How to Choose the Most Effective Assessments for Clients Who Have Chronic Disease
As a health and exercise professional, you play a pivotal role in helping your clients achieve their health, wellness and fitness goals by offering guidance, motivation, coaching and support. A crucial part of this process involves your intake and assessment process, which helps you understand their starting point, create customized training plans and provide the necessary coaching to help them reach their objectives.
Recent years have witnessed a shift in people’s motivations for exercising. While maintaining a healthy weight remains crucial, an increasing number of adults are turning to exercise to manage stress, improve sleep and reduce their reliance on medications, all of which can have a significant impact on their overall quality of life. This is especially true for those who are living with one or more chronic diseases, such as diabetes, heart disease and cancer. As a result, for many clients you may need to shift the focus of intake and assessment to look beyond fitness outcomes.
Chronic diseases represent a significant health crisis and are the leading causes of death and disability, according to the Centers for Disease Control and Prevention. Numerous organizations, including the American Heart Association, American Cancer Society and American Diabetes Association, have underscored the importance of exercise in managing these conditions. Nevertheless, research indicates that individuals with chronic diseases tend to exercise less than those without these conditions. Even institutions such as the National Institute for Aging emphasize the importance of exercise in the context of aging.
Clearly, exercise is essential, regardless of whether your client is among the six in 10 adults who have at least one medically managed chronic condition. In fact, one could argue that it is even more essential, but it’s worth considering if fitness outcomes—the primary target of assessments—can serve as effective motivators for them to sustain exercise and make essential lifestyle changes. In other words, do the fitness outcomes explored through traditional assessments provide enough motivation to encourage clients to stick with their exercise programs?
The short answer is, of course, not always. Read on to learn how you can more effectively work with individuals who have one or more chronic conditions, as well as some simple but powerful assessments you can use to track progress and empower your clients to keep moving forward.
Tailor Your Assessments to the Needs of the Individual
It’s essential to recognize that chronic diseases have both physical and emotional impacts on the body. While the physical effects are well understood, the emotional consequences can be more elusive. Both are often linked to unhealthy behaviors or coping strategies, such as increased sedentary behavior, poor dietary choices and alcohol use, as well as social isolation and a lack of supportive communities.
When evaluating a client’s overall quality of life, lifestyle and health history, it’s worth considering whether traditional assessments, such as the step test, sit-and-reach or body-composition measurements, truly matter during the initial appointment or if they merely reinforce the client’s current perception of their fitness and body discomfort.
That is not to say these assessments don’t have value or serve an important role in getting to know a client and establishing a baseline to guide exercise programming. For example, given that individuals with chronic diseases often have less skeletal muscle compared to their healthy counterparts, assessing muscular strength may be crucial for designing an effective exercise regimen.
Beyond their role in movement, skeletal muscles also play a vital part in metabolic health, as they are the primary consumers of glucose. Therefore, assessing muscle function, postural stability and kinetic chain mobility particularly through functional and movement training, is imperative. Other aspects to consider during assessments include sleep quality, emotional well-being, stress management and an individual's support system.
While using evidence-based measurements during the intake process is not mandatory and may be complex, it’s worthwhile to integrate well-being assessments and targeted discussions into the intake process. Additionally, the frequency of assessments can be personalized to keep clients engaged and motivated by showcasing meaningful results.
When working with individuals with chronic conditions, the opportunity to collaborate with their medical care team can enhance client adherence and create opportunities for business development.
As you conduct an initial client interview, consider asking questions such as:
- What motivated you to commit to this journey today?
- Can you tell me about your close relationships? Are they supportive or potential barriers?
- How can I support and motivate you?
- Do you prefer challenging exercises that push you out of your comfort zone or more supportive and motivational approaches?
- Have you had any noteworthy fitness or exercise experiences?
- How has your medical provider supported your condition management through lifestyle changes? Are you comfortable with me sharing updates with your provider?
When it comes to fitness measures, focus on those that assess muscular fitness, strength and functional abilities. Consider movements that account for extra weight or mobility limitations when moving in and out of machines, as well as activities that require getting up from the floor. These assessments should include moderate-to-high repetition ranges and incorporate range-of-motion movements.
Using the client’s own body weight (as opposed to external resistance) as a starting point is ideal for most clients and is easily measurable. Here’s a simple full-body assessment you can use:
- 1 minute of bench or box sit-to-stand (note the usage of arms for assistance): For clients who exhibit better functionality, use a wider stance and aim for a complete touch down to the bench or add a full overhead reach.
- 1 minute of elevated push-ups (on the countertop, bench or other elevated surface): Note the range of motion and body position.
- Elevated plank (up to one minute): Note the duration of the first hold.
Other effective movements include body-weight rows (using a suspension trainer or an elevated barbell), stair climbs, stationary lunges, shoulder presses using a wooden dowel, and a dynamometer to assess grip strength, which has been shown to be predictive of mortality.
Consider Multiple Dimensions of Well-being
In addition to fitness assessments, gaining insight into an individual’s overall well-being is invaluable. Various well-being assessments are available that focus on different health aspects and covering multiple dimensions of well-being. Many of these assessments target specific populations, such as the workforce or college students, and can provide valuable insights into your clients’ well-being, which can help you create a baseline of scoring that can be compared at a future date and discussed with your client.
Depending on the individual needs of your clients, additional tools worth considering are the Warwick Edinburgh Mental Well-being Scale (WEMWBS), the U Matter Assessment from Princeton and the Well-being Assessment for Adults from the Institute for Healthcare Improvement. All of these are evidence-based but may not fit your population or situation, so be sure to review them carefully.
Don’t Forget to Ask What Your Client Wants
In addition to making informed decisions about what assessments to use based on your client’s lifestyle and health history, it is also important to ask your client how they would like to monitor their progress. Including your client in the decision-making process about what may be meaningful for them to record and track throughout their program ensures a more client-centered and personalized approach to selecting assessments. To approach the topic of assessments with your client, try asking questions such as:
- What changes might be important for us to track throughout your exercise program?
- How will you know if the changes you are making are working?
- What aspects of your health have you monitored in the past and how did it help you to stay motivated?
- How would you like to monitor your progress?
Involving your client in assessment selection respects and promotes autonomy, which builds intrinsic motivation. And for clients who express a desire to address specific physical or health-related concerns, adding relevant assessments can provide a better understanding of their baseline and a tool for future comparisons. These assessments should be optional and based on the client's willingness to participate.
The ACE Mover Method™ in Action
To help put this information into context for your work as a health and exercise professional, the following section illustrates how the ACE Mover Method and the ACE ABC Approach™ can be applied to incorporate mental health and well-being into your work with a client, empowering them to pursue their physical activity goals and achieve greater mental health and wellness.
Meet Sarah, a new client who recently joined the gym and has signed up to work with a personal trainer. She is 44 years old, married with two young children and works in a technology job from home. She is currently taking blood pressure medication and her doctor informed her that her cholesterol and fasting glucose levels are on the rise. These health concerns, along with abdominal weight gain, have put her at increased risk for metabolic syndrome and pre-diabetes. Her doctor has suggested that she begin exercising and adopt a Mediterranean diet. During a preliminary conversation with the trainer, Sarah expressed feeling overwhelmed with her daily responsibilities.
Health and Exercise Professional: Hi, Sarah. It’s great to meet you! I’m glad you could make it today. You’ve taken a significant first step by committing to this session, and I’m excited to work with you.
Sarah: Thanks for accommodating my schedule. You’d think working from home would allow me more time, but there’s always so much to do for work and my family. I see friends who manage everything, including long workouts and homemade meals, and I feel like I never have enough time for my goals.
Health and Exercise Professional: Just being here and dedicating this hour to yourself is a fantastic start. Can you tell me a bit about your goals?
Sarah: I definitely want to lose weight. I’ve been gaining weight and feel uncomfortable in my skin. And if I can stop taking the blood pressure medication, which makes me feel achy and tired, that would be great.
Health and Exercise Professional: You mentioned your doctor’s advice about exercise and the Mediterranean diet. The Mediterranean diet is a solid choice, but if you'd like a personalized plan, I can refer you to a dietitian. Can you share what you hope to achieve as we begin our assessment?
Sarah: I want to lose weight, especially in my stomach, and I’d love to see more definition in my arms and legs. I enjoy walking but tend to use my phone while doing it. I’ve never been consistent with exercise, and I’ve avoided weights because I don’t want to look bulky.
Health and Exercise Professional: Walking is excellent, and incorporating strength training will help you tone your muscles. Don’t worry; women typically need to lift very heavy weights to put on a significant amount of muscle mass. But it’s good to remember that muscle is really beneficial for energy and metabolism, especially since muscle loss accelerates after the age of 30, and that loss occurs even faster when the body is coping with one or more chronic diseases.
We’ll start with two primary assessments today: a fitness assessment to gauge your current strength using body-weight movements and a well-being assessment to identify other areas we can work on, such as sleep or stress management. How does that sound?
Sarah: That sounds great. I’m relieved we’re not starting with the scale, but I’d like to track my weight in future sessions to monitor my progress. I hadn’t considered the other aspects of my life that exercise can help with, but I’d love to find ways to cope better with stress. My go-to, especially while working from home, is heading to the kitchen for caffeine or sugar. Can we discuss strategies for that too?
Health and Exercise Professional: Absolutely! Let’s begin with our fitness assessments. We’ll do a sit-to-stand, elevated push-up and a modified pull-up, each for one minute. Try to complete each movement with a full range of motion. After that, we’ll conduct a grip strength test and the well-being assessment.
Health and Exercise Professional: [After conducting assessments] Sarah, you did great! How did it feel?
Sarah: It felt great. I was nervous about not being able to complete the exercises, but I’m excited to take the well-being assessment to understand other areas I can work on in my life. I was surprised at how weak my grip strength is. Is there anything I can do to improve it? I’ve seen my mom struggle with opening jars, and I want to avoid that.
Health and Exercise Professional: Strengthening exercises will certainly help. Holding weights can build the muscles in your hands and forearms responsible for grip strength. I also came across an article linking the Mediterranean diet to improved grip strength. Would you like me to email it to you?
Sarah: Yes, please do. I have an upcoming appointment with my primary care doctor, and I plan to share it with her.
Health and Exercise Professional: Great! Our next appointment and your first training session is scheduled for Thursday. We’ll start working on exercises tailored to your current goals and fitness levels, and we will reassess your fitness and well-being in a month, just in time for you to share the results with your doctor. Stay hydrated, have a healthy dinner and I'll see you again soon!