Liability and safety issues merit serious focus and planning as members demand more Pilates-based activities.
According to the 2005 IDEA Fitness Programs & Equipment Survey (IDEA Fitness Manager, October 2005) and other industry statistics, Pilates continues to be among the fastest-growing exercise trends in the United States. More than 10.5 million people practiced Pilates in the United States in 2004, according to the most recent SUPERSTUDY® of Sports Participation, conducted by American Sports Data Inc. This represents a 500% growth rate over 4 years. What’s more, all signs indicate that the Pilates fire will continue to spread. One particular area of program growth for Pilates is personal training and small-group training on Pilates equipment.
Typically, Pilates is practiced under a qualified instructor’s close supervision, and this has helped limit the number of Pilates-related accidents. However, like every other exercise activity, Pilates has risks, and claims have been filed against professionals who teach it. As long as participation continues to grow, so does Pilates professionals’ risk of litigation.
This article provides general information on how to protect your Pilates business from lawsuits and how to manage risk. It is not intended to be legal advice and should not be considered a substitute for legal counsel or other professional services. If expert advice is required, please consult your legal counsel or other qualified professionals.
This material narrowly focuses on liability due to equipment-related injuries to Pilates clients. Because of space limitations, other valuable risk management policies regarding staff qualifications, training and emergency procedures could not be addressed in this article, but they, too, should be resolved at your facility to ensure a safe, effective and proactive approach to risk management in your business.
Leading industry professionals shared personal details for this article. Names and locations are not revealed, but events are true.
The Trapeze Table. An experienced trainer was working with a regular client on the trapeze table, also called the “trap table” and the “Cadillac,” but forgot to put the safety chain on the bar. (Normally, the safety chain or strap limits the movement range of the bar, which is under spring-loaded tension.) The bar came down, hit the client in the face and caused severe jaw injury. In other incidents, the bar hit the trainer.
The Wunda Chair. A trainer was working with a regular client on the Wunda Chair, and the bolt that secured the spring was loose. When the client applied tension to the bar, the spring pulled free and the bar snapped down on the client’s foot. The client suffered a broken toe.
The Reformer. Several reported incidents involved falls from the reformer. A typical scenario involved an experienced trainer working with a client in a standing position on the reformer. The client and/or trainer lost concentration, the carriage released quickly, and the client fell off onto the floor. Clients have suffered back and shoulder injuries from their falls.
All of these accidents occurred in seconds and resulted in serious consequences ranging from client injury to disruptive lawsuits. To manage risk in your business, consider the following questions:
1. How could these accidents have been avoided or minimized?
2. How could lawsuits after these accidents have been avoided?
“All of these safety issues are really about poor training—teachers progressing clients too quickly and putting them in positions that they can’t control,” says Howard Sichel, DC, chiropractor and owner of Power Pilates® in New York. “Individuals always need to be supervised by a teacher, and the instructor needs to organize the sessions. In the Power Pilates training program, we call it ‘the equipment and body scan’ for each exercise.”
Nora St. John—owner of Turning PointSM Studios in Walnut Creek, California, and education program director for Balanced Body® Inc. in Sacramento—says, “When it comes to accidents, your best line of defense is to deal with [the situation] really well at the time. Take the client seriously. Follow up with an incident report documenting exactly what happened. See whether or not the client needs to go to the doctor or emergency room. It’s so important to develop a positive, trusting relationship with your client.”
Ken Endelman, founder and chief executive officer (CEO) of Balanced Body, emphasizes consulting with your insurance carrier regarding its recommendations for what you should do before any accident occurs. “Each insurance provider has specific procedures and forms,” he says. “Be ready, and know how to handle any potential claim before it happens.”
Accidents can and do happen. However, we can reduce the odds, both of accidents and of being sued should they occur. Risk of liability exists when a trainer can potentially be held responsible for what caused an injury and therefore be required to pay for damages that resulted from the injury. Wearing blinders to this risk while operating your business endangers you and your clientele. Assuming that accidents can and will happen is realistic and fosters an atmosphere of prevention and preparedness.
The Lawyer Lobotomy. According to Jeff Frick—program manager and CEO of Fitness and Wellness Insurance Agency in Solana Beach, California—many fitness professionals assume that, because their clients are nice people with whom they have a good relationship, the clients won’t sue them. This is not always the case.
“I like to call it the ‘lawyer lobotomy,’” Frick says. “Often, when an accident occurs, the client is embarrassed at hurting himself and blames himself. However, after talking it over with family members and seeing a lawyer, he suddenly isn’t responsible for anything. Everything becomes the trainer’s fault.”
Frick recommends that trainers carry liability insurance and require clients to sign a waiver or similar type of assumption-of-risk document, depending on what type of form is standard practice for the state in which they live. Marci Clark, co-founder of PowerHouse Pilates in Pittsburgh, Pennsylvania, says, “Too many instructors are counting on the studio or fitness center to have enough insurance to cover them, which is not necessarily the case if a client sues them for injury.” Clark recommends that trainers join professional organizations such as IDEA in order to be eligible to purchase liability insurance at group member rates. The Pilates Method Alliance® also offers members access to insurance coverage as a member benefit.
In numerous states, courts are more frequently holding up waivers and assumption-of-risk forms as valid protection against litigation. Again, Frick stresses that, depending on where a trainer lives, he may need a document entitled “Assumption of Risk” or “Informed Consent” to protect his business from liability. For a detailed discussion of waivers and informed-consent forms, see “The Importance of Protective Legal Documentation” by Sean Riley, MS, JD, in the February 2006 issue of IDEA Trainer Success.
According to insurance providers, the second leading reason for claims against fitness trainers is injury resulting from equipment use—and case law is growing. No cases on the books specifically involve Pilates equipment. Nonetheless, existing exercise-equipment case law does highlight potential issues and provide guidelines on how to minimize liability. Equipment manufacturers, studio and facility owners and managers, and trainers can use these guidelines to protect themselves. The existing cases are based on legal theories from tort law that indicate that a personal trainer’s duty or standard of care is to take reasonable precautions to ensure that a client does not suffer injury. If a trainer fails to take such precautions, based on an evaluation of facts surrounding an incident, the trainer could be considered negligent and therefore liable or responsible.
The following practical risk management tips are based on case findings, legal analysis and insight from experienced practitioners. Words of wisdom from industry leaders are valuable because most cases are likely to be settled monetarily before being resolved in court. Litigation is expensive and time-consuming and results in negative public relations, even if the court eventually finds the studio, facility or trainer not legally liable.
Injured parties are naming more and more industry professionals as defendants in lawsuits. For example, in the event of an equipment-related accident or injury, people have sued manufacturers, designers, third-party equipment installers, facilities, owners, managers and trainers.
Tips: If you work with exercise equipment, anticipate that you may be sued. Protect yourself by following safety guidelines and industry standards and being proactive about risk management.
If a person is injured while using a piece of exercise equipment and the product is found defective in manufacture or design, a court may decide that the manufacturer is liable. A court may also find the equipment designer liable for design defects resulting in inherently unsafe equipment and leading to client injury.
Tips: Work only with reputable companies. Research companies before doing business with them. Ask about safety records, past litigation and accidents, and liability insurance coverage. Also ask about specific design enhancements made to improve equipment safety. For example, certain Pilates equipment manufacturers have added features such as nonskid surfaces, padded foot bars and standing platforms to reduce the risk of accidents. Lindsay G. Merrithew, president and CEO of STOTT PILATES®, a subsidiary of Merrithew Corporation, in Toronto, says, “We created the Group SPX Reformer specifically with clubs’ needs and safety issues in mind. It’s lightweight and stackable, making it safer and easier to lift and store. We always recommend that a minimum of two people stack the Group SPX Reformers six high on a floor, or five high on a rolling base.”
Injured parties have filed lawsuits based on claims that equipment was not properly assembled or installed. In case studies, courts have found facility owners liable for client injuries caused by using equipment that was incorrectly assembled or installed by facility employees.
Tips: Inspect all new pieces of equipment upon receipt to confirm that everything is in order. Use experienced equipment professionals for assembly and installation. Document that equipment has been inspected, assembled and installed per manufacturer instructions. Before any clients use new equipment, perform and document a test on the equipment to make sure that everything is working properly. Do not allow clients to discover assembly or installation errors.
If you purchase used equipment, inspect it even more carefully. Endelman recommends, “First, look for any signs of abuse. For example, if a machine has been dropped, it could have a hairline crack or loose joint. Warranties are generally not transferable, so it’s important to make sure that there are no structural problems. Also evaluate who is selling the equipment. If it’s an experienced studio or teacher, chances are good that the equipment has been maintained properly. Make sure that all of the bolts are tight, and, for an extra measure of safety, replace the springs.”
Clients have successfully won lawsuits in which the court found that injury occurred because weight training equipment was placed too close to other equipment to be safe. In these cases, a client typically is bumped while performing an exercise, loses control and sustains an injury.
Tips: Michael Arbuckle—director of operations at the Pilates Center of Austin in Austin, Texas—recommends a minimum of 30 inches between reformers to avoid bumps. In addition, he cautions against placing equipment with pole systems too close to mirrors and encourages using safety glass in the mirrors.
Endelman recommends at least a 6-foot diameter of space, centered at the foot end of the reformer, to avoid injuries related to people kicking each other. Not as much space is necessary at the top end of the reformer. Successful spatial arrangements include staggering reformers and placing them in a wedge shape.
Endelman also advises that trap tables not be placed too close to mirrors or windows and suggests the use of full-spectrum lighting. Lighting can be a safety issue if lack of sufficient illumination causes an injury. Endelman recommends full-spectrum light primarily as a comfort issue but believes that it does provide better-quality illumination.
Merrithew agrees with Arbuckle and Endelman on the importance of layout: “Many studio owners try to fit as much equipment as possible in a small space, but you don’t want to learn about liability the hard way.” STOTT PILATES provides a studio kit to help with spatial planning (available at www.stottpilates.com/planit), although it does not offer specific guidelines on distances between pieces of equipment.
Although no case study involves an accident due to lack of appropriate equipment storage, Pilates clients have injured themselves in studios by falling over equipment not put back in its proper place. Another potential source of liability related to equipment storage is unsupervised clients who gain access to equipment, misuse it and injure themselves.
Tips: Establishing storage policies and procedures before any equipment is purchased may prevent such injuries and risk exposure. If using portable equipment, staff must be trained on how to move and store it safely.
“When planning, many new studio owners forget to consider the importance of the right kind of storage,” notes Arbuckle. If you intend to use balls, rollers, poles and other loose pieces of equipment, plan specific storage places in your workout area so items are not left lying where people can trip over them and fall.
Endelman adds that storage solutions need to be resolved for fitness facilities that are creating an in-house Pilates studio or offering group reformer classes. “I know that in some of the Bally’s clubs offering group Allegro classes, they lock up equipment between classes,” he says. Other clubs lock up in-house studios when no one is present to supervise equipment use.
“If you store your Pilates equipment in an area that cannot be locked and is not visible to the front desk, find a way to lock it or make it unusable,” says Christine Romani-Ruby, MPT, ATC, co-founder and CEO of PowerHouse Pilates in Pittsburgh. “For example, take springs off the chair and put them in the office, or lock stacks of reformers so they cannot be unstacked. If you use portable reformers, choose ones that can be set up on one end rather than stacked: Because they are easier for instructors to pull out for class, there is less risk of injury. If you do stack reformers, get the lightest reformers you can find and do not stack more than five; the pile would be too high for ergonomic lifting. Furthermore, never expect staff to move wooden equipment on a regular basis; it is too awkward and heavy and will result in a staff injury or damage to the equipment.” Julie Lobdell, CEO and president of Peak Pilates, based in Boulder, Colorado, says, “Safety is always a high priority for us. Peak Pilates introduced the Peak PilateSystem™, which is the only foldable, multiuse and portable piece of Pilates equipment. It only requires 30 pounds of effort and can easily be folded by just one person.”
In equipment cases, courts have focused on whether or not exercise equipment was being used for its intended purpose and whether it was being maintained for that purpose per specific manufacturer guidelines. In particular, courts have examined whether parts were replaced in a timely manner and whether facility owners ensured that routine inspections and maintenance were conducted and documented.
Tips: Courts examine appropriateness of use. In a case where hotel management had placed home equipment in a hotel gym, the court found the hotel liable for injuries suffered by the client. In a training facility, owners should provide commercial equipment; manufacturers do not design home equipment to withstand the wear and tear of frequent use by multiple users.
Endelman emphasizes regular inspections and maintenance and accurate record keeping. “You need to be sued only once to realize their importance,” he says. Balanced Body Inc.’s guidelines call for routine equipment inspections at least quarterly. (See “Pilates Equipment Safety and Maintenance” on page 47.)
Arbuckle agrees that quarterly inspections are the minimum requirement but recommends monthly inspections to be on the safe side. He also suggests that studio personnel should follow a checklist when conducting inspections, to ensure that every item is covered. “One person in the studio can be assigned responsibility for ensuring that this task is completed. The inspection can even be conducted during regular staff meetings with everyone’s participation, to raise staff consciousness of the importance of safety and maintenance issues,” he points out.
According to Arbuckle, the possibility of a broken spring creates the most obvious potential for injury on a piece of Pilates equipment. He notes, “I recommend that springs be changed every 2 years, but there is no hard-and-fast rule. It depends completely on use. The best preventive measure is to conduct regular visual inspections of springs, watching in particular for a gap in the coils, which could lead to failure.”
Merrithew agrees. He says, “As with any fitness equipment, it’s important to follow the manufacturer’s safety and usage recommendations. At STOTT PILATES we include a Safety and Usage Manual as well as a complementary DVD that has a safety segment with every piece of resistance equipment we manufacture.”
Because maintenance affects equipment performance over time, you should exercise caution when purchasing used equipment. Request all maintenance records and original purchase and warranty information. Thoroughly inspect and test equipment and replace any worn parts.
In multiple exercise equipment cases, courts have zeroed in on whether or not instructional and warning signs were in place near equipment. In its 1997 Health/Fitness Facility Standards and Guidelines, the American College of Sports Medicine (ACSM) recommends that facilities post such signage near equipment to alert users to risks associated with certain activities (see “Know Industry Standards and Guidelines” on page 46). The American Society for Testing and Materials (www.astm.org) also has standards pertaining to equipment warnings.
Tips: All reformers, trap tables, wall units, ladder barrels and stability chairs manufactured by STOTT PILATES have warning labels. In addition, the reformer has a caution label that says, “Before getting on the Reformer, ensure at least one spring is securely attached to the gearbar”. Warning stickers are important to protect both the manufacturer and Pilates professionals. Owners should not remove equipment warnings.
In her studio, St. John displays warning signs in addition to the stickers on individual pieces of equipment. Romani-Ruby says, “One of our studios is in a wellness center, and the equipment is open. There are signs saying that the equipment is to be used only with the supervision of a trained Pilates personal trainer. We also post safety rules where staff will see them on a regular basis.” Merrithew says, “At STOTT PILATES we also include a facility safety sign for clubs and studios to post prominently for their members and instructors with equipment that we sell.”
Some studio owners are reluctant to post warning signs for aesthetic reasons. Nonetheless, courts consider the presence of signage critical when determining whether or not a facility owner has provided a safe exercise environment.
Courts have found that a health club owes a duty of reasonable care to protect members from injury while they are at the club. Toward this end, clubs are responsible for ensuring that members know how to use equipment properly. Clubs can fulfill that responsibility by not only instructing members how to use exercise machines but also supervising members while they use the machines.
Tips: “It is critical that facility owners require their instructors to complete a high-caliber training and obtain certification that tests an instructor’s knowledge of how to teach the exercises safely and use the equipment properly, every step,” says Merrithew. He believes that instructors should complete both a written and a practical exam before they can become certified.”
St. John adds, “With the growth of group reformer classes, we must make sure that instructors are well trained to deal with common problems, such as low-back pain, knee pain and osteoporosis. Instructors for group classes have to be able to choose appropriate exercises for the entire group while still giving [all participants] a good workout. For example, I teach a group class where everyone is over 50. I have to make sure I accommodate for one client’s bad knee and another client’s recurrent back problems. Exercises that require instructor spotting are generally inappropriate for a group class.”
St. John notes that the instructor in a group equipment class must emphasize and repeatedly demonstrate how to get on and off equipment safely and how to change springs, adjust ropes and lift the box, depending on what exercises are used.
All of these points highlight the importance of in-depth safety training for instructors before they ever begin teaching clients. Even more training and practice are then required to teach groups of people on equipment.
Studio owners should exercise particular caution regarding any “open studio” policies, or use of equipment by clients without trainers. This can be an area of high-risk exposure because it is known that correct use of Pilates equipment requires specialized training and that misuse can result in injury. Sichel is completely opposed to any unsupervised training on Pilates equipment.
If experienced clients are allowed to use equipment on their own, a policy should be set to confirm that they are not new users, that they know how to use the equipment appropriately, that they comprehend the dangers and risks associated with using the equipment and that they agree to assume those risks. Creating and filing a signed document noting each of these points could reduce risk exposure, although no cases have tested the validity of such a document.
Effective supervision of children is also essential. “Little fingers can get stuck in many places,” Arbuckle cautions. “Kids can get their hands in the carriage or underneath the wheels.” Peak Pilates Systems’ Euro-style day couch reformer for home use can function as a couch when not in use as exercise equipment. It is specially designed to be closed up so it can be left around kids.
Whether or not Pilates studio owners or Pilates trainers view themselves as part of the “fitness industry,” courts are likely to consider fitness facility industry standards in any cases involving Pilates facility incidents. Standards for health and fitness facilities are addressed in two key publications. The first of these is the joint American Heart Association (AHA) and ACSM statement “Recommendations for Cardiovascular Screening, Staffing and Emergency Policies at Health/Fitness Facilities,” updated 4 years later with the supplement “Automated External Defibrillators in Health/Fitness Facilities: Supplement to the AHA/ACSM Recommendations for Cardiovascular Screening, Staffing and Emergency Policies at Health/Fitness Facilities” (Balady et al. 1998; Balady et al. 2002). The second important publication is ACSM’s Health/Fitness Facility Standards and Guidelines (2nd edition) (Tharrett & Peterson 1997). These standards govern issues related to prescreening of facility users, qualifications of facility personnel and use of written emergency policies and procedures reviewed and practiced regularly. All club or studio owners and managers should be familiar with these publications (see “Know Industry Standards and Guidelines” on page 46).
Tips: Prescreening not only alerts you to clients who may need medical attention; it can also protect you against future claims related to aggravation of preexisting injuries or even give notice of potentially litigious clients.
St. John, formerly a Pilates trainer at St. Francis Memorial Hospital in San Francisco, advises trainers to screen new clients carefully and take preventive measures if necessary. “When I worked in a hospital setting, I encountered clients who told me about all the lawsuits they’d had,” she recalls. “This puts you on special alert that this client has a litigious pattern of behavior.”
St. John recommends listening closely to what new clients reveal to you. “If you think it is necessary, do not hesitate to refer a person back to his regular physician. It is better to discourage a potential client likely to sue you down the road.”
Numerous industry professionals reiterate the significance of prescreening. Often, clients come in with a pre-existing injury and, by training, aggravate it or simply have a flare-up of what has been a chronic condition. Without some form of prescreening documentation to remind them that their condition existed before training, they may forget and blame the Pilates training.
The best practice in some cases may be to require someone to get medical clearance. If a client receives this, you may also want to request a medical release to increase communication with the client’s healthcare provider. This alliance not only will strengthen your understanding of your client’s needs but also can lead to future referrals from healthcare practitioners who learn about you and develop respect for your Pilates practice.
With a commitment to safety education and comprehensive training for staff and proactive risk management, Pilates professionals can continue to protect clients from injury as the Pilates market continues growing. With a team effort among Pilates professionals and a shared consciousness toward protecting the respect for quality and results that Pilates currently enjoys, we can maintain this strong reputation.
Facility owners, managers and program directors who offer Pilates programs need to balance rapid growth to meet consumer demand with a recognition that investing in rigorous instructor education is the foundation for maintaining safe and effective programs. Similarly, trainers who work with Pilates equipment need to maintain respect for the depth and breadth of knowledge that is required for training clients. Trainers must always work within their current level of expertise, even as their aspirations may climb much higher.
WARNINGImproper use of exercise equipment may cause serious bodily injury. To reduce risk of injury, Please read the following:!
- Before starting any exercise program, consult a physician.
- Before using the equipment, read and follow instructions in the safety manual and obtain thorough instruction from a Qualified Trainer.
- Use equipment only for intended exercises.
- Ensure the equipment is properly adjusted for your size and ability level.
- Stop exercising if you experience chest pain, feel faint, have difficulty breathing or experience musculoskeletal discomfort.
- Keep clothing, body and hair free from all moving parts.
- Do not use if equipment appears worn, broken or damaged. Do not attempt to repair equipment yourself.
- Do not allow children to use or be around equipment without adult supervision.
- Do not remove this label. Replace label if damaged, illegible or removed.
!CAUTIONn Before getting on the Reformer, ensure at least one spring is securely attached to the gearbar
The American Heart Association (AHA) and the American College of Sports Medicine (ACSM) have approved these publications:
- Balady, G.J., et al. 1998. Recommendations for cardiovascular screening, staffing and emergency policies at health/fitness facilities. Circulation, 97 (22), 2283–93.
- Balady, G.J., et al. 2002. Automated external defibrillators in health/fitness facilities: Supplement to the AHA/ ACSM recommendations for cardiovascular screening, staffing and emergency policies at health/fitness facilities. Circulation, 105 (9), 1147–50.
- Tharrett, S.J., & Peterson, J.A. (Eds.). 1997. ACSM’s Health/Fitness Facility Standards and Guidelines (2nd ed.). Champaign, IL: Human Kinetics.
Safety inspections should be performed at least quarterly on all Pilates equipment. Specifically, inspect the following areas.Equipment Springs
Quarterly spring inspections are very important for safety. In general, springs under high-volume use should be replaced every 2–3 years. Old springs lose their resilience and, in a worst-case scenario, can actually break. Here’s what to look for when you inspect springs:
- Check for gaps between the coils when the spring is at rest. It’s fine for the tapered end of the spring to have a gap. (A gap is sometimes created when the hook is inserted during the manufacturing process.) However, the body of the spring should have no gaps. A gap indicates a weak point in the spring. If you see gaps in the body of the spring, replace it.
- Replace the spring if it is under tension and the spaces between the coils are not uniform.
- Rotate reformer springs of the same weight each quarter. People tend to use one spring more than the others. Rotating springs—as you would rotate tires on a car—helps them wear more evenly.
- If a spring hanging at rest has visible gaps (trapeze table, wall unit), replace it.Reformers
- Make sure that the risers are installed on the outside of the frame. Whereas only pressure can secure risers installed on the inside, both the frame and the bolts secure risers installed on the outside. That is the only safe configuration.
- Make sure that the springs are hooked beneath the carriage in a downward position. If hooked upward, they could fall off.
- Before a client uses the box and foot strap, make sure that the foot strap is under tension (with snaps pulling from the top of the eyebolt).
- When the reformer is not in use, make sure that at least two or three springs secure the carriage.
- Restore the “default setting” on your reformer after every session by connecting a certain number of springs, setting the foot bar at a predetermined height and putting the ropes in place. This ensures that the machine is ready for the next client and that the carriage is secured by the springs.
- To ensure smooth carriage travel and to maintain the longevity of the wheels, wipe down the tracks once a week. Use a cleaner such as Simple Green, Fantastik or 409. Do not use abrasive cleansers or pads; they can abrade the anodizing on the rails. Do not use WD-40 or silicone on the rails and wheels; these not only attract dust but can actually rinse out the lubricant in the bearings and shorten wheel life. If you feel a bump in the ride, dirt has probably adhered to the surface of the rails or wheels. In addition, be diligent about keeping hair out of the rails. Hair can wrap around the wheel axles, building up and eventually causing bearing failure.Trapeze Table/Cadillac
- The push-through bar can be dangerous and must be used with caution. A trainer should always keep one hand on the bar while a client uses it. That way, if the client inadvertently lets go of the bar, the trainer still has control of it.
- For bottom-sprung exercises, the safety strap or chain should always secure the bar to the frame. The strap should be attached so the angle of the bar is at approximately 4 o’clock to limit the range of the bar and prevent it from coming into contact with the client. Be sure to attach the strap or chain to the canopy frame and around the push-through bar, not the eyebolts. The strap or chain is only as strong as the weakest link, and the frame and bar are a great deal stronger than the eyebolts.
- When the client’s head is below the push-through bar, use either the middle or the high pivot bolt setting, not the low setting. This adds one more measure of safety.
- Manually check all eyebolts every quarter to ensure that they’re tight.Chairs
- When dismounting the chair, release the pedals slowly, with control. Do not let the pedals snap back.
- A client standing, sitting or lying on the chair increases the risk of falling. Standing exercises can be particularly precarious. If you have any doubt, spot your client.
American College of Sports Medicine. 2006. ACSM’s Guidelines for Exercise Testing and Prescription (7th ed.). Baltimore: Lippincott, Williams & Wilkins.
American College of Sports Medicine. 2006. ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription (5th ed.). Baltimore: Lippincott, Williams, & Wilkins.
Archer S. “Reward Carries Risk: A Liability Update.” 2004. IDEA Personal Trainer, 15 (4), 30–34.
Clark, M., & Romani-Ruby, C. 2001. The Pilates Reformer: A Manual for Instructors. Tarentum, PA: Word Association Publishers.
Cotten, D.J., & Cotten, M.B. 1997. Legal Aspects of Waivers in Sport, Recreation & Fitness Activities. Canton, OH: PRC Publishing.
Herbert, D.L., & Herbert, W.G. 1993. Legal Aspects of Preventive, Rehabilitative and Recreational Exercise Programs (3rd ed.). Canton, OH: PRC Publishing.
Koeberle, B.E. 1997. Legal Aspects of Personal Fitness Training (2nd ed.). Canton, OH: PRC Publishing.
Fitness and Wellness Insurance Agency, 380 Stevens Ave., Ste. 206, Solana Beach, CA 92075; (800) 395-8075 or (858) 259-5800; (866) 422-6579 (fax); firstname.lastname@example.org; www.fitnessandwellness.com.
The Pilates Method Alliance®, PO Box 370906, Miami, FL 33137-0906; (866) 573-4945 or (305) 573-4946; (305) 573-4461 (fax); email@example.com; www.pilatesmethodalliance.org.
Sports-Can Insurance Consultants Ltd., #730-800 W. Pender St., Vancouver, BC V6C 2V6; (800) 993-6388 or (604) 685-0050; (604) 669-1007 (fax); firstname.lastname@example.org; www.sports-can.ca.
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