Exercise Intervention Policies in Campus Fitness Centers

Today's generation of incoming college freshmen expect a college to deliver the full package - not just a good education, but the latest technology, luxurious dorms, state-of-the art buildings, an elite athletic program and of course, an extensive offering of recreational activities to keep them busy outside of class.

Photo fo a student working with a personal trainer

Today's generation of incoming college freshmen expect a college to deliver the full package - not just a good education, but the latest technology, luxurious dorms, state-of-the art buildings, an elite athletic program and of course, an extensive offering of recreational activities to keep them busy outside of class. "It used to be that a recreation center was something that was nice to have, and now you pretty much have to have one to keep pace," says Scott Peden, director of recreation at Butler University. "Butler is a perfect example. We didn't even have a rec center until I got here in 2006. We went from nothing to a brand-new facility and rec department. It's been a huge boon to the university."

Some college fitness centers could compete against top-of-the-line health clubs, and many students will utilize them as such, which means the fitness center's staff must have the training and expertise to handle the same problems commonly seen in health clubs. Some of these - ensuring that all equipment is properly maintained and in good working condition and all instructors are properly trained and certified - are fairly straightforward. But given that college students are more at risk than other age groups for developing eating disorders or other body image issues, college fitness centers must be prepared to deal with exercise addiction and even more sensitive issues.

"Some risk management departments or legal departments might say that recreation departments should be hands off," says Adrian Shepard, who worked with Peden as Butler's assistant director of recreation and now serves as integrated wellness coordinator at Winona State University. Legally, fitness professionals are not allowed to offer any medical opinion or diagnosis. They are trained to provide exercise instruction. But when members spend hours at a time at the gym exercising to the point of exhaustion, it's a hard problem to ignore.

"As a fitness professional, you feel like you should be doing something, because a person is putting themselves in harm's way. How do you approach it?" says Shepard. "It becomes more of an ethical dilemma. You don't want to put your job in jeopardy, but at the same time, you want to make sure you're providing a safe environment."

Whether a fitness center maintains a hands-off approach or decides to intervene for the student's well-being, official staff protocol should be developed. When Butler's Health and Recreation Complex opened in 2006, Shepard started to notice and become concerned about students he felt were over-exercising, an issue that the recreation department had no policy to address. Unsure of what to do, he reached out to his peers through the National Intramural-Recreational Sports Association. "An overwhelming majority of responses I received said, 'We're not doing anything, but if you figure something out, please let us know.'"

At the time, Shepard could find very little information about how recreation departments addressed issues of exercise addiction and eating disorders - few people were willing to talk about them. Says Peden, "The sense that we got was that people were afraid to get involved with the issue. They were either not confident in their ability to identify an issue, or if there was an issue, they felt like they weren't qualified to know what to do and how to intervene."

Though fitness center employees are not in a position to address health issues themselves, the structure of most university recreation departments puts them in close contact with other professionals who can. In developing a policy for Butler's fitness program, Shepard reached out to different areas of campus. "The group included recreation, academic, legal counsel, insurance providers, student services, counseling services, health services, dining services," he says. "The main goal was to work through the situation and find out how as a team we could approach the situation."

Various departments are integral not just to the formation of a policy but also in addressing an issue when it is raised. Butler maintains a risk assessment team comprised of members from different student affairs departments that handles a variety of student issues. A problem identified by fitness center employees also might manifest elsewhere in a student's life. Conferring with a team of other professionals helps define the scope and seriousness of a problem.

"Usually it's someone who has popped up on someone else's radar, as well," says Peden. "Behavior in our fitness facility is just one dot of many to connect. And that actually makes it easier because we're not just singling out the fact that people are working out too much. They may be really stressed about something, or they're using activity to cope with another part of their life, or it points to another health issue that's already at the attention of health services." Once the real issue is established, it can be referred to the appropriate professionals - generally counseling services or health services, depending on the issue and the school's protocol.

Communication about student health issues has become even easier in recent years as services such as health and counseling are finding a home within the student recreation centers. Not only does this make observation of at-risk exercisers easier, it also allows the fitness and recreation staff to coordinate with other departments on proactive awareness and education programs.

In February, the University of Oregon celebrated "All Sizes Fit" week. "It started out with the counseling center targeting events around education about eating disorders and resources available," says Chantelle Russell, Oregon's assistant director of fitness. "It morphed into an all-around discussion of healthy body image, taking care of yourself, exercising, that kind of thing." As part of its involvement, the fitness center offered free yoga classes, as well as a fitness challenge. And though the event itself lasted a week, the idea has been taken up by a student group that will continue to raise awareness of all types of health and body issues throughout the year.

Russell believes that the program is not only raising awareness for people suffering from body image issues, but making those around them more alert, as well, which helps the fitness center staff. Often, it's a friend or another facility patron who raises a concern about an individual. "We have more than 5,000 users coming through the building," says Russell. "Unless there's an unhealthy appearance, it probably goes under our radar more often than not. We don't track individuals every time they enter the building."

Photo of a flow chart for Student Recreation Center Compulsive Exercise Intervention Protocol

Even when they can't observe each individual in their facility, staff members still need to recognize the red flags. While personal trainers and other fitness staff may know what signs of trouble to look for among exercisers, student workers - who are often the "eyes and ears of the facility," as Shepard puts it - likely do not. "If someone expresses concern to a staff member, that staff member should be trained enough to observe something on their own, document it and get it to their supervisor."

Such education should be part of an extensive orientation for student workers. "You have to train them, make sure they know how to do CPR, use an AED - that's crisis management," says Marc Rabinoff, professor of human performance and sport at Metropolitan State College of Denver and president of Rabinoff Consulting Services, which provides liability and risk management consultations.

There is always the possibility that a fitness center and its employees will be held responsible if a user injures him- or herself, whether it is from misuse of equipment or self-injury from over-exercise. In forming Butler's exercise policies, Shepard consulted with three different attorneys to determine what liability issues the university might face if users did injure themselves through over-exercise. "There were, at that time anyway, no cases that showed liability for not monitoring," Shepard says. "But at the same time, one of the attorneys pointed out that there's no reason to assume that couldn't happen in the future."

Giving employees the education and confidence necessary to address problems can be a double-edged sword, and is often the reason fitness centers are discouraged from taking any action. Staff members also need to understand the limitations of their training - it prepares them only to identify a problem, not to address it themselves. "The staff is there to educate participants on what safe use is, how to prevent injury and reach training goals," Shepard says. Rabinoff also stresses the importance of not straying from topics outside the fitness staff's scope. "You have to make your staff aware not to give out advice to anyone about diet, drugs or supplements."

Not only is it imperative to educate student workers on what issues to look for on the exercise floor, it is also vital that all employees know how to respond appropriately. Approaching a person about an exercise issue must be done with extreme caution. If done incorrectly, a student may become alienated and stay away from the fitness center (and the center's resources), or he or she may become upset and lash out at the person intervening. At Butler, says Peden, "the counseling staff comes in with the personal trainers on a monthly basis at their staff meetings and reemphasizes what to look for and talks with the students about what they're seeing or how to react when there's an issue. We have a form that a student worker can fill out, which goes directly to me and our fitness director."

At that point, the student's involvement is usually complete. It should be the job of the fitness director and other recreation department staff to observe and monitor the individual and take further action as they deem necessary.

"It could be a student is trying to get into really good shape before spring break, or there's a dance or something coming up and they want to look really good and it's a crash course in terms of trying to get fit," says Peden.

When the behavior continues to be cause for concern, the next step in the protocol is usually to speak directly with the individual. Given the sensitive nature of the situation, the contact should be made by a staff member familiar or friendly with the individual, or a senior staff member who has attempted to befriend the person. Says Russell, "When we do approach someone, we try not to attack; we try to learn. It may turn out that someone is training for the Olympic trials, so they are training intensely. It's still a good conversation to have and an educational moment for us."

Suggestions for training programs are well within the scope of the fitness center's staff and can be addressed without further consultation with other departments. Still, this type of situation can be difficult to navigate if a patron is unwilling to accept assistance. "As part of the hiring interview process, we stage those situations to see how prospective employees initially respond, to see if they can actually handle approaching someone to correct their form," says Shepard, "The more training we did, and the more familiar that the staff became with proper exercise form and also how to approach the situation - really, performing quality customer service - the more comfortable they were approaching the situations."

If, in reaching out to the individual, the staff member still believes there is a health issue, he or she should express concern to the individual - without offering any diagnoses or judgments - and direct the individual to appropriate resources. After that point, how the situation progresses depends on how an individual reacts and what intervention protocol is in place. At Oregon's fitness center, staff will continue to observe the individual and document his or her behavior before a more senior member of the department approaches the individual with concerns. If a student fails to respond to any of the outreach attempts, he or she is referred to the Dean of Students and his or her fitness center privileges are revoked until he or she receives medical clearance from a physician.

The process works a bit differently for nonstudent members of Oregon's fitness center, which is also open to university staff, alumni and other groups. "We have much less ability to be involved if it's a nonstudent," says Russell. "We have more ability to restrict their memberships, but we have to make sure there's a reason behind it. We have much less information from nonstudents and fewer resources. We can't direct them to our health or counseling center. It is a little more challenging, but since I've been here, we haven't dealt with anyone who hasn't been a student."

Without the support network of other campus departments, the fitness center staff is again limited to offering only training or exercise program guidance. Since the staff cannot refer members to their health or counseling resources in the same way they can with students, Rabinoff says the best solution is to revoke membership before exercisers injure themselves. "By stopping them, you're saying, 'Look, you really shouldn't be doing this without a doctor's clearance. And until we get the doctor's clearance, you can't.'"

The protocol a fitness center uses will vary from one college to another, depending on the school's resources and program structure. As resources or structure change, the fitness center's policies should be evaluated and altered as necessary. Oregon's protocol, initially developed in 2001 and updated in 2003, underwent another revision last May. "We decided to revise the policy because there had been a lot of transition and employee turnover," Russell says. "We wanted to get all of our Department of Student Affairs people up to date and comfortable with the policy."

"Regardless of what protocol a university uses, it's important that those steps are clear and well-documented along the way, and that you're communicating well with your partners," Shepard says. As the policy is put into use, various strengths and weaknesses will also be identified, allowing the policy to be reworked and improved. Says Shepard, "The system we implemented changed almost every semester. Over time we were able to tweak it and make it more efficient. We got it down to a pretty smooth process where it took the liability and legal concerns out of the hands of the recreation department."

Shepard has also spent the past few years working with NIRSA to educate other recreation professionals and raise awareness of eating disorders and exercise issues in the campus recreation environment. Despite working for different universities, he and Peden continue to cooperate in addressing the issue. Says Peden, "I just hope that the conversation can keep moving and that recreation people will not be afraid anymore to say, 'No, we're not the experts.' We have to admit and recognize that we are the front lines, and instead of turning our heads and ignoring it, we should try to identify it and turn it over to the professionals - especially if they're under our own roof."