Before the first session, a coach must ask about far more than your goal. The mandatory minimum: current and past illnesses; previous surgeries and injuries; medications taken regularly; separately and directly — fainting, blackouts and dizziness; chest pain or tightness, shortness of breath at rest, irregular heartbeat; sleep, type of work and stress level; nutrition; religious and cultural restrictions; expectations and timeframes. The answers are written down, informed consent is signed, and resting blood pressure and heart rate are measured. Only then is one of three decisions made: we train, we train only after written medical clearance, we do not train. A coach who starts the first session without this conversation did not save your time — he breached a professional standard.
Screening serves four purposes, and none of them is called a formality
The pre-training interview does not exist to collect a signature. It has four distinct purposes, which are kept explicitly separate: identify conditions under which the session does not begin; identify conditions under which it proceeds with restrictions; gather data for prescribing load; create a document that protects both the client and the coach.
Hence the central documentation rule: a decision that is not written down counts as a decision never made. A verbal agreement confirms neither clearance nor refusal. "I asked and I remember" does not exist in a dispute.
What must actually be said in the first interview
The interview checklist: goal, training history, history of injuries and surgeries, illnesses, medications, sleep, type of work and stress level, nutrition, religious and cultural restrictions, expectations and timeframes. Two items are missed most often.
Fainting. The question about syncope and near-syncope is asked separately and directly, because a client does not report an episode nobody asked about. "Any complaints?" — "No." "Have you ever blacked out or lost consciousness?" — "Well, once, in summer, in the heat."
Medications. Only one phrasing works: "which tablets do you take regularly, including the ones you don't consider medication?" Asked "do you take any medicine?", a person with hypertension who has taken the same morning tablet for twenty years honestly answers "no".
PAR-Q+ and the ACSM algorithm — two tools a coach must know by name
PAR-Q+ is a physical activity readiness questionnaire: seven core questions plus follow-up blocks for specific conditions. Any positive answer moves the conversation into a follow-up block rather than closing the topic. ePARmed-X+ is the continuation of the same tool, addressed to the physician.
The ACSM pre-participation screening algorithm in its 2015 revision works from three inputs: the person's current physical activity level, the presence of signs and symptoms, and known cardiovascular, metabolic or renal disease — and it accounts for the planned exercise intensity. The 2015 revision reduced physician referrals by roughly 41 percent, but what moved was the referral threshold, not the coach's duty to recognise a symptom. Three typical errors in using these questionnaires: the coach fills it in for the client, skips the follow-up block, or treats it as a formality when the disease is already known.
The traffic light: three decisions, not two
The binary "healthy enough or not" does not work in a commercial gym: a large share of clients have hypertension, excess body weight or type 2 diabetes, and under binary logic these people are either turned away or the rule is dropped entirely. Hence three levels.
| Level | Meaning | What the coach does |
|---|---|---|
| Green | We train without restrictions | Normal programme, normal progression |
| Yellow | We train only after written medical clearance | Request to the physician, restricted intensity and exercise list |
| Red | We do not train | Referral to a physician, refusal recorded in writing |
Doubt is resolved in favour of the higher level. The clearance request is built so that the physician does not design the training but answers concrete questions: permitted intensity, prohibited body positions and manoeuvres, blood pressure and heart rate limits, signs for stopping the session, and how long the clearance is valid.
Contraindications: when the session does not start, no matter how much you insist
Red flags recognisable in the interview and by observation: chest pain or discomfort at rest and at low load, fainting and near-fainting, shortness of breath at rest, newly detected irregular pulse, uncontrolled hypertension, acute infection and fever, deep vein thrombosis, the early post-operative period, and complicated pregnancy. Numerical thresholds are collected in a single table of limit values, and no other figures are used on the gym floor. "Absolute" means the session does not begin or is stopped immediately, and may resume only on written medical clearance.
| Measure | Status | Action |
|---|---|---|
| Resting BP ≥ 180/110 mmHg | absolute | Session does not begin, written referral to a physician |
| Resting BP 160–179 and/or 100–109 mmHg | relative | Low and moderate intensity only, no breath-holding or Valsalva, no maximal testing |
| During exercise: systolic > 250 or diastolic > 115 mmHg | absolute | Stop immediately, seat the client, re-measure after 5 minutes |
| Resting heart rate > 120 bpm | absolute | Session does not begin, referral to a physician |
| Newly detected irregular pulse | absolute | Session cancelled, referral to a physician |
| SpO₂ during exercise ≤ 88 % | absolute | Stop immediately, re-measure, call an ambulance if it persists |
| Temperature ≥ 37.5 °C, acute infection | absolute | No session until full recovery |
| Blood glucose < 3.9 mmol/l | absolute | The 15/15 rule; start only at ≥ 5.0 mmol/l and feeling well |
| Blood glucose ≥ 13.9 mmol/l | absolute | No session without written medical clearance |
One boundary worth knowing: the coach does not measure glucose. The client reports the value from their own glucometer; the coach only makes the clearance decision.
Medications change the rules of training, and the question is not idle curiosity
The clearest example is beta blockers. They lower both resting and maximum heart rate, so the "220 minus age" formula and percentage-of-maximum zones give a systematically wrong answer. For such a client heart rate stops being a measure of intensity, and load is guided by the Borg 6–20 rating of perceived exertion with a target corridor of 12–14. A second reason to ask: beta blockade can mask the symptoms of hypoglycaemia.
Diuretics mean a risk of dehydration, potassium loss, orthostatic hypotension and cramps — hence a drinking plan and caution with the sauna and with heat. Metformin alone does not cause hypoglycaemia, but combined with sulfonylureas or insulin it does. In total the programme covers twelve drug groups under one scheme. And immediately the boundary: the coach records the medication in the client's file but does not discuss dosages, does not comment on the prescription, and never advises skipping or shifting a dose.
Pain: one scale for the whole gym
Pain is governed by a single numeric scale from 0 to 10, where 0 is no pain and 10 is the worst pain imaginable. The client states the number, the coach records it.
0–2 — train as usual, load may increase. 3–5 — train, but add nothing today or at the next session. Above 5 — stop the set and reduce the load by one step. Pain during an exercise must disappear as soon as the exercise ends, and pain after a session must return to its baseline level by the next morning.
Stop immediately and refer to a physician in case of pain at rest or at night, numbness, weakness in an arm or leg, impaired pelvic organ function, injury with a clear mechanism, fever, or unexplained weight loss.
What a coach never does
- Never diagnoses or names the presumed cause of pain or a symptom. "I'm not a doctor, but your labs clearly show…" is a diagnosis regardless of the disclaimer.
- Never interprets an ECG, lab results, imaging, or physicians' reports.
- Never prescribes, cancels or adjusts medications and supplements.
- Never writes rehabilitation programmes, prescribes therapeutic diets, or provides psychological treatment.
- Never runs exercise testing on people with established cardiovascular, metabolic or renal disease without written medical clearance.
- Never starts or continues a session once an absolute threshold is reached — regardless of how the client feels or how strongly they insist.
- Never forwards screening files, measurement results, client photos or videos through messaging apps.
And the rule that destroys the most popular illusion: a client's refusal of medical examination, their signature on the consent form and their insistence on training do not transfer the coach's responsibility to the client and do not change a single line of the table of limit values.
What an ordinary gym does and what the standard requires
| Common practice | Programme standard |
|---|---|
| One verbal question: "any contraindications?" | PAR-Q+ in writing, seven core questions plus follow-up blocks |
| Fainting is never asked about | A separate, direct question about fainting and blackouts |
| Heart rate zones from "220 minus age" for everyone | On beta blockers heart rate is not a measure of intensity; Borg scale, corridor 12–14 |
| The clearance decision stays in the coach's head | The decision and its reasoning are recorded in writing, dated and signed |
What remains genuinely unsettled
Posture and pain. Static postural assessment is weakly related to the presence of pain, and inter-rater reliability of visual assessment is low. "Pelvic tilt" as an explanation for back pain is a speech habit, not a conclusion.
Movement screening. Agreement between raters on FMS-type screens is high, with an intraclass correlation coefficient of about 0.81, yet injury prediction from a composite score of 14 or below is poor: sensitivity around 0.45, specificity around 0.71. The screen describes how a person moves today and feeds exercise selection; it is neither a diagnosis nor an injury forecast.
Body composition measurement. The standard error of skinfold caliper assessment is about ±3.5 percentage points of body fat, the typical error of bioimpedance is 3.5–8 percent, and a glass of water or a hot shower shifts its result by 2–3 percent. The error in estimating maximal oxygen uptake from submaximal cardio tests is 10–15 percent. Hence the programme rule: a measure whose error is unknown is no basis for changing a programme and is not reported to the client as a result.
Where the referral threshold belongs. The 2015 revision deliberately moved it, while PAR-Q+ itself is intentionally biased toward sensitivity, that is toward false positives. The balance between "never miss a sick person" and "don't send healthy people to the doctor" remains under discussion.
Myths
- "The questionnaire is a formality for the club's insurance." Three of screening's four purposes concern the client personally: not starting a dangerous session, restricting dangerous load, and prescribing the right one.
- "I'll sign that I take responsibility for myself and they'll take me." A client's signature does not transfer the coach's responsibility and does not cancel absolute thresholds.
- "180 over 110 is just nerves, we'll measure later." That is an absolute threshold. The session does not begin and a written referral is issued.
- "My coach will look at my lab results and explain them." Interpreting a laboratory result is diagnosis and lies outside the coaching profession.
- "I have a tilt, that's why it hurts." A coach may not name the cause of pain. He regulates load on the 0–10 scale and refers to a physician.
- "An older person with poor test results is better off not training." The opposite: a result below threshold means a referral to a physician and simultaneously starting safe strength work.
Check your coach in five minutes
- Did he ask separately about fainting and blackouts?
- Did he ask about regular tablets in a way that made you recall even the ones you don't think of as medication?
- Did he measure blood pressure and resting heart rate before the first load?
- Did he write the clearance decision down rather than just nod?
- Did he explain, before starting, which signs stop the session immediately?
If all five answers are yes, you are with a coach who works to the standard. The 720-hour retraining programme these rules come from was developed by the Bodybuilding and Fitness Federation of Uzbekistan, which owns the methodology used to train and certify coaches.
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