THE ROLE OF EXERCISE THERAPY IN HEALTH & FITNESS

At the Exercise Therapy Association, we see Exercise Therapists as essential bridges between exercise coaching and therapy. Our approach focuses on strategic and thoughtful exercise and stretch plans that align closely with therapy goals, promoting improved posture and overall well-being. We do not replace traditional therapy for medical conditions but collaborate closely with therapists and refer clients when necessary.

• ASSESSMENTS TO DETERMINE EXERCISE SELECTION RATHER THAN TREATMENT:
Similar to therapists, we utilize assessments such as basic movement screenings and function tests to identify areas for improvement. This informs our approach and helps us tailor exercises and stretches to best meet our clients' needs. We regularly gather feedback on movement, stability, and comfort to adjust our strategies for optimal results. Clients receive comprehensive handouts with visual and explanatory guides to facilitate ongoing improvement at home.

• HANDS-ON VS HANDS-OFF:
At the Exercise Therapy Association, our approach to solutions is "Hands-Off," contrasting with therapies like Chiropractic, Massage, or Physical Therapy, which typically involve "Hands-On" techniques such as stretching and active release. Instead, we empower clients to perform exercises and stretches independently, using minimal equipment and adaptable methods suitable for any environment. Our focus remains on maintaining healthy function through exercises that enhance posture and overall physical capability. Our guiding principle, "When in doubt - refer out," ensures clients receive specialized care from appropriate specialists as needed.

• EVERYDAY ACHES & PAINS VS DISEASE OR MEDICAL CONDITIONS:
We focus on overall health, which often improves everyday aches and pains, joint discomfort, and muscle soreness through targeted exercises and stretches that promote harmony and wellness. Our goal is to enhance overall well-being and functional ability, so clients feel their best. For serious medical conditions and disease, we prioritize referral to specialists who can provide specialized care. According to the Government of Canada, “Exercise therapists conduct fitness tests and assessments and design, develop and deliver rehabilitative exercise programs in occupational and health related settings.”
Source: Government of Canada

• COMPLIMENTARY VS STAND-ALONE SYSTEM:
Our system is designed to complement existing healthcare services rather than replace them. Many healthcare professionals, including massage therapists, chiropractors, and physical therapists, have integrated our methods into their practices to enhance client care. We liken visiting a therapist to visiting a dentist, where the exercise therapy protocols clients perform at home are akin to regular brushing and flossing. Personal trainers benefit from our education, which extends their understanding beyond standard exercise routines, incorporating knowledge of anatomy, physiology, and physical imbalances.

• IT’S NOT A NEW THING BUT A NEW TWIST ON THE OLD:
Exercise Therapy builds upon traditional exercise coaching, focusing on improving health, mobility, and function. Our approach is intentional and methodical, allowing us to tailor programs effectively and collaborate closely with other healthcare providers. We emphasize developing mental resilience, coaching clients to maintain proper form both physically and mentally. Lifestyle coaching is integral; educating clients on healthy habits to support their progress and overall well-being.

• EVIDENCE OF EFFECTIVENESS:
Our approach is rooted in scientific evidence supporting the therapeutic benefits of exercise, including improved muscle strength, flexibility, bone health, and overall quality of life. Extensive research across various disciplines substantiates these benefits. While our methods are grounded in established principles, we continually refine our strategies to optimize outcomes based on validated scientific principles. Medical professionals endorse our methods, supported by documented video case studies and client testimonials worldwide.

In conclusion, the Exercise Therapy Association is committed to bridging the gap between exercise coaching and therapy with a focused and thoughtful approach. By aligning exercise and stretch plans with therapy goals, we strive to enhance our clients' well-being and functionality, particularly in managing everyday aches and pains. While we do not replace traditional medical therapies, our collaboration with therapists ensures comprehensive care for our clients. Together with healthcare providers and clients alike, we continue to evolve to help people better, and help more people.

SCOPE OF PRACTICE FOR FITNESS TRAINERS

In the fitness industry, personal trainers often face critiques about their scope of practice. By understanding these criticisms and sticking to best practices, you can provide safe, effective services while minimizing legal risks. But don’t let this intimidate you! Instead, let’s break it down and understand these challenges so you can ensure you’re covered, and deliver outstanding service that keeps you at the top of your game!

COMMON CRITICISMS AND SCOPE OF PRACTICE ISSUES:

1. Nutritional Advice:
Critics frequently contend that personal trainers should refrain from offering nutritional guidance, which some nutrition professionals perceive as encroaching on their expertise. This concern is particularly valid, especially when fitness trainers lack sufficient nutritional knowledge but still provide advice and implement diet plans without thorough understanding. In many jurisdictions, providing general nutritional guidance is permissible, but creating customized meal plans or advising clients about medical conditions typically requires referral to certified nutritionists or dietitians for specialized advice.

It's essential to be aware of the regulations in your jurisdiction concerning nutritional guidance. For instance, in the USA, regulations vary significantly: some states permit individuals to provide personalized nutrition advice and use the title of dietitian without licensure, while others prohibit such practices even with advanced degrees, like a Ph.D. in nutrition. Moreover, what constitutes nutritional advice can be interpreted differently from state to state. For instance, recommending someone to "reduce carbohydrate intake" might appear general but could be interpreted as personalized advice depending on interpretation.

Even if you're allowed to give nutritional guidance, it's not without risks. You could still face a lawsuit if someone gets sick, even if it's unrelated to your advice, as they might claim it was due to your guidance. Always be cautious and mindful. For instance, if a client has a heart attack and dies, their family might claim your diet plan caused it. Always recommend consulting a doctor and putting your recommendations in writing to refer back to them if needed.

2. Supplement Recommendations:
Exercise caution when giving advice on supplements. Remember, supplements are not intended to treat, cure, or mitigate diseases; that responsibility lies with healthcare professionals. Instead of claiming that glucosamine reduces inflammation, it's appropriate to state that it may help with inflammation from ordinary wear and tear and exercise. This way, you keep your advice within the scope of practice by relating it to everyday activities rather than disease states. And in general, be very cautious about recommending supplements. A personal trainer advised a 37-year-old woman with hypertension to take nutritional supplements containing ephedra, which led to a fatal brain hemorrhage. Court ruling: In Capati v. Crunch Fitness International (Manhattan, NY - 2002), $1.75 million in damages was awarded against the trainer and the gym.

3. Psychological and Mindset Coaching:
Motivational support and goal-setting are within your scope, and you’re expected to inspire and empower! At the Exercise Therapy Association, we don’t feel personal trainers have been given the proper tools to succeed in this area, so we educate people on how to coach for success, mental toughness, and resilience to adversity. Inner strength leads to outer strength. However, fitness professionals should not be encouraging people to “tough it out” when dealing with mental health disorders, but should refer out for medical help under such conditions.

4. Working with Injured Clients:
It is within the scope of practice for personal trainers to work with clients who have injuries and aches and pains, but there are important guidelines to follow. Trainers must avoid diagnosing or treating injuries, and should focus on safe exercises that help improve strength, range of motion, function, and how comfortable certain movements and postures are. Assessments should be used as feedback loops to monitor progress, and make sure we are helping correctly.

Moreover, obtaining qualifications as an Exercise Therapist can complement a personal trainer's skill set. According to the Government of Canada, exercise therapists conduct fitness tests, assessments, and design rehabilitative exercise programs in various occupational and health-related settings. They undergo specialized training or acquire relevant experience beyond basic personal training education. The Exercise Therapy Association offers education and certification to health and fitness professionals, preparing them with the essential competencies to excel as exercise therapists.

Legal and Ethical Considerations

• Getting Insured On Claims:
Consider this: if you operate outside your scope of practice, what do you think insurance companies will say when there's a claim against you? They'll look for reasons not to pay those claims and will argue that you overstepped your professional limits. Personal training is an unregulated field in many regions, including Canada, where the Exercise Therapy Association operates. Without a formal body defining the scope of practice, the court system often determines negligence. Negligence occurs when a duty of care is not met, resulting in foreseeable injury. For instance, prescribing exercises beyond a client’s capability or failing to provide proper supervision can be deemed negligent.

• Assumption of Risk:
Clients typically sign liability waivers acknowledging the inherent risks associated with exercise. However, this does not exempt trainers from liability if they behave recklessly or show blatant disregard for client safety. Determining what constitutes high risk versus low risk is not always clearly defined and may vary depending on the situation.
 

Examples of Negligence:

• Improper Response to Emergencies:
Ignoring signs of serious health issues, like advising a client to continue exercising despite symptoms of a stroke or heart attack, can be dangerous. Stroke symptoms include sudden numbness or weakness, confusion, difficulty speaking, vision problems, severe headache, and trouble walking or balancing. Heart attack symptoms include chest pain or discomfort, cold sweat, fatigue, and lightheadedness, with pain possibly spreading to the shoulders, arms, back, neck, or jaw. If a client shows any of these signs, stop the exercise immediately and seek appropriate medical help.

These types of cases have led to legal action in the past. In one case, a 46-year-old inactive, overweight male suffered a heart attack towards the end of his first 60-minute physical training session with a new trainer. Court ruling: In Rostai v. Neste Enterprises (CA, 2006), the trainer was found negligent for failing to assess the client's fitness level before starting training and for misinterpreting signs of a heart attack as normal symptoms of physical exertion.

• Inappropriate Fitness Programs:
Advising a client to lift weights beyond their fitness level or prescribing exercises unsuitable for their condition can lead to serious problems. For instance, a trainer instructed a client who had undergone back surgery to perform a demanding workout involving burpees and deadlifts. As a result, the client suffered a severe back injury, requiring additional surgery and causing lasting pain and disability. In the case of Baldi-Perry v. Kaifas (Buffalo, NY - 2015), the court awarded the client $980,000 for her current and future pain and suffering.

• Lack of Proper Instruction:
Failing to supervise clients during challenging exercises, like heavy lifting or complex movements, can lead to injuries. For instance, in one case, an uncertified trainer instructed a client to perform reverse hyperextensions over a Swiss ball with a weight between their feet, then left to check their phone. The client swung their legs up, causing the weight to hit them in the head and resulting in an injury. Despite the trainer's lack of certification, negligent exercise choice, and leaving the client unsupervised, the case was dismissed, possibly due to the rarity of suing trainers in the country of Canada.

In another incident, I witnessed a trainer instructing a very overweight client to do high step-ups while holding heavy weights, despite the client being a beginner with poor balance. The client fell backwards and broke their arm. Despite the questionable exercise selection, the trainer showed empathy, accompanied the client to the hospital, and supported them throughout. The client forgave the trainer and continued working with them. There was no legal action taken. This was also in Canada.

I was told by a lawyer that often when a trainer is taken to court in Canada, it is to teach them a lesson, because they avoided accountability or didn’t apologize for what went wrong. The key point here is that we all make mistakes sometimes, but taking accountability and apologizing can be one of the most mature ways to handle these mistakes, while helping us avoid facing legal action.

In another incident in the USA, a woman who had informed her trainer of her inexperience with treadmills and her "very sedentary" lifestyle was left alone on a treadmill running at 3.5 mph. She drifted backwards, fell off the treadmill, and fractured her ankle. Court ruling: In Corrigan v. Musclemakers (Albany, NY - 1999), the trainer was found negligent for failing to instruct the inexperienced client on how to use the treadmill's control panel.

Training Space Negligence:
Ensuring a safe training environment is crucial to prevent accidents and injuries. A cluttered training space with hazards such as loose weights increases the risk of tripping and serious harm to clients. When such incidents occur, they are assessed similarly to other accidents in society. Determining the cause of a hazard, whether it was intentionally created or an accidental oversight, is important. Was the clutter and loose weights left by negligence in maintaining the space, or was it a deliberate act to harm a gym member? This distinction influences liability and the legal consequences that may follow. Therefore, maintaining a clean and hazard-free training space is not only a matter of safety but also mitigates potential legal liabilities for trainers and fitness facilities. In conclusion, always remember to put your weights away when you’re finished!

8 Best Practices Suggestions for Fitness Trainers:

1. Make Sure Clients Fill Out A Waiver:

It is essential to have clients fill out a physical readiness questionnaire and/or waiver before commencing any training sessions. In Canada, the Physical Activity Readiness Questionnaire (PAR-Q) is commonly used for this purpose. This documentation serves as crucial evidence in the event of any legal claims or disputes. This will be one of the first things they ask you about if there is a claim against you.

The PAR-Q helps assess clients' readiness for physical activity by identifying any potential health risks or medical conditions that may impact their participation in exercise programs. By completing this form, clients provide important information about their health history and current fitness levels, which can help trainers tailor workouts safely. Having clients complete these forms not only ensures legal compliance but also demonstrates a commitment to safety and professionalism.

2. Document Everything:
It is crucial for fitness professionals to maintain comprehensive records encompassing client health histories, detailed exercise plans, and any incidents that occur during training sessions. Keeping meticulous notes serves as a vital safeguard against potential claims and legal disputes.

Detailed exercise plans document the specific routines and techniques prescribed to clients, including modifications and progressions over time. These records not only track client development but also demonstrate the careful consideration given to their fitness journey.

In the unfortunate event of an incident or injury during training, thorough documentation becomes critical evidence. Detailed records can clarify the circumstances surrounding the incident, including actions taken by the trainer and client responses. This documentation can help protect trainers by providing a clear account of events and demonstrating adherence to professional standards and duty of care.

3. Be Mindful Of Symptoms Of A Medical Emergency:
Symptoms of a medical emergency may include severe chest pain, dizziness, fainting, extreme fatigue, confusion, and sudden weakness or numbness in the face, arms, or legs. If any of these symptoms occur during your training session, discontinue immediately and seek prompt medical attention.

4. Nutrition & Mindset, Stick To General Guidance:
Stay within your scope by offering general, everyday nutritional and mindset advice. Avoid diagnosing or treating any medical conditions or disorders. The more specific you get about macro and micronutrient quantities, or supplement recommendations, the more risk you could assume. Be mindful that regulations are different everywhere and can change. It's your job to make sure you follow local and international laws.

5. Avoid Language That Suggests You’re Diagnosing Or Treating:
Fitness trainers should be encouraged to support clients experiencing everyday muscle and joint discomfort, aches, and pains as these issues are common and can often be managed effectively with proper exercise and guidance. The fine line here is in the language you use. Avoid using terms that suggest you are "diagnosing" or "treating" anything, as this could be interpreted to imply you are trying to cure a disease or medical condition. Describe your services as enhancing wellness, improving function, and helping people feel better. Using terms like "improving" doesn't imply that things were bad to begin with.

6. Keep Safety A Top Priority:
Fitness professionals working with clients who have aches and pains often navigate a gray area. It's crucial to prioritize ensuring that clients have received medical clearance to exercise and to avoid negligence by refraining from prescribing high-risk movements that could reasonably lead to injury.

In terms of customizing workouts and prioritizing client safety, enhancing assessment skills minimizes the need for guesswork. Investing in ongoing education is key to mastering the field and applying sound judgment. Ultimately, the best defense against legal challenges is knowledge and practical application, coupled with common sense.

7. Stay Informed And Certified:
Regularly update your knowledge through continuous education and maintain relevant certifications to enhance your expertise and credibility. As you expand your skillset and qualifications, you expand your scope of practice. For example, at the Exercise Therapy Association, we provide robust training in the areas of anatomy, physiology, and physical imbalances in the body that goes well beyond standard personal training certifications, which helps improve everyday aches and pains, joint discomfort, and muscle soreness through targeted exercises and stretches that promote harmony and wellness.

8. When In Doubt Refer Out:
When faced with issues beyond your expertise, such as significant injuries or mental health concerns, it's essential to refer clients to the appropriate specialists. This not only ensures that clients receive the specialized care they need but also helps protect you legally.

When making a referral, it's important to document it in writing, such as through an email. Saving this email serves as a record of your decision and the steps you took to prioritize client well-being. This documentation is crucial because, in the future, unforeseen events unrelated to your assistance may lead to legal actions against you. Having proof of your referral can play a pivotal role in defending yourself against such claims.

CONCLUSION:
Personal trainers have a significant impact in health and fitness, guiding clients through transformative changes with their expertise. However, this role comes with great responsibility. It's crucial to understand your professional limits and ethical guidelines. By staying within these boundaries and communicating openly with clients, you not only help them achieve their fitness goals but also safeguard yourself from legal issues. Knowing when to refer clients to specialists and keeping detailed records further strengthens accountability and supports client safety. Continuous education ensures you provide up-to-date and safe training programs, fostering trust and long-term success in your clients' fitness journeys.

DISCLAIMER:
The Exercise Therapy Association, based in Canada, educates health and fitness professionals globally. While Exercise Therapy typically aligns with the scope of practice for personal trainers, specific regulations vary by jurisdiction and are subject to change. It is your responsibility to verify compliance with local and international laws before implementing Exercise Therapy Association methods in your practice.