'Prescribing the exercise was, in many ways, the most straightforward element of programme design for this client: remaining emotionally detached proved a steep learning curve for our exercise referral specialist. For a client who has decided to undergo a serious operation such as in this instance, there were many personal issues to resolve and, as the operation was recent, occasions when reassurance and external professional advice was sought.

Initially, the client had stated that “starving” was preferable to training in the gym – so it was clear that empathy, creative thinking and a real desire to help would be as crucial to success as general support. We also discussed long held beliefs and looked at alternative viewpoints, sharing tools and techniques for behavioural change.

• The following skills and behaviours can help build effective relationships and appropriate boundaries:
• Set boundaries at the start to safeguard both client and trainer
• Actively listen to the client and help them question limiting beliefs
• Recognise when outside help is required and refer on
• Be clear about the programme’s objectives and set out a clear pathway of how the client can achieve this, both in relation to exercise and lifestyle change
• Dedicate time to study research on relevant topics that are highlighted and make that information accessible in ways that bring it to life for the client
• Be part of a strong and experienced team (this certainly helped our trainer on this occasion).

We help clients by using the extensive repertoire of skills we have at our disposal, primarily around safe and effective exercise and incorporating lifestyle change. But we are not trained to counsel and it is paramount we recognise our professional boundaries, have the resources to refer appropriately and step back when we are not what our clients need most. Appreciating just what a difference we make in the lives of our clients is pretty amazing, after all!'