Typically an associate level degree with clinical practicum. 
  • Provides basic medical care
    • Monitoring vital signs
    • Assisting with daily patient activities
    • Administering medication
  • Supervised by registered nurses and doctors
• Registered Nurse (RN)
  • Typically, an associate or bachelor’s level degree with clinical practicum and national certification testing, licensure and all 50 states
• Nurse Practitioner (NP)
  • An advanced practice registered nurse with a graduate level degree, typically requiring several years of practical clinical experience.
  • Able to prescribe some medication and practice somewhat independently, varying by state
• Doctorate of Nursing Practice (PhD or DNP)
  • Often focus on advanced clinical practice, leadership, education, research, or healthcare policy.

Mental health professionals

• Support mental well-being and stress management.
• Address psychological barriers to exercise adherence.
• Psychologists (PhD)
  • Offer counseling and therapy for various mental health concerns.
  • Specialize in psychotherapy and behavior modification techniques.
• Counselors
  • Provide guidance and support for personal and emotional issues.
  • Offer counseling sessions to address specific challenges or concerns.
• Psychiatrists (MD)
  • Specialize in diagnosing and treating mental illnesses and disorders.
  • Licensed to prescribe medication and provide counseling or therapy.
• Clinical Social Worker (MSW and or LCSW)
  • Assist individuals and families in navigating social and emotional challenges.
  • Provide advocacy, support services, and resources for mental health issues.
• Psychiatric Nurse Practitioners (PMHNP)
  • Prescribe medication and offer therapy for mental health conditions.
  • Provide holistic care and management for psychiatric disorders.
• Marriage and Family Therapists (MFT)
  • Specialize in therapy for couples and families.
  • Address relationship issues, communication problems, and family dynamics.
• Licensed Professional Counselor (LPC) or Licensed Mental Health Counselor (LMHC)
  • Bachelors or masters level degree in counseling related field, plus supervised clinical experience and states certification, with variation by state.
  • Therapy is included within scope of practice. 

Chiropractors

• Specialize in musculoskeletal health and pain management.
• Aid in addressing posture, alignment, and joint health.

Massage therapists

• Aid in muscle recovery, relaxation, and stress relief.
• Complement exercise benefits by promoting recovery and reducing muscle tension.

Occupational therapists

• Focus on improving functional abilities and independence.
• Tailor exercise programs to meet specific functional goals.
• Certified Occupational Therapy Assistant (COTA)
  • Requires an associate level degree with national certification.
  • The profession is regulated in most states
• Occupational Therapist Registered (OTR)
  • BS or MS degree and occupational therapy with national certification.
  • Profession regulated in most states.
  • OTR’s treat injured or disabled individuals through therapeutic use of every activities
• Doctor of Occupational Therapy (DrOT)
  • The doctorate level degree with a dissertation defense and occupational therapy

Certified athletic trainer

• Collaborates with physicians
• Provides preventative services, emergency care, clinical diagnosis, therapeutic intervention, and rehabilitation of injuries and medical conditions.

Acupuncturist

• Acupuncture
  • Form of traditional Chinese medicine 
  • Involves inserting thin needles into specific points on the body to alleviate pain and treat various physical, mental, and emotional conditions.

Exercise professional

• Designs, implements, and oversees exercise programs.
• Often work at fitness centers, sports facilities, or healthcare settings.

Exercise psychologist

• Studies the psychological aspects of physical activity, exercise, and sport.
• Focuses on how mental and emotional factors influence performance and how physical activity affects mental health and well-being.

Health coach

• Supports individuals to achieve health and wellness goals through lifestyle and behavior modifications.
• Unregulated term. 

Medical assistant

• Performs administrative and clinical tasks. 
• Supports physicians and other healthcare providers to ensure efficient patient care.

ACE CPT Exam 

• ACE Personal Trainer Certification is a credential that signifies a personal trainer’s competence and expertise in the fitness field.
• Candidates seeking certification must pass an ACE CPT exam
  • Assesses knowledge and skills in exercise science, program design, client assessment, and professional conduct.
• Exam content outline is a comprehensive guide for candidates, outlining the specific domains, tasks, and knowledge/skill statements required to pass the exam and become ACE CPTs.
• Completing a variety of continuing education in a specialty area is the best way for an ACE CPT to be recognized as an expert in a given field.

Vocab

Lifestyle and behavior

• Sedentary
  • Characterized by little physical activity or prolonged sitting.
• Overweight
  • Exceeding healthy weight for height, often due to excess fat.
• Obesity
  • Excessive body fat accumulation, leading to health issues.

Cardiovascular and metabolic conditions

• Cardiovascular disease
  • Various heart and blood vessel conditions, such as heart attacks and strokes.
• Diabetes Type 2
  • Metabolic disorder marked by high blood sugar, often tied to obesity and lifestyle.
• Diabetes Type 1
  • Autoimmune disorder causing insufficient insulin production, requiring regular injections.
• High cholesterol
  • Elevated lipid levels in the blood, raising heart disease risk.
• Hypertension
  • Elevated blood pressure, a major heart disease risk.

Health metrics and measurements

• Body fat
  • Percentage of body mass composed of fat tissue, important for energy and insulation.
• Body composition
  • Ratio of fat to muscle, bone, and other tissues
  • One indicator of overall health and fitness.
• Cardiorespiratory fitness
  • Heart and lung capacity to provide oxygen during activity.
• Flexibility
  • Range of motion in joints, crucial for mobility and injury prevention.

Health concepts and devices

• Non-communicable diseases (NCD)
  • Chronic medical conditions unrelated to infections, often influenced by lifestyle choices.
• Health equity
  • Ensuring fair access to optimal health regardless of socioeconomic status.
• Mortality
  • The state of being subject to death; often used in population death rates.
• Cardiopulmonary resuscitation (CPR)
  • Life-saving technique 
  • Combines chest compressions and artificial ventilation to maintain circulatory flow and oxygenation during cardiac arrest.
• Automated external defibrillator (AED)
  • Portable medical device 
  • Automatically diagnoses life-threatening cardiac arrhythmias and delivers electrical shocks to restore a normal heart rhythm.

Substances and components

• Cholesterol
  • Fatty substance vital for cell function, but excessive levels can harm the heart.

Conclusion

In conclusion, CPTs are critical advocates for health and wellness.

By prioritizing professional standards, ongoing education, and ethical practices, they enhance their careers and significantly improve the lives of their clients. 

Through their commitment to disease prevention, health promotion, and overall well-being, CPTs create healthier communities and individuals.

If you enjoyed this post on the role and scope of practice of personal trainers, consider reading From Mile One to a Half Marathon: My Journey in Running.