Training without diagnostics is like operating without a medical report
"Training is only successful if it is adapted to the individual requirements of the client. The precise prerequisites are determined by a comprehensive anamnesis and thorough diagnosis". Every trainer has learned this, every trainer sells his training this way. But what does everyday life really look like? Do pre-diagnostics really play this central role in everyday training routine?
All fitness club operators regularly wonder about the benefits of diagnostics and especially about the cost-benefit factor. The range of diagnostic tools is extremely broad, both in terms of the type of technology and the parameters surveyed and in terms of the investment involved. What all diagnostic tools have in common is that they involve considerable personnel outlay. Tests must be carried out, results interpreted and, at best, integrated into training plans. Not least because of this effort, diagnostics in many fitness facilities is an additional service that has to be sold by the trainers. However, this inevitably leads to a situation where diagnostics are usually only carried out in the initial test and only rarely in the course of the training process – or if at all, usually with inexpensive and less time-consuming checks. But aren't we saving at the wrong end? Do diagnostics really only have an economic benefit if they are offered as an extra service at a fee? Or is this way of thinking too shortsighted? In order to find out, we have to take a closer look at the benefits of diagnostics as well as the added value for the client and thus also for the club.
How should diagnostics be incorporated into the training process?
Targeted training starts with a medical history and basic diagnostics.
The data and/or insights established by this are evaluated and interpreted by skilled staff and taken into consideration for planning exercises – needless to say, always in the context of the clients’ objectives. The diagnostic insights gained can change objectives fundamentally, for instance especially when an insight stands in the way of achieving a goal. Take for example high blood pressure (see box) – here the customer is required to first consult a physician after the diagnostics. Considering the insights gained the training plan probably needs to be re-oriented.
The basic prerequisite for success of regular training is based on the training plan drawn up.
Progress and finally achievement of objectives are verified with further checks accompanying training units.
Training without diagnostics is like operating without a medical report – making an incision first and only checking afterwards whether a surgical intervention is needed at all. Or: Training without diagnostics is like flying with a blind pilot. It may well be that the client is moving in the right direction but suffers a “crash landing” with damage by overstraining before reaching the destination. Alternatively, clients may just be flying in the wrong direction, never reaching their destinations and running out of fuel, i.e. motivation. These are just two metaphors for many other potential random results. In contrast to this, training plans based on previous diagnostics mean targeted planning of the direct route to customers’ self-set goals; on the fastest route in an ideal world, via expedient detours in the event of impairments such as diseases or injuries. It is true that doing proper diagnostics does not guarantee training success. However, when properly selected and employed diagnostics minimise sources of error and highlight potential risks. A basic question that each decision-maker in a fitness club has to answer is therefore whether they want to thoroughly plan training or just let customers train on the “off chance” without prior diagnostics. In this context, however, many trainers unfortunately rely on their customers’ description of their health and performance status. In view of the following data this approach is a dangerous exercise.
On diagnostics and diagnosis
Again and again, there is uncertainty about the terms diagnostics and diagnosis. This ambiguity unfortunately leads to the fact that some fitness clubs do not offer diagnostics. Of course, clubs may use diagnostics in the sense of training plans, training optimization and success control. But subjects may not be "diagnosed" with high blood pressure, for example – this can only be done by a physician. The same applies to performance tests that involve blood, e.g. lactate diagnostics. Here, medical training is a basic prerequisite for legal protection. We therefore recommend a legally detailed clarification before such tests are included in the diagnostics portfolio.
On data excerpts from German fitness and sports clubs
Let's confine ourselves to one clinical pattern, high blood pressure. Then an extract from the results of our nationwide study of German fitness clubs and sports clubs (n = 7 101) shows that one in five customers measured who, according to his own data, is "healthy" has undiscovered high blood pressure requiring treatment. So if we rely on the statements of these clients, statistically every fifth person who, according to their own statements, is healthy is at risk of overexertion and thus of further negative adjustment due to the over-intensive training. This means that in the worst case scenario blood pressure will continue to deteriorate despite training with all the consequences that this entails. This does not have to be the case if blood pressure is simply checked regularly. It is best, of course, to not only to take a single measurement, but repeated individual measurements or, even better, to use a continuous measurement procedure so that the probability of incorrect measurements is minimised.
No blind actionism
But let’s not fall victim to blind actionism. Of course, we want to know as much as possible about the customer, but an unnecessary flood of data also distracts from the essentials. So club operators have to ask themselves what data is really needed for sound training planning.
Ultimately, what diagnostics are the right ones?
Mobility tests, strength tests, performance tests, stress tests, body composition analyses, endurance tests ... As mentioned before, there is an enormous range of test possibilities. Each club has to decide for itself which diagnostic concepts are ultimately the right ones. Because this not least depends on the target group to be served. Basically, the motto reads: Only use those diagnostic devices or concepts that provide scientific evidence for the reliability and validity of the results. Because random results merely increase the probability of failure – doubly so:
One the one hand, there is, of course, always a danger of misjudging the initial state and customers simply train the wrong way.
Random results are also risky as potential improvements might not be confirmed by a re-check – i.e. despite successful training a failure is detected for customers because the measuring technology does not produce any reliable, reproducible results. Since the success of a fitness club depends on the success of its clients as few as possible factors should be left to chance. The random factor can be reduced by relying on proven measuring technology. Serious diagnostics suppliers can, as a rule, provide studies to prove the reliability of their diagnostic concepts and measured parameters. If they cannot provide such studies you should be sceptical. When selecting diagnostic concepts, a distinction should also be made between tests that can have a direct influence on the training plan and tests that are more useful during training, such as success monitoring and training motivation.
Basic checks are usually endurance tests, such as the recording of the stress blood pressure. This prevents the subject from exercising beyond their stress limit. In the short term, this would usually not be a problem, but could lead to negative adjustemnts in the organism over a longer period of time
Accompanying checks are usually body composition analyses. The predominant importance of this analysis is indisputably in the success control and motivation of the subject. Who would not be delighted to see body fat percentages decrease and muscle mass increase regularly? Depending on the result, the training can then be adapted. Of course, these results have no fundamental influence on training plans, especially when starting training. An example by way of an explanation: A high visceral fat content is associated with the development of high blood pressure. High blood pressure has a direct influence on training plans as the intensity has to be adjusted accordingly (downwards). Here it is not the measurement of visceral fat that determines the training plan, but the results of the blood pressure measurement.
Without a comprehensive clinical history and diagnosis, no targeted training planning can be carried out. The success of the training otherwise depends on the factor of chance. However, the use of diagnostics alone does not automatically minimize the random factor. The use of scientifically proven diagnostic concepts is necessary for random-free planning and verification of training. The kind of evidence-based diagnostics a fitness club ultimately offers always depends on the target group to be served. Finally, the question arises as to why diagnostics is often an additional service that has to be paid for extra – even though the elementary importance of diagnostics in the training process and in maximising success is undisputed. Here every decision maker in the fitness club should ask themselves whether the success of the individual subject should actually depend on the persuasiveness and sales power of the employee or the willingness of the customer to invest or not. Is a long-lasting membership and potential recommendation, due to proven training success, not more economical than the one-time income from the additional sale diagnostics? Due to the central importance of diagnostics in the training process, should it not logically be part of the membership fee to ensure as a standard process that every client is regularly guided on the road to success with an individual training plan? Because training without diagnostics is like operating without a clinical report.
Authors: Daniel Rothmund & Peter Röhr are both certified sports scientists and lecturers at the Bielefeld University in the fields “Sports Medicine – Health and Training”. Furthermore, they are the Managing Directors of Valitudo – Centre for Multi-Disciplinary Health Management and the developers of “MGM – My Health Manager – The Online Fitness Courses” and “MGM – The Diagnostics Tool”. Infos at www.valitudo.de