CBE: So it is better that the industry, itself, propose them to the state, instead of the reverse?
Eigenmann: The state can step in and come up with some regulations or laws, but they may not be favourable. Central regulation is always pretty difficult. Or, you come up with some self-regulation confirmed by a third party. You have an advisory council that sets the standards. If you do self-regulation, then the industry has a chance. If you wait . . . we know that the health club industry doesn't have a real strong lobby. It's just starting to build. IHRSA has started it in America. Andrea Deane has done work in the U.K. But in Europe, it's nonexistent to get your say in healthcare legislation, in the rules. There is a little in Germany, in Switzerland and in Austria.
CBE: In the health insurer's eyes, what is the weakest spot in terms of standards?
Eigenmann: Education. The people in healthcare are all highly trained. However, if you look at the average fitness trainer and the education he or she has gone through, it's very little. They have certifications, but look at who certifies. Everybody. Then you have no real standards.
CBE: Are you saying that health club staff should be highly trained as well?
Eigenmann: No. It's not desirable anyway, in my opinion, because as long as you talk about primary prevention to keep people healthy, you don't want to make it expensive. The problem is, you're not free to hire people with too much of an education because it's too costly. In Europe, salaries are up to 40 percent of your cost. Highly educated staff will make the service of a health club more expensive, which will, in turn, raise the price tag of club memberships, preventing widespread use of clubs. In public health, the effectiveness of an intervention is - arithmetically speaking - the product of the effectiveness of the intervention times the application of the intervention. We know that seatbelts are good. But if nobody buckles up, they're useless.
Working out in a health club is not rocket science. You should have procedures in place, so that if someone has a question, that person can be identified and directed to someone who has the answer. You can't assume in a health club that all of the trainers will know all of the answers. That's too expensive for most clubs. Most people just need to work out.
CBE: What about strength training?
Eigenmann: There is a lot of expert know-how in strength training machines-you can't do too many things wrong. So, you have to have procedures in place that identify people, who may, for example, have had major surgery, and therefore need to compensate for that. These members will be directed to a certain instructor who will know. You have to keep it simple. The quality of a health club is determined by the fact that its procedures allow people to work out in a safe environment individually, but not alone. In general, they don't need someone to hold their hands to do it. The goal of primary disease prevention is to have people exercise on their own.
CBE: And special populations?
Eigenmann: The medical community will tell you that someone with high blood pressure is different than someone else. But this is just partially the case. The training principles are still the same, even though there might be specific contraindications. Dealing with that person must involve high quality procedures that identify the person through risk assessment. In the case of special populations, your initial risk assessment becomes more important.
I would not advise health clubs to claim to do everything that the medical community can do. That will not raise credibility. But you can follow standardised procedures that have been developed with the medical community. If, for example, we want to set standards for a person with Multiple Sclerosis we go to the best professors in Switzerland, and ask what a Multiple Sclerosis patient can do with regard to physical activity. Then medical and health club experts transfer this to what can be done in a health club. The person goes to a doctor first, then comes to a club with a code from the doctor-generic information about what the person can do, how much, and what the contraindications are. You can standardise it. Having a set of standardised procedures incorporating expert know-how is what quality is about.
CBE: What are your thoughts on The European Register of Exercise Professionals?
Eigenmann: Basically, the registry is a big help. We are more or less running an unofficial registry for Switzerland. When it comes to the registry, however, it is also a marketing tool. You need some qualification; there is no doubt. It is good for the credibility of the industry. But if you are relying only on the qualifications of instructors who may be freelancers, that is a very dangerous path, in my opinion. You have no control over them; they can walk out the door and their expertise goes with them. You do have control over a set of standardised procedures that staff can follow.
CBE: How does The European Union fit into this?
Eigenmann: The EU has published two declarations - one on the academic side, which defines the bachelor's level and the master's level, and one where traditional vocational skills have been defined very generically at five levels. The European Health and Fitness Association has transferred this to fitness. This work was presented at Limerick. In the U.K., Skills Active, a charity that is endorsed and funded by the government, has been defining competencies on certain levels for certain fields of activity in the leisure sector. EHFA has used them as a model and refined them. The British Register is relying on those. As is the Australian, and the New Zealand, and the Irish.
ACE and ACSM certify, but no certifier in the U.S. follows the standards for those five levels. They're new - much of the work has been done in the last two years. Every education provider and certifier - even if accredited - is following its own curriculum and standards. Of course they're not completely different. But it's going to take another 10 years before all of the education providers adjust their curriculum to those vocational skills. It's important that we get some agreement, and it's a good beginning. This adds credibility. It's a strong move toward standardisation.
Patricia Amend, MA, the co-author of The 30-Minute Fitness Solution: A Four-Step Plan for Women of All Ages, is a contributing editor to CBE. She can be reached at Pamend@aol.com.
