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ACSM'S Health & Fitness Journal:
doi: 10.1249/FIT.0000000000000010
COLUMNS: The Legal Aspects

Philosophy & Standards Part II

Abbott, Anthony A. 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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INTRODUCTION

As previously written, this two-part article examines the philosophies that have led to the developmentof standards within the fitness industry. In Part I, we looked at the individual 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. This concept of a facility member’s philosophy regarding the need for exercise was addressed especially in light of one’s responsibility to society. The concern was the recognition that those who neglect their health and fitness become a burden to society because of unnecessary escalation of health care costs. As you may recall, this is not a new concept for, as the Greek physician Hippocrates stated, “Preservation of health is a duty. However, few people seem to be conscious of such a concept as physical morality” (11).

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In Part II, we now 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 for their membership. This philosophy toward the qualifications on the part of instructor personnel and the professional commitment on the part of facility management engenders an attitude of necessity and, therefore, portends standards.

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INSTRUCTOR RESPONSIBILITY

Unfortunately, many people think that fitness is a concept that they understand and that exercise is an activity about which they are knowledgeable. As they see the problem of exercise, it is just a matter of finding time to get around to it. However, nothing could be farther from the truth. Most people do not know how to exercise appropriately, as documented in a statewide research study in Florida wherein the exercise science knowledge base of both fitness facility instructors and facility members was surveyed and found lacking (1).

The fact is that exercise is a science; and for that reason, we need specialists to ensure that individuals go about fitness programming effectively and safely. Fortunately, when individuals are young, they can get away with many unsafe activities and unhealthy habits because the human body is very resilient. As we age, however, the body loses much of its resiliency; and, therefore, we become more susceptible to the danger of overstress, a danger that is heightened by the sedentary lifestyle and the many risk factors that older Americans often possess. Hence, there exists the need for qualified instructor personnel.

One may argue that qualified instructor personnel were not available hundreds and thousands of years ago, and yet humanity survived without such assistance. In an agrarian society, however, individuals were physically active at an early age and remained active throughout life, thereby maintaining a level of cardiovascular health and muscular development that enabled them to successfully cope with everyday stresses.

Fitness instructors truly have an important responsibility; for their job is that of exposing clients to the stress of exercise. In short, the instructor is saying to his client “I am an expert who understands the type of physical stresses that need to be applied to your body to bring about positive training effects while avoiding injuries.” There are few vocations that pose such threats to clients and potentially disastrous physical consequences when professional standards are not maintained.

In reality, the instructor needs to understand more than just the science of exercise because changing human behavior requires more than just knowledge and skills. It also demands the unique ability to motivate clients. Because of this fact, the fitness instructor has a broad-based job description.

An obvious component of the instructor’s job description is that of being a teacher. The instructor must teach not only the logic of human movement but also the practical skills. As academics and skills are not enough, the instructor must become a facilitator and enabler to assist the client in following through with the prescribed exercise program on a regular basis. Because poor health has become such a problem in society, the instructor also is charged with helping the client adopt an attitude wherein he or she accepts the preservation of his or her health as a social responsibility, an acceptance that earlier was referred to as “physical morality.”

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Unfortunately, the health club industry enjoys a dubious reputation because it has a poor “success rate” in large part because of the fact that most fitness instructors are unqualified to instruct as well as to motivate (7). To turn this state of affairs around, instructors must become the “experts” that they have long held themselves out to be. To be such a“professional,” they must develop a sound knowledge base in exercise science, along with the specific skills suited to their responsibilities; and this requires a comprehensive academic instruction coupled with extensive practical training.

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In addition, instructors must assume a positive attitude that generally has been lacking in the fitness industry. As they recognize the importance of their job, they should develop a sense of pride, but a pride without arrogance. As they master their job skills, they should develop a sense of confidence, but confidence with humility. Of greatest importance, they must demonstrate a sincere interest in their clients. It is an old adage that “People don’t care how much you know until they know how much you care.” Or as stated by Dale Carnegie, “You can make more friends in 2 months by becoming interested in other people than you can in 2 years by trying to get other people interested in you” (6). This caring attitude must be associated with a genuine enthusiasm reflecting the instructor’s joy found in both his work as well as his client relationships.

There are many motivational seminars available throughout the country that will allow instructor personnel to enhance their social and motivational skills. If not seminars, read books authored by motivational speakers such as Tony Robbins, or perhaps, invest in one of the first best-selling self-help books ever published, Dale Carnegie’s How to Win Friends and Influence People.

The instructor must continually pursue self-improvement. He or she must never be complacent with his or her job knowledge but always be seeking opportunities for formal training and continuing education in this field of exercise science.Equally important, he or she should work at improving his or her interpersonal relations through a better understanding of human dynamics and efforts to enhance his or her communication, motivational, and empowering skills. Wellness coach training has become an excellent vehicle by which instructors can enhance their interpersonal skills and improve their effectiveness with clients. Through an organization like Catalyst Coaching Institute that is a recognized American College of Sports Medicine (ACSM) provider, one can become a Certified Wellness Coach. Notwithstanding one’s effective coaching skills, the instructor must lead by example and be the role model that the client expects him or her to reflect.

Regarding client motivation, remember that people are social beings who thrive on positive feedback. Although negative reinforcement may have its place on certain occasions, in general, clients respond better to accolades. Positive reinforcement is what provides a “causal factor” or “incentive” and can help drive motivation. Success breeds success; therefore, instructors must look for opportunities to applaud the efforts of their clients, of course, only when deserved or merited. Undoubtedly, fitness testing with pretesting and posttesting provides an important motivational tool because clients are able to monitor their improvement and receive that “taste of success” that encourages further efforts.

As the public has every right to expect that fitness instructors and personal trainers are well qualified and thereby able to provide safe and effective exercise programming, then it is anticipated that there would be educational and skill requirements to be documented reflecting that, in fact, instructors and trainers have met adequate standards. Fitness facilities advertise the availability of not only exercise equipment but also the availability of certified instructors and trainers. To the lay public, certification would imply that instructors and trainers have met such standards and, therefore, would be individuals with whom it would be safe to train.

In general, what the public does not understand is that certification is a type of credential sought voluntarily and provided by a credentialing body that is either an association or business, whereas a license is a credential that is mandated by a governmental body and that is required to meet a set of standards agreed upon by recognized professionals within that field. Unfortunately, unlike ACSM, most fitness certifications are provided by businesses that are profit motivated and that recognize that certification examinations with exacting standards will realize a high failure rate that in turn will result in fewer candidate applications and decreased revenue.

More pressure will have to be placed on the fitness industry to generate a more proactive development of higher standards, ensuring public safety. Failure to self-regulate acceptable standards will mean the inability to preempt potentially negative legislation or governmental control such as a low standard of state licensure for which there is an increasinginterest. Without the elevation of standards, this country may see statutory requirements such as witnessed in Europe where the European Union has an increasing influence andfootprint in the health and fitness sector (10).

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FACILITY RESPONSIBILITY

The fitness boom has come of age during the past 20 to 30 years and, with it, facilities such as clubs, gyms, spas, and studios have proliferated while advertising the availability of professional instruction and services that implies safe and effective fitness programming. In reality, most fitness facilities lack credible certification and experience requirements for their fitness instructors and personal trainers (14). During the years, the media has even questioned the dangers of joining a fitness facility (16). In Miami, FL, WSVN Channel 7 News, a Fox affiliate, provided an investigative report entitled “Killer Workouts.” A few years ago, Dan Rather of ABC News dedicated two shows to “Who Is Training Your Trainers?” This past year, Inside Edition, a syndicated news program, presented an investigative report entitled “Are All Personal Trainers Qualified?.”

In those instances where training is provided, it is often on-the-job training by in-house instructors who frequently lack appropriate credentials themselves or, perhaps, a weekend certification program during which candidates are typically primed for specific questions to which they regurgitate the answers on examination. Although these pseudo “professional associations” will in advance forward candidates study materials for which they are responsible, there is never sufficient time for practical training and thorough testing to ensure the competency of candidates.

This absence of professional standards for fitness instructors often results in a basic lack of knowledge about planning, organizing, and leading individuals as well as groups in a safe and effective manner (15). Becoming a competent fitness instructor requires an in-depth knowledge of human anatomy, physiology, kinesiology, and exercise science along with extensive skill training. This cannot be achieved through weekend certification programs and even longer programs encompassing a few weeks. It would seem reasonable, from the standpoint of public safety, to expect some level of competence before fitness instructors as well as personal trainers are permitted to work with the public.

To develop the knowledge, skills, and abilities of a competent instructor, one must undergo academic training in exercise science through an accredited university or a vocational school that provides comprehensive education and hands-on training taught by qualified exercise physiologists who have extensive practical experience. On completion of academic instruction coupled with substantial hands-on training in the areas of health assessment, fitness testing, performance evaluation, program design, and client supervision, serious and knowledgeable students routinely seek certification through credible organizations such as ACSM.

Typically, fitness facilities have been sales oriented and not service oriented, which has contributed to their abysmal success rate. Circa the 1980s, Consumer’s Union published an article indicating that approximately 75% of people joining a health club did not return after about 2 to 3 weeks, and more people fell by the wayside after that period. Years ago, when retained as a consultant for a large fitness chain in south Florida, this author noted that, although the chain had a large membership according to their active roles, a small percentage of these members were using the facilities. In fact, it was determined that if 20% of their active membership showed up for 1 hour 3 days a week, the chain would violate ordinances for overcrowding. This problem, in large part, was caused by lifelong contracts that now normally are prohibited.

Currently, in Florida, as in most states, contracts are limited to 3 years, and there exist provisions for a way out if the member moves or becomes physically unable to use the facilities. Typically, contracts must have a provision that if the gym is moved more than 5 miles from its present location, it will provide membership at an alternate facility at no additional cost to the member. Facilities also are required to post a bond with the state to reimburse fees paid in advance by members if the facility goes out of business and does not provide an alternate facility (9).

Because of changes in contract law within the fitness industry and the ability of members to opt out of contracts or monthly commitments, member retention has reached a priority concern with numerous articles on recommendations of how to address this industry problem (17). The lack of qualified instructors previously discussed relates to the inability to provide adequate service and help ensure members’ success and consequent retention. This fact, coupled with other areas of serious concern, needs to be addressed by facilities if they wish to truly become responsible purveyors of health and fitness.

The successful facility must recognize its obligation to provide positive goods and services. This means that product sales should not include thigh creams, slender wraps, sauna suits, and the many other related items that are known to be worthless if not potentially dangerous (13). In addition, the sale of diet products and most supplements reflects a facility that does not have in mind the best interest of its members but rather solely a profit motive. Facilities must assume a leadership role in relation to demands of the public. If facility management understands that a product or service is worthless or possibly harmful, they should not provide such a product or service just because the public demands it. If the fitness industry wishes to improve its current image, it must commit to professionalism. To be professional, facilities must raise their standards and provide the following:

Client screening — to include thorough medical histories coupled with blood pressure, lifestyle questionnaires, fitness evaluations, and physician releases when necessary, is the first step to successful programming for members. In addition, fitness profiles should be available and encouraged for all members to establish a baseline of physical fitness, thereby allowing appropriate program design. Also, this baseline can be used for comparative purposes with follow-up testing, enabling members to receive feedback on their progress and its ensuing motivational reinforcement.

Orientations should be provided to all members regarding basic safety concerns with exercise in general as well as the safe operation of exercise equipment and amenities such as steam, sauna, and whirlpool. Thorough orientations and safety considerations are equally important for the conduct of all group classes. Program monitoring by staff and close supervision will ensure that orientation directives are carried out appropriately and activities are conducted safely.

The knowledge, skills, and abilities of instructor staff should be of vital concern to the extent that these attributes are continually being validated through documentation of credentials, verification of training, and periodic performance evaluations. Instructor concern for members and a member’s feedback also must be evaluated. Ongoing educational programs and training seminars should be made available not only for instructor personnel but also for members.

Facility utilization should be tracked to determine those members not attending with regularity so that follow-up calls can be made to encourage their return and continued usage of the facility. In addition, staying abreast of members’ activities and accomplishments in the community, along with their exercise habits, demonstrates a personal concern and reflects professionalism. Efforts also should be undertaken to provide a more positive experience or create a more attractive atmosphere that will ensure facility utilization. Staff must be prompted continually to think of ways in which they can motivate members to ensure exercise compliance.

Ideally, if a facility screens, tests, programs, and supervises its members appropriately, there should be minimal minor injuries and a lack of serious incidents. However, even with the best facility operation, there always is the possibility of an untoward incident to include sudden cardiac arrest. Therefore, it is incumbent on all facilities to be able to respond rapidly to any reasonably foreseeable emergency event that threatens the health and safety of its members. Toward this end, a facility must have a well-designed emergency plan, supported by appropriate equipment, which can be executed by qualified personnel in a timely manner (2).

All staff members should be certified in cardiopulmonary resuscitation (CPR) as well as First Aid by credible organizations such as the American Red Cross, American Heart Association, or the National Safety Council. In addition, selected on-duty staff if not all staff should be certified in CPR with an automated external defibrillator (AED). It has become an ACSM standard that AEDs should be immediately accessible in facilities along with appropriate first aid supplies found within emergency response kits (2). Unfortunately, the International Health Racquet and Sportsclub Association, a professional trade association for facilities, has not recognized AEDs as a standard owed to fitness facility participants (12). However, the insurance industry has stated that a failure to have an AED can increase a facility’s liability (5). It also is advisable to have the availability of supplemental oxygen that can be attached to a nasal cannula, oxygen mask, or resuscitation mask. The Red Cross has stated that the utilization of oxygen in any life-threatening emergency may double a victim’s chances of survival (3). However, it is important that staff receive thorough training in the administration of oxygen.

The emergency action plan (EAP) to include proper use of emergency equipment is meaningless if staff members are not effectively trained in the plan’s implementation and the equipment’s utilization. To ensure ongoing preparedness, emergency drills, both announced and unannounced, must be conducted periodically. After-action reports from such drills are essential to fine-tune the plan and thereby maximize protection of the membership. Details gathered from actual incidents and submitted in after-action reports allows management to determine the cause of the incident, was it preventable, was the EAP conducted properly, and what corrective actions are necessary (8).

The responsibilities to be met by committed facilities are numerous and beyond a comprehensive listing in this article. Therefore, it is recommended that managers of facilities be familiar with and maintain as part of their library the ACSM’s Health/Fitness Facility Standards and Guidelines and ACSM’s Guidelines for Exercise Testing and Prescription, as well as Health Fitness Management, a widely used university textbook that provides a comprehensive resource for managing and operating programs and facilities (4). These texts, along with the American Heart Association and American Red Cross manuals, will instruct owners and managers how to operate a facility, conduct fitness programming, and respond to emergencies and to do so in a manner that meets an acceptable standard of care. Again, “standard of care” is defined as what reasonable and prudent management of a facility would do in a similar situation, and this is the standard on which a facility will be judged should it become embroiled in litigation.

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References

1. Abbott A. Exercise Science Knowledge Base of Commercial Fitness Instructors in the State of Florida. ACSM Annual Conference 1990; 1989.

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

3. American Red Cross. Oxygen Administration. St. Louis (MO): Mosby Lifeline; 1993.

4. Bates M, editor. Health Fitness Management, 2nd ed. Champaign (IL): Human Kinetics; 2008.

5. Best’s Review Magazine/Journal. Oldwick (NJ): A.M. Best Company, Inc.; 2002.

6. Carnegie D. How to Win Friends and Influence People. New York (NY): Simon and Schuster; 1936.

7. Dietrich J, Waggoner S. The Complete Health Club Handbook. New York (NY): Simon and Schuster; 1983.

8. Eickhoff-Shemek J, et al. Risk Management for Health/Fitness Professionals. Philadelphia (PA): Lippincott Williams and Wilkins; 2009.

9. Florida Department of Agriculture and Consumer Services. Health Studios Act. 2013.

10. Health Club Management. Health Club Handbook. UK: The Leisure Media Company Limited; 2013.

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

12. International Health, Racquet & Sportsclub Association. Standards Facilitation Guide, 2nd ed. Boston (MA): IHRSA; 1998.

13. Jathar R. Sauna Suit Dangers. 2010. Buzzle.com.

14. Rabinoff MA. Fitness Club Evaluations, Unpublished Research Study, Denver (CO): Metropolitan State College; 1984.

15. Sharkey BJ. The Physiology of Fitness, Champaign (IL): Human Kinetics; 1984.

16. Springer K. Are health clubs risky? Newsweek. 1986.

17. Tharrett S, Peterson J. Membership attrition and club profitability, Fitness Management Magazine. Los Angeles (CA): TradePub; 2007.

© 2014 American College of Sports Medicine.

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