Received date: August 13, 2013; Accepted date: November 13, 2013; Published date: November 15, 2013
Citation: Weissman J, Magnus M, Niyonsenga T, Sattlethight AR (2013) Sports Nutrition Knowledge and Practices of Personal Trainers. J Community Med Health Educ 3:254. doi: 10.4172/2161-0711.1000254
Copyright: © 2013 Weissman J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Florida and 45 other states prohibit the practice of dietetics and nutrition by individuals who fail to satisfy certain minimum standards of education and training. Nonetheless, personal trainers (PTrs) in national chain gyms regularly engage in the unlicensed practice of nutrition counseling. The purpose of this study was to assess the sports nutrition knowledge and practices of personal trainers. Sixty PTrs at 14 fitness centers in South Florida, and 69 PTrs at the annual National Strength and Conditioning Association (NSCA) conference completed the study. The questionnaire was developed by two professionals, reviewed by a panel of eight experts, and then pilot tested with 10 PTrs. Analyses were performed using Statistical Packages for Social Sciences version 18. Test-retest reliability was estimated using the C Coefficient. Descriptive statistics as well as Spearman rank correlations, logistic regression models, and multiple regression models were also performed. Test-retest reliability estimates demonstrated that the questionnaire was in fair to almost perfect agreement. Approximately 91.5% of PTrs spend time on nutrition counseling with clients, and 42.6% include nutrition counseling services as part of their fees for services. The average nutrition knowledge score was 59.7% ± 21.2%. This convenience sample of South Florida PTrs and those attending the NSCA conference not only practice nutrition counseling services, but they also charge for these services. Violations of the state laws are likely to continue unless gyms are legally sanctioned.
Sports nutrition; Exercise; Dietetics; Regression models
By 1988, the Florida Legislature and 45 other states had enacted legislation prohibiting the practice of dietetics by individuals who fail to satisfy certain minimum standards of education [1,2]. Although personal trainers (PTrs) who work in national chain gyms regularly engage in nutrition counseling , there are no questionnaires or published quantitative reliability studies on nutrition knowledge or practices of PTrs. Therefore, creation of a new questionnaire was necessary. According to the American College of Sports Medicine (ACSM), certified personal trainers develop and supervise safe individualized exercise programs for persons based on exercise science principles. Nowhere in the scope of practice for personal training is nutritional counseling mentioned . Regardless, large chain gyms (Bally Total Fitness, 24-Hour Fitness, Club Fit, and Gold’s) advertise Gym that they offer nutrition counseling [5-9], claiming “Our personal trainers are experts at blend exercise, nutrition, and education to help you reach your total fitness goals and maintain results ,” and “You’re will train advise you on your diet [8-11]”.
The purpose of this study was: 1) to test the reliability of a new questionnaire on sports nutrition knowledge and practices of PTrs, and 2) to assess the sports nutrition practices and knowledge of personal trainers. The study sought to test two hypotheses:
1. The test-retest reliability of the questionnaire is in fair to almost perfect agreement.
2. Most PTrs (>50%) offer the inclusion of nutrition counseling as part of their fees for service.
A convenience sample of South Florida fitness centers was derived from an Internet search. Approximately 27 sites were approached, and 16 (59.3%) gym managers agreed to participate. The refusal rate for PTrs was 6.1%. Exclusion criteria were: unwillingness to participate, and PTrs who were under age 18 years. Permission to conduct the study was obtained from the Florida International University Institutional Review Board and the Sports Cardiovascular and Wellness Nutrition (SCAN) practice group of the Academy of Nutrition and Dietetics.
A 24-item questionnaire on sports nutrition knowledge and practices of PTrs was derived by two nutrition professionals (nutrition professor and nutrition master’s student) from the American Dietetic Association and the American College of Sports Medicine’s 2009 Joint Position Paper Nutrition and Athletic Performance . Face and content validity were determined by a panel of eight nutrition and exercise physiology experts. The questionnaire was pilot-tested with 10 personal trainers and subsequently revised.
A seven-minute interview was conducted with 62 PTrs at 14 fitness centers in South Florida and re-administered within three to five weeks. Two of the 62 PTrs could not be located for the retest. At the SCAN exhibitor booth at the NSCA conference, 69 PTrs successfully completed the questionnaire. The refusal rate was 4.2%. After completing the questionnaire, each PTr was given a sports nutrition brochure.
Data were analyzed using the Statistical Package for Social Sciences (SPSS) Version 18 . Cohen’s Kappa Coefficient was used to determine the test-retest reliability for each item. Agreement ranged from <0 to 0.81-1.0, where <0 indicates less than chance agreement, 0-0.20 indicates slight agreement, 0.21-0.4 fair agreement, 0.41-0.60 moderate agreement, 0.61-0.80 substantial agreement, and 0.81-1.0 indicates almost perfect agreement [14,15]. Frequencies, percentages, Spearman rank correlations, logistic regression models, and multiple regression models were also used to analyze the data. Significance of tests was ascertained using p-value ≤ 0.05 (5% being the usual alpha-level of significance). Respondents scored one point for correct responses and zero points for incorrect or “don’t know” responses.
Approximately 23 of 24 (95.8%) testable items in the questionnaire were in “fair”to “almost perfect” agreement (Tables 1 and 2) (14,15). The following results constitute data from 60 PTrs from the South Florida sample and 69 PTrs who attended the NSCA conference (n=129). The majority of the trainers were male (n=85, 64.9%). They practiced in 21 different states, and those in the southeast region of the United States (n=97, 75.2%) made up the majority of the sample, mostly working in Florida (65.1%, n=84). Length of time practicing as a PTr ranged from 0-5 years (n=74, 57.4%) to more than 10 years (n=36, 27.9%). Within the national conference sample, the type of gym environment in which PTrs worked varied from 1.4% in hospital gyms to 30.4% in college and university gyms.
|Where do you typically most often counsel your clients on nutrition?||0.790*|
|If you’d prefer more to times peonndutrition counseling with clients, what is the main issue preventing you from doing so?||0.688*|
|How would you describe your level of preparation in nutrition now?||0.662*|
|Compared to what you charge for personal training, how much do you usually charge for nutrition counseling?||0.628*|
|On average, what percentage of time do you usually spend on nutrition with clients?||0.553*|
|On average, how would you describe your client nutrition recommendations? On average, most of my clients follow:||0.519*|
|Would you prefer to spend more or less time on nutrition counseling?||0.488*|
|Some gyms have a consulting dietitian who offers guidance to trainers and clients. Have you ever collaborated with the consulting dietitian at your current workplace?||0.227**|
|Would you be willing to attend free nutrition workshops as part of your own personal continuing education?||0.223***|
Table 1: Test-Retest Reliability Coefficients for Personal Trainer Questionnaire (Nutrition Counseling Practice Questions).
|Which exercise and/or nutrition certification(s)/license(s) do you have?||0.923*|
|What is the highest level of education you have completed? What was your major for each degree||0.915*|
|For how many years have you been working as a personal trainer?||0.817*|
|During your certification training program to become a personal trainer, what percent of your total training program was devoted to teaching you about nutrition? For example, The Food Guide Pyramid, the Dietary Guidelines, Nutrition and Weight Loss, Sports Nutrition.||0.612*|
|During your training to become a personal trainer, what percent of your total training program was devoted to teaching you, specifically, how to counsel clients on nutrition? For example, how to recommend and negotiate dietary recommendations.||0.513*|
Table 2: Test-Retest Reliability Coefficients for Personal Trainer Questionnaire (Nutrition Preparation Items).
Although most of the trainers held a college degree (n=110, 85.2%), only one (0.8%) had a nutrition degree. Approximately 44.2% of trainers had a college degree in exercise science, exercise physiology, or another fitness-related field, with 32.6% holding a college degree in an unrelated field, and 7.8% with an unspecified major.
Actual and perceived dietetics preparation varied among trainers. Most trainers (n=79, 61.2%) reported they felt “somewhat prepared” to counsel on nutrition, and 20.9% indicated they “definitely ver prepared f.” Only 17.8% felt “unprepared” educate clients to about nutrition.
Among 129 PTrs, there were 27 PTr certifications, and 24.8% had received certifications from at least one National Committee for Certifying Agencies (NCCA) accredited organization  excluding ACSM, NSCA, American Council on Exercise (ACE), and National Academy of Sports Medicine (NASM). Approximately 57.4% trainers held certifications by at least one of the following organizations, either with or without additional certifications: ACE, NSCA, NASM, and ACSM. Approximately 14.0% trainers were certified by at least one organization but not certified by any NCCA accredited organization. The others (3.9%) were not certified. Additionally, 4.7% trainers held certifications in nutrition, and none were licensed nutritionist/dietitian or registered with the Academy of Nutrition and Dietetics. The majority of PTrs reported that during their personal training certification programs, 1-25% of the time was spent learning about nutrition (69.8%) and nutrition counseling (66.7%).
Most (n=101, 78.3%) trainers indicated they had never collaborated with a consulting dietitian at their current workplace. As many as 93% (n=120) of PTrs indicated they were willing to attend a free nutrition workshop.
Approximately 91.5% of PTrs reported they spend time on nutrition counseling with clients. About 61.2% of PTrs spend up to 25% of their time on nutrition counseling, 25.6% between 25-50%, 3.9% about 51- 75%, and 0.8% spend more than 75% of their time on nutrition. One (0.8%) response was missing. Trainers who spend time with clients on nutrition do so usually while training clients on the gym floor (61.2%), in an office (27.1%), at the client’s home (6.2%), or outside the gym via phone call (0.8%) or text messages (0.8%). One response (0.8%) was missing, and four (3.1%) PTrs reported they do not engage in nutrition counseling.
Most PTrs indicated a desire to spend additional time (n=66, 51.2%) on nutrition counseling with clients, but their barriers included: time constraints (23.2%); lack of nutrition knowledge (14%); their clients do not want to talk about nutrition (10.1%); and their boss will not allow them to spend more time on nutrition counseling (3.1%). Only 4 of 129 PTrs indicated they were not willing to spend more time on nutrition counseling because they were “notin certified nutrition.” Approximately 42.6% of PTrs acknowledged that their fees included charges for nutrition counseling. Nine (7.0%) PTrs were unsure of how nutrition fees are charged by their employer.
The majority of trainers (n=90, 69.8%) reported that their clients, on average, are compliant with at least 25% of their nutrition recommendations, and 8.5% of PTrs reported clients are usually compliant with more than 75% of their nutrition recommendations. Only 7.8% indicated they do not offer nutrition recommendations to clients.
The mean knowledge score for eight true/false statements was 59.7% ± 21.8 (Table 3). The highest mean knowledge scores were found among PTrs who: 1) were certified by one of four certification agencies: ACSM, NSCA, ACE, or NASM (mean score: 69.0% ±17.7) compared to all others (mean score: 46.9% ± 20.7) (p<001); and 2) among those PTrs who attended the NSCA conference (mean score: 70.04% ± 20.3) compared to those who did not attend (mean score: 40.8% ± 20.2%) (p<0.001). No relationships were found between nutrition knowledge and: gender, length of time working as a PT, amount of time reported as having spent learning about nutrition during their PTr certification programs, willingness to attend a free nutrition workshop, type of gym setting where they practiced, or having a college degree in any field including exercise science or related field. PTrs who attended the NSCA Conference were more likely (29.0% versus 10%) to have collaborated with an RD (p<0.008) compared to those who did not attend the conference.
The interplay of minimal nutrition preparation, less than adequate nutrition knowledge levels, inflated perceptions of nutrition preparation, and widespread desire to spend more time on nutrition among PTrs represents a curious phenomenon with unknown risks to personal training clients. Although the average sports nutrition knowledge score was less than adequate (59.6545% ± 21.87503), and only one PTr (of 129) had a nutrition-related college degree, 82.1% of PTrs described themselves as “somewhat” (61.2%) definitely or “very prepared” 20 (.9%) to educate their clients about nutrition. As many as 51.2% indicated a desire to spend even more time nutrition counseling their clients, with only 14.0% reporting that inadequate knowledge was their main barrier. Although 93.0% of PTrs indicated willingness to attend a free sports nutrition workshop, this should not necessarily be encouraged because PTrs who attend continuing education may be more likely to conduct nutrition counseling with suboptimal preparation and without a license/Academy Registration. Approximately 4.7% trainers held certifications in nutrition. Nonetheless, a person must have a minimum of a Bachelors degree along with registration with the ADA and/or a state license to legally practice nutrition counseling (in 46 states).
The most common topics of nutrition misinformation were related to protein requirements and dehydration. Approximately 59.7% of PTrs incorrectly indicated that the protein recommendation for an active American adult is a minimum of one gram/pound of body weight of protein/day, thereby promoting excessive intake of protein calories which: 1) sabotages weight loss attempts, 2) increases the risk of impaired renal function and dehydration and, at the very least, 3) wastes money. As many as 48.1% of PTrs incorrectly stated that dehydration begins to occur when an athlete experiences a total water deficit of more than 10% of body mass, when the goal is to prevent water loss exceeding 2% of body mass [12,17]. This is particularly troublesome since dehydration may: 1) increase the risk of potentially life-threatening heat injury and electrolyte disturbances, 2) result in skeletal muscle cramps and muscle fatigue, 3) cause altered cognitive function, and 4) increase glycogen utilization [12,17]. These knowledge deficits constitute a health risk of potentially major dimensions to personal training clients.
Future research may wish to examine the relationship between PTrs’ sales of performance-enhancing sports nutrition supplements (ie. Amino Acids, Creatine) and their knowledge of these supplements including the associated benefits and potential risks. The extent to which PTrs follow-up on their nutrition recommendations with clients, the quality of the PTrs’ nutrition recommendations, and the extent to which PTrs collaborate with registered dietitians have yet to be determined. Regarding clients, future research may also seek to examine clients’ perceptions of the usefulness of nutrition counseling from Ptrs and clients’ self-reported adherence to PTrs nutrition recommendations. Further research may need to identify and assess informal and formal sources of post-personal training certification education. Finally, it may be valuable to document the extent to which unlicensed chiropractors, nurses, sports coaches, massage therapists, wellness coaches, and health food store personnel offer nutrition counseling and the quality of their nutrition recommendations.
|Item, Accurate Response, Kappa Value||TRUE||FALSE||Don’t Know|
|The protein recommendation for an active American adult is a||N=65||N=52||N=11|
|Minimum of 1.0 gram/pound of body weight of protein per day. (False) 0.489*||50.40%||40.30%||8.50%|
|The fat recommendation for an active individual is no more than||N=42||N=74||N=12|
|10% of total energy consumption. (False) 0.366*||32.60%||57.40%||9.30%|
|Carbohydrate recommendations range from 2.7-4.5 grams/pound||N=78||N=24||N=26|
|(6-10grams/kilogram body weight) for active adults. (True) 0.386*||60.50%||18.60%||20.20%|
|Dehydration begins to occur when an athlete sweats so much||N=54||N=62||N=12|
|that he/she experiences a total water deficit of more than 10% of||41.90%||48.10%||9.30%|
|body mass. (False) 0.520*|
|1 gram of protein provides 4 kilocalories. (True) 0.403*||N=98||N=14||N=15|
|Peas and Beans are good sources of omega-3 Fatty acids.||N=30||N=79||N=19|
|The most effective way to lose weight is twofold: decrease total||N=47||N=76||N=6|
|calorie intake and decrease carbohydrate intake. (False) 0.749*||36.40%||58.90%||4.70%|
|As long as a person expends more calories than he/she||N=93||N=33||N=3|
|Consumes, he/she will lose weight. (True) 0.836*||72.10%||25.60%||2.30%|
Table 3: Sports Nutrition Knowledge Items and Kappa Values (N=129).
This study had several limitations: This is the first study to document the validity and reliability of a questionnaire on sports nutrition knowledge and practices among PTrs in urban metropolitan areas. Hence, there was no other relevant questionnaire on which the researchers could build upon or compare with the results of this study. Second, 75.1% of PTrs practiced in the Southeast region of the US, so results may not be representative of PTrs nationwide. Third, for the South Florida sample, typical distractions were friends, clients, and music; however, for the NSCA conference sample, distractions were general noise and other conference participants. Last, PTrs who attended the national conference may be more educated than those who were located in their employed gyms.
As many as 118 (91.5%) of 129 PTrs, all of whom are lacking basic sports nutrition knowledge and are unlicensed and unregistered to practice dietetics, reported that they offer nutrition counseling to clients. Approximately 61.2% of PTrs indicated they spend up to 25% of their time with clients on nutrition counseling. Furthermore, 42.6% of PTrs reported that their fees include charges for nutrition counselingthe services for which they are both untrained and unlicensed. Among 129 PTrs, 51.2% indicated they would like to spend more time on nutrition counseling despite the fact that during their PTr certification training program, they spent 1-25% of the time on nutrition (69.8%) and nutrition counseling (66.7%).
Fitness centers and personal trainers are advertising, hiring, and charging for unlicensed/untrained persons to conduct nutrition counseling. Violations are likely to continue unless gyms are legally sanctioned. However, it may be strategic to not only set a legal precedent but to also ensure maximum media coverage of litigation so that the fitness center industry is motivated to adopt voluntary compliance with state laws.
We would like to thank the Panel of Experts: Douglas Kalman, PhD; Sue Graves, PhD; Robert Zoeller, PhD; Pablo Costa, PhD; Patrick Jacobs, PhD; Michael Whitehurst, PhD; Edwin Ryan, PhD; Gale Welter, MS. We would also like to thank Gale Welter, MS, RD for allowing this study to be conducted at the SCAN exhibitor booth during the 2010 NSCA National Conference.
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