Aerobics teacher Debra Lanham knew she wasn't supposed to jump on the job, but she did anyway. She loved her job teaching aerobics at several gyms in San Francisco so much that once in front of a class, she was barely aware of the pain from heel spur syndrome and plantar fasciitis. And the high-energy music she played during class made her forget her injuries as well. "I'd turn up the music, really get into it, and start jumping," she says.
And that wasn't good. Jumping is a dirty word in the world of aerobic exercise, especially among the working wounded. It made Lanham a regular at her podiatrist's office, where she learned that her aerobics-worn feet had begun pronating, or rolling inward, flattening her arches and contributing to her heel and foot pain. Besides being fitted for corrective shoepads called orthotics, she learned how to prevent the pain by stretching her calves and tendons more thoroughly before working out, and replacing her athletic shoes before they were too worn. In fact, she collects new shoes as compulsively as some teenage girls buy clothes, dumping perfectly good pairs into thrift-store donation boxes.
"I give these shoes to Goodwill, and they look at me like, 'Those are brand new,'" Lanham says. "But I've learned once they bend or get the least bit soft, it's time for a new pair."
People who exercise sporadically can only imagine the grueling schedules that aerobics instructors face during a typical week at work. Although enthusiasts love the cameraderie of group aerobics, and instructors love the adrenaline thrill of leading high-energy classes, many instructors today risk repetitive stress and overuse injuries, along with job burnout, eating disorders, and hearing loss.
There are countless aerobics instructors in the United States, and the health problems they face reflect the evolution of this young profession. They went from stepping and punching in the '80s to training on machines in the '90s to more inventive classes like kickboxing and piyoga (pilates plus yoga) in the new millennium. While the type of injuries keep evolving with what's in vogue, there are recurring occupational hazards in a job where pounding, repetitive motions are a constant threat to muscles, tendons and bones, particularly in the knees and feet.
"Part of an aerobic teacher's job is to push the class, and in the process they are pushing themselves, often a dozen times a week," says sports medicine physician Dr. Jordan Metzl of New York's Hospital for Special Surgery. "What I see the most are bone and muscle overuse problems: stress fractures, shin splints, and tendinitis. There's a repetitive nature to many of the moves, so if the routines are not varied enough -- even if instructors are doing low-impact aerobics -- we see problems."
And teaching high-impact aerobics over a long period of time seems a virtual recipe for work injuries. One 1985 study done in the heyday of high-impact workouts found that 76 percent of aerobics teachers were suffering from some sort of injury, usually to their shins, knees or backs. Injuries may be one of the reasons these classes are dwindling. In 1999 about 6.2 million people in the US took at least one high-impact class, about half the number who took them in 1987, according to the research firm American Sports Data Inc. The same year, about 11.6 million exercisers opted for low-impact classes.
Even if their injuries aren't debilitating, many instructors have opted to reduce or eliminate their high-impact classes. Despite her precautions, for example, Lanham has had to cut back on teaching aerobics classes that involve a lot of jumping. Today only one of the 16 to 17 classes Lanham teaches each week is high-impact. But her workload is still higher than the industry ideal, which is no more than 10 to 12 classes per week.
"Don't punch the air"
If you're an aerobics instructor, you may have first heard of potentially hazardous exercises and equipment while getting your certification. Most of the nation's instructors have taken a six-month training program because major gyms and workout centers often require it. Teachers are expected to keep their skills up-to-date and get recertified every two years. (If you start out with other course training or a BA in physical education, the training time may be reduced.)
The four biggest programs also offer continuing education, which allows instructors to go into personal training and other specialty areas that pay better wages. Despite the opportunities afforded by continuing education, having to master ever more demanding programs -- such as kickboxing -- can create problems unless instructors learn how to protect themselves.
"We'll still see teachers punch the air 60 times in a ballistic way," says Meg Jordan, RN, PhD author of The Fitness Instinct and editor of American Fitness, the Aerobics and Fitness Association of America's (AFAA) magazine. "This really does nothing more than overstress the ligaments and the tendons in the shoulder. To try to protect the body, we publish standards and guidelines such as, 'Don't punch the air, don't repeat a move more than 16 times'."
Moreover, a variety of more subtle occupational hazards -- including stress -- may fail to come under scrutiny. "Psychological burnout is a big, big problem," laments Jordan, noting that instructors trapped in a windowless, fluorescent-lighted gym doing the same routine for hours a day plus preparation time are prime candidates. "It's just not addressed enough. This is a tough profession to advance in. To get enough savings to retire, or even just slow down, instructors depend completely on the hours that they move."
Sports medicine experts say that eating disorders are another widespread, yet hidden problem. In the 1988 survey Jordan conducted, she found that instructors are twice as vulnerable to eating disorders as the general public. About 80 percent of AFAA's instructors are women, and "these women are held up as role models, yet I hear all these sad disclosures from instructors that they feel fat when their body fat is 13 percent, far below the average of 26 percent," says Jordan. She maintains that a body fat of 22 percent to 24 percent is ideal. "So we're talking about someone who has a very disordered body image; they can't get fit enough. They lose their menstrual periods and are at an increased risk for osteoporosis."
Jordan says that sometimes this distorted body image translates into a form of "exercise bulimia," in which instructors punish themselves by overexercising. "We found 340 aerobics teachers out of a 1,000 had some sort of eating disorder, and I think it's even worse now. It's another reason people teach too many classes."
Many instructors also suffer hearing loss from the pulsating beat of the music that thunders during most classes. "I was visiting one of my classes, and I yelled to the instructor that I couldn't hear her commands," says Liz Neporent, who runs more than a dozen fitness centers in New York City. "Instead of turning down the music, she started using hand signals!" Many clubs now offer microphones to instructors because they complained of vocal cord damage along with hearing loss. It's wise to include regular hearing tests with yearly physical exams.
Toward a new kind of aerobics
Consuelo Faust's popular Rhythm and Motion dance workout may ultimately prove to be the best example of how instructors can combine the fun of moving around with good sports health. She found through trial and error that a dance theme means healthier instructors. "When we first started we were all jumping as high as we could. We had a lot more injuries. We tried step (aerobics) and found it boring. Around that time, we realized that what we really loved was dancing, so we began to structure our classes around a dance theme. We've had remarkably few injuries since then."
Peggy Jordan believes more instructors should follow suit. "I'd much rather dance than do up-and-down motions or jumping," she says. "The people in the club I go to always say, 'Give us more dance,' and I think the industry is lagging behind."
Indeed, Rhythm and Motion's classes offer more variety and safety in their moves. Rather than (repetitive) stepping and jumping, instructors combine elements of everything from African dance to salsa, jazz, hip hop, and boogie, and they emphasize keeping a low center of gravity and correct body alignment.
Dance instructors at Rhythm and Motion studios also decided radical measures were needed to counter the noise hazard. "We now have a meter that we keep set on a certain number to make sure we don't go over recommended decibel level," says owner and founder Consuelo Faust. "Plus, we put a piece of masking tape on the stereo's volume control" to keep it at a low setting.
Frequent colds a sign of overexertion?
Another precaution instructors can take is declining to teach when they have a bad cold. Some experts contend that cold viruses and other germs can be spread in the close quarters of a gym. Metzl, the sports medicine physician, advises sick instructors to teach only if they don't have a fever, and are not sneezing frequently. In addition to being contagious to others, frequent colds can be a sign that the instructor is suffering from overexertion.
For instructors like Lanham who went into the profession because they love moving around, Peggy Jordan thinks the key to staying healthy is finding a mentor and developing close connections with other teachers. "Everyone should seek out a more experienced instructor to bounce things off of, and people should connect with fellow teachers so that they can sub for one another when they're sick or feeling a little pain," she says. "That way they don't teach when they shouldn't."
Neporent advises instructors to always remember that they're teaching others. "I tell instructors to stop, walk around the room, check on their students, and correct their technique. That gives their bodies a break," she says.
Moving up the career ladder can provide another respite for sore bodies and prevent burnout as well. Aerobics instructor jobs are entry level positions, and by becoming certified as a personal trainer, an instructor can double her hourly rate while giving her body a break. For teachers interested in sports medicine, there's also a top-of-the-line certification for "fitness practitioner," which allows them to work in sports medicine clinics and rehab clinics. Some experts predict fitness practitioners will grow in demand as active baby boomers begin to face the limits of their sports-toned bodies.
Such alternatives may be especially useful today, since instructors are aging along with their students: These days, the average age of an AFAA instructor is 38, compared with 26.8 back in 1983. Lanham, for example, learned to prevent injuries when she was certified to be a personal trainer, but has found it more interesting to teach classes. Recently she decided to go back to school to become a clinical forensic psychologist. But, she adds, "There are so many things I love about teaching aerobics -- the adrenaline rush, the choreography. I'll always teach at least four or five classes a week, even when I finish my doctorate."
Aerobics and Fitness Association of America
Founded in 1983, this group has certified about 155,000 instructors in 73 countries. It produces educational materials for the fitness industry, including a textbook called Fitness Theory and Practice. For consumers, the association offers a flashcard set called "Fitness Gets Personal."
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