Understanding Scope of Practice

Working with clients who have chronic conditions requires clear understanding of what you can and cannot do as a fitness professional. Scope of practice defines the boundaries of your professional competence and legal authority. Staying within these boundaries protects both you and your clients while ensuring they receive appropriate care.

This chapter establishes the framework for working safely and effectively with clients who have chronic health conditions.

What Is Scope of Practice?

Definition

Scope of practice refers to the activities that a professional is trained, competent, and legally authorized to perform. It defines:

What you CAN do
What you CANNOT do
When you need to refer to other professionals
Your responsibilities and limitations

Why It Matters

For client safety:

Ensures clients receive appropriate care
Prevents harm from unqualified intervention
Maintains proper medical oversight

For your protection:

Defines legal boundaries
Protects against liability
Clarifies professional responsibilities

For the profession:

Maintains professional standards
Builds public trust
Supports interprofessional respect

Fitness Professional Scope

What Fitness Professionals CAN Do

Exercise programming:

Design appropriate exercise programs
Teach exercise technique
Progress and regress exercises
Monitor exercise responses
Adjust programming based on client feedback

General wellness guidance:

Encourage healthy lifestyle habits
Provide general nutrition information (depending on jurisdiction)
Support behavior change
Motivate and coach clients

Assessment within scope:

Conduct fitness assessments
Perform movement screens
Track progress over time
Identify when referral is needed

Working with chronic conditions (with clearance):

Implement exercise programs for cleared clients
Follow physician-provided guidelines
Monitor for warning signs
Modify exercises as needed
Communicate with healthcare team

What Fitness Professionals CANNOT Do

Medical functions:

Diagnose medical conditions
Treat or cure diseases
Prescribe exercise for medical conditions (without physician guidance)
Interpret medical tests
Provide therapy or rehabilitation
Recommend medication changes

Specialized care:

Perform physical therapy
Provide psychological counseling
Give specific nutritional prescriptions (in most jurisdictions)
Treat injuries
Manage acute medical events

Beyond training:

Make claims about curing or treating disease
Promise specific medical outcomes
Override medical advice
Practice outside your certification level

The Healthcare Team

Key Team Members

When working with clients with chronic conditions, you may interact with:

Primary care physician:

Oversees general health
Provides medical clearance
Coordinates care
Primary referral source

Specialists:

Cardiologists (heart conditions)
Endocrinologists (diabetes, thyroid)
Pulmonologists (respiratory conditions)
Rheumatologists (arthritis, autoimmune)
Orthopedists (musculoskeletal)

Allied health professionals:

Physical therapists
Occupational therapists
Registered dietitians
Psychologists/counselors
Diabetes educators

Your Role on the Team

As a fitness professional, you:

Implement exercise within provided guidelines
Report relevant observations
Refer when issues arise
Collaborate, don't compete
Respect others' expertise

Working with Medical Clearance

When to Require Clearance

Always require medical clearance when client has:

Known cardiovascular disease
Pulmonary disease
Metabolic disease (diabetes, thyroid)
Musculoskeletal conditions affecting exercise
Recent surgery or hospitalization
Multiple risk factors
Signs or symptoms of disease

What Clearance Should Include

Basic clearance should specify:

Client is cleared for exercise
Any restrictions or limitations
Activities to avoid
Warning signs to watch for
Recommended exercise parameters (if available)

Ideal clearance provides:

Specific intensity guidelines
Heart rate or RPE parameters
Activity restrictions
Contraindicated movements
Communication channel for questions

When Clearance Is Insufficient

If clearance is vague (just "cleared for exercise"), consider:

Requesting more specific guidance
Starting very conservatively
Monitoring carefully
Communicating any concerns back

When to Refer

Immediate Referral Situations

Refer immediately (stop exercise) if:

Chest pain or pressure
Severe shortness of breath
Dizziness or fainting
Severe pain anywhere
Signs of stroke (sudden weakness, speech difficulty)
Significant injury
Any acute emergency

Non-Emergency Referral Situations

Refer soon (modify or hold training) for:

New or worsening symptoms
Unusual fatigue or malaise
Persistent pain
Signs of condition flare-up
Unexpected exercise responses
Client health concerns
Anything outside your expertise

How to Refer

When making a referral:

Explain your concern clearly to the client
Recommend they contact appropriate provider
Offer to provide information to healthcare provider if helpful
Document the referral recommendation
Follow up on outcome

What to communicate:

"I've noticed [observation]"
"This is outside my expertise"
"I recommend you speak with your [doctor/specialist/PT]"
"Let me know what they say so we can adjust training"

Communication with Healthcare Providers

Establishing Communication

Initial contact:

Introduce yourself and your role
Explain you're working with their patient
Ask for any exercise guidelines or restrictions
Provide your contact information

Sample introduction: "Hello Dr. [Name], I'm [Your Name], a certified fitness professional working with [Client Name]. I wanted to introduce myself and ask if you have any specific exercise guidelines or restrictions I should follow when training them. Please feel free to contact me if you have any questions or concerns."

Ongoing Communication

Report to healthcare providers:

Unusual responses to exercise
Observations relevant to their condition
Questions about progression
Request for updated guidelines

Professional communication tips:

Be concise and factual
Use appropriate terminology
Don't overstep your role
Express concerns without diagnosing
Request guidance, don't demand

Documentation

Keep records of:

Medical clearance received
Communications with healthcare providers
Exercise performed and responses
Any symptoms reported
Referrals made
Program modifications

Liability and Protection

Protecting Yourself

Documentation:

Keep thorough records
Document clearances, communications, incidents
Use standardized forms
Maintain client files

Insurance:

Professional liability insurance is essential
Understand your coverage
Know your policy limitations

Contracts and waivers:

Use appropriate client agreements
Include informed consent
Have clients acknowledge risks
Review with legal professional

Continuing education:

Maintain certifications
Stay current with guidelines
Know your limitations
Seek additional training as needed

Red Flags to Avoid

Never:

Train clients who should have clearance but don't
Ignore warning signs during exercise
Make medical claims or diagnoses
Guarantee health outcomes
Override medical restrictions
Practice outside your qualifications

Expanding Your Competence

Appropriate Continuing Education

If you frequently work with specific populations:

Seek specialized certifications
Attend relevant workshops
Study condition-specific guidelines
Learn from allied professionals
Stay current with research

Specializations to Consider

Common specialty certifications:

Certified Cancer Exercise Trainer
Cardiac Rehabilitation certification
Diabetes exercise specialist
Arthritis exercise specialist
Senior fitness specialist
Pre/postnatal certification

Building Expertise Responsibly

Do:

Get proper training before working with specific populations
Start with lower-risk clients as you learn
Seek mentorship from experienced professionals
Build relationships with healthcare providers
Continue learning throughout career

Don't:

Claim expertise you don't have
Take on clients beyond your competence
Substitute courses for proper certification
Ignore scope limitations because you've "read about it"

Ethical Considerations

Client's Best Interest

Always prioritize the client's wellbeing:

Refer when appropriate, even if it means losing a client
Be honest about your limitations
Don't keep clients who need more than you can provide
Support, don't replace, medical care

Professional Integrity

Maintain ethical standards:

Be truthful about qualifications
Don't make unfounded claims
Respect other professionals
Keep client information confidential
Act within your competence

When in Doubt

The rule of thumb: If you're unsure whether something is within your scope:

It probably isn't
Err on the side of caution
Consult with other professionals
Refer if uncertain

Key Takeaways

Scope of practice defines what you can and cannot do professionally
Fitness professionals can design exercise programs but cannot diagnose or treat
Medical clearance is essential for clients with chronic conditions
Know when to refer and how to communicate with healthcare providers
Document everything for protection and continuity of care
Continuing education can expand your competence appropriately
When in doubt, refer—client safety always comes first
Professional relationships with healthcare providers benefit everyone