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ACSM'S Health & Fitness Journal:
doi: 10.1249/FIT.0b013e3182a35fb2
COLUMNS: The Legal Aspects

Philosophy and Standards, Part I

Abbott, Anthony Ed.D., FACSM, FNSCA

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Anthony A. Abbott, Ed.D., FACSM, FNSCA, is president of Fitness Institute International. He was a commanding officer of an Apollo Recovery Team and the Florida director of the Physical Fitness Institute of America that helped develop the exercise program for NASA and Apollo missions. He is an ACSM-certifiedPersonal Trainer, Health/Fitness Specialist, and Clinical Exercise Specialist as well as an NSCA-CPT, CSCS, and CSPS. Dr. Abbott is frequently retained as an expert witness in fitness facility litigations involving injuries and death.

Disclosure: The author declares no conflict of interest and does not have any financial disclosures.

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During litigation, the violation of “standard of care” is the focus of discovery and investigation. In the fitness industry, the standard of care required is that of a prudent professional — whether an individual instructor, personal trainer, or facility manager. The obvious question is “Who determines the standard?” Standards may be set forth by statutes or ordinances, by organizations or agencies, and by professions (3). For this reason, organizations like the American College of Sports Medicine (ACSM) and the National Strength and Conditioning Association have come forward with publications listing standards and guidelines.

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The fourth edition of ACSM’s Health/Fitness Facility Standards and Guidelines lists standards as “base performance criteria or minimum requirements that ACSM believes each health/fitness facility must meet to provide a relatively safe environment in which physical activities and programs can be conducted,” whereas guidelines are “recommendations that ACSM believes health and fitness operators should consider using to improve the quality of the experience they provide to users” (1). Regarding the more stringent standards, from where do they develop and what is their basis?

This two-part article examines the philosophies that have led to the development of standards within the fitness industry. In Part I, we look at the client who decides that he or she will begin to take charge of his or her health by embarking on an exercise program and joining a fitness facility. In Part II, we will examine instructor personnel within facilities and the training and qualifications that they should possess to work safely and effectively with the public. In addition, in Part II, we will discuss the type of professional commitment that facilities should embrace to provide a safe and satisfactory experience to their membership.

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“Preservation of health is a duty. However, few people seem to be conscious of such a concept as physical morality” (4). Although this quote is applicable today and might seem to have been written by a contemporary fitness evangelist, this is not the case. The above words were spoken long before the birth of Christ by a Greek physician named Hippocrates, “the Father of Medicine.” Obviously, this historical figure valued health to the degree that he envisioned moral obligations extending beyond the physician and his professional commitment that we know as “The Hippocratic Oath.” This Greek physician felt that every member of society had an obligation to recognize and practice this principle of physical morality.

What is physical morality? How does it relate to our present value system and the consequent development of standards? Should it be a part of our lives? And if so, would health education and promotion be able to affect behavioral change in this area? Answers to these questions lay the foundation for not only an understanding of our current health problems and their solutions but also standards evolving within the fitness industry.

By physical morality Hippocrates meant that individuals had an ethical responsibility to take charge of their own health. Those who failed to maintain and preserve their health to the best of their abilities were shirking their duties as citizens and, therefore, were guilty of immoral behavior. To the average American, this would undoubtedly seem to be an unfair and harsh judgment, especially in our democratic societywhere we cherish our freedom and even, perhaps, the freedom to neglect our health. It is likely that many would say that to choose to be unhealthy is one of our inalienable rights. But is it?

When we neglect our health, we become a tremendous burden to society. Nowhere is this more painfully evident than in America that has witnessed a recent expansion in health care costs to the tune of approximately 17.9% of our GDP in 2010 and a predicted 19.6% in 2021 or nearly a fifth of the U.S. economy (7). Because of this excessive expenditure, we currently are confronted with doubts about the stability of both Medicare and Medicaid.

As a result of our failure to adapt to the age of automation by programming physical activity and healthful eating into our lifestyles, Americans experience excessive degeneration and illness in their later years. As a country, we are suffering the pitfalls of technological success. Labor-saving machines have created not only more leisure time but also the sedentary lifestyle. In the land of plenty, the motivation born of hard times has given way to indolence. The abundance of food has made every day a feast day and America the world’s most overweight society. Even the miracles of modern medicine cannot prevent heart attacks and strokes caused by a diet too rich in fat and calories and a lifestyle lacking in exercise and physical activity. Modern technology may keep people alive longer, but only healthy lifestyles will ensure a vigorous robustexistence free of debilitation and hospitalization.

Because of this self-neglect and the increased cost of medical care, health insurance premiums have risen to unprecedented heights. To date, unfortunately, insurance companies have not really differentiated between those who take care of themselves and those who do not. Consequently, the healthy, those who make few claims, pay rates that are similar to the unhealthy who use the health care system more frequently. Therefore, the unhealthy are a “burden to the healthy,” who find themselves having to subsidize the self-abuse of most of the population.

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Many people with pride in their health and self-respect for their bodies take great offense at those who smoke, overeat, drink alcohol excessively, use drugs, fail to exercise, and, in general, practice self-destruction. One reason for such offense is that the unhealthy are a principal reason for the exceedingly high health care costs that must be borne by all.

As Hippocrates stated so long ago, perhaps everyone should recognize the moral imperative of pursuing good health. Or rather, everyone should make a philosophical commitment to good health within his or her value system. To this physician, physical morality was a duty, an obligation that befalls every member of society; for if one fails to live up to his or her physical capabilities, then one has placed an unfair burden on others.

If health education and promotion are to facilitate the development of a broad-based value system of health in which we avoid becoming a burden to others, then we must establish an operational definition of “health.” Recognizing that individuals will always have varying definitions of health, might there still be an overriding concept that permits a degree of freedom but ensures that general health habits are to the benefit of society and not its detriment.

A recent Gym, Health & Fitness Clubs Market Research Report stated “Gym membership numbers have increased considerably over the past 10 years, rising from 36.3 million in 2002 to more than 42.8 million by 2011” (5). Although this growth in memberships might seem to reflect an apparent increase in healthy lifestyling, this would not be borne out by the aforementioned expansion of health care costs as well as documented increases in obesity within the past 10 years (2). It could be that most people pay only lip service to any real concept of health. People may say that there is nothing they value more than their health; yet in reality, the statistics indicate that there is nothing they abuse more than their health and well-being. Typically, people concern themselves with their health only when it is in jeopardy. It is a tragedy that most people emphasize sickness rather than optimal health, that they are concerned with not dying rather than really living, and that they fail to accept the challenge of life’s great potentials.

For many people, health is defined as just the absence of disease. However, others today are redefining health as they begin to view this concept from a broader perspective. For these individuals, the wholesome lifestyle is evidenced through vitality, productivity, and happiness. In fact, this positive view has been written into the preamble of the World Health Organization’s constitution that reads “Health is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity” (10).

This new definition of health is slowly making inroads into the American psyche through a number of different appellations that continue to receive more attention. “Total fitness,” “holistic health,” “health enhancement,” and “lifestyle modification” are some of the more commonly used terms to describe this broad approach to the concept of health. Probably the most descriptive term that is slowly gaining general acceptance is that of “wellness.”

Much of the solution to our health problem is not only recognizing the perils of affluence but, more importantly, redefining the “good life” and affirming the fact that “we can be healthy and fit.” Professionals recognize that the answer to the health care crisis lies in great part to individuals assuming more personal responsibility. Two large studies from Northwestern Medicine concluded that a healthy lifestyle had a greater impact on cardiovascular health than genetics (8). Research indicates that genetics may only play a 25% to 30% role in what happens to our health (9)! Many of our health care crises are not brought on by a disease disorder per se but rather by a lifestyle disorder — a disorder that is a choice. Therefore, as a people, we must reconsider our goals through learning to value the quality of our lives as much as its material quantity.

To achieve a healthy lifestyle, one must take responsibility or “respond-ability” in that he or she will eat more healthfully and exercise more faithfully. To motivate and empower individuals to accept such lifestyle changes are the challenges. This ability to motivate and empower clients is the real mark of professionalism among fitness instructors and personal trainers.

However, a word of caution is in order. Embarrassing individuals through exposing their lack of physical fitness or obvious obesity seems not to elicit a positive response. Americans already live in a culture that has a prevalent and pervasive obesity bias that leads todiscrimination (6). There exists a weight-related stigma in that, often, the obese are attributed with having both a lack of willpower and motivation. They are frequently thought to be lazy or do not care about their appearance. This stereotyping and subsequent discrimination have not led to change.

Again, the professional instructor ortrainer must not lay a guilt trip on the client by appealing to physical morality, but rather through positive reinforcement; educate and motivate the clientto take charge of his or her health and fitness. Eventually, as a result of becominghealthier and physically fit, the client will better understand the benefits of a healthy lifestyle and hopefully will buy into this concept of physical morality.

As a nation, we must understand that wellness encompasses physical fitness, an essential key to a life well lived. We must know that fitness is part of the foundational basis of health, energy, and strength that makes possible life’s more desirable achievements. Fitness is being able to say “I will be trim and strong, and I will take charge of my health.” It is knowing that the excessive degeneration of old age is to a great extent preventable, not inevitable, and that fitness is for everyone, not just for athletes or faddists. Fitness is a way of life, a type of thinking, and a set of values just as much as it is the technique of sport or exercise. Furthermore, when the basic principles of fitness are understood, it can be achieved with a limited investment of time and money. This type of thinking and value system engenders an attitude of necessity and, therefore, portends standards.

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1. American College of Sports Medicine. ACSM’s Health/Fitness Facility Standards and Guidelines. 4th ed. Champaign (IL): Human Kinetics; 2012.

2. Center for Disease Control and Prevention. Prevalence of Self-Reported Obesity Among U.S. Adults. Atlanta (GA): Centers for Disease Control and Prevention; 2011.

3. Cotton D, et al. Law for Recreation and Sport Managers. Dubuque (IA): Kendall/Hunt Publishing Co.; 2001.

4. Hippocrates, Asclepiades. Treatise on the Preservation of Health. London (UK): John Bell Publisher; 1776.

5. PRWeb. IBIS World: Gym, Health & Fitness Clubs Market Research Report. 2013.

6. Puhl R, Brownell KD. Bias, discrimination and obesity. Obes Res. 2001; 9 (12): 788–805.

7. Radnofsky L. Steep rise in health costs projected. Wall Street J. 2012.

8. Cardiovascular health in middle age and beyond: a gift from your genes or is it earned by a healthy lifestyle and within your control? Sci News. 2010.

9. Slagboom P, et al. Genomics of Human Longevity, London (UK): The Royal Society; 2011.

10. World Health Organization. Constitution of the World Health Organization, Geneva (Switzerland): World Health Organization; 1946.

© 2013 American College of Sports Medicine.


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