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NEWSLETTER 4 – MAY 2009
In this newsletter:
1.
Osteoporosis
– What every trainer should know
1a Background, Pathophysiology, Biomechanics,
Frequency, Mortality/Morbidity
1b Clinical – History,
Physical, Causes,
1c Treatment – Rehabilitation Program
1d Medication
2.
Red and
Processed Meat intake linked to Mortality
3.
Young
Vegetarians may be at Increased risk of eating disorders
4.
Sleep loss
and Eating Behaviour
5.
RPL –
Recognition of Prior Learning – Available from July 2009
6.
Draft
Fitness Industry Regulations - How will you or you establishment be affected
Osteoporosis
– What every trainer should know
Background
Osteoporosis,
a chronic progressive disease, is the most common metabolic bone disease in the
A
Bone mineral density (BMD) in a patient is related to peak
bone mass and, subsequently, bone loss. The World Health Organization has
established the following definitions of osteoporosis based on bone mass
density measurements in white women:
Patients within this group who have already experienced 1 or
more fractures are deemed to have severe or established osteoporosis. Although
these definitions are necessary to establish the prevalence of osteoporosis,
they should not be used as the sole determinant of treatment decisions.
Understanding
the pathogenesis of osteoporosis starts with knowing how bone formation and
remodeling occur. Osteoblasts are osteoid formers, and osteoclasts are bone resorbers.
Both osteoblasts and osteoclasts are formed in the bone marrow. Bone formation is not static; it is a system
that is remodeled constantly. In adults, approximately 25% of trabecular bone is resorbed and
replaced every year, compared with only 3% of cortical bone.
Bone is continually remodeled throughout life because bones
sustain recurring microtrauma. Bone remodeling occurs
at discrete sites within the skeleton and proceeds in an orderly fashion. Bone resorption is always followed by bone formation, a
phenomenon referred to as coupling. In osteoporosis, this coupling mechanism is
thought to be unable to keep up with the constant microtrauma to trabecular bone.
The hallmark of osteoporosis is a reduction in skeletal mass
caused by an imbalance between bone resorption and
bone formation. Loss of gonadal function and aging
are the 2 most important factors contributing to the development of this
condition. Studies have shown that bone loss in women accelerates rapidly in
the first years after menopause. The lack of gonadal hormones is thought to up-regulate osteoclast progenitor cells.
In contrast to postmenopausal bone loss, which is associated
with excessive osteoclast activity, the bone loss
that accompanies aging is associated with a progressive decline in the supply
of osteoblasts in proportion to the demand. This
demand is ultimately determined by the frequency with which new multicellular units are created and new cycles of
remodeling are initiated.
Osteoporosis may be confused with osteomalacia.
The normal human skeleton is composed of a mineral component, calcium hydroxyapatite (60%), and organic material, mainly collagen
(40%). In osteoporosis, the bones are porous and brittle, while in osteomalacia the bones are soft. This difference in bone
consistency is related to the proportion of mineral to organic material
content. In osteoporosis, the mineral-to-collagen ratio is within the reference
range, whereas in osteomalacia, the proportion of
mineral composition is reduced relative to organic mineral content.
Biomechanics
An understanding of the biomechanics of bone provides
greater appreciation as to why bone may be susceptible to an increased risk of
fracture. When vertical loads are placed on bone, such as tibial and femoral metaphyses and vertebral bodies, a
substantial amount of bony strength is derived from the horizontal trabecular cross-bracing system. This system of horizontal
cross-bracing trabeculae assists in supporting the
vertical elements, thus limiting lateral bowing and fractures that may occur
with vertical loading. Disruption of such trabecular connections is known to occur preferentially in patients with osteoporosis,
particularly in postmenopausal women, making females more at risk than males
for vertebral compression fractures.
In 1998, Rosen and Tenenhouse studied the unsupported trabeculae and their
susceptibility to fracture within each vertebral body. They found an
extraordinarily high prevalence of trabecular fracture callus sites within vertebral bodies examined at autopsy, typically
200-450 healing or healed fractures per vertebral body. These horizontal trabecular fractures are asymptomatic, and their
accumulation reflects the impact of lost trabecular bone and greatly weakens the cancellous structure of
the vertebral body. The reason for preferential osteoclastic severance of horizontal trabeculae is unknown. Some
authors have attributed this phenomenon to overaggressive osteoclastic resorption.
Most
studies assessing the prevalence and incidence of osteoporosis use the rate of
fracture as a marker for the presence of this disorder, although BMD also
relates to risk of disease and fracture. The risk of new vertebral fractures
increases by a factor of 2-2.4 for each SD decrease of bone density
measurement. In 1998, statistics from the National Osteoporosis Foundation
estimated that more than 10 million men and women in the
International
Osteoporosis
is a very common metabolic bone disease worldwide, with similar incidence as
noted in the
Mortality/Morbidity
Many
individuals experience morbidity associated with the pain, disability, and
diminished quality of life caused by osteoporosis-related fractures. Hip
fractures are known to increase mortality rates in both men and women.
Secondary complications of hip fractures include nosocomial infections and pulmonary thromboembolism. While the
overall prevalence of hip fracture is greater in women than in men, a similar
number of men and women die as a consequence of hip fractures because men with
hip fractures have a higher mortality rate. The impact of vertebral fractures
increases and they increase in number. As posture worsens and kyphosis progresses, patients experience difficulty
with balance, back pain, respiratory compromise, and an increased risk of
pneumonia. Overall function declines, and patients may lose their
ability to live independently.
Race
In 1981,
Melton et al reported that the prevalence of hip fractures is higher in white
populations, regardless of geographic location. Another study indicated that
the incidence of hip fractures was lower among African Americans in the
Women have a
2-fold increase in the number of fractures resulting from nontraumatic causes, compared with men of the same age. Men have a higher prevalence of
secondary osteoporosis, with an estimated 45-60% being a consequence of hypogonadism, alcoholism, or glucocorticoid excess. Only 35-40% of osteoporosis diagnosed in men is considered primary in
nature.
Age
In 1982,
Jensen et al studied Danish women aged 70 years and found a 21% prevalence of
vertebral fractures. In 1989, Melton et al reported that 27% of women in their
study had evidence of vertebral fractures by age 65 years. The number of
osteoporotic fractures increases with age. Wrist fractures typically occur
first, when individuals are aged approximately 50-59 years. Vertebral fractures
occur more often in the seventh decade of life, and hip fractures occur more
often in the eighth decade of life (see the information bullet on secondary
osteoporosis, under Causes.).
Clinical
History
Physical
The physical
examination should begin with an inspection of the patient. Height measurement
with a stadiometer at each visit is useful.
Causes
Osteoporosis
has been divided into several classifications according to etiology and
localization in the skeleton. Osteoporosis is initially divided into localized
and generalized categories. These 2 main categories are classified further into
primary and secondary osteoporosis.
Physical
Therapy
The
first goal of rehabilitation in osteoporosis patients is to control pain if a
fracture has occurred. Physical therapy then focuses on improving function and
reducing disability. Spinal compression fractures can be extremely painful and
can cause short- and long-term morbidity. Oral analgesics on a regular schedule
can be implemented. Pain-relieving modalities such as moist hot packs and transcutaneous electrical nerve stimulation should also be
considered. During this period of acute pain management, monitoring the patient
carefully for signs of constipation, urinary retention, and respiratory
depression, which can occur with the use of narcotic analgesics, is essential.
A comfortable mechanical support for the spine and, in some
cases, a thoracic orthosis, may need to be
prescribed. The primary reason for the application of a thoracic orthosis is to limit motion in the spine. The length of
time a patient should wear a rigid spinal orthosis is
undetermined. What is well known is that immobilization contributes to bone
demineralization.
During the early mobilization period, deep breathing
exercises, pectoral and intercostal strengthening,
and back conservation techniques need to be implemented.
As soon as the course of therapy allows, weightbearing exercises should be initiated. Weightbearing activities are essential for maintenance of bone mass (Wolff law). Aerobic
low-impact exercises, such as walking and bicycling, generally are recommended.
During these activities, ensure the patient maintains an upright spinal
alignment. In 1984, Sinaki and Mikkelsen showed that exercises that place flexion forces on the vertebrae tend to cause
an increase in the number of vertebral fractures in patients.
Although swimming is not a weightbearing exercise that will improve BMD, it does provide chest expansion, spinal
extension, and low-impact cardiopulmonary fitness.
Isometric exercises should be used to strengthen abdominal
muscles, aiding in the prevention of a kyphosis.
Occupational Therapy
Home
modification focuses on reducing the risk of falling by installing handrails
and grab bars in hallways, stairs, and bathrooms. The use of a shower chair,
tub bench, and adaptive bathing devices also can be beneficial. The application of nonskid tape to steps (indoors and outdoors), as
well as the removal of throw rugs, greatly improves home safety.
Surgical
Intervention
Percutaneous vertebroplasty (PVP) with polymethylmethacrylate (PMMA) was
developed in 1984. The first indication for this treatment was aggressive
vertebral angiomas. PVP with PMMA was then used for
other lesions that weakened the vertebral body, such as malignant tumors. PMMA
is the principal component of bone cements used for rapid stable fixation of
implants, such as metal and plastic prosthetics placed in living bone during
orthopedic procedures. PVP is one therapeutic alternative for the treatment of
pain associated with compression fractures. PMMA is used in PVP to fortify a
collapsed vertebral body and stabilize the vertebral column. Success with vertebroplasty is limited by the lack of significant height
restoration and the high rate of cement extravasation.
The second therapeutic alternative for vertebral compression
fractures is balloon kyphoplasty, whereby the
vertebra is initially expanded with an inflatable balloon tamp. This reduces
the fracture and restores height to the vertebral body. The balloon is then
removed and cement is injected into the cavity under lower pressure than that
used in PVP, thereby reducing the risk of cement extravasation.
PVP and balloon kyphoplasty are
indicated in patients with incapacitating and persistent severe focal back pain
related to vertebral collapse. At the primary author's institution, vertebroplasty is used for lesions above T8 and kyphoplasty is used for the remainder.
In 1997, Jensen et al studied age-related or steroid-induced
osteoporotic vertebrae with partial compression fractures in patients who
underwent PVP with PMMA. A total of 48 vertebrae in 30 patients were injected,
and 90% of the patients described marked improvement of pain within 1 week of
treatment. All the patients who experienced pain relief noted increased
mobility and decreased need for narcotics. The patients were tracked for an
average of 9 months, and the rate of long-term pain relief was reported to be
approximately 80%. Whether this pain relief was related to mechanical
stabilization of the spine or was secondary to neurotoxic effects of PMMA remains to be determined.
Traditional operative management of vertebral compression
fractures is uncommon and is usually reserved for gross spinal deformity or for
threatened or existing neurologic impairment. Operative interventions include
anterior and posterior decompression and stabilization with placement of such
internal fixation devices as screws, plates, cages, or rods. Bone grafting is
routinely performed to achieve bony union. The failure rate of spinal arthrodesis is significant because achieving adequate
fixation of hardware in osteoporotic bone is difficult. Moreover, patients who
are elderly have a reduced osteogenic potential.
Consultations
Consultation
with a nonsurgical spine specialist is appropriate for a patient who is not a
surgical candidate or whose symptoms persist despite surgical fixation.
Consultation with a spine surgeon is appropriate for patients with intractable,
severe, function-limiting symptomatology that has not
been relieved by non-interventional techniques.
Medication
Currently, no treatment can
completely reverse established osteoporosis. Early intervention can prevent
osteoporosis in most people. For patients with established osteoporosis,
medical intervention can halt its progression. If secondary osteoporosis is
present, treatment for the primary disorder should be provided.
Prevention of osteoporosis has 2 components, behavior
modification and pharmacologic interventions. In 1998, the National
Osteoporosis Foundation outlined that the following factors should be modified
to reduce the risk of development of osteoporosis: cigarette smoking; physical
inactivity; and intake of alcohol, caffeine, sodium, animal protein, and calcium.
The pharmacologic prevention methods include calcium supplementation and
administration of estrogen, raloxifene, and bisphosphonates (with the exception of intravenous ibandronate).
Some of the preventative measures are also used in the
treatment of osteoporosis. The goal of the current recommendations for daily
calcium intake is to ensure that individuals maintain an adequate calcium
balance. Several large studies have demonstrated that supplementation of
calcium and vitamin D resulted in a 30-70% reduction of fracture rates over 2-4
years.
In 1994, the National Institutes of Health recommended the
following daily calcium intake:
Vitamin D is increasingly being recognized as a key element
in overall bone health and muscle function. The minimum daily requirement in
patients with osteoporosis is 800 IU of vitamin D3, or cholecalciferol.
Many patients require more, continuously or for a short period, to be
considered vitamin D replete, defined as a serum 25-hydroxyvitamin D level of 32 ng/mL.
Although not currently recommended for the treatment of
osteoporosis, HRT is important to mention because many osteoporosis patients in
a typical practice still use it for controlling postmenopausal symptoms. The
results of the Women's Health Initiative were distressing with respect to the
adverse outcomes associated with combined estrogen and progesterone therapy (eg, risks for myocardial infarction, stroke, deep venous
thrombosis, and breast cancer) and estrogen alone (eg,
risks for stroke and deep venous thrombosis); however, it was the first
randomized controlled trial that demonstrated that HRT was efficacious in
preventing nonvertebral fractures, in the order of
35%.
US Food and
Drug Administration–approved pharmacologic treatment options for osteoporosis
include raloxifene, calcitonin, bisphosphonates, and teriparatide (human recombinant PTH 1-34).
Raloxifene is part of a class of compounds termed selective estrogen receptor modulators
(SERMs), which provide the beneficial effects of estrogen without the
potentially adverse outcomes. Raloxifene has been
shown to prevent bone loss, and data in females with osteoporosis have
demonstrated that raloxifene causes a 35% reduction
in the risk of vertebral fractures. It has also been shown to reduce the
prevalence of invasive breast cancer. Raloxifene has
been shown to increase the incidence of deep vein thrombosis and hot flashes.
In 601 postmenopausal women who had daily therapy with raloxifene,
BMD was increased, serum concentrations of total low-density lipoprotein
cholesterol were lowered, and the endometrium was not
stimulated.
Calcitonin is a hormone that decreases osteoclast activity,
thereby impeding postmenopausal bone loss. Results from a single controlled
clinical trial indicate that calcitonin may decrease
osteoporotic vertebral fractures by approximately 30%. In the first 2 years, calcitonin has been found to increase spinal BMD by
approximately 2%. Calcitonin also has an analgesic
property that makes it ideally suited for the treatment of acute vertebral
fractures. Calcitonin is delivered as a single daily
intranasal spray that provides 200 U of the drug. The drug can be delivered
subcutaneously, but this route is rarely used.
Bisphosphonates have been used for the prevention and treatment of osteoporosis. When used for
prevention, the recommended dose of both alendronate and risedronate is 5 mg/d. In a study by Hosking et
al, doses of 2.5 mg and 5 mg of alendronate were
evaluated in postmenopausal women who did not have osteoporosis. They found
that the women who received placebo lost BMD at all measured sites, whereas the
women treated with 5 mg/d of alendronate had a mean
increase in BMD of 3.5% ± 0.2% at the lumbar spine, 1.9% ± 0.1% at the hip, and
0.7% ± 0.1% for the total body (all, P <.001).
Alendronate has been shown to increase both spinal and hip mineral density in
postmenopausal women. Well-conducted controlled clinical trials using alendronate sodium indicate that treatment reduces the rate
of fracture at the spine, hip, and wrist by 50% in patients with osteoporosis.
The treatment dose of alendronate is 70 mg/wk, to be
taken sitting upright with a large glass of water at least 30 minutes before eating
in the morning. Newer bisphosphonates include risedronate, dosed at 35 mg every weekend, and ibandronate, dosed at 150 mg/mo. The latter has not shown
efficacy in nonvertebral fractures in the clinical
trials. Ibandronate is also available as an intravenous
formulation that is given every 3 months. It is an excellent choice for
patients intolerant to oral bisphosphonates or in
those in whom adherence is an issue.
Over time, bisphosphonate therapy
decreases bone turnover and, at very high levels in animals, decreases bone
strength and resilience. Some limited reports, including that by Odvina et al from 2005, describe patients on long-term bisphosphonate therapy developing transverse stress
fractures; biopsy specimens of these individuals have suggested extremely low
turnover states. Therefore, while the bisphosphonates are outstanding in their efficacy, bone turnover markers should be monitored;
if these become profoundly suppressed, the patient should be taken off the bisphosphonates and given a rest period until he or she can
return to therapeutic levels (NTx, 20-40).
Teriparatide,
human recombinant PTH 1-34, is the only available anabolic agent for the
treatment of osteoporosis. When PTH is given continuously, it is associated
with increased osteoclastic and osteoblastic turnover, leading to a net loss of bone. However, in an intermittent
subcutaneous administration of 20 mcg/d, PTH has been
demonstrated to lead to a very active anabolic phase, with bone mass increasing
up to 13% over 2 years in the spine and to a lesser degree within the hip (Dempster, 2001; Neer, 2001; Body,
2002).
Most studies with PTH have been performed on women. The
medication decreases the risk of vertebral and nonvertebral fractures to the same extent as bisphosphonates. Teriparatide is given for a maximum of 2 years, after which
time the gains in BMD achieved with PTH are secure and can even be augmented
with bisphosphonate therapy, otherwise the BMD slowly
deteriorates to pretreatment levels (
According to Finkelstein et al in 2003, initial studies
using a combination of concurrent PTH and bisphosphonate therapy showed decreased benefit compared with therapy with either agent alone;
therefore, the general recommendation is that these drugs be given separately
and in sequence. A 2005 study by Cosman and
colleagues challenged this conclusion by giving 3-month-on, 3-month-off pulses
of teriparatide while the subjects were on weekly alendronate; BMD in the spine increased above that of the alendronate-only arm. This pulsed regimen appears to take
advantage of the 3- to 4-month so-called anabolic window, in which the markers
of bone formation rise more quickly than the markers of bone resorption.
Studies by Deal et al from 2005 and Ste-Marie et al from
2006 on women have shown that the concurrent use of estrogen or raloxifene can enhance the bone-forming effects of teriparatide. Data on the use of PTH in men are much more
limited, but they appear to have relatively comparable efficacy.
Indications for PTH in men and women are a bone density
decline while on bisphosphonate therapy, bone density
stabilization while on extremely low-level bisphosphonate therapy, a fracture occurring while on bisphosphonate therapy, or a very low initial bone turnover rate for which an anabolic effect
is clearly warranted.
Denosumab is a novel agent that has been studied in both cancer patients and in patients
with postmenopausal osteoporosis. It is a fully human monoclonal antibody
against RANKL (ie, receptor activator of nuclear
factor kappa-B ligand). RANKL is a key mediator of
the resorptive phase of bone remodeling. In patients
with multiple myeloma or bone metastases from breast cancer, a single
subcutaneous dose of denosumab decreases bone
turnover markers within 1 day, and this effect is sustained through 84 days at
the higher doses used in one study. Although no fracture data are available as
yet, denosumab was shown to increase BMD and decrease
bone resorption in postmenopausal women with
osteoporosis over a 12-month period.
Denosumab is currently in phase 3 clinical studies for both metastatic bone disease and
postmenopausal osteoporosis. Because the overactivity of RANKL is a major factor in bone loss in patients with autoimmune and
inflammatory disorders such as ulcerative colitis, denosumab may become first-line therapy for these patients.
Red
and Processed Meat Intake Linked to Mortality
Eating red and processed meat is associated with modest
increases in total mortality, cancer mortality, and cardiovascular disease
mortality rates, according to the results of a large, prospective study
reported in the March 23 issue of the Archives of Internal Medicine.
"High intakes of red or processed meat may increase the
risk of mortality," write Rashmi Sinha, PhD, from the National Cancer Institute, National
Institutes of Health, Department of Health and Human Services in
The National Institutes of Health–AARP Diet and Health Study
enrolled approximately half a million people aged 50 to 71 years at baseline. A
food frequency questionnaire administered at baseline allowed estimation of
meat intake, and Cox proportional hazards regression models allowed calculation
of hazard ratios (HRs) and 95% confidence intervals (CIs) within quintiles of
meat intake.
Red meat included all types of beef and pork such as bacon,
beef, cold cuts, hamburgers, hotdogs, steak, and meats in pizza, lasagna, and
stew. White meat included chicken, turkey, and fish along with poultry cold
cuts, canned tuna, and low-fat hotdogs. Processed meats could include either
red or white meats in the form of sandwich meats or cold cuts as well as bacon,
red meat and poultry sausages, and regular hotdogs and low-fat hotdogs made
from poultry. The authors note that some of the meats may overlap in the 3
categories, but they were not duplicated or used in the same models in the
study analysis.
The models considered covariates of age, education, marital
status, presence or absence of family history of cancer (for cancer mortality
only), race, body mass index, smoking history, physical activity, energy
intake, alcohol drinking, use of vitamin supplements, fruit consumption,
vegetable consumption, and use of menopausal hormone therapy in women. Primary
endpoints of the study were total mortality and deaths caused by cancer,
cardiovascular disease, injury and sudden deaths, and all other causes.
During 10 years of follow-up, 47,976 men and 23,276 women
died. Overall mortality risks were increased for men and women in the highest vs the lowest quintile of red meat intake (HR, 1.31; 95%
CI, 1.27 - 1.35; and HR, 1.36; 95% CI, 1.30-1.43, respectively) and
processed meat intake (HR, 1.16; 95% CI, 1.12 - 1.20; and HR, 1.25;
95% CI, 1.20 - 1.31, respectively). Men and women with higher intake
also had increased risks for cancer mortality for red meat (HR, 1.22; 95% CI,
1.16 - 1.29; and HR, 1.20; 95% CI, 1.12 - 1.30,
respectively) and processed meat (HR, 1.12; 95% CI, 1.06 - 1.19; and
HR, 1.11; 95% CI 1.04 - 1.19, respectively).
Cardiovascular disease risk was increased for men and women
in the highest quintile of intake of red meat (HR, 1.27; 95% CI,
1.20 - 1.35; and HR, 1.50; 95% CI, 1.37 - 1.65,
respectively) and processed meat (HR, 1.09; 95% CI, 1.03 - 1.15; and
HR, 1.38; 95% CI, 1.26 - 1.51, respectively). For the highest vs the lowest quintile of white meat intake for both men
and women, there was an inverse association for total mortality, cancer
mortality, and mortality from all other causes.
"Red and processed meat intakes were associated with
modest increases in total mortality, cancer mortality, and cardiovascular
disease mortality," the study authors write. "In contrast, high white
meat intake and a low-risk meat diet was associated
with a small decrease in total and cancer mortality."
Limitations of this study include possible residual
confounding by smoking; possible measurement error; and cohort predominantly
non-Hispanic white, more educated, with less smoking, less fat and red meat
intake, and more intake of fiber and fruit and vegetables than similarly aged
adults in the US population, limiting generalizability.
"These results complement the recommendations by the
American Institute for Cancer Research and the World Cancer Research Fund to
reduce red and processed meat intake to decrease cancer incidence," the
study authors write. "Future research should investigate the relation
between subtypes of meat and specific causes of mortality."
In an accompanying editorial, Barry M. Popkin,
PhD, from the
"Of equal importance is the role of clinicians as
public health advocates," Dr. Popkin writes.
"Far too few clinicians speak out on topics such as this. What the public
hears is the side of the profession that is preaching vegetarian diets and not
the side of the profession that is discussing moderation as a healthy
option."
The Intramural Research Program of the National Institute of
Health, National Cancer Institute supported this study in part. The study
authors have disclosed no relevant financial relationships. Dr. Popkin is not a vegetarian and has no financial conflict of
interest related to any food product as it affects health.
Arch Intern Med. 2009;169:543-545,
562-571.
Clinical Context
Dietary patterns are changing around the globe, and an
editorial by Popkin, which accompanies the current
article, describes these patterns. Individuals in higher-income countries
continue to consume meat and dairy products at 2 to 3 times the rate of
lower-income countries. However, meat and dairy products are becoming a more
common dietary staple in some developing countries, particularly
In part, higher consumption of meat is the result of a lower
cost of beef vs several decades ago. At the same
time, the cost of grains and rice has increased significantly on the world
market in the last 6 years. This has important environmental consequences, as
the need for water and feedstock is much higher in raising animals vs raising basic crops.
Meat consumption can have significant effects on rates of
obesity and overall health as well. The current study examines a large cohort
of adults to determine the effect of meat intake on mortality rates.
Study Highlights
Pearls for Practice
In
the current study, red meat and processed meat consumption were associated with
higher rates of all-cause, cardiovascular, and cancer mortality. However, white
meat consumption was associated with a lower risk for mortality.
Most studies that have tested the effect of sleep loss on
feeding behaviors have been performed in animals. Both total sleep deprivation
and REM sleep deprivation produce a syndrome of increased feeding but a
decrease in weight in rats.[1] Furthermore, sleep-deprived animals
show preference for a high-carbohydrate diet.[2] Studies performed
in humans have shown similar results and suggest that sleep deprivation has
direct effects on eating behavior; sleep-deprived humans also show increased
appetite, particularly for high-carbohydrate, calorie-rich foods.[3] Mechanisms for these associations may be mediated in part by changes in
hormones related to feeding; both sleep-deprived humans and rodents show
increases in ghrelin, a hormone that increases
feeding, and decreases in leptin, a hormone that
decreases feeding.
Epidemiologic studies also show
significant associations between sleep amount and obesity. In numerous studies
in both children and adults, hours of sleep per night are inversely correlated
with body mass index. A study of patients in primary care settings found that
overweight and obese patients slept less than those of normal weight.[4] A study of 5- and 6-year-old children found that the prevalence of obesity was
increased as sleep amount decreased, independently of other factors.[5] A recent study found that although short sleep amount was associated with
increased BMI, insomnia per se was not.[6] However, other studies
have noted that overweight individuals have an increased risk for insomnia; for
example, in men, obesity was an independent risk factor for insomnia,[7] and in a study of older adults, those with a BMI > 27 were more likely to
get the least amount of sleep (< 4.5 hours per night).[8] Although a causal association between short sleep or insomnia and obesity has
not yet been proven, the findings suggest the possibility that sleep may be
important in the prevention and treatment of obesity.
Young
Vegetarians May Be at Increased Risk for Eating Disorders
— Adolescent and young adult
vegetarians appear to be at greater risk for disordered eating behaviors, new
research suggests.
A large cross-sectional analysis of data from Project EAT
(Eating Among Teens) — a study of socio-environmental, personal, and behavioral
determinants of dietary intake and weight status in adolescents — shows that
adolescent and young adult vegetarians are more likely to report binge eating
with loss of control compared with non-vegetarians.
Further, adolescents and young adult former vegetarians were
more likely than never vegetarians to engage in extreme weight-control
behaviors.
"Findings from the present study indicate that
adolescent and young adult vegetarians may experience the health benefits
associated with increased fruit and vegetable intake, and young adults may have
the added advantage of decreased risk for overweight and obesity,"
principal investigator Ramona Robinson-O'Brien, PhD, RD, from the College of
Saint Benedict and Saint John's University, in St. Joseph, Minnesota, told Medscape Psychiatry.
"However, current vegetarians may be at increased risk
for binge eating, while former vegetarians may be at increased risk for extreme
unhealthful weight-control behaviors," she added.
The study is published in the April issue of the Journal
of the American Dietetic Association.
"Acceptable" Weight-Loss Strategy
According to the authors, previous research indicates that
adolescents with symptoms of eating disorders may adopt a vegetarian diet as a
weight-loss strategy because it is a "socially acceptable way to avoid
eating certain food groups." Further, they note, female adolescents are
more likely than boys to adopt vegetarianism as a method of weight loss.
To examine characteristics of current and former adolescent
and young adult vegetarians and investigate the potential link between
vegetarianism, weight, dietary intake, and weight-control behaviors, the
investigators analyzed data from 2516 study participants aged 15 to 23 years.
These subjects had been part of Project EAT-I, an earlier
survey of middle- and high-school students from 31 Minnesota schools using
in-class surveys, food frequency questionnaires, and anthropometric measures
taken during the 1998–1999 academic year.
Participants were identified as current (4.3%), former
(10.8%), and never (84.9%) vegetarians. Subjects were divided into 2 cohorts
categorized by age — adolescents (15 to 18 years) and young adults (19 to 23
years).
Mailed surveys, which included questions assessing
vegetarian and weight status, dietary quality, physical activity, binge eating,
weight-control behaviors, substance use, and demographics were sent to all
participants of Project EAT-I.
The final analysis was based on completed surveys from 2516
subjects.
Less Likely to Be Overweight
Among adolescent subjects, a higher percentage of former
vegetarians reported engaging in more extreme unhealthful weight-control
behaviors such as taking diet pills and vomiting as well as laxative and
diuretic use compared with never vegetarians (P < .005). This was
also the case among young adult former vegetarians (P < .001).
In addition, a higher percentage of young current and former
vegetarians reported engaging in binge eating with loss of control compared
with never vegetarians (P < .001).
In the older cohort, a higher percentage of current
vegetarians also reported engaging in binge eating with loss of control
compared with former and never vegetarians.
The investigators also found that, among the younger cohort,
no statistically significant differences were found with regard to weight
status. Among the older cohort, current vegetarians had a lower body-mass index
and were less likely to be overweight or obese when compared with never
vegetarians.
Among the younger cohort, current vegetarians consumed the
highest daily servings of fruits and vegetables (P < .001) and the
lowest proportion of calories as total and saturated fat (P < .001)
when compared with former and never vegetarians.
In both the younger and older cohort, no statistically
significant differences were found between current, former, and never vegetarians
with regard to time spent engaged in moderate and vigorous physical activity or
participation in a sport or activity where it is important to stay a certain
weight.
Assessing Motives May Be Important
The study findings, said Dr. Robinson-O'Brien, suggest it
may be beneficial for clinicians to investigate an individual's motives for
choosing a vegetarian diet and ask about current and former vegetarian status
when assessing risk for disordered eating behaviors.
Further, she said, "when guiding adolescent and young
adult vegetarians in proper nutrition and meal planning, it is important to
recognize the potential health benefits and risks associated with a vegetarian
diet."
Future research in this population may be useful in
identifying longer-term benefits and risks associated with vegetarian diets,
said Dr. Robinson-O'Brien.
She added that in-depth qualitative research with teens
might provide additional insight into the associations between specific
motivations and risk for disordered eating behaviors.
RPL – Recognition of Prior Learning
– Available from July 2009
Summary
Recognition of Prior Learning (RPL) in
Education and Training Quality Assurance Bodies (ETQAs), providers
of education and training, constituents of Sector Education and Training
Authorities (SETAs) and most importantly, the main beneficiaries of the
process, the learners.
Recognition of Prior Learning (RPL) is defined in the National
Standards Bodies Regulations
(No 18787 of 28 March 1998, issued in terms of the SAQA Act 58 of
1995) as follows:
This definition makes clear a number of principles in the
development and execution of RPL:
• Learning occurs in all kinds of situations – formally,
informally and non-formally;
• Measurement of the learning takes place against specific
learning outcomes required for a
specific qualification; and
• Credits are awarded for such learning if it meets the
requirements of the qualification.
Therefore, the process of recognising prior learning is about:
• Identifying what the candidate knows and can do;
• Matching the candidate’s skills, knowledge and
experience to specific standards and the
associated assessment criteria of a qualification;
• Assessing the candidate against those standards; and
• Crediting the candidate for skills, knowledge and
experience built up through formal,
informal and non-formal learning that occurred in the past.
“Recognition of prior learning means
the comparison of the previous learning and experience of a learner howsoever
obtained against the learning outcomes required for a specified qualification,
and the acceptance for purposes of qualification of that which meets the
requirements”.
We will be offering this facility at
the International College of Kinesis as from July 2009
Draft
Fitness Industry Regulations - How will you or you establishment be affected
FITNESS INDUSTRY REGULATIONS, 2009
SPORT AND RECREATION
GOVERNMENT
NOTICE
The Minister for
Sport and Recreation has under section 14 of the National Sport and Recreation
Act, 1998 (Act No. 110 of 1998 as amended), and after consultation with the
South African Sports Confederation and Olympic Committee, made the Regulations
in the Schedule.
Definitions
1.
In
these Regulations a word or expression to which a meaning has been assigned in
the Act has that meaning unless the contents indicate otherwise –
“accreditation” means the accreditation by the
Fitness Board of a fitness establishment in terms of section 11 in compliance
with the criteria as referred to in regulation 15;
“Act” means the National Sport and Recreation Act, 1998 (Act No. 110 of 1998
as
amended);
“annual fee” means the fee payable on an annual basis as contemplated in terms of
regulation 7(1);
“apparently healthy” means in relation to any person, a person who is a
symptomatic and with no more than one coronary risk factor;
“cardio-vascular mode of equipment” means heart, vascular and respiratory equipment (e. g. treadmills, stationery cycles, arm ergometers and stepping machines) that train the heart and lungs-
(a)
involving large muscle groups; and
(b) are rhythmic and aerobic by nature.
“coronary risk factor” means any major risk factor for a heart attack that may
include any of the following amongst others:
(a) in the case of men, above the age of 45 years
and in the case of women above 55 years;
(b)
a family history of Myocardial infarction (heart attack) or
sudden death-
(i)
before the
age of 55 years in respect of a father or other male first degree relative, or
(ii)
before 65 years in mother or other female first degree
relative;
(c)
cigarette smoking;
(d) sedentary lifestyle or inactivity;
(e)
a person with high cholesterol above 5.0 mmol/l;
(f)
a person with insulin dependant diabetes who are above the age of 30 years or who have
had it for more than 15 years; or
(g)
a person with non-insulin dependant diabetes who are above the
age of 35 years.
“CPR” means
cardiopulmonary resuscitation;
“de-accreditation” means an action as contemplated in regulation 18;
“disability” means a mobility, intellectual or hearing impairment such as
cerebral palsy, severe epilepsy, amputation, spinal cord injury, visual
impairment, les autres (including dwarves or an
impairment resulting from genetic problems), intellectual disability including
a deaf person;
“disability friendly” means that a fitness
establishment has complied with the following in order to meet the needs of a
person with a disability:
(a)
with regard to its facility:
(i)
The shower
and toilet area must be accessible for a person in a wheelchair in terms of
South African Bureau of Standards;
(ii)
If a pool
is available, the deck of the pool must be accessible for a person in a
wheelchair; and
(iii)
A person
with any disability should be able to train his or her full body in every mode
(strength, flexibility, cardiovascular, etc.) at a fitness establishment.
(b)
with regard to its equipment:
(i)
A
wheelchair should be able to move freely between all the equipment of the
fitness establishment;
(ii)
Sufficient
equipment must be in place at the fitness establishment to enable the person
with a disability to train his/her full body in all different modes as referred
to in par. (c) (iii) above;
(iii)
The said
equipment should be well marked for a person with visual impairment; and
(iv)
Specialized
equipment for a person with a disability must be available at the fitness
establishment.
(c)
with regard to its personnel, a qualified assistant must be present at a fitness
establishment to assist a person with a disability at all time: Provided that
if the person with a disability is accompanied by his/her personal assistant,
the personal assistant may assist the person with disability free of charge but
takes over the responsibility of the qualified assistant of the fitness
establishment and is fully responsible for the person with a disability;
(d)
with regard to emergency procedures, sufficient procedures
must be in place to assist a person with a disability in the case of an
emergency in the fitness establishment; and
(e)
with regard to safety standards for disabled persons in
general, a fitness establishment must have at least the following available for
disabled persons:
(i)
a defibrulator;
(ii)
a fist aid
kit for disabled persons; and
(iii)
sufficient
number of staff that is specifically trained to assist disabled persons;
“ETD” means
education, training and development requirements;
“Fitness Board” means the Fitness Industry Board of South Africa established in terms of its
own Constitution;
“fitness establishment” means:
(a)
any
establishment in which supervised physical activity takes place to enhance
fitness levels;
(b)
any
establishment that offers/provides services and/or equipment for use by the
public for the purposes of fitness; and
(c)
any
establishment that charges a fee to persons using equipment and/or facilities
or supervised instruction in enhancing fitness;
‘fitness professional’ means any person in the Republic who has been registered in
terms of these Regulations and performs activities regulated by the Fitness
Board in terms of published scopes of practices;
“increased risk” means in relation to any person, a person who has signs or symptoms of
possible cardiopulmonary or metabolic diseases and/or at least two coronary
risk factors;
“known disease” means in relation to any person, a person with a known cardiac,
pulmonary or metabolic disease and chronic diseases of lifestyle;
“listing” means the listing of a fitness professional as referred to in regulation 2(1)
of these Regulations;
“Minister” means the
Minister responsible for Sport and Recreation South Africa;
“national fitness organization” means an organization registered with the Sports
Confederation possessing a national membership and being constituted for the
purposes of promoting fitness;
“NQF” means the
national qualifications framework;
“Occupational Health and Safety Act” means Act No. 85 of 1993;
“owner/manager” means
the owner/manager of a fitness establishment;
“Promotion of Access to Information Act” means Act No. 2 of 2000;
“Promotion of Administrative Justice Act” means Act No. 3 of 2000;
“Promotion of Equality and Prevention of Unfair
Discrimination Act” means Act
No. 4 of 2000;
“person” means any natural person;
“personnel” means fitness professionals registered with the Fitness Board and which
are employed as staff at an accredited fitness establishment in terms of these
Regulations;
“prescribe” means prescribed by regulation;
“qualified assistant” means a person referred to in the definition of “disability
friendly” under the personnel of the fitness establishment, having
successfully completed the SRF 31-Unit Standard level 5 / 5 credits that
includes persons with disabilities in sport, recreation and fitness activities)
or any equivalent qualification;
“Sports Confederation” means the Sports
Confederation as contemplated in terms of the definitions of the Act;
“SAQA” means the South African Qualification
Authority;
“SRSA” means
Sport and Recreation South Africa, the national Department responsible for
sport and recreation in the Republic;
“specialized equipment” means any available specialized equipment at a fitness
establishment for specific tasks, amongst others.
Registration of fitness professionals
2.(1) No
person shall practice as a fitness professional as defined by the rolls
published annually by the Fitness Board unless he or she:
(a) has applied in writing within 6 months after the
promulgation of these regulations to the Fitness Board to be listed on the said
rolls; and
(b) is registered in writing by the Fitness Board in terms of
these Regulations within 2 years after the promulgation of these Regulations as
a fitness professional.
(2)
Any person
who intends to be registered as a fitness professional in terms of these
Regulations shall apply to the Fitness Board in writing and shall submit the
certified qualification which, in his or her submission, entitles him or her to
such registration, together with such proof of his or her identity and of the
authenticity and validity of the qualification submitted, as may be required by
the Fitness Board.
(3)
If the
Fitness Board is satisfied that the qualification and the other documents
submitted in support of the application comply with the requirements of these
Regulations, it shall, upon payment of the prescribed fee, cause the necessary
entry to be made in the register and shall thereupon issue a registration
certificate authorizing the applicant, subject to the provisions of these
Regulations or any other law, to practice the profession of a fitness
professional within the stipulated scope of practice.
(4)
A fitness
professional shall at all times conduct himself or herself in accordance with
the provisions of the code of conduct as determined by the Fitness Board from
time to time: Provided that the Fitness Board may, subject to the compliance
with the Promotion of Administrative Justice Act, cancel or suspend such
registration if it deems it appropriate.
Registers of fitness professionals
3. The
Fitness Board shall keep separate registers in respect of various rolls of
fitness professionals and shall enter in the appropriate register the
prescribed particulars of every person whose application is granted in terms of
regulation 2(3).
Qualifications required for registration as fitness
professionals
4. In
order to qualify for registration as a fitness professional, an applicant must
have obtained the qualifications as set out in the Constitution of the Fitness
Board which may, if possessed alone or together with another qualification,
entitle the possessor thereof to registration as a fitness professional,
subject to complying with the conditions or requirements prescribed in terms of
the provisions of the said Constitution.
Foreign qualifications
5. The Fitness Board may register as a fitness
professional, any person who has acquired a qualification or undergone training
outside the Republic if such qualification or training in the opinion of the
Fitness Board, is commensurate with the standards regulated by the Fitness
Board within the Republic in the Constitution of the Fitness Board and the
rules and regulations of the South African Qualification Authority.
Period of registration
6.
Any
person registered by the Fitness Board as a fitness professional in terms of
regulation 2 shall be entitled to practise as such,
only for the period or periods determined by the Fitness Board in writing,
during which period he or she shall satisfy the Fitness Board that:
(a)
he or she possesses professional knowledge and ability of a
standard not lower than prescribed in respect of fitness professionals in the
Republic;
(b)
he or she is conversant with the laws of the Republic
regarding the fitness practice in the area or areas determined by the Fitness
Board; and
(c)
he or she
fulfils any further conditions determined by the Fitness Board.
Registration
fees
7.(1) The Minister may on the recommendation of
the Fitness Board at any time by notice in the Government Gazette determine the
fee to be paid annually to the Fitness Board by a fitness professional.
(2)
Different
fees may be fixed in respect of different categories of fitness professionals.
8. Notwithstanding
any provision to the contrary in these Regulations, the Fitness Board may,
subject to the Promotion of Administrative of Justice Act referred to above,
refuse to register any person as referred to regulation 2(3) or to remove the
name of any person to the register if, in the opinion of the Fitness Board,
such person is by reason of a conviction, in the Republic or elsewhere, of a
prescribed offence, not fit to practise as a fitness
professional.
9.(1) No person shall
employ any other person to perform the work of a fitness professional unless
such other person is registered in terms of regulation 2(3) above.
(2) The
prohibition in subregulation (1) shall not apply in
respect of a student fitness professional registered with an accredited
education and training provider as defined in the South African Qualifications
Authority Act, 1995 (Act No 58 of 1995) if the act in question is performed for
purposes of his or her training in the fitness practice and is supervised by a
registered fitness professional.
(2)
Nothing
contained in subregulation (2) shall be construed as
prohibiting the education and training of any student in the fitness practice,
or the employment of any student fitness professional in an accredited fitness
establishment.
10.(1) Of its own
initiative or by submission from any person, the Fitness Board may convene a
disciplinary panel to consider the conduct of a registered fitness professional
and/or an owner/manager: Provided that in the event of a complaint by a person-
(a)
the
submission to the Fitness Board must be in writing within a time frame of
thirty (30) days after the cause of the complaint has arisen;
(b)
such a
person must confirm his/her willingness in writing to-
(i)
testify
at the said disciplinary hearing, if necessary;
(ii)
submit
any supporting evidence to the Fitness Board in order to substantiate the said
complaint; and
(iii)
identify other persons that can assist in the corroboration of
the said complaint.
(2) If the Fitness Board is of the opinion
that a fitness professional and/or an owner/manager has contravened the code of
conduct for a fitness professional and/or an owner/manager, the Fitness Board
may impose an appropriate sanction, which may include the following amongst
others:
(a)
a written warning to the fitness professional and/or an
owner/manager;
(b)
a fine not exceeding R10 000 payable by the said fitness
professional and/ or owner/manager;
(c)
in the case of a fitness professional-
(i) a suspension from the fitness professional register for a
period of time as specified by the Fitness Board in writing;
(ii) the removal of such a fitness professional from the fitness professional register;
(d)
in the case of an owner/manager of a fitness establishment-
(i) a suspension of such owner/manager from the fitness establishment
for a period of time as specified by the Fitness Board in writing; or
(ii)
a notification to such owner/manager in writing of any decision taken by the
Fitness Board in terms of regulation 17.
11.(1) A fitness establishment shall not conduct business as a fitness
establishment unless:
(a)
it has applied in writing to the Fitness
Board within a period not exceeding 6 months after the promulgation of these
Regulations for the listing of such an establishment;
(b)
it is accredited by the Fitness Board in
writing within a period not exceeding two years after the promulgation of the
Regulations; and
(c)
it has complied with the provisions of the
Occupational Health and Safety Act as well as the Promotion of Equality and
Prevention of Unfair Discrimination Act.
(2) The
Fitness Board shall accredit and grade all fitness establishments in the
Republic in writing.
(3) There
shall be two grading systems for fitness establishments namely one for
multi-purpose establishments and one for single purpose establishments.
(4) A
multi-purpose establishment shall have 5 grades of establishment, namely Blue,
Bronze, Silver, Gold and Platinum.
(5) A
single purpose establishment shall have 4 grades of establishment, namely Blue,
Bronze, Silver and Gold.
(6) A
fitness establishment may be awarded a certificate to offer a service above its
level of grading if the Fitness Board deems it fit.
(7)
A
fitness establishment shall at all times comply with the requirements of its
conditions of accreditation as determined by the Fitness Board in writing: Provided the Fitness Board may, subject to
the compliance with the said Promotion of Administrative Justice Act, cancel or
suspend such registration if it deems it appropriate.
(8) All
grades of fitness establishments as referred to in regulation 13 must comply
with the Promotion of Equality and Prevention of Unfair Discrimination Act.
as well as the Occupational Health and Safety
Act.
12. Any fitness establishment that, in the
opinion of the Fitness Board, does not comply with the criteria for
accreditation as prescribed by the Fitness Board from time to time, may be
refused accreditation by the Fitness Board: Provided that the Fitness Board may subject to the compliance with the
said Promotion of Administrative Justice Act, cancel or suspend such
registration if it deems it appropriate.
13.(1) A blue grade
fitness establishment shall comply with the following requirements amongst
others:
(i)
All fitness professionals of the establishment must be
registered at the level of Exercise Leaders or above;
(ii)
All personnel of the establishment must be CPR or first aid
qualified by a SAQA accredited organization;
(iii)
The establishment must have available for use by the public a
minimum range of equipment as contemplated in the Schedule attached hereto;
(iv)
The establishment shall only admit a person classified as
‘apparently healthy’ person as referred in regulation 1 after completing a
screening questionnaire for assessment purposes to use its equipment and/or
facilities or supervised instruction in enhancing fitness unless such a person
is in possession of written permission from a registered medical practitioner
to make use of its fitness facilities and services; and
(v) The said establishment shall comply with the provisions of
the Occupational Health and Safety Act as well as the Promotion of Equality and
Prevention of Unfair Discrimination Act.
(2) A bronze grade fitness establishment
shall comply with the following requirements, amongst others:
(i)
At least one fitness professional of the establishment must
be registered at the level of Exercise Leader or above and least one fitness
professional must be in possession of an NQF level 5 National Certificate in
Fitness;
(ii)
All
personnel of the establishment must be CPR and first aid qualified by a SAQA
accredited organization;
(iii)
The
establishment must have available for use by the public a range of equipment as
contemplated in the Schedule attached hereto;
(iv)
The establishment
shall only admit a person classified as ‘apparently healthy’ person in
regulation 1 after completing a screening questionnaire for assessment purposes
to use its equipment and/or facilities or supervised instruction in enhancing
fitness unless such a person is in possession of written permission from a
registered medical practitioner to make use of its fitness facilities and
services;
(v)
The
said establishment shall comply with the provisions of the Occupational Health
and Safety Act as well as the Promotion of Equality and Prevention of Unfair
Discrimination Act; and
(vi) A bronze grade fitness establishment is not
required to offer any recreational facilities additional to those normally
offered to the public in the course of its business.
(3) A silver grade fitness establishment
shall comply with following requirements amongst others:
(i)
At
least two of fitness professionals of the establishment must be in possession
of an NQF level 5 National Certificate in Fitness;
(ii)
All
personnel of the establishment must be CPR and first aid qualified by a SAQA
accredited organization;
(iii)
The
establishment must have available for use by the public a wide range of
equipment as contemplated in the Schedule attached hereto;
(iv)
The
establishment shall have sufficiently qualified staff to supervise and monitor
the use of equipment at all times and participation in programmes by all
special populations as defined in regulation 1;
(v)
The
said establishment shall comply with the provisions of the Occupational Health
and Safety Act as well as the Promotion of Equality and Prevention of Unfair
Discrimination Act; and
(vi) A silver grade fitness establishment is
required to offer a minimum of one recreational facility additional to those
normally offered to the public in the course of its business.
(4) A gold grade fitness establishment shall
comply with the following requirements amongst others:
(i)
At
least 4 fitness professionals must be in possession of a relevant NQF level 5
National Certificate in Fitness and at least one fitness professional must have
a relevant NQF level 7 National Certificate in Fitness;
(ii)
All
personnel of the establishment must be CPR and first aid qualified by a SAQA
accredited organization;
(iii)
The
establishment must have available for use by the public a wide range of
equipment, including specialized equipment as contemplated in the
Schedule attached hereto;
(iv)
The
establishment shall have sufficiently qualified staff to supervise and monitor
the use of equipment and participation in programmes by all special populations
and by increased risk clients as defined in regulation 1;
(v)
The
establishment shall have attained the status of “disability friendly” as
defined in regulation 1;
(vi)
The
said establishment shall comply with the provisions of the Occupational Health
and Safety Act as well as the Promotion of Equality and Prevention of Unfair
Discrimination Act; and
(vii)
A gold
grade fitness establishment is required to offer a minimum of two recreational
facilities additional to those normally offered to the public in the course of
its business: Provided that in the event of a swimming pool and /or any other
recreational facility available at the fitness establishment, it must be
accessible to a person in a wheelchair.
(5) A platinum grade fitness establishment
shall comply with the following requirements amongst others:
(i)
At
least 5 fitness professionals must be in possession of a relevant NQF level 5
National Certificate in Fitness and least two fitness professionals must have a
relevant NQF level 7 National Certificate in Fitness;
(ii)
All fitness professionals of the establishment must be CPR
and first aid qualified;
(iii)
The establishment must have available for use by the public a
wide range of equipment, including high-tech equipment as contemplated in the
Schedule attached hereto;
(iv)
The establishment shall have sufficiently qualified staff to
supervise and monitor the use of equipment and participation in programmes by
all special populations and by increased risk clients as defined in regulation
1;
(v)
The establishment shall have attained the status of
“disability friendly” as defined in regulation 1;
(vi)
The establishment shall make available to clients in the
establishment, access to rehabilitation programmes offered by qualified and
registered personnel;
(vii)
The establishment shall make available to clients in the
establishment, access to qualified and registered health professionals;
(viii)
The
said establishment shall comply with the provisions of the Occupational Health
and Safety Act as well as the Promotion of Equality and Prevention of Unfair
Discrimination Act; and
(ix)
A
platinum grade fitness establishment is required to offer a minimum of four
recreational facilities additional to those normally offered to the public in
the course of its business: Provided that in the event of a swimming pool and
/or any other recreational facility available at the fitness establishment, it
must be accessible to a person in a wheelchair.
(6)
Irrespective of the grade of a fitness establishment, it
shall ensure that the standard quality of its equipment is properly and
consistently maintained: Provided that the Fitness Board shall have the power
to inspect a fitness establishment every two years to determine its grading
level including the standard quality of its equipment.
(7) In the event of a written complaint received from a person regarding the poor
quality of its equipment, a fitness establishment shall ensure that the
complaint is addressed within a reasonable time after receiving such complaint:
Provided further that if the said establishment fails to address such a
complaint accordingly, such a person shall have the right, subject to complying
with the procedures referred to in regulation 10(1), to approach the Fitness
Board for further relieve.
(8)
The Fitness Board shall subsequently have the power to make a
ruling in this regard by informing the fitness establishment of its decision in
writing: Provided that in the event of non-compliance in respect of such a
decision by the said establishment, any of the actions contemplated in regulations
10(2) and 17 may be taken respectively by the Fitness Board against a fitness
professional, the owner/manager of a fitness establishment and/or the fitness
establishment itself.
Database
of accredited fitness establishments
14.(1) The Fitness Board
shall keep a database of accredited fitness establishments classified according
to their grade of accreditation
(2) The Fitness Board shall make this
database available annually via a publication in the Government Gazette and/or
the fitness industry appropriate communication to members of the public if
requested to do so in writing but subject to the provisions of the said
Promotion of Access to Information Act.
16.
Any
fitness establishment accredited by the Fitness Board shall be entitled to
operate as a fitness establishment, only for the period or periods determined
by the Fitness Board in writing, during which period the establishment shall
satisfy the Fitness Board that all conditions as determined by the Fitness
Board from time to time have been met.
17. Notwithstanding the above, the Fitness
Board may of its own initiative convene an extraordinary audit of a fitness
establishment that has been accredited and graded in terms of regulation 10(2).
De-accreditation of and other sanctions against
fitness establishment
18. If the Fitness Board is of the opinion
that the fitness establishment has contravened its conditions of accreditation
as determined by it from time to time, the Fitness Board may impose an
appropriate sanction of one or all of the following, amongst others:
(a)
a written warning to the fitness establishment;
(b)
a fine not exceeding R80 000 payable by the fitness
establishment;
(c) a suspension of the accreditation of the
fitness establishment for a period of
time as specified by the Fitness Board in writing;
(d)
the de-accreditation of the said establishment by stipulating
in writing that de-accredited fitness establishment -
(i)
must be closed down; and
(ii)
may not carry on any of its former activities as an
accredited fitness establishment in such de-accredited state as from a date
determined by the Fitness Board in writing
:Provided
that if such a de-accredited establishment fails to comply with a stipulation
as referred to in subparagraph (i) and (ii) above, it
shall commit an offence that is punishable by law; and
(e)
the down-grading of the fitness establishment to a level as determined by the
Fitness Board in writing.
19. A fitness
establishment that has been accredited in terms of regulation 11, shall not be
entitled to cede its accreditation to another fitness establishment unless such
cession has been approved by the Fitness Board in writing.
20.(1) The
Minister may, on the recommendation of the Fitness Board, at any time by notice
in the Government Gazette fix a fee to be paid by a fitness
establishment to the Fitness Board for the process of accreditation.
(2) The Minister
may, on the recommendation of the Fitness Board at any time by notice in the Government
Gazette fix a fee to be paid by a fitness establishment for the annual
retention of accreditation by the establishment.
(3) Different
fees may be fixed in respect of different grades of fitness establishment.
21. Notwithstanding the provisions of
regulation 16, any fitness establishment that fails to comply with any
provision of these Regulations shall be guilty of an offence and on conviction
be liable to a fine not exceeding R 80 000.
Dispute resolution and appeals
22.(1) Any dispute
arising from any matter pertaining to these Regulations must be dealt with in
accordance with section 13 of the Act.
(2) Any person who is aggrieved by a
decision or, where applicable, the terms and conditions attributable to such a
decision, taken in terms of these Regulations may, within a period of seven (7)
days after service of the notification of the relevant decision, appeal to the
SRSA;
(3) In addition to the provisions
contained in sub-regulation 1, SRSA may also:
(a) hear and decide on any dispute
arising in terms of these Regulations as contemplated in terms of section 13 of
the National Sport and Recreation Act as referred to above;
(b) confirm or set aside any sanction
imposed in terms of these Regulations;
(c) may in the place of any sanction so
set aside, impose any sanction which in its opinion should and could lawfully
have been imposed.
(4) Any person lodging an appeal or
referring a dispute to SRSA as contemplated in these Regulations, shall do so,
in writing, within the time frames provided for in terms of these Regulations
and the grounds of appeal or background details surrounding the referred
dispute must set out fully and clearly the grounds of appeal or basis of the
referred dispute, as well as any legal representations and arguments which the
appellant or person referring the dispute believes may be relevant to the
matter.
(5) Any party involved in the prosecution
of an appeal or hearing of a dispute, shall be entitled to be represented by a
person of his or her own choice.
(6) The normal generally accepted rules
and procedures of administrative law and natural justice shall apply to the
prosecution of appeals or the hearing of disputes as contemplated in these
Regulations.
Transitional provisions
23.(1) An applicant that has, prior to the promulgation of
these Regulations, never before applied to be registered as a fitness
professional, shall be entitled to apply to the Fitness Board for such a new
registration subject to complying with the terms and conditions as set out
hereunder and/or any other requirement that the Fitness Board may determine
from time to time.
(2)
The Fitness Board shall, only insofar as such a new application is concerned,
be compelled to register such a new applicant as fitness professional at the
level as determined by the Fitness Board from time to time, subject to the
following:
(i)
the
said new application must be in writing;
(ii)
the application in question must conform to
the provisions of regulation 2 (2) and (3); and
(iii)
the application must be received by the
Fitness Board not later than a period of 2 years after the date of commencement
of the promulgation of these Regulations: Provided that the transitional
provisions as contemplated in this regulation shall be automatically repealed
after the period as referred to in subregulation (2)(iii) has lapsed.
Short title and
commencement
24.(1) These Regulations are called the Fitness
Industry of South Africa Regulations, 2009.
(2) Different
dates for the commencement of different regulations contained in these
regulations may be determined from time to time.
Notwithstanding
the contents of the issues dealt with specifically hereunder, the details
pertaining to these issues are by no means exhaustive and should be read and
interpreted in conjunction with any relevant provisions contained in the
Constitution, guidelines, code of conduct and/or any other relevant manual
or document of the Fitness Board in this
regard.
Equipment:
Class of equipment to be utilized at a fitness
establishment irrespective of the grading level of the said establishment
:
A. Strength
and conditioning modes of equipment which may include any of the following
amongst others::
§
Therabands, swiss balls,
mats, ropes;
§
Free
weights including dumbbells, barbells, benches (incline, decline, flat),
cable/pulley machines; and
§
Machines
for upper body and lower body.
B. Cardio vascular modes of equipment means any of the following, amongst others:
§
Cycles;
§
Treadmills;
§
Rowing
machines;
§
Step machines
and step benches; and
§
Arm ergometers.
Minimum equipment required to be available at each
level of grading of accredited fitness establishments:
Blue fitness establishments:
A blue fitness establishment must
at least have the following equipment available:
§
At least
one cardio vascular mode of equipment (e.g. cycles); and
§
Strengthening
and conditioning modes of equipment must have the ability to train the whole
body using one class of equipment (e.g. therabands).
Bronze fitness establishments:
A bronze fitness establishment must
at least have the following equipment available:
§
All the
requirements for all modes of equipment at the blue grading level must be
complied with;
§
Specialised equipment in at least one cardio
vascular mode of equipment (e.g. cycle lab will have more advanced cycles than
cycles found at the blue level. Also the number of cycles will be more than at
the blue level) must be available; and
§
At least
one cardio vascular mode of equipment and the ability to train the whole body
using one class of equipment must be available.
Silver fitness establishments:
A silver fitness establishment must
at least have the following equipment available:
·
All the requirements for all modes of equipment at the
bronze grading level must be complied with;
§
At least
two cardio vascular modes of equipment must be available; and
§
Upper and
lower body machines and free-weights representing strengthening and
conditioning modes of equipment must also be available.
Gold fitness establishments:
A gold fitness establishment must
at least have the following equipment available:
·
All the requirements for all modes of equipment at the silver
grading level must be complied with;
§
At least
three cardio vascular modes of equipment must be available;
§
Machines
for upper and lower body and free-weights representing strengthening and
conditioning modes of equipment must be available; and
§
Specialized
equipment for a person with a disability must be available: Provided that a
wheelchair should be able to move freely between all the equipment of the
establishment: Provided further that the said equipment-
§
must enable a person with a disability to train his/her full
body in all different modes of equipment as referred to par. A and B of the
Schedule; and
§
must be clearly marked for a person with a visual impairment.
Platinum fitness establishments:
A platinum fitness establishment
must at least have the following equipment available:
§
All the
requirements for all modes of equipment at the gold grading levels must be
complied with;
§
At least
four cardio vascular modes of equipment, upper and lower body machines,
free-weights and stabilizing equipment such as swiss balls must be available as strengthening and conditioning modes of equipment.
§
Specialized
equipment for a person with a disability must be available: Provided that a
wheelchair should be able to move freely between all the equipment of the
establishment: Provided further that the said equipment-
§
must enable a person with a disability to train his/her full
body in all different modes of equipment as referred to par. A and B of the
Schedule; and
§
must be clearly marked for a person with a visual impairment.
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For more information on this and all our other courses go to
our website: www.collegeofkinesis.com
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