Chapter 56 Exercise Leadership Issues and Concerns Erin Houser, MA   What does exercise leadership mean to you?  When the words are heard together, you may think of the stereotypical aerobics instructor.  Female, blonde, bubbly, and almost too energetic. Although these characteristics are certainly not detrimental, what really is an "aerobics instructor"?  To begin with, it is important to address the term itself.  There is the general belief that it was derived from the 1980s "aerobic boom" -- and has continued into the new millennium and engulfed us throughout our fitness crazes.  But, as exercise physiologists, we know that the term  "aerobic" means "with oxygen."  We know that aerobic power is more enduring than that of anaerobic power (without oxygen).  However, both can be described as work of the myocardium, or myocardial contraction, which is derived from energy, which is produced by oxygen, which is delivered via cardiac output, which is directly related to stroke volume.  In other words, the word "aerobic" implies that (at the heart level) the rate of cardiac efficiency is a ratio of the total body oxygen consumption to that of the heart's need for oxygen. For the most part,  "aerobics classes" are mostly aerobic, but the classes also include other components such as strength and flexibility development.  Since anaerobic and aerobic activities include different biochemical components, traverse different metabolic pathways, and produce different chemical and metabolic enzymes, perhaps, we should change our way of thinking and define the classes correctly.  Titles with such names as group fitness, strength and conditioning class (or more specific terms such as "kick-strength" describing a kickbox and strength class) often seem more appropriate.  Now that terminology has been dealt with to some extent, why do exercise physiologists find themselves as exercise leaders?  Why do they exercise?  It’s true that when we think about ancient times, medieval times, and ages throughout generations, much more physical work was performed for daily living tasks and survival.  There was a greater need for energy for daily living tasks (of which, again, requires muscle contraction, which requires oxygen that is delivered by cardiac output).  Today, life in the 21st century is much different.  Society has been computerized and "remotatized,"-- if you will.  We have televisions, stereos, and even lawn mowers with remote controls.  We have computers and electronic gadgets, not to mention cars, performing what our ancestors did with their own muscle contraction.  Couple these concepts with a booming fast-food restaurant business along with junk food and media and it is no wonder children are becoming more and more obese.  No wonder our nation is the number one "fattest" nation on earth! So, what is the answer to the question: "Why exercise?"  Exercise promotes health benefits.  It is helpful in preventing certain diseases, and it is increasingly evident that exercise is medicine.   Regular exercise produces important and sustainable physiological and mental benefits for many cardiovascular, metabolic, and emotional diseases and disorders.  Cardiovascular diseases such as heart disease, stroke, peripheral vascular disease, and high blood pressure, can be benefited by exercise because physical activity can help to lower the resting heart rate, increase stroke volume, thereby increasing cardiac output, and reduce blood pressure in submaximal work. It can also promote healthy arteries which allow for better blood flow, thus increasing work capacity.  Exercise also can promote a better blood fat profile, and body fat reduction.  Because of the reduction of body fat, exercise may inhibit promotion of adult onset diabetes (non-insulin dependent, or type II), with the promotion of carbohydrate metabolism. Exercise can also lessen the risk of colon cancer, possibly due to better circulation contributing to better transit time of food.  Exercise can increase lean body mass, reduce body fat, and inhibit fat distribution centrally.  With respect to stress and tension, exercise has been shown to relieve some symptoms of depression.  It can relieve back pain by improving muscle strength and endurance, flexibility, and posture, along with increasing bone density to hinder osteoporosis development.  Obviously, exercise is important for a variety of reasons.  From this point forward, this chapter will address exercise and leadership. What are your mechanical responsibilities to your clientele as an exercise leader?  What are your psychosocial responsibilities to yourself and your clientele as an exercise leader?  What are your professional responsibilities to yourself, your clientele, and your field as an exercise leader and professional?  Mechanical Responsibilities This section will discuss in detail the mechanics involved with teaching a group fitness class. For the most part, almost anyone can teach a fitness class, right?  Possibly.  But, if we re-word the question and say "for the most part, almost anyone can teach an efficient fitness class, right?"  The answer would be absolutely NOT!  In order to teach a proper and efficient fitness class, the exercise leaders must not only include the main components such as flexibility, strength, and aerobic activity, but also be knowledgeable of these components as well.  The leader must include safety, proper choreography usage, and proper music.  He/she must also be competent in designing exercise programs and be familiar with the fitness industry and different types of exercise equipment.  Being creative is extremely important as well since it encourages motivation among the participants. Flexibility and Strength Concerns It should be mentioned that although flexibility, strength, and aerobic components are all different and separate from one another, they oftentimes overlap when physical fitness is discussed. Hence, in the following paragraphs, you will sometimes see them listed harmoniously.  The following phrases contain examples of "being knowledgeable" about the certain components.  In other words, doing some research and "keeping up" with current findings.  The science of "being knowledgeable" could have been listed under either mechanical, psychosocial, or professional responsibilities.  Because we are talking about increasing the exercise leaders' education regarding physical fitness, and because these components are mentioned in the context of mechanical responsibilities, this issue will be addressed as a whole throughout this segment of the chapter. As most fitness professionals know, the field is constantly changing.  This is both good and bad.  It is changing for the good in the respect that there is more research, more education, more opportunity for qualified individuals to lead the industry.  Also, due to competition, more creative and safer exercise equipment have been made available to the public sector. However, there are several important questions that need answers:  "Is all of the research valid?"  "Are qualified individuals performing the research?"  Also, it is unfortunately but ture that fitness trainers have become a dime a dozen and many clubs hire trainers who are not even certified!  Further, many certifications have become a dime a dozen as well, not requiring any former fitness and health education background or experience prior to taking the certification exam.  A similar statement can be made regarding the advantages concerning the competitive atmosphere (e.g., due to competition, more creative and "gimicky" exercise equipment increase the possibility of producing negative results). Regular participation in resistance training and flexibility can benefit bodily posture, reduce the risk of injury in the elderly population, as well as prevent falls, and contribute to better balance, coordination, and agility.  Given that low back pain is a prevalent condition in the adult population due to muscular imbalance, weak and/or atrophied muscles, and a sedentary lifestyle, increasing flexibility in the mid-trunk and thigh region should contribute to increased low back health.  Concentration on lumbar mobility, hamstring and hip flexor flexibility, and abdominal and back extensor strength and endurance helps to balance the mid-trunk and thigh areas.  Here, flexibility is defined as the functional capacity of the joints to move through a full range of motion.  The goal is of course to increase the clienteles’ range of motion across as many major joints as possible.  Some flexibility examples of stretching safely would be to make sure the fitness participants are knowledgeable about the range of motion within their own joints.  They should be encouraged to progress slowly, and to practice faithfully range of motion work slowly and safely. Safety is also a major concern when the performance of strength exercises comes into play.  While there may be posters of  “do not do this exercise” and/or “do these exercises" -- simple reminders of proper form should include:  (1) keep the patellae properly aligned with the  malleoli so as not to overextend the patellar region; (2) watch for hyperextension of the back, especially the lumbar region which is seemingly the most vulnerable and the most likely to receive injury within and between lumbar vertebrae four and five, and sacral vertebra one; and (3) generally, hyper/over-extension of all joint regions should be guarded by the trainer and trainee, and neutral positions practiced.  Also, too much resistance  accompanied with too little repetitions may set the stage for serious injury.  Proper spotting techniques need to be taught effectively and sufficiently to staff and instructors as well as clients.  Spotting clinics within fitness establishments are a MUST in order for proper safety goals to be obtained.  The spotting clinics are not just for the safety of the lifter, but the spotter as well.  Cardiovascular Concerns Instructors should know and understand the various heart rate methods to determine exercise heart rate.  Charts should be displayed where fitness participants can see them and read them with ease.  Also, the Borg’s rate of perceived exertion scale may be helpful for many participants.  Instructions regarding these charts and how to use them should be either written on the charts by the manufacturers, or clearly written and posted near the charts by the fitness personnel.  There should also be instructions encouraging fitness participants to ask the staff if they are unsure as how to interpret the charts.  The instructor should teach the participants the steps and interpretations of the charts.  Also, the group fitness leader should tak time to check the heart rate, the breath rate, and/or rate of perceived exertion of their participants. Additionally, when addressing safety issues, all participants should fill out a health-check card prior to beginning the exercise program.  The health-check cards should include a specific and detailed medical history questionnaire that should not only be read and answered by the participants, but signed and dated as well.  Further, the instructors should read, sign, and date the questionnaires, and they should address all individuals in regards to medical history.  If any of the "high risk" categories have been answered positively, the client should be referred to a medical doctor for a physical examination prior to beginning the exercise program.  It is not within the fitness professional or exercise physiologist’s legal boundaries to diagnose or treat any kind of medical disorder or disease.  And, yet they should be aware of all high risk situations, be ready to discuss their duty as an exercise physiologist with prevention and possible recognition of certain disorders, and be knowledgeable about referring clientele to medical doctors. Proper safety also includes inspection of the fitness area itself.  The flooring should be dance floor/gymnasium-type wood flooring.  The area should be well ventilated with proper fire escapes and building codes.  The clientele should be encouraged to wear proper fitness clothing.  Some clientele may go for a few years without purchasing new footwear.   Often times, these participants may complain about mild to moderate plantar, anterior tibial, and patellar pain.  Malleoli and metatarsal pain could be included in this discussion, too.  What these individuals are unaware of is that the pain could have been easily prevented, and possibly easily corrected by just changing the footwear.  The pain could become more prominent in other areas such as their pelvic region (sacroiliac joint area), lumbar, and vertebral column if it is not corrected.  This is termed "referred pain" defines the condition when pain begins in one place, and ends up in another. In the case of plantar fasciitis (inflammation of the plantar region), it is possible an individual’s shoes are so tattered and torn that the sole has absolutely no cushion or support any longer. This allows for the impact of working out to be taken detrimentally within the plantar region. Anterior tibial pain could be a result of poor medial support within a client’s shoe.  If this person tends to evert the feet, and if he/she has poor medial support on top of that, he/she may be setting him- or herself up for what is known as shin splints.  Patellar pain may occur due to referral pain from a distal region or, if a client has "too new" shoes that have too solid of grips on the soles, he/she may experience patellar pain when the body turns one way due to the overgripping tendency of the shoes.  The patellar region does not turn with the body, thus producing a painful torque that could result in injury.  Proper Choreography Usage Proper choreography usage is essential for any workout that is meant to be efficiently stimulating.  The word "efficient" is used in reference to all fitness goals being met with a balanced, safe, and effective approach, and the word "stimulating" is used to represent motivation.  The participants must feel motivated  in order to give it their all and, oftentimes, the members will show up unmotivated.  They have turned the motivation factor over to you, the fitness professional.  They feel as though it is YOUR job to motivate them!  At times, I am in agreement with them.  It IS the instrutor's job to motivate them during the workout.  However, they will need to motivate themselves to a certain degree in order to show up for class, continue the program, eat healthy, and practice other fitness and health tips So, how does one motivate prospective fitness participants to actually participate effectively, or even participate for that matter?  This is where creativity plays a large role.  But, beware -- just because I’ve mentioned creativity, it should not be taken out of context.  With all of the new fitness gimmicks and choreography that is available in this day and age of the fitness craze, one must be careful when designing programs.  In my experience, I have seen instructors become so pressured to perform new and dazzling routines that they have forgotten about safety and ability of their clientele.  One skill that I have seen misused entirely is "turns." Turns on the floor without any other equipment and turns on the step.  If the participants’ shoes are worn and slippery on the bottom or if they are new and have too much traction, the potential exists for possible injury.  They can also become quite dizzy if too many turns are consecutively performed.  Of course, results like this can have a detrimental affect on a client's workout.  Another piece of equipment, along with the choreography I have seen abused is the Johnny G. spinning bike.  There are actually instructors who suggest taking out the saddle altogether.  This suggestion is of course ludicrous!  The instructors have fallen into that "pressure trap" where they feel as though they need to produce some new and exciting moves in order to "stay on top of things."  But, what they do not realize, is that they are setting the participants up for possible serious injury!  Imagine if Lance Armstrong were to take his saddle out of his bike when he trains for the Tour de France, what do you think would hapen?  Why wouldn’t he take it out if it is supposed to increase VO2 uptake, increase our caloric burn, and increase our strength?  He doesn’t do it because he knows that he can train very effectively by sitting in his saddle!  This is not to say that I think it is a bad thing to stand and perform a run or hill climb, or even jump while spinning.  These are all skills that may enhance one’s workout, (if in no other way, than variety and isolation and/or utilization of certain muscle groups).  But, when instructors begin dabbling with equipment and choreography without being educated about the possible pitfalls, it can produce hazardous results. It is not a bad idea to go "back to the basics" when choreographing routines.  I have used many basic movements in my classes I’ve taught and frequently these routines produce the best results and most positive comments from participants.  Proper choreography should include all components of physical fitness, with emphasis on the one element that is meant to be emphasized.  For example, in a cardiokick class, obviously a cardiovascular workout is what should take up a good portion of the class, with flexibility being added at the beginning and both strength and flexibility being added at the end.  Proper choreography should of course include a sufficient warm-up, main event, and cool-down.  When verbally leading the class, it is best to count down from 8 or 4, using number 1 as your space to cue. So, 4-3-2 switch!  Also, counting does not have to be done in a nicely choreographed class.  You could use movements that are done per seconds instead of having to count down all of the time.  For instance, one could perform a class of plyometrics using the step, along with stations or a circuit, which would enable all participants to get a good workout without ever having to worry about which foot they are on, and/or which count.  Classes like this are easier to follow for many people, and I like to recommend them for instructors who are not familiar with choreography and counting and cueing, and for participants who do not feel comfortable with counting, cueing, and ‘fancy’ choreography. When choreographing, upper and lower body movements should include balanced skills. You should change the moves accordingly throughout the routine in order to allow usage of all muscle groups involved.  Also, agonistic and antagonistic muscle groups should both be emphasized throughout the workout.  For instance, many skills in a fitness class require use of the quadriceps muscle group.  Therefore, the functional opposite, the hamstrings, should also be included and isolated for work so as not to create a muscular imbalance.  I also like to recommend using all directions of movement throughout the fitness class.  Front, back, side to side, and corner to corner. This gives the class more variety and  creativity, thus, motivation for the participants.  However, the directions should be slowly incorporated so as not to confuse the participants.  Choreography of routines can be done by utilizing many different methods.  Two basic modes of choreographing include: the add-on method, and segmenting.  The add-on method involves (after the warm-up and entering the cardiovascular portion) beginning with two or three skills and then adding on to them, always reverting back to the beginning movements that you started with.  Toward the end you will have a group of movements embodied within the workout where you have repeated the very beginning a number of times!  This is a very fatiguing workout, but with modifications, your participants will enjoy it because they become quite familiar with it and always know what is coming next.  Also, if you include a running or power walking lap around the studio or gym within that workout you will always be coming back to that lap so, consequently, you may be doing 10 laps throughout the workout (or however many depending upon where you inserted your lap).  The same thing goes for a set of 8 squats, or 8 jumping jacks, or 15 seconds of  "quick feet" where you shuffle in place, or whatever you decide to emphasize. The segmented method includes choreographing a series of 8 counts or movements, and then combining them.  For example, you could teach your class one set of four eight counts to begin with.  You would start with the first eight count, and maybe do it for 16 counts or more until the entire class feels comfortable with it, then move on to the next 8 count (you are still in your first set of four eight counts).  When the class learns well the first set of four eight counts by doing them in counts of eight, you can ‘leave’ that set aside for a time, and move on to another new set of four eight counts.  Take the necessary time to teach your class the new set, then, when they are familiarized with this new set, go back to the first set, and combine the two.  Once the two sets are combined, you may set aside the first combined two sets, and move on to do the same thing with another two sets of four eight counts.  Then, combine these sets.  Next, you can combine the entire four sets of eight counts to make an entire routine.  I would like to stress the importance of teaching different levels and modifications of all skills. If someone is in your class who cannot run or jump, they can still get a great workout doing low impact with your help with modifications.  Do not assume that people will know how to modify.  Most likely they will not, therefore, they need to be shown the different levels and modifications.  For example, the simple jumping jack can be modified by level I being one leg at a time laterally stepping with arms doing the "regular jack" (low impact) and level II being the regular jack.  High knee runs can be modified by level I being a march in place, level II being a ‘baby jog’ or very small jog in place with the knees in the front, and level III being the actual high knee run.  If you are planning on doing a step class and someone shows up to your class who is unable to step due to patellar injury, level I  modification for that person could be to conduct the same movements as the rest of the class, only without actually using a step.  These levels can be designed for any skill, eight count, or movement you incorporate into your class.  If you teach and encourage your participants to use different levels, they will feel comfortable doing it.  If the teacher is not effectively guiding the class, the class will do whatever the instructor does no matter what.  Yes, when the instructor raises their hands to give directions, or even to fix their microphone, there will be people in the class who follow those movements.  This may seem comical, but it can be dangerous if the instructor is working at level II or III for themselves, and not correctly informing the class of level I for those who may need it.  On the other hand, it should be mentioned that although there may be many participants in your class who need to be motivated, there may also be persons in your class who have the "do it or die" attitude.  These people may need some advice and instruction on modifications as well, as they may be predisposing themselves to injury by overdoing it.  It is the fitness professional’s responsibility to ensure the safety of all participants and it takes experience to recognize these characteristics in people.  Every instructor should plan their class as if they had a conglomeration of fitness levels all within the same class ranging from their Grandma, to "athlete Joe," to middle-aged people with lumbar or patellar injuries.  If you plan on teaching a class conducive to these types of people, and plan on them all being in the same class, then you are a good instructor! Music When choosing music for your fitness classes, it is important to choose stimulating music that appeals to at least a good portion of the class.  You will never be able to please everyone’s musical tastes.  Personally, I like to utilize all kinds of music in my classes ranging from 80s rock, to Enya, to River Dance and Cirque de Soleil, to alternative music, some rap, some "fun" songs such as the "Chicken Dance" and rock version of "Sesame Street,"  "George Winston" piano music, and Christian music such as "Third Day" and "Michael W. Smith."  By consolidating many types of music, you are bound to please everyone at least once! Also, it is imperative in choosing music that has uplifting and proper lyrics.  There is a lot of  published music that is absolutely not acceptable for fitness classes, no matter how good the tempo is, or how motivating it may be.  Songs containing lyrics that allow for arisen offense to anyone are prohibited. Lastly, the music should have a safe and effective tempo.  Many fitness studios have a tempo controller that is located on the sound system where you can adjust the music playing to any tempo you need for what you are doing.  However, if your system does not have this luxury, you will need to find music that is within a certain beat range.  Usually, 122-124 beats per minute tempo allows for good stepping music, and faster music for movements done on the floor without the step.  Cardiokick classes can go either way, depending on what type of movements you are performing.  But I would probably recommend the tempo to be similar to that of stepping, or slightly slower, again, depending on your movements.  If you try to instruct your class to step to music that is way too fast, they may injure themselves just by trying to keep up.