In general, establishment of licensure laws moves to exclude individuals from a stated form of health practice. These licensed individuals cast a dim view of education and enhancement of a particular school of thought that may be contrary to their basic structure. Therefore, the very act of licensure may exclude those for whom it may serve the best purpose. Because of the present lack of demonstrated increased risk of injury or death from exercise instruction, we must assume this risk is low. Given this, responsibility for seeking out qualified exercise instruction to deal with the client's preferences and personal medical condition(s) is with the client. To date, market forces are already moving in this direction faster than most realize. Professional fitness organizations are publicizing the qualifications of their certified instructors and setting up guidelines for the facilities they work in.

To further legitimize their professional standing and give the public an appearance of quality assurance, some fitness professionals have turned to the American Kinesiotherapy Association, based in Washington state. Since 1954, the AKA has been a fully accredited, state recognized licensed organization that provides therapeutic exercise as part of the health care system. They operate primarily within the Veteran's Administration system, but are expanding their markets to private practice, rehab settings, and sports medicine practices. Persons who wish to sit for the AKA board exam must have a BS degree in a related field, and over 1,000 clinical internship hours in certain health care areas (counseling, orthopedics, pediatrics, exercise physiology, and adapted exercise). If is is licensure that fitness professionals are seeking, then the AKA may be a "best-fit" option for them. Why re-invent the wheel?

Secondly, health care reform spurred great changes in the way people think about insurance in this country. If you ask any licensed professional, they will state that, in part, their licensure means they can bill insurance companies for their services, although it doesn't necessitate payment. It is the type, quality, and outcome of service that counts. Since this is one area that many fitness professionals are seeking to enter, awareness of facts concerning third party reimbursement are needed. 1) Fee for service is changing rapidly, and moving to a "capitated fee structure", meaning that insurers will pay providers a certain amount of dollars per patient to take care of their needs and a limited number of dollars per procedure, regardless of the degree of health or illness of the patient. The patient is responsible for whatever fees not paid for or the provider "makes due" with the length of service dictated by the insurer to help the patient achieve functional status. The provider must provide justifying documentation proving that extended or different types of treatment will provide the desired outcomes in order to be paid any further (5, 17). In many cases, this patient is referred to community health/fitness programs, because it is economically unfeasible for the health professional to see the patient for an extended period of time. This is a blessing and can be very lucrative for the fitness industry, as many health clubs and instructors have come to realize. Most personal trainers are used to working under a fee-for-service arrangement. Insurance reimbursement is seen as supplemental income. Many allied health care centers that rely solely on third party reimbursement have drastically changed their business arrangements to keep ahead of the changing market. Some have gone exclusively to a capitate fee arrangement.