HIGH-INTENSITY

EXERCISE AND THE

LEGAL LIABILITY RISKS
by JoAnn M. Eickhoff-Shemek, Ph.D., FACSM, FAWHP and Margaret C. Keiper, Ph.D.

LEARNING OBJECTIVES
Through a description and analysis of two negligence lawsuits
involving high-intensity exercise programs, readers of this article
will obtain an understanding and appreciation of (a) legal and risk
management concepts related to negligence, (b) legal liability risks that
exist in high-intensity exercise programs, and (c) risk management
strategies that can be developed and implemented to minimize legal
liability risks associated with high-intensity exercise programs.

Key words:
Negligence, Legal Duties, Injury Risks, Professional Standard of
Care, Risk Management

INTRODUCTION

he interest in high-intensity exercise

programs such as high-intensity interval training (HIIT), P90X, and Insanity
has increased tremendously in recent years. The
topic of high-intensity exercise has been covered extensively at professional conferences
such as ACSMs Annual Meeting, ACSMs
Health & Fitness Summit & Exposition, and in
the media (e.g., conducting a Google search on
the topic of high-intensity exercise will bring
up numerous articles published in a wide
variety of media outlets). Studies that have
investigated these types of high-intensity exercise programs V those that are performed in
short periods V also referred to as extreme
conditioning programs (ECPs) V have found
that many health and fitness benefits can be
achieved with this type of training (21).
However, the lingering question is: do the
benefits of ECPs outweigh any increased risks

30

of injury as well as the litigation that may

follow?
According to Bergeron et al. (5), empirical
research is needed to determine if there is an
increased risk of injury with these ECPs when
compared with traditional exercise programs
of low, moderate, or vigorous intensity. See
Table 1 for levels of exercise intensity. Although
not specific to ECPs, there is evidence that
vigorous exercise can increase the risk of a
cardiac event (acute myocardial infarction or
sudden death) particularly among habitually
sedentary persons and also in exerciseconditioned individuals (17). Therefore, it can be
speculated that high-intensity exercise may
increase these risks even more. Kohl and Murray
(11) also discuss the causes of musculoskeletal
injuries associated with physical activity and state
that it is well demonstrated in the literature that,
the more physical activity an individual performs,
the higher the risks of musculoskeletal injuries.
Anecdotal evidence of increased injury risks
associated with ECPs does exist. In military
settings, clinical observations of injuries such as
torn ligaments, stress fractures, and exertional
rhabdomyolysis (rhabdo), particularly among
novice participants, have been reported at increasing rates as ECPs grow in their popularity (5). The
number of cases of rhabdo among collegiate
athletes also seems to be increasing according to
an article published in the Journal of Athletic
Training (7). In this consensus statement (7) that
provided 10 recommendations to help end conditioning morbidity and mortality of athletes, the
authors stated that Excesses in strength training
and conditioning V workouts that are too novel,
too much, too soon, or too intense (or a
combination of these) V have a strong connection to exertional rhabdomyolysis (p. 477).
Injuries that have resulted from high-intensity

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VOL. 18/ NO. 5

TABLE 1: Exercise Intensity Levels*

Intensity
Low (very light to light)

%HRmax

%VO2max

G57 to G64

G37 to G45

Moderate

64 to G76

45 to G64

Vigorous

76 to G96

64 to G91

Q96

Q91

High (near maximal to maximal)

*Adapted from ACSMs Guidelines for Exercise Testing and Prescription

(12, p. 165).

exercise programs also have led to negligence lawsuits as

demonstrated in two cases discussed in this article: Rostai (14)
and Proffitt (13). See Table 2 for a brief description of what

occurred in each of these cases. The purpose of this article is to

explain how the high-intensity exercise programs in these cases
led to the injuries and subsequent litigations. Read the Facts V
What Happened in Table 2 that describe the design of the highintensity exercise programs that the fitness trainers had their clients
perform in each of the two cases. These designs may be similar
to the types of fast-growing high-intensity programs being offered
in fitness facilities across the United States and throughout the
world. Furthermore, this article aims to describe risk management
strategies that the fitness trainers and facilities involved in these
cases could have developed and implemented to prevent the
injuries from occurring in the first place. But first, a brief
explanation is needed on: (a) negligence and legal duties, (b)
causes of injuries from a legal perspective, (c) the professional

TABLE 2: Negligence Lawsuits: Rostai and Proffitt

Facts V What
Happened

Harm/Injury
to Plaintiff

Negligence Claims Against the

Defendants

Courts Ruling V For or Against

Plaintiff and Courts Reasoning

Rostai v.
Neste
Enterprises
(14)

During his first personal training

session, the plaintiff (Rostai, who
was 46 years old, overweight,
and inactive) suffered a heart
attack toward the end of his
60-minute session. Continually
throughout the workout, the trainer
kept pushing Rostai to perform
strenuous exercises (repeated sets
and fast reps of bench presses and
calisthenics with no rest periods)
despite signs and symptoms of
overexertion and several requests
by Rostai for a break. By the end
of the session, Rostai was in
extreme pain and told his trainer
to call 911 because he thought he
was having a heart attack.

Heart attack

Rostai claimed that the

defendants (the trainer and
facility) were negligent because the
trainer (a) failed to assess his health
and physical condition, in particular,
his cardiac risk factors before
exercise; (b) aggressively
challenged him to perform
beyond his level of physical
ability and fitness even after
observing him exhibiting certain signs/
symptoms; and (c) denied
his several requests for a break
throughout the session.

AGAINST V The court ruled that

Rostai assumed the risks even
though the court acknowledged that
the trainer was negligent, that is, did
not assess plaintiffs level of fitness
and may have interpreted plaintiffs
complaints (tiredness, shortness of
breath, profuse sweating) as usual
signs of physical exertion versus
signs/symptoms of a heart attack. The
court explained their ruling by stating
that there was no evidence of
intentional or reckless conduct on the
part of the trainer and, therefore, the
plaintiff assumed the risks.
Note: The primary assumption of
risk defense is usually effective in
protecting defendants for injuries
caused by inherent risks but not for
negligent conduct. Legal scholars
have disagreed with this courts ruling
and reasoning.

Proffitt v.
Global
Fitness
Holdings,
LLC,
et al. (13)

The personal fitness trainer, in

the first session with the plaintiff
(Proffitt, who had not worked out
in 20 years and was overweight),
had him perform numerous bouts
of strenuous squatting exercises
and directed him to continue the
exercises even after signs and
symptoms of overexertion and
requests by Proffitt to stop. For
many hours after the session,
Proffitt
experienced extreme pain and
fatigue and, after 38 hours,
he noticed his urine was dark
brown. He went to the emergency
room where he was diagnosed
as having rhabdo and was
hospitalized for 8 days.

Rhabdo
resulting in
permanent
injuries,
including 30%
loss of
muscle tissue
in both
quadriceps
muscles

The plaintiff filed a negligence

lawsuit against the trainer and the
facility listing numerous negligence
claims. Some of these included that
the personal trainer failed to (a)
assess the health/fitness status of the
client, (b) provide an exercise
program within clients safe fitness
capacity, and (c) respond to the clients complaints of fatigue during the
training session. The lawsuit also
claimed that the facility failed to
ensure that the fitness trainer was
properly trained to assess the
plaintiffs health history, assess his
fitness abilities, and design an
appropriate training program. The
claims also were filed as gross and
willful/wanton negligence.

SETTLED V for $75,000 that

included medical expenses of
$20,000 and lost wages of $6,000.
Note: Other similar lawsuits
involving rhabdo against fitness
trainers and facilities also have
occurred. In addition, several
athletes in collegiate and high school
athletic programs have been
hospitalized with rhabdo after
completing intense workouts. One of
these programs involved 13 football
players at the University of Iowa in
2011. The University of Iowas Board
of Regents report indicated that the
strength and conditioning coaches
had no knowledge of rhabdo (16).

Case

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31

High-Intensity Exercise
standard of care, and (d) defenses to negligence actions. Each of
these topics is discussed with application to the high-intensity
exercise programs in Rostai and Proffitt.

NEGLIGENCE AND LEGAL DUTIES

In a negligence lawsuit, the plaintiff (injured party) has to prove
that the defendant (fitness trainer and/or facility) had a duty,
breached that duty, and that the breach of duty proximately caused
the injury (9). Whether or not there is empirical evidence to show
a link between high-intensity exercise and an increased risk of
injury will not be a major factor that courts will consider when
determining duty. The major factor will be the conduct (the
behavior V inaction or improper action) of the fitness trainer, that
is, whether the trainers conduct was consistent with the standard
of care or the duty owed to the plaintiff. In negligence lawsuits,
courts often rely on expert testimony when determining legal
duties. Expert witnesses, who are most often experienced professionals with medical or doctoral degrees, educate the court as to
what the duty was given the situation and whether or not, in their
opinion, the defendant breached that duty. To support their expert
opinion, they often introduce standards and guidelines published
by highly regarded professional organizations within that field to
help provide evidence of the duty owed to the plaintiff. If the court
finds the defendant liable for negligence, the defendant likely will
have to pay the plaintiff compensatory damages (e.g., costs
associated with medical expenses, lost wages, pain, and suffering)
and sometimes additional damages called punitive damages if
found liable for gross negligence. The distinction between
negligence (ordinary negligence) and gross negligence is
explained next. Courts award punitive damages to punish the
wrongdoer (defendant) for malicious or reckless conduct.

CAUSES OF INJURIES FROM A LEGAL PERSPECTIVE

Relevant to negligence, there are three major causes of injury
that are listed below (9). An injury that results in a negligence
lawsuit usually involves one of these three causes or a
combination of them. For example, the plaintiff in Proffitt
(13) claimed that his injuries were caused by both ordinary and
gross negligence of the defendants.
There are three causes of injury in this context:

1) Inherent Risks: No ones fault; the injuries just happen

(inseparable from the activity); inherent risks (minor, major,
life threatening, and death) exist in all fitness activities,
and participants need to be informed of these risks before
beginning an exercise program.

2) Negligence (or Ordinary Negligence): The fault of the

fitness trainer and/or facility (e.g., failure to meet the
standard of care because of careless conduct V inaction
or improper action) and/or the fault of the participant
(e.g., misuse of exercise equipment).

3) Gross Negligence: A type of fault that is more serious than

ordinary negligence; also referred to as willful/wanton or

32

reckless conduct (e.g., the defendant has prior knowledge

of a risk/danger that has caused injuries and chooses to not
take any steps to minimize that risk/danger); the risk of
injury is clearly foreseeable.
It is important to note that sometimes a plaintiff may file a
negligence lawsuit against a fitness trainer and the facility even
when his or her injury was caused by inherent risks. If the evidence
shows that the injury was indeed caused by inherent risks, it is
unlikely that the plaintiff will be able to prove negligence and
recover any damages. Generally, the law does not allow plaintiffs to
recover damages for injuries caused by inherent risks because they
assume these risks. However, if risks are increased over and
above those inherent in the activity because of the conduct of the
fitness trainer, plaintiffs may be able to prove that the fitness trainer
and the facility were negligent, as demonstrated in cases even
involving more traditional exercise programs (9). These increased
risks are more obvious in ECPs, which can lead to a higher
likelihood of negligence being proven because of the highintensity design of the program alone. In addition, it is possible V
as established in Profffit (13) V that injuries occurring in highintensity programs can result in gross negligence claims. For
example, plaintiffs may claim that the defendants had prior
knowledge that participants had been injured in their programs
and the defendants took no precautions to help prevent the injuries
from reoccurring in the future.

THE PROFESSIONAL STANDARD OF CARE

According to van der Smissen (22), if one accepts responsibility
for giving leadership to an activity or providing a service, ones
performance is measured against the standard of care of a qualified
professional for that situation (p. 40). For that situation is
determined by reference to the following three factors:

1) Nature of the activity: The professional must be aware of

the skills and abilities the participant needs to participate
safely in the activity, for example, if these are complex or
advanced, the professional must have the knowledge to apply
these skills and abilities.
ECPs would be considered complex and advanced
exercise programs compared with most traditional exercise
programs and therefore to meet this factor, they should only be
taught by fitness trainers who are fully aware of the skills and
abilities a participant needs to perform these type of exercise
programs safely. Given the fact that the fitness trainers in Rostai
and Proffitt, failed to assess the fitness skills/abilities of their
clients, it appears that they did not possess enough knowledge
to design a simple beginner-level exercise program safely, let
alone an advanced program.

2) Type of participants: The professional must be aware of

individual factors of the participant, for example, health
conditions that impose increased risks and know how to
minimize those risks.

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VOL. 18/ NO. 5

To meet this factor, fitness professionals that train individuals

with medical conditions need to possess advanced certification and
education in the exercise sciences such as a certification and
academic course work in clinical exercise (23). Fitness trainers,
like the one in Rostai, who do not have these advanced
qualifications (and competencies) but train individuals with
medical conditions anyway will likely not be able to meet the
professional standard of care.

3) Environmental conditions: The professional must be

aware of any conditions that may increase risks, for
example, heat, humidity, slippery floor surfaces, and know
how to minimize those risks.
To meet this factor, the professional needs to be aware of,
understand, and be able to apply the latest scientific information. For
example, the professional should be current on ways to prevent heat
injuries. This would include being familiar with position papers
published by professional organizations that describe specific
precautions that need to be adhered to to minimize the risk of
heat injuries. The environment also deals with properly maintaining
exercise equipment and floor surfaces (there are many injuries in
fitness facilities because of poor maintenance of equipment and
floor surfaces) as well as enforcing policies that require participants
to return equipment such as dumbbells and exercise balls to their
storage racks to help prevent tripping accidents. Also, some ECPs
use equipment that pose unusually high risks compared with more
common types of equipment if the trainer and/or client is not
familiar with the way to use them properly. Examples of such
equipment are gymnastics rings and hanging ropes.
It is important to realize that expert witnesses often refer to these
three factors in their testimony. Unfortunately, fitness trainers, like
those in Rostai and Proffitt, probably do not realize that they will
likely be held to the professional standard of care and what this all
entails. Therefore, they unknowingly expose themselves to
breaching their duties and professional standards of care.

DEFENSES TO NEGLIGENCE ACTIONS

Several legal defenses are available to defendants to refute or defend
negligence claims/lawsuits. Two common defenses are (a) primary
assumption of risk defense and (b) waiver defense. The primary
assumption of risk is a legal doctrine that basically provides that
individuals cannot recover for an injury they received when
voluntarily exposing themselves to a known and appreciated danger
(6). This defense applies to injuries caused by inherent risks not
negligence. However, for it to be effective, the plaintiff must know,
understand, and appreciate the inherent risks and voluntarily assume
them. Courts will investigate several factors when determining
whether or not this defense will protect the defendants. For
example, one factor is the experience level of the plaintiff, for
example, a novice will not be able to fully understand and
appreciate all of the inherent risks until he or she has obtained
enough experience. If a novice begins with a high-intensity
VOL. 18/ NO. 5

program (an advanced program), this defense will likely not apply
because the novice does not understand and appreciate the inherent
risks associated with beginning an exercise program V let alone
an advanced program. Another factor is the nature of the activity,
for example, courts have ruled that the primary assumption of risk
will likely apply to sports programs but perhaps not exercise
programs. In Santana v. Womens Workout and Weight Loss
Centers, Inc. (15), the court stated that sports by their nature
inherently create extreme risks of injuries because of elements like
physical contact between participantsIor competition aimed at
scoring points, racing against time, or accomplishing feats of speed,
strength, agility, and grace (pp. 25, 26). The court also stated that
because exercise programs are designed to enhance health and
fitness, they should not be designed to create extreme risks of
injury. For example, the primary assumption of risk might be
effective for competitions such as marathons but may not be
effective for general high-intensity exercise programs such as HIIT
and P90X. In Santana, the fitness instructors conduct increased the
risks of injury over and above those inherent in the activity and
therefore the assumption of risk defense was not effective in
protecting the defendants. Therefore, it is likely this defense will not
be effective with high-intensity exercise programs because of the
intentional design of the program as well as the conduct of the
fitness trainers who have their participants work out at levels that
can create increased risks of injury.
The second common defense against negligence is a waiver. A
waiver (prospective release) is a contract signed by an individual
before participation that absolves (protects) the defendants (e.g.,
fitness trainer and facility) from their own negligence. Waivers can
be an effective defense for ordinary negligence; however, they
are against public policy in certain states (8). For example, there is
a long-held ruling of the Virginia Supreme Court that waivers are
unenforceable for personal injury because they are against public
policy. The legality of waivers is based on individual state laws
and, therefore, fitness trainers and managers need to consult with a
competent lawyer in their jurisdiction before considering the use of
waivers in their programs. It also is important to realize that
waivers do not protect against gross negligence claims (8) like
those made by the plaintiff in Proffitt. When a plaintiff claims that
the defendants were grossly negligent, he or she will seek punitive
damages in addition to compensatory damages.
It is essential for fitness trainers and facilities to have adequate
liability insurance. If they are found liable for damages in a
negligence case, the insurance provider is obligated to pay out the
damages up to the limits of the policy (9). Fitness managers need
to be sure that their general liability insurance policies cover
high-intensity exercise programs. If not, additional coverage
should be purchased. Fitness managers also should require their
fitness trainers to purchase professional liability insurance or
provide it for them. If liability insurance to cover high-intensity
exercise programs cannot be obtained or is cost-prohibitive, the
facility should not offer these programs. It also is important to
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High-Intensity Exercise
realize that liability insurance covers compensatory damages but
does not cover punitive damages for gross negligence (9).
Purchasing liability insurance and having participants sign a
waiver are effective risk management strategies but are only
protective after an injury has occurred. They do nothing to enhance
safety or help prevent injuries. Developing and implementing
strategies that help minimize injuries should be the main risk
management focus of fitness trainers and managers. To begin this
process, it is necessary to first obtain an understanding of the many
legal liability exposures that exist in fitness programs.

LEGAL LIABILITY EXPOSURES

All fitness programs are subject to numerous legal liability
exposures across seven different areas, as shown in Figure 1.
Fitness trainers and managers have many potential legal duties
in each of these areas, and the failure to carry out these duties is
what creates legal liability exposures V situations that create a
risk of injury that can lead to negligence claims and/or
lawsuits. However, there also are many effective risk management strategies that can be developed and implemented to
minimize legal liability exposures. The many legal liability
exposures that exist in each of the seven areas and corresponding risk management strategies have been presented elsewhere
(9). Readers of this Journal also can obtain an appreciation of
how legal liability exposures can lead to injuries and litigation
by reading two recent legal columns by Anthony A. Abbott, Ed.D.,
FACSM (1,3). As a nationally known and highly respected expert
witness, Dr. Abbott describes many cases in which he served as an
expert witness as well as the facts, issues, and outcomes of
several negligence cases that are, unfortunately, all too common in

Figure 1. Seven areas of legal liability exposures*.

34

the fitness field. The following will focus on the legal liability
exposures specific to the Rostai and Proffitt cases and
risk management strategies that could have minimized these
liability exposures.

LEGAL LIABILITY EXPOSURES IN ROSTAI AND PROFFITT

Specific legal liability exposures that led to the injuries in these cases
will be discussed under two general legal liability exposures that were
evident across the two cases: (a) the program did not have
qualified and competent fitness trainers leading the exercises,
and (b) the program design did not incorporate recognized and
accepted practices for safe and effective exercise. Although not
stated in the evidence presented in these cases, it appears that the
fitness trainers were not qualified (e.g., did not possess any
credentials such as a degree or certification) in the exercise sciences.
Whether or not a fitness trainer possesses certain credentials is
a factor courts will consider in negligence cases; however, a much
more important factor will be whether or not the trainer was
competent, that is, did his or her conduct breach a duty or not.
The lack of competence of the fitness trainers was evident in both
cases. Neither of the trainers (a) conducted preactivity health
screening to determine if medical clearance was warranted;
(b) performed a fitness assessment to ascertain initial fitness
levels and abilities; (c) understood how to design and implement
a proper workout for deconditioned novice exercisers such as
knowing how to properly apply a basic safety principle of
exercise called progression; (d) realized that signs and symptoms
of overexertion can lead to serious consequences such as rhabdo
or a heart attack, especially if strenuous exercise continues; and
(e) granted the repeated requests for a break made by their clients
during the workout and instead pushed them more and more
above their limits. Any expert witness would easily be able to
demonstrate that failures like these constitute breaches of duties or
professional standards of care and caused the injuries to the
plaintiffs. It is interesting to point out, perhaps, why the clients in
these cases did not question their trainer when they were continually
pushed above their limits or why they just did not stop on their own.
A likely answer to this is that they trusted and relied on their trainer
as an expert and assumed he knew what he was doing and,
therefore, would certainly not do anything to injure them. Also,
novices will not know what to expect from an exercise program
and, as stated above, will not know, understand, and appreciate the
risks and what precautions to take to minimize the risks.
Although the lack of formal education and training in the
exercise sciences probably contributed significantly to the
incompetence of the trainers in these cases, it is important to
realize that just because someone is qualified (e.g., possesses a
degree, certification), this does not necessarily mean that he or
she is competent. In addition to increases in cases of rhabdo
occurring during strength and conditioning workouts among
collegiate athletes, the article cited above also stated that a total
of 21 National Collegiate Athletic Association (NCAA) football

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players had died since 2000 during conditioning workouts, and

75% of these deaths were Division I players (7). It is likely that
these programs have qualified strength and conditioning coaches
with degrees and professional certifications in exercise science.
Despite their qualifications, the conduct/competence of these
strength and conditioning coaches comes into question when
serious injuries and deaths occur that could have been prevented
by implementing proper training methods and precautions, even
when training elite athletes. Of the 21 reported deaths of NCAA
football players, 11 of them occurred during day 1 or day 2
workouts (7), and the injuries suffered by Rostai and Proffitt
occurred on their first day of training. Therefore, progression is a
critical principle of safe and effective exercise that should be
well understood and applied by all fitness professionals no
matter what population they are training.
The design of the high-intensity exercise programs in these cases
clearly did not meet accepted and recognized practices of safe and
effective exercise. First, all exercise programs should have new
participants complete preactivity screening procedures (12). If an
individual is classified as at risk (e.g., has risk factors, medical
conditions) V as Rostai would have been because he had several
cardiovascular risk factors V then medical clearance should be
obtained. With high-intensity exercise programs, medical providers who complete and sign the medical clearance form need
to know that they are clearing their patient for this type of
exercise. Therefore, the clearance form should contain a section
where this can be indicated (Figure 2). It is unlikely that the
participants in these two cases would have been medically
cleared for high-intensity exercise given that they were
deconditioned novice exercisers. Program design problems also
were evident from the training methods used by the fitness
trainers in these cases, for example, performing maximal or nearmaximal exercises in short periods with little or no rest intervals
is not consistent with safe training principles, at least not for the
plaintiffs in these cases. Evidence that has helped demonstrate
that a program design is inappropriate has included publications
such as the ACSM Position Stand (4): Progression Models in
Resistance Training for Healthy Adults.
Plaintiffs often claim that they were not warned of known risks
and dangers inherent in a program and, if they had been, they would
not have participated. Participants in all fitness programs need to be
informed of the inherent risks that can lead to all types of injuries V
minor (e.g., sprains and strains), major (e.g., fractures), life
threatening (e.g., heart attack, rhabdo), and even death (9). These
inherent risks should be described in a written document that
is signed by the participant before participation, for example, an
informed consent or express assumption of risk (9). It may be
wise to include in these documents, with the advice of legal
counsel, a clause that explicitly states that the probability of these
types of injuries occurring is greater in high-intensity
programs than in lower-intensity programs. Documents like
these may strengthen the primary assumption of risk
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Figure 2. Medical clearance form.

defense but, as described above, several other factors are

considered to determine whether or not this defense will be
effective in protecting the defendants from liability.

RISK MANAGEMENT
It is likely that the injuries in these two cases could have been
prevented by developing and implementing effective risk management strategies that is a major responsibility of all fitness
managers. To be successful as a risk management manager, fitness
managers first need to become aware of the many legal liability
exposures that exist in traditional fitness programs and, if offering
high-intensity exercise programs, the additional liability exposures
that can be created with these programs. They also need to be
aware of important risk management strategies to minimize these
legal liability exposures.
Risk management strategies that need to be addressed
specifically in high-intensity programs include (a) the need for
trainers to be well qualified (e.g., possess advanced knowledge,
skills, and experience in the exercise sciences) because these
types of programs would be considered advanced, not beginner
level; (b) the need to conduct preactivity screening and obtain
medical clearance specifically for high-intensity exercise for
individuals who are at risk and if they are not cleared, they
should not participate in these programs; and (c) the need for
trainers to be competent, for example, know how to apply basic
exercise principles like progression that are based on wellestablished standards and respond properly if signs and symptoms
of overexertion occur. Therefore, it is essential for managers to
obtain formal education and training in the exercise sciences and
legal/risk management areas; however, many lack knowledge and
skills in these areas (2). This lack of knowledge and skills can lead
to poor decision making when it comes to the safety of participants.

NEED FOR EDUCATION: EXERCISE SCIENCES AND

LEGAL/RISK MANAGEMENT
Because employers of fitness facilities can be held liable for the
negligent acts of their employees through a legal doctrine called
respondeat superior, they have a vested interest to hire only
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High-Intensity Exercise
qualified and competent fitness trainers. In Rostai (14) and Proffitt
(13), the facility (employer) was named as a defendant along with
the fitness trainer because of this legal doctrine. Therefore, fitness
managers need to be able to distinguish the well-recognized
certifications from the so-called fly-by-night certifications when it
comes to hiring trainers. Although many in the general public
cannot make this distinction because they believe that a certified
fitness trainer is a qualified and competent trainer, it does not
excuse managers from not being able to make this distinction.
Many certifications do not require any formal education such as
classroom instruction in the exercise sciences along with an
internship that provides meaningful real-world practical experiences before sitting for the examination. In addition, most
examinations do not require any practical component to evaluate
the competence of the candidate. Formal education is the best
approach to prepare qualified and competent fitness trainers.
Therefore, managers who are truly concerned about the safety of
their participants and want to minimize one of the most significant
legal liability exposures they face V unqualified and incompetent
fitness trainers V they would require and/or provide formal
education for their fitness trainers. It may be that fitness trainers
who have a degree in exercise science will need formal,
supervised, and evaluated practical experiences to become
competent if their academic program did not provide this
important component of formal education adequately.
In addition to formal education in the exercise sciences, all fitness
trainers and managers should be well educated in the area of legal
liability and risk management. They should be aware of the many legal
liability exposures that exist in the seven areas (Figure 1) and the risk
management strategies to minimize them. To develop knowledge
and skills in this area, formal education is again needed. Academic
programs V both undergraduate and graduate V should have a
required course devoted to these topics but, unfortunately, it often is
not addressed adequately in most programs (9). The educational
content associated with certification programs also should include
legal and risk management knowledge and skills that candidates
need to obtain before taking the certification examinations as the
ACSM certifications do, for example, specific learning domains
such as Domain IV (Legal/Professional) and Domain V (Management) that includes risk management recently were established for
the ACSM Certified Health Fitness SpecialistSM (12).

A NEED TO FOCUS ON INJURY PREVENTION

According to a U.S. Centers for Disease Control and Prevention
(CDC) report V CDCs Injury Research Agenda 2009Y2018 (19) V
about 11,000 persons per day receive treatment in U.S. emergency
departments for injuries because of sport, recreation, and exercise. It
is unknown how many of these are exercise injuries and, out of
those, how many are caused by high-intensity exercise. However,
data from the U.S. Consumer Product Safety Commissions
National Electronic Injury Surveillance System have shown that
injuries associated with exercise are increasing (18). Between

36

2010 and 2012, injuries related to exercise and exercise equipment

increased from 382,970 to 459,978 V a 20% rise (18). Perhaps
the number of injuries is increasing because more people are
exercising except this explanation is not supported from recent
reports that have shown little progress toward meeting federal
guidelines to increase physical activity (10). The CDC report (19)
states that injuries are a leading reason individuals stop participating in physical activity and that one of its major research goals is
to investigate ways to minimize injury risks among people who
are beginning or increasing physical activity.
One strategy to meet this national goal to minimize injury risks
is for fitness trainers and managers to provide safe and effective
programs for their participants. With regard to high-intensity
exercise, special attention to safety needs to be made given the
potential increased risks of injuries and the tremendous growth
and popularity of these programs. For some Americans who are
healthy, fit, and want to cut their exercise time to 20 minutes a day
versus following the U.S. Guidelines for Physical Activity (20),
which recommend lower intensity levels and longer duration,
high-intensity programs may not impose greater risks of injuries.
However, many Americans may not realize the increased
risks of injury these programs can create especially if they are not
informed of these risks by their fitness trainers and managers.
Many Americans have medical conditions and cardiovascular risk
factors, not to mention being unfit. These individuals should not
participate in high-intensity exercise programs until they have
been cleared medically and have obtained a fitness level high
enough to tolerate strenuous workouts safely. These two
recommendations alone could help decrease the injury risks
associated with these programs. Related to injuries, it is unknown
if theres an increased risk of injury in individuals who sustain
these high-intensity exercise programs during a long period.
Longitudinal studies are needed to answer this question.

References
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ACSMs HEALTH & FITNESS JOURNALA | www.acsm-healthfitness.org

Copyright 2014 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.

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JoAnn M. Eickhoff-Shemek, Ph.D., FACSM,

FAWHP, is a professor of exercise science at
the University of South Florida. Her teaching and research focus on legal liability and
risk management issues in the health/fitness
field. She is the lead author of a comprehensive textbook entitled Risk Management
for Health/Fitness Professionals: Legal Issues and Strategies.
Dr. Eickhoff-Shemek served as the Legal Columnist for
A
ACSMs Health & Fitness Journal for 10 years
(2001Y2010). She is an ACSM-certified HFD, HFS, and ETT
and a fellow of ACSM. She received her Ph.D. from the
University of Nebraska-Lincoln in 1995.
Margaret C. Keiper, Ph.D., is an assistant
professor in the physical education and sport
department at Central Michigan University
where she instructs at both the undergraduate and the graduate levels. One of
her research interests is risk management
strategies in extreme fitness activities. She is
a part of the Meijer State Games of Michigan (MSGM) oversight
committee and oversees risk management strategies for the
MSGM. She received her Ph.D. in Sports Administration from
the University of New Mexico.

BRIDGING THE GAP

All fitness trainers and managers have legal duties toward
their participants, with an overall duty to provide reasonably
safe programs V meaning, taking steps to develop and
implement risk management strategies to help prevent
injuries from occurring. To minimize injuries and the litigation
that often follows, fitness trainers and managers first need to
learn the many legal liability exposures (situations that create
a risk of injury) that exist in fitness programs and specific risk
management strategies that can minimize them. Because
high-intensity exercise programs can create an increased
risk for injuries, it is likely that participants will continue to
be injured and subsequently file negligence claims/lawsuits
against the fitness trainers and managers, unless steps are
taken to minimize the increased risks. The high costs
associated with litigation, alone, should be an incentive to
minimize legal liability exposures; however, taking steps to
help ensure the safety of participants should be the main
reason. After all, the number one responsibility of all fitness
professionals is the safety of their participants.

Disclosure: The authors declare no conflicts of interest and do

not have any financial disclosures.

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ACSMs HEALTH & FITNESS JOURNALA

Copyright 2014 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.

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