Anxiety, depression, diabetes(type 2), hip replacement, knee pain, knee surgery, knee replacement, wrist pain, wrist surgery, elbow pain, elbow surgery, shoulder pain, shoulder surgery, COPD, high blood pressure, parkinsonisms, MS, cancer, back pain, back surgery, osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, osteoporosis, high blood pressure, asthma and stroke.
Above are a list of conditions, off the top of my head, that I have come across in my time in the fitness industry. Most of them I encountered in a non exercise referral situation, i.e. they joined the gym or a class and walked in, not as part of a specialised scheme. (And full disclosure, I have some of the things listed above as well!).
There are no special populations.
The fitness industry and fitness qualifications still talk about special populations.
As I've said before, there are no special populations anymore. The special population is the person who walks into the gym or a class with no injuries or medical conditions. Unless you are training a group of 19 year olds, this is probably never going to happen.
Referral schemes never quite cut it.
There was a time, 10 years ago or so, when anyone with one of the above conditions would come through an exercise referral scheme, they would have a GP referral letter, and normally they would be older, had never exercised before and exercise had become the last resort of the medical profession.
Adherence with this group was normally low, and finance was a typical barrier. I'm not saying there weren't some success stories, and some peoples lives were changed. But it has never quite achieved what it could have.
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| GP referral 10 years ago: Look you can sit down and watch TV, just like at home. If you have an injury or medical condition you do NOT have to use this. |
Now, people with injuries and medical conditions are not coming through referral schemes. They are coming to standard classes and gyms. They are bypassing the medical profession.
On the one hand it is a positive thing, this population is more self motivated. Typically they may have been exercising for the whole lives. We are now seeing the baby boomer generation and younger, the ones who have always exercised. They have been coming to classes for 15 to 20 years and they aren't stopping now.
Teach a standard aerobics class, total body toning class with 20 people in, and you may be dealing with 20 different types of injury and medical condition.
Sometimes the participants wont tell you they have these conditions, or tell you half way through or expect you to have a plethora of modifications ready for them. I think some members of the public think you have been taught all these modifications. What is actually true: the instructor is using their experience and making their best guess at that time...
For example, I have covered LBT and toning classes where people have said to me lunges hurt my knees" or "squats hurt my knees". This would beg the question, what were you expecting to be doing in an LBT class? My standard response is, if it hurts don't do it, and maybe you should go and see a physio or get a one to one session with some health professional to sort out your knee problems before you come to a mainstream class?
Yes, we need to educate the public, but we also need to educate ourselves.
GP Referral, Level 3 PT, level 4 something.
In the UK most personal trainers have the standard level 3 qualification. And most specialised qualifications for exercise referral are level 4.
The standard level 3 personal training qualification doesn't prepare the student for all the health conditions they are going to encounter and nor in fact do the level 4 qualifications.
It's not the fault of of the well intentioned people paying the money to do these courses. As far as they are concerned this is the industry standard qualification they need.
When I did the GP referral qualification we spent a lot of time working out VO2 Max percentages, which I have never used ever again, and learning the stages of change model, which again is not that useful when faced with someone who has had a hip replacement. Then we went through all the medications for blood pressure and their side effects. The amount of time spent on specific exercise was minimal.
The level 4 back pain specialist course I went on suggested playing bingo sitting on a swiss ball was a good thing for people with back pain (true story!). I learned more from reading McGills books. The course gave me precisely zero tools to use with an active person with low back pain.
Now, this was fine back in the day, when the referral clients you were seeing were sedentary individuals, and frail old people. In these cases, the axiom, of any gentle movement is going to be good holds true. And yes we should still help these people.
But what happens, when faced with the highly motivated individual who has had a hip replacement or knee surgery and has been discharged by the physio service who turns up for an orientation.
They have signed the waiver form saying they are good to go, and then they spring it on you.
Or you are about to do some hip moves in a pilates class, and one of the participants say "I've had a hip replacement, can I do this, what can I do instead?" They think you have been taught what to do in this situation...
Of course, rule 1 is do no harm. Rule 2 is educate yourself, because the fitness industry system of qualifications has let you down. Rule 3 is be honest.
Quick fixes.
People want quick fixes and quick answers. Instructors, how many time have you been sitting in the gym and someone comes up to you and says "what can I do for this shoulder pain I have or back pain or knee pain?". Have they seen a physio? Sometimes yes, mostly no. When you say maybe they should go and see one, they look disappointed that you didn't give them the magic shoulder exercise that will fix them after you have assessed their shoulder with your MRI/ X ray vision.
The honest answer of course is "it depends", I will have to do an hour assessment to figure out what is best for you, it costs this amount... can be met with disbelief. They are used to the quick answer, they are not used to someone saying maybe this class isn't for you right now. They are used to fitness professionals bluffing or feigning expertise.
But mostly they are used to the fitness industry ignoring their needs.
Insular. Lost markets, lost people, lost opportunity.
A vast number of the public feel excluded by fitness and gyms. "It's not for them."
And yet the Academy of Medical Royal Colleges calls exercise
"The miracle cure."We have become an insular industry, "get ripped", "get shredded" messages, with increasingly hardcore messages about HIIT, and high level exercise that appeals to 1% of people (our fitness friends) and not the public.
At the other end of the spectrum, google "GP referral" or "exercise referral" and its the usual images of some white haired pensioners in their 90's waving their arms around in a studio, or a doctor with a stethoscope.
Or the classic gym marketing image of a trainer next to someone on a swiss ball that appeals to precisely no one.
The woman or man in his/her 40, 50's or even 60's doesn't associate themselves with 'old persons exercise'. The want help and advice, they don't want to be treated like "old people".
There is also a race to the bottom, to provide the cheapest gym with no support.
At the same time there is a race to the top to be the exclusive PT, strength & conditioning, high cost facility. (Where in fact the trainer still only has the level 3 PT qualification everyone has, and if you turn up with an injury or medical condition or an athletic goal you are going to get exactly the same workout).
And the people with a few injuries, niggles, maybe a medical condition or two but who want support and don't feel old or broken are left out.
No one is broken.
Of course, if everyone is broken, no one is broken. People are just people. Life happens.
As a society we are at crisis point with preventable disease.
Fitness should be at the forefront of helping people and educating people.
But we are are not.
The NHS lets people down with its pharmaceutical centred strategy. The media let people down with its confusing messages.
But we are also to blame. Yes, I am talking to you REPs and Active IQ with your lack of quality courses addressing what the public and instructors need. Hold your head in shame that you think mickey mouse, poor quality, distance learning level 3 is acceptable.
Yes, I'm talking to you Universities, with your sports science degrees and sports coaching degrees, churning out graduates that have no practical knowledge of how to help unfit people.
Personal trainers don't need to be physiotherapists. But we should be the go to place for people wanting to get all the benefits of exercise.
It doesn't have to complicated. It has to be sincere, quality, evidence based, compassionate and results driven. If you're not budget or coaching professional sports people, it's all you've got.
We should be better, we should be the fitness experts. The market is waiting.
"First move well, then move often." - Gray Cook
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