Just as doctors submit to national boards, personal trainers soon will have the option to take national boards. The question is, should they?
By Dec. 31, 2005, the International Health, Racquet and Sportsclub Association (IHRSA) has recommended that club owners only hire personal trainers with certifications from agencies accredited through the National Commission for Certifying Agencies (NCCA). So far, IHRSA has made no recommendation about the national boards, a test that will not be accredited by NCCA. In the meantime, some insurance companies are looking at possible changes in insuring personal trainers based on whether they have certifications or have taken the national boards.
The National Board of Fitness Examiners (NBFE), which is developing the national boards and will offer the written portion starting in April, sees itself as an industry initiative that is defining “scopes of practice” and “standards of practice” for fitness professionals, said Dr. Sal Arria, who spearheaded creation of the NBFE. Arria contends that certifying organizations rely on their own standards and tests, which means standards and tests vary from organization to organization, resulting in various skill levels for personal trainers. In hopes of standardization, the NBFE is establishing one national standard of excellence that every certifying organization and college is free to adopt and use, he said.
However, some certifying agencies ask what gives the NBFE the right to say its exams are the standard. Instead, they argue, the NBFE standards are just a different set of national standards than every other certifying agency has already set.
“Who is making the decision that their standards are higher than the oldest and most revered certifying agency in the country?” asked Ken Germano at the American Council on Exercise (ACE), which is one of two certifying agencies (National Strength and Conditioning Association is the other) that already has NCCA accreditation.
NBFE detractors also argue that the NBFE is just another certifying agency.
“NBFE is not going to be any different than ACE or us, it's just that they are going to have the word ‘board’ in it,” said Dr. Brian Biagioli, director of education at certifying agency National Council on Strength and Fitness (NCSF), which has applied for third-party accreditation through NCCA. “So you have a lot of people trying to run and hop on this bandwagon so they can keep their business going…. ACE has a board exam, NCSF has a board exam. All they (NBFE) are is a clever name to confuse people.”
However, another certifying agency, American Fitness Professionals & Associates (AFPA), disagrees.
“The NBFE, which has the endorsement of the National Board of Medical Examiners (NBME) as well as 17 independent fitness organizations in the United States is not another certifying agency,” said Mark J. Occhipinti, Ph.D.c, president of American Fitness Professionals & Associates (AFPA), which is an NBFE affiliate. “The NBFE represents an idea and the initiative of many fitness and medical professionals to ‘raise the bar,’ so to speak, to enhance the position of personal trainers nationally.”
Arria said that the critical difference between the NBFE and a certifying agency is its origin. The NBFE invited leaders of certification organizations, gym and club owners, medical and allied health professionals, fitness professionals, colleges, universities, IHRSA and related stakeholders in the fitness industry to help develop the NBFE in the belief that true industry standards cannot be identified by a single entity or by the collective efforts of just one area of the fitness industry, Arria said.
“The NBFE was founded as a place where all industry stakeholders can join together to define and create these standards to protect the public and truly raise the bar for our industry as a whole,” he said.
In addition, the nature and origin of NBFE's examination differs from that of a certification organization because the NBFE has many groups and organizations involved in developing the test, which provides a broader and more expansive viewpoint from the preliminary test planning and domain analysis, through item writing and validation, Arria said. The initial focus group of subject matter experts, called NBFE fellows, collectively hold dozens of certifications from well-known agencies, have diverse undergraduate and graduate academic training and are active trainers, he said.
However, Biagioli said that NCSF and many other certifying agencies also develop their tests using subject matter experts with various certifications and from various fields including academia, allied health and personal training.
But Arria insisted the NBFE standards were higher than those of certifying agencies.
“We are holding the entire test development process to a standard that far exceeds third-party accreditation and any other in the history of the fitness industry,” said Arria.
For example, NCCA accreditation doesn't stipulate external audits within the test development process, but NBFE has done external audits. Most organizations elect to contract a psychometrician for the construction of the test and NBFE has selected the top high-stakes test development company in world, Thompson Prometric, to work with it, Arria said. (NCSF and others applying for NCCA accreditation also used Thompson Prometric, Biagioli said.) NBFE has elected to validate each phase of test development with an additional check. NBFE deployed its test survey to both an open and closed population to validate its outcome. In addition, the NBFE is contracting with the NBME to review the entire item bank created by the NBFE fellows. The NBME will also independently audit the outcome of the beta test and will examine the findings of Thompson Prometric. The NBFE will follow the same process in the development and deployment of the practical component of the National Board exams (part two of the exams, which is under development).
The process is long and careful, but not any longer or more careful than the process that an accredited certifying agency must go through for its tests to be NCCA accredited, countered Biagioli.
Regardless of test development methods, Biagioli's main concern is the legal defensibility of any exam, especially since one lawsuit can cost a club owner millions.
“So if you have a liability risk, you have to have defensibility,” Biagioli said. “That comes from having an accredited exam or practical component — an assessment that is validated so it's legally defensible.” While Biagioli said that the national boards may offer legal defensibility, Arria was sure they would hold up in a court of law because they had been developed using a psychometrician company.
Liability is a big reason for the whole accreditation push on the club owner side. However, for insurance companies, it hasn't yet become a major issue, according to Ken Reinig of Association Insurance Group. He said that while some underwriting companies say they want boards or accreditation, “the reality is that the possibility of litigation from an independent contractor being sued is so unlikely that they don't even care if they have a certification.”
However, some insurance companies are studying the issue. Robert Kuchefski of insurance broker firm Hoffman Insurance Services has talked to Philadelphia Insurance Companies and “they are taking a long, hard look at insuring personal trainers who are certified through an accredited certifying agency vs. those certified by a non-accredited.”
The NBFE is not getting its exam accredited, meaning that non-accredited would include personal trainers who passed the national board but don't have a certification through a certifying agency that has been third-party accredited. However, to take the national boards, a personal trainer must have a certification from a certifying agency that is an NBFE affiliate — and the majority of the NBFE affiliate certifying agencies are not applying for NCCA accreditation although some have accreditation from or are applying for accreditation from Vital Research, another accreditation company.
Arria, on the other hand, has spoken with three major insurance carriers who are considering making the national board a prerequisite for insurance through them, he said.
The different views of the NBFE can be traced back to the two schools of thought about the reason for raising personal trainer standards. One school believes club owners and personal trainers must be protected from lawsuits and the public protected from bad personal trainers. The way to do that, they argue, is through accreditation because accreditation offers legal defensibility. The other camp believes that the goal of raising standards is to improve the personal trainer's standing in the medical community (thereby increasing medical referrals and possible insurance reimbursement for sessions). For this camp, national boards are the answer because those in the allied health field must take national boards and, therefore, they understand the significance that passing national boards implies, making medical referrals more probable.
Arria does not support accreditation alone because the NCCA doesn't allow certifying agencies to require their own prescribed education courses to sit for their exams. Arria is concerned certification organizations will drop their educational requirement to meet accreditation standards.
“There are far too many organizations that require just optional study material or an optional textbook or to downloaded a free manual to qualify them to take their exam,” said Arria. “We feel a mandatory educational program and practical hands-on examination should be a mandatory requirement to become a personal trainer.”
Trainers who sit for the NBFE Personal Fitness Trainer Examination must have completed an educational program from an NBFE affiliate or prescribed coursework from an accredited U.S. college or university.
However, Biagioli defended NCCA's stipulation on educational requirements saying that it prevented companies from forcing people to go through their program to sit for their exam.
“We provide different ways to get educated in personal training, but if you come out of college with a four-year degree, you shouldn't have to sit through our courses to sit for our exam,” Biagioli said.
Other questions have been raised about the NBFE. Biagioli said that some people have questioned where this group originated (since Arria founded the certifying agency International Sports Sciences Association) and whether its formation could “take advantage” of the accreditation confusion. After all, if the NBFE is successful in making personal trainers think they must take the national boards, then the NBFE stands to make a lot of money at $295 per written exam, Biagioli said.
However, Arria defended the organization saying, “The NBFE is a not-for-profit corporation. The cost for developing and deploying examinations at this level is extensive, particularly when considering practical examinations. Revenue will be returned into updating and improving existing examinations and developing new ones,” Arria said. Some of the money will also go to promoting registered personal fitness trainers and the health clubs that employ them to doctors, chiropractors and the public.
AFFECT ON THE INDUSTRY
The accreditation issue and national boards have had an effect on many certifying agencies. Some are spending thousands of dollars to become NCCA accredited. Others are embracing the NBFE by becoming affiliates. The Aerobics and Fitness Association of America (AFAA) is an NBFE affiliate. It also is offering a new three-day personal fitness trainer certification course in place of its old personal trainer certification course. The two courses differ in approach, structure and numerous other details, said Linda Pfeffer, president of AFAA. Even though the exam was composed prior to the national boards, AFAA is promoting the exam as an ideal starting point to help personal trainers prepare for the national boards. The course ends with both a written and practical examination and replaces AFAA's previously offered personal trainer certification course. Vital Research has accredited the curriculum and exam.
The accreditation discussion is affecting certifications beyond personal training. The Pilates Method Alliance (PMA) will begin offering a national certification exam in August 2005 for Pilates instructors. The exam, which will be submitted to NCCA for accreditation, will measure whether or not a Pilates instructor can perform job-related duties with competence.
Although the IHRSA recommendation about accreditation only affects personal trainers, Kevin Bowen, PMA CEO and co-founder, said that the certification issue would be spreading industry wide. Besides, many personal trainers double as Pilates instructors.
Despite the flurry of activity among certifying agencies, the debate over this issue is far from over. In the end, it may not matter whether the NBFE is another certifying agency or not. Instead, the future shape of personal trainer education and exams may boil down to what insurance companies decide to do. After all, money talks, and the risk of paying more for insurance on a club and on personal trainers because of which exams they've taken to be certified or deemed NBFE approved could cause club owners and personal training managers to rethink who they've been hiring and which certifications they'll require for personal trainers in the future.
Editor's Note: For a history of the whole accreditation issue, visit the AAPT web site at www.aapt.net.