client consultation
client consultation
WHY
Where: at goodlife
Why: has been exercising in various ways for as long as he can remember mainly in endurance type exercise, however he now
How will you feel when you achieve your results: Fitter and want to gain the muscle power
How will you feel if you didn't achieve your results: stuck where I am now
What have been your previous / current bad habits that have led you to this point?
John has presented a challenge for
you that he stands very close to you when he talks and does not give me my
personal space
How serious are you on a scale of 1-10: 5
Have you ever felt 100% comfortable with fitness in the past? 6 months
How do you want to feel in the future - two/three words? Fit fabulous
WOW PT
Favourite exercises/ way of exercising? I have done yoga classes previoulsy and enjoyed those
3 things your ideal PT session or program would have: Cardio, flexiblity and fun
Intensity (1-10): 5
Notes:
Need to refer to nutritionist
STAGE 1 (COMPULSORY)
AIM: To identify individuals with known disease, and/or signs or symptoms of disease, who may be at a higher risk of an
adverse event due to exercise. An adverse event refers to an unexpected event that occurs as a consequence of an
exercise session, resulting in ill health, physical harm or death to an individual.
This stage may be self-administered and self-evaluated by the client. Please complete the questions below and refer to
the figures on page 2. Should you have any questions about the screening form please contact your exercise professional
for clarification.
1.
Has your medical practitioner ever told you that you have a heart condition
or have you ever suffered a stroke? ✔
2.
Do you ever experience unexplained pains or discomfort in your chest at rest
or during physical activity/exercise? ✔
3.
Do you ever feel faint, dizzy or lose balance during physical
activity/exercise? ✔
4.
Have you had an asthma attack requiring immediate medical attention at any
time over the last 72 months? ✔
5.
If you have diabetes (type 1 or 2) have you had trouble controlling your
blood sugar (glucose) in the last 3 months? ✔
6.
Do you have any other conditions that may require special consideration for
you to exercise? ✔
IF YOU ANSWERED 'YES': to any of the 6 questions, please seek guidance from an
appropriate allied health professional or medical practitioner prior to undertaking exercise.
IF YOU ANSWERED 'NO': to any of the 6 questions, please proceed to question 7 and calculate your typical
weighted physical exercise per week.
Describe your current physical activity/exercise levels in a typical week Weighted physical activity/exercise per
7. by stating the frequency and duration at the different intensities. For week
intensity guidelines consult figure 2. Total mins = (minutes of light + moderate)
Intensity Light Moderate Vigorous/High + (2 x minutes of vigorous/high)
STAGE 1 (COMPULSORY)
Did you answer yes to any question in Stage 1?
NO YES
*HRmax - estimated heart rate maximum. Calculated by subtracting age in years from 220 (eg. for a 50-year-old person= 220-50 = 170 beats
per minute). #=Borg's Rating of Perceived Exertion (RPE) scale, category scale 0-10. Modified from Norton K, L. Norton & D. Sadgrove. (2010).
Position statement on physical activity and exercise intensity terminology. J Sci Med Sport 13, 496-502.
8. Demographics
Risk of an adverse event increases with age,
Age: 46 particularly males > 45 years and females > 55
years
Male ✔ Female
11. Body Composition Any of the below increases the risk of chronic
diseases:
Weight (kg): 72 Height (cm): 162
BMI >30kg/m²
Body Mass Index (kg/m²): 22.5
Waist >94cm male or >80cm female
Waist Circumference (cm): 72cm
12. Have you been told that you have high blood
pressure?
STAGE 2 (CONTINUED)
Yes No ✔
Any of the below increases the risk of heart disease:
If known:
Total cholesterol (mmol/L): Total cholesterol > 5.2mmol/L
HDL (mmol/L):
HDL < 1.0mmol/L
LDL (mmol/L):
Triglycerides (mmol/L): LDL > 3.4mmol/L
Triglycerides > 1.7mmol/L
Are you taking any medication for this condition/?
Yes No ✔
14. Have you been told that you have high blood sugar
(glucose)?
Yes No ✔
If known:
Fasting blood glucose (mmol/L): Fasting blood sugar (glucose) > 5.5mmol/L increases
the risk of diabetes
Are you taking any medication for this condition?
Yes No ✔
15. Are you currently taking prescribed medication(s) Taking medication indicates a medically diagnosed
for any condition(s)? These are additional to those problem. Judgment is required when taking medication
already provided. information into account for determining appropriate
exercise prescription because it is common for clients
Yes No ✔ to list ‘medications’ that include contraceptive pills,
vitamin supplements and other non- pharmaceutical
If yes, what are the medical conditions? tablets. Exercise professionals are not expected to have
an exhaustive understanding of medications. Therefore,
it may be important to use common language to
describe what medical conditions the drugs are
prescribed for
16. Have you spent time in hospital (including day There are positive relationships between illness
admission) for any condition/illness/injury during rates and death versus the number and length of
the last 12 months? hospital admissions in the previous 12 months. This
includes admissions for heart disease, lung disease
Yes No ✔ (eg. Chronic Obstructive Pulmonary Disease (COPD)
and asthma), dementia, hi fractures, infectious
If yes, provide details: episodes and inflammatory bowel disease.
Admissions are also correlated to ‘poor health’
status and negative health behaviours such as
smoking, alcohol consumption and poor diet
patterns.
17. Are you pregnant or have you given birth within During pregnancy and after recent childbirth are
the last 12 months? times to be more cautious with exercise.
Appropriate exercise prescription results in
Yes No ✔ improved health to mother and baby. However,
joints gradually loosen to prepare for birth and may
If yes, provide details: lead to an increased risk of injury especially in the
pelvic joints. Activities involving jumping, frequent
changes of direction and excessive stretching
should be avoided, as should jerky ballistic
movements. Guidelines/fact sheets can be found
here: 1) www. exercisemedicine.com.au 2)
www.fitness.org.au/Pre-and-Post- Natal-Exercise-
Guidelines
18. Do you have any diagnosed muscle, bone, Almost everyone has experienced some level of
tendon, ligament or joint problems that you have soreness following unaccustomed exercise or
been told could be made worse by participating in activity but this is not really what this question is
exercise? designed to identify. Soreness due to unaccustomed
activity is not the same as pain in the joint, muscle
Yes No ✔ or bone. Pain is more extreme and may represent an
injury, serious inflammatory episode or infection. If
If yes, provide details: it is an acute injury then it is possible that further
medical guidance may be required.
Important Information: This screening tool is part of the Adult Pre-Exercise Screening System (APSS) and should read with the APSS guidelines (see
User Guide) on how to use the information collected and to address the aims of each stage. This does not constitute medical advice. This form, the
guidelines, and the APSS (together 'the material') is not intended for use to diagnose, treat, cure or prevent any medical conditions, is not intended to
be professional advice and is not a substitute for independent health professional advice. Exercise & Sports Science Australia, Sports Medicine
Australia, and Exercise is Medicine (together 'the organisations') do not accept liability for any claims, howsoever described, for loss, damage and/or
injury in connection with the use of any of the material, or any reliance on the information therein. While care has been taken to ensure the
information contained in the material is accurate at the date of publication, the organisations do not warrant its accuracy. No warranties (including
but not limited to warranties as to safety) and no guarantees against injury or death are given by the organisations in connection with the use or
reliance on the material. If you intend to take any action or inaction based on this form, the guidelines and/or the APSS, it is recommended that you
obtain your own professional advice based on your specific circumstances.
Sessions / week: 2
Notes:
he would like to up her training to 3 days per week - cardio based sessions. She enjoys dance so I will be
recommending one for them be one of our group zumba classes at the gym. And then 2 PT sessions with me based
on cardio and flexiblity 45mins.
In relation to nutrition she said she has little knowledge on what to do.
Current nutrition information (servings per day in relation to eat for health)
*Only complete this if this client is being referred to a nutritionist or dietitian
3 serves fruit
5 serves grain
0 meat but 1 serve eggs each day
2 serves yoghurt / cheese
CLIENT CONSENT
I give my permission for NHFA to communicate with the referring Practitioner and/or my GP regarding my
health status and my progress relating to my exercise program.
With this referral I will attach a copy of the pre-screening information. In response to screening results I
am requesting your guidance in relation to my client's condition to ensure delivery of a safe and effective
exercise program.
I will book an appointment with Melanie to give her the nutrition plan. Thank you for providing the
training information.
PRACTITIONER SIGNATURE:
NHFA
16 Nexus Way
SOUTHPORT, QLD 4215
[email protected]
STATUS OF REFERRAL
✔ Complete
Incomplete
The "Trainer" means the Australian Registered Business individual fitness professional.
The "Activity" means the participation in personal/ group strength, fitness and conditioning
training and general advices.
I certify that I am 18 years or older and have read this document and fully understand it. As a
parent or guardian of the participant
(a) I agree to the above for myself and on behalf of the participant and,
(b) Indemnify and will keep indemnified any person or body directly or indirectly associated
with the conduct of the activity on the terms referred to.
40.6 66
78
42 41
32 32 29 29
78
103 102
14 14 20 20
13 13 19 19
10 10 22 22
20 20 12 12
20 20 10 10
322 322
HEART RATE
Resting heart rate Heart rate during exercise Post exercise heart rate
60 150 75
Below there are examples of tests for each of the following components of fitness: Cardiovascular
endurance, muscle strength, muscle endurance and flexibility.
Choose a minimum of 1 test for each component based on your clients' goals. After recording the results
suggest two exercises for each component that you may put in their program to help them achieve their
goals. Section 2.6 in your resource booklet will help you with the testing information.
CARDIOVASCULAR ENDURANCE:
MUSCULAR ENDURANCE:
MUSCULAR STRENGTH:
Back Squat
Bench Press
FLEXIBILITY:
WEEK 1
WEEK 2
Gym Goodlife - cardio equipment bike rower cross trainer and treadmill
MUSIC, VENUE, EQUIPMENT (if relevant):
Pre-Screening Notes/Special Needs: Session Goals: (if group session, how did you
accommodate for individual goals?)
He has been referred by her doctor cardio okay to help
her condition. gain muscle power
PARTICIPANT EVALUATION
Easy to understand
✔
Acknowledged my fitness goals
✔
Explained exercises well
✔
Demonstrated where necessary
✔
Gave different variations of
movements ✔
Enjoyed the session
✔
Notes on feedback from clients - things that went well and any problems to be resolved:
He has a prejuidoce ming not a giving a space to explain
Self-evaluation:
NAME:
John Dover DATE: 14/08/2024 SESSION#: 2
Pre-Screening Notes/Special Needs: Session Goals: (if group session, how did you
He was improving accommodate for individual goals?)
Muscle power
PARTICIPANT EVALUATION
Easy to understand
✔
Acknowledged my fitness goals
✔
Explained exercises well
✔
Demonstrated where necessary
✔
Gave different variations of
movements ✔
Enjoyed the session
✔
Notes on feedback from clients - things that went well and any problems to be resolved:
Self-evaluation:
EMAIL: [email protected]
2. In relation to the above goals, explain what advice you will provide keeping within your scope and
referring if necessary:
I will see what she is eating within eat for health guidelines and refer her for specific foods for that condition.
LEAN MEATS,
MILK, YOGHURT,
VEGETABLES, POULTRY, FISH,
GRAIN FOODS CHEESE AND/OR
LEGUMES, BEANS EGGS, TOFU, NUTS,
ALTERNATIVES
SEEDS
2/2 5 1 2
Number of Servings
increasing his amoutn of vegetables and grains would be best recommedation and keeping discertionary foods to a
minimum
A healthy diet improves quality of life and wellbeing, and protects against chronic disease
Poor choices can lead to disease, Unfortunately, diet-related chronic diseases are currently a major cause of death
and disability among Australians.
he will have more energy to do her exercise and more motivation and it should help with her condition.
Thinking ahead and planning meals and snacks for yourself or your family based on the Australian Dietary
Guidelines and Australian Guide to Healthy Eating is the key to healthy eating and also the best way to lose weight.
Planning helps manage the budget, makes shopping easier and maximises foods that are high in nutrients, but
lower in kilojoules.
Suggested snacks -small amount of nuts, youghurt, fruit, celery and carrot sticks
Reading food labels:
The Nutrition information panel on a food label offers the simplest and easiest way to choose foods with less
saturated fat, salt (sodium), added sugars and kilojoules, and more fibre. It can also be used to decide how large
one serve of a food group choice or discretionary food would be and whether it’s worth the kilojoules. This is
particularly important if you are trying to lose weight.
First use the Australian guide to healthy eating to decide whether a food belongs in the five food groups and is an
‘everyday’ food for eating regularly, or a discretionary food best eaten only sometimes or in small amounts.
Then use the Nutrition information panel to compare similar packaged foods and to decide which product provides
less saturated fat, salt (sodium), added sugars and kilojoules per 100gm and more fibre per serve.
he would like a more detailed plan as mentioned so I have referred to a nutritionist - then I can support her following
that.
Read up on cystic fybrosis so I have an understanding about why the nutritionist will choose certain foods.