With the advent of the Internet, we witnessed an explosion of information sharing in all areas of interest including health and fitness. The Internet has provided benefits to consumers as well as the purveyors of products and services such as personal trainers who have been able to attract clients anywhere within the United States not to mention abroad.
Through the Internet, personal trainers have gained access to an unlimited number of potential clients, thereby increasing their income. However, along with this financial advantage, there exist a number of pitfalls; for as one’s access to clientele increases via the cyber environment, so does one’s exposure to legal liability (8). When analyzing “risk versus benefit,” one must look at the risks and benefits not only to the personal trainer but also to the client.
An obvious benefit to the client is a reduced cost of training, although there are a variety of options currently available that range from inexpensive to very expensive depending on the level of services the client desires. People who are unable to afford the hourly rate of an actual one-on-one session with a trainer may now have the means to retain a distant trainer who can spread his/her costs out among many online clients. The fact is that many persons have achieved improved levels of health and fitness simply because education and training have been made more affordable.
Costs to the client may even be lowered more if online personal training is taken within a group setting. Training becomes individualized for a small group of like members, rather than the individual, that enables the cost to be spread out among the members of the group. Some clients may even choose to have a combination of customized individual programs with their online trainers as well as online group sessions.
Another benefit is that of privacy. No longer does the client worry about the prying eyes and curiosity of fitness facility members that may lead one to feel estranged among what may seem like a population of fit people. Within the privacy of the home, the client feels protected, secure, and not afraid of being embarrassed and intimidated by surrounding slim and muscular exercisers. Such privacy may allow the individual to achieve a level of fitness that would enable him/her to gain confidence in his/her appearance and eventually enter the gym environment without a sense of awkwardness.
Convenience is a motivating factor and real benefit as the client can choose to do his/her workout when and where he or she wants. Too often, clients cannot make sessions because their schedules just do not mesh with that of their trainers’ available times. Online training gives the client the freedom to schedule workouts around other commitments, both business and personal. Another problem avoided with the in-person trainer is that of a last-minute emergency requiring that an appointment be missed, a no-show for which the client must pay.
Many clients who have found good personal trainers also may find themselves frustrated if they have to move out of town and can no longer meet in person with their trainers. However, if their trainers do both in-person and online training, they may not have to find comparable trainers in their new locations but rather now may develop online relationships with the trainers with whom they have been comfortable.
Quality of training can become another benefit because online personal training allows clients to access some of the most highly qualified trainers in the industry who otherwise might not be available because of location or cost. Because the personal trainer can expand his/her reach through the Internet, clients may seek out and vet trainers until they are satisfied with the competency and cost of their selected trainers.
An obvious risk is the lack of direct supervision that can lead to serious concerns, such as safety that will be elaborated on later as the job description of the personal trainer is discussed. In fact, online personal training is not personal but rather impersonal. Therefore, many have argued, and understandably so, that these services provided over the Internet should fall under the concept of coaching.
Whereas the actual personal trainer conducts direct services to the client regarding health appraisals, fitness testing, exercise programming, and training supervision, the online or cyber coach is limited in many of these capabilities and consequently across the years has been involved primarily in providing educational and behavioral strategies to the client. However, with the advent of newer technologies, more and more online options are being offered that provide personalized workouts with visual aids.
The personal trainer guides and supervises the client through an actual workout while typically the cyber coach guides the client through his or her life choices related to health and fitness while also providing written and visual exercise guidelines. True, online coaches may critique clients’ videos of their workouts; but this after-the-fact video analysis does not provide the immediate feedback given by the in-person trainer, feedback that enables the client to develop desired exercise techniques more safely. Many personal trainers have recognized the benefits of coaching and, therefore, have added life coaching or wellness coaching skills to their direct or face-to-face practice with clients. With the availability of wellness-coaching certification programs, both personal trainers and online coaches may improve their motivational skills through learning sound counseling practices and lay psychological methodologies.
Many cyber coaches have been under the misconception that because they do not provide direct fitness services, they, therefore, are immune to any legal liability. This is untrue because liability exposures do exist as the coach provides education, behavioral strategies, and exercise guidelines to assist clients in improving their health and fitness (5).
This unique relationship between the cyber coach and the client is technically a fiduciary relationship that has specific implications. The fiduciary relationship has been defined as a “special relationship of trust and confidence which is something more than the ordinary honor of the marketplace… in these relationships, the law demands a higher than ordinary degree of care and responsibility from the dominant or trusted party” (4). This higher degree of care is based on the fact that “one person places complete confidence in another in regard to a particular transaction… the relationship is one of moral or personal responsibility due to the superior knowledge and training of the fiduciary (coach) as compared to the one (client) whose affairs (health and fitness) the fiduciary is handling” (10).
In this relationship, the coach becomes the agent, whereas the client is viewed as the principal, and the type of trust between the agent and the principal is one wherein care and responsibility must be taken for the best interest of the principal. In effect, the agent/coach must act for someone else’s benefit while subordinating his/her personal interests to that of the principal/client, an action that generally is viewed as the highest standard of care available under the law (9).
As previously mentioned, there are a number of safety concerns related to training clients online. Frequently, cyber coaches try to provide some of the similar services that they provide as a personal trainer acting directly with clients on a face-to-face basis. For a number of reasons that will become apparent, this type of effort is difficult at best and often impossible, thereby increasing the potential for litigation. These safety concerns are to be analyzed in light of the job responsibilities of a personal trainer.
These job responsibilities become the legal duties owed by the personal trainer to his/her client, duties also viewed as the “standard of care,” as published by professional organizations. In previous articles, these duties have been summed up in the concept of “STEPS to Success: Avoiding Legal Liability,” whereby the acronym STEPS stands for Screening, Testing, Evaluation, Programming, and Supervision (Table) (3).
SCREENING — HEALTH APPRAISAL
Any exercise programming should be initiated with a screening process that provides a working knowledge base of a client’s past and present health history as well as health and exercise habits. Before an exercise program is undertaken, it is prudent to complete this health appraisal and risk assessment to determine if there are any medical conditions and/or risk factors that could lead to life-threatening situations such as cardiac arrest and, therefore, contraindications to exercise (6).
Recently, the American College of Sports Medicine (ACSM) has updated its recommendations for exercise preparticipation health screening to identify those persons who may be at elevated risk for exercise-related sudden cardiac death and/or acute myocardial infarction (7). Because of studies that have indicated that current ACSM guidelines may be too stringent and therefore have resulted in excessive physician referrals thereby creating a barrier to exercise participation, guidelines have been relaxed. After the convening of a scientific roundtable, a new health screening model was proposed on the basis of three factors. These factors are 1) the individual’s current level of physical activity; 2) the presence of signs or symptoms and/or known cardiovascular, metabolic, or renal disease; and 3) the desired exercise intensity, three variables that have been identified as risk modulators of exercise-related cardiovascular events.
The health appraisal allows the personal trainer to better assess the suitability of exercise for his/her prospective client and whether the client should receive a physician’s clearance before exercise testing and programming. Consequently, it minimizes the risk of injury, disability, or even death to the client while lessening the potential for litigation against the trainer. It also establishes the appropriateness of the next step in this fiduciary relationship — fitness testing.
Most individuals are inclined to be overly optimistic about their health status; and consequently, they are likely to convey a more positive image of their health than is truly the case. When assessing a client’s health via the Internet, the coach does not have the ability to pick up on audible cues; or when assessing verbally by telephone, the coach does not have access to the client’s nonverbal communication or body language. Therefore, the coach is less likely to pick up on some nuances that could convey a poorer health status than reported.
Without personal contact, the coach may be less likely to determine whether clients are thorough and truthful in their responses. Questioning with face-to-face contact is more likely to engender an honest answer. Logically, it would seem that online health appraisals would have a tendency to be less accurate and subsequently more suspect than those administered in the presence of clients. Therefore, this author is of the opinion that, when dealing with online clients, a very comprehensive screening device should be used, even more comprehensive than the recently updated ACSM health screening model. The PAR-Q has obvious limitations and certainly would not qualify as a comprehensive screening device.
For the coach’s protection, he or she should have the client sign the health appraisal or medical history form and have it witnessed and then forwarded for evaluation and filing. An example of a signature block on which the client would sign off could be as follows: “The undersigned swears that the above information is true and correct to the best of his/her knowledge and recognizes that this assessment is not the equivalent of a medical evaluation or diagnosis.” As discussed in previous columns, the personal trainer, or in this case the coach, is a suspectician, not a diagnostician.
Another concern during the health appraisal is the privacy of information that is transmitted across the Internet. Cyberspace security is problematic and continually at risk, a risk that in turn could lead to a violation of Health Insurance Portability and Accountability Act (HIPAA) guidelines. Under the Department of Health and Human Services, the HIPAA of 1996 was established to protect the confidentiality of a client’s health information (1). In addition to a coach’s requirement to keep a client’s health information in a secure file, he or she also must safeguard the transmission of such information. Not to do so could potentially create a liability concern. The transmission of health appraisals or medical history forms may be more secure using “snail mail.”
Part of any minimal screening for a client is the taking of blood pressure, even of the client whose apparent medical history would not warrant a physician’s clearance. Here, the client may be required to visit a local health clinic where blood pressure screening is offered free of charge. Pharmaceutical walk-in clinics also can provide this service; however, clients should be advised not to just self-administer a blood pressure analysis with the units found within stores and pharmacies because these units are frequently very inaccurate.
TESTING — FITNESS PROFILE
Once clients have been screened thoroughly and cleared for exercise programming, the next step is fitness testing. The purpose of testing is threefold: 1) educating clients about their fitness status in relation to standards for individuals of the same age and sex; 2) providing data that will help in the development of exercise programming for the different components of fitness; and 3) collecting baseline data against which future testing data may be compared for motivational purposes.
Unfortunately, testing the online client is not only difficult but also potentially risky. A client may be referred to a competent local trainer who could provide a fitness assessment and forward data to the coach. If a trainer is not available, the testing may be limited to self-measurements such as one’s weight and girth measurements. Based on the health appraisal and exercise history, the client may be given directives to include age- and health-appropriate activities such as push-ups, pull-ups, curl-ups, dips, body weight squats, range-of-motion (ROM) tests, and perhaps even the Rockport One-Mile Walking Test.
The concern with testing is that, although a client may be given specific directives in writing as well as verbally regarding how to perform a fitness test, the coach is not available to ensure proper technique. The coach’s absence could lead to the client’s overexercising, which not only is potentially dangerous but also could result in delayed onset muscle soreness (DOMS), thereby interfering with program compliance.
On receiving and/or determining fitness testing results, the coach must evaluate these data associated with the health appraisal and be prepared to share such information with the client. Typically, initial evaluation of data for each test is based on classification scales for sex and age. However, the coach must be careful not to get “locked in” to just comparing his/her clients with the normative data available. To evaluate clients strictly on this basis is to overlook the important principle of “individual differences” that are less likely to be appreciated with the on-site absence of the coach.
The evaluation of health information and fitness testing data is used for exercise programming. As previously discussed, the likelihood of health appraisals tending to be somewhat inaccurate, and even suspect, coupled with limited fitness testing data, may result in substandard fitness programming.
If programming is substandard, there is a greater opportunity for client failure as well as injuries and deaths, leading to litigation. Of great concern, coaches may prescribe inappropriate intensities for cardiovascular training. Because of tremendous variability in maximal heart rates, a client may be instructed to work at a lesser intensity than is needed to achieve satisfactory results and consequently become discouraged and quit. On the other extreme, the client may be instructed to work at a higher intensity than is safe, thereby leading to discomfort, discouragement, and possible cardiovascular complications.
Regarding muscular training, clients may be provided with programs that fall short of their capabilities or, perhaps, are overly stressful, leading to muscular and/or connective tissue damage. One may become discouraged with inadequate muscular development or, perhaps, be afflicted with a condition as severe as rhabdomyolysis. In light of flexibility programming, clients may fail to receive those exercises appropriate for their individual structure or, perhaps, be instructed to assume excessive ROM that could lead to ligamentous laxity and joint instability. Cardiovascular, muscular, and ROM programming concerns can be avoided and/or corrected with attentive supervision.
Most importantly, what is lacking in cyberspace training is supervision. Without direct supervision, the coach cannot correct a client’s poor and potentially dangerous form during exercise. He is unable to detect biomechanical imbalances, discern overexertion, recognize unsafe ROM, and note impending structural failure. He is unable to set loads and adjust the volume of training based on the client’s performance. An obvious concern with free weight training is the availability of a spotter.
In online training, a major pitfall is the ability to convey instructions with enough clarity to ensure proper adherence. “Even the most carefully written instructions on how to perform an exercise may be misunderstood; and in cyberspace, miscommunications cannot be instantly recognized and remedied. Should a client misconstrue your instructions, get injured, and sue, you would face the impossible task of proving that your instructions were subject to only one interpretation (8).” Supervision minimizes this risk.
The greatest supervision concern is how can the coach respond to an emergency situation? How can the coach provide first aid from afar? In the event of a cardiac arrest, how can the coach administer CPR and deploy a defibrillator? The number one priority of the coach is the health and safety of his/her client. This priority cannot be met without supervision! Hence, the high standard of a fiduciary relationship is violated. Whether ensuring proper exercise technique or responding to an emergency, supervision is essential. A lack of supervision increases the possibility of a coach becoming embroiled in litigation.
To minimize this potential for litigation and to enhance the quality and safety of online services, coaches may be in close enough proximity of some clients to have periodic in-person meetings. Alternately, the coach may arrange for Skype, Face Time, YouTube, or other HIPAA-compliant two-way video streaming sessions. Many coaches will prepare personalized DVDs with specific cues on how to best perform an exercise, along with cautionary notes relating to dangerous technique(s).
Waivers or releases of liability may be unenforceable because some states like Louisiana, Montana, New Mexico, and Virginia hold waivers or releases to be against public policy in fitness settings (8). In addition, the requirements to uphold the validity of a waiver vary from state to state in that some states have very rigorous requirements to uphold a waiver whereas others may have very lenient to moderate requirements. As the law regarding waivers differs from state to state as well as changes from time to time, no assumption of risk forms should be adopted without individual legal advice, an advisement found on multiple forms within ACSM’s Health/Fitness Facility Standards and Guidelines (2). Consequently, the coach must use different waivers to satisfy the requirements of each state within which he or she has clients. Because of the lack of supervision in online training, the coach may be wise to include in the waiver that he or she will not be available in case of an emergency.
Contracts may be written, verbal, and even implied. Ideally, the coach will require an express or written contract with all clients whether dealing with them locally or outside of his/her traveled area. This document memorializes the agreement and designates the fiduciary relationship, outlining the responsibilities or duties the agent/coach and the principal/client have to each other. Verbal agreements, which all too often are used, are recognized as binding contracts within courts of law. Some mutual understandings are found to be enforceable contracts based on implied consent between parties. It may be that two parties agree to exchange services (i.e., personal training for printing services), and this becomes a recognized contract.
In summary, online training does have advantages for both coaches and clients. However, online training ventures have many inherent risks that all too often coaches fail to recognize. It is incumbent on the coach to evaluate the multiple shortcomings of online training and determine whether the benefits outweigh the risks for both coach and client.