Safeguarding Guidance For Personal Trainers Against Minimised CV System Due To COVID

Mar 18, 2021

By Tim Saye

We recently looked at some of the risks when training clients that have had COVID-19. The physical effects of COVID aren't just felt in the short term limitations of their health and well-being, but longer-term, if they have long COVID, they may not be fully feeling themselves for quite some time. 

As a personal trainer, your role during this time is to help your client switch their focus to healthy habits and nourishing food. But once your client is ready to return to exercise, how can you support them in their journey back to health and make sure we're following proper medical guidance on what they need? The answer lies in our normal scope of practice but being absolutely crystal clear on what needs to happen for physical training to recommence. 

Step 1. Request Medical Clearance From GP

When it comes to returning to exercise after recovering from COVID for one of your clients, you may want to have a paper from their GP and potentially another from a cardiologist if they had severe symptoms before resuming their sessions. 

The risks of medical complications are considerably increased if your client had COVID. They're likely in regular contact with their GP and monitored by healthcare staff for some time after being clear of the virus. Taking direct guidance from the medical profession should guide your actions as a personal trainer and your client's activities.

Step 2. CV Assessment

Just like before COVID was a consideration, performing a cardiovascular assessment of your client will be critical. In terms of assessing lung capacity, your client may be able to compare performance on a peak flow meter. Alternatively, they may only have the ability to walk to the end of the garden path and consider the perceived exertion rate. The specific test matters less than consistently testing the same variable.

If they were clients before getting COVID, likely, you would both notice a significant reduction in cardiovascular capacity. That's fine, and the medical recommendation is to reduce intensity and training load to around 50% and to increase by no more than 10% per week in the beginning. 

Research suggests that 20-50% of people reporting to hospital with symptoms of COVID have chest pain related to heart problems, potential sudden heart failure, irregular heartbeats, and sometimes even need to be resuscitated because their hearts stop beating. 

Step 3. Heart Rate Training

Heart rate training for most general population clients is usually unnecessary, and other methods, such as RPE, are generally adequate. However, with clients who have had COVID, this could be a helpful indicator of why things feel much more demanding than they used to.

With the recommendation to reduce the effort to an initial 50%, 
heart rate training could monitor when your client is working too light or straining. The latter could be a sign to dial back the intensity. You will also be able to identify when they return to full health so that you can select the right intensity for development. With heart rate training, it's worth noting that a chest strap is more accurate than a wrist-based heart rate tracker if your client or yourself can invest in that.

Step 3. The Importance Of A Strong Referral Network

Recommendations from the British Medical Journal suggest using a multidisciplinary approach to support clients with their return to physical activity. Before commencing their training session, measuring pulse oxygen saturation through a fingertip sensor to monitor "silent hypoxemia" could be advisable. 

You can also use the handgrip assessment to test skeletal muscle function, including a measure of mitochondrial fitness. Finally, monitoring heart rate variability via a compatible fitness tracker to monitor fatigue and recovery can help you understand how much strain your client can take on any given day.

As personal trainers, you will be well placed to advise your client on exercise, but working alongside other health professionals will be essential. In addition to the medical team that will be overseeing the return to full health, there also may be other health care professionals involved. Working together with a group consisting of physios, osteopaths, and even mental health professionals could be required for some clients.

Step 4. Consistency And Progressive Load

While consistency will be vital in getting your client back to total health, your focus may be on progressively overloading them in terms of good habits and rebuilding a nutritional foundation together. Getting them to perform a daily walk around the block consistently will be far more important than getting them to bag a personal best - and that might be the case for several months. 

The goal will be to help them stay focused on their health and be patient with the progress they're making. But as a client-centered fitness professional, you already knew that. Their well-being will be of the utmost importance, which could involve them feeling frustrated about their perceived loss of fitness. 

This is when having a compassionate fitness professional in their corner could mean the difference between health and a dangerous setback. Our advice is to tread lightly, stay attentive, and be on the cautious side when it comes to exercise-induced symptoms, including extended DOMS and fatigue.


It's more important than ever that every personal trainer and online coach checks their paperwork is in order. If there's any missing documentation in your client files, particularly the PAR-Q, now is the time to collect these documents. 

If you need to liaise with other health professionals, far from making you look like you're unsure, it presents you as a true professional that's clear about what their clients need. In the following article, we're going to look at some practical steps to help ease our clients back into training without risking any setbacks to their health.