Risk stratification

An example of an informed consent form can be found in the Learner Assessment Record (LAR).

Duty of care

An instructor has a duty of care to ensure they take every precaution to protect the wellbeing of their class participants. A duty of care is when an individual is responsible for an activity where there is a risk of potential physical, mental or economic harm. It’s designed to protect against unreasonable suffering or loss to an individual. If there is a breach of duty then a legal liability could be imposed against the duty of care owner. Group exercise instructors have a duty of care to ensure participants are taught safe and effective exercise. Simply leading without giving teaching points or making corrections to bad technique means there is a breach. Allowing participants to join in after missing a warm up or leaving prior to cooling down appropriately could also land an instructor in court.

The key factor for determining participation in activity should be the extent to which the potential or actual risks are outweighed by the benefits. This is called risk stratification. Usually, the benefits of being more active will outweigh the risks.

Risk stratification will:

• Identify people who may be at risk during exercise or during a physical assessment or test.

• Assess the level of risk (low, moderate, high) to the participant and the likelihood and severity of risk attached to a client becoming more active. • Assist with exercise prescription and recommendations. • Enable the development of a suitably informed, safe and effective exercise programme, where the level of risk is acceptable and minimised. • Ascertaining the appropriate level of monitoring and supervision.

Risk stratification models provide some guidance that can be used by an instructor to identify the participant’s Cardiovascular Disease (CVD) risk factors and other lifestyle factors that could increase risks. The client can usually be assigned to one of following categories:

• Medical referral participant has a serious condition or serious medical risk factor for

CVD. They should always be referred to a medical professional for clearance. The majority of participants’ in this group will benefit from a regular exercise programme but need to be supervised by an appropriately qualified instructor.

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• Special attention participant may have several factors that contribute a higher risk for CVD. Many factors have to be taken into consideration. Two or more risk factors place the client at low to moderate risk and multiple factors will increase the risk.

These clients should be referred to a medical professional for clearance and might be best suited to an exercise referral instructor.

• Normal (fit and healthy) participant has no health problems, no identified risk factors for CVD and have been following a regular exercise programme for at least two months.

Risk stratification methods

In the UK, there is no single model used for risk stratification and therefore no standardised approach within the fitness industry.

Risk stratification pyramid

The risk stratification pyramid is one of the earliest UK models for risk stratification. This model identifies four levels of client:

• Apparently healthy populations at the bottom of the pyramid. • Followed by low-risk populations. • Moderate-risk populations. • High-risk populations at the top.

At each stage of the pyramid the qualifications that an instructor needs in order to work with these groups are stated (based on the qualifications available at the time it was developed) along with the type of exercise environment/ activity setting.

The logic model

The ACSM model for risk stratification states that the health and medical history of the person should be reviewed to check for:

• The presence of diagnosed CVD conditions. • Signs and symptoms to indicate the presence of CVD, pulmonary disease and/or metabolic disease. • CVD risk factors.

Clients who show more than two signs and symptoms should be signposted to a GP prior to participation and may then be referred for a more specialist programme depending on other factors e.g., current activity levels and overall health status. See appendix.

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