Certification Programs Give Trainers More Tools to Help Clients

They once catered only to the rich and vain, but personal trainers have become so prevalent and affordable that they are shaping up everyone from schoolchildren to senior citizens. Many focus on helping people improve their appearance or sports performance, but a growing number now specialize in helping people with chronic medical conditions.

“Physical activity is an essential piece of treatment for many health conditions, yet physicians get almost no training in how to prescribe exercise,” says Susan Bartlett, a clinical psychologist and instructor of medicine at the Johns Hopkins School of Medicine in Baltimore. “Exercise specialists can help people bridge the gap between being released from cardiac rehab and going to the health club to work out on their own.”

For consumers, however, this important step is not necessarily simple. Personal training is an unregulated specialty, and certifications can come from any of more than 250 organizations with requirements that range from looking buff to holding advanced degrees in exercise science and related fields.

To distinguish the emerging breed of well-educated exercise specialists from unqualified “gym rats,” top professional organizations have begun offering new certification programs designed to teach trainers how to work with clients who have chronic health conditions such as diabetes, arthritis, asthma, high blood pressure, pregnancy, osteoporosis and lower back pain.

For example, last year the American Council on Exercise began offering personal trainers the chance to become “clinical exercise specialists.” Using input from physicians, these specialists work with clients for several weeks or months until they are able to continue on their own, says Bartlett, who helped design the ACE program.

“Many people with medical conditions value being able to work one-on-one with these specialists, and it can be central to their ability to stick with an exercise program and achieve results,” Bartlett says. She cites an extremely overweight patient who had tried and quit numerous exercise programs until she began working with a trainer.

“For the first time she was able to lose 30 pounds and keep it off for two years,” Bartlett says. “She still meets with the trainer once a week and shares the sessions with her sister as a way to reduce costs.”

For people with chronic medical conditions, an exercise specialist can be a more affordable alternative than working with physical therapists or other health-care professionals. Trainers’ fees range from $30 to $100 an hour depending on location and experience. The downside is that personal trainers’ fees are typically not reimbursable by insurance, though some insurance and fitness-industry experts say that could change.

Some people seeking trainers do so when insurance payments for physical therapy run out.

“Many patients are discharged from the system and told to keep exercising but often aren’t sure what to do,” says Scott Ackerman, owner of Elite Fitness Concepts, a health, sports and post-rehab facility in Great Falls, Va. “Doctors may be afraid to send these patients to the local health club, where a personal trainer could be a guy whose qualification is wearing a shirt that says ‘trainer.’ ”

Ackerman, who has an undergraduate degree in exercise science, holds certificates from numerous professional organizations and serves as the assistant strength and conditioning coach for the Washington Redskins, says that when he launched his business several years ago, he visited several local orthopedists to introduce himself and his services.

“At first they sent me some easy patients, then more and more challenging ones,” Ackerman says. “Now it’s really snowballing.”

Even though trainers’ fees are typically lower than those charged by other health-care professionals, cost is still often a barrier.

“It’s not easy to get people to go to a personal trainer if it involves cost,” says Howard Goldstein, an internist and cardiologist in private practice in Rockville, Md. Yet Goldstein frequently gives patients phone numbers of trainers he trusts, especially, he says, “if they’re in their 40s and up and headed for cardiovascular problems or diabetes if they don’t start exercising.”

A runner who started working out with a personal trainer to prepare for his first marathon in 1988, Goldstein says, “I’ve preached the benefits of exercise for years. But to tell someone to exercise without being specific is not helpful. Even if they only see a trainer for a few months to get into the groove of knowing how to exercise properly, it can serve them well for the rest of their lives. Those who do take my advice and see a trainer always come back and thank me.”

As a physician who prescribes exercise, Goldstein is in the minority.

“Only an estimated 30% of doctors effectively counsel patients about physical activity,” says Michael Pratt, a medical epidemiologist at the U.S. Centers for Disease Control and Prevention. “Most physicians recognize that exercise is important, but the predominant force in health care now is cost-cutting, and practices that have long-term benefit, like exercise, are getting short shrift.” Doctors also lack the time and frequently the knowledge, he says, to instruct patients about exercise.

Consumer demand for trainers who could help manage medical conditions is partly responsible for the creation of new exercise practitioner certifications, says Susan Johnson, director of continuing education and certification programs at the Cooper Institute for Aerobics Research in Dallas. “Real people, with real health conditions, started showing up in health clubs,” she says. “Many trainers wanted extra education to work with these special populations.”

Even the best personal-trainer certifications generally qualify someone to work only with “apparently healthy adults,” says Maya Rhinewine, who trains clients at the Bethesda-Chevy Chase (Md.) YMCA. “That’s kind of a joke because almost everyone has some sort of health condition, whether it’s a bad back or a bad knee. When I heard that ACE was offering a clinical exercise specialist program, I went to the first seating, in March of 1999.”

Although they’re still in the minority, some physicians insist that exercise be an essential component of medical treatment.

“Every patient in this practice gets an exercise program,” says Michael April, a specialist in pain management and sports injuries at the Center for Physical Medicine and Rehabilitation in Rockville, Md.

“People who are in pain develop weakness and lose flexibility, which becomes a vicious cycle causing more pain and weakness,” says April, who often recommends specific personal trainers to older patients, to competitive athletes and to those recovering from an injury.

Frequently, he says, trainers help patients identify unrecognized sources of pain. “Someone who has tennis elbow may discover they have a weak shoulder,” April notes. “When they strengthen their shoulder and entire upper extremity, their elbow pain goes away.”

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Resources

Credentials from these organizations, which offer specialized training in working with clients with medical conditions, generally signify a well-qualified exercise professional:

* American College of Sports Medicine, 401 W. Michigan St., Indianapolis, IN 46202; or https://www.acsm.org.

* American Council on Exercise, 5820 Oberlin Drive, San Diego, CA 92121; referrals are available through the organization’s Web site and consumer hot line, (800) 825-3636 or https://www.acefitness.org.

* Cooper Institute for Aerobics Research, 12200 Preston Road, Dallas, TX 75230; or https://www.cooperinst.org.

* National Strength and Conditioning Assn., P.O. Box 8140, Lincoln, NE 68501; consumer referrals are available on the organization’s Web site (https://www.nsca-lift.org) and by calling (800) 815-6826.

* National Strength Professionals Assn., 700 Russell Ave., Gaithersburg, MD 20877; or https://www.nspainc.com. For referrals, call (800) 494-6772.

* Aerobics and Fitness Assn. of America, 15250 Ventura Blvd., Suite 200, Sherman Oaks, CA 91403; or https://www.afaa.com. Referrals are available by calling (800) 446-2322, Ext. 259.