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Description
Key Concepts
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Lesson Overview

Screening and client intake are the foundation of safe, effective, and legally defensible coaching practice. Before any training begins — particularly with special populations — a systematic process of health assessment is required. This lesson teaches you the tools, frameworks, and professional standards for client screening at AURUM, with particular attention to the populations covered in this module: older adults, post-rehabilitation clients, and individuals with metabolic conditions.

Learning Objectives

  • Understand why systematic screening is required for safety, programming, and liability
  • Administer and interpret the PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone)
  • Conduct a comprehensive health history intake covering medications, diagnoses, surgeries, and goals
  • Identify red flags that require GP or specialist referral before starting training
  • Apply professional documentation standards that protect both client and coach
  • Use the first session as a clinical assessment opportunity, not just an introduction

Why Screening Matters

Screening serves three distinct but equally important functions:

1. Safety
Identifies contraindications to exercise — conditions where training would be unsafe without medical management or modification. Without screening, you may unknowingly train a client whose resting blood pressure is 200/120, or who had a cardiac stent placed 6 weeks ago, or who has active DVT. These are not theoretical risks — they are real scenarios that occur when intake is skipped.
2. Programming
Health history determines protocol modifications. A client with a known shoulder impingement needs ROM restrictions before their first session — not discovered during it. Medications affect training response (beta-blockers blunt heart rate response; diuretics increase dehydration risk). Previous injuries, surgeries, and diagnoses all shape what is appropriate and what requires adaptation.
3. Liability and Professional Standards
Documented screening is your professional and legal protection. If an adverse event occurs during training, documented evidence that you followed the established standard of care — conducted PAR-Q, identified no contraindications, or referred appropriately — is essential. Absence of documentation is absence of evidence that you acted professionally.

The PAR-Q+: What It Is and How to Use It

The PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone) is the internationally recognized gold-standard pre-participation screening tool for exercise professionals. It was developed by the Canadian Society for Exercise Physiology (CSEP) and is updated periodically to reflect current evidence. It supersedes the original PAR-Q with a more nuanced, condition-specific structure.

The PAR-Q+ consists of two parts:

  • Part 1 — General health questions (7 questions): Covers heart conditions, chest pain, dizziness/fainting, bone/joint problems, medication for blood pressure or heart, pregnancy, and "any other reason" that should limit exercise. If all are answered NO, the client can begin moderate-intensity exercise. If any are YES, proceed to Part 2.
  • Part 2 — Condition-specific follow-up questions: For clients who answered YES to any Part 1 question, Part 2 asks condition-specific follow-up questions across 11 domains (cardiovascular, metabolic, mental health, respiratory, spinal cord injury, stroke, musculoskeletal, cancer, pregnancy, etc.). The answers to Part 2 determine whether the client can exercise without physician consultation, with physician consultation, or only in a medically supervised setting.

Practical implementation at AURUM: the PAR-Q+ should be completed in writing by the client and signed before the first session. It is not sufficient to ask the questions verbally and rely on memory. The signed form becomes part of the client's permanent file. It should be re-administered annually, or any time the client reports a significant health change.

An important limitation of the PAR-Q+: it relies on the client accurately reporting their health status. Some clients are unaware of conditions (undiagnosed hypertension is extremely common), and others may underreport to avoid being told they cannot train. This is why the PAR-Q+ is necessary but not sufficient — it must be complemented by a more thorough health history conversation.

The Comprehensive Health History Questionnaire

Beyond the PAR-Q+, a comprehensive health history intake should capture the following domains. Every domain provides information that directly affects programming decisions:

Current Medications
Beta-blockers (attenuate heart rate response — don't use HR as effort indicator). Diuretics (dehydration risk). Blood thinners/anticoagulants (bruising risk, medical alert). Insulin/sulfonylureas (hypoglycemia risk). Corticosteroids (long-term use causes bone density loss — relevant to loading decisions). Any recent medication changes.
Medical Diagnoses
Current and historical diagnoses. Particularly relevant: cardiovascular disease, diabetes, osteoporosis/osteopenia, arthritis, neurological conditions, cancer history, chronic pain syndromes, autoimmune conditions. Any diagnosed psychiatric conditions that may affect session management.
Surgical History
All surgeries relevant to the musculoskeletal system: joint replacements (hip, knee, shoulder, spine). Date of surgery and current restrictions. Name of surgeon and physiotherapist for potential contact. Any implants or hardware (joint replacements, pacemakers, metal fixation plates).
Current Pain and Movement Restrictions
Location, character, and pattern of any current pain. What aggravates it. What relieves it. Any movements that should be avoided. Any physiotherapy or medical restrictions currently in place. Pain during rest vs. pain during movement — important differentiation for training decisions.
Exercise History
Previous exercise experience. Any previous injuries related to exercise. Any negative experiences with gyms, trainers, or exercise in general (relevant for coaching approach). Current activity level outside of AURUM sessions. Sport participation.
Goals and Expectations
Specific functional goals (what do they want to keep doing, or do again). Timeline expectations. Any physician or physiotherapist recommendations that led them to AURUM. What success looks like to them in 6 and 12 months.

Red Flags Requiring GP Referral Before Starting

The following findings during intake require written GP or specialist clearance before the first training session. These are not optional professional courtesies — they are safety-critical thresholds:

  • Chest pain, tightness, or pressure at rest or during exertion — potential cardiac origin; must be evaluated before exercise stress
  • Unexplained syncope (fainting) or pre-syncope — may indicate arrhythmia or autonomic dysfunction
  • Resting blood pressure above 180/110 mmHg — uncontrolled hypertension is a training contraindication
  • Recent cardiac event within the past 3 months — myocardial infarction, stent placement, bypass surgery, arrhythmia treatment
  • Active cancer treatment (chemotherapy or radiation) — requires oncologist clearance and specific precautions
  • Confirmed or suspected deep vein thrombosis (DVT) or pulmonary embolism — acute phase is an absolute contraindication
  • Recent fracture (within 6–8 weeks, unhealed) — loading at the fracture site is contraindicated until radiological evidence of healing
  • Severe uncontrolled diabetes (HbA1c above 10% or recurrent hypoglycemic episodes) — requires physician management before introducing significant exercise stress
  • Active infection or fever — systemic illness is a temporary absolute contraindication to intense exercise
  • Unexplained severe or progressive pain — new, unexplained musculoskeletal or visceral pain should be investigated before attributing to a training-manageable cause

Documentation Standards

Documentation is not bureaucracy — it is professional protection, continuity of care, and communication. Every AURUM client file should contain:

  • Signed, dated PAR-Q+ form
  • Signed health history questionnaire
  • Documented discussion of any identified risks or restrictions
  • Any GP or physiotherapy clearance letters (photocopied and retained)
  • Session-by-session notes on any new symptoms, pain reports, or client concerns
  • Documented ROM restrictions by exercise (e.g., "leg press — knee flexion restricted to 80°")
  • Emergency contact information

Retention: health records should be retained for a minimum of 10 years after the last session with the client. In the event of an adverse outcome, documentation from even years prior may be relevant. Use a systematic, consistent format — handwritten notes in a margin are not a professional record.

The Intake Conversation: Building Trust While Gathering Information

The health intake is not a bureaucratic formality — it is often the first substantive interaction between coach and client. How you conduct it sets the tone for the entire coaching relationship. For older adults and post-rehabilitation clients especially, the intake conversation is an opportunity to establish psychological safety before any physical demand is introduced.

Principles for effective intake conversations:

  • Frame it as partnership, not interrogation: "I want to understand your health and what brings you here so I can design training that's right for you specifically — not a generic programme." This positions the health history as a service to the client, not a gatekeeping exercise.
  • Normalize sensitive questions: "I ask everyone these questions regardless of age or health status — it helps me make sure we work within the right range for you." This reduces the social awkwardness of asking about medications, diagnoses, and limitations.
  • Listen for what is not said: Clients often minimize or omit health information they fear will disqualify them from training. Follow up vague answers. "You mentioned occasional dizziness — can you tell me more about when that tends to happen?"
  • End with goals: Close the intake by anchoring to what the client wants to achieve. This connects the assessment process to a positive future orientation and ensures the session data serves the client's actual priorities.

The First Session as a Screening Opportunity

The first training session — even if the client has completed all paperwork — should function as an extended clinical assessment. You are learning about the client's movement patterns, pain responses, cardiovascular response to exercise, and psychological relationship to physical challenge. These observations cannot be captured on a questionnaire.

Specific observations to make during the first session:

  • Resting posture and gait — do you see kyphosis, antalgic gait, limb asymmetry?
  • Movement quality during machine setup — does the client compensate or guard during seating?
  • Pain response during exercise — is there pain at specific ROM points? Note the angle and report level.
  • Cardiovascular response — is breathlessness disproportionate to effort? Any flushing, pallor, or sweating that seems excessive?
  • Force asymmetry — the AURUM data will show left-right differences on leg press. A >15% asymmetry is clinically significant and warrants documentation and monitoring.
  • Post-session response — does the client feel appropriately fatigued but well, or do they report dizziness, nausea, or unusual symptoms? Follow up at the start of the next session.

Ongoing screening is not a one-time event. At the start of every session, ask a brief standard check-in: "Any changes in your health since last time? New medications? Any pain or unusual symptoms this week?" This takes 60 seconds and provides critical safety information. It also communicates to the client that their wellbeing — not just their performance — is your primary professional concern.