Personal fitness trainers should know the limits of their knowledge and scope of practice. There should be regular referrals to health professionals as any health issue pops up or if the trainer has a question.

Medical Issues

A personal trainer should refer any client to a doctor or medical professional when a medical issue becomes apparent or suspected. This is often done before training even starts. Any time that I come across something that wasn’t covered in my certification or other training, I send them to the appropriate doctor with a note of what I encountered, and the question I am trying to get answered.

Any time I have a new high-risk client with an existing medical condition, I send them to a doctor first. I provide a written statement from me that includes my proposed exercise for the first month. It isn’t a detailed daily exercise routine, but it would include something like “Cardiovascular exercise on the treadmill or recumbent bike up to 20 minutes at a time and not to exceed a heart rate of 130bpm.”

You can get as detailed as you want. The point is to be very clear with the doctor on your intended direction of the program. Include your credentials and a small note of your experience with other clients of this type. Ask whether the client needs to have a follow up with the doctor and, if so, how many weeks or months after the start of the program. Have a clear space for the doctor to sign that says “Ok to begin exercise program as described above.”

Doctors love to receive this kind of communication. Every single one I have talked to and given these kind of letters are beyond happy that I am helping their patients.

You see, doctors try to help people all day, but they don’t have a support group to make sure that their recommendations are being carried out. To the doctor, a fitness trainer is his reach beyond the office to see that people get better.

The doctor has had a lot of failures in trying to help his patients. When you start helping him heal them one by one, the response really is funny and cute. The doctors brighten right up!

Follow Ups With General Practitioners

When you’ve made good progress and need okay for another, more intense, program, send the doctor a report of your client’s general exercise routine, weight log, diet log, blood pressure log, and whatever other log you are keeping.

If you feel comfortable, ask for a general okay to exercise under your supervision as you see fit. If the person is still high risk, get a very precise recommendation. I started doing this because there were clients that I was absolutely unwilling to train. One of them twisted my arm and said, “Look, if I get my doctor to okay the program, will you be willing to train me?” I said yes.

How This Covers You Legally

With your own certification and trainer’s insurance in order, getting a doctor’s okay on a specific exercise program should cover pretty much all bases.

If something goes wrong, I can’t think of anything else to tell a judge. If you’re training them by the book (base your training plan on something written by the organization that certified you), you have the book to show it, you have the general practitioner’s signature on the program, then I can’t imagine any way that you’d be found guilty of any kind of malpractice. This would only be in the very unfortunate circumstance that the person suffers a major medical emergency.

If it is an obese and diabetic person with high blood pressure, you should take their weight, blood sugar levels and blood pressure at the beginning of every session. Log it so that you can prove to anyone beyond any doubt that you handled this situation responsibly.

Running your clients this way – from the viewpoint of legal – makes you very meticulous and interested in the details. Do it. If you’re not a details person, do it as an exercise to get better at the details.

How Clients Respond to All of This

Every client I have worked with in this manner was beyond thankful.

There aren’t words to even describe the feelings of someone receiving all of this help from you and their doctor.

It makes them even more willing to follow your advice, which causes them to reach their goals faster. It is a bit of a snowball effect.

If you then do something further, like inviting their family to the gym for a workout or just a meet-and-greet, you’ve basically solidified yourself as a member of the family. I’ve done this, where I said, “Bring in your husband and I’ll put him through an initial assessment.”

It was the holidays and I had a lot of extra time with most people screwing off on their exercise and diets, so it was literally no skin off my back to help someone for free. The guy was so impressed that he signed up for training as well – NOT EVEN MY INITIAL INTENTION!

He was happy to see his wife doing so well and wanted to be a part of it. When I showed him the possible improvements in his health, he was hooked too.

Don’t forget that you’re in the business of changing lives.

Where Are Personal Trainers in the Health Industry?

We aren’t really hooked into the medical system. And, in my opinion, that is a problem.

If you go to a doctor who is a general practitioner and talk about a chronic pain in your shoulder, he can write up an official referral to see a physical therapist. Fitness trainers have no such fancy referrals and we aren’t hooked into the medical insurance system.

In some cases, insurance won’t pay for the physical therapist visit unless it is referred by a general practitioner. It depends on where you live and what kind of insurance you have.

Any time I’ve kind of shoved my way into the medical system (as in the example above), I’ve been welcomed with open arms.

Should Medical Insurance Pay for Personal Fitness Trainers?

I am actually surprised that this isn’t some government-subsidized activity, given that 2/3 of Americans are overweight.

It is an epidemic. But since it is slow, it gets no attention. It’s probably because the big sugar companies (such as Coke) have lobbyists. That would be my first guess.

But I have never heard of health insurance paying for a personal trainer. I researched it to be sure, and I was instantly proven wrong. Apparently, it can happen if certain conditions are met.

This is something I’m baffled on and am not qualified to answer in full. It’s still sinking in and I may do a deep dive to answer this question in full at a later date.

Times You Should Absolutely Refer Clients to Medical Professionals

Example: One time a client came off the treadmill, felt a little tired and dizzy and a drop of blood came out of his nose. I had him lay down on the ground. There was a doctor (who just happened to be exercising) nearby and I asked her to have a look at him. I sent someone to get the blood pressure machine and we checked it.

His blood pressure was very, very high. He didn’t want to go to the hospital, but the doctor was very firm and didn’t give him an option. She drove him there herself.

Example: A new client came in and would constantly have to sit down. She came to me saying that her doctor referred her, so I didn’t get in touch with the doctor myself. She had high blood pressure, but she said it was under control. I didn’t check myself (my fault). I eventually put 2 and 2 together and had her sit down while I checked her blood pressure.

It was low. Real low.

I told her that I wasn’t going to train her again until she sees her doctor to get this sorted out. I wrote a note to the doctor and described what was going on and what we found. She went to see the doctor, got her blood pressure medication cut back, then all was fine.

You see, she kept sitting down because she felt like she was going to pass out. That’s what low blood pressure feels like. You’ll be kneeling down and you stand up real fast, then feel kind of light headed. She was at least aware enough to sit down before she passed out, but it was caused by too much blood pressure medication.

Example: I had a woman doing box jumps up and down on a platform. She missed one and cut her leg open. Blood was everywhere. This woman (same doctor as above) drove herself to the hospital and sewed her own shin up.

I can’t make this stuff up, guys.


The point of all of this is that you should reach out to the medical professionals in your city.

Find a good chiropractor, physical therapist, general practitioner and have them all in your phone. There’s no reason you can’t just call them.

If you’re sending them patients, then they will be happy to take your calls and your referrals.

You are an ally in their humanitarian effort to better the health of the community. Doctors are generally trying to help people and when they find someone who is also on their side, well, you’re officially in with the medical community.

Get ready for invitations to holiday parties, free chiropractic adjustments, and all sorts of other odd side perks. DO NOT do this for the side perks. Don’t even ask for any perks. I’m just saying that they will come.

When you’re making a name for yourself in the city, remember that you did it by helping people who almost lost all hope at having a better life.

Your ability to help them puts you in a position of power. Take a moment and let that sink in.

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