Why Structured Intake Matters for Post-Physical Therapy Clients

Joshua Roiland, BS, CSCS, CES, FNS, FMS-1

Program Director, Best Fitness

January 20th, 2026

Case Study: The Risk of Inadequate Screening

(Presented anonymously to protect client privacy)

A client with ambitious training goals approached us for personal training. Following a comprehensive review of their medical history and overall risk profile, it was determined that initiating structured training at that time was not appropriate based on identified health considerations. In alignment with established American College of Sports Medicine (ACSM) guidelines, the client was advised to seek medical clearance prior to beginning a formal training program, with the understanding that light-to-moderate physical activity would be appropriate following physician approval, as recommended for individuals with identified risk factors.

Shortly afterward, the client initiated training elsewhere without comparable screening or individualized oversight and subsequently experienced a serious adverse health event requiring hospitalization.

While no individual or facility is being blamed, this case underscores the critical importance of structured intake, appropriate risk stratification, and individualized programming in reducing preventable adverse events during exercise participation.

The Need for Structured Intake in Post-Rehabilitation Clients

Several studies highlight that "Prescription from ordinary primary care centres staff yielded adherence to PA practice in the long term" (Martin) and clinical guidance increasingly supports exercise referral schemes as a way to improve activity adherence and health outcomes.

This evolving practice is part of a broader shift toward collaborative models of care. There is a growing need for structured, evidence-based intake processes that prioritize safety, individualized programming, and measurable outcomes. This article outlines a framework reflecting emerging best practices in fitness for rehabilitation populations.

Common Pitfalls in Current Fitness Settings

• Minimal assessment: Many gyms provide equipment but lack intake or risk assessment. Despite industry guidelines, "only 40 of 123 health/ fitness facilities asked members to complete a pre-exercise screening. [and] that for those that did, only 50% required physician clearance for high-risk members prior to participation"(Springer) Clients often navigate programs independently, increasing risk if prior injuries or medical conditions are not evaluated.

• Reliance on liability waivers: Some facilities allow members to train freely without structured guidance, which is risky for high-risk or ambitious goals.

• Revenue over programming: Certain gyms prioritize membership revenue over individualized programming, leaving clients vulnerable to unsafe exercise.

  
  

Even in welcoming environments, the absence of systematic intake and assessment can lead to adverse outcomes. Structured programming ensures guidance aligned with abilities, medical history, and goals.

Industry Standards in Fitness Intake

Modern practice is shifting toward differentiated intake pathways, replacing one-size-fits-all methodologies with individualized, evidence-informed exercise programs that complement medical care and rehabilitation.

At Best Fitness, I oversee programming and client care as the owner and bring expertise as a:

• NSCA Certified Strength and Conditioning Specialist (CSCS)

• NASM Corrective Exercise Specialist (CES)

• ACE Fitness Nutrition Specialist (FNS)

• FMS-1 Certificate Holder

  
  

I propose the use of a two tiered process including four population categories to ensure safe, effective programming for every personal training client:

The Best Fitness Tiered Intake Framework

Our facility utilizes a dual-layered screening process. We first stratify by Pathophysiological Risk (ACSM Guidelines) to ensure medical safety, followed by varying degrees of biomechanical assessment which are provided based on population and individual level requirements.

Category I: Post-Rehabilitative Transition (The "Bridge" Phase)

• ACSM/Clinical Profile: Individuals recently discharged from acute physical therapy or surgical intervention. While no longer requiring clinical "treatment," these clients possess "sub-medical" movement compensations and guarded neural patterns that contraindicate high-threshold loading.

• Strategic Focus: Implementation of the NASM Corrective Exercise Screen, followed by the usage of specially designed individual programs based on the Corrective Exercise Continuum. We focus on Inhibiting overactive synergists, Lengthening shortened structures, Activating underactive local stabilizers, and Integrating those components into functional patterns. This population may proceed to Category II, III or IV based on program success, and client goals.

Note: Expanded screening protocols and fitness assessment rationale for this population using the NASM CES protocol will be addressed in a dedicated professional resource in the upcoming blog posts

Category II: Medically Managed / Controlled Clinical

• ACSM/Clinical Profile: Clients with known, stable chronic conditions (e.g., Hypertension, Type II Diabetes, or controlled metabolic disease). These individuals require Pre-participation Health Screening to determine if medical clearance is necessary prior to initiating vigorous exercise.

• Strategic Focus: Symptom-limited progression and physiological monitoring. Exercise is programmed as a non-pharmacological intervention, focusing on improving systemic health markers while respecting clinical boundaries.

Note: Expanded screening protocols and fitness assessment rationale for this population will be addressed in a dedicated professional resource in the upcoming blog posts

Category III: Asymptomatic / Low-Risk (General Population)

ACSM / Clinical Profile: Individuals without known cardiovascular, metabolic, or renal disease and no signs or symptoms suggestive of underlying pathology.

Screening Focus: Baseline fitness and movement literacy screening to establish current capacity and identify modifiable risk factors.

Programming Emphasis: Progressive strength training, metabolic conditioning, and foundational injury-prevention strategies aligned with individual goals.

Note: Expanded screening protocols and movement assessment rationale for this population will be addressed in a dedicated professional resource in the upcoming blog posts

Category IV: Performance & High-Demand Populations

ACSM / Clinical Profile: Asymptomatic individuals with high physical demands related to sport, tactical, or occupational performance.

Screening Focus: Advanced movement analysis and workload tolerance screening to assess force production, movement efficiency, and injury risk.

Programming Emphasis: High-threshold loading, power development, and pre-habilitative strategies designed to increase resilience under repeated stress.

Detailed biomechanical screening frameworks and performance-specific assessment models will be addressed in a dedicated professional resource in the coming weeks.

This layered approach enables tailored assessments, safe progression, and measurable outcomes.

Why Structured Intake Matters

Implementing structured intake benefits the field by:

• Enhancing client safety through systematic screening

• Improving outcomes with individualized programming creating a "significant difference... following individualized and standardised interventions"(Kirton)

• Aligning with evolving professional standards, emphasizing ethical, evidence-based practice

• Encouraging collaboration between fitness professionals, medical providers, and rehabilitation specialists

This approach reflects the direction of the fitness profession: individualized, evidence-informed exercise pathways that prioritize safety and accountability while improving measurable outcomes.

Positive Case Study: Improved Shoulder Function

(Presented anonymously to protect client privacy)

A middle-aged client with chronic knee issues, under the care of their physician and physical therapist, began working with me to address subclinical upper body movement limitations and general fitness.

At the start, they had limited shoulder flexion and could not raise their arms overhead. Through targeted mobility drills, corrective exercises, and progressive resistance training, the client achieved full, pain-free overhead range of motion. As a result, they were able to perform band-assisted pull-ups and continue safely building upper body strength.

Working in collaboration with their healthcare team, this sub-medical approach allowed the client to progress safely without exceeding their medical clearance.

This case demonstrates how structured, individualized programming can improve functional movement and reduce discomfort, highlighting the value of sub-medical corrective strategies in complementing professional care.

Baseline Facility Standards for Safe Referrals

When referring clients to a fitness facility, PTs and rehabilitation professionals should look for:

• Structured intake: Medical history, movement assessment, and goal evaluation

• Qualified coaching staff: NCCA-accredited certifications AND qualified oversight in corrective/post-rehab programming

• Evidence-informed programming: Tailored to abilities, health status, and rehab stage with measurable progression

• Safe training environment: Proper equipment, high-risk movement protocols, and monitoring

• Collaboration with healthcare providers: Communication with physicians/PTs as needed

Conclusion

Structured intake is no longer optional for fitness professionals working with post-rehabilitation or medically referred clients. By adopting differentiated screening categories, evidence-based

assessments, and progressive programming, exercise professionals can:

• Ensure client safety

• Improve measurable outcomes

• Align with emerging standards in the fitness field

For a more in-depth professional guide with step-by-step protocols, diagrams, and evidence-based recommendations for post-PT clients, a resource will be available next week.

*Medically-Referred & Post-Rehabilitation Coaching

At Best Fitness, all coaches working with medically referred or post-PT clients are NCCA-accredited Level Fitness Professionals. Each client receives a structured intake, movement assessment, and individualized exercise program (with the qualified oversight from the program director) designed to safely support recovery, functional movement, and overall fitness. Our coaches collaborate with healthcare providers when appropriate, ensuring evidence-informed, sub-medical programming.

Citations:

Kirton, Michael J., et al. “The Effects of Standardised versus Individualised Aerobic Exercise Prescription on Fitness-Fatness Index in Sedentary Adults: A Randomised Controlled Trial.” Journal of Sports Science & Medicine, vol. 21, no. 3, 1 Sept. 2022, pp. 347–355, PMC9459763, https://pmc.ncbi.nlm.nih.gov/articles/PMC9459763/

Martín-Borràs, C., Giné-Garriga, M., Puig-Ribera, A., Martín, C., Solà, M., & Cuesta-Vargas, A. I., et al. (2018). A new model of exercise referral scheme in primary care: Is the effect on adherence to physical activity sustainable in the long term? A 15-month randomised controlled trial. BMJ Open, 8(3), e017211. https://doi.org/10.1136/bmjopen-2017-017211

Springer, J. B., J. M. Eickhoff-Shemek, and E. J. Zuberbuehler. “An Investigation of Pre-Activity Cardiovascular Screening Procedures in Health/Fitness Facilities: Part I: Is Adherence with National Standards Decreasing?” Preventive Cardiology, vol. 12, no. 3, 2009, pp. 155–162.

*Artificial intelligence was used as a drafting aid. All content was researched, reviewed, and edited by Joshua Roiland, B.S., C.S.C.S., C.E.S., F.N.S., FMS-1.