It is well documented that exercise and improved fitness has a positive impact on the lives of participants (18, 19, 24-26). The joint pronouncements on the benefits of exercise from the American College of Sports Medicine, the Centers for Disease Control, and the National Institutes of Health with continued media publicity have led to more participants into the fitness market. Because market demands for quality health clubs and instructors, the profession has designed certification programs, presumably to give the public a perception of quality for those instructing the public. Several professional fitness organizations including the National Academy of Sports Medicine (NASM), National Strength and Conditioning Association (NSCA), International Sport Sciences Association (ISSA), Aerobics and Fitness Association of America (AFAA), and the American Council on Exercise (ACE) have certification programs, each varying in the levels of competency with no apparent concensus for a baseline level. Because of the varying levels and quality of these certifications, the public is being sent mixed messages on instructor certifications.

The California Fitness Instructor Act, although well-intended, was an ill-fated attempt as a consumer protection act to exclude from practice those instructors who presented the highest risk to the public (those with the least education or who are negligent). This bill made no reference to published reviews on the topic of licensure, or scope of practice within the exercise profession (6,9). Further, it did not have the support of the organizations it was designed to regulate. This bill would have come under the guise of "Sunrise" legislation - meaning there would have to be documented proof that fitness instruction was inherently dangerous to the public safety and thereby need state regulation. To date, there is little documentation concerning injuries or court judgements against personal trainers or fitness staff who do not perform their jobs well and post a consumer risk. Until further documentation is published, any form of licensure at the state level may be premature and destined to fail in any state.

The Clinton bill and others on national health care reform may be dead, but private sector reform is not. Before the Feds began their push for reform, private insurers and corporations had already begun to set limits on how much they were going to pay and were demanding proof that the interventions being provided were delivering a quality outcome. Enter the world of managed care and capitation. These market forces and the public's demand for the best health care available have forced a critical appraisal of prevention and wellness services as a means of containing costs (15, 21, 23).