ISSUE 1 - 2017 - EREPSISSN 2522-1310 EUROPEACTIVE The House of Sport Avenue des Arts 43 – 7ème étage 1040 Brussels, Belgium Tel.: +3226499044 ISSUE 1 - 2017

ISSN 2522-1310

EUROPEACTIVE

The House of Sport

Avenue des Arts 43 – 7ème étage

1040 Brussels, Belgium

Tel.: +3226499044 www.europeactive.eu

ISSUE 1 - 2017

Issue 1 - 2017

ISSN: 2522-1310 ©Copyright EuropeActive 2017

1

Contents

FOREWORD by Rita Santos Rocha & Alfonso Jimenez ................................................ 4

European Journal for Exercise Professionals – SCOPE AND EDITORIAL BOARD .... 6

1 - EXPERT OPINION: The need for Research and Evaluation skills for Exercise

Professionals, a high-value challenge to be addressed [Alfonso Jimenez & Simona

Pajaujiene] ........................................................................................................................ 9

Introduction ................................................................................................................ 10

Physical activity vs inactivity ..................................................................................... 11

Current physical activity policy and challenges for the health and fitness sector ...... 12

Conclusions ................................................................................................................ 15

References .............................................................................................................. 16

2 - EXPERT OPINION: Exercise counselling by general practitioners. Exercise

prescription by exercise specialists [César Chaves Oliveira & Rui Garganta] .............. 18

Promoting Exercise .................................................................................................... 19

Are general practitioners promoting more exercise? .................................................. 20

Are we more active? ................................................................................................... 20

Barriers to exercise prescription by general practitioners .......................................... 21

Why “exercise is NOT medicine” .............................................................................. 24

Conclusion .................................................................................................................. 26

References .............................................................................................................. 27

3 - REVIEW PAPER: Fitness professionals’ pedagogical intervention [Susana Franco

& Vera Simões] .............................................................................................................. 29

Background ................................................................................................................. 30

Discussion ................................................................................................................... 30

Implications for practice ............................................................................................. 35

References .............................................................................................................. 36

4 - ORIGINAL RESEARCH: The transtheoretical model of behaviour change and

strategies for fitness professionals to increase exercise behaviour [Jan Middelkamp] .. 39

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Introduction ................................................................................................................ 40

Transtheoretical Model of Behaviour Change........................................................ 40

Integrative Model ................................................................................................... 44

Practical applications .................................................................................................. 45

Conclusion .................................................................................................................. 47

References .............................................................................................................. 48

5 - ORIGINAL RESEARCH: Health Promotion in Commercial Fitness Gyms. An

analysis of organizational culture as an organization-specific premise for decision-

making. [Thomas Rieger & Michael Pfleger] ................................................................ 50

Introduction ................................................................................................................ 51

State of Research .................................................................................................... 52

Aspects of Organizational Theory .......................................................................... 53

The Organizational Culture as a part of the Social System .................................... 54

The Implementation of a Health Promotion Orientation ........................................ 58

Derivation of Research Questions .......................................................................... 59

Methodological approach ........................................................................................... 59

Qualitative Evaluation ............................................................................................ 60

Document Analysis ................................................................................................ 61

Results ........................................................................................................................ 61

Self-Conception of Commercial Fitness Gyms ...................................................... 61

Organizational Culture and Health Promotion ....................................................... 65

Conclusion .................................................................................................................. 68

References .............................................................................................................. 69

6 - ORIGINAL RESEARCH: How exercising women feel about their bodies and

behave in fitness club environment? [Simona Pajaujiene] ............................................. 71

Introduction ................................................................................................................ 72

Methods ...................................................................................................................... 74

Participants ............................................................................................................. 74

Instrument ............................................................................................................... 74

Results ........................................................................................................................ 74

Discussion ................................................................................................................... 79

Conclusions ................................................................................................................ 82

Practical applications .................................................................................................. 82

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References .............................................................................................................. 83

7 - ORIGINAL RESEARCH: Step-Exercise as a mean of bone health improvement

[Rita Santos Rocha] ........................................................................................................ 84

Introduction ................................................................................................................ 85

Exercise and bone health ........................................................................................ 85

Exercise and ground reaction forces ....................................................................... 87

Step-Exercise and osteogenic potential .................................................................. 88

Purposes .................................................................................................................. 89

Methods ...................................................................................................................... 90

Results ........................................................................................................................ 91

Discussion ................................................................................................................... 94

Implications for practice ............................................................................................. 96

Conclusion .................................................................................................................. 97

References .............................................................................................................. 97

8 - PRACTICE UPDATE: How can we motivate the "unsocial" children in Fitness

classes? [Eljona Spaho] ................................................................................................ 100

Introduction .............................................................................................................. 101

How can we motivate the "unsocial" children/members in fitness classes? ............ 101

How can we motivate the children/student/member?............................................... 102

What should we do as teachers/instructors to motivate the children/members? ...... 105

How can we involve the parents? ............................................................................. 106

How can we adopt our teaching method? ................................................................. 107

Discussion ................................................................................................................. 110

Overall Conclusion ................................................................................................... 111

References ............................................................................................................ 111

European Journal for Exercise Professionals – INSTRUCTIONS FOR AUTHORS

AND SUBMISSION PROCESS .................................................................................. 112

OTHER PUBLICATIONS BY EUROPEACTIVE ..................................................... 115

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FOREWORD by Rita Santos Rocha & Alfonso Jimenez

It is our pleasure to welcome you to the First Issue of the European Journal for

Exercise Professionals. This new publication by EuropeActive is focused on

providing up-to-date information to all exercise professionals, from research to

practice and from practice to research on all topics of interest for the fitness

industry, active leisure, health promotion, and sports fields.

Current literature supports the recommendation to initiate or continue an active

and healthy lifestyle in our perinatal lives and across the lifespan. There are plenty

of evidence-based studies that support the benefits of physical activity and exercise

on the promotion of health and well-being outcomes. Those include, as examples,

the reduction of several disease risks, prevention of hypertension, diabetes, or

musculoskeletal disorders, improvement of weight control, mental health, and

physical fitness, as well as the improvement of several disease treatments.

Moreover, epidemiologic studies prove the positive effect of physical fitness in

terms of a reduced risk of mortality, and improved quality of life.

Exercise professionals are key players in promoting the above benefits, and are the

main actors in planning and delivering exercise programmes, and in assuring

positive fitness outcomes.

Exercise professionals are required to develop and maintain a commitment to the

lifelong learning process in relation to their role, the professional context in which

they operate (including market evolution and development) and any technical and

scientific updates focusing on their particular field of expertise and experience. Our

aim, each year, is to gather relevant materials for exercise professionals, and their

multidisciplinary teams, that will support these requirements and bridge the gap

between science and practice.

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This first issue includes a selection of content, from “expert opinion”, “original

articles”, “review articles”, and ”practice updates” coming from authors across

Europe (Germany, The Netherlands, Denmark, Lithuania, United Kingdom, Spain,

and Portugal).

A wide range of content - research and higher education, marketing and

management, vocational education and practice based - will be included in future

editions, and as editors we aim to further involve exercise professionals, employers,

suppliers, students, and researchers in contributing to these editions.

We are pleased to recommend this first issue to all exercise professionals, and to

anyone else who is interested in the fitness industry, and in getting MORE

PEOPLE, MORE ACTIVE, MORE OFTEN.

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European Journal for Exercise Professionals – SCOPE AND

EDITORIAL BOARD

The European Journal for Exercise Professionals is an on-going peer-reviewed

online journal which publishes articles on important trends and developments in the

fitness industry and related fields.

Journal scope:

The European Journal for Exercise Professionals is an official publication of

EuropeActive, available free to all EREPS members. It aims to provide up-to-date

information to all exercise professionals, from research to practice and from

practice to research on all topics of interest for the active leisure and sports fields.

Topics include exercise prescription & assessment, personal training, group

exercise, outdoor exercise, sports, health & nutrition, lifestyle, injuries prevention,

professional development, special populations (special phases of life, clinical

conditions and disabled people), fitness trends, exercise and health costs, worksite

health & exercise promotion, physiology and biomechanics of exercise, pedagogy

and psychology of sports and exercise, club management, sport law, among others.

Its mission is to promote and distribute accurate, unbiased, and authoritative

information on health and fitness.

The European Journal for Exercise Professionals includes components of

research and higher education, marketing and management, vocational education

and practice based on EuropeActive’s Fitness Standards and European

Qualifications Framework, as well as continuing education opportunities.

Target audience:

Mainly practitioner-focused, the European Journal for Exercise Professionals

will be written for exercise specialists, personal trainers, exercise

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leaders/instructors, academics and researchers working in the Health & Fitness

field, in-training professionals, graduate students in the field of Health & Fitness,

programme managers, club managers, rehabilitation specialists, exercise-test

technologists, and other professionals related to the Health & Fitness industry.

Publisher:

EuropeActive

House of Sport, Avenue des Arts 43 - 7 ème étage

1040 Bruxelles, Belgium

ISSN 2522-1310

Key title: European journal for exercise professionals

Abbreviated key title: Eur. j. exerc. prof.

URL: http://www.ereps.eu/ejep/ejep

Editors-in-Chief:

Prof. Rita Santos-Rocha, PhD, ESDRM-IPSantarém / EuropeActive (Portugal)

Prof. Alfonso Jimenez, Coventry University (United Kingdom / Spain)

Editorial Board:

Dr. Simona Pajaujiene, PhD, Lithuanian Sports University / Active Training /

EuropeActive (Lithuania)

Dr. Alexis Batrakoulis, MSc, GRAFTS / EuropeActive (Greece)

Dr. László Zopcsak, PhD, International Wellness Institute (Hungary)

Dr. Lou Atkinson, PhD, Aston University (United Kingdom)

Dr. Cedric X. Bryant, PhD, FACSM, American Council on Exercise (United

States)

Prof. Gary Liguori, PhD, University of Rhode Island (United States)

Prof. Thomas Rieger, BiTS University (Germany)

Dr. Jan Middlekamp, HDD Group / BlackBoxFitness (The Netherlands)

Dr. Julian Berriman, MA, Professional Standards Committee, EuropeActive

(United Kingdom)

http://www.ereps.eu/ejep/ejep

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External Reviewers:

Dr. Silvano Zanuso, PhD, University of Padova / Technogym Research

Department (Italy)

Dr. Anna Szumilewicz, PhD, Gdansk Sports University (Poland)

Prof. Susana Franco, PhD, ESDRM-IPSantarém (Portugal)

Dr. Antonino Bianco, PhD, University of Palermo (Italy)

Dr. Fernando Naclerio, University of Greenwich (United Kingdom)

Prof. João Brito, ESDRM-IPSantarém (Portugal)

Dr. Adrian Casas, University of La Plata (Argentina)

Dr. Steven Mann, ukactive Research Institute (United Kingdom)

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1 - EXPERT OPINION: The need for Research and Evaluation

skills for Exercise Professionals, a high-value challenge to be

addressed [Alfonso Jimenez & Simona Pajaujiene]

Alfonso Jimenez1 , Simona Pajaujiene2

1Centre for Applied Biological & Exercise Sciences, Coventry University, UK.

E-mail: [email protected]

2Lithuanian Sports University, Lithuania. ActiveTraining – Training provider,

Lithuania. EuropeActive – Professional Standards Committee.


1 Alfonso Jimenez, 1970, Madrid, Spain. A truly international scholar, fully involved in the health and fitness industry

since the late 80s, Alfonso has worked as fitness and group exercise instructor, personal trainer, programme director, club manager and senior executive before moving into academia. Former Chairman of the Standards Council at EuropeActive and Honorary Member, he is Professor of Exercise Science & Health and Executive Director of the Centre for Applied Biological and Exercise Sciences at Coventry University; Chair of the Research & Dissemination Commission at the Healthy & Active Living Foundation in Spain. Co-Director of the Healthy & Active Living National Observatory at Universidad Rey Juan Carlos de Madrid (Spain); Scientific Advisory Board member at ukactive Research Institute; Formal member of the “Active Leisure Alliance Task Group” as expert from Academia; and Visiting Professor at ISEAL, Victoria University (Melbourne, Australia), the University of Greenwich (London, UK) and EUSES, University of Girona (Spain). Research interests: active living, exercise prescription, clinical exercise and worksite health promotion. Qualifications: BSc in Sport & Exercise Sciences (1993); PhD in Exercise Physiology (2003), postdoctoral training in Physical Activity & Health Promotion (2007), CSCS, NSCA-CPT. More info: CoventryU ResearchGate LinkedIn 2 Simona Pajaujien, 1970, Kaunas, Lithuania. She has been involved in fitness training, exercise for health and fitness

education for over 25 years and currently works as trainer, group fitness instructor, educator, speaker, author and technical expert. She is a lecturer and coordinator for several study programmes at the Lithuanian Sports University since 2004. Research interest: Health Education; Body Image in Sport and Leisure Physical Activity; Weight Control and Exercising Behaviour. She is a program director and founder of accredited vocational training school - ActiveTraining. Member of Professional Standards Committee – EuropeActive. Qualifications: BSc in Sport Sciences (1995); MSc in Public Health – Health and Fitness (2004); PhD in Social Science – Sports Science and Education (2012). More info: ResearchGate LinkedIn

mailto:[email protected]


http://www.coventry.ac.uk/research/research-directories/researchers/professor-alfonso-jimenez/

https://www.researchgate.net/profile/Alfonso_Jimenez

https://www.linkedin.com/in/prjimenez/

https://www.researchgate.net/profile/Simona_Pajaujiene2/contributions

https://lt.linkedin.com/in/simonapajaujiene

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“High-quality research and robust evidence are the cornerstones of effective policy, and while we know

that physical activity is one of the most powerful medicines available to society, and we’ve proven that

adding just small amounts of activity improves the health and wellbeing of almost everyone – all the

resources and time spent investigating activity amounts to very little unless we know how to support

more people, to be more active, more often. We have to support the academic community and

physical activity providers to put research at the heart of practice.” (Prof. Greg Whyte, ukactive

Blueprint for an Active Britain, 2015) [1]

Abstract: Despite the known benefits of physical activity, there is a worldwide trend towards less

total daily physical activity, and as a consequence, physical inactivity has become a leading risk factor

for chronic health disorders. The health and fitness sector is expanding very fast, although its overall

impact is only addressing the needs of about 11% of the European population. Exercise professionals

should play a more proactive role model supporting thousands of inactive potential clients. Providing

solid evidence-based information about the benefits of active living could act as a valuable driver for

positive behavioral change. The education and professional development of exercise professionals are

missing a solid training in basic research and evaluation skills. These new skills, integrated into the

formal training and practice of exercise professionals, will allow the whole Physical Activity sector, and

specially the health and fitness industry, to develop new knowledge, transform current professional

practice, inform public policy and expand the innovation capacity of our field.

Key-words: health and fitness sector, physical activity, research, evidence-based, competency,

exercise professionals

Introduction

A sedentary lifestyle is a risk factor for the development of many chronic illnesses,

and a main cause of premature death. Furthermore, living an active life brings

other social and psychological benefits. At the same time, poor nutrition makes an

important contribution to the burden of disease. A diet high in saturated fat and

energy-dense foods, and low in fruit and vegetables – along with a sedentary

lifestyle and smoking – is the major cause of cardiovascular diseases (CVD), cancer

and obesity.

There is significant evidence to show that physical inactivity and over-nutrition are

associated with a substantial economic burden in industrialized countries.

Implementation of specific strategies to modify inactive behavior is critical, but

could be associated with considerable costs if they are not properly evidenced and

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structured. To address large and meaningful public health benefits in improving the

health of adults, the cost-effectiveness of those intervention strategies will be of

major importance in addition to their health/clinical effectiveness. The current level

of evidence is not sufficient [2], and few studies published relate to the

potential positive impact that the health and fitness industry could bring.

From the UN High-level Meeting on NCDs Prevention and Control Political

Declaration (NYC, Sep’11) [3], to the top evidences published at Lancet Series on

Physical Activity (2012, 2016) [4,5], there is a clear message that Physical

Activity and Exercise can play a major role in the Public Health agenda, and

significant funding and resources are being put in place to identify cost-effective

active living models of implementation and delivery.

Physical activity vs inactivity

Physical activity is one of the most basic human functions. It is an important

foundation of health throughout life. Its known health benefits include a reduced

risk of cardiovascular disease, hypertension, diabetes and certain forms of cancer;

it also has an important role in the management of certain chronic conditions. In

addition, it has positive effects on mental health by reducing stress reactions,

anxiety and depression and by possibly delaying the effects of Alzheimer’s disease

and other forms of dementia. Furthermore, physical activity is a key determinant of

energy expenditure and is therefore fundamental to achieving energy balance and

weight control. Throughout childhood and adolescence, physical activity is

necessary for the development of basic motor skills, as well as musculoskeletal

development. Furthermore, physical activity is also embedded in the United Nations

Convention on the Rights of the Child. In adults, physical activity maintains muscle

strength and increases cardiorespiratory fitness and bone health. Among older

people, physical activity helps to maintain health, agility and functional

independence and to enhance social participation and quality of life. It may also

help to prevent falls and assists in chronic disease rehabilitation, becoming a critical

component of a healthy life.

Despite the known benefits of physical activity, there is a worldwide trend towards

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less total daily physical activity. Globally, one-third of adults do not achieve the

recommended levels of physical activity. In Europe, estimates indicate that more

than one-third of adults are insufficiently active [6]. While there are some

continuing challenges in terms of the validity and comparability of data on levels of

physical activity across Europe, recent figures from member States of the European

Union (EU) indicate that six in every 10 people above 15 years of age never or

seldom exercise or play a sport and more than half never or seldom engage in

other kinds of physical activity, such as cycling, dancing or gardening. At the same

time, a high proportion of adults in Europe spends more than four hours a day

sitting, which could be a contributing factor to sedentary lifestyles.

As a consequence, physical inactivity has become a leading risk factor for chronic

health disorders: 1 million deaths (about 10% of the total) and 8.3 million

disability-adjusted life years lost per year in the WHO European Region are

attributable to physical inactivity. It is estimated to cause 5% of the burden of

coronary heart disease, 7% of type 2 diabetes, 9% of breast cancer and 10% of

colon cancer [7]. Rising rates of overweight and obesity have also been reported in

many countries in the Region during the past few decades. The statistics are

disturbing: in 46 countries (accounting for 87% of the Region), more than 50% of

adults are overweight or obese; in several of those countries the rate is close to

70% of the adult population. Overweight and obesity are also highly prevalent

among children and adolescents, particularly in Southern European countries.

Physical inactivity has been identified as contributing to the energy imbalance that

leads to weight gain. Collectively, physical inactivity has not only substantial

consequences for direct health-care costs but also causes high indirect costs due to

increased periods of sick leave, work disabilities and premature deaths. For a

population of 10 million people, where half the population is insufficiently active,

the overall cost is estimated to be €910 million per year [8].

Current physical activity policy and challenges for the health and

fitness sector

The recently launched Physical Activity Strategy for the WHO European

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Region 2016–2025 [9] is building on the commitments of Health 2020 – the

WHO European policy framework for health and well-being – and aligns with

existing WHO frameworks and strategies, such as the Global action plan for the

prevention and control of non-communicable diseases 2013–2020, the Action Plan

for implementation of the European Strategy for the Prevention and Control of Non-

communicable Diseases 2012–2016, the Global Strategy on Diet, Physical Activity

and Health and the WHO Global Recommendations on Physical Activity for Health.

The leadership for promoting health-enhancing physical activity is set out for the

national ministries of health with a formal encouragement to establish coordination

mechanisms between the areas of health, sports, education, transport, urban

planning, environment and social affairs sectors.

The EU-WHO Strategy identifies five priority areas, with Evaluation and Research

as the fifth one (1 – Providing leadership and coordination for the promotion of

physical activity; 2 – Supporting the development of children and adolescents; 3 –

Promoting physical activity for all adults as part of daily life, including during

transport, leisure time, at the workplace and through the health-care system; 4 –

Promoting physical activity among older people; 5 – Supporting action through

monitoring, surveillance, the provision of tools, enabling platforms, evaluation and

research) [9]. With the main goal of supporting the strategy and related actions

(through monitoring, surveillance, and provision of tools, enabling platforms,

evaluation and research), the priority considers that strengthen the evidence

base for physical activity promotion is a key issue to address.

The European health and fitness sector is rapidly developing. It currently serves

over 50 million consumers, generates 26.8 billion Euro in revenues, employs

400,000 people, and consists of 48,000 facilities [10]. The collaboration between

healthcare systems and the health and fitness sector is very important, yet the

interaction between both in Europe is not always sufficient [11, 12].

Getting and staying fit is the result of the integration of both physical activity and

exercise in your lifestyle and the application of solid evidence-based interventions

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will guarantee effective positive results achieved safely and progressively. Science

and applied research are progressing faster than ever, and we, exercise

professionals, should be able to build the bridge between theory and

practice. Exercise professionals should be upskilled based on the current

evidences allowing the public to achieve their exercise goals easier, faster and

safer.

The health and fitness industry, and very specially EuropeActive, have been

actively involved (since 2007) in projects and activities in partnership with

Governments across Europe to promote an active and healthy behaviour, and

significant funding support has been received from the European Commission in

that regard [13]. In fact, the health and fitness sector, represented by

EuropeActive, recognizes its responsibility to work with partners at all levels across

the European Union to create a healthier society, where living an active lifestyle is

the social norm, rather than an exception, and where daily physical activity and

exercise is seen as part of the routine part of the prevention and management of

disease. Its mission is to get more people | more active | more often [14]. But

despite the obvious capacity of the fitness sector across Europe, its willingness to

contribute to increased levels of physical activity, and its track record of positive

performance, the sector is rarely recognized in national governments’

physical activity promotion programmes and campaigns.

The underlying reasons for the interaction between the healthcare system and

health and fitness industry in Europe are not always sufficient identified [11, 12].

And what we consider are the reasons for this? Firstly, exercise professionals have

not historically been considered as an extension of the health care team [12].

Unfortunately, representatives of healthcare systems tend to view the health and

fitness sector to be founded on principles that differ from medical system and

lacking the “credibility” and “authenticity” to partner on NCDs prevention [14]. The

main problem is that the health and fitness sector in some cases is seen as a

private multibillion industry, feeding modern consumerism and making business by

manipulating clients’ concerns similarly as hamburger restaurant chains [15].

Secondly, the healthcare system is not prepared to apply exercise prescription as a

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first-line therapy because of the lack of the specific HEPA related education in the

training of general practitioners [16].

Exercise professionals are the main source to convey exercise-related information

for the general public. They provide information and implement exercise

counselling, exercise prescription, client’s fitness assessment and guidance.

Unfortunately, there is a lack of review studies on the analysis of their education

and professional competencies [17], it is unclear how they obtain evidence–based

information and other issues associated with their education and lifelong learning

[17, 18]. However, it is revealed that exercise professionals with higher level of

education (e.g., graduate degrees) are more likely to use scholarly sources of

evidence compared to those with lower levels of education who are more likely to

rely on mass media, including the internet [19, 20]. Therefore, given exercise

professional's role in advising the general public, their accessibility, and the

emerging evidence-based guidelines on the best practices related to the use of

exercise and nutrition interventions, further research is needed to ensure that

exercise professionals, working with the public, integrate new research knowledge

into their fitness assessment and exercise guidance [17]. One critical element in

this regard is the fact that the Health and Fitness Industry is not investing

resources to provide solid evidences supporting its capacity to deliver

meaningful and sustainable public health outcomes.

Conclusions

As health and fitness sector expands very fast, exercise professionals should play a

proactive role model for thousands of clients. The education and professional

development of exercise professionals are missing a solid training in basic

research and evaluation skills (from critical analysis to data collection, pre- and

post- intervention assessments, data analysis and reporting).

These new skills integrated into the formal training and practice of exercise

professionals will allow the whole Physical Activity sector, and specially the health

and fitness industry, to develop new knowledge, transform current professional

practice, inform public policy and expand the innovation capacity of our field.

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Public health commissioners should not only insist on evidence-based practice, but

should insist that ongoing data capture is a feature of all commissioned

interventions. Accordingly, we (practitioners, operators and training providers)

must become adept at embedding data capture and analysis into all relevant

activity. Representative bodies must lobby government, health agencies and

research councils to provide greater funding for effectiveness research [21].

The value of Research and Evaluation for the health and fitness industry will be

immense on delivering solutions and innovative ways of tackling inactivity at

population level, and its broad implementation will become a long lasting legacy for

a different, positive and more active future.

Due to the aforementioned challenges in public health, the healthcare and the

health and fitness sector should review and reformulate their current strategies.

This will be critically important in the light of the implementation of the EU-WHO

Physical Activity Strategy for the European Region 2016-2025. Moreover, it will be

relevant for the recognition of the value of the health and fitness sector as an

effective partner on the public health agenda worldwide.

References

1. ukactive (2015). ukactive’s Blueprint for an Active Britain, Research and Evaluation, 30-34. http://www.ukactive.com/downloads/managed/ukactives_Blueprint_for_an_Active_Britain_-_online.pdf

2. Muller-Riemenschneider, F., Reinhold, T., Willich, S. N. (2009). Cost-effectiveness of interventions promoting physical activity. British Journal of Sports Medicine, 43, 70–76.

3. http://www.ncdalliance.org/sites/default/files/rfiles/Key%20Points%20of%20Political%20Declaration.pdf

4. The Lancet Series on Physical Activity (2012). Physical Activity 2012. http://www.thelancet.com/series/physical-activity

5. The Lancet Series on Physical Activity (2016). Physical Activity 2016: Progress and Challenges. http://www.thelancet.com/series/physical-activity-2016

6. Hallal, P.C., Andersen, L.B., Bull, F.C., Guthold, R., Haskell, W., Ekelund, U. (2012). Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet, 380(9838), 247–257.

7. Lee, I.M., Shiroma, E.J., Lobelo, F., Puska, P., Blair, S.N., Katzmarzyk, P.T. (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet, 380(9838), 219–229.

8. Word Health Organization (2007). Steps to health: a European framework to promote physical activity for health. Copenhagen: WHO Regional Office for Europe. http://www.euro.who.int/__data/assets/pdf_file/0020/101684/E90191.pdf

9. World Health Organization (2015). Physical activity strategy for the WHO European Region 2016–2025. Copenhagen: WHO Regional Office for Europe. http://www.euro.who.int/__data/assets/pdf_file/0010/282961/65wd09e_PhysicalActivityStrategy_150474.pdf?ua=1

http://www.ukactive.com/downloads/managed/ukactives_Blueprint_for_an_Active_Britain_-_online.pdf

http://www.ukactive.com/downloads/managed/ukactives_Blueprint_for_an_Active_Britain_-_online.pdf

http://www.ncdalliance.org/sites/default/files/rfiles/Key%20Points%20of%20Political%20Declaration.pdf

http://www.ncdalliance.org/sites/default/files/rfiles/Key%20Points%20of%20Political%20Declaration.pdf

http://www.thelancet.com/series/physical-activity

http://www.thelancet.com/series/physical-activity-2016

http://www.euro.who.int/__data/assets/pdf_file/0020/101684/E90191.pdf

http://www.euro.who.int/__data/assets/pdf_file/0010/282961/65wd09e_PhysicalActivityStrategy_150474.pdf?ua=1

http://www.euro.who.int/__data/assets/pdf_file/0010/282961/65wd09e_PhysicalActivityStrategy_150474.pdf?ua=1

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10. Deloitte & EuropeActive (2016). European Health & Fitness Market Report 2016. Cologne, Germany. Available: http://www.europeactive.eu/blog/europeactive-and-deloitte-publish-european-health-fitness-market-report-2016

11. Sagner, M., Katz, D., Egger, G., Lianov, L., Schulz, K.H., Braman, M., et al. (2014). Lifestyle medicine potential for reversing a world of chronic disease epidemic: from cell to community. Int J Clin Pract, 68(11), 1289-92.

12. Muth, N.D., Vargo, K., Bryant, C.X. (2015). The role of the fitness professional in the clinical setting. Curr Sports Med Rep, 14(4), 301-12.

13. EHFA (2011). Becoming the Hub. The Health and Fitness Sector and the Future of Health Enhancing Physical Activity. Final Report, http://www.ehfa-programmes.eu/sites/ehfa-programmes.eu/files/documents/hub/HUB_THE%20FINAL%20REPORT.pdf

14. Matheson, G.O., Klügl, M., Engebretsen, L., Bendiksen, F., Blair, S.N., Börjesson, M., et al. (2013). Prevention and management of non-communicable disease: the IOC consensus statement, Lausanne. British Journal of Sports Medicine, 47(16), 1003-11.

15. Andreasson, J., Johansson, T. (2014). ‘Doing for group exercise what McDonald's did for hamburgers’: Les Mills, and the fitness professional as global traveler. Sport Educ Soc, 21(2), 148-65.

16. Joy, E., Blair, S.N., McBride, P., Sallis, R. (2013). Physical activity counselling in sports medicine: a call to action. British Journal of Sports Medicine, 47(1), 49-53.

17. Stacey, D., Hopkins, M., Adamo, K.B., Shorr, R., Prud’home, D. (2010). Knowledge translation to fitness trainers: A systematic review. Implementation Science, 5:28.

18. Waryasz, G.R., Daniels, A.H., Gil, J.A., Siric, V., Eberson, C.P. (2016). Personal trainer demographics, current practice trends and common trainee injuries. Orthopedic Reviews, 8:6600.

19. Hare, S.W., Price, J.H., Flynn, M.G., King, K.A. (2000). Attitudes and perceptions of fitness professionals regarding obesity. J Community Health, 25, 5-21.

20. Forsyth, G., Handcock, P., Rose, E., Jenkins, C. (2005). Fitness instructors: How does their knowledge on weight loss measure up? Health Education Journal, 64(2), 154-167.

21. Beedie, C., Mann, S., Jimenez, A., et al. (2016). Death by effectiveness: exercise as medicine caught in the efficacy trap! British Journal of Sports Medicine, 50(6), 323-4.

http://www.europeactive.eu/blog/europeactive-and-deloitte-publish-european-health-fitness-market-report-2016

http://www.europeactive.eu/blog/europeactive-and-deloitte-publish-european-health-fitness-market-report-2016

http://www.ehfa-programmes.eu/sites/ehfa-programmes.eu/files/documents/hub/HUB_THE%20FINAL%20REPORT.pdf

http://www.ehfa-programmes.eu/sites/ehfa-programmes.eu/files/documents/hub/HUB_THE%20FINAL%20REPORT.pdf

https://www.ncbi.nlm.nih.gov/pubmed/25807166

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2 - EXPERT OPINION: Exercise counselling by general

practitioners. Exercise prescription by exercise specialists

[César Chaves Oliveira & Rui Garganta]

César Chaves Oliveira3, Rui Garganta4

3Instituto Politécnico de Viana do Castelo, Escola Superior de Desporto e Lazer,

Portugal.


4Faculdade de Desporto, Universidade do Porto, Portugal.


Abstract: In 2007, the American College of Sports Medicine (ACSM), with endorsement from the

American Medical Association and the Office of the Surgeon General, launched a global initiative termed

“Exercise is Medicine”, to mobilize physicians, healthcare professionals and providers, and educators to

promote exercise in their practice or activities to prevent, reduce, manage, or treat diseases that impact

health and the quality of life in humans. Since then, physicians are increasingly advising their patients to

exercise, although the number of them that comply with this practice is still generally low. Far more

important, data shows that people are less active than before. Here we discuss the main barriers

physicians face to exercise promotion and highlight the main features of successful interventions, with

an emphasis on the role of exercise specialists. Finally, we argue that exercise prescription should only

be performed by exercise specialists, as only they possess the required deep knowledge of the exercise

techniques, methods, and types most suited for each individual and only they have the time and

commitment to support, supervise and motivate patients before, during and after any kind of physical

activity or exercise programme that is implemented.

Key-words: exercise prescription, personal trainer, medicine, exercise is medicine.

3 César Chaves Oliveira has a PhD in Physical Activity and Health and is currently an assistant teacher at Sports and

Leisure School, of Polytechnic Institute of Viana do Castelo, Portugal. He has worked in the exercise training and fitness

industries for almost 2 decades, addressing both special and healthy populations. He is a scientific writer, consultant

and lecturer in exercise, health and nutrition subjects. 4 Rui Garganta has a PhD in Sports Sciences and is currently a full professor at Oporto Sports Faculty, University of

Porto, Portugal. He has worked in the exercise training and fitness industries for almost 3 decades, addressing both

special and healthy populations. He is a scientific writer, consultant and lecturer in exercise, health and nutrition

subjects.



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Promoting Exercise

The protective effects of physical activity and exercise on various chronic diseases

are overwhelmingly well studied and supported in the literature and are comparable

to drug interventions on mortality outcomes [1, 2]. Whether through physical

activity or by exhibiting a higher fitness level or reducing the amount of time one

spends sitting, non-sedentary people can significantly reduce their mortality risks

[3]. Nevertheless, a recent European Report found that the amount of people that

never exercises or play sports raised from the previously 39% in 2009 to 42% four

years later [4]. In the United States, only 21% of the total population met the full

guidelines for both aerobic and muscle-strengthening activity and critically only 3%

met the muscle-strengthening activity guidelines [5]. Furthermore, it may be that

for several health diseases, the recommended minimum amount of physical activity

does not convey special protection. In particular, it was found that individuals with

a total activity level of 600 metabolic equivalents (MET [6]) minutes/week (the

minimum recommended level, corresponding to 150 minutes/week at a moderate

intensity or 75 minutes/week at a vigorous intensity) had only a 2% lower risk of

diabetes compared with those reporting no physical activity. However, an increase

from 600 to 3600 MET minutes/week reduced the risk by an additional 19%. This

means that for significant reductions in the risk of some conditions (this study

addressed breast cancer, colon cancer, diabetes, ischemic heart disease, and

ischemic stroke events), people may actually need to perform several times the

recommended minimum of physical activity [7]. Hence, getting people to be more

active seems to be a vital public health matter. The role and relevance of medical

professionals are evident and pivotal, as they can reach almost all of the total

population of a country and within a relatively short period of time [8]. As such, in

2007, the American College of Sports Medicine (ACSM), with endorsement from the

American Medical Association and the Office of the Surgeon General, launched a

global initiative (termed “Exercise is Medicine - EIM”) to mobilize physicians,

healthcare professionals and providers, and educators to promote exercise in their

practice or activities to prevent, reduce, manage, or treat diseases that impact

health and the quality of life in humans [9, 10]. According to the programme, the

EIM initiative is achieved by: 1 - Assessing physical activity levels of each patient at

Issue 1 - 2017


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every clinic visit; 2 - Providing patients with an exercise “prescription” that can be

tailored to their specific disease conditions; and 3 - Referring patients to a trusted

network of local evidence-based physical activity programs led by qualified

professionals [11]. In summary, the EIM clinically links all the community in order

to develop and support a physically active lifestyle of all patients involved in this

initiative. So is EIM initiative being successful?

Are general practitioners promoting more exercise?

The first thing one must consider is if general practitioners are actually prescribing

more physical activity to their patients nowadays. By analysing data from the

National Center for Health Statistics, of the Centers for Disease Control and

Prevention, we can observe that in 2010, about one in three adults who had seen a

physician or other health professional in the past year had been advised to begin or

continue to do exercise or physical activity. From the same database we also find

that the percentage of adults who have been advised to exercise increased from

22.6% in 2000 to 32.4% in 2010 [12]. In the UK, it was found that 46% of patients

have reported receiving advice about physical activity and exercise from their

general practitioner [13]. This data seems to confirm that physicians are

increasingly advising their patients to exercise. Nevertheless, these numbers are

still far from optimal and are generally considered to be low [13].

Are we more active?

Although physicians are increasingly recommending physical activity and exercise

for their patients, data from the total population evidences that people are not

getting more active. In fact, trends from 2010 to 2015 reveal that the inactivity

rate changed from 26.8% in 2010 to 27.7% in 2015, which translates to a total of

81,6 million inactive Americans in the past year [14]. In Europe the trend for

physical inactivity is similar, as previously pointed [4]. Not surprisingly, studies

confirm that the effectiveness of physical activity counselling in improving patient’s

physical activity levels is mixed [15]. Simply advising people to take more exercise

seems to be an ineffective means to get them more active, but even adopting a

more personalized approach may not render the intended effects. To highlight this,

we recall the results of a study that compared the effects of direct advice or brief

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negotiation groups to a control group and found no differences in weekly energy

expenditure among them, after the intervention [16]. In fact, exercise advice has

shown multiple times its efficacy (results in a controlled environment) but not its

effectiveness [17].

Barriers to exercise prescription by general practitioners

Physicians meet various barriers to physical activity promotion and these barriers

are at least partially responsible for the mixed results on the physical activity

advice effectiveness. These include the perception that their patients are

uninterested in increasing their physical activity levels and are unlikely to change

their behaviour [18], and the fact that when they do devote time to counselling,

they do not usually receive positive feedback from patients becoming more

physically active [19]. This is not without reasoning, especially when we look at the

best case scenario adopted in a study conducted in Spain [20], where fifty-six

Spanish family physicians were randomized to either the intervention or standard

care arm of the trial. The physicians recruited 4.317 physically inactive patients

(2.248 for intervention and 2.069 for control protocols) from a systematic sample

after assessing their physical activity in routine practice. Intervention physicians

provided advice to all patients and a physical activity prescription to the subgroup

attending an additional appointment (30%). The main outcome measure was the

change in physical activity measured by blinded nurses using the 7-Day Physical

Activity Recall [21]. Secondary outcomes included cardiorespiratory fitness and

health-related quality of life. The results are surprising. At 6 months, intervention

patients increased physical activity more than controls (18 min/wk) but the

proportion of the population achieving minimal physical activity recommendations

was only 3.9% higher in the intervention group. Moreover, no differences were

found in secondary outcomes, despite all patients from the intervention group being

advised to exercise and 30% of them being given a physical activity prescription

[20]. Nevertheless, there are other barriers to exercise promotion, like physician’s

own physical activity habits, as less active physicians are less likely to engage in

such practices with their patients [22]. However, we consider the following two, to

be some of the most important barriers to exercise promotion: the first one is the

physician’s lack of knowledge of physical activity and exercise: more than one-half

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of the physicians trained in the US in 2013 received no formal education in physical

activity and most courses focused on exercise physiology and used a clinical

approach, rendering physicians ill-prepared to assist their patients in a manner

consistent with several national programmes, like Healthy People 2020, the

National Physical Activity Plan, or the EIM initiative [23]. In a study conducted on

UK medical students, on their final year, it was found that: physical inactivity was

incorrectly perceived to be the least important risk factor for global mortality; that

only 36% of students reported they were aware of the current UK physical activity

guidelines, while (by comparison) 94% knew UK alcohol guidelines; and that only

9% were able to adequately define ‘moderate/vigorous exercise intensity’, key

aspects of the UK Chief Medical Office physical activity guidelines (a number of

responses could be considered dangerous to patient’s health) [24]. Despite these

findings, 52% of the students stated they felt adequately trained to give physical

activity advice to the general public. The other notable barrier to physical activity

promotion is physicians’ lack of time [18]: a study designed to compare

determinants of consultation length in six European countries (Belgium,

Switzerland, Germany, Spain, Netherlands, United Kingdom), found that the

average length of a consultation in general practice was just under 11 minutes,

ranging from 7.6 minutes in Germany to 15.6 in Switzerland (20). Since even ‘brief

counselling’ in successful physical activity promotion interventions requires at least

3 to 5 minutes [25], we argue if physicians should devote almost 50% of their

consultation time to accurately evaluate their patient’s fitness levels and to

prescribe exercise according to his condition/illness, while concomitantly neglecting

medical related issues.

Fortunately, physicians do not need to perform extensive counselling to be able to

assist their patients with increasing their physical activity, as they could use their

limited time and resources by referring them to external sources for more

comprehensive community-based support. Exercise referral schemes consist of an

assessment involving a primary care or allied health professional to determine that

someone is inactive, a referral to a physical activity specialist or service, an

assessment to determine what programme of physical activity to recommend and

participation in that programme [26]. These type of schemes show promise in

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conveying better health outcomes than a far simpler exercise advice procedure [26,

27]. Along with exercise adherence, which is defined as successful if participants

complete a prescribed exercise routine for at least two-thirds of the time [28],

exercise maintenance is a key feature for a lifelong healthy physical activity status.

One of the most cited barriers to exercise maintenance after study completion was

the lack of professional support beyond the end of the programme, as found in a

review of 33 UK-relevant studies [26]. Participants who dropped out of exercise

post-completion of referral cited the removal of the exercise professional as the

primary motivating factor [29]. In a recent study, the researchers explored the

experiences of weight management clients in their meetings with registered

dietitians, personal trainers, and health behaviour counsellors in order to explain

how these services are perceived and received by participants. It was found that

the personal trainers received the highest percentage of positive codes (92.1%)

and that the participants tended to highlight the interpersonal experiences and

knowledge acquired and the specific exercise techniques or personalized programs

that were available [30]. Research also suggests that one-on-one personal training

is an effective method for changing attitudes and thereby increasing the amount of

physical activity. In one study, it was found that weekly sessions with a personal

trainer significantly increased clients’ ability to move upward through the stages of

change in regard to physical activity. Overall, 60 percent of study participants

moved up one stage, while 13 percent moved up two stages, demonstrating

evidence of health-behaviour change over a 10-week period [31]. Others

demonstrated more favourable outcomes on cognitive processes of change,

decisional balance, and scheduling self-efficacy of female college students receiving

personal trainer services [32] or higher values for the perception of autonomy

support, relatedness and competence in the same context of personal training [33].

This kind of supervision does not necessarily need to take place at a traditional gym

facility. In fact, researchers at Adelphi University compared in-home and at-the-

gym personal training and found that both were effective in terms of weight loss,

cardiovascular function, adherence and motivation, with little differences between

the two [34]. Although not rich, some research points to less loss to follow-up and

more adherence to exercise with a personal trainer versus unsupervised exercise or

a group exercise modality as BodyPump™ (loss to follow-up and number of

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sessions completed were 17% and 32.2 with a personal trainer, 40% and 26.9 with

unsupervised training and 32% and 21.1 with BodyPump™) [35]. Once being

supervised, patients are expected not only to exhibit lesser drop-out rates but also

a significant improvement on specific and relevant health indicators. It has been

shown that members whose training was directed by well-qualified personal

trainers administering evidence-based training regimens achieved significantly

greater improvements in lean body mass and other dimensions of fitness than

members who direct their own training [36]. Other studies achieved similar results

[37, 38]. This highlights not only the importance of interdisciplinary approaches to

achieving a favourable outcome, but also the specific and unique contribution of

exercise specialists and specifically personal trainers to the promotion and

maintenance of an active lifestyle.

Why “exercise is NOT medicine”

Many people are advocates of the EIM philosophy. We can easily understand why

this happens, as exercise undoubtedly has the ability to boost the health of the

populations.

But “exercise” and “medicine” are actually two very distinct concepts that should

never be confused: we define “medicine” as “the science or practice of the

diagnosis, treatment, and prevention of disease” [39], while the definition of

“exercise” is much more comprehensive and reflects its reach - that is obviously not

constrained to health promotion or management - “something performed or

practiced in order to develop, improve, or display a specific capability or skill”;

“Activity requiring physical effort, carried out to sustain or improve health and

fitness” [39]. As Andy Smith brilliantly puts it, “Exercise is Recreation not Medicine”

[40]. In his article, he further highlights the realms of “exercise is recreation” by

stating its features: (1) a focus on the experience of the user, (2) the promotion of

well-being, (3) the importance of community, (4) embracing inclusivity, (5) sport,

(6) aesthetics, and (7) leisure time [40]. As we can easily find, most of these

characteristics are unique to “exercise” and not to “medicine”. Even if we compare

both terms from a medical point of view, we can see many differences between

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them (table 1).

Table 1 - Comparison of Medicine vs Exercise

MEDICINE EXERCISE

When to use In the need to prevent, manage or treat a diagnosed disease

To improve health, to have fun, to master a skill, to improve body composition, and many others

Target Someone's disease The person

Contraindications Several: See Drug Label Not applicable

How to use According to drug label Endless possibilities

Dosage According to drug label Endless possibilities

Duration of treatment According to drug label Not applicable

Action in case of overdose According to drug label Rest

Interaction with other drugs/forms of exercise

From non-significant to life-threatening

From non-significant to beneficial

If we further indulge ourselves in this kind of comparisons, we can continue to find

significant differences between two of the most well-known forms of administration

of medicine and exercise (table 2).

Nevertheless, there are two major similarities between “medicine” and “exercise”:

1) a bad prescription can strongly affect the beneficial outcomes expected from

both sciences and 2) the best practice is made by those who are trained and have

studied and worked in the related area of expertise.

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Table 2 - Comparison of Aspirin vs Walking/running

ASPIRIN [41] WALKING/RUNNING

Minimum dose to promote an effect

50 mg Variable: depends on subject characteristics5

Contraindications Allergy; Reye’s Syndrome None6

Warnings Alcohol, Coagulation Abnormalities, GI side effects, Peptic Ulcer Disease

None

Precautions Renal Failure, Hepatic Insufficiency, Sodium Restricted Diets

None, except those regarding injury prevention and outdoor conditions (e.g. traffic conditions)

Drug/exercise interaction

ACE inhibitors, Acetazolamide, Anticoagulant Therapy, Anticonvulsants, Beta Blockers, Diuretics, Methotrexate, Non-steroidal Anti-inflammatory Drugs, Oral Hypoglycemics, Uricosuric Agents

Interaction with other forms of exercise is generally favourable

Adverse reaction

Dysrhythmias, dyspepsia, coagulopathy, acute anaphylaxis, rhabdomyolysis, pulmonary edema, and many others

Rare, occasional delay onset muscle soreness

Conclusion

In conclusion, we believe that the EIM mantra is reductionist to exercise as exercise

is much more than medicine [42-44]. Exercise presents both treatment AND

preventative benefits, but also many other unique facets that medicine can never

aspire to convey. One in particular is critical for a successful exercise promotion

intervention: enjoyment.

Instead of exercise being prescribed like a drug [45], we feel that the medical staff

should only refer their patient’s to community-based exercise facilities and/or to

exercise professionals as only they possess the required deep knowledge on the

exercise techniques, methods, and types most suited for each individual and only

they have the time and commitment to support, supervise and motivate patients

before, during and after any kind of physical activity or exercise programme that is

implemented. An interdisciplinary approach is needed to augment population’s

physical activity levels but the specificity of each intervention is key. For the results

5 Some subjects can (and do) achieve some kind of “effect” with lower doses than ACSM suggested guidelines.

Conversely, others need higher doses to provoke any measurable effect. 6 The risks of walking or running under a determined medical condition are still lesser than the benefits of walking or

running under those conditions, hence there are no contraindications for these modes of exercise.

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we are all aiming for, we believe that general practitioners should only prescribe

medicine and exercise should only be prescribed by exercise specialists.

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36. Storer TW, Dolezal BA, Berenc MN, Timmins JE, Cooper CB. Effect of supervised, periodized exercise training vs. self-directed training on lean body mass and other fitness variables in health club members. J Strength Cond Res. 2014;28(7):1995-2006.

37. Maloof RM, Zabik RM, Dawson ML. THE EFFECT OF USE OF A PERSONAL TRAINER ON IMPROVEMENT OF HEALTH RELATED FITNESS FOR ADULTS. Medicine & Science in Sports & Exercise. 2001;33(5):S74.

38. Ratamess NA, Faigenbaum AD, Hoffman JR, Kang J. Self-Selected Resistance Training Intensity in Healthy Women: The Influence of a Personal Trainer. The Journal of Strength & Conditioning Research. 2008;22(1):103-11.

39. Dictionaries O. Language matters http://www.oxforddictionaries.com/definition/english/exercise2016 [cited 2016 10th of September].

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42. Swisher AK. Yes, “Exercise is Medicine”….but It Is So Much More! Cardiopulmonary Physical Therapy Journal. 2010;21(4):4-.

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44. Sjøgaard G, Christensen JR, Justesen JB, Murray M, Dalager T, Fredslund GH, et al. Exercise is more than medicine: The working age population's well-being and productivity. Journal of Sport and Health Science. 2016;5(2):159-65.

45. Nunan D. Doctors should be able to prescribe exercise like a drug. BMJ. 2016;353.

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3 - REVIEW PAPER: Fitness professionals’ pedagogical

intervention [Susana Franco & Vera Simões]

Susana Franco7, Vera Simões8

7ESDRM-IPSantarém - Sport Sciences School of Rio Maior, Polytechnic Institute of

Santarém, Portugal.


8ESDRM-IPSantarém - Sport Sciences School of Rio Maior, Polytechnic Institute of

Santarém, Portugal.


Abstract: It is recognised the importance of fitness professionals’ intervention for fitness centres’

quality and participants’ satisfaction and retention. The objective of this article is to present several

studies that show some particular aspects of pedagogical intervention which must be taken into account

for participants’ satisfaction and retention, namely encouragement, instruction and pay attention to

participants. Some implications for the practice of fitness professionals’ pedagogical intervention are

presented.

Key-words: Pedagogical intervention; Fitness professionals; Quality; Satisfaction

7 PhD Methodological Foundations of Research on Physical Activity and Sport; Master Degree in Exercise and Health;

Bachelor in Sport Sciences – Physical Education and Sport. Associate Professor at ESDRM-IPSantarém, Portugal. Subjects teaching: Fitness; Fitness Assessment and Exercise Prescription; Sport and Fitness Pedagogy; Fitness Internship, Thesis. Fitness Instructor in several Health Clubs. Conferences’ speaker in several events related with Fitness. Participation in several workshops, Conventions, Congress related with Fitness. Research and publication areas: Fitness and Sport Pedagogy. Participation in several European I&D Projects: Sport Physical Education and Coaching in Health (SPEACH), Fitness e-Learning Team Training (FELT2), e-Learning Fitness (e-LF), Physical Activity and Lifestyle Counselling (PALC), European Accreditation – Fitness (EA-Fitness), ECVET-Fitness, Aligning a European Higher Education Structure in Sport Science (AEHESIS). 8 PhD in Sport Sciences; Master Degree in Sport and Exercise Psychology; Post-Graduations in Fitness – Personal

Training and in Groups Fitness Instructor; Bachelor in Sport – Fitness. Assistant Professor at ESDRM-IPSantarém, Portugal. Subjects teaching: Fitness; Fitness Assessment and Exercise Prescription; Sport and Fitness Pedagogy; Exercise for Special Populations; Sport Systematic; Fitness Internship, Thesis. Teacher and coordinator of extracurricular subject, Fitness, in an elementary private school in Lisbon. Fitness Instructor in several Health Clubs. Conferences’ speaker in several events related with Fitness. Participation in several workshops, Conventions, Congress related with Fitness. Research and publication areas: Fitness and Sport Pedagogy. Participation in several European I&D Projects: Fitness e-Learning Team Training (FELT2), e-Learning Fitness (e-LF), Physical Activity and Lifestyle Counselling (PALC).


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Background

Although known the innumerable benefits of exercise [1,2], according to Sport and

Physical Activity Eurobarometer [3], there is still a large number (42%) of

European Union citizens that never exercised or played sport. One of the concerns

of fitness centres managers is to present a quality service, which, according to

several authors, may provide clients’ satisfaction and consequently clients’

retention [4-12]. Several authors refer the importance of human resources,

particularly fitness professionals, in a quality service of fitness centres and

participants’ satisfaction and retention [12-22]. The adherence to physical activity

in unsupervised program setting is very low [23], which reinforce the importance of

the intervention of fitness professionals. Fitness professionals can be one of the

participant's drop out motives from fitness centres [24], or can be a motive to

choose a fitness centre [25].

Discussion

Considering the importance of fitness professionals’ quality for participants’

satisfaction and retention, Campos, Simões and Franco [26] develop a study to

identify the quality indicators of group fitness instructors. After interviewed 100

fitness stakeholders (gym owners/general managers, technical directors, trainers,

instructor and fitness participants) and have done a content analysis, they found 4

dimensions of group fitness instructors’ quality: professional, relational, technical

and pedagogical. The quality indicators of each dimension can be observed in table

3.

Table 3 - Quality indicators of each dimension of group fitness instructors’ quality

[26]

Dimensions Indicators

Professional Assiduity, Dedication, Ethics, Experience, Image, Punctuality

Relational Good mood, Communication, Cordiality, Availability, Empathy, Honesty, Humility,

Sympathy

Technical Fitness level, Knowledge, Musical skills, Technical performance, Technical

education, Innovation, Planning

Pedagogical Adaptability, Dynamism, Instruction, Motivate

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The most cited quality indicators, in Campos et al. study [26], were empathy (from

relational dimension), motivate and instruction (from pedagogical dimension). This

study, like others studies [6,12,27-30], reveal the importance of fitness

professionals’ pedagogical intervention in fitness centres’ quality and participants’

satisfaction and retention.

In fact, there is a positive relation between the participants’ satisfaction and the

fitness professionals’ pedagogical behaviour [31]. Franco et al. [31] studied this

relation, in group fitness classes, and found a significant positive relation between

participants’ satisfaction and the following fitness instructors’ pedagogical

behaviours: encouragement, instruction (information, correction, positive

evaluation, negative evaluation and questioning) and monitoring (observe and pay

attention to what participants do and say). Therefore, behaviours for encouraging,

instruct and for pay attention to participants can contribute to increasing

participants’ satisfaction. Authors also found a significant negative relation between

participants’ satisfaction and the behaviour independent exercise of fitness

instructors, which means that if during a group fitness classes the fitness instructor

performs the exercise with participants but don’t pay attention to them,

participants will be less satisfied.

According to the multidimensional model of sports leadership from Chelladurai [32],

the satisfaction level of participants results from the level of congruence between

required, actual and preferred behaviour. This model also shows that situational

characteristics (e.g., group dimension, activity, objectives, tasks, etc.) and member

characteristics (e.g., age, gender, participant experience, personality, etc.) are

related to required and preferred behaviour. Based on this model, Franco, Cordeiro

and Cabeceiras [33] study participants’ preferences about group fitness instructors

characteristics in different activities, namely: resistance training, hip hop, aqua-

fitness and fitness-combat. They found some similarities in the participants’

preferences about group fitness instructors’ characteristics in different fitness

activities, such as being dynamic and motivator, that are two of the most preferred

characteristics by participants about group fitness instructors. However, authors

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found significant differences between groups in 8 of the 23 characteristics. Authors

also study participants’ preferences of different group ages, about fitness

instructors’ characteristics, and they verify similarities in different group ages about

the most preferred characteristics in group fitness instructors, namely being

dynamic, motivator and imaginative. Nonetheless, they found significant differences

between groups in 14 of the 23 characteristics. Considering these results, it’s

important that fitness professionals adapt their intervention to participants’

characteristics, such as participants’ age, and to situational characteristics, such as

the activity.

Considering the importance, for participants’ satisfaction, of congruence between

required, actual and preferred behaviour about fitness professionals, it’s important

to know what participants prefer for fitness professionals act according to their

preferences. Participants’ preferences about fitness instructors’ pedagogical

behaviour were studied, in different group fitness activities, namely resistance

training [31], indoor cycling [34] and Zumba® [35]. Results are summarized in

table 4.

Table 4 - Participants’ preferences about fitness instructors’ pedagogical

behaviour, in resistance training [31], indoor cycling [34] and Zumba® [35]: most

preferred and less preferred behaviours.

Most preferred behaviours Less preferred behaviours

Resistance training

Encouragement (E, WE), Demonstration with information, Information (E, WE), Participative exercise (with clients as a

participant), Correction (E, WE), Positive evaluation (E), Questioning (E)

Conversations with others (clients or staff out of the class; E, WE), Attention to

interventions of others (clients or staff out of the class; E, WE), Negative affectivity (E, WE), Other behaviours (e.g., drink water or clean the face with a towel

without pay attention to participants), Independent exercise (do exercise without

pay attention to participants), Demonstration without information

Indoor cycling

Encouragement (E, WE), Questioning

(WE), Participative exercise, Positive evaluation (E), Positive affectivity (E, WE),

Correction (WE), Information (E)

Negative affectivity (E, WE), Conversations

with others (E, WE), Attention to interventions of others (E, WE),

Independent exercise, Other behaviours

Zumba® Demonstration with information,

Information (E, WE), Encouragement (E)

Conversations with others (E, WE), Attention to interventions of others (E, WE), Independent exercise, Negative affectivity (E, WE), Other behaviours, Demonstration without information

E: fitness instructor behaviour doing exercise simultaneously; WE: fitness instructor behaviour without

doing exercise simultaneously.

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There are some common participants’ preferred fitness professionals’ behaviours in

different activities, such as encourage participants and give information to explain

exercise while performing the exercise with participants (table 4). However, there is

some behaviours specificity that participants prefer in each group fitness activity.

For example, considering that indoor cycling requires fewer changes in the

exercises and consequently less instruction than the others activities, so, probably

for “breaking the ice” during practice, participants like that the instructor interacts

with them to create a good climate. In activities that require more technical skills,

like resistance training or Zumba®, participants prefer that, besides just show

(demonstrate) the model, also explain, with verbal and/or non-verbal instruction,

how to perform the exercises. Franco et al. [35] also found significant differences

between participants’ preference about the following instructional behaviour, which

means that participants don’t want just a model to see during “the Zumba® party”,

but also an explanation of the exercises: give information explaining the exercise,

verbally or non-verbally, while doing exercise; give information explaining the

exercise, verbally or non-verbally; show the model, before participants perform the

exercise, and give information explaining the exercise, verbally or non-verbally;

just show the model before participants perform the exercise (significantly less

preferred, compared with others).

There are also some common less participants’ preferred fitness professionals’

behaviours in different activities, which are related to bad mood or don’t pay

attention to participants, namely: negative affectivity creating a bad class climate;

conversations with people outside of the class (other clients or staff); pay attention

to interventions of people out of the class (other clients or staff); other behaviours,

such as fix the clothes, drink water, clean the sweat; do exercise without pay

attention to participants.

Considering that for a participant have a higher level of satisfaction the perception

and the preferences should be congruent [32], some studies were done to check

this congruence in fitness. Franco and Simões [36] compared participants’

perception and preferences, about pedagogical feedback of Body Pump®

instructors, and found significant differences in 19 of the 24 types of feedback.

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These results probably mean that participants are not satisfied with feedback of

Body Pump® instructors, which may be due to, in closed pre-choreographed

program, the obligation to follow the choreography, and perform pedagogical

functions for that, may limit the availability of fitness professional to observe and

correct participants.

In another study [31] group fitness instructors’ observed behaviour, participants’

perception and preferences, about pedagogical intervention, were related. Although

there was no congruence between the observed behaviour of the instructors and

the preference of the participants in various categories (26 of 33), there was

always congruence between perception and preference, which, perhaps, may

contribute to the participants satisfaction with the instructor, considering that

satisfaction results from the level of congruence between preference and

perception. But when authors relate observed behaviour with participants’

perception they only found 15 significant positive relations in the 33 tested

behaviours. Participants’ perception is influenced by their preference and affective

reactions, so the participants’ perception may not reflect reality [37].

Sometimes it is not just the participants who have no sense of reality, but also

fitness professionals. A study [38] that relates self-perception with the observed

behaviour of group fitness instructors, verified that fitness instructors had no idea

about one-third of the behaviours they performed. Considering these results, it is

important that fitness professionals do a self-analysis of their own intervention to

have a better sense of the reality [38].

A systematic process of supervision and self-analysis, through observation, using

for example videos, observation systems or checklists, should be done to collect

information about fitness professionals’ intervention, and give feedback for they

improve their professional performance. There are some observation systems about

fitness professional intervention, validated for fitness context, namely about

general pedagogic intervention [31,39], pedagogic feedback [40], class climate

[41], instruction [42], non-verbal kinetic communication [43], non-verbal

proxemics communication [44].

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There are also instruments to know participants opinion about fitness professionals’

intervention, validated for this context, namely about fitness professional quality

[45], general pedagogic intervention [31,46] and pedagogic feedback [47].

Implications for practice

For participants’ retention and satisfaction, fitness professionals should focus their

pedagogical intervention especially in [31,34,35]:

Encouragement for practice;

Instruction situations: demonstrating and explaining verbally and non-

verbally the exercises, question participants about their physical state and

exercises’ understanding, correct participants’ performance and praise

them;

Pay attention to participants, observing and hear them.

Fitness professionals should adapt their intervention to participants’ characteristics

(e.g., age, gender, participant experience, personality) and to situational

characteristics (e.g., group dimension, activity, objectives, tasks).

For a continuous professional development fitness professionals should often do:

Continuous education [48];

Systematic self-analysis [49,50];

Be supervised by other professionals or coordinators [49,50];

For systematic self-analysis and supervision, observation systems, specific for

fitness context [31,39-44], can be used for this process. Surveys about

participants’ opinion [31,45-47] should sometimes be applied, to know their opinion

and adapt the intervention to preferences of class in general and to each individual

in specific, which can contribute to participants’ satisfaction and retention.

A triangulation of these different perspectives (observed behaviour, participants’

perception and preferences, instructors’ self-perception) can be used for a better

comprehension of the fitness professionals’ intervention, adjusting and improving it

[31,38,51].

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References

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2. World Health Organization. Global Recommendation on Physical Activity for Health. Geneve: World Health Organization; 2010.

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14. Albayrak T, Caber M. Symmetric and Asymmetric Influences of Service Attributes: The Case of Fitness Clubs Managing Leisure. 2014;19(5):307-20.

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19. Alexandris K, Palialia E. Measuring Customer Satisfaction in Fitness Centres in Greece: An Exploratory Study. Managing Leisure. 1999;4(4):218-28.

20. Lagrosen S, Lagrosen Y. Exploring Service Quality in the Health and Fitness Industry. Managing

Service Quality. 2007;17(1):41-53. 21. Yildiz SM. An Importance-Performance Analysis of Fitness Center Service Quality: Empirical Results

from Fitness Centers inTurkey. African Journal of Business Management. 2011;5(16):7031-41. 22. Tsitskari E, Antoniadis C, Costa G. Investigating the Relationship Among Service Quality, Customer

Satisfaction and Psychological Commitment in Cyprian Fitness Centres. Journal of Physical Education and Sport. 2014;14(4):514-20.

23. Sperandei S, Vieira MC, Reis AC. Adherence to Physical Activity in an Unsupervised Setting: Explanatory Variables for High Attrition Rates Among Fitness Center Members. Journal of Science and Medicine in Sport. 2016;19:916-20.

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27. Wininger SR. Instructors' and Classroom Characteristics Associated with Exercise Enjoyment by Females. Perceptual and Motor Skills. 2002;94:395-8.

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28. Cloes M, Laraki N, Zatta S, Piéron M, editors. Identification des Critères Associés à la Qualité des Instructeurs d'Aérobic. Comparaison des Avis des Clients et des Intervenants. Colloque L'Intervention dans le Domaine des Activités Physiques et Sportives: Compétence(s) en Mutation?; 2001; Grenoble.

29. Loughead TM, Carron AV. The Mediating Role of Cohesion in the Leader Behavior - Satisfaction Relationship. Psychology of Sport and Exercise. 2004;5:355-71.

30. Collishaw MA, Dyer L, Boies K. The Authenticity of Positive Emotional Displays: Client Responses to Leisure Service Employees. Journal of Leisure Research. 2008;40(1):23-46.

31. Franco S, Rodrigues J, Castañer M. Case Study 6.3: The Behaviour of Fitness Instructors and the Preferences and Satisfaction Levels of Users. In: Camerino O, Castañer M, Anguera MT, editors. Mixed Methods Research in the Movement Sciences. Oxon: Routledge; 2012. p. 202-14.

32. Chelladurai P. Leadership in Sport: A Review. International Journal of Sport Psychology. 1990;21:328-54.

33. Franco S, Cordeiro V, Cabeceiras M, editors. Perception and Preferences of Participants about Fitness Instructors' Profile - Comparison between Age Groups and Different Activities. 9th Annual Congress of the European College of Sport Science; 2004; Clermont-Ferrand, France: European College of Sport Science.

34. Mercê C, Franco S, Alves S, Campos F, Simões V. Preferências dos Praticantes de Indoor-Cycling, relativamente ao Comportamento Pedagógico do Instrutor. Revista da UIIPS. 2014;2(1):59.

35. Franco S, Mercê C, Simões V. Preferência dos Praticantes Acerca do Comportamento Pedagógico dos Instrutores de Zumba. Journal of Sport Pedagogy and Research. 2015;1(6):30-5.

36. Franco S, Simões V, editors. Participants' Perception and Preference about Body Pump® Instructors' Pedagogical Feedback. 11th Annual Congress of the European College of Sport Science; 2006; Lausanne - Switzerland.

37. Chelladurai P, Riemer HA. Measurement of Leadership in Sport. In: Duda JL, editor. Advances in Sport and Exercise Psychology. Morgantown, WV: Fitness Information Technology; 1998. p. 227-53.

38. Franco S, Simões V, Castañer M, Rodrigues J, Anguera MT. La Conducta de los Instructores de Fitness: Triangulación entre la Percepción de los Practicantes, Auto-percepción de los Instructores Y Conducta Observada. Revista de Psicología del Deporte. 2013;22(2):321-9.

39. Franco S, Rodrigues J, Castañer M. Comportamento Pedagógico dos Instrutores de Aulas de Grupo de Fitness de Localizada. Fitness & Performance Journal. 2008;7(4):251-63.

40. Simões V. Análise do Feedback Pedagógico em Instrutores Estagiários e Experientes na Atividade de Localizada. Comportamentos de Feedback Observados, Auto-perceção dos Instrutores e Preferências dos Praticantes [Tese de Doutoramento]. Vila Real: Universidade de Trás-os-Montes e Alto Douro; 2013.

41. Dias I. Desenvolvimento e Validação do Sistema de Observação do Clima de Aula, em Aulas de Grupo de Fitness [Dissertação de Mestrado]. Rio Maior: Escola Superior de Desporto de Rio Maior; 2015.

42. Luís T. Desenvolvimento, Validação e Aplicação Piloto do Sistema de Obsrvação da Instrução do

Instrutor de Fitness em Aulas de Grupo de Pilates (SOIIF-Pilates) [Dissertação de Mestrado]. Rio Maior: Escola Superior de Desporto de Rio Maior; 2017.

43. Alves S, Rodrigues J, Balcells MC, Foguet OC, Sequeira P, Carvalhinho L, et al. Validação e Desenvolvimento de um Sistema de Observação da Comunicação Cinésica do Instrutor de Fitness. Motricidade. 2014;10(1):77-87.

44. Alves S, Rodrigues J, Balcells MC, Foguet OC, Sequeira P, Carvalhinho L, et al. Sistema de Observação da Comunicação Proxémica do Instrutor de Fitness (SOPROX-Fitness): Desenvolvimento, Validação e Estudo Piloto. Revista Iberoamericana de Psicología del Ejercicio y el Deporte. 2013;8(2):281-99.

45. Campos F, Simões V, Franco S. A Qualidade em Atividades de Grupo de Fitness: Construção e Validação do Questionário "Qualidade do Instrutor de Fitness - Atividades de Grupo" (QIF-AG). Revista Psicologia. 2016;30(1):37-48.

46. Franco S, Simões V, Alves S, Moutão J, Cid L, Rodrigues J, editors. Development of the Questionnaire Instructors’ Pedagogical Behavior in Group Fitness Classes. XII ENSSEE Forum; 2013; Groningen, Holand.

47. Simões V, Rodrigues J, Alves S, Franco S. Validação do Questionário de Feedback de Instrutores de Fitness em Aulas de Grupo. Revista da UIIPS. 2013;1(1):227.

48. Batrakoulis A, Rieger T. European Barometer on the Top Future Trends in Education, Training and Certification of the Exercise Professionals. Journal for Physical Education and Sport Science. 2014;1(1):10-26.

49. Franco S, Simões V. Lazer e Qualidade de Vida: Formação de Técnicos de Fitness. In: Resende R, Albuquerque A, Gomes AR, editors. Formação e Saberes em Desporto e Educação Física. Lisboa: Visão e Contextos; 2015. p. 477-508.

50. Simões V, Santos-Rocha R. Communication: Giving and Gaining Feedback. In: Santos-Rocha R,

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Rieger T, Jiménez A, editors. EuropeActive’s Essentials of Fitness Instructiors. Champaing, IL: Human Kinetics; 2015. p. 9-13.

51. Simões V, Santos-Rocha R. Body Awareness and Exercise Technique. In: Rieger T, Naclerio F, Jiménez A, Moody J, editors. EuropeActive's Foundations for Exercise Professionals. Champaign, Il: Human Kinetics; 2015. p. 191-8.

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4 - ORIGINAL RESEARCH: The transtheoretical model of

behaviour change and strategies for fitness professionals to

increase exercise behaviour [Jan Middelkamp]

Jan Middelkamp9

9Behavioural Science Institute, Radboud University, Montessorilaan 3,

Postbox 9104, 6500 HE, Nijmegen, the Netherlands.


Abstract: The transtheoretical model of behaviour change (TTM) is often used to understand changes

in health-related behaviour, like exercise. This model also provides a practical framework for tailor-made

interventions, using four core constructs. The purpose of this paper is to apply this integrative model

towards exercise and provide strategies to be used by fitness professionals to increase exercise

behaviour of their clients or members, ultimately to maximise their health and fitness levels.

Key-words: Stages of change, adherence, health

9 Jan Middelkamp is a PhD researcher at the Radboud University in The Netherlands with a special interest in exercise

behaviour change. He lectures in motivation, health behaviour change, personal training and member retention. Jan is a board member of EuropeActive, Development Director at HDD Group and CEO of BlackBoxPublishers. More info: www.janmiddelkamp.com.


http://www.janmiddelkamp.com/

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Introduction

It is well documented that physical activity (PA) and exercise are beneficial for

health. This holds for individuals as well as for the population in general [1,2]. This

article focuses on exercise only, defined as planned, structured, repetitive bodily

movements with the intention to improve or maintain (physical) fitness or health

[3]. In the health and fitness sector, clients or members predominantly exercise for

health benefits [4]. Several studies demonstrate that exercise behaviour, meaning

the adoption of new behaviour and the maintenance of existing behaviour

(adherence), is problematic [5]. According to the International, Health, Racquet

and Sportsclub Association [6], approximately 151 million individuals exercise in

fitness facilities worldwide. In regards to exercising in a fitness setting, three kinds

of behaviour are relevant. First, an individual has to enter the facility, denoted as

attendance behaviour. Second, the individual has to attend the programme,

labelled as programme attendance. Third, the person needs to exercise according

to certain standards or minimums in terms of frequency, duration and intensity, in

short exercise behaviour. Research on attendance and exercise behaviour in health

and fitness shows strong indications that the frequencies are low. Middelkamp et al.

[7] reported low amounts of exercise sessions, analysing a database of 259,000 ex-

members with an average of 1.1 sessions per month over 24-months, including a

mix of individual and group exercise behaviour. Health effects based on these

frequencies will be marginal at best. In regards to types of exercises, a Dutch study

[8] reports that most males (60%) and females (45%) combine individual and

group exercises, but 31% of the females only participate in group exercise

programmes. The study also reports that most individuals participate in two or

more types of programmes; about 50% participate in at least one group exercise

programme and 23% participate only in group exercise classes with an instructor. A

core task of fitness professionals is to support and increase all three kinds of

behaviour, to ultimately maximise the effects of exercise towards the health and

fitness levels of clients and members.

Transtheoretical Model of Behaviour Change

To systematically study and understand exercise behaviour, but also to provide

practical strategies, several social-cognitive models have been put forward. The

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transtheoretical model (TTM) is frequently used to study different kinds of health

behaviours, including smoking, physical activity and exercise. In different

populations and settings, the existence of significant relationships between the TTM

and exercise behaviour have been demonstrated [9-11]. To increase exercise

behaviour, an in-depth understanding of the development of this specific behaviour

and its change over time is needed, which makes the TTM useful as a theoretical

model. The TTM model was originally developed by observing smokers that wanted

to change their behaviour without professional intervention, the so-called self-

changers. The model describes four key variables: stages of change; decisional

balance; self-efficacy and processes of change. The stages of change contain five

main stages to cease an unhealthy or adopt a healthy behaviour (like exercise), or

six stages if the termination/relapse stage is also included [12]. The stages are

presented in table 5.

Table 5 - Stages of change.

Stage Name Description

1 Pre-

contemplation People who aren’t currently not thinking of changing their behaviour. In short: I WON’T and I CAN’T stage.

2 Contemplation People who aren’t currently changing their behaviour, but do intent to change in the next six months. In short: I MIGHT stage.

3 Preparation People who are preparing to change their behaviour within the next 30 days. In short: I WILL stage.

4 Action People who made a change in their behaviour, but have changed recently (up to six months but no longer). In short: I AM stage.

5 Maintenance People who have changed for some time, at least six months. The behaviour has become a reasonably stable characteristic. In short: I HAVE stage.

6 Relapse On the one hand, people can maintain their behaviour, on the other hand, they can relapse into the previous behaviour and return to the earlier stages.

The decisional balance is the second construct of the TTM, and contains two main

scales of Pros and Cons for changing behaviour. There are four dimensions for Pros:

useful benefits for the self; useful benefits for others; self-approval; approval of

others. There are also four dimensions for Cons: useful losses for the self; useful

losses for others; self-disapproval; disapproval of others. The Pros and Cons are

important for influencing persons in an early stage (pre-contemplation –

preparation) to the action stage.

The third construct is self-efficacy [13]. In short, self-efficacy is a person’s belief in

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capabilities to overcome personal, social and environmental barriers to exercise.

Self-efficacy is commonly split and measured in two aspects and scales: Barrier

self-efficacy is the confidence to overcome barriers to exercise; Temptation is

characterised as the negative impulses to revert back to previous behaviours.

According to self-efficacy theory, two important factors can influence the confidence

to adopt and maintain exercise behaviour. The first is efficacy expectations, that is

one’s belief about their own competence. The second factor is outcome

expectations, one’s belief in regards to the perceived result or outcomes of exercise

behaviour. According to self-efficacy theory, human behaviour is strongly

influenced by self-regulation [14]. The self-regulative mechanisms operate through

three subfunctions; Self-monitoring of one’s behaviour on determinants and

consequences; Judgement of one’s behaviour in relation to personal standards and

circumstances; Affective self-reaction. To increase self-efficacy, exercisers should

be first supported in selecting the right exercises to increase efficacy expectations.

Second, they need guidance in managing outcome expectations, for example by

setting and tracking relevant goals.

The fourth construct measures ten processes of change, which can be divided into

five cognitive processes and five behavioural processes. The five cognitive

processes are: consciousness raising (e.g., looking for information); dramatic relief

(e.g., emotional aspects of change); environmental reevaluation (e.g., assessment

of how inactivity affects society); self-reevaluation (e.g., assessment of personal

values) and social liberation (e.g., awareness, availability and acceptance of active

lifestyles in society). The five behavioural processes are: counter conditioning (e.g.,

substituting physical activity for sedentary leisure choices); helping relationship

(e.g., using social support during change); reinforcement management (e.g., self-

reward for change); self-liberation (e.g., commitment and self-efficacy beliefs

about change); stimulus control (e.g., managing situations that prompt inactivity or

activity) [15,16].

Spencer et al. [11] reviewed 150 studies using the TTM. A total of 31 stage-

matched intervention studies were reviewed and 25 studies were shown to be

successful in motivating participants towards higher stages and increased amounts

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of exercise. Towards the health and fitness sector, Middelkamp et al. [17] executed

a systematic review on exercise behaviour in fitness clubs. A small amount of

studies used constructs of the TTM. For example, Nigg et al. [18] tested the

decisional balance sheet (DBS). The experimental group received a phone call and

were asked to think systematically and record the expected gains and losses of

exercising in a fitness centre. Members reported twice as many Pros as Cons. Pros

were: good equipment/facilities and social interaction. Cons were: crowded

conditions and lack of equipment. Attendance declined from the 4th week baseline

to the 8th week in control and placebo group, but less change in the experimental

group. DBS was effective to keep attendance up [19]. Annesi [19] tested the effect

of a multiple component behaviour change treatment package (for 36 weeks),

partly based on the constructs of self-efficacy and processes of change. The

package included strategies like relapse prevention, self-reinforcement, and

contracting. All studies (US, Great Britain and Italy) showed a significantly higher

attendance (13-30%) and less drop-out (30-39%) for the treatment group [19].

This coach-approach system was also tested in Annesi [20,21], Annesi and Unruh

[22], and Annesi et al. [23], and proved again that adherence was positively

influenced by the intervention. Cox et al. [24] compared home versus fitness centre

based exercise for 18 months, using the stages of change constructs. The centre

based group had higher adherence than the home based group (97, 94, 81%

versus 87, 76, 61%) at respectively 6, 12 and 18 months. The levels of drop-out

range from 3 to 39%. Levesque et al. [25] studied how learned resourcefulness is

related to spontaneous process of change in 6 months, at adult members (n=104)

in the preparation stage of the TTM. Learned resourcefulness are regulatory skills

that enable a person to self-control his/her behaviour. Persons with stronger self-

regulatory capacity use more processes of change over time. They try harder in

attempting to maintain exercise involvement. Middelkamp et al. (2016) tested two

self-regulation interventions to increase self-efficacy and group exercise behaviour.

In total 122 participants (Mage 42.02 yr.; SD 12.29; 67% females) were recruited

and randomly assigned to one control and two experimental groups. The control

group was limited to participate in one virtual group exercise programme only

(group 1). The first experimental group was able to self-set their activities and

participate in multiple group exercise programmes (group 2). The second

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experimental group received an additional monthly coaching protocol to manage

self-set goals (group 3). An ANOVA indicated that mean sessions between group 1

and 3, and 2 and 3 differed significantly (p<.05) in 12 weeks. Descriptive statistics

demonstrate mean group exercise sessions over the total of 12 weeks of 2.74 (SD

4.65) in the control group; 4.75 (SD 6.08) in the first experimental group, and

12.25 (SD 9.07) for the second experimental group. Regression analysis indicated

that self-efficacy at 8-weeks explained the highest variance in overall group

exercise sessions (R2 =.18; p<.05). Overall drop-out rates were 88% in group 1,

78% in group 2 and 48% in group 3. The results demonstrate that exercise

behaviour can be increased by a self-efficacy based intervention.

Integrative Model

The TTM is an integrative model, using key constructs of other models or theories,

like self-efficacy. The organising construct of the TTM are the stages of changes.

Increasing exercise behaviour ultimately means that exercisers move upwards in

the stages of change. The constructs of self-efficacy, decisional balance and

processes of change support this progression. Figure 1 presents how the Pros and

Cons of decisional balance can develop during the stages [26]. Pros and Cons play

an important role in the early stages, meaning that Pros increase and Cons

decrease.

Figure 1 - Development of Pros & Cons during the stages of change.

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For self-efficacy, the same type of development can be presented for barrier self-

efficacy and temptation to not exercise. The last will decrease moving over the

stages of change, this first will increase because exercisers gain more and more

strategies to overcome barriers.

Figure 2 - Development of Self-Efficacy during the stages of change.

Fallon et al. [27] report several differences between men and women. Compared to

men, women reported significantly less barriers-efficacy, greater pros of exercise,

and greater use of behavioural and experiential processes of change. For the men,

affect temptation was the only significant correlate of action/maintenance, while

barriers efficacy, environmental evaluation, and affect temptation were associated

with maintenance/termination. For the women, environmental re-evaluation and

social liberation were associated with action/maintenance, while barriers-efficacy

was the only construct correlated with maintenance/termination.

Practical applications

The TTM implicates strongly that behaviour change strategies should address the

specific stage of a client or member. It is of no use to provide a pre-contemplator

with self-efficacy driven exercise goals. Keep in mind that defining the stages of

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change of a single person should be done per type of health behaviour. In table 6,

health-related behaviours like physical activity, exercise, smoking and sitting, are

summarised and by example connected to a stage of change for an imaginary

person. In the case of this person, let's name him Jan, it is clear that he is

preparing to start an exercise programme. So strategies to support Jan’s exercise

behaviour could be related to this stage. When it comes to his sitting behaviour, he

is not considering any change, which can be damaging for his health if he is sitting

for many hours a day. The result is that a different approach is needed to change

this type of behaviour.

Table 6 - Combinations between type of health behaviour and stages of change

[28]

As discussed, self-efficacy is one of the strongest and most tested constructs of the

TTM with a large amount of studies demonstrating positive effects on increasing

exercise behaviour. There are four sources for an individual’s self-efficacy. These

are (in order of effectiveness): Past experiences in performing specific behaviours;

Vicarious experiences (watching others successfully perform behaviours); Verbal

persuasion (being told that one is capable); Experiences of physiological arousal.

Self-efficacy can be increased by implementing simple strategies in an exercise

programme of a client or member. The same strategies can be used within a

nutritional or physical activity programme, if applied to a specific stage. Clients

should be interviewed about past experiences and choose a starting activity where

they feel confident with. Add new activities later when their confidence has

increased. Give examples of other clients that specific behaviour can be done,

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preferably other that are similar to the client. Within a specific behaviour

alternatives and options to progress the work-out or regress the work-out should

be provided. Also, educate clients on the expected outcomes and positives of their

(exercise) behaviour. Be very specific in the outcome and what to expect and

supply clients with self-monitoring systems so they can track how they are doing.

The processes of change provide a list of strategies to increase exercise behaviour.

The cognitive processes are most effective in the early stages of change. For

example a pre-contemplator can be moved towards a contemplator by

consciousness raising, like providing information and dramatic relief, increasing the

emotional aspects of (not) changing. The five behavioural strategies are used most

in the later stages of change, for example to adhere to an exercise programme.

Strategies as helping relationship, meaning using social support during change, and

reinforcement management should be implemented during the action and

maintenance stage of an exercise programme.

Conclusion

The health and fitness sector has been growing globally since the eighties, offering

exercise programmes to hundreds of millions of members worldwide. It seems

positive that so many start an exercise programme in a type of fitness facility, but

exercise adherence is low and drop-out rates are high. People are paying to not to

go to the gym [29]. In general, researchers show a lack of interest in this

population and specific setting. Even when studies on other populations can be

applied to exercise behaviour in fitness clubs, specific research in this context is

needed to develop tailor-made strategies and programmes to increase exercise

behaviour and ultimately the health and fitness levels of members. The

transtheoretical model of behaviour change offers a practical framework for this but

needs additional research to improve the effectiveness of programmes to support

the mission of EuropeActive: More people, more active, more often.

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References

1. American College of Sports Medicine (2010). ACSM’s guidelines for exercise testing and prescription. American College of Sports Medicine. 8th revised edition. Williams & Wilkins.

2. Dishman, R.K., Heath G.W., & Lee, I-M. (2013) Physical activity epidemiology. 2nd Edition. Human Kinetics Publishers, Champaign USA.

3. Buckworth J., Dishman, R.K., O’Conner, P.J., & Tomporowski, P.D. (2013). Exercise Psychology, 2nd Edition. Human Kinetics, Champaign, USA.

4. Baart de la Faille, M., Middelkamp, J., & Steenbergen, J. (2012). The state of research in the global fitness industry. BlackBox Publishers, the Netherlands.

5. Berger, B.G., Pargman, D., & Weinberg, R.S. (2002). Foundations of exercise psychology. Morgantown, WV: Fitness Information Technology.

6. IHRSA (2016). The IHRSA global report. Boston, USA. 7. Middelkamp, J., Van Rooijen, M. and Steenbergen, B. (2016) Attendance behaviour of ex-members

in fitness clubs: A retrospective study applying the stages of change. Perceptual and Motor Skills, 122 (1), 350 – 359.

8. Hover P., S. Hakkers and Breedveld, K. (2012) Trendrapport fitnessbranche 2012. Mulier Instituut, Den Bosch & Arko Sportsmedia, Nieuwegein.

9. Fallon, E.A., Hausenblas, H.A., & Nigg, C.R. (2005). The transtheoretical model and exercise adherence: examining construct associations in later stages of change. Psychology of Sport and Exercise, 6(6), 629-641.

10. Marshall, S. J., & Biddle, S. J. H. (2001). The transtheoretical model of behaviour change: A meta-analysis of application to physical activity and exercise. Annals of Behavioural Medicine, 23, 229-291.

11. Spencer, L., Adams, T. B., Malone, S., Roy, L., & Yost, E. (2006). Applying the transtheoretical model to exercise: a systematic and comprehensive review of the literature. Health promotion practice, 7(4), 428-443.

12. Prochaska, J., & Marcus, B. (1994). The transtheoretical model: applications to exercise. Dishman R.K. ed. (1994) Advances in exercise adherence. Human Kinetics, Illinois, 161 - 180.

13. Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman. 14. Bandura, A. (1991) Social cognitive theory of self-regulation. Organizational behaviour and human

decision processes, 50, 248 – 287. 15. Dishman, R. K., Jackson, A. S., & Bray, M. S. (2010). Validity of processes of change in physical

activity among college students in the TIGER study. Annals of Behavioural Medicine, 40(2), 164-175.

16. Reed, G.R. (2001). Adherence to exercise and the transtheoretical model of behaviour change. In: Bull, S. (Ed.) (2001) Adherence issues in sport and exercise, 19 – 45.

17. Middelkamp, J. and Steenbergen, B. (2015) The transtheoretical model and exercise behaviour of members in fitness clubs: Systematic review. Journal of Fitness Research, 4, 2, August 2015, 43 – 54.

18. Nigg, C.R., Courneya, K.S., & Estabrooks, P.A. (1997). Maintaining attendance at a fitness center: an application of the decision balance sheet. Behavioural medicine, 23: 130 – 137.

19. Annesi, J.J. (2003). Effects of a Cognitive Behavioural Treatment Package on Exercise Attendance and Drop-Out in Fitness Centers. European Journal of Sport Science, 3 (2): 1 - 16.

20. Annesi, J.J. (2004b). Relationship of social cognitive theory factors to exercise maintenance in

adults. Perceptual and Motor Skills, 99: 142-148. 21. Annesi, J.J. (2007). Effects of computer feedback and behavioural support protocol on dropout from

a newly initiated exercise programme. Perceptual and Motor Skills, 105: 55 – 66. 22. Annesi, J.J., & Unruh, J.L. (2007). Effects of the coach approach intervention on drop-out rates

among adults initiating exercise programmes at nine YMCA’s over three years. Perceptual and Motor Skills, 104: 459 – 466.

23. Annesi J.J., Unruh, J.L., Marti, C.N., Gorjala, S., & Tennant, G. (2011). Effects of the coach approach intervention on adherence to exercise in obese women: assessing mediation of social cognitive theory factors. Research Quarterly for Exercise and Sport, 82 (1): 99 – 108.

24. Cox, K.L., Burke, V., Gorely, T.J., Beilin, L.J., & Puddey, B. (2003). Controlled comparison of retention and adherence in home- versus centre-initiated exercise interventions in woman ages 40-65 years: the SWEAT study (sedentary woman exercise adherence trail). Preventive Medicine, 36: 17 - 29.

25. Levesque, L., Gauvin, L., & Desharnais, R. (2003). Maintaining exercise involvement: the role of learned resourcefulness in process of change. Psychology of Sport and Exercise, 4: 237 – 253.

26. Velicer, W. F, Prochaska, J. O., Fava, J. L., Norman, G. J., & Redding, C. A. (1998). Smoking cessation and stress management: Applications of the Transtheoretical Model of behavior change. Homeostasis, 38, 216-233.

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27. Fallon, E.A., Hausenblas, H.A., & Nigg, C.R. (2005). The transtheoretical model and exercise adherence: examining construct associations in later stages of change. Psychology of Sport and Exercise, 6(6), 629-641.

28. Middelkamp, J. (Ed) (2015). EuropeActive’s Essentials of Motivation and Behaviour Change. EuropeActive, Brussels, BlackBoxPublishers, The Netherlands.

29. DellaVigna, S. & Malmendier, U. (2006). Paying not to go to the gym. The American Economic Review, 96: 604 – 719.

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5 - ORIGINAL RESEARCH: Health Promotion in Commercial

Fitness Gyms. An analysis of organizational culture as an

organization-specific premise for decision-making. [Thomas

Rieger & Michael Pfleger]

Thomas Rieger10*

Michael Pfleger11

10 & 11 Business and Information Technology School (BiTS), Staatlich anerkannte

private Hochschule, Reiterweg 26b, 58636 Iserlohn, Germany

* Contact person for this article. E-mail: [email protected]

Abstract: Commercial fitness gyms often consider themselves as professional healthcare

organizations and strive for co-operations with stakeholders of the healthcare system. For gym

managers the decision to include exercise programmes into their portfolio of services is of vital

importance. This article analyses whether the implementation of health-oriented exercise programmes in

commercial fitness gyms, particularly against the background of the existing corporate culture, is

feasible. First, the most important characteristics of a corporate culture are described from a theoretical

perspective. Subsequently, the results of an empirical analysis are presented. They indicate that the

integration of specific exercise programme services can be classified as economically reasonable. Fitness

gyms have shed their idealistic identity and changed into market-oriented enterprises.

Key-words: gym, health promotion

10

Thomas Rieger was the Chairman of the Standards Council of EuropeActive (2012-2015). He holds a Doctoral

Degree in Social Sciences with a specialization in Sport Science (German PhD-equivalent) from the University of

Tübingen and a Master Degree in Public Health. In 2007 he was appointed as a Professor of Sport Management at the

Business and Information Technology School – BiTS in Iserlohn, Germany. At BiTS University he is Vice-Dean of the

Bachelor Programme Sport & Event Management and the Master Programme International Sport & Event Management.

He served as Visiting Professor at the Real Madrid Graduate School and the European University Cyprus in Nicosia.

Before entering academia in 2006, he gained more than six years of work experience in the fitness industry, especially

in the fields of fitness marketing and quality management. 11

Michael Pfleger is a Master degree student of the Sport Management at the Business and Information Technology School – BiTS in Iserlohn, Germany.

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Introduction In the last three decades commercial fitness gyms have become a central element

of the German sport system. According to the annually published statistics of

Deloitte nine million people hold a membership in a commercial fitness gym

(Deloitte & EuropeActive, 2016). Between 2000 and 2006 the fitness sector had to

overcome a critical situation because of a declining number of members, though

since 2007 the numbers have again steadily increased. Commercial fitness gyms

are market-driven organizations with the need to open themselves for changes in

their environment, to reflect decisions permanently and to adapt strategies for

ensuring their economical existence. The increasing number of gyms led to

competitive situations and to a professionalization of programs and services with

the purpose to achieve differentiation. One effect was that the independent, owner-

managed gyms lost market share for the benefit of fitness gym chains. In addition,

services of health promotion have been successively included into the range. The

qualitative and health-oriented optimization of gym equipment and the expansion

of an intra-industry market for study programs in exercise and health sciences are

indicators for a prioritization. Health and health promotion have become core

components of the product policy of fitness gyms. Furthermore, it has to be

mentioned, that beside the focusing on exercise, approaches of quality

management have been integrated into the organizational structure not only to

maintain and improve the operational efficiency but also for the successful

implementation of exercise programmes (Eigenmann, 2004; Rieger, 2007).

Currently the question whether these programmes fulfil the scientific quality

requirements of exercise programmes (Bouchard, Blair & Haskell, 2006; Brehm,

1997; 1998) are mostly unacknowledged, because the primary organizational

purpose of a commercial gym is not to improve the health status of its customers

by providing scientific based exercise programs or a qualitative sports medical

coaching, but rather to maximize profit.

At this point one question becomes relevant: Under which premises does a

commercial fitness gym include a health promotion orientation or, even better,

does it offer programs with a health promotion orientation or not? This article deals

with the decision whether to implement health-oriented exercise programs or not.

Taking into consideration, that „decisions are incidents, that occur in a certain

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moment and with their appearance already disappear“ (Luhmann, 1988, p. 168,

author’s translation), it gets obvious, that a decision does not describe a process, it

only determines the moment to differentiate the pre form the post. In order to

answer the main question of this article, it is necessary to focus on the rules, which

influence a decision, namely the organizational decision programmes (e.g., the

organizational culture) (Luhmann, 2000). Accordingly, it has to be assumed that

commercial fitness gyms differ from organizations of the healthcare system,

because of their economic orientation.

The present article tries to give answers to the question under which premises

health-oriented exercise programmes are implemented. Therefore, the current

state of research will be illuminated. Afterwards a theoretical approach for the

characterization of organizational decision programmes will be deduced. Within a

qualitative empirical study in the region of East Westphalia/Germany owners of

commercial fitness gyms have been interviewed. Against the background of the

theoretical approach and the related empirical results implications regarding the

feasibility of implementation of health-oriented exercise programmes are

formulated.

State of Research

The current state of research about the commercial fitness gym as a specific type of

organization reveals a lack of publications. Most of the literature makes the

motivational structure of gym customers a subject of discussion (Schubert, 1998;

Heinemann & Schubert, 1990; Kosinski & Schubert, 1989; Janssen, Wegner &

Beyer, 1989). An analysis of the importance of exercise programmes was only

accomplished with regard to these motivational structures. Several authors could

identify a higher importance of health-related compared to other motives (Mrazek,

1988; Trillitzsch, 2004). The study of organizational structures was only taken up

by some publications (Dreßler, 2003; Rampf, 1998; Sack & Hennrich, 1989;

Dietrich, Heinemann & Schubert, 1990). A detailed characterization of

organizational decision programmes in commercial fitness gyms has been left out of

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consideration. In this context the sports club12 research can rely on results with

more solid evidence. Sports clubs have changed only marginally throughout the last

years because of their tendency to an organizational closing (Baur & Braun, 2003;

Emrich, 2005; Emrich, Pitsch & Papathanassiou, 2001 and others). Even these

publications only deliver a minor contribution for the explanation of organizational

decision programmes in sports organizations. Thiel and Meier (2004) submitted a

remarkable publication, which characterizes the sports club as an immunological

organization based on the organizational theoretical approach of Niklas Luhmann

(2000). During its existence the sports club has learned to neutralize environmental

influences like value changes or changes in the sport demand.

In summary, the current state of research is deficient. That is primarily because of

the lacking research interest in sport science towards the fitness sector. Especially

a missing theoretical approach to explain organizational decision-making obstructs

answering the question, why commercial fitness gyms offer health-oriented

exercise programs.

In the next step the main theoretical aspects of sports club research (Thiel & Meier,

2004; Thiel et al., 2006; Thiel & Mayer, 2010) should be deduced and afterwards

be transferred to the commercial fitness gym as a different type of organization in

the sport system.

Aspects of Organizational Theory

Organisations permanently make decisions. With regard to the main question it is

necessary to analyse the reasons and premises for decisions in gyms. The basis for

such a ‘decision-oriented’ consideration of organisations is issued by Luhmann’s

sociological management approach. Thus, organisations construct and reconstruct

themselves by the communication of decisions (Luhmann, 2000). A cluster of

decisions arises from these decisions. Within this cluster every decision has a

meaning for another decision, in other words, the organisation deals with decisions

about decisions (Luhmann, 2000). Therefore, Luhmann introduces the term

12

In the German sport system the term (sports) club always refers to voluntary (non-profit) sports organizations with

significant differences to economic enterprises (Thiel & Mayer, 2009).

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decision premises. These premises are basic decisions, build the structure of an

organisation and provide an orientation for upcoming decisions. Two categories of

premises have to be distinguished: the decidable decision premises and the non-

decidable decision premises.

The first category is empirically observable and differentiated into (1) the decision

programmes (Entscheidungsprogramme), „which define the objectives of the

organization and the methods used to achieve them“ (Thiel & Mayer, 2010, p. 85,

author’s translation), (2) the communication channels and (3) the human

resources. The non-decidable premises can be described as informal values and

traditions, which are not scrutinized by the members of the organisation. Luhmann

uses the term organizational culture (2000), which fills a major role for analysing

the main task of this paper. A complete analysis of the decision premises would

exceed the scope of this paper. So the next step is to focus on the emergence and

impact of organizational culture in commercial fitness gyms. From this point on it is

possible to comprehend the decision process for the implementation of health-

oriented exercise programmes.

The Organizational Culture as a part of the Social System

Before approaching the term organizational culture, a brief introduction of the

concept of organizational learning must be prepended to ensure a better

understanding of the functions of organizational culture.

Several sociological publications, which define learning as an adjustment process

based on precise goals, identified two basic functions of organizational learning.

1. A member of the organization learns to accomplish actions by referring to the

goals and rules of the organization (Argyris & Schön, 1978).

2. The organizational rules should be scrutinized by reflection. This type of

organizational learning also implies that the organization does not learn

directly by observing the relationship to its environment. Because of its

autopoetic and self-referential orientation the organization has the ability to

create the importance of irritations in its environment by itself (Baecker,

1999; Luhmann, 2000; Willke 1998). Changes in the environment are only

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perceived, when they seem to be relevant for the organization. Nevertheless,

the parameters to evaluate this relevance are created by the organization. If

the organization sees itself forced to change structures, this happens on the

basis of internal developed criteria. Substantial structural changes can be the

result, because the organization differentiates a dynamic system of self-

reflection, which is permanently in search of necessities to adjust.

Out of these two functions of organizational learning arises a third one. The

determination on specific premises leads inevitably to a permanent reflection of

decisions (Luhmann, 2000; Thiel & Meier, 2004), which initiates an organizational

hang-up and a restriction in the ability to act. Organizations need an orientation,

which allows them to ensure the approval of decisions without reflecting

permanently. This task is succeeded by the organizational culture (Luhmann,

2000). The culture is not called into question by the organization, it is composed of

several non-decidable decision premises like traditions, common values and general

accepted informal rules (Thiel & Meier, 2004).

In its development organizational culture is marked by contingency, because it

emerges in its own system and based on the system’s operations (Thiel et al.,

2006). Within the organization it is not contingent, but rather understood as an

implicitness, which is accepted by everyone (Luhmann, 2000). The non-decidable

decision premises work secretly and they participate unnoticeably in all decision

processes. Moreover, they promote the community spirit within the organization.

Organizational culture emerges spontaneously and is a „redundant communication“

(Luhmann, 2000, p. 243, author’s translation). In order to ensure that decisions are

accepted, the organizational culture has furthermore the task to reduce

uncertainty, as it generates intimacy with its informal rules, provides stability for

the system and enables to distinguish from other systems (Luhmann, 2000; Thiel

et al., 2006). The concealment and informality of organizational culture influence

the capability to react flexibly to environmental changes much clearer than the

decidable decision premises. This does not mean, that culture is not adaptable, but

it is “more stable than the decidable decision premises” (Thiel et al., 2006, p. 31,

author’s translation). Especially in organization with poorly defined decidable

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decision premises, the organizational culture gains importance when it comes to

evaluate environmental changes. To put it simple in terms: porous and non-

stringent decidable decision premises, namely decision programs, communication

channels and human resources are combined with a stable and dominant

organizational culture, which is very slow and of limited adaptability (Walgenbach,

1999). In contrast, clear decision premises are rather combined with a sub-stable

culture, which is more adaptable and able to respond more flexible to changes in

the environment of the organization.

Referred to Kieser a change of organizational culture requires the formulation of

guiding principles, since this makes contours of the organizational culture visible

(Kieser, 1999). To recognize informal premises can interfere the stability of the

organization, because guiding principles are directly related to the interests,

intentions and conflicts of the organizational members (Luhmann, 2000). In this

context, the organizational culture creates the possibility of a comprehensive

organizational change, which simultaneously questions the organizational structure

and leads to a disorientation that “can only be compensated by decisions

successively” (Thiel et al., 2006, p. 32, author’s translation).

The introduced theoretical approach should be transferred to the commercial fitness

gym as a specific organizational type. As already mentioned, commercial fitness

gyms are economic enterprises and act on the basis of the premises of the

economic system with the main goal to maximize profit (Rieger, 2007; Thiel,

1997). Commercial fitness gyms have, like all economic enterprises, a clear

recognizable target structure, which can be differentiated in main goals and

subgoals. This reveals a distinction to voluntary sports clubs. Their target structure

does not show a comparable system, subgoals are difficult to identify. In

commercial fitness gyms explicit guidelines for communication channels prevail,

which were built up on power and hierarchy. While a sports club manager needs a

democratic legitimation for implementing to programmes or hire people (Thiel et

al., 2006), the gym manager can enforce his ideas against employees will. The

communication channels comprise positions, which are filled up with full-time

employees with a professional knowledge. In voluntary sports clubs the recruitment

process is often influenced by private relationship between its members. A fitness

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instructor needs expertise to fulfil his tasks appropriately. All these characteristics

show that commercial fitness gyms have clear defined decidable decision premises

(decision programs, communication channels, human resources). At this point it

can be assumed that commercial fitness gyms are thoroughly adaptable especially

by regarding the organizational culture in combination with the distinct decision

programmes, communication channels and human resources. The premises for

changes of the organizational culture are favourable. Regarding the history of the

commercial fitness market obvious changes in the mission statements have taken

place. Starting with the 80’s the commercial fitness market was primarily

dominated by performance-oriented weight training with a ‘No Pain-No Gain-

Mentality’. During the last fifteen years the mission statements of commercial

fitness gyms have significantly changed in favour of health-oriented statements

(Rieger, 2007; Zarotis et al., 2003). The main reasons for this change are the

diversified market situations. Health-oriented goals play a major part in the motive

structure of gym customers. This key information is selected by the organization

and supports the decision-making process. Commercial fitness gyms are as

economic enterprises directly affected by market influences. It has to be assumed

that it is vital for commercial fitness gyms to react on the motive-related irritations

from the surroundings with a reflection or even a adaption of mission statements,

because a customer orientation gets more and more important as a result of the

intensive competitive situation on the fitness market (Covell et al. 2007; Rieger,

2007; Trillitzsch, 2004). This market orientation implies an adaptable character of

the organizational culture. Furthermore, the risks, which are connected with an

organizational change, are small in economic enterprises, because in commercial

organizations “positions (Stellen) have the responsibility for the maintenance of the

system” (Thiel et al., 2006, p. 33, author’s translation). Each and every day holder

of positions make a contribution for the attainment of the primary organization’s

purpose in the decision-making framework (Japp, 1992).

At this point it is has to be assumed that the organizational culture does not hinder

an organizational change. It is more the decidable decision premises, which are

opposed to a change, especially if it works against the primary organizational

purpose: the maximization of profit. Health-oriented exercise programmes are also

affected. Their implementation is a subject to very tight limits, if they are classified

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as problematic from an economical point of view.

The Implementation of a Health Promotion Orientation

Against the background of the current results commercial fitness gyms are

dynamic, flexible and innovative organizations. Health promotion orientation seems

to be implementable, if it supports the organizational purpose. The organizational

culture appears to be more adaptable than in non-profit-organizations.

In preparation for the empirical analysis the theoretical results should be

summarized relating to Thiel et al. (2006) and be transferred to the decision

problem in commercial fitness gyms whether to implement programmes with a

health promotion orientation or not.

First, it is necessary to place the concrete decision for or against health promotion

programs in the centre of consideration. As decisions are not made independently,

a selection of information takes place, which helps to make the right decision in

relation to the organizational purpose. An orientation towards information like

market developments or demander’s needs is only realizable on the basis of

decision premises.

As an economic organization a commercial fitness gym is marked by organizational

knowledge and a clear defined system of objectives. All decisions derive from the

pressure for economic efficiency. One mentionable example is the realization of

current fitness trends in the product policy, particularly for the group training

offers.13 Programmes, trends and ideas will be connectable in the organization as

long as they make economically sense. Commercial fitness gyms have developed

detailed and fixed rules to secure organizational knowledge. This indicates a major

importance of decision programmes for economic enterprises and hence also for

commercial fitness gyms.

13

Trends in group training are subject to a short product life cycle, so that the returns are also limited to a short period

of time.

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As mentioned before, the decision-making structure of commercial fitness gyms is

also influenced by the organizational culture. Due to its concealment it only appears

empirically observable, if the self-conception is scrutinized.

The implementation of exercise programmes, especially by taking quality

management aspects into consideration, is a manifest intervention for the

organization. With regard to the old-fashioned ‘no pain-no gain’-orientation and the

necessity to earn money, the decision whether to implement or not leads to a

reflection of organizational culture and thus to a discussion about self-conception.

The implementation does not end with the decision, if pro or contra health

promotion, because such decisions initiate long-term processes, which could be

undone. For example, the satisfaction of customers is a key aspect. A permanent

dissatisfaction must entail an intervention. Hence, it is possible that specific

exercise programme will be included or excluded.

Derivation of Research Questions

Organizational culture always moves into the foreground, when serious decisions in

organizations – like the implementation of health-oriented exercise programmes –

have to be made. The characterization of decision-making structures in order to

organizational cultural aspects has to be underlined empirically. Therefore, the

made assumptions have to be operationalized. The following questions can be

derived:

Are there characteristics or developments with a special significance?

Which kind of traditions can be identified?

Have there been any changes in the product policy since the opening?

Is the economical development satisfying?

Why are health-oriented exercise programmes offered?

Which significance has health-oriented exercise programmes?

Methodological approach

The aim of the empirical study was not to reproduce a representative illustration of

exercise program offers in commercial fitness gyms, rather than to deeply

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illuminate the organizational cultural premises for the implementation of health

promotion orientation in the form of exercise programs.

For the study in the region East Westphalia/Germany a qualitative empirical design

has been developed, composed of expert interviews and a documentary analysis.

Apart from questions concerning developed values and traditions, purpose and

conditional programmes, personal recruitment and communication channels have

mainly been analysed.

The size of the analysed fitness gyms is between 400 and 1.800 square meters. All

of them have an equipped gym floor, a group training area and a spa. Furthermore,

they offer exercise programmes in cooperation with different health insurances in

the framework of § 20 of the German social security code.

The empirical design consciously relies on a qualitative approach, because it was

necessary to take a ‘deeper look’ into the organizations. It is not possible to ensure

the realization of this requirement with quantitative methods. In total, eleven

owners and managers of commercial fitness gyms have been interviewed (table 7).

All interviews were recorded on a tape and afterwards a transcript was written. The

analysis of information brochures, workout schedules and advertising brochures

completed the empirical design.

Table 7 - Interview Study – Overview

Interview Study

Owners/Managers of Commercial Fitness Gyms

11 Interviews 651 Interview Minutes

(10,85 Interview Hours)

Minimal Length 41 mins Maximal Length 76 mins

Average 59 mins

Qualitative Evaluation

In the beginning of the research study the knowledge about organizational

sociological premises for the implementation of health-oriented exercise

programmes and its actual dissemination in commercial fitness gyms was low and

the need for transparency and information was high. Methods of the qualitative

evaluation research were used to find out the organization-specific reasons if and

why owners and responsible managers decide for or against such an

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implementation.

Qualitative studies do not aim for a representative status, but rather seek for a

detailed acquisition of the subject. A complete survey would only allow a superficial

description of the organizational structure.

Document Analysis

Considering the amount of already existing material like market statistics,

information and advertising brochures, training schedules and anamnesis the

document analysis was integrated into the research design. It supplements the

expert interviews, because of its non-reactive character (Mayring, 2002). The

documents have been collected, analysed and evaluated.

The evaluation of the empirical data was accomplished by using the qualitative

content analysis by Mayring (2003).

Results

It was problematic to illustrate an organizational culture empirically. This is chiefly

due to the fact, that the culture does not appear openly to the outside and works

invisibly (Thiel et al., 2006). Therefore, it was not possible to fall back on a proven

empirical instrument. This deficit was compensated through creating an information

basis about traditions, corporate history and fundamental values with the aim to

illuminate the self-conception and then to derive essential characteristics about the

organizational culture.

Self-Conception of Commercial Fitness Gyms

The commercial fitness gyms chosen for the research had different firm ages. The

oldest provider started in 1977 and the youngest in 2000. Reflecting the different

developments in the histories of the examined providers, it became obvious, that a

rethinking process had taken place, centred on entrepreneurial thinking:

“Formerly, when I started with my gym, I was a sportsman, who had a

gym as a part-time work. And nowadays it is the other way, now I am

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the person, who manages everything and besides I exercise”

(Interviewee 10, p. 7 of transcript, author’s translation).

For the clarification of possible changes in the self-conception interviewees were

asked about the reasons, why they decided for a self-employment in the

commercial fitness market. The majority of respondents referred to the high

identification potential of fitness activities and relativized the necessity of a

professional corporate management during the pioneering days of the commercial

fitness sector. Considering the motives to become self-employed, interviewee No. 7

said:

“Because I am very interested in fitness and I do training. And because I

totally support fitness ... I would not like to sell unhealthy products“


A professionalization of operational and sales processes was not relevant in the

past, because “we just opened the gym door and the people came” (Interviewee 9,

p. 2 of transcript, author’s translation). Tendencies toward professionalization in the

commercial fitness industry made a contribution to overcome old and to develop

new mission statements in the related organizations and thus initiated changes in

the self-conception. The importance of commercial interests moves to the

foreground and is directly related to the developments of the market and the

general economic circumstances:

“Right now I think differently, today I do it to earn money ... because I

bear a big risk“ (Interviewee 1, p. 9 of transcript, author’s translation).

Interviewer: “Are you satisfied with the development of your

business?“

Interviewee No. 3: “It could be better. The market situation is a

disaster. Well, when we started ten years ago, we had the biggest gym

here in East-Westphalia and … we were so new, all the other gyms were

hardcore bodybuilding gyms … and afterwards they shot up like

mushrooms … Within one kilometer there are meanwhile seven gyms.“

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Interviewer: „The competitive situation is critical?“

Interviewee No. 3: „It is catastrophic” (Interviewee 3, p. 6 of

transcript, author’s translation).

All corporate histories of the analysed gyms were marked by one specific

characteristic. Radical market-related changes led to so far not necessary adaptions

in strategic marketing, because “you have to make more serious efforts, more

marketing, more advertising campaigns, you need more innovative ideas to even

make the people come to the gym” (Interviewee 9, p. 10 of transcript, author’s

translation). Main reason for these adaptions was mostly the dramatic development

of the cost situation, which should be compensated by focusing on sales activities:

“Because of the costs, which occurred for example through the state you

can recognize that you need nearly fifty members more per year to

generate the same profit and that frightens me” (Interviewee 8, p. 12 of


These reactions to influences indicate a change in the self-conception. Due to the

empirical material a development from idealistic to service-oriented organizations

has taken place. Evidences can be found in numerous interview sections and

documents:

“Of course you have to balance, what the prospective customer wants.

For somebody how wants to take part in a group workout or to train his

endurance, it is not useful to offer a preventive back training. You can

offer, but you have to listen carefully, what the people want. You must

be customer-oriented in that moment” (Interviewee 7, p. 2 of transcript,

author’s translation).

“How did you find about us? Why do you start with exercising? Which

wishes do you have, which exercise goals do you want to achieve?

Which body parts do you want to train? What do you think how long you

have to exercise to achieve your goals?” (Anamnestic Questionnaire

Gym 2, p. 1, author’s translation).

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Aspects of customer orientation become more and more important, but are not

internalized by all organizations:

Interviewer: “A prospective consumer subscribes a member. What

comes next?”

Interviewee 4: “Health check consisting of body fat measurement, blood

pressure measurement, mobility test, endurance test, a complete

anamnesis … including health problems, sport-related experience, goals,

possible training frequency, surgeries, chronic diseases like

osteoporosis, rheumatism … acute symptoms” (Interviewee 4, p. 12 of


A comprehensive training guidance and assistance at the beginning of a gym

membership is an indication of professionalism, but this does not necessarily mean

customer orientation as well, because the quantity and quality of this process

should be related to customers’ needs. During the interviews it became apparent,

that the product orientation overlaps the customer orientation. This attitude is

latently based on existing idealistic influences and is represented in the

understanding of quality:

„Well, at least we are committed to fitness with high standard, that

simply means quality of guidance and assistance. People do not come

here just for fun, we accomplish a complete health check, which is also

offered by other gyms, but the important question is always: What is

behind? How much know-how is behind that” (Interviewee 4, p. 5 of


Summarizing the results for the self-conception of commercial fitness gyms it is

obvious, that a professionalization process has taken place, which is accompanied

by a change of self-conception. They understand themselves as qualitative sport

service suppliers. The decipherment of the term quality occurs differently. While

some suppliers equate quality with product orientation, others realized the

necessity of customer orientation and set up their processes accordingly. In the

opinion of the interviewed managers professionalism and quality are directly

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connected to the implementation of exercising programs. How far this appreciation

has been strengthened in the organizations should be shown in the following.

Organizational Culture and Health Promotion

The empirical results revealed a high willingness to change the range of offered

services. This seems to indicate minor barriers for the implementation of exercising

programmes with a health promotion orientation. The majority of respondents see

economic advantages in relation to exercising programmes and services:

„In the past people mainly joined a fitness gym with the motive to build

muscles. Things have changed dramatically. People go to a fitness gym

to stay healthy, to strengthen their back, to improve their motor

function and their endurance“ (Interviewee 6, p. 1 of transcript, author’s

translation).

Advantages of a specialization in exercising result from the

„activities of the health insurances, who permanently push that topic

into the foreground, it becomes more and more important in people’s

perception. And the grants ... which are offered by the insurances are

very attractive for the members“ (Interviewee 6, p. 1 of transcript,

author’s translation).

These prejudices necessarily result in a more health-oriented supply, because there

is a durable necessity for the supplier, to orientate himself according to the

demanders’ requirements. The necessity is even existential according to this

statement:

“I believe that if we did not have these health promoting offers: Would

we still be there? Probably not. Therefore it is clear according to the

market position, also the realm of interests, but mostly the market

position. We have to position ourselves in that scope and in our case

that is especially the health sector. In other gyms, they just got fitness

and strength training, nothing concerned with health” (Interviewee 3, p.

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14 of transcript, author’s translation).

Within the theoretical considerations of this article, it was already mentioned that

decision programmes, communication channels and the staff take a commanding

appointment. Therefore, it is possible to implement programmes which help to

achieve the primary organizational purpose. Furthermore, it was possible to

ascertain a transformation towards professionalization of the management in the

last subchapter. In what way does a strength training oriented culture affect the

necessity to differentiate health offers? The values, according to how a gym was

controlled and supplied his products, haven’t been marked with health-related

issues in the earlier years, because

“twenty years ago, one left the roots of bodybuilding and it was all

about beauty and gaining muscles…about a complete new kind of sport

in general” (Interviewee 11, p.1 of transcript, author’s translation).

This change is also recognizable because of the change and the restructuring of

technical equipment:

“Well, concerning the equipment you can say that at the beginning there

was an upright bike, but no courses. It was quite small at the beginning,

but over the years, the cardio area was remarkably expanded and

professionalized. Meanwhile, we own more than 40 pieces of cardio

equipment” (Interviewee 10, p. 5 of transcript, author’s translation).

The organizational culture is expressed intensely, if, for instance, conflicts

concerning the implementation of innovative programmes occur or not occur. There

is no controversy arising at the explanation of the empirical material; a health

oriented reorientation was conflict-free completed. The commercial attractiveness is

too dominant:

“Primarily it is of course the commercial aspect, we started to question

ourselves, what we can still do with our grounds? We have got a lot of

customers…and we believe that we are able to attach even more customers

because of the health oriented sector of sports and fitness” (Interviewee 6.

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p. 7 of transcript, author’s translation).

Demand satisfactory innovations are connectable without internal conflicts.

Organizational culture does not develop a defense mechanism in order to prevent

such an implementation.

But in what case does such a defense mechanism get promoted? At all times, if the

commercial traceability of certain supplies or structures is questioned because of

indirectly caused impacts (Thiel et al. 2006, p. 41). An Important achievement of

the empirical investigation was the fact, that health promoting exercise

programmes frequently go hand in hand with the necessity of orienting towards

quality.

“In my opinion it will be further important to provide quality in the

fitness sector. The members and new members should say: Oh yeah,

right here we are treated like human beings. There is a certain quality”


An investment in quality does not mean to underestimate the investments

according to the declarations of the operators; especially if it is about certification

of offers by external institutions or associations:

“Each seal is not recognized by everybody. If it was about that, you

were ought to own a lot of seals and that is a matter of money. It is

very expensive and it has to be re-examined every year. And every year

you have to pay it again” (Interviewee 3, p. 12 of transcript, author’s

translation).

Within a difficult business situation, the question arises, to what extent,

organizational culture is impeding the continuation of expensive programmes. As a

result of cost reduction, it would not be possible to fulfill the quality requirements,

which health programmes are ought to have, “because if you reduce the costs,

quality is suffering as well” (Interviewee 1, p. 8 of transcript, author’s translation).

Similar arguments can be found in the following statements:

“Like in every company, you would act then and emphasize different

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aspects that would be more interesting under an economical view”

(Interviewee 7, p. 15 of transcript, author’s translation)

Question: “Would you release cost intensive staff?”

Interviewee 6: “Sure, we already did that in the last years. As I told

you, we now have got only one certainly employed and

four temporary employed people in the gym”


Organizational culture operates in stages of economical problems. Commercial

conditioned incisions in quality of health promoting offers can be completed without

conflicts, although the suppliers act as quality-oriented exercise service providers in

the external image.14

Conclusion

Decision-making processes in commercial gyms are influenced by their

organizational culture. Models of mutability and resistance depend on organizational

culture to a certain extent. This is the case by regarding the question if and to what

extent decision-making processes can be kicked off, which are not fitting to the

self-image of an organization, but are important for change processes.

The decision for expansion of the health-oriented service spectrum follows a

previous modification. As a result of intensification of competitive situations, such

strategic options gradually got access to the facilities that were no longer idealistic

marked, but were distinguished by a strict economical character. In this context,

this can be named as a pressure of professionalization. According to the empirical

material, we can determine a transformation from idealism to market orientation.

Not every changing process necessarily has to go hand in hand with a change in

self-understanding. A specialization in the health sector leads to a modification of

the spectrum of supply, communication and in the personal structure, because a

health promoting programme is oriented towards the fitness demanders. Therefore,

no organizational change has to be done. Because of their merchantability and the

14

One supplier even changed his corporate slogan from “Where fitness is fun” into “Where health is fun”.

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public acceptance, health promoting offers refer to the identity of commercial

gyms. If gyms experience economic trouble despite professionalized health

orientation, conflicts would appear. The maintenance of a necessary level of quality

requires enormous financial efforts and money that is probably not available to that

extent. Expensive health programmes as profit generating products are inevitably

questioned and other options, such as discount strategies become connectable.

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Nutzung, Stellenwert. Berlin: Institut für Sportwissenschaft der Freien Universität Berlin. 24. Schubert, M. (1998). Zur Nachfragestruktur in kommerziellen Fitnessanlagen. Ergebnisse einer

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30. Zarotis, G.F., Athanailidis, I., Tosunidis, A., Katsagolis, A. & Lagerström, D. (2003). Geschichte und Zukunft des Fitness-Sport. Gesundheitssport und Sporttherapie, 19, 15-18.

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6 - ORIGINAL RESEARCH: How exercising women feel about

their bodies and behave in fitness club environment? [Simona

Pajaujiene]

Simona Pajaujiene15

15Lithuanian Sports University. Lithuania, ActiveTraining – Training provider,

Lithuania. EuropeActive – Professional Standards Committee.


Abstract: Girls and women receive constant messages from their social (including fitness)

environment that a thin physique is very attractive. Given increasing public health concerns regarding

low rates of physical activity and prevalence of unhealthy eating and exercising habits, research is

needed to better understand the psychosocial factors which influence exercise participation or resistance

to exercise. The aim of the study was to reveal how exercising women feel and behave in fitness clubs

environment. The research has suggested that women are negatively impacted by the constant pressure

of cultural messages that imply that the female body is a public domain for all evaluate and to

“consume”. Many women were dissatisfied with body weight and chose leisure physical activity for the

weight reduction and figure improvement reasons. The obligatory exercising is featured by the women in

fitness clubs. A large part of participants exercise despite illness or injury for fear to miss training

session. More than half of women dramatically worried about their figures and even feared of other

people opinions about it. These emotional state and behavior can lead to unpleasant experiences during

exercise in fitness environment and decrease the adherence rates. Understanding the factors which

foster negative emotions and unhealthy behaviours of women exercising in fitness centres is important

for health educators and exercise professionals.

Key-words: body image, women, fitness environment, weight loss, exercise

15

Simona Pajaujien, 1970, Kaunas, Lithuania. She has been involved in fitness training, exercise for health and fitness education for over 25 years and currently works as trainer, group fitness instructor, educator, speaker, author and technical expert. She is a lecturer and coordinator for several study programmes at the Lithuanian Sports University since 2004. Research interest: Health Education; Body Image in Sport and Leisure Physical Activity; Weight Control and Exercising Behaviour. She is a program director and founder of accredited vocational training school - ActiveTraining. Member of Professional Standards Committee – EuropeActive. Qualifications: BSc in Sport Sciences (1995); MSc in Public Health – Health and Fitness (2004); PhD in Social Science – Sports Science and Education (2012). More info: ResearchGate LinkedIn


https://www.researchgate.net/profile/Simona_Pajaujiene2/contributions

https://lt.linkedin.com/in/simonapajaujiene

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Introduction

With the prevalence of body cult in the Western society, more and more people feel

pressure to conform to social expectations. Media constantly is bombarding with

the messages how to be fit (thin or muscular), nice and forever young. Therefore,

for many people leisure sports become means to acquire a desired body. In other

words, in consumer society Health becomes an alibi for improving Appearance [1].

The global pandemic of obesity is unquestionable truth with evidence [2], but in

addition another great concern is huge dissatisfaction with own bodies, depression,

anxiety, low self-esteem, unhealthy weight lose behavior, disordered eating, etc.

[3].

There is a big increase of leisure sports facilities across the Europe and especially in

health and fitness sector [4]. Paradoxically, but the increase in facilities that offer

spaces and services related to physical exercise and sports activities was

accompanied by a significant increase in obesity and a sedentary lifestyle [5].

Research suggests that 50% of persons starting an exercise program will drop out

within the first 6 months [6]. A person with low self-worth (i.e., self-doubt,

insecure, negative self-talk) and poor body image is more likely to be an exercise

dropout [7]. Therefore, given increasing public health concerns regarding low rates

of physical activity and prevalence of unhealthy eating habits, research is needed to

better understand the psychosocial factors which influence exercise participation or

resistance to exercise.

So the questions could be raised: Do we know how people feel in the fitness

environment? What are their expectations and behavior? Can exercise professionals

do some harm to customers putting too much emphasis on body and appearance?

Fitness clubs create an atmosphere in which the appearance is in the spotlight. As

usual the fitness environment contains a large number of clearly objectifying

features for people: multiple full-length mirrors, posters that idealize the body, the

opportunity for direct comparison with nice looking fitness instructors and other

participants, tight and revealing (lycra) exercise clothing, etc. People exercising in

fitness centres are observed to raise significant requirements for their appearance,

and sometimes have inadequate body weight perception [8]. Critical comments

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from teacher or trainer can be one of the most patent risk factors for developing

eating disorders [9]. A substantial body of evidence demonstrates that the

excessive emphasis on fitness, incorrect behaviour of trainers, and the environment

of fitness clubs may promote a number of negative consequences. The pursuit of

physical perfection can lead to pathological behavior and poor psychological state

(figure 3).

Figure 3 - Hypothetical links between fitness environment, the pursuit of physical

perfection and negative outcomes.

The researches show that psychological factors play a crucial role in adherence to

physical activity, exercise and fitness [7, 10]. Fitness environment may promote

negative emotions towards own body, and compensatory behaviours after missed

workout session, which can become one of the risk factors of psychological health.

Studies show that exercisers’ body image is an important factor associated with

wellbeing, exercise motivation and specific exercise–related behaviour [11].

Although appearance improvement is the strong driving force for the health and

fitness industry, we lack the millions of men and women in exercise sector. If our

goal is to make Europe more active, we should discuss what could be barriers and

obstacles for that. The analysis of factors which might influence exercise adherence

is an important issue for physical activity promotion.

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The aim of the study is to reveal how women involved in recreational physical

activity feel and behave in fitness clubs environment and identify the links between

the fitness environment and the attitude and behaviour of exercising women.

Methods

Participants

The study sample consisted of 287 Lithuanian women involved in recreational

physical activity in fitness clubs. The sample was selected using a random cluster

sampling approach, i.e. selecting one group of exercising women from each club.

The mean age of the sample was 29.4 years (SD=9). Most of the women were

exercising for figure improvement reason (39.7%), 3-4 times a week (63.1%) for

more than 2 years (46.7%). 39% of women were engaged only in aerobics groups,

33.1% - in GYM, 27.9% combined both types of sports.

Instrument

The attitude of participating women to behavior related to weight loss was

evaluated according to our 41-item questionnaire consisting of variables as weight-

related body image (accuracy of perception of body weight, attitude towards value

of slimness, weight control concerns, current attempts to lose weight, emotions

related to weight control), exercise motivation and obligatory motivation to

exercise, instructor’s encouragement to go on a diet. Internal consistency of the

questionnaire was satisfactory (Cronbach α was 0.7). Test-retest reliability was 0.8

after a 2-week interval of retesting.

Results

Mean BMI of the sample was 21.8±2.9 kg/m² (16.4-36.5 kg/m²). The majority of

the women were normal weight (n=222, 77.4%), 13 (4.5%) were underweight, 52

(18%) - overweight. Despite the fact that majority had normal body weight as

much as 217 (64.4%) women expressed weight dissatisfaction. The majority of

body weight dissatisfied women were in the overweight group, however even

59.9% of women with normal BMI were dissatisfied with body weight too

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(χ²=32.936, df=2, p=0.000). Perhaps this is why most of the women were

exercising for figure improvement reason (39.7%) and 75.3% sought to reduce

their body weight. The most satisfied with body weight were underweight women,

but even 10% of them desired to lose a few kilograms (figure 4).

Figure 4 - Distribution of desirable body weight among BMI groups (χ2=228.3;

df=12, p=0.000).

A significant number of women admitted that slimness and physical attractiveness

are very important life factors, which can determine their career and relationships.

In addition, many women (57.8%) dramatically worried about their figures and

even feared of other people opinions about it. Slimness as a value was very

relevant among overweight and body weight dissatisfied women (p<0.001). These

women also expressed significantly more anxiety and depressive mood about their

figure and weight control when joined fitness club. It is important to highlight that

exercise motivation to improve figure were significantly related with all mentioned

feeling and attitudes (table 8).

Logistic regression analysis confirmed that women with the highest BMI most of all

associated physical attractiveness with body weight. They 2.5 times more as others

confirmed the value of body weight on attractiveness (95% CI: 1.09-5.93) and

even four times as often tended to admit that their achievements in life would have

been greater if they had been thinner (95% CI: 1.97-9.76). Reasons for exercise

were also associated with the drive to lose weight. Women who started exercising

5

33.3

100

10

70.8

61.1

70

22.7

5.6 20

1.5

<18.5 18.5-24.9 24.9-29.9 >29.9

%

Want to gain some weight

Satisfied with body weight

Want to lose a few kg

Wish to lose 10 kg

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for other than health reasons, twice as often admitted that they had obsessive

thoughts about weight control (95% CI: 1.11-3,.), more than twice as often felt

guilty about weight gain (95% CI: 1.43-4.89).

Table 8 - Women`s opinion about value of slimness in life, attitude to their body

and emotional expression in fitness environment by BMI, body weight satisfaction

and motivation groups (%).

Variables

N (%)

Conviction that physica

l

attra

ctiv

eness

depends

on

body w

eig

ht

Conviction that gener

al s

ucc

ess in

life

dep

ends on slim

nes

s

Anxie

ty, depre

ssiv

e m

oods

and

fears

conce

rnin

g o

thers

opin

ions

about th

e fig

ure

Obse

ssio

n w

ith w

eig

ht co

ntrol

when jo

ined fitness

tra

inin

g

The

imag

es in m

irrors

cause

neg

ativ

e em

otio

ns re

gar

ding their

bodies

Com

par

ed their bodies to

the

bodies of o

ther

exe

rcising w

om

en,

and fe

lt th

emse

lves infe

rior

Avo

ids cloth

ing e

mphas

ising their

body

shap

e during sports

%

60.3 44.1 57.8 45.6 90.6 47 29.3

BMI

Underweight

Normal

Overweight

13 (4.5)

222 (77.4)

52 (18)

61.5

55

82.7*

7.7

37.8

80.4**

30.8

55.9

74.5**

15.4

45.5

54.9**

69.2

90.5

96.1*

15.4

41.9

75**

7.7

26.1

48.1**

Attitude to the body weight

Body satisfied

Body dissatisfied

104 (36.2)

183 (63.8)

47.1

67.8**

14.4

61**

36.5

70.3*

21.2

59.9*

76.9

98.4**

18.3

62.8**

15.4

37.2**

Reasons for exercise

Enjoyment

Figure improvement

Health and fitness

78 (27.2)

114 (39.7)

95 (33.1)

47.4

75.4**

52.6

34.6

54.4*

39.4

44.9

74.6**

48.9

28.2

71.1**

29.8

85.9

98.2**

85.1

44.9

61.4**

30.5

17.9

40.4*

25.3

* p<0.05; ** p<0.001

The participants were asked to assess how they feel in a fitness environment.

Results showed that the images in mirrors cause negative emotions for the majority

(90.6%) of women regarding their bodies, 47% compared their bodies to the

bodies of other participants, and felt themselves inferior, therefore, one-third of

women (29.3%) avoids clothing emphasizing their body shape during sports. These

emotions were significantly more expressed among women with higher BMI,

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dissatisfied with own body weight, and exercising for figure improvement reason

(table 8). Interesting, but age was not related to these feelings (p>0.05).

The study revealed that 15.5% of women for weight loss reason reported using

unhealthy weight reduction behaviour (starvation, smoke, use laxatives, diuretics,

diet pills, vomiting, etc.), which is the most evidence in group of dissatisfied with

their body weight women comparing with satisfied participants (81.4% versus

18.6%; χ2=6.03; df=1, p=0.014). This unhealthy practice was also related to

exercise motivation: more women exercising for figure improvement reason

demonstrated this behaviour comparing with women exercising for enjoyment and

health reasons (accordingly 21.9%, 14.9% and 7.9%; χ2=7.57, df=2, p=0.023).

BMI and age were not related to unhealthy behavior (p>0.05).

Dieting is quite widespread among in fitness activity involved women. Our study

found that nearly half of participants (42.7%) practiced frequent and constant

dieting, 41.8% - admitted overeating behavior followed by negative emotion and

feelings of guilt. 8% of women experienced binge eating followed by compensatory

behaviors ( a symptom of bulimia nervosa).

We considered the role of fitness instructor as the most significant factor of fitness

environment. 65.5% of women admitted that instructor is continuously explaining

how to reduce the amount of body fat, and 23% of women were proposed by the

trainer to go on a diet and to use slimming food supplements. Logistic regression

analysis confirmed that instructor`s recommendation to go on a diet and advised

slimming food supplements has a significant influence on physically active

women`s desire to lose weight: they twice as often reported frequent and constant

dieting (95% CI: 1.21-4.26), twice as often displayed overeating behaviour (95%

CI: 1.08-4.08).

In our study large part of women experienced different characteristics related to

the concern and obligatory exercising behaviour. Concern about body image forced

to exercise 87% of women and this emotion was more expressed in groups of

overweight, body dissatisfied, and women exercising for figure improvement

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reason. Fear that without exercising they will gain weight expressed half of the

women (50.9%). The most women with this fear were in dissatisfied with body

weight (p<0.001) and figure improvement (p<0.001) groups. Exercising despite

illness or injury to fear to miss training session confirmed 35.7% of women. It was

significantly more popular among women with normal BMI (p<0.05). After missed

training session 43.6% of participants feel guilty and other depressive feelings.

Surprisingly, but it was more expressed in underweight women group (p<0.05).

These feelings also were more common for body dissatisfied (p<0.05) and

exercising for figure improvement (p<0.001) women (table 9).

Table 9 - Women`s concerns and behaviors in view of obligatory exercising by BMI,

body weight satisfaction, motivation and instructor’s influence groups (%).

Variables

Conce

rn a

bout body

imag

e fo

rce

to e

xerc

ise

Fear

s th

at w

ithout

exer

cising the

body

weight will

gain

Exe

rcising d

espite

illness

or inju

ry fo

r fe

ar

to m

iss training ses

sion

After

a m

isse

d tra

ining

sess

ion fe

el g

uilty,

anxiety

, dep

ress

ion

Com

pen

sato

ry

beh

aviours

after

misse

d

training

%

87.1 50.9 35.7 43.6 40

BMI

Underweight

Normal

Overweight

84.6

85.1

96.2*

30.8

50

59.6

7.7

39.4*

26.9

69.2*

45.5

28.8

38.5

40.1

40.4

Reasons for exercise

Enjoyment

Figure improvement

Health and fitness

75.6

97.4**

84.2

41

65.8**

41.1

33.3

31.6

42.6

42.3

68.4**

53.7

38.5

47.4

32.6

Attitude to the body weight

Body satisfied

Body dissatisfied

77.9

92.3*

37.5

58.5**

42.7

31.7

44.2

63.4*

26.9

47.5**

Women received instructor’s encouragement for

diet and supplements

Yes

No

89.4

86.4

71.2**

44.8

30.3

37.3

68.2*

52.9

54.5*

35.7

* p<0.05; ** p<0.001

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40% of exercising women reported that after a missed training session they take

compensatory actions. The most popular compensatory behaviours after missed

training were limiting food consumption (16.7%) and exercising more intensively

and longer during the next workout (23.3%). BMI, exercise motivation, body

weight evaluation, age were not significantly related to compensatory strategy.

However, the women with the highest BMI “punish” themselves by limiting food,

whereas women with normal BMI exercise for longer periods, and more intensively

during the next workout session (χ=17,86; df=6; p=0.007). Instructor’s

encouragement to go on a diet and use slimming supplements was also related to

the women’s concern and obligatory exercising behaviour. Women with instructor

influence significantly more often expressed the fear that without exercising body

weight will gain (p<0.001), feelings of guilt, depression after a missed training

(p<0.05) and compensatory actions after missed training (p<0.05).

Discussion

Our research has suggested that women are negatively impacted by the constant

pressure of cultural messages that imply that the female body is a public domain

for all evaluate and to “consume”. Many women (even with normal BMI) were

dissatisfied with body weight and chose leisure physical activity for the weight

reduction reasons. More than half of women dramatically worried about their

figures and even feared of other people opinions about it. This emotional state can

lead to unpleasant experiences during exercise in a fitness environment.

Truth be told, many persons are so ashamed of the way they look that they

don’t even want to be seen in public exercising. Because cultural standards for

the feminine beauty are impossible to realize fully, women, who internalize them,

feel shame. This shame is not simply negative feelings about the body, but about

the self [12]. In our study the most negative emotions and the biggest influence of

fitness environment felt overweight women. These results are similar to others

studies where was confirmed that overweight / obese people suffer from

psychosocial stress caused by social pressure to lose weight, have low self-esteem,

are often dieting, are more likely to get depression compared to their peers with

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normal weight [8, 12-13].

Motivation to exercise was very important factor in our research. It was revealed

that women with figure improvement motivation have the most negative attitude to

their body, emotional expression (concern, anxiety, fear, depressive mood) and

compensatory behaviour. Other studies also confirm that exercising for weight

control, body tone, and attractiveness has been associated with increased negative

feelings and outcomes as body dissatisfaction, eating disorders, and lower body

esteem [14]. Thus, exercising motivation related to body shape

improvement can be one of the precursors of problematic body image. It

should be noted that body image concerns are associated with extrinsic exercise

goals particularly with exercising for appearance improvement [14-15]. Self-

determination theory [16], suggests that in exercise domain people pursuing health

and social engagement goals will be more persistent and experience greater well-

being than those pursuing attractiveness or social recognition goals.

The results of our research contribute that part of women in fitness clubs use

unhealthy weight control methods, have overeating and body dissatisfaction

problems. The combination of these factors can lead to overweight, obesity or even

eating disorders [17]. Although many countries have obesity problems, most

attempts to lose weight and go on a diet are made by people of normal weight. The

study revealed that women’s ambition to reduce weight was mostly related not with

the current body weight, but with the belief that they weigh too much. Unhealthy

weight loss behaviors were the most prevalent in body dissatisfied and exercising

for appearance improving women’s group.

The role of the trainer is very important for exercising participants. Instructor`s

recommendation to go on a diet and advised slimming food supplements has a

significant influence on physically active women`s desire to lose weight. The use of

various supplements has become a meaningful part of the fitness culture.

Exercisers’ body image concerns, especially extreme weight and shape controlling

behaviors, were associated with the use of so-called “appearance and performance

enhancing drugs” [18]. Many fitness clubs additionally profit from the sale of food

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supplements, so in this way, trainers are encouraged to be active sellers.

It was revealed that the obligatory exercising is featured by our women in fitness

clubs. A large part of women exercise despite illness or injury for fear to miss a

training session. What does it mean? Researches point out that the time spent

exercising within the fitness centre environment was more highly related to body

image and eating disorders than time spent exercising outside of the fitness centre

environment [14]. Thus, a problematic question remains relevant: is the weight

loss behavior among physically active women induced by the fitness environment

or do they join fitness clubs already being dissatisfied with their body weight? It

should be noted that the usual fitness environment raises the positive emotions and

long-term internal motivation not for everybody. If we want to attract more people

to be more active we have to realize that many people are obese, dissatisfied with

their bodies and with sensitive emotional experiences associated with their bodies.

Weight loss should not always be the primary goal of fitness training. In the most

cases the goal is the overall health – wellbeing, life quality and chronic disease

prevention. The benefits of physical activity are huge [19] and therefore, they

should not be narrowed to the body weight control or figure improvement.

The overview of the study suggests that Lithuanians still do not give adequate

priority for physical activity. Furthermore, they have a wrong imagination about

weight control and exercising behavior. It is also a lack of experience, skills and

knowledge about the health promotion through physical activity and healthy

lifestyle. It is clear that recognition of fitness sector requires a systematic,

multistage and cross-sectional approach to promoting behavioral change, a new

understanding of what it means to be "fit "and what to expect from the trainer as

well as fitness services, promote the political, social, and environmental changes.

Necessary dialogue across different stakeholder communities about the way in

which exercise professionals might be better to meet growing societal need and

expectations place upon them.

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Conclusions

Fitness environment may promote negative emotions towards own body, unhealthy

exercising and weight loss behavior among women. The biggest influence of fitness

environment felt overweight women. The strongest predictors of weight loss

behavior among women exercising in fitness clubs were: body dissatisfaction,

exercise motivation for appearance reason, instructor`s encouragement to go on a

diet and use slimming supplements.

Practical applications

The training environment affects the behaviour of women, and their attitude

to their bodies. Fitness centers should avoid an intensive demonstration of

lean and/or muscular body images and control other factors (i.e., mirrored

walls, advertising) which might foster external motivation in fitness

exercisers of both genders.

Health educators and exercise promoters should make more efforts

changing perceptions of competence by shifting focus from body weight

control to overall feelings of interest and enjoyment. They have client focus

on his/her personal accomplishments and not compare herself/himself to

others.

Educators, coaches, teachers should stop the negative messages about the

bodies and identify the individuality and uniqueness.

Body weight does not reflect the physical condition and physical fitness, thus

unreasonable weight control can cause various health problems.

It is recommended to avoid too frequent and public weighing procedures

and criticism related to body weight and shape. Comments made and

attitudes displayed can have an impact on a person's body image and

attitude towards exercise and eating.

It is important to direct the basic information about nutrition and weight

control for all participants, not just for persons who are overweight.

Educators should focus on the client education on the many health and

lifestyle benefits of exercise, not on weight, and avoid to provide

unsubstantiated information.

Exercise professionals should be more responsible and consider the

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behaviour of women weight loss, preventing the sports of turning into

excessive exercising or addiction.

Is important to note that negative self-esteem or body dissatisfaction does

not develop healthy weight control behaviours, but rather predicts such

behaviour, which can lead to the risk of obesity, eating disorders and lower

health in general.

References

1. Maquire, J. S. (2001). Fit and flexible: The fitness industry, personal trainers and emotional service labour. Journal of Sport and Social, 18, 379–402.

2. Dumith, S. C., Ramires, V. V., Souza, M. A., et al. (2010). Overweight / obesity and physical fitness among children and adolescents. Journal of Physical Activity and Health, 7, 641–648.

3. Sanchez-Carracedo, D., Neumark-Sztainer, D, Lopez-Guimera, G. (2012). Integrated prevention of obesity and eating disorders: barriers, developments and opportunities. Public Health Nutrition, 15(12):2295-309.

4. EuropeActive & Deloitte (2016). European Health and Fitness Market Report 2016. Duesseldorf: Deloitte.

5. Swift, L.D., Johannsen, N.M., Lavie, C.J., et al. (2014). The Role of Exercise and Physical Activity in Weight Loss and Maintenance. Obesity and Obesity Paradox in Cardiovascular Diseases. Progress in Cardiovascular Diseases, 56 (4):441–447.

6. Wilson, K., Brookfield, D. (2009). Effect of goal setting on motivation and adherence in a six-week exercise program. International Journal of Sport and Exercise Physiology, 6, 89-100.

7. Huberty, J.L., Ransdell, L.B., Sigman, C., Flohr, J.A., Schult, B., Grosshans, O., and Durrant, L. (2008). Explaining long-term exercise adherence in women who complete a structured exercise program. Research Quarterly for Exercise and Sport, 79(3), 374-384.

8. Pajaujienė, S. (2009). Kaip sveikatingumo klubų aplinkoje jaučiasi ir elgiasi laisvalaikiu sportuojančios moterys? Sporto mokslas, 4 (58), 62–69.

9. Jacobi, C., Fittig, E., Bryson, S.W., Wilfley, D., et al. (2011). Who is really at risk? Identifying risk factors for subthreshold and full syndrome eating disorders in a high-risk sample. Psychological Medicine, 41, 1939-1949.

10. Trost, S.G., Owen, N., Bauman, A.E., Sallis, J.F., Brown, W. (2002). Correlates of adults participation in physical activity: review and update. Medicine & Science in Sports & Exercise,

34(12):1996–2001. 11. Melbye, L., Tenenbaum, G., Eklund, R. (2008). Self-Objectification and Exercise Behaviors: The

Mediating Role of Social Physique Anxiety. Journal of Applied Biobehavioral Research, 12, 196–220. 12. Jankauskiene, R., Pajaujiene, S. (2011). Disordered eating attitudes and body shame among

athletes, exercisers and sedentary female college students. The Journal of Sports Medicine and Physical Fitness, 2, 52 (1), 92–101.

13. Babio, N., Arija, V., Sancho, C., Canals, J. (2008). Factors associated with the body dissatisfaction in non-clinical adolescents at risk of eating disorders. Journal of Public Health, 16, 107–115.

14. Prichard, I., Tiggeman, M. (2008). Relations among exercise type, self-objectification, and body image in the fitness centre environment: The role of reason for exercise. Psychology of Sport and Exercise, 9 (6), 855–866.

15. LePage, M. L., Crowther, J. H. (2010). The effects of exercise on body satisfaction and affect. Body image, 7(2), 124-130.

16. Deci, E. L., Ryan, R. M. (2008). Self-determination theory: A macrotheory of human motivation, development, and health. Canadian psychology / Psychologie Canadienne, 49(3), 182.

17. Haines, J., Neumark-Sztainer, D. (2006). Prevention of obesity and eating disorders: a consideration of shared risk factors. Health Education Research, 21, 770–782.

18. Hildebrandt, T., Alfano, L., Langenbucher, J. W. (2010). Body image disturbance in 1000 male appearance and performance enhancing drug users. Journal of Psychiatric Research, 44(13), 841-846.

19. Booth, F. W., Roberts, C. K., Laye, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology, 2:1143-1211.

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7 - ORIGINAL RESEARCH: Step-Exercise as a mean of bone

health improvement [Rita Santos Rocha]

Rita Santos Rocha16

16IPS-ESDRM - Polytechnic Institute of Santarém - Sport Sciences School of Rio

Maior, Portugal. UL-FMH-CIPER - University of Lisbon - Faculty of Human Kinetics -

Interdisciplinary Centre for the Study of Human Performance, Portugal.

EuropeActive – Professional Standards Committee


Abstract: Physical exercise has been found to be effective in the prevention of osteoporosis,

especially those activities that include impact loading. Activities such as walking, jogging and stair

climbing, introduce stress to the skeleton through ground reaction forces (GRF). The analysis of GRF

helps to understand the magnitude and pattern of loading experienced by the body while in contact with

the ground. The purposes were to analyse the peak-GRF and loading-rate produced by Step-Exercise in

18 skilled females; and to investigate the effect of stepping-rate and step-pattern. Step-Exercise seems

to produce greater loading than walking and at increased stepping-rates its loading could be compared

to those obtained during comfortable running. Loading can be effectively controlled by varying stepping-

rate and step-patterns during classes. Controlled stepping exercise appears relatively safe with respect

to the magnitude of loading regarding bone health.

Key-words: step, bone health, ground reaction forces

16

Rita Santos-Rocha, 1971, Lisbon, Portugal. Associate Professor at ESDRM-IPS. She has been teaching subjects

such as Physical Activity and Public Health; Exercise Testing and Prescription; and Exercise Biomechanics, since 1998.

Fitness training provider since 1995. Researcher at CIPER-FMH-UL with participation in research projects in the fields

of Active Pregnancy, Active School, Active Ageing, and Biomechanics. Member of the Scientific Committee of the

Gymnastics Federation of Portugal (since 2006). Member of the Professional Standards Committee – EuropeActive

(since 2011). BSc in Sport Sciences (1996); MSc in Exercise & Health (2000); PhD in Human Movement – Health &

Fitness (2006). Past occupations: fitness instructor, group gymnastics trainer and physical education teacher. List of

publications in ORCID | ResearchGate


http://orcid.org/0000-0001-7188-8383

https://www.researchgate.net/profile/Rita_Santos-Rocha

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Introduction

Exercise and bone health

Recreational Exercise aiming to improve or maintain health and fitness refers to a

group of physical activities performed by a large number of participants worldwide,

regardless of age and physical or health status [1]. The main objectives of these

physical activities are to provide healthy mechanical and metabolic stimuli as well

as improve adherence. Exercise professionals must provide effective sessions

according to established principles of training and use several tools [1,2]. Besides

its cardiovascular benefits, the structure of exercise sessions and exercise

prescription, concerning rate and magnitude of skeletal loading, can improve the

osteogenic potential of physical activity [3,4].

Exercise Prescription concerns in a sequence of procedures aiming to adapt the

stimuli of the different forms and modes of Exercise to participant’s goals and

needs, using the information of health and fitness assessment, respecting the main

roles of Exercise and the safety of participants [5,6]. In what is concerned to

health-related cardiovascular Exercise, plenty of well-documented references can

be found in the literature [5,6]. Those include the metabolic expenditure of several

forms of physical activity and the step-by-step case studies developed in order to

adapt the metabolic calculations to meet participants’ goals of losing weight or

improving cardiorespiratory fitness.

To give a figurative example, considering that a person is running for 30 min at a

comfortable speed, this type of exercise could be considered a stimulus that can be

translated into an “aerobic effort whose intensity is about 60% of the maximal

oxygen uptake, which is consuming a certain amount of calories”, or into a

“mechanical effort of which vertical component of the ground reaction force is about

1600 Newton or about two times the person’s body weight, and it has been applied

to 1500 times on each foot”. In the first case, we are referring to the specific

effects of this exercise on the cardiorespiratory system and body composition. In

the second case, we are referring to the specific benefits of this exercise on the

musculoskeletal system and bone health.

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Regarding bone health, bone mineral density, osteoporosis and osteoporotic

fractures have become one of the major health problems in Western countries [7].

As explained by Beck [8], normal physiological loading causes a range of

deformation reactions (strains) in bone, including compression, tension, shear,

torsion, and vibration. Bone exhibits an intrinsic ability to adapt to alterations in

chronic loading to withstand future loads of the same nature (Wolff’s Law).

Adaptation of bone to loading changes occurs via increased modelling and/or

remodelling.

Physical exercise has been found to be effective in the prevention of osteoporosis,

especially those activities that include impact loading [9-13] and progressive

resistance training [14]. Physical activity, particularly weight-bearing exercise, is

thought to provide the mechanical stimuli or "loading" important for the

maintenance and improvement of bone health, whereas it is well-established that

physical inactivity has been implicated in bone loss and its associated health costs.

High-intensity resistance training has the added benefit of influencing multiple risk

factors for osteoporosis including improved strength and balance and increased

muscle mass in older adults [14]. Moreover, the regular participation of young

people (18-22 years) in weight-bearing exercise might be beneficial for accruing

peak bone mass and optimizing bone structure [15].

The load-bearing capacity of bone reflects both its material properties, such as

density and modulus, and the spatial distribution of bone tissue. These features of

bone strength are all developed and maintained in part by forces applied to the

bone during daily activities and exercise, i.e., functional loading through physical

activity exerts a positive influence on bone mass [16]. Lifestyle choices are

attributed to 40% to 60% of adult peak bone mass, and there is strong evidence

for the benefits of physical activity and calcium intake on bone mass accretion [17].

Hinton et al. [18] concluded that 12 months of resistance training or jump training

increased bone mineral density (BMD) of the whole body and lumbar spine, while

resistance training also increased hip BMD, in moderately active, osteopenic men

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(mean age of 44 years). Kemmler et al. [19] concluded that changes of exercise

levels directly or indirectly caused by occupational factors during young adulthood

significantly affected generation and/or maintenance of peak bone mass. Moreover,

physical activity in youth could reduce the burden of fragility fractures since

Exercise-associated bone trait benefits are found long term after retirement from

sports together with a lower fracture risk [20].

Exercise and ground reaction forces

The major biological effects of forces include changes in the development of

biological tissue and transportation of nutrients through the human body [21]. The

effects of biomechanical loading applied on the Musculoskeletal System can be

either biopositives or bionegatives. Regular exposure to moderately high

magnitudes of force is desirable within certain levels, because mechanical stress

will induce adaptation of biological structures, however the same forces might

produce undesirable effects such as discomfort, pain and injury, especially when

forces are too repetitive in a period of time [22,23]. Load repetition generally does

not result in injury during normal activity, although it has been suggested that

repeated impacts such as the collision of the foot with the ground during

locomotion can result in microtrauma [24]. In Sports and Exercise Biomechanics,

two areas of research are of major interest: 1) the quantification or estimation of

the mechanical load acting on the biological structures; and 2) the study of

biological effects of locally acting forces on living tissue; effects such as growth and

development or overload and injuries [25].

Kohrt et al. [26] defined that activities such as walking, jogging and stair climbing,

involves a group of exercises that introduce stress to the skeleton through ground

reaction forces (GRF); and activities such as weight lifting and rowing constitute a

group of exercises that introduce stress to the skeleton through joint reaction

forces (JRF). Both the GRF and the JRF exercise programmes resulted in significant

and similar increases in BMD of the whole body. Nikander et al. [12] performed

research with 255 premenopausal female athletes and referred that the loadings

that arise from high impacts or impacts from atypical loading directions seem to be

effective. Also, the authors reported that high-impact loading (e.g., volleyball) and

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odd-impact loading (e.g., step aerobics and soccer) activities were associated with

the highest BMD of the femoral neck and bone strength (index Z) when compared

to high-magnitude loading (e.g., weightlifting), low-impact loading (e.g.,

orienteering and cross-country skiing), and non-impact loading (e.g., swimming

and cycling) activities. Jämsä et al. [13] studied for the first time the association

between the intensity of physical activity and proximal femur BMD, using a long-

term quantification of daily activity based on the vertical component of the

acceleration. It appears that strength and overall fitness can be improved at any

age through a carefully planned exercise programme.

Understanding the magnitude of loading is important for exercise prescription and

to design rehabilitation programmes. The vertical peak-GRF allows characterizing

movement in terms of biomechanical loading. It has been suggested that there is

an optimal amount of loading that healthy individuals should maintain and that

loading above a certain limit might be related to the risk of injury [27]. High

skeletal loading intensity has been defined as peak-GRF of greater than 4 times

body weight (BW), moderate intensity as 2-4 BW, and low intensity as GRF less

than 2-BW, and a minimum osteogenic effect was related to 1-2 BW [4,10,27]. The

magnitude of GRF has also been associated, although never verified, with the high

incidence of lower extremities injuries in fitness instructors [28]. Nevertheless, the

human body has a number of mechanisms by which load is attenuated. On one

hand, the body has structures such as fat pads on the plantar surface of the foot,

cartilage in the joints and bone, and soft tissues surrounding the bone. On the

other hand, there are also particular motions of the segments that attenuate shock.

In the lower extremity, these include knee flexion, subtalar pronation, and ankle

dorsiflexion [24].

Step-Exercise and osteogenic potential

Step-Exercise, described in a previous study [29], involves a large number of

loading cycles during each session, which might help to meet the recommendation

of 10,000 steps a day [30], and there are several evidence-based studies on its

cardiovascular benefits [31-35]. When Step-ReebokTM programme was created in

1994, its proponents claimed that GRF were similar to those of walking [36]. Miller

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[22] reported that GRF in walking has a maximum value of 1-1.2 BW, and in

running, can achieve 3-5 BW. However, the intensity of the workout depends on

the adaptations of stepping-rate (125-150 beats-per-minute – bpm); and on

selecting the types of movements included in a more or less complex choreography

(e.g., propulsive movements). Usually a Step Exercise class is performed with a

mean (±sd) stepping rate of 135±5 bpm, involving a mean (±sd) number of

loading cycles of 4194.1±1055.2, ranging from 1874 to 7250 [29]. A major concern

is how to control the intensity of the workout, maintaining safe and effective levels

of mechanical load, since the GRF of a Step session depends on the type and

number of movements performed [29].

Several authors referred that Step-Exercise seems to induce greater loading than

walking, and at increased stepping-rates its impact loading could be compared to

those obtained during comfortable running and high impact aerobics, but with a

lower risk of injury [37-47]. Most of these studies reported the effects of vertical

peak-GRF during the descending-phase of basic-step, and only a few references

reported the internal loading during Step-Exercise [38,48].

Moreover, one may be interested in the magnitude or in how fast the force is

increasing or decreasing. The loading-rate describes this behaviour. The

quantification of the initial part of the vertical GRF curve may be effectively

characterized by the loading-rate, due to the absence of an impact peak in certain

cases. It is often assumed that the loading-rate is associated with the development

of movement-related injuries [21].

Purposes

To investigate the differences that exist between four stepping-rate conditions

(125/130/135/140-bpm) and ascending and descending-phases of four step-

patterns (basic-step/knee-lift/run-step/knee-hop) in the vertical-1st-peak (FZ) and

in the vertical-1st-peak loading-rate (LR-FZ), in Step-Exercise. We hypothesized

that Step-Exercise is low to moderate activity, and the step-patterns with

propulsion should present higher load than non-propulsive movements, and loading

increases with faster stepping-rate.

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Methods

Eighteen female (mean±sd age 29.1±6.8 years; body mass 58.9±6.4 kg; height

1.66±0.06 m) with no history of lower limb trauma or disease, volunteered to

participate in the study. These women were experienced fitness instructors who

were graduate in sport sciences and possessed at least 3 years of teaching

experience. They were led through a sequence of 8 stepping tasks: right-basic-

step, right-knee-lift, left-basic-step, left-knee-lift, right-run-step, right-knee-hop,

left-run-step, left-knee-hop. This sequence ensured a mechanical balance between

both lower limbs. No arm movements were added and participants wore similar

shoes. Verbal instruction was provided during the tests. Music was used to maintain

cadence. All experimental trials were conducted in a “crescent cadence” order.

These procedures were adopted so the result would reflect typical class conditions.

Body weight was measured using a force-platform. The subjects were allowed to

familiarize to each speed before data collection, and was given approximately 60-

90s of rest between trials so as to reduce the potential effects of fatigue. Further

description of the procedures can be found in Santos-Rocha et al. [47].

The stepping-up movements were performed on a 17 cm height force-platform

(AMTI) (substituting the step-bench) and on a force-platform (Kistler) on ground

level for stepping-down [46]. The software Acqknowledge-3.7.3. (BIOPAC) was

used to collect GRF at 1000-Hz and process data. Data were smoothed with a

Hamming low pass digital filter of 8-Hz. Peak values were collected and normalized

to BW in Excel (Microsoft). Loading-rate (N/s) was calculated (loading-rate=peak-

force-N/time-to-peak-s) and normalized to BW/s (figure 5).

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Figure 5 - Identification of the peak of the vertical ground reaction force, and the calculation of the loading rate regarding the descending phase of a basic step at

130 bpm, of one of the subjects.

Using SPSS (Statistical Package for the Social Sciences) the vertical-1st peak (FZ) in

BW and the vertical-1st peak loading-rate (LR-FZ) in BW/s were analysed

statistically. Descriptive statistics are reported and a one-way ANOVA for repeated

measures (RM) was used to determine whether there were significant differences

between the conditions of stepping-rate and step-patterns, resulting in two within-

subjects factors. Prior to performing RM, Kolmogorov-Smirnov normality test and

Mauchly’s test of sphericity were conducted. In the cases sphericity was not

assumed the Huynh-Feldt correction was used. The pairwise comparisons with the

Bonferroni confidence interval adjustments were used to identify where differences

could be found. The level of statistical significance was set at p≤.05.

Results

Figure 6 represents the identification of the movements studied, and shows the

phases of reception during which the peak values were collected. The results

showed that during stepping at different cadences the vertical GRF curves were

very regular and repetitive among subjects, despite different interval time among

conditions. We observed the absence of impact peaks in the movements analysed.

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Figure 6 - Vertical components of the ground reaction force of one representative subject at 140 beats per minute. The arrows identify the phases during which the

peak values were collected within the sequence of the 8 Step movements using the

vertical component of the ground reaction force, during the ascending (AMTI Fz) and descending (FZ) phases of the movements: black arrows show basic-step; grey

arrows show knee-lift; black dashed arrows show run-step; and grey dashed

arrows show knee-hop.

Table 10 shows the descriptive statistics of FZ and LR-FZ. Table 11 shows the

results of ANOVA-RM and Bonferroni pairwise comparisons of the parameters

analysed, as well as the summary of the confirmation of the hypothesis. The test of

within-subjects effects has shown no interaction between step-pattern and

stepping-rate in LR-FZ (descending-phase). There was interaction between

conditions in relation to: FZ (ascending-phase, p=0.001; descending-phase,

p=0.011) and LR-FZ (ascending-phase, p=0.002).

0.00000 3.33525 6.67050 10.00575seconds

0.00

144.97

289.94

434.91

N

AM

TI_

Fx

0.00

436.00

872.01

1308.01

N

AM

TI_

Fz

0.00

495.81

991.61

1487.42

NFZ

-315.19

-157.59

0.00

157.59

NFX

Right

Basic

Step

Right

Run

Step

Left

Basic

Step

Left

Run

Step

Right

Knee

Lift

Left

Knee

Lift

Right

Knee

Hop

Left

Knee

Hop

GRFGRF

0.00000 3.33525 6.67050 10.00575seconds

0.00

144.97

289.94

434.91

N

AM

TI_

Fx

0.00

436.00

872.01

1308.01

N

AM

TI_

Fz

0.00

495.81

991.61

1487.42

NFZ

-315.19

-157.59

0.00

157.59

NFX

Right

Basic

Step

Right

Run

Step

Left

Basic

Step

Left

Run

Step

Right

Knee

Lift

Left

Knee

Lift

Right

Knee

Hop

Left

Knee

Hop

GRFGRF

0.00000 3.33525 6.67050 10.00575seconds

0.00

144.97

289.94

434.91

N

AM

TI_

Fx

0.00

436.00

872.01

1308.01

N

AM

TI_

Fz

0.00

495.81

991.61

1487.42

NFZ

-315.19

-157.59

0.00

157.59

NFX

Right

Basic

Step

Right

Run

Step

Left

Basic

Step

Left

Run

Step

Right

Knee

Lift

Left

Knee

Lift

Right

Knee

Hop

Left

Knee

Hop

GRFGRF

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Table 10 - Descriptive statistics of the peak vertical ground reaction force (FZ) normalized to body weight (BW) and of the loading rate of the peak vertical ground

reaction force normalized to body weight per second (BW/s), during ascending phase and descending phase of four Step-patterns (basic-step, knee-lift, run-step

and knee-hop) performed at four stepping-rates (125, 130, 135 and 140 bpm).

BASIC-STEP KNEE-LIFT RUN-STEP KNEE-HOP

BPM 125 130 135 140 125 130 135 140 125 130 135 140 125 130 135 140

ASCENDING PHASE – PEAK FZ GRF (BW)

Mean 1.2 1.2 1.2 1.2 1.3 1.2 1.3 1.3 2.1 2.2 2.2 2.3 1.8 1.8 1.8 1.8

sd 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.2 0.3 0.3 0.2 0.2 0.2 0.2 0.2

Min 1.0 1.0 1.0 1.0 1.0 1.1 1.1 1.0 1.7 1.5 1.6 1.9 1.5 1.5 1.5 1.5

Max 1.4 1.4 1.5 1.5 1.6 1.5 1.5 1.6 2.6 3.0 3.1 2.7 2.1 2.2 2.2 2.2

Range 0.4 0.5 0.4 0.5 0.6 0.5 0.4 0.6 0.9 1.5 1.5 0.9 0.6 0.8 0.7 0.7

DESCENDING PHASE – PEAK FZ GRF (BW)

Mean 1.7 1.7 1.7 1.7 1.7 1.7 1.7 1.8 1.7 1.7 1.8 1.8 1.6 1.6 1.6 1.6

sd 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.3 0.2 0.2 0.3 0.2 0.2 0.2 0.3 0.3

Min 1.3 1.3 1.3 1.2 1.2 1.3 1.3 1.3 1.4 1.3 1.4 1.4 1.2 1.2 1.1 1.1

Max 2.1 2.1 2.1 2.2 2.0 2.3 2.1 2.3 2.2 2.4 2.3 2.3 2.0 2.2 2.0 2.1

Range 0.7 0.8 0.8 1.0 0.8 1.0 0.8 1.0 0.8 1.1 0.9 1.0 0.8 1.0 1.0 1.0

ASCENDING PHASE – LOADING RATE PEAK FZ (BW/s)

Mean 5.8 5.9 6.0 6.3 4.9 5.1 5.1 5.5 8.7 9.0 9.2 10.2 6.5 6.8 6.6 7.2

sd 0.9 1.0 1.2 1.3 0.8 0.7 0.6 0.6 2.1 2.0 1.8 1.5 1.0 1.3 1.1 1.0

Min 4.0 3.9 4.1 4.1 3.5 3.9 4.1 4.4 5.4 4.8 5.7 6.8 4.5 4.8 4.9 5.3

Max 7.3 8.2 8.9 9.3 6.4 7.2 7.4 6.9 14.1 13.5 13.1 13.1 8.4 10.4 9.7 9.1

Range 3.3 4.3 4.7 5.2 3.0 3.3 3.4 2.5 8.7 8.7 7.4 6.3 3.8 5.6 4.8 3.8

DESCENDING PHASE – LOADING RATE PEAK FZ (BW/s)

Mean 8.1 8.2 8.5 8.5 7.4 7.9 8.3 8.5 7.8 8.3 8.5 8.5 7.4 7.5 7.8 7.7

sd 1.4 1.3 1.8 1.6 1.1 1.6 1.7 1.7 1.3 1.7 1.6 1.3 1.2 1.8 1.7 1.5

Min 4.9 5.9 6.3 5.8 4.7 4.5 5.8 5.1 4.7 6.2 5.2 6.3 4.4 4.8 4.8 5.4

Max 10.9 11.1 12.8 12.5 9.4 13.5 15.6 13.1 10.4 12.8 12.1 11.9 10.7 13.2 12.3 11.0

Range 6.0 5.2 6.5 6.7 4.8 9.0 9.7 8.0 5.6 6.7 6.9 5.6 6.3 8.4 7.5 5.6

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Table 11 - Summary of the results of the statistical analysis (ANOVA repeated measures) performed with vertical peak ground reaction forces (FZ) parameters.

Significantly statistical differences (p≤0.050) were found among the following conditions of stepping-rate and step-pattern.

STEPPING-RATE STEP-PATTERN

Peak FZ ascending phase

ANOVA-RM F(3,105)=12.652 (p=0.000) All (p≤0.013); except 125-130 bpm; except 135-140 bpm Increases as stepping-rate increases Hypothesis confirmed

F(2.086,73.005)=441.251 (p=0.000) All (p=0.000) Greater values in run-step Hypothesis confirmed

Peak FZ descending phase

F(3,105)=5.901 (p=0.001) 125-135 bpm (p=0.001); 125-140 bpm (p=0.015) Increases as stepping-rate increases Hypothesis confirmed

F(2.200,77.000)=14.301 (p=0.000) basic-hop (p=0.000); knee lift-hop (p=0.003); run-hop (p=0.000) Hypothesis not confirmed

Loading rate FZ ascending phase

F(3,105)=17.838 (p=0.000)

125-140 bpm (p=0.000); 130-140 bpm (p=0.000); 135-140 bpm (p=0.000) Increases as stepping-rate increases Hypothesis confirmed

F(2.398,83.925)=147.162 (p=0.000) All (p=0.000) Greater values in run-step Hypothesis confirmed

Loading rate FZ descending phase

F(2.715,95.041)=8.432 (p=0.000) 125-135 bpm (p=0.000); 125-140 bpm (p=0.000) Increases as stepping-rate increases Hypothesis confirmed

F(3,105)=8.770 (p=0.000) basic-hop (p=0.000); run-hop (p=0.003) Hypothesis not confirmed

Discussion

The GRF may provide a surrogate measure of the strain experienced by bone on a

variety of loading activities such as Step movements [47]. The analysis of GRF has

shown that higher loads occur during the reception on the step-bench (in

propulsion movements: run-step and knee-hop) and during the reception on the

ground (in non-propulsion movements: basic-step and knee-lift). The results of FZ

in basic-step (descending-phase) were greater than those reported by other

authors that used slower cadences (120-bpm) [37,38,42] but are in line with those

obtained by Teriet and Finch [40]. In knee-lift (descending-phase) the results were

greater than those reported by Farrington and Dyson [37] that used slower

cadences (120-bpm). The results in both phases are in line with those obtained by

Panda [49]. In run-step the mean FZ was 2.3-BW (ascending-phase) and 1.8-BW

(descending-phase). Tagen and Zebas [50] reported 2.5-BW during ascending-

phase of run (126-bpm). The results of FZ in knee-hop (ascending-phase) are in

line with those reported by Machado and Abrantes [45] that also used slower

cadences (120-bpm). The results for both phases of all movements performed at

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130 and 140-bpm were around 0.1-0.2 smaller than those obtained in our previous

studies using pressure insoles [46]. Therefore, Step-Exercise seems to produce

greater loading than walking and at increased stepping-rates its loading could be

compared to those obtained during comfortable running [22].

The results obtained for vertical peak-forces suggest that Step-Exercise is a low to

moderate activity, depending on the inclusion of non-propulsion or propulsion, and

stepping-rate (with experienced participants). Teriet and Finch [40] suggested that

the faster loading and unloading-rates of the musculature due to the faster

stepping-rates (122 to 130-bpm) caused less control of the movement, resulting in

a 4% increase in the FZ and therefore, the use of faster tempos in a beginning level

class could be a source of elevated risk for potential injury. Our results support the

conclusion of Scharff-Olson et al. [41] that experience with Step-Exercise may

afford an ability to make uniform and force-absorbing adjustments in FZ at

increased speeds.

The time of peak FZ, ranged 0.20-0.28s (ascending-phase) and 0.21-0.22s

(descending-phase). The interval time decreased with stepping-rate, meaning that

the same movement has to be performed in the same form but with less time. This

is reflected by the increase in loading-rate. Loading-rate was associated to 77 BW/s

in running speed at 3m/s [22]. In the present study, the mean LR-FZ increased

with stepping-rate, and the greatest value was found in ascending-phase of run-

step. In descending-phase it increased significantly with stepping-rate. The larger

peaks and loading-rates indicate a loss of shock absorbing capacity. This might

increase their susceptibility to lower extremity overuse injuries.

The results indicate that lower extremity external loading can be effectively

controlled by varying stepping-rate during Step classes, and by choosing

movements mechanically similar to those analysed in the present study. As an

example, the run-step clearly induced greater forces and loading-rate, which might

be more related to injury.

These findings indicate the relative contributions of stepping-rate and different

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choreographic movements to the external forces experienced during Step-Exercise.

Further research is needed focusing other step-patterns in order to select those

that are more appropriate to be included in Exercise and Rehabilitation

programmes. The present investigation provides biomechanical data that may be

used as a basis for comparison with patients, older adults and beginners that

participate in Step classes. However, the present results are based on a sample of

18 experienced and physically active instructors, thus, both kinematics [51] and

force characteristics of the tasks may be different if participants with less

experience in Step are involved, and establishing norms for other populations

requires understanding other factors that affect GRF.

Implications for practice

Our results showed that increasing step frequency leads to an increase in the

mechanical load, which appears to be supported by adaptations of the movement

technique which might be related with the increasing GRF. However, if technique

adaptations occur, especially in the knee joint, together with greater GRF and

moments of force and decreased time for contact and force transfer, the stepping-

rate, being one of the most important determinants of exercise intensity,

particularly above 135-bpm, should be chosen carefully in classes, having always in

consideration the participants’ experience in this activity.

The results contribute to understanding how skilled participants deal with the

increase of the external load during Step-Exercise. Skilled participants appear to

control the increase of stepping-rate by means of knee and ankle adaptations.

These joints might be at greater risk of injury in the case of overuse, especially the

knee joint. In order to prevent injury, proper instruction should be provided in

relation to foot placement on the step-bench and on the ground, as well as

information concerning knee flexion. Our results indicate that lower extremity

external loading can be effectively controlled by varying stepping-rate during Step

classes and selecting step-patterns. The results are also relevant to determine

which movements and cadences can be recommended to be included in

rehabilitation or sports programmes where walking and running are prescribed.

Assuming that walking or running are “safe” activities to be included in exercise

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programmes, oriented stepping exercise appear relatively safe with respect to the

magnitude of loading.

Conclusion

Step-Exercise is performed using music that sets movement cadence which

involves the repetition of exercises that induce peak-GRF of low magnitude

moderate activity (1-2.5 BW), depending on step-patterns included, but of high

frequency (3750-4050 loading cycles during a 30-min session), depending on the

stepping-rate, using music speed at 125/135-bpm, that may be recommended for

bone health improvement.

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27. Shaw, J.M., Witzke, K.A. & Winters, K.M. (2001). Exercise for skeletal health and osteoporosis prevention. In: Hauber, M. (editor), ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription (4th ed). Baltimore: Williams and Wilkins, Ch 34.

28. Rousanoglou, E.N. & Boudolos, K.D. (2005). Ground reaction forces and heart rate profile of aerobic dance instructors during a low and high impact exercise programme. Journal of Sports Medicine and Physical Fitness, 45(2), 162-170.

29. Santos-Rocha, R., Oliveira, C. & Veloso, A. (2006). Osteogenic index of Step-Exercise depending on choreographic movements, session duration and stepping-rate. British Journal of Sports Medicine, 40, 860-866 (published online 18 Aug 2006; DOI: 10.1136/bjsm.2006.029413).

30. Wilde, BE; Sidman CL & Corbin, CB (2001). A 10,000-step count as a physical target for sedentary women. Research Quarterly in Exercise and Sport, 72(4), (pp 411-414).

31. Stanforth, D., Stanforth, P.R. & Velasquez, K.S. (1993) Aerobic requirement of bench stepping. International Journal of Sports Medicine, 14(3), 129-133.

32. Scharff-Olson, M., Williford, H.N., Blessing, D.L. & Brown, J.A. (1996). The physiological effects of bench/Step-Exercise. Sports Medicine, 21(3), 164-175.

33. Kin Ilser, A., Kosar, S.N. & Korkusuz, F. (2001). Effects of step aerobics and aerobic dancing on serum lipids and lipoproteins. Journal of Sports Medicine and Physical Fitness, 41(3), 380-385.

34. Kraemer, W.J., Keuning, M., Ratamess, N.A., Volek, J.S., McCormick, M., Bush, J.A., Nindl, B.C., Gordon, S.E., Mazzetti, S.A., Newton, R.U., Gómez, A.L., Wickham, R.B., Rubin, M.R. & Hakkinen, K. (2001). Resistance training combined with bench-step aerobics enhances women’s health profile. Medicine & Science in Sports & Exercise, 33(2), 259-269.

35. Ohta M, Eguchi Y, Inoue T, Honda T, Morita Y, Konno Y, Yamato H, Kumashiro M. Effects of bench step exercise intervention on work ability in terms of cardiovascular risk factors and oxidative stress: a randomized controlled study. Int J Occup Saf Ergon. 2015;21(2):141-9. doi: 10.1080/10803548.2015.1029293. PubMed PMID: 26323772.

36. Reebok University Press (1994). Introduction to Step Reebok. Stoughton: Reebok International, Ltd.

37. Farrington, T. & Dyson, R. (1995). Ground reaction forces during step aerobics. Journal of Human Movement Studies, 29, 89-98.

38. Bezner, S.A., Chinworth, S.A., Drewlinger, D.M., Kern, J.C., Rast, P.D., Robinson, R.E. & Wilkerson, J.D. (1996). Step aerobics: a kinematic and kinetic analysis. In: Wilkerson, J.D. et al. (editors), Proceedings of the XV International Symposium on Biomechanics in Sports. Denton, Texas: Texas Women’s University Press, 252-254.

39. Hecko, K. & Finch, A. (1996). Effects of prolonged bench stepping on impact forces. In: Abrantes, J. (editor), Proceedings of the XIV International Symposium on Biomechanics in Sports. Lisbon: Edições FMH, 464-466.

40. Teriet, C.R. & Finch, A.E. (1997). Effects of varied music tempos and volumes on vertical impact forces produced in step aerobics. In: Wilkerson, J.D. et al. (editors), XV International Symposium on Biomechanics in Sports. Denton, Texas: Texas Women’s University Press, 148.

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41. Scharff-Olson, M., Williford, H.N., Blessing, D.L., Moses, R. & Wang, T. (1997). Vertical impact forces during bench-step aerobics: exercise rate and experience. Perceptual Motor Skills, 84, 267-274.

42. Maybury, M.C. & Waterfield, J. (1997). An investigation into the relationship between step height and ground reaction forces in Step-Exercise: a pilot study. British Journal of Sports Medicine, 31, 109-113.

43. Wieczorek, S.A., Duarte, M. & Amadio, A.C. (1997). Estudo da força reação do solo no movimento básico de “step” (in Portuguese). Revista Paulista de Educação Física, São Paulo, 11(2), 103-115.

44. Williford, H.N., Richards, L.A., Scharff-Olson, M., Brown, J., Blessing, D. & Duey, W.J. (1998). Bench stepping and running in women. Changes in fitness and injury status. Journal of Sports Medicine and Physical Fitness, 38(3), 221-226.

45. Machado, M.L. & Abrantes, J. (1998). Basic-step vs. power step: peak values of vertical GRF analysis. In: Hartmut et al. (editors), Proceedings of the XVI International Symposium on Biomechanics in Sports. Universitatverlag Konstanz Gmbh, 514-517.

46. Santos-Rocha, R. & Veloso, A. (2007). Comparative study of plantar pressure during Step-Exercise in different floor conditions. Journal of Applied Biomechanics, 23, 158-164.

47. Santos-Rocha, R, Veloso, A & Machado, ML (2009). Analysis of ground reaction forces in step-exercise depending on step-pattern and stepping-rate. Journal of Strength and Conditioning Research. 23(1), January 2009, 209-224. DOI: 10.1519/JSC.0b013e3181889119.

48. Santos-Rocha, R, Veloso, A, Machado, ML, Valamatos, MJ & Ferreira, C (2009). Peak ground and joint reaction forces in step-exercise depending on step-pattern and stepping-rate. The Open Sports Sciences Journal. 2, 10-21. DOI: 10.2174/1875399X00902010010

49. Panda, M.D.J. (2003). Estudo Dinâmico dos Principais Passos do Step Training. Master thesis (Portuguese). Brasil: Centro de Educação Física, Fisioterapia e Desportos - Universidade do Estado de Santa Catarina (not published).

50. Tagen, L.S. & Zebas, C.J. (1996). Ground reaction forces of three propulsive movements in step aerobics. Medicine & Science in Sports & Exercise, 28 (5), abstract 155.

51. Santos-Rocha, R, Veloso, A, Valamatos, MJ, Machado, ML & André, HI (2009). Analysis of kinematics of the lower limb during step-exercise. Perceptual and Motor Skills. 109, 3, 851-869. DOI: 10.2466/pms.109.3.851-869

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8 - PRACTICE UPDATE: How can we motivate the "unsocial"

children in Fitness classes? [Eljona Spaho]

Eljona Spaho17

17Fitness Advisor and Personal Trainer at Charlottehaven Fitness. Group Fitness

Instructor at Fitness World in Copenhagen, Denmark.


Abstract: Nowadays teaching people becomes more and more challenging. In my classes I encounter

difficult people that is why I sat down many days read different scientific articles and books and by

combining the theoretical approaches with my many years work experience I came up to a solution

which helps me a lot in my work. Now I want to share it with all the other teachers.

When we teach we should consider that people are different, considering their resources and

backgrounds. In order to tackle the difficult ones we should try to understand their resources and

backgrounds and instead of thinking of them as a problem, we should try to find a solution that requires

collaboration and adaptation to their current resources and backgrounds. In this article, I apply this

approach when we encounter difficult children/members in fitness classes, but it can be applied in any

teaching situation.

Key-words: motivation, children, fitness

17

Eljona Spaho has a Master's Degree in International Business from Copenhagen Business School and is a Group Fitness Instructor, Personal Trainer and Fitness Nutritionist certified in USA and Denmark. Have been working since 2010 in fitness industry, teaching people of all ages. Furthermore have 2 years’ experience with teaching students at the University.


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Introduction

My focus with this article is how to include the children with antisocial behaviors, in

fitness classes, where they don’t disturb the teaching, and even behave good and

have good results in their training. The postmodern society focuses on the

individual and on how individuals can contribute to family, community and work.

We see suddenly for schools or other institutions that mediate different knowledge

and skills to the children that the challenge is no longer only the academic

difficulties but the social ones18. Antisocial children signal the risk for future

difficulties; both for the individual and for society as a whole such as poor

adaptation to working life, family problems, high risk of school dropout etc.,19

therefore, we play as instructors a very important role, not only to teach fitness but

also to raise children with interpersonal skills.

I teach fitness in a class where Joanne is a child 10 years old. She is not focused in

the class; she does not listen and destroys the teaching for the others. My

colleagues informed me that she was just a difficult child, and was tackled by

criticizing her and trying to convince her to attend the class without disturbing. This

approach was energy consuming and not very helpful because every time she

stopped for a while, she started again and again. I decided to study more closely

this issue and come up with new solutions that I will show through this article.

How can we motivate the "unsocial" children/members in fitness

classes?

In order to answer this question, I will focus on the problematic questions below

that support the overall theme's subject.

Problematic questions:

How can we motivate the children/members from their perspective?

What should we do as teacher/instructors to motivate the

children/members?

How can we involve the parents?

18

Positive behavior and supportive learning environment in school, A. Arnesen, T. Ogden, M.A. Sørlie, 2008, 13 19

Positive behavior and supportive learning environment in school, A. Arnesen, T. Ogden, M.A. Sørlie, 2008, 15

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How can we adopt our teaching method?

How can we motivate the children/student/member?

I will try to answer this by focusing on a student/child's perspective.

There is a too large spread between individual' abilities and there are children who

are being distracted and restless. There is said of an "MTV generation" who learned

to zap between channels for what is interesting and a "Nintendo generation" who

choose faster and switch to something else if the contents are not catchy. Each

person is unique. We all have the same basic systems-features, yet we are all

different. Our differences are due to genetic conditions, different ways of thinking,

different talents, etc. Because we are different, it is important to maintain a high

degree of freedom in learning situations20.

In my work as a fitness teacher with the "unsocial" child/member I thought to

tackle Joanne in a different way, not to criticize her. I began to think about how I

could turn all the waste of energy on my side, from trying all the time to convince

her to participate in the education process, to find a way that could benefit us all.

In order to do that I considered different theories and other possible solutions.

I thought one cause of her not following the teaching could be because her skills

are higher or lower than the challenge of teaching, she is exposed.

Csikszentmihalyi21 has created a model that illustrates how learning is considered in

relation to the skills and the challenge of teaching (figure 7). The optimal learning

and wellbeing occurs when there is a balance between children's skills and training

challenge. Not optimum learning and well-being occurs when the challenge is

greater or less than the skill.

I will suppose that the child’s skills are greater than the challenges of fitness

teaching she was exposed. In order to examine the child’s skills, I used the

Activity Triangle Model22 (figure 8).

20

Play, learning and creativity, why happy children learn more, H. H. Knoop, 2002, 71 21

Play, learning and creativity, why happy children learn more, H. H. Knoop, 2002, 48 22

Focus, Journal of Sports Science, 1 February 2009, 33 rd ed., page 21

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Csikszentmihalyi model

High Anxiety

Challenge Flow-Optimal

learning

and well-being

Low

Boredom

0

Low Competence High

Figure 7 - Flow-The natural balance between challenges and skills

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Repeat

Control the skill gained

Experiment Competition

Examine the skills Use the skills

Figure 8 - Activity Triangle

After I had examined the child's skills, I made the exercises a little more difficult in

order the challenge to live up to her already gained skills. When making a program

the teacher must take into account the skills of the children/members in order to

provide them the right challenges. For example, if there is a wide disparity in the

children/members skills the teacher should not make many competitive exercises

but try to find some exercises where everyone can participate. When working with

children is very important to consider their resources and ideas23.

In conclusion, each person is unique. The teacher/instructor must take into account

the children's skills. To ensure that all children/members must attend classes and

get an optimal learning and well-being the challenge must be adapted to the skills.

It is important to turn the negative energy caused by the mismatch of skill with

challenge into something positive and constructive, so the children/members get

something out of the teaching.

23

Intervention in school, J. N. Murphy and B. L. Duncan, 2008, 51

Activity

Triangle

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What should we do as teachers/instructors to motivate the

children/members?

Do you thrive as a fitness instructor with your work? Often it is difficult to work with

unfocused and troubled children, and there are too many differences between the

individual children's abilities in relation to fitness learning. The fitness teacher

maybe thrives by working with his interest, but to work with the children is very

demanding. The relationship teacher/student is a mutual relationship. It is the

student's job to be open to the teacher's teaching but he or she must also show

interest in the teaching. Therefore, the teacher/instructor must be inspiring. When

working with children it is particularly important that the teacher/instructor is

aware of its resources and ideas. What characterizes the skilled and well-liked

teacher is that he is motivated, dedicated, inspiring, captivating, brave,

experimental, is in control and has empathy, is professional competent, has a

positive and pleasing personality, shows interest, etc. The teacher/instructor should

show personal dynamism and charisma. These has partly to do with body language,

use of voice, enthusiasm, eye contact and the distance and location relative to the

student or students when teaching. The teacher/instructor must be responsive and

open to suggestions and requests. This will allow the students/members to have far

more influence and probably feel more freedom and interest24.

The teacher can also use the PALS (Possitive, Attidude, Learning, Support)

model25 that focuses on positive behavior, supportive learning environment and

interaction. The teacher/instructor must make sure to get positive personal contact

with every student/member during a lesson.

The "unsocial" child/member had experienced only criticism from the other

teachers/instructors. I was wondering how I could get a positive contact with her,

that she saw me as a teacher/instructor who likes her and think positively about

her. After I adjusted the challenge of teaching, I saw that she participated in class

and was no longer disturbing because she was occupied in doing the exercises that

matched her skills. I started to say in front of the class how good she did the

exercises. She was very happy because before she had experienced only criticism

from the previous teachers/instructors.

24

Focus, Journal of Sports Science, 1 January 2004, 28th ed., page 29

25 Positive behavior and supportive learning environment in school, A. Arnesen, T. Ogden, M.A. Sørlie, 2008, 15

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In conclusion, the teacher/instructor plays an important role in motivating the

children. If we as teachers/instructors work to find ways to solve student issues in a

positive and constructive way this benefits both the children and the

teacher/instructor.

How can we involve the parents?

The teacher/instructor must be professional, friendly, reliable and have a good

conversation with the parents. Whether you are parent or teacher, you both want

the best for the child. There is a distinction between primary and secondary

socialization. The primary socialization occurs in the family. The secondary takes

place in school. Therefore, it is important to investigate the role of families in the

socialization26.

I was wandering if the "unsocial" child’s behavior had also something to do with the

upbringing. According to Ericsson's Socialization Stages Model27 the child goes

through some development stages (table 12).

Table 12 - Ericsson’s Socialization Stages Model

Life stage / age of

the child Challenge - what needs to be learned

Infant Basic trust over distrust. The child must learn to feel safe, it's nice to be here in the world

2-3 years old Independence over doubt. The child must experience a self-esteem that they have the

right to demand while respecting others

4-5 years old Initiative over blame. The child must learn to act with determination and at the same time

learn that cannot handle everything

6-12 years old Ability over inferiority. The child must learn to complete tasks and resist the feeling of

inferiority when the task is too severe

After I spoke with the parents of the "unsocial" child, I understood that the parents

had not been able to raise their child as good as possible in the 2-3 years’ phase

"the child should experience such esteem that it has the right to require respect

and to respect others". Therefore, I told the parents to work with their child and

teach her at home "to respect others".

26

Parental cooperation, C. Højholt, 2005, 102 27

Life in Denmark, B. Jakobsen and O. Outzen, 2004, 17

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The school/gym environment is different than at home where the small community

can be better organized. The child at school/gym must learn to be part of an

environment that is different from home environment. When one thinks about

school/gym environment one think of it primarily as a learning institution, but

parents see it also as an environment where their children learn to interact socially.

They want their children to learn to work together, resolve conflicts together in

other words to be part of a community. Therefore, the parents should collaborate

with the teachers to help each other in educating social children28.

In conclusion, the parents should collaborate with the teachers. Parents play an

important role in the motivation of children and together with the

teachers/instructors should educate social children.

How can we adopt our teaching method?

It has been much research into learning principles. We can distinguish between four

different types of learning processes: habituation, classical conditioning, operant

conditioning and complex learning29.

Habituation is the learning process through which we learn, is the "habit", a habit

that we no longer need to use mental energy/attention to it. Habituation is often

the reason why we are bored as monotonous repetitions will stimulate us less and

less. In order not to make teaching monotonous and in particular to stimulate the

"unsocial" children the teacher can try to vary the elements of teaching as shown at

the Activity Circle30 (figure 9).

28

Collaboration on children’s development, C. Højholt, 123-125 29

Play, learning and creativity, why happy children learn more, Hans Henrik Knoop, 2002, page 61-64 30

Focus, Journal of Sports Science, 2 May 2005, 29th edition, page 11

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Figure 9 - Activity Circle

The teacher can use various tools to make the same exercise interesting, change

the participants, etc.

Classical conditioning is the learning process through which we learn that a

stimulus follows another. We can connect different experiences, i.e., develop phobic

reactions if we don't like the experience. If the child/student has a bad experience

with fitness every time he hears the word fitness, he will become irritated or

develop phobic reactions such as become nauseous. If we keep only criticizing the

"unsocial" child/student/member, there will come a time when she will associate

fitness with a negative experience, which may result in that she will stop coming to

classes. On the other hand, the school is interested in increasing participation,

therefore it should be a positive experience to go to fitness.

Operant conditioning is a learning process where we learn that an active action

causes a certain consistency. For example, if the children are praised for helping

with teaching, the greater the likelihood that they participate more actively in the

class in the future. We are attracted to situations where we have experiences

where we do well. In order to provide positive experiences to the "unsocial" child I

Rules Focus Participants

Action Activity’s Circle Time

Tools Space

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should praise her when she does something good also in front of the parents, which

will result in more active participation in class next time.

Complex learning is the most advanced form. The following criteria are very

important in this learning process:

The new knowledge should preferably contribute to the person's overall set

of competencies.

Children/members should feel that what they learn gives them more

freedom by giving them new opportunities.

The new teaching should preferably not be too hard to learn. This includes:

Be careful not to overwhelm children/members with a lot of teaching.

Should not be too strong contrast to the person's already established ways

of thinking-meet the child/member where it is and let this be the starting

point for its learning.

The new exercises should be preferably easy to demonstrate and

communicate.

The new exercises should preferably be something that the person wants to

share with others.

Considering all this theoretical background I try to create a positive experience and

in a constructive way with the "unsocial" child/member. I allow her to help me

during the teaching for example by using her as a model during exercises

presented in front of the class. By providing all these positive experiences at the

end, we will have a child/member changed from "unsocial" to a highly motivated

child who on her own initiative helps the teacher and tells proudly about it to her

parents.

In conclusion, the fitness teacher/instructor must ensure that teaching does not

become monotonous and boring. Furthermore, the teaching should be fun, so the

children/students/members associate it with an exciting and fun experience. Fitness

teachers must praise the children/student/member when they do well, by doing so

they will attract them to participate more actively in class in the future.

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Discussion

I wrote this article to figure out how to motivate the "unsocial"

children/students/members to the fitness classes and I came up to these

conclusions and practical recommendations.

In your daily teaching work when you encounter the “unsocial” ones consider that

each person is unique, according to their skills. This is the reason why in order to

get an optimal learning and well-being the challenge must be adapted to the skills.

By doing so we turn the negative situations caused by the mismatch of skill with

challenge into positive and constructive situations, where the children/members

learn and behave well. For example, if you have a child/student/member who

considers the exercises boring because her skills are higher than the level of fitness

exercises she is exposed, you can give her extra challenges and she will stop

disrupting the teaching because the challenges will be the same as her level of

skills.

You as teachers/instructors play an important role in motivating the children by

being positive and constructive rather than criticizing and arguing with the children.

You as parents should collaborate with the teachers to educate social children; if

you work together, you will support each other. It is not enough, if only the teacher

tries to educate your child and at home, he still keeps being “unsocial”.

Furthermore, if the parents of the children do not collaborate with the teacher, the

teacher cannot decipher the children's behavior. Through conversation with the

parents, the teacher finds out which phase of appropriate upbringing he/she is

missing, where the parents should especially focus on to correct at the home

environment.

The fitness teacher/instructor must ensure that teaching does not become

monotonous and boring but fun, so the children/students/members associate it with

an exciting and fun experience. Fitness teachers must praise the

children/students/members when they do well, by doing so they will attract them to

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participate more actively in class in the future, it helps changing their behavior and

way of being in class and the manner in which they participate in teaching. If we

experience the child is inactive and not participates and even annoys the other

children for example by being aggressive and teasing, if we implement the new

teaching tools, the fitness classes will alter, and the children/members will

participate actively and their behavior will change positively.

Overall Conclusion

As an overall conclusion and recommendation, I can say that the "unsocial"

children/members can be motivated by taking into account their social and fitness

skills. By increasing the cooperation between the teachers/instructors and parents

and adopting the teaching to the individual child/student/member. Not criticize but

tackle them positively and in a constructive way.

References

1. Arnesen, Anne; Ogden, Terje; Sørlie, Mari-Anne; Klausen, Honoré M. Positiv adfærd og støttende læringsmiljø i skolen (Positive behavior and supportive learning environment in school).; 2008. 13, 15 p. ISBN-13: 9788772812588

2. Fokus (Focus), Journal of Sports Science, 1 February 2009, 33d edition 3. Fokus (Focus), Journal of Sports Science, 1 January 2004, 28th edition 4. Fokus (Focus), Journal of Sports Science, 2 May 2005, 29th edition 5. Højholt, Charlotte. Højholt Ch and other editors. Forældresamarbejde: forskning i fællesskab

(Parental cooperation: research in community), 2005. 102 p. ISBN 87-7706-470-4 6. Højholt, Charlotte. Samarbejde om børns udvikling (Collaboration on children's development),

2001. 123-125 p. ISBN-13: 9788700486881 7. Jakobsen, Benny and Outzen, Ove. Liv i Danmark (Life in Denmark).; 2004. 17 p. ISBN 978-87-

7970-105-2 8. Knoop, Hans Henrik. Leg, læring og kreativitet : hvorfor glade børn lærer mere (Play, learning and

creativity, why happy children learn more), 2002. 48, 61-64, 71 p. ISBN 9788711437025 9. Murphy, John N. and Duncan, Barry L. Intervention i skolen (Intervention in school), 2008. 51 p.

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European Journal for Exercise Professionals – INSTRUCTIONS

FOR AUTHORS AND SUBMISSION PROCESS

Journal’s format and frequency:

The European Journal for Exercise Professionals is an on-going peer-reviewed

online journal which publishes articles on important trends and developments in the

fitness industry and related fields. Each volume will include a set of articles written

in English, which were published in EREPS website during the previous year.

The Journal publishes short articles (up to 3000 words) related to original research,

review papers, expert opinion, technical notes, practice updates, and ethical and

legal commentaries. Articles will provide evidence-based information that is of

immediate use to practitioners. Each article includes a 150-250 words abstract,

with open access to general public. This abstract is also in English but there is the

option of including another abstract written in the author(s) native language(s).

Instructions for authors:

Title (up to 20 words): verdana, 12 pts, 1.5 spaces, justified, bold case

(e.g., The Fitness Sector gets a new publication)

Type of article: original research, review papers, expert opinion, technical

notes, practice updates, ethical and legal commentary

Author(s) name(s): verdana, 10 pts, 1.5 spaces, justified, bold case (e.g.,

Maria Smith)

Affiliation(s): Health Club (…), University (…)

Country(ies)

Contact(s): e-mail address

Key-words (up to 6)

Second language abstract (if applicable): (yes/no), which one?

Main text (up to 3000 words): verdana, 10 pts, 1.5 spaces, justified

Sections: introduction, objectives, methods, discussion, practical

applications / background, discussion, implications for practice

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References in text using [number]

Original figures (up to six)

Tables (up to two)

References (Vancouver style), e.g., Smith M, The Fitness Sector gets a new

publication. EuropeActive’s Journal for Exercise Professionals, 2016, vol 1

Short resumé of authors (up to 100 words)

Submission Process:

Manuscripts must be submitted in a word file, as an attachment to the e-mail:

[email protected]. If the Editors find that the submitted manuscript

is of sufficient quality and falls within the scope of the European Journal for

Exercise Professionals, they will assign the manuscript to a minimum of one and

a maximum of two peer-reviewers.

The reviewers submit their reports on the manuscripts along with their

recommendation of one of the following actions to the Editors:

Publish Unaltered

Consider after Minor Changes

Consider after Major Changes

Reject

After reviewers submit their reports, the Editors can make one of the following

editorial recommendations:

Publish Unaltered - the manuscript is accepted for publication

Consider after Minor/Major Changes - the authors are notified to revise their

manuscripts and submit a final copy of their manuscript with the required

changes suggested by the reviewers. The Editors review the revised

manuscript after the changes have been made by the authors. Once the

Editors agree with the final manuscript, it is accepted for publication

Reject - the Editors can reject any manuscript because of inappropriateness

of its subject, lack of quality, or if two of the reviewers recommend rejecting

the manuscript

Issue 1 - 2017


114

Article Processing Charges:

The European Journal for Exercise Professionals is an Open Access journal for

EREPS members. The abstract of the article is open for general public. Publishing

an article is free for the authors. Each year volume will be freely available for

download.

Please, submit your manuscript in a word file, as an attachment to this e-mail

address: [email protected]


Issue 1 - 2017


115

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ISSUE 1 - 2017 - EREPSISSN 2522-1310 EUROPEACTIVE The House of Sport Avenue des Arts 43 – 7ème étage 1040 Brussels, Belgium Tel.: +3226499044 ISSUE 1 - 2017