Whether a fitness-only facility or a multipurpose facility, there are important and specific standards to which management must adhere to be in compliance with all federal, state, and local building codes (1, p. 50). From the standpoint of operating a successful facility, there also are obvious requirements that must be met to ensure that members are being serviced safely and effectively. This column will address just some of those safety concerns that this author has encountered during his work as an expert witness in facility litigations. It should be noted that the following article is not intended to provide a comprehensive resource for the layout and maintenance concerns of a fitness facility. For those interested in such details, they should consult Chapter 6 of the fourth edition of ACSM’s Health/Fitness Facility Standards and Guidelines.
When taking prospective members on a tour of a fitness facility, salespeople will typically highlight the availability of not only a variety of exercise equipment but also an abundance of such equipment. This sales approach has been an effective marketing tool because most people want to be assured that they will not only have the availability of a wide selection of equipment from which to choose but also that they will not have to wait in line to access a particular exercise machine. However, to provide an abundance of equipment, many facilities have had to cram numerous exercise machines within limited space, thereby creating a crowding problem that may endanger their members.
CHALLENGES WITH CARDIOVASCULAR EXERCISE EQUIPMENT
The most popular forms of aerobic exercise equipment are treadmills, exercycles, ellipticals, and stair climbers. When considering treadmill placement, it frequently is observed that these machines are located in one long treadmill bank with insufficient distance or spacing between neighboring treadmills. Each type of exercise machine, including treadmills, should have a clear floor space of at least 30 by 48 inches and should be served by an accessible route (1, p. 170). This would mean that there would be at least 2½ ft between treadmills, allowing space for dismounting the treadmill while holding on to the railing.
Regarding the square footage for a treadmill, it is considered a standard by the National Strength & Conditioning Association (NSCA) that there should be at least 45 sq ft allotted for its placement (2, p. 552). This would be consistent with ACSM’s previously mentioned recommendation for clear floor space or what NSCA refers to as a safety space cushion (2, p. 551).
When treadmills do not have clear floor space or a safety space cushion, then users cannot dismount from the side of the machine while holding on to the railings but rather, must walk to the back and step off. Very few treadmills have railings that extend to the back, and therefore, the user will have to step down from the treadmill without the benefit of a safety railing onto which he or she may hold. Lacking this support, users are at greater risk for spraining or even breaking an ankle. This especially is true for seniors who may have impaired balance and require a railing for a stable dismount.
In addition, when clear floor space is not available, members may step on to a neighboring treadmill in their effort to dismount. If that treadmill is running, which may be difficult to discern with all the noise of a treadmill bank and typical background music within a facility, the member may find himself or herself suddenly careening to the back end without the ability to stabilize and consequently falling.
In addition to this potential for injury during a treadmill dismount, there have been numerous injuries reported of individuals falling while walking on treadmills. One of the primary reasons has been the lack of instruction on how to operate the control panel, adjust the speed, control the gait, maintain belt position, stop the belt, and other guidelines related to the safe operation of a treadmill. A typical example would be the New York case of Corrigan v Musclemakers, Inc., wherein a 49-year-old woman, during her first visit and with no previous fitness facility experience, was placed on a treadmill set at 3.5 mph, given no instruction, told to walk for 20 minutes, and left unattended. As a result of her drifting to the rear on the belt and her natural attempt to walk faster, she was thrown off the machine and sustained a fractured ankle (3, p. 66).
Another frequent cause of treadmill injuries has been the lack of instruction on how to start a treadmill and where to stand. Such an example would be the case of Saleh v Service Merchandise, when a 59-year-old woman experienced both a knee and back injury as she collapsed on a treadmill at this retail chain (4). As a result of the sales person failing to tell her how to prepare for the start by straddling the belt and holding onto the rail, she was caught off guard by the belt’s movement and subsequently fell. Unfortunately, this same type of injury occurs oftentimes in fitness facilities when a new member is standing on a treadmill belt as an instructor hits the “start” button while failing to caution the member about the impending and sudden belt movement.
As indicated previously, the standard regarding clear floor space or safety space cushion applies to all aerobic exercise equipment and not just to treadmills. Yet, routinely, it is found within fitness facilities that exercycles, ellipticals, and arc trainers are located so close to each other that individuals find it difficult to dismount without coming in contact with neighboring equipment and their users, increasing the possibility of stumbling, tripping, and falling.
RESISTIVE EXERCISE TRAINING
This spacing standard not only applies to aerobic equipment but also to resistive exercise machines and free weights. As indicated in ACSM’s Health/Fitness Facility Standards and Guidelines, there should be a clear floor space of at least 30 inches between resistive exercise equipment whether it be machinery, free weights, or a combination of both (1, p. 171). When considering neighboring free-weight stations such as a bench press and a standing overhead press, NSCA’s Essentials of Strength Training and Conditioning states that there should be at least 36 inches between bar ends as well as a similar distance from weight trees (2, p. 550).
Regarding power exercises such as a power clean, push press, clean and jerk, and snatches, NSCA recommends that such exercises be located away from windows, mirrors, exits, and entrances to avoid breakage of glass, distraction, or collision with other equipment or individuals (2, p. 550). Although these exercises should not be directly spotted, there remains a strong need for professional supervision to ensure safety and proper lifting technique.
One of the pieces of resistive exercise equipment with which there have been numerous injuries is that of the lat pulldown machine. It is not unusual to find lat pulldown machines using attachments that are not recommended by the equipment manufacturer. Although an attachment like the “S” hook may seem to provide a benefit because it permits a more rapid exchange of various bars, it also provides a threat to member safety. It is important that management not allow the use of such attachments even though requested by members. Additional attachments should not be permitted on equipment without first establishing their efficacy and safety.
In Santucci v Jockey Club, the plaintiff was working with her personal trainer on a lat pulldown machine (5). The bar was attached to the cable’s thimble by means of an “s” hook rather than the preferred gated snap hook. However, when the plaintiff lost control of the bar and her trainer failed to spot her correctly, the bar flew up until the weight stack bottomed out. At this point, the 14-lb bar, with its upward momentum, came off the open end of the “s” hook and fell on the plaintiff’s forehead, wherein she suffered a severe laceration and required 35 stitches. The manufacturer’s maintenance and inspection manual specifically read: “never use s-hooks” (6, p. 8).
In Costa v Lyle Alzada’s Golds Gym, the plaintiff also was working out with a lat pulldown machine when she was injured (7). With this particular piece of equipment, the top plate on the weight stack was 10 lbs, and therefore, the instructional manual specified that any bars used on this equipment should not exceed this 10-lb limit. However, heavier bars were made available and such a heavier bar was on the machine as the plaintiff prepared to reset the weight. When the plaintiff leaned over and pulled the pin from the weight stack, the top plate could not counteract the weight of the 14-lb bar, which landed on her head, knocked her unconscious, and broke her jaw.
In Kosik v Scandinavian, the plaintiff was severely injured because of an equipment failure as a result of a lack of maintenance on a lat pulldown machine (8). The cable attachment parted from the weight stack as a strong effort was applied to the bar. The plaintiff received a serious laceration of the skull along with multiple herniations of cervical discs that necessitated vertebral fusion.
Another machine that often leads to injuries is the leg press, especially the incline leg press. There are a number of specific guidelines to ensure proper form and technique such as appropriate foot spacing, knees tracking over feet, not locking out knee joint, limited knee flexion, and the prevention of legs collapsing and bowing. Of great importance is the necessity of pulling on the grip handles to ensure that the buttocks does not come off the seat and consequently place excessive stress on the low back.
In Dunlap v Planet Fitness, the plaintiff was injured on a plate-loaded incline leg press machine as a result of improper guidance during a one-time session from an unqualified (weekend certification) personal trainer, who gave her cursory instruction ignoring such principles as discussed previously (9). In addition, he assigned her an arbitrary weight to be used when training on her own, and this without testing what she was capable of handling. As a result, she suffered a serious knee injury for which she had multiple surgeries that left her with a permanent disability and chronic pain.
Another leg press machine injury was due to a lack of signage. In Ortega v Intervest, the plaintiff was seriously injured as she tried to adjust a universal leg press machine that was down for repairs without any warning signage (10). A staff member had elevated the selector shaft with its one, fixed 10-lb plate above the weight stack and then placed the shaft’s end off center and on top of the stack. When the plaintiff grasped the end of the selector shaft and realigned it with the weight stack tunnel or center hole, the shaft with its plate dropped suddenly into the hole, and her hand was crushed between two plates resulting in a permanent disability.
It should be understood by management that cautionary, readily visible, and easily understood signage is important to communicate effectively with members to protect them from potential injury and safeguard the business from becoming embroiled in litigation (11, p. 254). When equipment is down for repair, it should be dealt with immediately; and if such repair will be a lengthy project, then ideally, the equipment should be taken off the floor for safety compliance and effective repair (11, p. 295). If equipment removal is not possible, then professional-looking signage such as “out of order” must be placed where easily observed from all angles. Recognizing that at times, members may ignore signage and try to use damaged and potentially dangerous equipment, it would be wise to have the ability to seal off an area with yellow tape such as used at hazardous scenes.
As with the leg press, there are potential dangers with some of the hack squat machines that use many of the same specific guidelines to ensure proper form and technique as the leg press. Unlike the leg press, where it is important to maintain the buttocks on the seat pad, the hack squat user must keep his or her back flat on the back pad. Many individuals experience pain in the knees with the hack squat, in which case placing the feet higher on the platform may relieve the discomfort. If this adjustment does not provide relief, then this machine should be avoided. Having the release mechanism separate from the grip handles is an important consideration that enables the user to determine that he or she can handle the weight before releasing the safety stop. One popular equipment manufacturer has designed the hack squat with parallel release and grip handles that are identical in configuration and only 2 inches apart. By inadvertently grabbing the release handle, one may experience the full load without being prepared, an event that can lead to crushing consequences.
Many pieces of resistive exercise equipment have safety mechanisms and range limiters available; however, it is common for them to be ignored, thereby increasing the potential for injury. Typically, power racks or squat racks will have horizontal safety bars that can be placed just below the client’s lowest or bottom position (12, p. 320). This prevents the lifter from exceeding a safe range of motion while simultaneously ensuring that the bars can support the weight should one fail to recover an upright position. Sometimes, it is not a matter of the lifter ignoring bar placement but rather, a matter of being unable to find the bars that are known to disappear. Similarly, Smith machines have range limiters that frequently are ignored or just not recognized.
Many pieces of resistive exercise equipment need to be bolted down to the floor because of their narrow base of support and high center of gravity. If not secured, the equipment presents a level of instability and may fall on an unsuspecting victim. Because of the frequent moving of strength training equipment in a facility, management often is reluctant to bolt down machines because any future rearranging of equipment would leave holes in the matting or carpeting.
In one such case, a facility member decided to do sit-ups with his feet anchored under an unbolted bicep machine that had an unsafe ratio of base of support to center of gravity. On completing his sit-ups, he grabbed the upper framework of the machine with which to pull himself up from the ground, a maneuver that caused the machine to overturn, leaving him with a severe back injury.
In Barnhard v Cybex International, Inc., the plaintiff was using an unbolted 608-lb leg extension machine for a stretching exercise when it toppled and severed her spinal cord, rendering her a quadriplegic (13). The argument for product liability was based on this manufacturer of commercial exercise equipment having sold a defectively designed and unstable product. The jury also found that the equipment manufacturer failed to give warning of this “tip-over hazard” after having received notice of others having been injured on like products.
There have been similar incidents reported with cable crossover machines that have fallen over. It must be recognized that the use of machines for other purposes than intended coupled with the potential for toppling is a foreseeable event; and therefore, any machine with a high center of gravity and limited base of support should be bolted down.
BODY WEIGHT TRAINING
An everyday exercise such as pull-ups or chin-ups is one that few people would think of as having potential for injury. However, because of the extreme height of some bars in gyms, individuals may be required to jump to grasp a bar. Failing to jump high enough or missing the grip, many individuals have fallen on their backs and suffered serious injuries. When one mounts a bar in his or her home, it should not be any higher than the tips of one’s fingers when the arms are extended overhead to avoid leaping to grab the bar.
In facilities, bars should be mounted at fingertip level for the average height of men and women, which the U.S. Centers for Disease Control & Prevention (CDC) has determined to be 5 ft 9 inches for men and 5 ft 4 inches for women (14). For those individuals taller than the average, they can bend their knees and then go through the full range of motion. For those shorter than the average, they may need a boost from a trainer or stand on a stable platform enabling them to reach the bar. Caution! Just as one should not jump from the ground, it is that much more dangerous to jump from a platform.
A common problem leading to litigation is a lack of maintenance of equipment. In Beauchamp v Golds Gym, the plaintiff was injured while sitting on a bench doing bicep curls (15). The bench height was adjustable by means of a pull pin mechanism that had been partially bent in addition to having a fatigued spring. The bench was 15 years old and had no record of ever being inspected, nor had the pull pin ever been replaced. Because of the pin having been bent and the spring having metal fatigue, the pin was not fully inserted as the plaintiff began her exercise. Evidently, the swinging action of the weights created a jarring effect on the defectively engaged locking mechanism that contributed to the pin’s release and the seat’s collapse. The extended fall and sudden stop led to extreme compressive forces on the spinal column and multiple disc herniations requiring two lumbar surgeries that left her with a permanent disability.
The maintenance of exercise equipment is both a challenge and a headache to the management of any fitness facility. Improperly maintained equipment not only displeases members but also poses a threat to their health and safety. In addition to the obvious need for cleanliness of equipment, there is the priority to maintain optimal functioning of equipment and to avoid any malfunctions that could jeopardize the safe operation of that equipment. Therefore, preventive maintenance is the preferred method for enhancing member safety (11, p. 289). Some equipment must be inspected daily whereas other equipment may require only weekly or monthly inspections. Inspections need to be recorded in maintenance logs, wherein equipment needing service and repair can be designated. If a full-time, qualified maintenance person cannot be funded, then contract maintenance companies should be considered. In some cases, a member of a facility’s team may come from the service field and, therefore, maintain equipment on a contractual basis along with other responsibilities. Frequently, such an individual is aware of servicing problems that frequently escape management’s understanding.
MAXIMIZING FACILITY USER SAFETY
Maintaining good surveillance of an exercise area with all its equipment is of extreme importance. This ability to visualize an entire floor without any blind spots ensures that staff can respond to a downed member without delay. For this reason, taller equipment is typically placed against walls whereas smaller and shorter equipment is placed in the middle of the room to not obstruct the view of supervisory staff (2, p. 550).
Whether working with aerobic or resistive equipment, facility members should always be provided a safety orientation. Before allowing members access to equipment, there should be a walkthrough of the facility reviewing equipment operation with an emphasis on safety considerations (11, p. 271). In addition to previously outlined cautionary concerns, members must be instructed on how to control intensity of exercise and how to avoid overstressing themselves.
As frequently stressed in previous Legal Aspects columns, the number one priority of any fitness facility should be the health and safety of its members. To this end, facility management must continually be conscious of creating a safe environment for all its activities (11, p. 254). The International Health, Racquet and Sportsclub Association (IHRSA), the professional trade association of the health club industry, stated in its 1998 Standards Facilitation Guide Code of Conduct that member clubs must systematically upgrade their professional knowledge and keep abreast of new developments in the field as well as design their facilities and programs with the members’ safety in mind (16, p. 2). This same Code of Conduct requirement for member clubs was reiterated in their most recent 2005 Guide to Club Membership Conduct (17, p. 1).
When it comes to facility equipment, the most important piece of equipment would be that of an automatic external defibrillator (AED); yet unbelievably, there are still some facilities that are not equipped with this lifesaving device. To provide the gift of life, fitness facilities and their staff should have the ready availability of AEDs and ideally, even oxygen. This emergency equipment is essential if we are to give the victims of myocardial infarction and sudden cardiac arrest a fighting chance. Therefore, it stands to reason that fitness instructors and personal trainers should encourage and even insist on the training for and the use of such equipment within their respective fitness facilities if such practices are not already in place.
Nevertheless, it is essential to recognize that emergency equipment alone will not save lives. Such equipment may provide a false sense of security if it is not backed up with qualified staff knowledgeable and skilled in deploying this equipment (18). Therefore, of paramount importance is the training and preparedness of professional staff that can successfully meet and manage emergencies. This readiness can only be achieved and documented with emergency rehearsals and sufficient drills, both announced and unannounced. A well-trained and prepared staff reflects that a facility truly is concerned with the health and safety of its members.