Fitness Research Update: How much nutrition advice can a PT give their clients?
With an increasing demand from clients for their trainers to provide them with nutritional guidance, the question arises of what advice can be given within the scope of practice.
Research paper: Do the nutrition qualifications and professional practices of Registered Exercise Professionals align?
Research team: Mark R McKean, Gary Slater, Florin Oprescu, Brendan J Burkett
Published: International Journal of Sport Nutrition and Exercise Metabolism
Read more: dx.doi.org/10.1123/ijsnem.2014-0051
Introduction: The fitness industry is flourishing in Australia. The number of Registered Exercise Professionals (REPs) in Australia has increased in parallel with the expansion of new fitness service delivery models. Within Australia, 17 per cent of adult females and 11 per cent of adult males participated in regular aerobics, fitness or gym activities in 2011. It is estimated that even a small (3 per cent) increase in fitness centre utilisation by the adult population has the potential to deliver important health care savings at a population level. Fitness professionals could thus play an important role in the health sector, working with government towards a healthier Australian population through a range of initiatives.
Physical activity in combination with nutrition therapy can have a greater impact on health outcomes than physical activity alone. The current health promotion model supports two methods of gaining healthy lifestyle advice: government sponsored public health campaigns that provide basic advice and guidance; and individual counselling from a university-trained, accredited practicing dietitian (APD) for nutrition advice and/or a university-trained accredited exercise physiologist (AEP) for physical activity advice.
Individuals seeking more specific fitness advice who attend a fitness facility may turn to a REP, an exercise professional with qualifications that can be acquired outside of a university at the certificate or diploma level. It is acknowledged by a number of industry associations that the professional scope of practice between those providing exercise advice and those providing nutrition advice is not clearly defined. Despite this, clients do expect health and nutrition advice from their REP. However, there is little research available on the practices and provision of nutrition advice, an important health education component in lifestyle modification, by REPs. Such information is critical to assist decision making in terms of professional scope of practice.
The current Australian national training package for the training of REPs includes only one unit of nutrition-based competency at Certificate III level. This competency is the basis for the scope of practice draft document guide for REPs including ‘Provision of general non-medical nutrition information in accordance with nationally endorsed evidence based guidelines. The advice and information provided is general and not individually tailored’ (Fitness Australia, 2013). Given the large population served by REPs, the interpretation and compliance with this statement may have significant professional and legal implications that could surface unless appropriate measures are developed to better define and enforce this scope.
Methods: A survey of REPs was conducted over a five-month period using an online survey service. The majority of questions were closed-ended to facilitate the administration of the questionnaire and subsequent data analysis. Questions were clustered by content to facilitate memory. Demographic variables sought included gender and age, plus self-reported body mass and height. Experience and education variables included years worked in the fitness industry, academic qualifications and hours of additional industry-based nutrition training completed. Feedback was sought on sources of nutrition information used by REPs, plus their confidence in these sources of information.
Results: Males attended significantly more nutrition training than females (p = 0.048). Forty per cent of all REPs completed no additional nutrition related education after graduation. Eighty-eight per cent of all respondents provided nutrition advice to their clients, with no significant difference between male and female respondents (p = 0.709). There was no significant difference between those with nutrition and dietetic qualifications in the manner in which they provided advice. The number of males who worked in group environments was significantly greater than that of females (p = 0.001).
Discussion: The primary finding of this investigation is that the majority of REPs who completed the questionnaire provide individual dietary advice to their clients, including advice relating to underlying medical conditions (i.e. medical nutrition therapy), suggesting this is common practice within the industry. This clearly breaches REPs scope of professional practice, which limits advice to the provision of general non-medical nutrition information in accordance with nationally endorsed evidence-based guidelines that is not individually tailored. This is concerning given exercise professionals training curriculum has limited nutrition education and the majority undertake no (40 per cent) or limited (25 per cent) post-fitness course nutrition-specific professional development opportunities. This reinforces a need for the industry to enforce clearly defined professional boundaries and facilitate a collaborative multi-discipline approach to client servicing in order to deliver a holistic approach to lifestyle modification and favourable fitness and health outcomes.
An understanding of the background and current practices of REPs regarding their interaction with clients is essential in order to systematically assess their relevance as health education facilitators. It is important to note that individuals who access the services of REPs may already be motivated to change their health behaviours and seek support and health-related information. Such information in many cases may be the only health education they get, due to time constraints or limited health professional availability. Indeed the literature indicates the value of REPs in supporting healthy outcomes related to diseases such as obesity, diabetes, and heart disease. With nearly three million people currently served by the fitness industry in Australia, this could provide a feasible communication and education channel for health care through direct support services. These services, however, should be within a clearly defined scope of professional practice and in collaboration with other specialised health service providers.
The data suggests exercise professionals may be motivated to further develop skills in coaching, providing advice and educating clients. More than 50 per cent of respondents had at least 5 years’ experience and a further 25 per cent had more than 10 years’ experience within the profession. A quarter (25.9 per cent) of respondents reported having both an undergraduate degree and more than 5 years’ experience. This suggests that the exercise professional occupation may have long term career pathways and may enable individuals to remain in the industry and further enhance their skills as both exercise professionals and health educators. Commitment to professional development and years of experience may result in improved communication skills, and this may further enhance the potential of exercise professionals to act as health educators – but the foundation knowledge of the exercise professional to carry this out is yet to be determined. The nutrition knowledge and skills of exercise professionals warrants investigation to better understand their potential role as educators and public health resources focused on healthy nutrition issues.
While there appears to be an increasing public demand placed on the exercise professional to offer nutrition advice, there is limited evidence on the nutrition competency skills of REPs in offering individual dietary advice. The development of additional competencies in the communication and provision of health information and problem solving of clients’ lifestyle choices, as well as educating clients regarding the misconceptions about healthy eating, could be facilitated through curriculum adjustments in REPs training programs (i.e. Certificate III and IV packages). Given this, clearly defined professional boundaries must be promoted and encouraged for REPs and other members of the health care team in lifestyle education of clients. This, in conjunction with a more collaborative approach to client servicing, will result in more favourable health and fitness outcomes.
Conclusion: While exercise professionals appear to be well placed to influence and improve health through exercise and health education, the results from this study indicate the majority of REPs respondents do not have adequate training or experience to provide the nutritional advice sought by the public. Based on these findings, it is recommended that the nutrition advice provided to REPs during training be limited to general non-medical nutrition information in accordance with nationally endorsed evidence-based guidelines, and that issues pertaining to scope of practice be addressed, and onward referral to other health professionals advocated.
Fitness Research is a partnership between Australian Fitness Network, the University of the Sunshine Coast and the Australian Institute of Fitness. Its mission is to improve the health of Australians through an improved body of fitness knowledge. Access current and back issues of the Journal of Fitness Research at fitnessresearch.com.au/journal