Exercise Professionals’

Action Guide
Exercise Professionals’
Action Guide

How to Work with Health Care Providers:

A Systematic Approach
This Exercise is Medicine® Action Guide provides exercise professionals with
a blueprint for how to work effectively with physicians and other health care
providers to use exercise and physical activity, in the correct “dosage,” as an
effective patient care “prescription.” This guide supports one of the primary goals of the Exercise
is Medicine initiative: to bring health care providers and exercise professionals together as part
of the care continuum and ensure that exercise professionals are prepared to work safely and
effectively with referred patients.

By using the resources listed below, you will be able to optimize your opportunities to build
credibility and work with health care professionals in your community. These forms/resources can
be found on the EIM website (www.exerciseismedicine.org) on the Exercise Professionals page,
and their use is referenced within this guide.

Due to potential variations in the law from one state to another, the documents provided in this
guide should be reviewed and approved by legal counsel before they are used by you or your
organization. ACSM makes no warranties or representations regarding the documents provided in
this guide, and you or your organization assume all risk associated with any use of these documents.

Sample Forms and Templates

1. A
 CSM’s Exercise Preparticipation Screening Questionnaire for Exercise Professionals
• This questionnaire should be used in conjunction with ACSM’s screening algorithm
from ACSM’s Guidelines for Exercise Testing and Prescription.
2. H
 ealth History Questionnaire
3. S
 ample Medical Clearance Form
• I f you are going to reproduce this form for publication (written or electronic), please
obtain permission first from the author.
4. F
 itness Assessment Data Sheet template
•M
 odify this template to reflect the assessments that you typically provide.
5. I nitial Fitness Assessment/Physical Activity Plan
6. P
 atient Fitness Progress Report
7. I nformed Consent for Participation in a Health and Fitness Training Program
8. C
 ancellation Policy
9. A
 CSM’s Rx for Health series handout: Being Active for Better Health (this title and
others that are specific to various medical conditions can be found at
www.exerciseismedicine.org).

Exercise Professionals’ Action Guide 2

 Step 1: Professional Preparation
Develop your knowledge, skills and abilities, and you’ll be rewarded. You’ll need
a combination of formal education, recognized and respected certifications, and
practical business skills.

• Formal education: Earning at least a bachelor’s degree in an exercise science/wellness

field is important when working with a physician or other health care provider. Physicians
appreciate the value of a science-based college education; whereas they often don’t
understand the confusing landscape of fitness certifications. A college education improves
your chances of becoming a valued member of the extended health care team. If you do not
currently have a degree, do your best to attain one.
• Credentials: Become certified by an NCCA accredited or ISO/IEC 17024 fitness
organization such as ACSM, NSCA, ACE or NASM. For a list of NCCA accredited
certifications go to http://www.credentialingexcellence.org/nccadirectory. You will likely
have to explain the value of NCCA certification by educating a provider that this is the
same organization that certifies other respected health care professionals such as emergency
medical technicians (EMT), registered dietitians (RD), respiratory therapists (CRT),
and many nursing subspecialties. Earn the ACSM EIM Credential to give you additional
knowledge and credibility (may be required to facilitate EIM programming). The online
course modules associated with the EIM Credential are available as continuing education
to anyone who is interested in learning more about health care, guiding clients/patients
with common chronic medical conditions and providing effective behavioral support.
Accredited certifications require that you possess a current certification in CPR/AED. This
is critical for your client’s protection as well as your own and will be expected by a referring
health care provider.
• Practical skills: Expand your knowledge and skills through internships, seminars,
conferences and varied employment settings. Find a mentor with expertise in your area of
interest and create opportunities to work with them, even if it means volunteering your
time. If you plan to work with a specific population, participate in hands-on continuing
education to enhance your ability to tailor a workout program to their special needs.
• Work Experience (medical fitness, corporate, club/private studios, etc.): Working in
a variety of settings can teach you how to effectively guide different populations (i.e.
seniors, students, sedentary individuals, or those with chronic health conditions or medical
challenges) using a variety of tools and techniques. Take the opportunity to learn from
seasoned and respected exercise professionals, teachers and health care providers who can
provide you with valuable insights.
• Obtain and maintain professional liability insurance: Consider ACSM’s insurance
partner Forest T. Jones. To obtain rate information, contact FTJ directly at (866) 820-5183
and identify yourself as an ACSM Member or ACSM Certified Professional.

Be a Lifelong Learner
Every exercise professional, particularly in the medical fitness space, should stay on top of the
latest developments in the science and practice of exercise prescription, training and testing.
This means attending conferences and workshops to acquire new skills and knowledge,
reading relevant articles and journals such as ACSM’s Health & Fitness Journal ®, visiting
ACSM’s website, reading ACSM’s and EIM’s e-newsletters, and utilizing the latest publications
to inform your practice. Consider some of these essential ACSM titles for your library:
• ACSM’s Guidelines for Exercise Testing and Prescription, 11th edition
• ACSM’s Resources for the Exercise Physiologist, 3rd edition ( June 2021)

3 Exercise Professionals’ Action Guide

 • ACSM’s Exercise Testing and Prescription, 1st edition ( Jan 2018)
• ACSM’s Clinical Exercise Physiology, 1st edition (Oct 2018)
• ACSM’s Complete Guide to Fitness & Health, 2nd edition (2017)

Step 2: Connect with health care providers and

medical practices
There are many ways to begin to establish connections with local health care
providers and medical practices. Try any and all of these:
• Ideally, you work in a fitness facility that has a formal association with a local health
care system or medical practice. Health care systems that have made a commitment to
support healthy lifestyles for both patients and providers may offer various interventions,
particularly as part of population health programming. Incorporating Exercise is Medicine®
means that a practice has integrated the Physical Activity Vital Sign (PAVS) into the
electronic health record (EHR) to assess whether the patient is meeting the National
Physical Activity Guidelines. They have also set up a systematic referral process to
allow patients to access physical activity resources (programs, places or professionals) in
the community or within the health care system. Ask your club manager to approach
clinic leadership at a nearby medical facility to offer exercise services through a formal
partnership. Consider discounted memberships for employees of the health care system.
Doing a good job with these clients and sending concise progress notes that can be
scanned and entered into the EHR will position you as an extended member of the health
care team.
• I f a client has made good progress, ask if they would be willing to share this information
with their health care provider. Write a summary progress note that they can take with
them to their next appointment. If a provider has two or three patients getting healthier
and more active as a result of their work with you, that’s one of the best sources of
advertising. Results speak volumes. Follow up by contacting the office and leaving your
information/business cards with the provider’s medical assistant; indicate the you have
been working with several patients from the practice already.
• There may be opportunities to provide small group exercise or personal training services
to class participants in the National Diabetes Prevention Program, particularly since
new program criteria now include physical activity as an outcome measure. Since these
individuals have been diagnosed with pre-diabetes and possibly other cardiac risk factors,
exercise professionals must have the knowledge and skills to work safely with these
populations. Obtain the EIM Credential to learn more about working with those who
have prediabetes and type 2 diabetes. Go to the DPP website to find out about how to
become a DPP lifestyle coach or identify local programs that might need fitness services
(www.cdc.gov/diabetes/prevention/index.html). To facilitate a DPP program for Medicare
participants, it is necessary to have a National Provider Identifier (NPI) number. Clinical
exercise physiologists (CEPs) are listed in the NPI code. If you are a CEP and don’t already
have an NPI number, now is the time to get one. Go to: https://nppes.cms.hhs.gov/#/.

Exercise Professionals’ Action Guide 4

 • Attend community lectures or events given by physicians and other health care providers,
particularly around a topic of relevance regarding physical activity and health outcomes.
Introduce yourself at the end, pose a thoughtful question about the topic, and ask if
you could help them and their patients. Briefly (30 seconds!) share your educational
qualifications and special training. Have business cards handy and indicate where you train
clients (at a club, in their homes, etc.). Providers will be impressed if you are knowledgeable
yet eager to learn.
• Physicians who exercise are more likely to recommend physical activity to their patients. If
you work closely with health care providers who use your fitness facility, ask if they would
be willing to refer appropriate patients to you or to a program within the facility. What
would make that process easy for them and their patients? Perhaps they could introduce
you to a colleague or member of their medical team with whom you could discuss this
further.
• Many health care providers are more likely to refer to a specialty program that meets the
needs of their patients, rather than an individual personal trainer. Develop, deliver and
promote a population-specific or Exercise is Medicine® program at your fitness facility.
EIM programs must meet certain criteria and be facilitated by exercise professionals with
the EIM Credential. Small group exercise programs tailored to individuals who are not
typically served by many fitness facilities (those with chronic diseases, older clients, etc.)
can provide needed social support, guidance and structure.
• Check to see if there is a Walk with a Doc program in your community
(https://walkwithadoc.org/). In this program physicians generously share their time and
go for a walk with patients, usually on a weekend morning. Join the walk, be friendly, and
encourage the participants. Introduce yourself to any clinicians who are present and offer
to assist with the program if needed, or to work individually with their patients.
• Volunteer to lend your expertise to community fitness activities sponsored by a local
hospital/clinic. Write an article for a hospital health/wellness newsletter or website blog
on the benefits of exercise for a specific medical condition, including brief training tips and
your contact information. Partner with clinicians to give community presentations. Get
your name out there!
• Health care providers prefer brief “meet and greets.” A short face-to-face meeting helps
to establish a personal connection. You may be able to catch a provider for a few minutes
during lunch or invite them to an open house or lunch at your fitness facility. Put together
a packet to include your business cards, flyers for patients, and a handwritten card.
• Your resume or marketing piece should be concise and highlight your most impressive
education, certifications and skills. Indicate where you provide services (patient’s home,
specific fitness facility, etc.). You might include one or two brief testimonials from satisfied
providers or patients. This piece may be provided to interested patients at the time of their
medical appointments. If the medical practice keeps a list of community resources for
patients, your goal is to get on that list as a credible physical activity professional.

5 Exercise Professionals’ Action Guide

 Step 3: Working with Referred Patients/Clients

Patient/client safety is your first area of concern.

• When you accept a new client or receive a referral from a health care provider,
use the Exercise Preparticipation Health Screening Questionnaire for
Exercise Professionals form, guided by the updated screening algorithm found in the 11th
edition of ACSM’s Guidelines for Exercise Testing and Prescription. A handy infographic
of this algorithm can be found on the ACSM website. If you have any questions about
the individual’s ability to safely engage in exercise, utilize the Medical Clearance Form
and obtain the referring provider’s approval and/or patient-specific guidelines. You may
also use the Health History Questionnaire, Fitness Assessment, Informed Consent and
Cancellation Policy forms that you’ll find in this guide. To find the most recent version of
the PAR-Q+ physical activity readiness questionnaire, go to www.eparmedx.com.
• Utilize the latest edition of ACSM’s Guidelines for Exercise Testing and Prescription to
ensure that you are applying the most up-to-date recommendations regarding exercise for
sedentary individuals and those with common chronic diseases or medical conditions.
• Thoughtfully apply the principles of progression, intensity and volume (frequency and
time) to engage your patients in safe and enjoyable exercise. Begin with light-to-moderate
intensity exercise (that the client enjoys and/or agrees to do). Move your client through a
progressive transitional period to allow them to acclimate to the program, minimize the
risk of musculoskeletal injuries, and have a pleasant experience to facilitate adherence.
• If your client is apparently healthy, provide EIM’s Being Active for Better Health and
Sit Less Move More patient handouts (print or email). If your client has a chronic health
condition, look at EIM’s Your Prescription for Health series to see if your patient’s
condition is included. Provide a copy–if not already given to them by their health care
provider–and review the disease-specific guidelines. This series was created with experts
from the American College of Sports Medicine and is available in Spanish.
• Be aware of any disease-specific risks associated with exercise when your client has a health
concern. If your client experiences significant changes in their health or mobility status that
affect their ability to exercise safely, encourage them to contact their health care provider.
If you have concerns or questions about the client’s safety during a workout, discontinue
exercise and seek advice from the referring provider or the appropriate medical expert.
• Monitor your clients for signs or symptoms of cardiovascular disease/distress. Know the
closest location of an AED in your facility. Maintain your CPR/AED certification and
periodically review the key steps and emergency procedures in your facility.

Build a safe and effective program.

• Conduct an individualized assessment of the client/patient. This can be comprehensive
or targeted to the individual’s health concerns or primary diagnosis. Establish a baseline
so that you can measure your client’s progress. A sample Fitness Assessment Data Sheet
is provided, but should be modified based on patient type, health, fitness, access to
equipment, and setting.
• If the results of the Exercise Preparticipation Screening form indicate the need for medical
clearance prior to the initiation of moderate or vigorous-intensity exercise, request a

Exercise Professionals’ Action Guide 6

 completed medical clearance form from the patient’s primary care provider. Consider using
the sample Medical Clearance Form. Fill out as much information as you can so that it’s
easy for the provider or medical staff to complete it and send back to you (with the patient
or by mail). Your client/patient will need to sign a release of medical information form at
their doctor’s office, allowing you to receive any protected health information.

Provide behavioral support to engage your client.

• Your ultimate goal is to build your client’s self-efficacy, so they continue to integrate
physical activity into their lives long after their contact with you has ended. You want
them to feel so good about their experience with exercise that they can say “I’m the kind of
person who is physically active because it’s part of who I am now – and I actually enjoy it!”
• Utilize motivational interviewing to tap into the patient’s own reasons for being there and
what lifestyle changes THEY would like to make – what’s important to THEM.
• Acquire new skills as a lifestyle or health/wellness coach to make you more effective in
supporting and guiding your patients toward a physically active lifestyle. Wellcoaches, an
ACSM partner, and the International Consortium for Health and Wellness Coaching
(ICHWC) provide respected training and certifications for individuals wanting to move
into this profession. https://wellcoachesschool.com/ and https://ichwc.org/. Exercise
professionals make themselves even more valuable in a health care setting when they can
facilitate a spectrum of healthy lifestyle changes in this new role.
• Establish a schedule of regular appointments that works for your client. Plan to contact
them via email, phone or text (their preference) to confirm their participation and
reinforce their activity plan. Even brief touchpoints help to keep your clients engaged and
accountable. Leverage digital activity trackers and smart phone apps. Remember that in
this era of technology, a personal touch and genuine concern can be powerful.

Step 4: Communicating with Providers

Instead of hand-written patient charts, medical information is now managed
almost solely through an electronic health record (EHR). This means that all
information about a patient’s care, both within and outside of the health care
provider’s office, must be communicated and stored electronically. This provides
a challenge for community-based exercise professionals who deliver fitness services outside of
the health system. Any written notes or assessment documentation will need to be scanned
into the EHR by a member of the office staff to be part of the patient’s record. Find out what
communication method is preferred, e.g. fax, secure email?

You have several communication goals:

• if needed, ensure that you have medical clearance and individualized guidelines from the
health care provider;
• provide information to the clinician from the patient’s initial assessment and send periodic
progress notes (know that the patient can access their medical records so keep that in mind
when offering opinions or making subjective observations about a client);

7 Exercise Professionals’ Action Guide

 • establish your professionalism and responsiveness;
• refer the patient back to their provider when there is a concern or recommend other
professional resources that may be helpful (dietitian, mental health professional, certified
diabetes educator, etc.).
Consider the following tips:
• W hen communicating with a health care provider, use concise documentation and focus
on functional outcomes and disease-specific data that may be affected by the physical
activity intervention. Initial Fitness Assessment/Physical Activity Plan and Patient Fitness
Progress Report sample forms are provided. Send initial assessment notes and periodic
updates (every 3-6 months) to the health care provider. If your client tells you that they
have an upcoming visit with their provider, this is an ideal time to either send a progress
report or ask the client to carry one with them to the appointment.
• You may keep a detailed record of your client’s exercise regimen and fitness measurements,
but a summary of the most relevant data will be most appreciated by the provider – and
may actually be read! This requires thoughtful decision-making about what’s most likely
to be clinically meaningful to the provider. You may also wish to report data related to
compliance with the program (attendance, exercise volume) and/or achievement of the
recommended levels of physical activity.
• Always protect the privacy of patient/client information. If the fitness facility where you
work has a formal partnership with a health care system, it is your responsibility to be
aware of the basic tenets of HIPAA legislation and follow them. Don’t discuss a patient’s
medical history, personal health, or fitness information with other clients or staff, unless
your client has given written permission for you to do so. To enable communication
between you and the client’s health care provider, the client will likely need to sign a release
of medical information form at the provider’s office.
• Health care providers have clinic schedules and obligations that are stressful and time-
consuming. They typically won’t have time to speak with you during a busy clinic day.
Rates of stress and burnout are at an all-time high. Physicians must rely heavily on
a support team of medical and office staff to see patients and manage their practice.
Anything you can do to make life easier or work through other designated members of the
team will be appreciated. Ask when/how you can contact a provider if needed, i.e. phone,
text or email, particularly if you have questions or concerns about their patient’s response to
exercise.
• Technology solutions: As health care systems explore ways to track and monitor patient
health data and treatment compliance, mobile applications and digital tracking devices are
beginning to be utilized. If you can enter patient data directly into one of these platforms
to automatically sync with the patient record, that is ideal.

Exercise Professionals’ Action Guide 8

Typical Sequence of Steps During a Patient’s Office Visit

1. P
 atient moves from waiting room to exam room, where a medical assistant:
• Measures the patient’s weight, blood pressure and other vital signs (hopefully including the
PAVS);
• Asks the patient the reason for their office visit;
• Asks the patient what medications they are currently taking;
• Leaves the patient in the exam room, informing them that the health care provider will be
in shortly.
2. H
 ealth Care Provider (MD, DO, NP, PA) enters the exam room and:
• Reviews the patient’s chart, looking at the reason for the patient’s office visit, their body
weight, blood pressure, and medications being taken, as well as any other relevant historical
data;
• Reviews/discusses the results of any tests made prior to the office visit;
• Discusses areas of concern expressed by the patient or identified in the health history;
• Makes appropriate recommendations to improve or manage the patient’s health.
o It is during this last (“recommendation”) phase of the office visit that a health care

provider can and should recommend exercise as a treatment solution and identify any
activity limitations.
o This is also the time when the health care provider could make a recommendation or

referral for the patient to consult with a physical activity resource either within (physical
therapy, cardiac rehabilitation) or outside the health system (fitness facility, exercise
program, exercise professional).
3. M
 A or LPN returns to the exam room to follow-up with the patient and ensures that the
patient understands the provider’s instructions and next steps regarding:
• follow-up testing or appointments
• educational materials recommended by the provider
• referrals or prescriptions

Final Thoughts
Having a successful referral relationship with a health care provider or medical practice will
allow you to make a difference in the lives of those who can benefit most from increased levels of
physical activity. You will expand the health care provider’s reach and effectiveness by providing
services that they don’t have the time nor the ability to deliver. Providers want to see how their
patients benefitted from your intervention – show them results to confirm that you delivered.

Copyright © 2022 Exercise is Medicine

9 Exercise Professionals’ Action Guide