An investigation of risk management practices in the health and fitness facilities in Queensland: Minimising the likelihood of legal liability

The Australian health/fitness industry is an important contributor to the national preventative public health strategy against obesity and associated health risk factors such as coronary heart disease, diabetes, various forms of cancer, osteoporosis and mental health problems (Commonwealth of Australia, 2010; Mathers et al., 2000). Although regular physical activity can significantly reduce obesity and associated health risk factors, epidemiological studies show that vigorous exercise can trigger cardiac events, especially in habitually sedentary people with known or unknown coronary artery disease (Corrado et al., 2006b). Furthermore, participation in physical activity by persons with obesity and diabetes is associated with an increased risk for musculoskeletal injuries, joint injuries, osteoarthritis, and disability (Brukner and Brown, 2005; Wilder and Cicchetti, 2009). A recent Victorian study drew attention to the concerns of the exercise participants (Finch et al., 2009b) of multipurpose recreational facilities that showed lack of safety policies and practices (Finch et al., 2009a). According to studies conducted in the United States health/fitness facilities that show low cardiac emergency preparation, lack pre-activity screening procedures and do not follow risk management recommendations and policies published by the leading national professional organizations (Connaughton, Spengler and Zhang, 2007) expose themselves to serious risk of litigation (Eickhoff-Shemek, 2010). In this regard, it is suggested that it is crucial for health and fitness facilities to implement effective risk management programs to provide reasonably safe services to their customers. In contrast, following changes to the Australian law in 2002 that was prompted by a perceived crisis in public liability insurance and an emerging ‘litigation culture’, recreational service providers in Australia have been given the right to contract out of their implied duty of care to their customers by use of exclusion clauses that can limit or exclude liability for negligence and breach of an implied warranty that services would be provided with reasonable care and skill. However, there were concerns that this blanket protection would cause recreational service providers to refuse to invest in injury prevention practices and risk the safety of their consumers (Australian Consumer and Competition Commission, 2005; McDonald, 2005). Therefore, proper implementation of risk management programs by recreational service providers to effectively prevent injuries and minimise subsequent liability claims was stressed (Standing Committee on Recreation and Sport, 2002). Despite the fact that the health/fitness industry represents a significant portion of the recreational services offered in Australia, little is known about the implementation of risk management practices in health/fitness facilities. In this light, the main purpose of this study was to investigate implementation of risk management practices in the health/fitness facilities in Queensland. Secondary aims of this study were: (a) to identify the potential sources of legal liability in the health/fitness industry, which will help (b) to develop a risk management assessment questionnaire for health/fitness facilities. The data was gathered from the managers of health/fitness facilities (n=52) in Queensland using the self-developed and pilot tested Health and Fitness Industry Risk Management Questionnaire (HFRMQ). The statistical analysis of the data was conducted using descriptive statistics and non-parametric tests (p<0.5). The major findings of the study indicated that health/fitness facilities in Queensland had low adherence to risk management practices related to ‘emergency plans’, ‘inspections’ and ‘staff’, whereas risk management practices such as ‘waivers’ and ‘insurance’ were among the most implemented and valued risk management practices. However, neither waivers nor insurance can prevent injuries or adverse health outcomes that can occur as a result of negligently provided services in health/fitness facilities. Furthermore, as recent case law analysed in this study illustrates, waivers may not always be enforceable, and hence fail to prevent a successful lawsuit. In this light, the discussion and conclusions of this study highlights the need for health/fitness facilities to develop and implement effective risk management programs to provide reasonably safe services in the first place, which in turn minimises the risk of legal liability claims

Manipulator design for a haptic system with improved performance

This paper presents the work carried out to improve the design of an existing kinesthetic haptic device. The proposed improvement is designated for enhancing this device’s impedance width which is a common metric in performance evaluation of haptic devices. In this study, kinematic design optimization, static balancing, constructional design enhancement and actuation system design studies are presented.The Scientific and Technological Research Council of Turkey (grant number 117M405

A Systematic Review of the Effects of Pilates Method of Exercise in Healthy People

Objective: To evaluate evidence for the effectiveness of the Pilates method of exercise (PME) in healthy people. Data Sources: Published research was identified by searching Science Direct, MEDLINE, PubMed, SPORTDiscus, PEDro, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. Study Selection: Research studies published from inception to May 7, 2011 were selected for evaluation. Two reviewers independently applied the inclusion criteria to selected potential studies. Studies were included if they were published in a peer-reviewed journal, written in the English language, conducted as a randomized controlled trial (RCT) or quasi-RCT in healthy people, had an inactive and/or exercise control group(s), included key study outcomes, and used the PME as the study intervention in at least 1 study arm. Data Extraction: Two reviewers independently extracted data (study, design, subjects, intervention, key outcomes results), applied the Physiotherapy Evidence Database (PEDro) scale to assess the method quality of selected studies, and determined the strength of the evidence using the best evidence synthesis grading system. Data Synthesis: Sixteen studies met the inclusion criteria. PEDro scale values ranged from 3 to 7 (mean, 4.1), indicating a low level of scientific rigor. The outcomes studied most often were flexibility, muscular endurance, strength, and postural alignment. The PME appears to be effective in improving flexibility (strong evidence), dynamic balance (strong evidence), and muscular endurance (moderate evidence) in healthy people. Conclusions: There was strong evidence to support the use of the PME at least to the end of training to improve flexibility and dynamic balance and moderate evidence to enhance muscular endurance. Future RCTs should focus on the components of blinding, concealed allocation, subject adherence, intention- to-treat analysis, and follow-up designs

Emergency response management and outcomes of out-of-hospital sudden cardiac arrest patients at exercise and sport facilities in Queensland, Australia

Sekendiz, B ORCiD: 0000-0002-5657-0008Aim: In the event of an out-of-hospital sudden cardiac arrest (OHSCA), timely cardiopulmonary resuscitation (CPR) and utilisation of an automated external defibrillator (AED) are crucial to increase the chances of survival. This study aims to analyse the emergency response management and outcomes of OHSCA patients at exercise and sport facilities (ESF) in Queensland, Australia. Methods: The de-identified electronic OHSCA data was obtained from the Queensland Ambulance Services (QAS) for the eight year period between 2007 and 2015. The data was systematically extracted, coded and categorised before statistical analysis. Results: There were 250 OHSCA cases at ESF after exclusions (e.g. vehicle trauma, home, <18 years old) key word search by type of sports. Potential cases were manually reviewed by street address for relevance. The OHSCA patients had a mean age of 59.39 (±15.169) and were mostly male (n=187, 86.6%). Following paramedic’s arrival and treatment, 38.8% (n=97) of the OHSCA patients improved, while 32.4% (n= 81) died mostly on the scene (25.2%, n=63). On-arrival, 75.6% (n=189) of the OHSCA patients were being applied CPR by the bystanders that was associated with 6.8% more improvement of the patients compared to no CPR by the bystanders. However, effective CPR (38%, n=95) was associated with 13.6% more improvement of the patients than non-effective CPR (62%, n=155) by the bystanders. Only at 12.4% (n=31) of the ESF both CPR and AED were applied by the bystanders that was associated with 4% less deaths than CPR only. Conclusions: These findings show that emergency management of cardiac events at ESF in Queensland are suboptimal. This study has implications for ESF operators to revise their risk management programs including medical emergency plans and procedures, and ensure they have staff currently trained in CPR and use of an AED to be capable of properly responding to an unexpected SCA event

The time is now

Sekendiz, B ORCiD: 0000-0002-5657-0008Dr Betul Sekendiz questions emergency preparedness at fitness and sport facilities

Türkiye'de sağlık ve fitness endüstrisinin mevcut durumunu belirlemek için yapılan bir pilot çalışma

Before Turkey starts lamentation about her residents̕ poor state of health due to lack of regular physical activity, the fitness facilities should be recognized as means of exercise and recreational activities for all. Yet the lack of studies regarding the status of the health and fitness industry of Turkey such as the credentials of education and certification of the fitness professionals surges the fitness industry into the unknown. The purpose of this study was to investigate the status of the health and fitness industry in Turkey. In order to investigate the current status of the health and fitness industry in Turkey, a pilot study was conducted to adopt the أSurvey of the Health and Fitness Industryؤ developed by Dean Mantia (2000). Participants (N=167) were queried in the areas of business operations, professional development, growth opportunities and consumer influences. Using SPSS frequency counts and percentile rankings were used to analyze and compare responses of the three sub-groups (18 % managers, 62 % instructors, 20 % consumers) that were surveyed. The findings of the study demonstrates that although the industry seems to be in a rapid growth phase, there are problems that would not allow the future success of the industry. The consumers overestimate the credentials of the fitness professionals, and at the same time quickly withdraw if their goals are not met. The industry lacks standardization, and regulations are not adequate to save it from abuse. Although the Bodybuilding and Fitness Federation emerged as the major certification body, it holds less than half (38 %) of the industry, and lacks trust and respect by the fitness professionals due to illegalities. The industry is driven by fad and fashion and the role of the media, and marketing practices seems to be underrated despite their educational value to make the consumers take responsibility ofM.S. - Master of Scienc

How to improve quality of pre-exercise screening in the fitness industry?

Sekendiz, B ORCiD: 0000-0002-5657-0008Background: In Australia, more people with increasingly complicated health risks are using fitness facilities to improve their health and wellbeing. Therefore, it is crucial for fitness facilities to ensure the safety of their customers by properly utilising best practice pre-exercise screening procedures. Aim: The aim of this study was to identify the quality of pre-exercise screening in the fitness industry, and explore solutions to the identified problems from the perspective of fitness professionals

Emergency preparedness in the health and fitness facilities in Queensland

Introduction: The Australian health/fitness industry is an important contributor to the national preventative public health strategy against obesity and associated health risk factors such as coronary heart disease, diabetes, various forms of cancer, osteoporosis and mental health problems (Commonwealth of Australia, 2010; Mathers et al., 2000). Although regular physical activity can significantly reduce obesity and associated health risk factors, epidemiological studies show that vigorous exercise can trigger cardiac events, especially in habitually sedentary people with known or unknown coronary artery disease (Corrado et al., 2006b). In this regard, the aim of this study was to investigate if the health and fitness facilities in Queensland comply with risk management practices related to emergency plans such as cardiovascular screening, emergency procedures and the use of automated external defibrillators (AEDs) as described in published international standards. Methodology: The data was gathered from the managers of all health/fitness facilities in Queensland (n=262) using the self-developed Health and Fitness Industry Risk Management Questionnaire (HFRMQ) (α= .87). Overall, 52 health/fitness facility managers participated in the study yielding a return rate. Descriptive statistics and Spearman`s correlation were conducted for the data analysis using PASW Statistics 18. Results: The results of the study showed that the health and fitness facilities in Queensland show low compliance with emergency related risk management practices (mean=3.5±.616). Even though, the majority of the health/fitness facilities (78.8%) have a written emergency plan in place (mean=4.04±.989), neither these facilities revise their emergency plans (mean=2.54±.999), nor physically rehearse their emergency response systems at regular intervals (mean=2.63±1.205). Besides, only 19% of the health/fitness facilities have at least one AED installed (mean=2.35±1.282) while only 15.4% of their staff recruited to use the AED in case of emergency hold current AED training and certificate (mean=3.61± .916). Discussion and Conclusions: The results of this study highlight the need for proper adaptation and implementation of risk management practices related to emergency plans in the health and fitness facilities in Queensland. In this regard, a policy development and regulation of the health/fitness industry to implement proper risk management programs including but not limited to emergency procedures, processes and use of AEDs so as to promote physical activity in reasonably safe facilities is suggested