Scope of Practice of a Personal Trainer
A big problem in the fitness industry, in general, is personal trainers going outside of their scope of practice. These days, functional training has taken over the personal training industry as evidence-based best practice. However, this has led many coaches to cross the line in their qualifications. Many gyms and personal training studios have their trainers perform things like postural assessments and functional movement screens to diagnose potential problems with normal daily activities. How many coaches are actually trained to do this? For example, I have seen x-rays of people who seem to have exaggerated postures when looking at their skin, but the x-ray shows nothing abnormal. In this context, if we tried to correct the situation, we could actually be doing more damage. The question that must be answered is: are we really qualified to diagnose anything?
Many “functional” trainers walk the fine line between physical therapist and personal trainer by diagnosing problems (muscle imbalances, joint pain, etc.) and attempting corrective exercises to fix the problem. Is this really within the scope of a personal trainer’s practice? Let’s take a closer look at some definitions of scope of practice from the American Council on Exercise (ACE), the American College of Sports Medicine (ACSM), and the National Strength and Conditioning Association (NSCA). These are three very well recognized and established personal training certifications within the fitness industry. The NSCA developed a definition of a professional for its primary certification, Certified Strength and Conditioning Specialist (CSCS), which states that the CSCS is a professional who “practically applies core knowledge to assess, motivate, educate, and train athletes for the purpose of main objective of improving sports performance. It further states that it is the job of a CSCS to consult and refer athletes to medical, dietary, athletic training, and sports training professionals when appropriate. ACE is silent in its definition of a personal trainer’s scope of practice about the diagnosis of abnormalities. He mentions that trainers can develop and implement programs for people who are apparently healthy (what does “apparently healthy” really mean? Is it a matter of judgment?) or are medically cleared.
Similar to the CSCS definition of a professional, it specifically says that a trainer’s job is to “recognize what is within the scope of practice and always refer clients to other health professionals when appropriate.” The ACSM states that “The ACSM Certified Personal Trainer is a fitness professional involved in the development and implementation of an individualized approach to exercising leadership in healthy populations and/or those who are medically cleared to exercise.” There is nothing in their scope of practice statement that says that a trainer must be able to diagnose and/or treat any ailment. Eickhoff-Shemek and Deja (2002) echo these claims in their article “Four Steps to Minimizing Liability in Exercise Programs.” Sean Riley, a licensed attorney and exercise physiologist, cautions us that only a trainer can legally design and implement training programs (Riley, 2005). He further states that acting outside this scope is illegally practicing medicine (Riley, 2005). Trainers can be found guilty of an offense if they “practice or attempt to practice, or…advertise or present themselves as practicing, any system or mode of treating the sick or afflicted…or diagnose, treat or operates for or prescribes for any blemish, disorder, injury or other physical or mental condition… without being authorized to perform such act…” (Herbert & Herbert, 2002). This was written specifically for California, but many states have similar statutes. As with the aforementioned scope of practice statements from the NSCA, ACE, and ACSM, Riley notes that “…it’s up to you to turn down clients whose needs outweigh your skills and knowledge.” This opens up a whole new can of worms, as most trainers are paid on commission, making it difficult to turn clients away.
It IS appropriate that we, as exercise professionals, note limitations in our clients. This could range from limitations in ROM, strength, coordination, and even mental capacity. From here, unless you are a qualified professional, it is our job to fix these issues while keeping our customers active and healthy and not making the problem worse. Bottom line: personal trainers need to monitor themselves and know when their job is done and someone else’s is starting.
Eickhoff-Shemek, J. & Deja, K. (2002). Four steps to minimize legal liability in exercise programs. ACMS Health & Fitness Journal, 4(4), 13-18.
Herbert, D. & Herbert, W. (2002). Legal aspects of preventive, rehabilitative and recreational exercise programs. (4th ed.). Canton, OH. Publications of the People’s Republic of China.
Riley, S. (2005). Respecting your limits. IDEA Trainer Success, 2(4), retrieved from http://www.ideafit.com/fitness-articles/personal-training/personal-training-ethics-scope-of-practice