In 2004 Fred Widland attended his first free personal training session at Manhattan’s Crunch Fitness International gym, USA. As reported in the New York Post, Widland, the self-confessed couch potato and ex-smoker, undertook a supervised training session that left him with severe kidney damage through the toxic condition of exertional rhabdomyolysis [1
]. More recently in 2013 Rebecca Johnson, from Brighton, UK, participated in a private personal training session. However, as reported in the Mail Online [2
], after the session Johnson, an experienced exerciser, stated:
A few times I said to the personal trainer I was finding it tough and I didn’t know if I could carry on. ‘But he encouraged me to dig deep to do the best possible. As he was the professional. I did as he asked. I thought no pain, no gain’.
As a result, Johnson’s experiences ended with a similar outcome to Widland: after observing blood in her urine she was taken to hospital to avoid life-threatening complications and was left with debilitating ill-health for several months. A year later, in 2014, Daniel Popp undertook a supervised training session at SnapFitness in Queensland, Australia and suffered the same issues as both Widland and Johnson claiming: “my urine went as back as leather!” [3
]. Again, the filed lawsuit stated that despite the exerciser claiming they were unable to undertake the given exercise regime, the trainer persisted to push the client to a point of physiological danger. Historically, there have been demands to recognize and deal with similar problems in exercise contexts e.g., [4
] but evidence suggests these experiences are not an uncommon trend. For example between 2011 and 2014, the reported cases of exercise induced rhabdomyolysis admitted to a single University hospital increased four-fold [5
]. Thus concern arises as to the increasing incidence of these and similar reports of other exercise-induced injuries and debilitation.
In attempting to locate ‘blame’ for the negative exercise experiences the primary focus has been on the exercise professional. As a result, the academic consideration is that “trainers need better education on using the guidelines to initiate and achieve health benefits and avoid problems.” [6
], (p. 698). Thus blame is considered to be found in the lack of professional education. Furthermore a philosophy for the ‘individualism of blame’ becomes evident with the recent growth in legal specialists. For example accidentclaims.co.uk now offer Gym Accident Compensation Claims Experts (100% no win no fee); whilst actionsinjurysolicitors.co.uk advertise they have successfully obtained £6000 for a gym client’s finger injury1
. Consequently the premise is made that the problem lies with the ‘rogue’ trainer due to their lack of consideration for, and/or knowledge of, ethical and contextual demands in delivering appropriate exercise experiences [7
This essay is an attempt to present a critical and alternate argument to the current position of blame based on ‘individual errors of judgement’ and the conclusion that professionals fail to follow the educational guidelines. The thesis presented follows a parallel line to existing challenges of the implied assumption that exercise is a medicine in contemporary definitions, and specifically argues that a deference to the paradigm of medical science has initiated an increasing scientism
within exercise science and, by association, the domain’s professionals [9
]. Stated explicitly, it is argued that an increasing belief in warranting scientific processes validation beyond their bounds is leading to an exercise nemesis with hazardous consequences for public health [12
]. As a result, this paper argues an alternate proposition: the cause of the negative experiences may be due to a deference to the professional exercise guidelines themselves, as opposed to their avoidance in the choices of ‘rogue’ or, as assumed, insufficiently educated trainer.
In presenting this argument, firstly a very brief overview of the concept of scientism and the issues which have historically beset medical science is presented. There is insufficient space within this paper to comprehensively review the debates surrounding scientism within medical literature. Consequently, a summary is presented of the key issues which may emerge as exercise science aligns the practice of exercise professionals to this paradigm. Secondly, this paper will then explore the results of a systematic scoping review of the exercise professional’s knowledge base and consider the implications of these findings.
2. Issues of Scientism in Medicine
Medicine has become regarded as a knowledge system which has shaken off the ‘magical’ and ‘superstitious’ past to stand alongside the natural sciences of physics, mathematics and chemistry [13
]. Thus, once considered the domain of charlatans and quacks, medicine, through a scientific rhetoric, has emerged as a key factor in determining social policy, technological advancement and bureaucratic governance of ‘day-to-day living’ in the 21stC [13
]. This success has been credited to the application of what is termed the biomedical model; a scientific paradigm which can be summarized through four fundamental assumptions [14
Disease is defined as a deviation from a statistical norm and measurable level of biological functioning.
Each defined disease is a specific and individual ‘entity’; generic regardless of culture and context.
Medicine is a neutral, objective science without recourse to relational, metaphysical or existential considerations.
Medicine allows for an ontological foundation of mind-body dualism.
Furthermore the biomedical paradigm is a position in which the body is presented ontologically “as docile—something physicians could observe, manipulate, transform and improve.” [15
], (p. 221). Consequently, through a biological machine metaphor, medicine is able to rationalize the body as an object for discipline and control. As Nicholson states, it is this model which provides the most powerful theoretical tool of modern scientific medicine and biology [16
Increasingly, society has embraced this biomedical and scientific mind-set. Health discourses have become almost singularly based upon a biological and mechanistic linearity, and taught through delineated categories of ‘healthy versus unhealthy’ [17
]. As a result, a medical scientism has pervaded contemporary culture in search of therapeutic miracles and ‘magic bullets’ [18
]. Defined as a position in which positivistic science is extolled as the only ‘methodology’ and ‘real knowledge’ needed to deal with the human condition, this scientism ultimately suggests that the science of the biomedical paradigm should be applied to the understanding all health and wellbeing discourses [19
Ultimately, through a double hermeneutical process, biomedicine has re-created in secular terms a 21stC belief in Gnosticism [22
]. That is a ‘faith’ in the power of science to eventually understand all of ‘nature’s secrets’ leads to a medical science which will cure all the ‘evils’ of ill-health [24
]. In line with Gnostic beliefs of a ‘true’ knowledge which will provide ultimate enlightenment, there is a faith in Western medical technologies to create a new evolution of society [23
Yet despite this Gnostic scientism, it has been demonstrated that the underpinning biomedical paradigm is a key factor in a number of emergent medical issues. As highlighted 40 years ago in Illich’s Medical Nemesis
, whilst achievements over some major disease cannot be dismissed neither can the dangers of iatrogenesis which modern medicine creates [26
]. That is, biomedicine is in a dangerous position through which it may become its own nemesis. As Illich argues: medicine generates as many problems as it solves. Hence, contemporary scientific medicine has brought with it issues of hazardous side-effects, the medicalization of normal functioning, declining wellbeing and the generation of a morbid society [17
]. As a result, there are a number of concerns voiced as to the appropriateness of the biomedical paradigm to meet the demands of society’s health needs e.g., [26
Despite warnings of biomedicine’s dangers inherent in its philosophical position, there is evidence of a growing demand to follow this paradigm in the exercise domain. This is exceptionally evident in the Exercise is Medicine™ (EIM) scheme, a joint project by the American College of Sports Medicine (ACSM) and the American Medical Association (AMA). Initiated in 2007, it is an attempt to align exercise practice with medical intervention [23
]. The project’s objective is the habitual implementation of exercise for the management, prevention and treatment of disease and to “ensure exercise is thought of as a medication to be prescribed to patients” [34
], (p. 413). The EIM has now been adopted on a global scale by 43 countries and is considered a key component in the development of public health strategies [10
]. Although, at present, there appears to be no formal UK affiliation with the EIM, the ACSM’s philosophy is the dominant principle supported by the majority of UK researchers, practitioners, and related organizations such as the National Institute for Health Care and Excellence (NICE) exercise referral schemes [35
The dominance of a scientific exercise paradigm is reflected in the mission statements of the major fitness professional organizations and leaders. For example:
The ACSM [American College of Sports Medicine] promotes and integrates scientific research, education and practical applications of sports medicine and exercise science to maintain and enhance physical performance, fitness, health and quality of life.
Furthermore, the ‘National Academy of Sports Medicine’ (NASM) states explicitly its demand for the scientific process in its professional practices:
A new form of exercise may allegedly produce significant results, but if it is not supported by scientific research, it becomes a questionable trend.
As a result, such organizations have created a form of scientism based on a de facto acceptance of a biomedical philosophy [34
]. That is: exercise is not only the answer but a scientifically and medically justifiable solution. Yet, these organizations, which promote the advancement of a biomedical exercise science and increasingly call for a scientific evidence base, appear to ignore the considerable dissent to biomedicine’s scientism [31
]. Accusations of scientism have already been made in sports research [38
], and the dangers challenging the ‘loss of the person’ in the pursuit of a scientific understanding of sport have been voiced [39
]. But such critiques are limited in the exercise domain with the literature providing any critical analysis focused predominantly political or sociological perspectives as opposed to methodological e.g., [9
The aforementioned lack of philosophical discussion through paradigmatic and methodological criticism may prove problematic. Specifically, it can be argued that through such perspectives evidence of the negative effects of a scientific approach may already be observable in exercise practice e.g., [1
]. As a result, mirroring Illich’s warnings of iatrogenesis, data would suggest that an increasingly ‘biomedical’ exercise science could lead further down a pathway already criticized as dangerous. Consequently, it is argued that a significant and deeper critical reflection should be undertaken concerning the appropriateness of the biomedical paradigm for exercise science. Crucially, this analysis should focus on the nature of knowledge presented to and utilized by professionals in developing exercise experiences [44
]. Thus, the hazards of rhabdomyolysis and similar debilitations experienced by participants may be due to a ‘nemesis of biomedical exercise’ lying at the root of the exercise professional’s praxis. As a result it is proposed that the foundational paradigm upon which exercise praxis is built should be the starting point of inquisition.
An analysis of evidence leads to the argument that the praxis of exercise professionals is hindered by the philosophical foundations of knowledge upon which it is built. What becomes evident is that the biomedical paradigm underpinning exercise praxis does not appear to align to foundations of professional knowledge demonstrated as effective in related disciplines [80
] Summarizing previous literature, Fox et al. identify that professional knowledge consists of four intersecting dimensions: propositional, process, personal and value-based [63
]. As a result, successful professional knowledge is derived from an amalgam of theory, practice, experience and values. Therefore, the decision making process within a professional context is a judgement made based on a broad scopes of knowledge as opposed to the constraints of scientific propositions and mechanistic application [63
]. Research suggests that in practice some trainers may draw upon all four elements described by Fox et al.’s summary [62
]. Yet, despite this observation, sources of knowledge beyond propositional science do not appear to be presented as wholly appropriate within the educational process or academic literature. Thus it can be argued that other dimensions of professional knowledge are not considered with a similar level of authority as the biomedical proposition [48
Importantly, it can be reasoned that the future advancement of educational processes will be primarily along increasingly scientific propositional lines and the implementation of the biomedical paradigm [51
]. There is an increasing development of online and digital approaches to personal trainer education. For example, companies such as Origym and PTcareer now offer 4 and 5 week online courses2
. Due to the nature of this delivery, the elements of professional knowledge beyond the scientific and propositional fact conceivably must be limited. Thus, arguably, the exposure to professional experiences and consideration of praxis which draws on, social and humanistic interactions beyond the linearity of data analysis and prescription, may not be limited [64
]. Utilizing a pedagogical curricula based on linearity, uniformity, and digital efficiency in both teaching and assessment would seem a difficult means through which to express the dynamism inherent in the ludic exercise encounter. Therefore, it can be contended these emerging educational processes support the increasing medicalization of the exercise professional role and the promotion of a biomedical scientism in the supporting exercise science.
The current epistemological foundations demonstrate an emphasis on biomedical science, this in turn creates an ontology of a scientific process. From this position the exercise professional is challenged in the difficult axiological position of experiencing a dynamic, chaotic and humanistic encounter through the lens of a techno-rational biomedical intervention. But, as previously discussed, the dangers of a limited epistemological position have been articulated effectively and discussed in fields such as nursing, medical practitioners and teaching cf. [82
]. Therefore, there is a need for exercise praxis to move beyond dichotomous assumptions of either/or in professional knowledge [85
]. Professional knowledge should be maintained as a development of wisdom through the artful application of science [73
As discussed the reductionism to the biomedical paradigm brings inherent disadvantages and a stance which would appear counter to the expectations of those involved with providing health and wellbeing agendas. Thus, whilst academics argue that problems could be avoided through greater education on the scientific and academic guidelines, the argument is that the guidelines should first be questioned through a philosophical perspective [6
]. As McNamee suggests, the use of science in the development of health, fitness and exercise is beyond debate [86
]. However there is a need for critical philosophical reflection on the basis of the science being presented as the panacea for the current societal health and wellbeing issues.