"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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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 http://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 http://www.acefitness.org.
* Cooper Institute for Aerobics Research, 12200 Preston Road, Dallas, TX 75230; or http://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 (http://www.nsca-lift.org) and by calling (800) 815-6826.
* National Strength Professionals Assn., 700 Russell Ave., Gaithersburg, MD 20877; or http://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 http://www.afaa.com. Referrals are available by calling (800) 446-2322, Ext. 259.