ACE Personal Trainer Manual, 4th edition Chapter 1: Role and Scope of Practice for the Personal Trainer 1
Introduction The human body responds to the stress of physical movement with improved fitness and health. 2008 Physical Activity Guidelines for Americans (U.S. Department of Health & Human Services) – Regular physical activity reduces the risk of many adverse health outcomes. – For most health outcomes, additional benefits occur as the amount of physical activity increases. – Most health benefits occur with at least 150 minutes a week of moderate-intensity physical activity, such as brisk walking. – Both aerobic and muscle-strengthening activity are beneficial. – Health benefits occur across all population groups. – The health benefits of physical activity occur for people with disabilities. – The benefits of physical activity far outweigh the possibility of adverse outcomes.
Personal Trainer • Healthcare professional who works to make safe and effective exercise programs for apparently healthy clients.
• Personal Trainer – Responsible for designing a comprehensive exercise program to meet an individuals needs and goals while also considering a person’s health history – Become an incredibly fast growing and expansive field • Work with all types of individuals
– Providing increasing services in post-rehabilitation training, sports conditioning, special medical needs, and weight management
The Role of Fitness Professionals The role of fitness professionals in relation to the other members of the healthcare team is presented on the following slide. The personal trainer should obtain written permission from the client to communicate with the referring physician. Even when clients do not have a physician’s referral, it is important for the personal trainer to maintain confidential records that include the client’s: – Program – Progress – Health-history information
• No single standard qualification for a person to practice as a personal fitness trainer • Most organizations have specific requirements, mandatory testing/retesting, renewal periods, and continuing education • Some even require a formal educational degree in exercise science or another related field
– primary organizations • • • • • • •
American College of Sports Medicine (ACSM) National Academy of Sports Medicine (NASM) National Strength and Conditioning Association (NSCA) American Council on Exercise (ACE) National Council on Strength & Fitness (NCSF) National Exercise Trainers Associaton (NETA) International Fitness Association (IFA)
Specialty Areas Within Allied Healthcare Figure 1-1
The ACE Personal Trainer Certification
Candidates must meet or surpass a level of “minimum competency” as assessed by a competency-based evaluation (exam) to show that they are adequately qualified to work in the profession. The primary purpose of a certification is to protect the public from harm. An ACE-certified Personal Trainer has proven competence in: – Making safe and effective exercise-programming decisions in a variety of practical situations – Minimizing client risk and exposure to harm
Defining “Scope of Practice” A scope of practice defines the: – Legal range of services that professionals in a given field can provide – Settings in which those services can be provided – Guidelines or parameters that must be followed
The laws, rules, and regulations that govern a profession are established for the protection of the public. Fitness professionals as a collective group have a general scope of practice, as presented on the following slide.
General Scope of Practice
Fitness Professionals DO NOT:
Fitness Professionals DO:
Diagnose
• Receive exercise, health, or nutrition guidelines from a physician, physical therapist, registered dietician, etc. • Follow national consensus guidelines for exercise programs for medical disorders • Screen for exercise limitations • Identify potential risk factors through screening • Refer clients to an appropriate allied health professional or medical practitioner
Prescribe
• Design exercise programs • Refer clients to an appropriate allied health professional or medical practitioner for an exercise prescription
Prescribe diets or recommend specific supplements
• Provide general information on healthy eating, according to the MyPyramid Food Guidance System • Refer clients to a dietician or nutritionist for a specific diet plan
Treat injury or disease
• Refer clients to an appropriate allied health professional or medical practitioner for treatment • Use exercise to help improve overall health • Help clients follow physician or therapist advice
Monitor progress for medically referred clients
• Document progress • Report progress to an appropriate allied health professional or medical practitioner • Follow physician, therapist, or dietician recommendations
Rehabilitate
• Design an exercise program once a client has been released from rehabilitation
Counsel
• Coach • Provide general information • Refer patients to a qualified counselor or therapist
Work with patients
• Work with clients
Table 1-2 page 8
Scope of Practice for ACE-certified Personal Trainers
ACE-certified Personal Trainers must work within their defined scope of practice (as presented on the following slide) to: – Provide effective services to their clients – Gain and maintain support from the healthcare community – Avoid the legal ramifications of providing services outside their professional scope
ACE-certified Personal Trainer Scope of Practice Figure 1-2 page 9 The ACE-certified Personal Trainer is a fitness professional who has met all requirements of the American Council on Exercise to develop and implement fitness programs for individuals who have no apparent physical limitations or special medical needs. The ACE-certified Personal Trainer realizes that personal training is a service industry focused on helping people enhance fitness and modify risk factors for disease to improve health. As members of the allied healthcare continuum with a primary focus on prevention, ACE-certified Personal Trainers have a scope of practice that includes: Developing and implementing exercise programs that are safe, effective, and appropriate for individuals who are apparently healthy or have medical clearance to exercise Conducting health-history interviews and stratifying risk for cardiovascular disease with clients in order to determine the need for referral and identify contraindications for exercise Administering appropriate fitness assessments based on the client’s health history, current fitness, lifestyle factors, and goals using research-proven and published protocols Assisting clients in setting and achieving realistic fitness goals Teaching correct exercise methods and progressions through demonstration, explanation, and proper cueing and spotting techniques Empowering individuals to begin and adhere to their exercise programs using guidance, support, motivation, lapseprevention strategies, and effective feedback Designing structured exercise programs for one-on-one and small-group personal training Educating clients about fitness- and health-related topics to help them in adopting healthful behaviors that facilitate exercise program success Protecting client confidentiality according to the Health Insurance Portability and Accountability Act (HIPAA) and related regional and national laws Always acting with professionalism, respect, and integrity Recognizing what is within the scope of practice and always referring clients to other healthcare professionals when appropriate Being prepared for emergency situations and responding appropriately when they occur
Working Within the Scope of Practice Personal trainers should never provide services that are outside their defined scope of practice. Overlap exists among professions within the healthcare field.
Working With Other Healthcare Professionals
A personal trainer should not make recommendations that contradict those of the client’s healthcare team. Each state, province, and country has specific laws about the responsibilities of different healthcare professions. It is the responsibility of the personal trainer to: – Learn and adhere to the laws in his or her geographical area – Work within the ACE-certified Personal Trainer scope of practice and adhere to the ACE Code of Ethics
Knowledge, Skills, and Abilities The ACE Personal Trainer Certification is designed for fitness professionals wanting to provide oneon-one and small-group exercise instruction to apparently healthy individuals. The certification program is continually evaluated. The outline of tasks, knowledge, and skills is published as the ACE Personal Trainer Exam Content Outline Published as Appendix B in the ACE Personal Trainer Manual, 4th ed. Found on the ACE website at: www.acefitness.org/getcertified/aboutexam_pt.aspx
ACE Code of Ethics Appendix A •
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ACE-certified Professionals are guided by the following principles of conduct as they interact with clients/participants, the public, and other health and fitness professionals. ACE-certified Professionals will endeavor to: – Provide safe and effective instruction – Provide equal and fair treatment to all clients – Stay up-to-date on the latest health and fitness research and understand its practical application – Maintain current CPR certification and knowledge of first-aid services – Comply with all applicable business, employment, and intellectual property laws – Maintain the confidentiality of all client information – Refer clients to more qualified health or medical professionals when appropriate – Uphold and enhance public appreciation and trust for the health and fitness industry – Establish and maintain clear professional boundaries
Client Privacy Clients will share confidential information with the personal trainer. To help prevent violations of client privacy, ACE-certified Professionals should adhere to the Health Insurance Portability and Accountability Act (HIPAA). – Following HIPAA regulations can help maintain the confidentiality of each client’s protected health information.
Referral • Personal trainers must refer clients who require services outside their scope of practice. • Proper referral ensures that clients are provided with appropriate care from qualified providers. • Referrals can also come to the personal trainer from other health professionals.
Developing a Referral Network Trainers should identify allied health professionals who are reputable. Potential referral sources include: – Mind/body instructors – Smoking cessation programs – Aquatic exercise programs – Support groups – Massage therapists Research instructors, programs, or organizations before recommending any programs or services to a client. With proper networking, the personal trainer may also gain referrals from the other health and fitness professionals within the network.
Safety All fitness professionals should do what they can to minimize risk for everyone in the fitness facility, including: – – – – – –
Proper equipment maintenance and storage Ensuring appropriate cleanliness of the facility Understanding emergency procedures Conducting a health-history assessment Determining appropriate levels of intensity for initial exercise program design Helping clients perform exercises in a safe and effective manner with proper progressions
Even with the best risk-management program, injuries and incidents can still occur. – As such, ACE recommends that all ACE-certified Professionals carry professional liability insurance.
Supplements Supplements are not regulated by the U.S. Food and Drug Administration (FDA). It is not illegal for fitness facilities to sell commercial nutritional supplements. – However, it is irresponsible for them to provide supplement recommendations without the appropriate staff to give such advice.
Personal trainers are not qualified to recommend supplements to clients. – Unless a personal trainer is also a registered dietitian or a physician, he or she does not have the expertise or legal qualifications necessary to recommend supplements.
Educating Clients About Supplements Personal trainers should educate themselves about supplements. The personal trainer should help the client understand that: – Fitness goals can be reached without supplements – Supplements can have negative and potentially harmful side effects
Some clients insist on using dietary supplements. – The personal trainer should refer the client to a qualified physician or registered dietitian for guidance.
Ramifications of Offering Inappropriate Services
• Offering services that are within the legal realm of other healthcare professions are in violation of the ACE Code of Ethics. • The client scenarios on the following slide provide examples of services that are within and outside the scope of practice.
Appropriate Scope of Practice
Table 1-3 page 15
Negligence • • • • •
Failing to perform as a reasonable and prudent person would under similar circumstances is considered negligence. In the case of personal trainers, a reasonable and prudent person is someone who adheres to the established standard of care. Since standards of care can and do change, it is critical that personal trainers stay abreast of new guidelines through continuing education. A negligent act can occur if a trainer fails to act (act of omission) or acts inappropriately (act of commission). To substantiate a charge of negligence in court, the plaintiff must establish four elements: – – – –
The defendant had a duty to protect the plaintiff from injury The defendant failed to uphold the standard of care necessary to perform that duty Damage or injury to the plaintiff occurred This damage or injury was caused by the defendant’s breach of duty (proximate causation)
Vicarious Liability and Waivers •
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Vicarious liability (also known as respondeat superior) means that employers are responsible for the employment actions of their employees. If an employee is negligent while working within the normal scope of employment, it is likely that the injured party will sue not only the employee, but also the employer or employers. The use of waivers is critical in personal training, as a properly worded exculpatory clause bars the injured from potential recovery. There are some potential issues that every personal trainer must investigate with an attorney prior to crafting a waiver. – –
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State-specific validity Types of activities and potential risks of injury that would be barred from recovery
Waivers typically do not protect the personal trainer from injuries directly caused by gross negligence.
Agreements to Participate, Informed Consent, and Waivers
• Personal trainers should understand the use of agreements to participate, informed consent, and waivers. – They can be important defenses in litigation for negligence.
• Ideally, each of these forms should be printed (avoid handwritten agreements) and signed by all clients before beginning the first exercise session. • Before a personal trainer begins using any of these documents, it is critical that legal counsel specializing in health and fitness in the personal trainer’s state be consulted.
Agreement to Participate • Personal trainers should have a process to formally warn their clients about the potential dangers of exercise. • An agreement to participate serves to demonstrate that: – The client was made aware of the “normal” outcomes of certain types of physical activity – The client willingly assumed the risks of participation
• The agreement to participate should detail: – Nature of the activity – Potential risks to be encountered – Expected behaviors of the participant
• Typically, agreements to participate are incorporated into other documents, such as informed consent forms and waivers.
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Informed Consent An informed consent form can be utilized to demonstrate that a client acknowledges that he or she has been specifically informed about the risks associated with the activity in which he or she is about to engage. – Client gives consent to participate in an exercise program and/or have something done to him or her by the personal trainer (e.g., fitness assessments), and therefore can differ slightly from an agreement to participate – Primarily intended to communicate the potential benefits and dangers of the program or exercise testing procedures to the client – Should detail the possible discomforts involved and potential alternatives
• The informed consent form, combined with oral communication, prepares the client for the positive and negative effects of certain types of exercise.
Procedures
• Valid agreements to participate, informed consent forms, and waivers must be administered properly to clients. • Minors cannot legally sign a contract, so in most cases a waiver signed by a child will be invalidated by the courts. • Personal trainers should remember to have every member of a family sign an individual waiver. • The personal trainer should retain the paperwork on file at least until the statute of limitations—the time allotted to sue for damages— has elapsed.
Legal Responsibilities • The personal trainer should prepare for each training session with safety as the first priority. – This provides a better experience for the client and increases the likelihood that the client will continue to utilize the trainer’s services.
• An inspection of facilities and equipment and a review of the protocols regarding supervision and instruction should be regularly performed.
Facilities • Personal trainers have an obligation to ensure that the facilities used are free from unreasonable hazards. • At the very least, the physical environment should be inspected each day prior to beginning any training session. • The inspection should consider the following issues: – Trainers should ensure that floor surfaces will cushion the feet, knees, and legs from excessive stress. – There should be sufficient free space available to protect the client from other patrons and from hurting him- or herself on equipment. – Functional lighting must be sufficient for chosen exercises. – There must be functional heating and air conditioning systems. – Proximity to drinking fountains and bathrooms is important for some clients.
Use of Public Spaces • In some jurisdictions it is illegal to train clients on public beaches, parks, or trails. – It is the trainer’s responsibility to know the local laws prior to using these areas.
• Once a “legal” outdoor area has been selected for a training session, the trainer should understand the potential dangers of the area. – Weather – Potential acts of God
• It is the trainer’s responsibility to that the activities will not pose clients.
ensure a significant risk for
Equipment • All equipment should meet the highest safety and design standards and should be purchased from a reputable manufacturer. • Equipment must be regularly inspected and properly maintained. • Protocol for broken equipment – Once something is deemed unsafe, the personal trainer should immediately remove the equipment from the training area. – If quick removal is not feasible, the equipment should be disabled to prevent further use until repaired. – “Do not use” signs easily fall off and unsuspecting patrons may be injured when trying to use the broken equipment.
• Manufacturers typically provide maintenance schedules for equipment.
Supervision • General supervision – Overseeing a group of people, such as when a group fitness instructor leads a large class • Specific supervision – Occurs when an individual is supervised while performing a specific activity, such as what typically occurs during a personal-training session • A trainer should never leave a client when there is a potential for injury. • Trainers who work with two or more clients should design the workouts to alternate between activities requiring general and specific supervision. • Trainers should eliminate any time that a client is not in their direct view. • Before beginning any session, the trainer must adequately plan for any emergencies that may arise. • Personal trainers should also be aware of the actions of their employees.
Instruction • Personal trainers should utilize instructional techniques that are consistent with current professional practices. • Proper instruction also means individualizing workout routines for each client. • Personal trainers should insist on proper use of equipment and performance of activities at all times. • Trainers should avoid touching clients unless it is essential for proper instruction. – Clients should be informed about the purpose of potential touching before it occurs. – If a client objects, an alternative exercise should be utilized.
Safety Guidelines • • • • • • • • • • •
Be sure that all sessions are well-planned, appropriate, and documented. Communicate and enforce all safety rules for equipment use. Ensure that equipment meets or exceeds all industry standards. Inspect all equipment prior to use and document adherence to maintenance schedules. Never allow unsupervised activity by the client. Limit participation to those under contract. Clearly warn clients about the specific risks of planned activities. Only select activities within the defined scope of practice and appropriate areas of expertise. Ensure that clients wear any necessary protective equipment. Review the emergency plan [access to a phone and 911 for emergency medical services (EMS)]. Stay up-to-date with certifications and education in the field.
Liability Insurance • Even after taking precautions, personal trainers should obtain professional liability insurance. • ACE recommends retaining at least $1 million in coverage, as medical expenses can easily cost hundreds of thousands of dollars. • The American Council on Exercise has established relationships with reputable insurance carriers who specialize in the fitness industry. – Visit www.acefitness.org/pdfs/personal-trainer-insurance.pdf for more information. • Owners who will use their own homes or clients’ homes should ensure that a specific insurance rider will cover those activities. • Specific language should provide liability protection for trainers who utilize outdoor settings for their training activities. • For trainers who own their own fitness clubs, insurance should be retained that covers potential problems with the facility as well as the instruction and supervision of the trainer.
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Employees and Independent Contractors Many fitness employers now require their employees to demonstrate proof of liability insurance when they are hired. – Employers should ensure that employees renew and verify their policies annually. – Potential employees may wish to verify that the fitness center has adequate coverage.
• Independent contractors must maintain adequate insurance. • The employment or independent contractor agreement between the fitness center and the personal trainer should contain language detailing insurance requirements and responsibilities.
Other Business Concerns With Legal Implications
• Personal trainers must be aware of the implications of other potential legal issues, including those related to: – Marketing activities – Intellectual property – Transportation – Financing
Marketing Activities • Unfortunately, it has become common for some fitness centers to utilize improper marketing tactics to attract and retain clients. • Personal trainers should understand the marketing and operating activities that their fitness centers may utilize. • If a fitness center is behaving unethically or illegally, the personal trainer may be “associated” with those practices. – Trainers should only associate with fitness facilities that maintain high legal and ethical standards.
Intellectual Property • Music recordings and television programming sold commercially are intended strictly for the private, noncommercial use of the purchaser. – In many cases, copyright violations occur when a fitness center utilizes music or television broadcasts.
• ASCAP and BMI issue licenses for the commercial use of broadcasts and recordings, but their fees may be prohibitive. – A good option is to purchase recordings produced specifically for use in fitness facilities.
• When training clients in their homes, personal trainers can have clients provide the music for each session.
Transportation • In most cases, personal trainers will meet their clients at a fitness center or some other location. • There may be a situation where the personal trainer provides transportation for the client to or from a training session. – Trainers should be aware that many “standard” automobile insurance policies may not cover injuries sustained by clients riding in the trainer’s vehicle.
• If the trainer is going to provide a ride to a client, the trainer should check his or her auto insurance policy to ensure that potential injuries from accidents are covered.
Financing • As personal trainers create and expand their businesses, they may need to seek financing for certain activities. • Banks and other lenders usually will only loan money if it is personally guaranteed by an individual. • Unfortunately, many companies have advertised “business loans” that are in fact personal loans. – Personal trainers who thought that only their businesses were liable for the financial obligation later learned that the lender was able to pursue the trainer for unpaid debts. – Trainers should read and understand the “fine print” of any loan prior to signing.
Assessing Identified Risks • The personal trainer must review each risk, with consideration given to the probability that the risk could occur and, if so, what would be the conceivable severity. • The table below can be used to assess the identified risks.
Summary • In providing quality personalized fitness instruction, legal and business concerns are of paramount importance. • Ultimately, it is the personal trainer’s responsibility to thoroughly understand the legal guidelines that must be followed to create a safe and enjoyable environment for clients.
