Written by: Kevin Cann
I am writing this article to spark discussion and debate, in the hope of being able to advance the exercise, strength and conditioning, fitness, wellness…field. You see there is one problem, what the hell do we even call it? The field lacks so much structure and organization that we all even call it by a different name.
All of us in the field even give ourselves different job titles. We could have 3 people with the exact same educational background and certifications even call themselves by different titles. One might be a strength coach, the other a personal trainer, and the other a fitness coach. This is confusing for the consumer, hell, it is confusing for me. Not to be disrespectful in any way, but what the fudge is a lifestyle coach?
This is not to take anything away from people out there using different titles. We all got into this field to help people and I truly believe that 99% of the people in this field have good intentions. However, we need to set some standards and create some type of professional structure.
Now, I know that in most cases you need to have a personal training certification to call yourself one of many fancy titles. However, is this enough? Some of these certifications can be obtained in a weekend, and some have a fancy textbook with information that you will probably never reference. Either way the entrance requirements for the field are very minimal.
With minimal entry requirements, we get a field with many of its members just doing it because it is easy to get into. Also, with minimal requirements, we get minimal pay and benefits. Not saying that you cannot do well in the field, you absolutely can if you bust your ass and you are willing to put in your time.
Many doctors and physical therapists are reluctant to send patients to a personal trainer because there is no quality control. Of course you can network and find ones who will. We have a few in our network at TPS that are great, but how many places really have a setup like that? In over a decade of being in this field, I will tell you not very many.
Personal trainers are in the perfect spot to help the healthcare crisis we are currently in. Regular exercise is known to help PREVENT heart disease, diabetes, cancer, mood disorders, joint degradation, and many more issues. There are 25 chronic health conditions that exercise can help prevent. Not only that, but we spend billions on orthopedic issues every year. If we were stronger and moved a little better, perhaps this number would decrease.
We also have a healthcare system that sets people up in a cycle. For example, all through college we were active playing sports, running, and lifting weights. Once we graduated we were busy building a career and family. The sporting activities went away, and the running and lifting sessions were sporadic at best. Sporadic, that is, until our knees started to hurt so we couldn’t lift weights and run anymore.
Running and lifting had been reduced to an elliptical or bike. This didn’t last long because it was boring. The knee pain did not go away, but is now accompanied by back pain, probably from sitting all day long. The weight has steadily climbed up while mood has steadily decreased.
You go to one doctor to deal with the pain and maybe get prescribed physical therapy with some medications. The doctor looks at your blood work and sees that you have high cholesterol and are pre-diabetic. He recommends that you start a prescription of Lipitor. Probably only a matter of time until the diabetes medication comes into play.
You go to physical therapy and it helps, but only temporarily. Surgery becomes a real option at this point because you can’t take the pain anymore. You decide to see a psychiatrist because you are feeling depressed. They prescribe you an anti-depressant and anti-anxiety medication. These pills make you gain even more weight (maybe even pushing you into type 2 diabetes) and the cycle continues downward.
Sadly, this is more common than not for your average American. This costs a lot of money over time, and all of these issues could have been prevented if the person was seeing someone to exercise regularly. The problem now is that personal training is very expensive, and you may be paying for someone with good intentions, but no clue how to put those good intentions into a well laid out plan for that individual. Due to the pricing of personal training, it is only available to a specific demographic of the population.
A few months ago I would have argued up and down that there should be minimal, formal educational standards to enter the field. Now, that is not saying that there are not good coaches out there without formal education in the field, because there are plenty. I work with a group of great coaches that do not have formal education, but years of education under a bar. Sadly, this is not the majority of the field. This is a very small minority.
Instead of making formal education a requirement, perhaps we should distinguish those with higher education from those with certifications only. It used to be that physical therapists only needed bachelor degrees to practice, but now they require doctorates. There is a large gap between a doctor and someone that passed a weekend certification course. We need something to bridge that gap.
Now that physical therapists are doctors, anyone with a little pain gets referred to one. This leads to an increase in insurance premiums as well as long waits to get in to see the doctor. Most of these issues can be resolved with just learning how to move better. Not only will the pain get resolved, but we will be preventing many other diseases.
This is what Canada did in 2013. They developed the profession of kinesiology. The practice of kinesiology as defined by the Ontario Kinesiology Association is “The assessment of movement, performance, and function and the rehabilitation, prevention, and management of disorders to maintain, rehabilitate, or enhance movement, performance, and function, in the areas of sport, recreation, work, exercise, and activities of daily living.”
Along with that definition, they have a clearly written scope of practice that spells out what a kinesiologist can and cannot do. The entire list can be found here (http://www.coko.ca/application/files/6914/5401/2080/Scope_of_Practice_Controlled_Act_and_Delegations_Guideline_January_2016.pdf ). If you do not want to read the whole thing here is a quick summary of what they can do:
Electrical therapy techniques including:
* IFC
* TENS
* Therapeutic Ultrasound
* Pulsed High Frequency
* Low Intensity Laser Therapy
* Therapeutic application of heat and cold
* General nutritional counseling
* Fitness & Health Evaluations and Exercise prescription
* Athletic training, therapy and interventions
* Ergonomics
* Biomechanics
* Exercise Physiology
* Completion of insurance assessment forms (subject to form specific limitations)
* Manual osteopathic techniques/modalities
Basically, if you are in pain because you move like shit, you can see a kinesiologist. If you have pain due to certain diseases and post-operative rehabilitation, you would see a physical therapist. This can help to decrease wait time to see a physical therapist as well as control costs on care. A physical therapist is a doctor, and gets paid like one. Maybe it would be cheaper to see a kinesiologist?
In order to be a kinesiologist in Canada you must have an undergraduate or graduate degree in kinesiology. Those with degrees in exercise physiology fall under certified personal trainers and certified exercise physiologists. I am not sure what the educational requirements are for those titles. With a graduate degree in kinesiology you get more leeway in what you can utilize as tools for your clients.
As someone with a master’s degree in kinesiology, I like this idea. It bridges the gap between physical therapy and exercise. It ensures people are being properly screened and treated. It is rare that someone walks into a gym without any issues or restrictions. You must understand the human body and how it moves to be able to screen someone appropriately. There are many trainers that screen now, but miss many things in the screening process because they do not truly understand human movement. With that said, keep screening because it is better than not doing it at all.
I also think this would help give doctors more faith to prescribe exercise as a solution. Not that this should be the case, but as Americans we tend to respect higher levels of education. Exercise is a lot cheaper than a lifetime of prescription medications.
I am not sure what the healthcare contributions are for these services as I could not find that information. I would imagine that they do not pay $90-$150/session. This may help lower the costs of training sessions, opening it up to more income levels. If this happens I see the people in the field making more overall money even though sessions would be cheaper.
Maybe once the health insurance stops covering visits, or the client is no longer in pain, they get released to a certified personal trainer in the same facility that works under the guidance of a kinesiologist. This helps put some quality control on the trainers. Sessions with a trainer in this scenario would be cheaper than they were with the kinesiologist.
The average certified personal trainer makes roughly $33k per year with minimal benefits. They are usually only paid during training hours which makes it difficult for time off and there is no steady pay. Some months will always be better than others.
If training becomes more available to the masses, and we can save money on healthcare, trainers could have a job making a steady hourly wage that leads to a larger salary than the average now. Who knows, I could be way off base.
I just think with more structure and organization, more people will exercise with a qualified professional and improve overall quality of life, something that the medical profession is lacking now. I am very curious as to what others thoughts on this topic are so please discuss in the commen
After spending $5,000 out of pocket, and spending 3 morning a week for 6 months in Physical Therapy, followed by a foot surgery, I was disappointed with my level of care and STILL experiencing symptoms. Eventually I said screw it, I don’t need a Dr, and started digging through the internet to see how the hippies and fringe folks are solving their issues. I taught myself how to walk properly, got better shoes, and did specific exercises to help my condition. Now I’m virtually pain free and can enjoy my walking, hiking, biking, and jogging habits. If my first step had been to go to a movement expert and fix my broken walking and running patterns, I may have been able to avoid the surgery. If my insurance wasn’t such sh*t (USA), maybe I would have afforded to seek treatment earlier and headed things off before they got too bad (but that’s a different rant).
I don’t think we need formal structure or organization. There is no one structure that is going to work for everyone and there is no single entry point, for professionals or clients. And legal requirements is only going to limit access (as it has in the medical industry). But those of us in the Preventative Care (?) industry, can create our own structures and organization.
I think the best thing that we can all do is educate our clients and potential clients (as well as ourselves) about what we all do. Whatever we call ourselves and regardless of the degrees we have, the more of us that are being open and honest about our skills and knowledge (and sharing that kind of information freely), the more that the public can learn where they fit in our industry at different points in their life.
I also think that this is the best way to keep cost down for as many people as possible AND to keep all of us in business. By allowing for different entry points for professionals (group exercise, professional degrees, and everything in between), we will be able to offer more different price points. And the best way for all of us to grow our client base and keep us all in business is to refer clients and share information (as appropriate) in all directions.
And education includes telling people what to look for in other professionals and just sharing your opinion on the other parts of the Restorative Care (?) industry. Just make sure it’s an informed opinion.
Preventative and Restorative Care?
Preventative and Rehabilitative Care?
Physical Wellness Industry?
I have no idea what to call those of us either. I barely know what to call myself. Marketing will probably be the deciding factor.
Great article, topic, and discussion!
This discussion is right in my wheelhouse as a long-time strength and conditioning coach and doctor of physical therapy.
I think the confusion in the fitness and rehab industries stems from a variety of confounding factors: clients lack the knowledge to discern where they fit in on the spectrum of rehab to fitness; physical therapists are trained as generalists and get little to no education on how to transition an individual from rehab patient to fitness client; the fitness professional has the opposite problem-they can sell themselves well but often don’t have the formal or experiential educational background to know how to sort out which clients they can help and which they need to refer for outside help. Throw in a healthy dose of ego on all sides, and getting everyone on the same page becomes problematic, to say the least.
I think the fix lies in bridging the gap between the PT/healthcare folks and the fitness folks. Creating an environment where all parties see themselves as players on the same team, part of a mutually accommodating system. That requires both sides to raise their game. The PT/healthcare crowd needs to look at functional outcomes beyond pain control and symptom management. The fitness folks need some baseline clinical exam skills as it relates to movement ability, systemic red flags, and lifestyle factors that can contribute to their clients health and ability to participate in a fitness program.
I agree with Anna that legislating this problem is not going to help anyone. I think it’s up to the respective professions to set higher standards for the people they employ.
Also, I want to extend my sympathy to Lomark for the poor care he received in PT. It is absolutely absurd that you spent 6 months in PT and had to figure out on your own how to walk properly, find the right shoes, and what exercises would help you feel and perform better. I don’t know what your former PT was doing with you, but it certainly wasn’t their job.