College Blog
For many, a new year means a renewed focus on health and fitness goals.
Whether it’s building muscle, losing weight or training for a big race, January has many people hitting the gym – and some turning to physiotherapy.
But is it a physiotherapist’s job to help a patient meet their new year’s resolutions?
In this blog post we look at where physiotherapy fits into helping patients reach their health goals – and where it’s outside your scope of practice and could cross the line into personal training.
Weight Loss: Not a Physiotherapist’s Job
When it comes to weight loss, the boundaries are clear. Physiotherapists cannot diagnose a patient as overweight or underweight – and they should never prescribe weight loss or weight gain as part of a treatment plan.
Similarly, there’s no reason for a physiotherapist to analyze a patient’s body mass index (BMI) or give advice based on it.
If a patient asks you for help losing weight, you can refer them to a health professional who deals with diet and nutrition as part of their scope of practice (for example a doctor, nurse practitioner or dietitian).
A Note About Weight Bias
Weight bias (making assumptions about someone based solely on their weight) is a real problem in health care. In some cases, it’s deadly.
It’s important to be self-reflective so you can recognize if you’re making assumptions about a patient based on their size. Negative stereotypes can get in the way of seeing your patient as a full person and correctly diagnosing their problem.
Physiotherapy vs. Personal Training
What about a patient who wants to walk longer distances or learn to lift weights?
If pain or restrictions in movement prevent them from reaching their goal, physiotherapy can help.
Maybe it’s designing a program with gradual increases in walking distance, taking into account the patient’s chronic disease. Or giving the patient exercises to stabilize their knees so they can avoid pain while moving.
Remember, physiotherapy treatment needs to center around a specific diagnosis determined through an assessment.
A vague diagnosis like “lack of core strength” isn’t enough. While lack of core strength could be one of the findings of your assessment, it isn’t a physiotherapy diagnosis.
Physiotherapy care also must include a plan for discharge – in other words, when treatment will stop.
For example, if a patient wants to learn how to lift weights safely after an injury, they should be discharged once they’ve learned the proper technique and given a program they can follow on their own.
Without a clear plan for self-management and discharge, what you’re providing is likely personal training, not physiotherapy.
Misrepresenting personal training as physiotherapy could result in a complaint to the College. Insurance providers could also flag you for excessive billing or even delist your registration number.
Delegating Care
Remember, when you delegate care to a physiotherapist assistant (PTA), you are still responsible for that care.
The PTA can’t change the treatment plan on their own. And you, as the physiotherapist, can only assign care you are also qualified to deliver.
Any situation where the physiotherapist will be supervising remotely, for example assigning care to a physiotherapist assistant who works in a fitness facility where the PT does not, should raise red flags. These kinds of arrangements make it hard for you to meet your professional obligations.
Not only could you lose your license as a physiotherapist, but patients lose out on quality physiotherapy care. Without proper supervision, patients may get hurt or fail to improve. Patients could also lose access to their health benefits if an insurer determines you are fraudulently billing fitness training as physiotherapy.
Quick Checklist: Is It Physiotherapy?
Ask yourself:
Have I performed an assessment that would meet the requirements of the Assessment, Diagnosis, Treatment Standard?
Is there a clear physiotherapy diagnosis?
Are there SMART goals for the patient?
Does the treatment plan include anticipated discharge? Are we working towards self-management? Physiotherapy treatment should not continue indefinitely.
If you are assigning care to an assistant, can you meet the requirements of the Supervision Standard?
If you answered no to any of the questions above, you may be crossing the line into personal training.
Avoid putting patients – and your license – at risk. Follow the standards and stay within scope.
Resources
Assessment, Treatment, Diagnosis Standard
Supervision Standard
Physiotherapy Scope of Practice
Inappropriate Business Practices
Think Twice About Job Offers Like This
Case of the Month
In regards to a client’s weight, many of the best practice guidelines, for example, for arthritis and low back pain, include weight management. As physiotherapists, how should we tackle this topic with clients?
When weight management is mentioned in best practice guidelines, it can feel awkward as physiotherapists because we don’t diagnose obesity or manage weight in a medical sense. That said, we do have a role in talking about factors that influence pain, function, and recovery.
A helpful starting point could be to keep the focus on function and symptoms, not on labels or numbers.
For conditions like knee osteoarthritis or persistent low back pain, clinical guidelines recognise that higher body weight can increase mechanical load on joints and tissues, which may contribute to pain or reduced tolerance to activity. Framing the discussion around “joint load,” “movement demands,” or “things that can affect your symptoms” keeps the conversation squarely within physiotherapy scope and avoids judgement. Non-mechanical factors, such as potential inflammatory contributors, should be managed by the patient’s medical providers.
In keeping with the Evidence-Informed Practice standard, it’s also important to anchor the conversation in evidence, not opinion. When physiotherapists explain that exercise and, where appropriate, weight management are recommended in recognised guidelines, it normalises the topic as part of best practice care rather than a personal critique.
In Ontario, for example, the Ontario Health Osteoarthritis Quality Standard includes education, therapeutic exercise, physical activity, and weight management as components of high quality conservative care (Ontario Health, 2024).
How we raise the topic matters just as much as whether we raise it. Asking permission can go a long way:
“Would it be okay if we talk about some factors that can influence joint load and pain, including physical activity and weight?”
This respects the patient’s autonomy and aligns with the Communication and Duty of Care Standard’s expectations around respectful, person centred communication and duty of care.
As physiotherapists, our role is not to calculate BMI, set weight loss targets, or provide personalized dietary advice. Instead, we can:
• Explain how movement, strength, and activity levels affect symptoms
• Support patients to become more active in ways that feel achievable and safe
• Emphasise improvements in pain, mobility, and participation as meaningful outcomes
If a patient expresses interest in weight management beyond physical activity, we can support collaborative care by suggesting follow up with their family doctor or referral to another provider, such as a dietitian. This is consistent with the Collaborative Care Standard around working within scope and collaborating appropriately with the wider healthcare team.
Finally, it’s worth being mindful of weight stigma. Guidelines such as the Canadian Adult Obesity Clinical Practice Guideline emphasise avoiding judgemental language and focusing on health promoting behaviours rather than body size alone (Obesity Canada, 2023). A strengths based, respectful approach helps maintain trust and keeps patients engaged in care.
In short, physiotherapists should tackle weight related topics by focusing on function, linking discussions to evidence based guidelines, communicating with sensitivity, and staying within scope, while supporting patients to access broader care when appropriate.