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The Canadian personal training Survey.

INTRODUCTION

A profession is a vocation or calling grounded in advanced learning of scientific principles relating to one's occupation. Each profession has an organized body of knowledge, organizations to disseminate this knowledge, a code of ethics to guide professional practice and recognition of authority by the public (10). Public recognition of authority has traditionally involved membership, certification, registration and licensure of individuals meeting the minimal standards required for successful practice.

Given the link between regular physical activity, exercise and personal wellbeing, fitness professionals are in a position to have a large, favourable impact on the health of the population. The role of the personal trainer for the provision of services within this industry has seen exponential growth. Personal training is big business, and millions of dollars are spent by individuals, corporations and insurance providers on fitness advice and personal training each year. Certifications have been developed to meet the demands of the ever-increasing number of personal trainers. However, not all certifications are equal, nor were they designed to be so. Each certification provides a service to a niche market and develops knowledge and/or skills that provide an opportunity to work with a small segment of the population. In a regulated industry, the health and fitness practitioners involved in exercise program design and delivery would be required to meet academic and professional standards that are deemed necessary for safe, effective program delivery and service. However, these requirements vary depending on the health status of the client population.

To insure adequate level of care, most allied health professionals (e.g. nutritionists, certified athletic trainers, physiotherapists) are required to have a degree that develops the knowledge, skills and abilities required to function within their health professions, and are then required to pass a rigorous certification examination that determines their readiness for practicing their craft. This insures that the individuals possessed the practical skills and abilities that are not always contained with a formal education.

Allied-health practitioners are provided the authority to practice through provincial health legislation in Canada, which also carefully defines their scope of practice (5). These health practitioners understand the limitations of their practice because it is dictated by provincial health legislation, and enforced by a professional licensing board. However, while this is true of most allied health care professionals, health care professionals worry that fitness practitioners have an ill-defined scope of practice and often extend their practice beyond their training and certification when referral would be prudent (10). Individuals seeking assistance from personal trainers deserve fitness professionals who possess a level of knowledge, skills and abilities in exercise science that enable them to design a safe, injury-free and optimal fitness program (13). However, Anderson (1, 2) suggests that there is much confusion within the fitness industry that leaves consumers at a disadvantage when purchasing the services of fitness professionals. The purpose of the present survey was to examine the variability in service provision, knowledge and beliefs of Canadian personal trainers across levels of certification and education. Particular emphasis was placed on the personal trainer's perceived role and scope of practice as compared to the scope of practice set for each certification and the expected scope of practice for each level of education.

METHODS

Procedures

Data were collected over an eight-month period via the Internet using a secured website (www.canadianpersonaltrainer.com) that contained the questionnaire. Participants were notified of the study and provided login information for the website through various certifying, provincial and national organizations and their newsletters. The survey instrument included demographical data that included age, gender, level of education, and certifications held. It also collected information on the types of screening and assessment tools that were used, and exercise prescription and services provided. In addition, the survey asked for information concerning their knowledge and use of nutrition, weight management, physical activity, and general wellness information.

Responses to tools and services used within their practice were scored on a scale from 1 to 7, with 1 being "never use" (use with less than 10% of their clients) and 7 being "always use" (used with greater than 90% of their clients). Responses concerning knowledge were scored on a scale from 1 to 5, with 1 being "strongly agree" and 5 being "strongly disagree". Participants also rated each of knowledge-based questions on frequency of use on a similar 1 to 5 scale with 1 being "never use" (use with less than 10% of their clients), 3 being "sometimes use" (used with 41-60% of clients) and 5 being "always use" (used with greater than 90% of their clients).

Statistical Analyses

Responses were compiled using Microsoft Access (2003) from which Microsoft Excel (2003) files were generated for calculation of mean and median responses, stratified by level of education (high school completion, some university or college certificate (1 year), college diploma (2-3 years), and those with a bachelor degree or higher).

RESULTS

Overall there were 268 complete responses from independent e-mail addresses. Over two thirds of the respondents were male, while the median age of both the male and female respondents was between 30 and 39 years of age, and was consistent across all levels of education. Nine percent of the respondents had only a high-school education, 19.2% had 1 year of university or college, 18.0% had a college diploma or 2 years of university, while 53.9% had at least a bachelor degree. Of the 268, 55% were certified by the Canadian Society for Exercise Physiology (CSEP), with two thirds of those having the Certified Fitness Consultant. Fifteen percent of the respondents held only one certification, which was rarely a CSEP certification; 85% of the respondents held multiple certifications, with up to 8 certifications identified per person. The median number of certifications held by those who held a CSEP certification was 5.

Participants were asked to identify those services with which they provided clients: choices of lifestyle counselling (LC), aerobic training (AT), weight training (WT), nutritional counselling (NC), athletic conditioning (AC), and therapeutic exercise (TE). A greater percentage of those with a higher level of education provided a wider range of services (Table 1).

Prescreening Tools

For a fitness professional, the initial visit with any client is designed to become familiar with the client's physical activity and medical history, which is done through pre- screening. Common tools used in the process of prescreening and rapport building were listed in the survey, and some of the results can be found in Table 2.

Assessment Practices

Results vary dramatically across the assessment protocols used by each group of individuals. The step test was the least used aerobic fitness assessment tool, while those with a diploma chose the treadmill as their most frequently used apparatus for aerobic fitness assessment (see Table 3). Similarly, with muscular fitness few individuals indicated using the hand grip dynamometer (grip strength) as an assessment tool. The most common muscular fitness assessment tool was the 5-10 repetition maximum, while individuals across all levels of education report performing muscle balance testing.

Scope of Practice

Responses to training methods used were similar across all levels of education. Heart rate monitoring and rating of perceived exertion were both commonly used in aerobic exercise prescription. The median values for responses indicate that heart rate monitoring was used "sometimes", whereas RPE was used "almost all the time" for prescribing aerobic exercise intensities across all levels of education.

Nutrition

All education levels admit to performing some type of nutritional counselling (median = 4 to 5 across categories). According to the median values, those with one year of university were found to offer more nutritional counselling (median = 5) than the other education levels, as were those with a college diploma (median = 4.5). Services offered by those with some university education to the majority of their clients include nutritional assessment, counselling and modification of eating behaviours. Not one education level claimed to prescribe nutritional supplements.

Participants were also asked specific questions regarding their agreement with and use of various nutrition concepts. While respondents identified the important nutritional concepts and agreed with them, few used the information with their clients. For example, respondents believed the information in the Canada Food Guide was important, but few used the tool; while respondents believed that healthy eating tips such as avoiding excess alcohol, salt, and attaining adequate water and fibre were important, again, few used the information with their clients. There was not one nutrition concept in which all four education levels agreed or disagreed with, with large data ranges in the response patterns. The only nutrition concept that all education levels admitted to "never" prescribing to their clients were creatine supplements for the enhancement of muscle mass. The importance of eating a healthy breakfast was less important to those having a high school education, and the message was used infrequently with their clients.

Weight Management

Respondents were questioned on multiple ideas regarding weight management. All education levels agreed that maintaining a healthy weight is essential to good health, while all agreed that they should not reduce caloric intake by more than 500 kcal per day without consultation, although few referred clients to a nutritionist. In general trainers rarely report prescribing any of the "fad" diets such as Atkins, one-food-centred, fasting, low-carbohydrates and high-protein diets for long-term weight loss, although those with a high school education claimed to "usually" promote high-fat diets and one-food-centred diets to lose body fat.

General Wellness

General wellness questions pertained to health behaviours and environmental conditions that translate into improved client health. All respondents were asked questions regarding lifestyle choices of which many of the respondents strongly agreed; however very few were used or promoted to their clients. Only those considered to have had one year or less of university reported that they always promote annual medical check ups, sufficient sleep each night and allowing time for leisure pursuits. All education levels surveyed considered physical activity as an important mechanism for coping with daily stress, and encouraged their clients to avoid exposure to cigarettes. Those with a high school education strongly agreed that individuals should reduce the time spent on non- active activities such as watching television, using the computer and other sedentary activities; however, while identifying the reduction of sedentary pursuits as important lifestyle behaviours that clients should adopt, few actively promote these behaviours to their clients.

Therapeutic Exercise

Results suggest that, although therapeutic exercise is not in the scope of practice of most of the respondents, 53.4% of the respondents claimed to perform therapeutic exercise. The most commonly performed therapeutic exercises by all levels of training were for skeletal and metabolic disorders, with those with a diploma performing more of these activities than any other education level (Table 4). Interestingly, this differs slightly from the general question concerning "do you perform therapeutic exercise" as presented in Table 1, where those with a degree or higher were initially classified as performing more therapeutic exercise.

DISCUSSION

The tremendous growth in the fitness industry has caused a demand for entry- level personnel. However, with this growth has come the recruitment of individuals who have little knowledge, experience or advanced training in the field. To help fill the need for entry level personnel in the fitness industry there has been a proliferation of certifications. Certification is a way of ensuring that all entry level personnel meet a minimal standard, as determined by the certification agency, in hopes of protecting the employer and the consumer. Certification also acknowledges competence in the knowledge and practical skills that are required to work effectively in the industry at various levels (1, 2). However, to date there is no legislation that defines "personal fitness trainer" nor any legal requirement for a personal trainer to be certified in Canada (7). Further, while standards and guidelines are emerging in the fitness industry there are no repercussions for those that engage in training activities that fall outside of their legitimate sphere of competence (9).

The justification for regulated practices of fitness practitioners could easily mirror those of other health professionals, in producing better service provision to clients, while removing some of the consumer's confusion concerning from whom they should be obtaining services (11). It can be argued that consumers do not have adequate knowledge to distinguish between the plethora of certified individuals, nor do they have the knowledge to differentiate between poor, adequate and excellent service provision (11). While certification verifies that a candidate meets the certification criteria, consumers do not recognize the subtle differences between the certifications.

Without standard certification entrance and exit criteria, and standardized methods of determining mastery of prerequisite knowledge, skills and abilities, consumers have no assurances that their certified personal trainers have met standards that would allow them to provide safe and effective instruction. In fact, Malek et al. (13) report that "inadequate screening and premature certification of unqualified candidates can expose both health clubs and certifying organizations to liability should clients suffer injuries due to negligence of an unqualified personal fitness trainer (p. 24)." For this reason, it is in the best interest of all parties to implement certification standards that will reduce the injury risk of clients, while reducing the liability of the trainer, employer, and certifying organization. This involves clearly defined scopes of practice for each level of fitness practitioner, much like nursing has done (8). The scope of practice must address the requirement for the use of "specialized knowledge and skill" in the provision of "safe and competent" care, while limiting the practitioner's duties to those for which they have adequate "knowledge, skills, and abilities" (5).

As with many certifying bodies, the mission of the Canadian Society for Exercise Physiology Health and Fitness Program is to ensure that quality fitness practices and services are available to clients. Within their certification paradigm they clearly delineate the services that may be provided by those possessing each level of certification (www.csep.ca/hfp.asp), and for which they are insured through their standard insurance policies. Within their model, a person possessing a college certificate, diploma, or two years of university training may perform fitness and lifestyle assessment of apparently healthy individuals, while providing general information pertaining to physical activity, fitness and lifestyle; a person possessing a university degree may perform a wide variety of assessment and interpretation services while developing specific exercise programs to address each client's goals and present fitness level. Neither have the provision of specific dietary analysis and modification within their scope of practice.

Within the fitness industry, a general personal training certification offered to those with prior continuing education certifications (weekend or short-term) and experience is presently the minimal requirement for providing basic services to apparently healthy populations between 18 and 60 (such as weight room supervision). In a professional model, a two-year diploma should be thought of as the minimal prerequisite for these employees. However, using the basic tenets within the defined scope of practice for fitness practitioners as defined by the Canadian Society of Exercise Physiology Health and Fitness Program (www.csep.ca/hfp.asp), the results of the present study would suggest that many of the fitness professionals at each education level utilize assessment techniques or provide exercise advice and/or services to clients that fall outside of their scope of practice, and for which they would not be insured. This is similar to the results found in the United States (9, 13, 15).

The present results support the notion that those with higher level of education provide a wider range of services, while working outside of their scope of practice less than those with less education. However, results also suggest that individuals across all education levels work outside their scope of practice, and the differences between services provided by a high school graduate and degreed professional are not significant. While 54% of the respondents held a degree, 21% were certified as a Professional Fitness and Lifestyle Consultant (now Certified Exercise Physiologist), yet over 50% of the respondents reported performing nutritional consulting and therapeutic exercise. While Thomas et al. (16) found trainers to value their experience as a trainer as much as having a degree, Malek et al. (13) strongly argued that a degree be the minimal education for any work in personal training. These authors found that those with a degree were more knowledgeable in the field of fitness than those with less education but extensive experience.

In examining the roles of personal trainers, Gavin (9) found strong evidence that trainers engage in and take responsibility for activities that fall outside their scope of practice, or "legitimate domains of competence and influence". While he found trainers to believe their role was predominantly in building the physical aspects of a client's repertoire, he found that they widely endorsed providing health, nutrition, and even personal advice. Gavin argues that, in a new profession, trainers need to overstep their bounds to attract and retain enough clients to meet financial obligations, reflecting a "survival strategy" in which trainers expand their services to clients in order to retain their clientele for a longer duration of time. From the present results, apparently fitness professionals frequently overestimate their abilities and "widen their base of professed expertise to survive" (9) regardless of the level of education.

Personal trainers often provide a range of services the include assessment, prescription and counselling in fitness related areas. Certifications for personal trainers range from weekend certification with no formal education for those working with apparently healthy young adults to a degreed individual for working with men over 40 and women over 50 with two or more cardiovascular risk factors to a degreed individual with post-degree qualifications (e.g. ACSM Exercise Specialist) for those working with individuals with known cardiovascular disease (4). While at no time may personal trainers diagnose injury or disease or treat such disorders (12), fitness professionals may be viewed as a continuation of the health-care system, offering preventative measures to healthy individuals, while prescribing exercise in collaboration with other health care providers to reduce disability and disease.

For a fitness professional, the initial visit with any client is designed to become familiar with the client's physical activity and medical history, which is done through pre- screening. Pre-screening helps the fitness professional to design fitness programs specialized to the client's goals, and interests, as well as to identify any possible risks the clients may have in performing exercise. In the present study, trainers across all levels of education (except for those with a high school education) stated that they always use the PAR-Q when pre-screening their clients as supported by CSEP and the American College of Sports Medicine. This is contrary to the finding of McInnis et al. (14) who found only 61% of the facilities surveyed to always perform pre-screening of new members, while only 49% of those that do screen require physician clearance for clients with two or more cardiac risk factors.

Various methods are available to trainers for fitness assessment; however, most certifications are prescriptive in regards to what protocols are acceptable. The aerobic fitness test that is sanctioned for use by non-degreed individuals for use with apparently healthy individuals is the step test; however, based on the present results very few use this in practice. Those with a high school education or degree reported using the step test "sometimes" while those with a certificate or diploma reported "never" using this protocol. In the prescription of aerobic exercise, intensities were prescribed as ratings of perceived exertion and heart rate most often. However, while trainers reported using accepted methods of prescribing exercise intensity, Malek et al. (13) found only 3% of personal trainers to use proper heart rate intensities as outlined by ACSM when prescribing cardiovascular exercise.

Muscular strength is often measured through the use of a hand grip dynamometer and is embedded in the Canadian Physical Activity, Fitness and Lifestyle Assessment protocols for which 45% of the present respondents were certified to perform. However, the median score for all education levels indicated that they "never" use this technique in strength determination, even though it is required for the determination of a combined muscular fitness score. Respondents with a high school education and those with a degree or higher indicated that they use this protocol some of the time, whereas those considered to have some university or those with a diploma claimed to never use this protocol.

It is reported that fitness professionals rarely decline exercise prescription to clients if they feel there is little risk, often taking responsibility for practices that fall outside their legitimate scope of practice (9). Fitness practitioners often believe that experience is at least as valuable as a college degree or course work in preparing them to work with diverse client groups (16). However, fitness professional lacking specific education and training are rarely insured by the certifying body or employer to perform these tasks. The present results support the notion that fitness professionals in Canada work beyond their scope of practice, with 54.4% of the respondents providing therapeutic exercise and most performing posture analysis and muscle balance testing--techniques restricted to rehabilitation specialists and certified clinical exercise physiologist.

Personal fitness trainers offering services beyond their scope of practice and formal training was also evident in the area of nutrition and weight loss. Thomas et al. (16) found 84% of the fitness professionals in Texas to suggest protein consumption in excess of the recommended 8-15% of daily caloric intake (37% recommending greater than 25% of total caloric intake be protein). In the present study trainers across all levels of education promoted the use of protein supplements to their clients for muscle mass gains ranging from sometimes to frequently, although were less likely to support fad diets. However, those with less education than a formal degree were found to often perform nutritional assessment, counselling and eating behaviour modification despite the fact that these participants did not report using concepts embedded within the Canada Food Guide. This is similar to results found in United States where Ryan (15) found 26% of personal trainers to use nutritional analysis software, 70% to provide nutritional assessment and 75% to provide nutritional coaching practices that are reserved to the scope of practice of registered dieticians who have four years of specific nutrition education, and practices that clearly fall outside the scope of practice of a personal trainer.

CONCLUSION

At present it appears that a large portion of fitness practitioners in Canada provide services outside of their scope of practice and level of training--a trend that has been recognized previously in other countries (9). If the fitness profession is to advance, certifying agencies and organizations must put their personal differences aside and agree on a method of standardization, and embed this practice within the continuum of health-care provision (1, 3, 7). Options may include third-party accreditation of certifying agencies, national board exams for each level of fitness practitioner, or licensure (3, 13). No matter what option is adopted, in order to protect the consumers of fitness related services there must be a process for limiting the role of those who hold no certification and who have no formal education while providing a clear distinction between the scope of practice of a fitness professional (competent degreed individual), trainer or technician (college diploma or equivalent) and leader (short duration workshops). Each scope of practice must be clearly defined, widely promoted within the public domain and clearly expressed to, and understood by, the trainer, the employer, consumer and other health-care practitioners.

It would be interesting to have accurate data on injuries incurred by clients as a result of direct contact with, and the actions of, a personal trainer, and one may well argue that if few minor or major injuries occur, scopes of practice that limit activities may be misguided. However, at the present time personal trainers at each level of education MUST be acutely aware of the limitations imposed by their level of education and certification, and the activities they may perform legitimately within their insured scope of practice to avoid personal liability.

ACKNOWLEDGEMENTS

Authors would like to thank ThinkLabs (Abbotsford, BC) for preparing the online survey.

Address for correspondence: Anderson GS. PhD., Kinesiology and Physical Education, University of the Fraser Valley, Abbotsford, BC, Canada, V2S 7M8. Phone (604) 854-4564; FAX: (604) 855 7558; Email. gregory.anderson@ufv.ca

REFERENCES

(1.) Anderson GS. The Pro-file: Greg Anderson, PhD. CanFitPro 2005; March/April:38-41.

(2.) Anderson GS. Canadian Forum: Fitness professional? Fit Bus Can 2000; 1(4):50.

(3.) Archer S. Navigating PFT certifications. IDEA Fit J2004; September: 3-8.

(4.) Balady GF. et al. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Circulation 1998; 97:2283-2293.

(5.) Blair PA. Determine your scope of practice. Nurs Manage 2003; 34(4):20-22.

(6.) Canadian Society for Exercise Physiology. www.csep.ca/hfp.asp Viewed August 26, 2009.

(7.) Couzens GS. Personal trainers: a formula for fitness? Phys Sportsmed 1992; 20(11):130-132.

(8.) Daly WM, Carnwell R. Nursing roles and levels of practice: A framework for differentiating between elementary, specialist and advancing nurse practice. J Clin Nurs 2003; 12:158-167.

(9.) Gavin J. Personal trainer's perceptions of role responsibilities, conflicts, and boundaries. Ethics Behav 1996; 6(1):55-70.

(10.) Hilgenkamp K. Ethical behaviour and professionalism in the business of health and fitness. ACSM's Health Fit J 1998; 2(4):24-27.

(11.) Holcombe RG. Eliminating scope of practice and licensing laws to improve health care. J Law Med Ethics 2003; 31:236-246.

(12.) IDEA Opinion Statement (2001). Benefits of a working relationship between medical and allied health practitioners and personal fitness trainers. IDEA Health & Fitness Association.

(13.) Malek MH, Nalbone DP, Berger DE, Coburn JW. Importance of health science education for personal fitness trainers. J Strength Cond Res 2002; 16(1):19-24.

(14.) McInnis KJ, Hayakawa S, Balady GJ. Cardiovascular screening and emergency procedures at health fitness centers. Am J Cardiol 1997; 80(3):380-383.

(15.) Ryan P. Trendsetting. IDEA Fit J2004; 16(5):S2-S14.

(16.) Thomas DQ, Long KA, Meyers B. Survey of personal trainers in Houston, Texas. Natl Str Cond Assoc J 1993; 15(3):43-46.

GREGORY ANDERSON, BRYNNE ELLIOTT, NATE WOODS

Kinesiology and Physical Education, University of the Fraser Valley, Abbotsford,

BC CANADA
Table 1: Self-reported training services provided for trainers with
varying levels of education.

Services Provided         High     Certificate   Diploma     Degree +
                          School   (1 yr)        (2-3 yrs)   (4+ yrs)

Percent of total           9.0     19.2          18.0        53.9
  population
Percent male              72.7     74.5          72.7        65.2
Lifestyle Counselling     59.1     55.4          44.8        73.5
Aerobic Training          77.3     57.1          55.2        81.1
Weight Training           95.5     78.6          72.4        93.2
Nutritional Counselling   59.1     57.1          44.8        68.9
Athletic Conditioning     36.4     42.9          44.8        53.0
Therapeutic Exercise      50.0     42.9          34.5        63.6

Table 2: Pre-screening tools used by trainers with varying levels
of education (1-Never use; 7--Always use).

Pre-Screening Tools         High     Certificate   Diploma     Degree +
                            School   (1 yr)        (2-3 yrs)   (4+ yrs)

PAR Q and/or PARmed-X        6.5          7            7          7
Stage of change               1           3            2          2
  questionnaire
Lifestyle Questionnaire       3           5            4          5
Physical Activity Logbook     4           6            5          5
Goal Setting Worksheet        5           6           4.5         5
Self Contract                 4           2            4          3

Table 3: Fitness assessment practices of trainers with varying levels
of education (1-Never use; 7--Always use).

                            High    Certificate    Diploma    Degree +
Fitness Assessment         School     (1 yr)      (2-3 yrs)   (4+ yrs)
Aerobic Fitness Tests
#NAME?                       3           2            2          1
--Step test                  3           1            1          3
--Treadmill/running         2.5          1            5          3
Muscular Fitness Tests
--Grip Strength              1           1            1          1
--5-10 RM strength test      4           3            4         4.5
--Abdominal Muscular         2           2            2          2
  Endurance
--Lower Back Muscular        4           3            4          4
  Endurance
--Muscle balance testing     6           6            7          6
Flexibility
--Sit & Reach               6.5          5            6         4.5
--Goniometer                 1           3            4          4
Other
--Posture Analysis           7           7            7          7

Table 4: Median scores for therapeutic exercise services provided by
trainers with varying levels of education (1-Never perform; 7 -
Always perform).

Therapeutic Exercise       High    Certificate    Diploma    Degree +
Prescription              School     (1 yr)      (2-3 yrs)   (4+ yrs)

--Lower back pain           1           1            1         1.5
--Skeletal disorders       3.5          4            4          3
--Neural disorders          1           1            1          1
--Metabolic disorders       3           3            4          3
--Immunologic disorders     1           1            1          2
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Title Annotation:Fitness and Training
Author:Anderson, Gregory; Elliott, Brynne; Woods, Nate
Publication:Journal of Exercise Physiology Online
Article Type:Report
Geographic Code:1CANA
Date:Oct 1, 2010
Words:4714
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