By JoAnn Eickhoff-Shemek, Ph.D., FACSM
Introduction
Over the past 2-3 decades, many “safety” advances in the fitness field have occurred including: a) research resulting in numerous publications that describe how to safely design exercise programs for healthy individuals and those with medical conditions, b) academic programs in exercise science that help prepare qualified and competent professionals, and c) safety standards and guidelines published by professional organizations.
Today, consumers should have no concerns regarding their safety when joining a fitness facility or participating in an exercise program, right? Wrong — Caveat Emptor! Many trends exist in the fitness field that can create “increased risks” for injuries and result in litigation. Two are rapidly growing and should be concerning to the consumer: (1) high intensity exercise, and (2) poorly educated fitness trainers.
High-Intensity Exercise
A recent study of fitness trends (1) conducted by the American College of Sports Medicine(ACSM) found the #1 trend in 2014 to be high intensity interval training (HIIT). The growth of HIIT and other high intensity programs such as CrossFit and P90X has been remarkable. For example, CrossFit’s revenue and number of affiliates (gyms) in 2012 were $50 million and 6,775, respectively, with projections by the end of 2013 reaching $100 million and 10,000 (2).
Although evidence exists that continuous high-intensity exercise performed in a very short time (e.g., 20 minutes/session) with little or no rest periods can achieve health/fitness benefits, these types of programs also have been shown to create increased risks of injuries, and in some cases, serious injuries (3). For example, in a consensus statement (4), it states that “Excesses in strength training and conditioning–workouts that are too novel, too much, too soon, or too intense…have a strong connection to exertional rhabdomyolysis” (p. 477) — a medical condition that results from skeletal muscle damage that can lead to kidney failure.
In the Mimms case(5), the plaintiff was hospitalized with serious injuries including rhabdomyolysis, two days after he completed his first CrossFit training session. He filed a negligence lawsuit against the fitness trainer and facility listing several negligence claims (e.g., improper instruction and program design). He was awarded $300,000 in damages. Part of the evidence in this case included the testimony of an expert witness who stated that the design of the program was inconsistent with safe training principles as described in an ACSM position paper (6). Other high intensity exercise programs have also resulted in serious injuries and negligence lawsuits (3, 7). Many risk management strategies can be developed to minimize the increased risks associated with high intensity programs, but fitness trainers (and managers) must possess the knowledge and skills to implement them.
Poorly Educated Fitness Trainers
The fitness field is not government-regulated. Several states have proposed licensure bills for fitness trainers, but none have become law. The field is self-regulated primarily through certifications that fitness trainers can obtain by passing a certification exam. With no government (or other) oversight, any organization can offer a certification. Given the growth of personal training in recent years, the number of certifications has increased significantly with hundreds of them now available. Being “certified” is the most recognized credential for anyone wanting to become a trainer, but these certifications vary tremendously in their exam content and rigor.
One attempt, perhaps, to increase the credibility of these certification exams has been for certifying organizations to have their exam become accredited by the National Commission of Certifying Agencies (NCCA) or a similar agency. According to Dr. Anthony Abbott, a well-known expert witness, who has taken over 30 of these certification exams, including many that are accredited, states “the concept of accreditation has lost most of its value” because even the accredited exams “are posing poorly written and simplistic questions” and “without using well-constructed and challenging application and analysis questions, exams are not able to probe the depth of the trainer’s knowledge” (8, p. 100).
Interestingly, many of the proposed licensing bills included formal education requirements, i.e., classroom instruction and practical experience. However, effective lobbying efforts by those opposing formal education has resulted in some of these bills being revised to require an accredited certification as the only educational credential needed. Therefore, if licensure does occur in the future it may not address the problems of the poorly-educated trainer. Licensing usually raises the bar for someone to enter a profession because of the educational credentials required.
A major problem with certifications is that consumers often believe that a “certified” trainer is qualified and competent. That can be a very wrong, risky belief. Many clients of fitness trainers have been seriously injured resulting in lawsuits against the trainers and their employers due to incompetence (negligent conduct) of the trainer (7). Another major problem with certifications is that trainers (and some employers) may believe they are qualified and competent once they pass any certification exam and/or an “accredited” exam, but in reality they may not be. Fitness trainers who are unaware of their many legal duties with regard to the safe delivery of an exercise program, unknowingly, subject themselves to a standard of care for which they are not prepared to meet. They may not realize that expert witnesses, like Dr. Abbott, will likely be judging their conduct in a negligence lawsuit.
Conclusion
In addition to these two emerging trends, other fast-growing trends also exist that can put consumers at increased risk for injuries. For example, the number of unsupervised fitness facilities has grown tremendously in recent years. With little or no staff supervision, it is impossible for these facilities to meet the many safety standards/guidelines published by professional organizations. Another is the increasing popularity and participation in mud runs. Many people have been seriously injured (and some have died) while participating in these events resulting in litigation. Often, with many of these emerging trends, the focus is on profit instead of safety.
Until there is government regulation or some other oversight to help ensure fitness safety, consumers will continue to be exposed to these types of emerging trends that can put them at “increased risk” for injuries, many times unknowingly. Caveat Emptor! Well informed consumers can always select from the many fitness facilities/programs that focus on safety — those that hire “educated” fitness professionals and managers (e.g., those with academic degrees in exercise science and professional certifications) who understand and apply the research with regard to safe exercise and follow published safety standards/guidelines.
JoAnn Eickhoff-Shemek is a professor of exercise science at the University of South Florida where her teaching and research focus on legal liability and risk management. She is the lead author of a textbook entitled Risk Management for Health/Fitness Professionals: Legal Issues and Strategies. For more information about this text and the educational programs (faculty training course for academicians and a continuing education course for professionals) that Dr. Eickhoff-Shemek and one of her co-authors (David L. Herbert, J.D.) have developed, go to www.fitnesslawacademy.com.
References
Thompson WR. (2013). Worldwide survey of fitness trends for 2014. ACSM’s Health & Fitness Journal, 17(6):10-20.
Helm B. (2013). Do not cross CrossFit. Inc. July/August:102-105, 114-115.
Bergeron MF, Nindl BC, Deuster PA, et al. (2011). Consortium for health and military performance and American College of Sports Medicine consensus paper on extreme conditioning programs in military personnel. Current Sports Medicine Reports, 10(6):383-389.
Casa DJ, Anderson SA, Baker L, et al. (2012). The inter-association task force for preventing sudden death in collegiate conditioning sessions: Best practices recommendations. Journal of Athletic Training, 47(4):477-480.
Mimms v. Ruthless Training Concepts, LLC (Case No. 78584, Cir. Ct. of Prince William County, VA, 2008).
ACSM Position Stand. (2009). Progression models in resistance training for healthy adults. Medicine & Science in Sports & Exercise, 41(3):687-708.
Eickhoff-Shemek J. (2010). An analysis of 8 negligence lawsuits against personal fitness trainers: 3 major liability exposures revealed. ACSM’s Health & Fitness Journal, 14(5):34-37.
Abbott AA. (2009). Fitness professionals: Certified, qualified and justified. The Exercise Standards and Malpractice Reporter, 23(2):98-101.
