When you are asked to design a program for a new client, the information you need includes an appraisal questionnaire, an assessment of the level of activity current and past and client goals. Based on the answers to those questions through motivational interviewing, performance testing and goal setting, you would design the fitness program based on the evidence to support the implementation of your program for your client, right?
Critical appraisal of a topic means more than finding information that fits with what you already believe. Trainers should evaluate all evidence on the topic by applying the acronym PICOS:
Sifting through the evidence
Exactly what the evidence is becomes the $1 million question. The Evidence-Based Practice Model (Sackett et al, 2011) provides an excellent framework from which to identify levels of evidence in order to make an informed decision.
Too often trainers read blogs by their favorite internet guru or see an article or eye-catching infographic that talks about an exercise or program that is the latest industry rage. Implementing that advice fits at the bottom of the Quality of Evidence Pyramid. While the advice may in fact be supported by research and best practice, it is important for trainers to critically appraise the evidence first-hand to be sure it is the right fit for their client. Looking at the hierarchy of evidence for yourself, whether through critically-appraised articles, critically-appraised topics or systematic reviews, provides you with the information you need to determine whether the exercise or program meets the needs of your client, based on his/her previous and current activity level and program goals.
- Patient (client) or problem
- Intervention
- Comparison
- Outcome
- Study type
An example of PICOS for personal trainers:
- P = older adults with poor hamstring flexibility
- I = foam rolling before exercise
- C = traditional static stretching routine
- O = improved range of motion
- S = randomized control trial (high-level of evidence)
Evaluating the evidence
When critically appraising an article, ask three questions: 1) Were the articles or studies on a population that matches your client? 2) Were they well-designed studies? and 3) Based on your experience and the results of the studies, would this exercise most likely be of benefit? This is why personal training is both an art and a science—trainers need not only to know the science behind everything they do but also the art of applying the science in the best interest of each client, on a client-by-client basis. Follow the evidence!
