"Not just personal training" Investigating the provision of nutrition care from Personal Trainers in Australia

Abstract

Poor dietary behaviours and physical inactivity are prevalent modifiable risk factors for chronic disease. Fitness professionals, such as personal trainers, provide individualised exercise prescription for healthy individuals. National and international scopes of practice highlight that personal trainers should provide nutrition care in line with national dietary guidelines. Nutrition care is considered as any interaction between a professional and a client that facilitates changes in a dietary behaviour. However, the role of personal trainers in providing nutrition care has been controversial and largely unstudied. Professionals within and outside the fitness industry have identified the provision of nutrition care beyond the recommended scope of practice as an industry risk. Nutrition care beyond the national dietary guidelines may lead to poor health outcomes for clients. While it is apparent that personal trainers provide nutrition care beyond the national dietary guidelines; it is unclear if this occurs intentionally or if it arises secondary to implementing changes in exercise behaviours. As such, this research employed the PRECEDE steps of the PRECEDE-PROCEED framework to systematically explore environmental and behavioural factors that influence personal trainers to provide nutrition care beyond their scope of practice. A programmatic approach to research was also applied so that each study informed the next. Study one investigated the intention of fitness businesses to provide nutrition care through a review of advertised services on fitness business websites. This study confirmed that personal trainers are advertised as able to provide care beyond their scope of practice. Study two used an online survey to investigate client expectations in regards to nutrition care from personal trainers. Most respondents expected personal trainers to provide nutrition care and be knowledgeable on a range of nutrition topics, some of which extend beyond the scope of practice for personal trainers. Study three used a validated online tool to measure self-perceived competence of personal trainers to provide nutrition care. Overall, personal trainers were confident in their ability and showed favourable attitudes towards providing nutrition care to clients. Study four explored the context in which personal trainers provide nutrition care through in-depth interviews with personal trainers practising in Australia. All personal trainers reported providing nutrition care and claimed that nutrition care was an important component of their role. Still, many were unaware of their scope of practice regarding nutrition care and described a gap between the nutrition education they had received and their perceived nutrition role. Study five explored the regulatory environment of personal training through a review of international education and occupational standards. Educational and occupational standards varied widely between countries, and within countries, suggesting minimal alignment with the international standards. Collectively, these studies highlighted numerous behavioural and environmental issues that contribute to personal trainers providing nutrition care beyond their recommended scope of practice. The behaviour of personal trainers providing nutrition care beyond their recommended scope of practice has been enabled by positive attitudes and behavioural beliefs regarding the provision of nutrition care. Environmental issues including regulatory weaknesses and social expectations facilitate the provision of nutrition care beyond the recommended scope of practice for registered fitness professionals. Future efforts should be directed towards developing and assessing clear role statements for personal trainers to provide nutrition care, including specific nutrition-related knowledge and skills required for safe and effective practice. The acceptability, feasibility, and interpretation of these role statements should be tested among key stakeholders. Ultimately this may support personal trainers to provide safe and effective nutrition care that will support optimal health of their clients.