Jan. 3 2019 11:45 AM

The clear boundaries of scope of practice for personal trainers

Blurred lines

In the current state of the fitness industry, and given the large exposure and use of social media, the staggering abundance of self-proclaimed training and nutrition "experts" has become more rampant. In a 2000's survey, there were over 62,000 personal trainers and fitness professionals at work in the United States (1). According to the 2005 Bureau of Labor Statistics, there were approximately 182,000 personal trainers. In May of 2012 (2), there were more than 234,000 people employed in the category of “fitness trainers,” an increase of about 40 percent from 10 years earlier. This is an astronomical increase and shows a commanding and future need for personal training. Further, an eight percent job growth has been predicted for personal trainers and fitness professionals over the period of 2014 through 2024.

The primary factors influencing these projections are due to increases in the aging population, the proliferation of childhood obesity and businesses offering employees programs to maintain physical fitness. Education is the most important aspect to success in any of these growing areas of need, and the certified personal trainer and fitness professional should have an educational background in a fitness-related field such as exercise science or kinesiology. The ongoing reality, however, are coaches, trainers and even unqualified lay persons providing layers of training and nutrition advice outside of their education and scope of practice.

A personal trainer’s scope of practice

The scope of practice of the certified personal trainer involves the responsibility of interviewing potential clients to gather relevant information regarding their personal health history, lifestyle and willingness to exercise. For personal trainers and fitness professionals, much of the centered care is concentrated on instructing, demonstrating, teaching, evaluating, and providing extensive education to clients for exercise. A premier and powerful aspect of personal training focuses on the qualities and abilities of teaching and educating clients.

There are certain subject identities that a successful personal trainer and coach must acquire and understand. These guiding principles include areas of kinesiology, exercise biomechanics, exercise physiology, sport and exercise nutrition, injury prevention and disease prevention. All of these exhibit direct applications for all clients. Knowing and applying these essential principles, the successful personal trainer can effectively integrate, sequence and program accordingly based on the client’s goals. Effective fitness professionals implement a problem-solving method with their instruction, which increases the communication and exchange between the personal trainer and client (3,4). Personal trainers should be able to demonstrate great flexibility and adaptability to teaching either new or variations of exercise technique, or even modify if necessary (3).

Outside the boundaries

With the increased prevalence of chronic disease, personal trainers and fitness professionals need to be observant in their efforts to gain new clients and maintain current clients, while maintaining the scope of practice boundaries afforded by their certification, knowledge and background. If a trainer holds a CPT certification but has a client performing exercises usually reserved for a physical therapist or licensed rehab specialist, and the client incurs an injury, guilt by association can damage the reputation of the certifying organization as well as the facility and trainer. It has been reported that there has been a rise in client and athlete injuries utilizing exercises beyond their physical capacity that were recommended by unqualified trainers (5). Consequently, the widespread problem of CPTs working beyond their scope of practice should create concern for fitness facilities, owners and managers, in addition to certifying organizations who have CPTs misrepresenting their brands, and the public who may experience various conditions. This is both an issue within training and nutrition. Depending on a trainer’s experience and credentials, if nutritional advice is given, if treatment for injury or disease is recommended, or if behavioral counseling or therapy is offered, then the trainer may be working outside their scope of practice. This would make the trainer and facility a target for a negligence lawsuit.

It is the position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine that athletes be referred to a registered dietitian for a personalized nutrition plan (9). Further, those that are providing strength and conditioning programs should be certified by a governing organization (i.e. NSCA), and not perceived to be an expert simply on their physical status alone, but a combination of a wealth and diverse background of the exercise sciences.

To address potential concerns of CPTs working outside the scope of practice, and to retain a higher percentage of clients, service needs should be identified, and a system of improved checks-and-balances should be implemented. Here are some questions that can help determine this process:

  1. Who are your customers and individuals involved? Clients, managers, facility owners, private certifying organizations, regular gym goers?

  2. What are the expectations? To provide effective training and life-long results? To create connection and buy-in? Customized training and individualization?
  3. How can you increase quality service? Are you communicating effectively with clients and athletes? What does the process look like? Does the client know about your educational background? How do you assess each person before beginning a program? Do you have a network of referral clinicians and other providers to refer out when an issue outside of the scope of practice for a CPT occurs?

Are you communicating effectively with clients and athletes? What does the process look like? Does the client know about your educational background? How do you assess each person before beginning a program? Do you have a network of referral clinicians and other providers to refer out when an issue outside of the scope of practice for a CPT occurs?

It is imperative the general and athletic populations are very informed. It’s crucial that coaches and trainers do not confuse reading nutrition or training from various sources and actually understand it from a physiological and performance perspective on a much deeper level.

Bottom line: Know what you know. Know what you don’t know. Act accordingly with your knowledge.

References

1). IDEA. IDEA/ASD Personal Fitness Training Survey: The Consumer Perspective. [online]. http:/www.ideafit.com/prasdsurvey.cfm. 2000

2). Bureau of Labor Statistics. http://www.bls.gov/oes/current/oes399031.htm. 2012

3). Hattie J. Teachers make a difference: What is the research evidence. Presented at: Australian Council for Educational Research, 2003.

4). McComas WF. Thinking, teaching, and learning science outside the boxes. Sci Teach 76: 24–28, 2009.

5. Abbott, A. Resistance training and litigation. ACSM’s Health & Fitness Journal 20(5): 61-65, 2016.

6. Zinn, C.; Schofield, G.; Wall, C. Evaluation of sports nutrition knowledge of new zealand premier club rugby coaches. Int. J. Sport Nutr. Exerc. Metab. 2006, 16, 214–225.

7. Smith-Rockwell, M.; Nickols-Richardson, S.M.; Thye, F.W. Nutrition knowledge, opinions, and practices of coaches and athletic trainers at a division 1 university. Int. J. Sport Nutr. Exerc.

Metab. 2001, 11, 174–185

8). Maxwell, C; Ruth, Kyle, and Friesen, Carol. Sports Nutrition Knowledge, Perceptions, Resources,and Advice Given by Certified CrossFit Trainers. Sports. March 2017

9). Thomas, D.T.; Erdman, K.A.; Burke, L.M. Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance. J. Acad. Nutr. Diet. 2016, 116, 501–528.

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