Monday, November 19, 2007

Should All Personal Trainers be Allowed to Treat Obesity?

In today’s edition of CMAJ there is a statement worth noting regarding the qualifications that exercise professionals should have before being allowed to work with obese individuals.

The basic point of this statement (co-signed by a number of prominent Canadian Kinesiologists and Exercise Physiologists) is that because many overweight and obese individuals are at an increased risk of various co-morbidities, including cardiovascular disease, it is imperative that exercise professionals involved in treating such individuals have a clear knowledge of the absolute and relative contraindications to exercise for patients with obesity.

The authors strongly believe that such knowledge can only be developed through formal and rigorous post-secondary academic training within a faculty of exercise science, which is in clear contrast to some personal training designations provided by “for-profit” organizations that do not require advanced college or university education in health or exercise science. In their statement, the authors go on to describe what they feel is an acceptable standard of qualification and certification that will best ensure patient safety.

The points are certainly well taken and I fully agree that dealing with obese patients in particular requires sound medical knowledge and expertise in exercise physiology.

Not only are obese patients at increased cardiovascular risk, but they are also at extreme risk for mechanical injury due to lack of flexibility, balance and coordination, particularly during weight-bearing exercises. Existing back, hip and knee problems can easily be exacerbated by a misguided “boot-camp-drill-sergeant” approach to “let’s-burn-off-those-calories”.

Immobility resulting from musculoskeletal injury caused by improper and overzealous exercise routines can only exacerbate obesity and cardiovascular risk factors and will certainly pose a direct threat to effective weight management.

The much bigger question here is not just about personal trainers or self-appointed exercise gurus but rather about the entire for-profit “weight-loss industry”.

While there is certainly an important and often invaluable role for lay-persons in peer-support groups, buddy systems and walking clubs, the fact that patients often have no way of recognizing qualified from unqualified health professionals can indeed pose a health hazard, particularly for obese individuals who will clutch at any straw for help.

The key question indeed is that if obesity is really a disease, should someone who is not a certified and regulated health professional be allowed to offer treatment? Can we forbid self-appointed “health advocates” to offer their services? Probably not. Would we recommend that our patients seek help or advise from individuals with “iffy” qualifications? Not likely.

An important function of WW will be to help patients find community services that help them improve their health (with or without weight loss!) without putting themselves at risk.

Clearly, the bigger the patient, the greater the risk – self-imposed limitations and/or legal restrictions on working with clients above a certain size may well be in the interest of anyone working in this industry who does not have the training and credentials to work with obese clients.

AMS

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2 Responses to “Should All Personal Trainers be Allowed to Treat Obesity?”

  1. Dr. Sharma’s Obesity Notes » Blog Archive » Is Obesity a Risk Factor for Tendinopathy? says:

    [...] good reason, why exercise professionals working with obese clients (as blogged before) need a sound understanding not just of exercise physiology but also of musculoskeletal [...]

  2. Spencer Jackson says:

    I think its something of a myth that a personal trainer will take personal control of someones battle against obesity. Speaking for my own personal training program for overweight individuals, I always ensure that they seek approval of my program from their general practitioner. I most cases I send my personal training candidate along to their doctor with a written comprehensive program of exercises and timeline and actively seek their approval and have never experienced anything other than positive feedback from the medical profession.

    I think that it is terribly important for the personal trainer to be fully trained and sensitive to the abilities of their wards. The program should be gradual and core training concentrated. We intially concentrate on natural movement and gradually improve both the flexibility and core fitness of the candidate, allowing them to say when they feel able to move towards more taxing programs. At each stage we ensure that the overweight candidate visits their GP for health checks.

    I think that to improve the fitness of someone who is overweight should be a partnership between the individual, their GP and a trained personal fitness instructor. Each component has their own responsibilities and confidence in each is essential for success.

    I hope that I have reassured you that we are not all army bootcamp commandants, hell bent on beating the fat from people.

    All the best

    Spencer :-)

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