by Tom Nikkola, CSCS, CISSN, PN

Body fat tests. Movement screens. Max squat and bench press tests. VO2 Max assessments.

These assessments, and more, are the common starting points for the fitness programs of most clients.

Each assessment is valuable for designing an exercise program and for measuring progress throughout the program.

Each one of these tests is missing something, however.

None of them can provide a clear picture of a client’s internal health.

And without measuring and managing internal health, it’s possible a client will never reach his or her full potential.

I couldn’t conceive of starting a client on a new program without him or her getting a clear picture of their internal health. You’ll better understand why this is so important based on the information below.

The following four reasons are why fitness professionals must embrace the importance of lab testing.


According to the U.S. Centers for Disease Control, 35 percent of adults have pre-diabetes and most don’t know it. This doesn’t include the 26 million who have full-blown diabetes, a quarter of whom don’t know they have it.

How about this? Forty-three percent of men over 65 years have low testosterone.[i] Some suggest that one in four men over age of 30 have low testosterone. For guys, we might know in the back of our mind that something is wrong, but unless we’re faced with the facts, we are resistant to change.

What about hypothyroidism? Most women know someone who has it – if they don’t have it themselves. Many individuals with thyroid dysfunction don’t know it because they only have their thyroid-stimulating hormone (TSH) measured when they get traditional lab testing.

And what about those individuals who are hooked on chronic cardio but have elevated inflammatory markers, thus increasing their risk of heart disease, and don’t know it?

The point is, there are too many things a person can have working against him or her for a trainer to expect a client to just start with an exercise and nutrition program and obtain optimal health, fitness, or performance.

Without measuring internal health markers, fitness professionals can’t be certain they are providing the best training and coaching for their clients they are capable of.

When a client has a postural issue or a muscular imbalance, that issue becomes a major factor in designing an exercise program.

If a client is trying to lose body fat, the fitness professional provides coaching that changes nutrition habits in a way that results in lower body fat.

Likewise, when internal lab markers are out of range, regulating those markers can also become individual goals for a training, nutrition, and lifestyle program.

From my own experience with getting lab test results, I was alarmed at how high my ferritin levels were, because elevated ferritin levels are associated with an increased risk of developing heart disease.

As you can see below, the first two times my labs were done, my ferritin was off the chart. It was more than twice as high as the upper end of the normal range.

After my second lab draw I decided to do something about it. I began giving blood every couple of months. As you can see, my ferritin level dropped dramatically. And I’m doing something valuable to others!

At this point I’ve donated over a gallon of blood and the benefit to me is a much-reduced risk of developing heart disease.

Did I look like a heart attack waiting to happen on the outside? No. That’s why I used my blood chemistry, not the mirror, to monitor my health.


In the pursuit of optimal health, it is important to realize you will never achieve perfection. There will always be health and fitness measures to improve.

As mentioned above, my ferritin level was of concern to me. However, now that my ferritin is under control, I’m on to figuring out how to improve the next marker that is out of range.

As you can see from the chart below, my sex-hormone binding globulin (SGBG) has been pretty high compared to my other hormone levels.

SHBG has many roles, but one of them is to bind free testosterone.[ii] When testosterone is bound to SHBG it doesn’t have its metabolic effects. For me, I’m making a reasonable amount of testosterone, but my free testosterone is at the lower end of normal.

If my SHBG comes down, will my free testosterone go up? Theoretically. Or will my total testosterone drop? We’ll see.

The point is, there will almost always be something an individual can do to improve his or her health markers.

Focusing on individual markers, and making adjustments to nutrition, exercise, and lifestyle programs, helps identify what works best for each individual client.

Over time, clients will gain a better understanding of their bodies and a greater appreciation of the importance of nutrition, exercise, and lifestyle choices.


I’ve become a little bit numb to “before and after” weight-loss photos because there are lots of ways to get someone to lose weight. A weight-loss program or a personal trainer assisting a client doesn’t have to be that good to help someone lose weight.

People can count online points and eat whatever they want and still lose weight, even though their body fat percentage will probably still be pretty high.

I know many trainers who still have their clients follow low-calorie diets and spend hours doing cardio. The weight comes off for a contest or photo shoot, but their metabolism is a wreck.

They soon gain the weight back, and then some, but have the added psychological burden of feeling like a failure.

This type of “before and after” change isn’t impressive. In fact, it often becomes disheartening because the short-term excitement of achieving the weight loss is often followed with the depression of gaining the weight back.

That being said, there are many excellent fitness professionals who do design nutrition, exercise, and lifestyle programs that result in long-term, sustainable fat loss. And, you would see in most of these cases that client lab markers would be significantly improved as well.

As a fitness professional, I would want to know that my programs aren’t just making my clients look better on the outside, but they’re also improving their health on the inside.

And clients are often thrilled to share improvements in their health markers in a testimonial. That’s powerful!


Although there are many exciting aspects to lab testing, the reality is that some individuals will actually discover that something is seriously wrong.

More serious health problems can often be discovered based on lab work before external symptoms appear.

While these situations are always unfortunate, the fact that they’re caught before outward symptoms develop means the health problem is probably in its early stage and can be treated more easily.

While I was at Life Time Fitness managing the lab testing program offered through their fitness professionals, I became aware of a trainer’s client in her 20’s who complained of regular fatigue. She and her trainer had changed her exercise and nutrition program and she was sticking with it to the letter.

But her fatigue didn’t go away.

The trainer finally convinced her to get a full lab panel done. When she got her results back many of her lab markers were out of range.

She brought the results to her doctor and found out she had cancer. Fortunately, it was caught early enough that it was easily treated.

The Wellness Complete lab package includes the following lab tests: