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Respecting Your Boundaries

Legal & Risk Management
By Sean Riley, MS, JD

Respecting Your Boundaries
Always remember, your job is to design exercise programs– not to treat, diagnose or prescribe. Study after study has demonstrated that regular physical activity is important to good health. In an attempt to promote clients’ well-being, personal fitness trainers (PFTs) may find themselves involved in activities that can blur the line between fitness and medicine. As a trainer, you must be vigilant to avoid crossing that line by involving yourself in areas that exceed your professional scope of practice. Some cloudy areas include accepting physician referrals, claiming clinical certifications and offering nutrition advice. mental condition . . . without being authorized to perform such act . . .” (Herbert & Herbert 2002). Other states have similar codes. In the ideal situation, a referring physician provides basic exercise goals for a patient, and the PFT sends regular progress reports to the physician. However, all too often, once a client is referred to a PFT, no feedback passes between physician and trainer. Such a scenario may place a burden on you to make medically related judgments. Frequently a physician will give a patient a written “exercise prescription,” which the patient then gives to you. This is precisely how patients get referrals to physical therapists. From a legal standpoint, by accepting such a referral along with an exercise “prescription,” you might be practicing what is reserved by law for licensed physical therapists, thereby exceeding your scope of practice.

and professional complications, since they blur the line between physical fitness and medical treatment. The term clinical is commonly reserved for state-regulated medical or research-oriented procedures and practices. Clients may assume that individuals possessing clinical certifications possess superior knowledge, skills and abilities. Unqualified trainers might be matched up with health-impaired patients who need the specialized treatment of medically trained personnel. It is up to you to refuse clients whose needs exceed your abilities and knowledge.

The Risks of Rendering Nutrition Advice
A 2003 IDEA member satisfaction report found that 61% recommend or discuss nutrition/weight management products with their clients (IDEA 2003). This is not surprising. The media are so saturated with “hype” about products that supposedly increase muscle mass and shed body fat that questions from clients inevitably arise. To the client you are an expert in all facets of fitness, including nutrition. You must clarify this misunderstanding, since your risk of legal exposure is overwhelming if you recommend nutrition supplements. Consider the following scenario. A woman in New York collapsed while doing light squats under her trainer’s supervision and later died of a stroke (Williams 2000). Her trainer had recommended that she use a dietary supplement containing ephedrine. Ephedrine can interact catastrophically with one’s blood pressure, and such interaction was the cause of the woman’s death. Consequently, a lawsuit was filed (Capati v. Crunch Fitness International). How unfortunate that an individual who made such an active attempt to improve her lifestyle lost her life because of it! That trainer made a disastrous error that should be a red flag to all PFTs.

The Perils of Physician Referrals
Poor dietary habits, work-related stress, smoking and physical inactivity are key risk factors for disease. Physicians continually advise patients to remedy these habits and, since regular activity is one remedy, doctors may refer patients to PFTs for an exercise program. But beware: As a PFT, you are under a legal duty to design and demonstrate only training regimes. You are not a physician, a psychologist or a pharmacist. To act as such is to unlawfully practice medicine, a criminal offense punishable by jail time in most states. California, for example, enforces the ACC (Association of Corporate Counsel) Business and Professions Code, section 2052, which states that a person is guilty of a crime if he or she “practices or attempts to practice, or . . . advertises or holds himself or herself out as practicing, any system or mode of treating the sick or afflicted . . . or who diagnoses, treats, operates for or prescribes for any ailment, blemish, disorder, injury or other physical or

The Complications of Clinical Certifications
As insurance companies continue to limit coverage, causing patients in physical rehabilitation to make fewer doctors’ visits, trainers become a primary avenue for patients’ physical activity programs (Schnirring 2000). Some professional organizations have recently introduced socalled “clinical” certifications for trainers who work with patients with specific medical conditions, such as diabetes, cancer, coronary artery disease, orthopedic problems and AIDS, all of which are overwhelmingly medically oriented (Williams 2000). Although such certifications may be well merited, they carry potential legal

Remaining Within Your Scope of Duty
You are legally permitted to perform one task: Plan and implement exercise programs. You should not do the following: I Diagnose illnesses or injuries, including

Se p t e m b e r 2 0 0 5 ID E A Tr a i n e r S u c c e ss

sports-related injuries, however minor.
I Recommend dietary supplements, in-

cluding protein powders.
I Counsel clients with regard to eating

disorders or emotional food binges. All these tasks are limited to licensed physicians, pharmacists, dietitians and psychologists. For a PFT to perform these tasks is to risk legal liability.

Rather than giving clients advice you are not authorized to give, provide them with the names of specialists who can be of service, and perhaps even arrange a complimentary consultation. Clients will appreciate your sincere interest in their well-being.
Sean Riley, a licensed attorney, earned his JD from Loyola Law School and works as an exercise physiologist in Los Angeles, California. He earned his master’s degree in exercise science from California State University, Long Beach, where he was awarded the Graduate Dean’s List Award, the university’s top honor. Contact him at [email protected].

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