Fitness Goals and Physiotherapy: Where Is the Line? 

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. 

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.  

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