{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T07:26:14Z","timestamp":1777620374010,"version":"3.51.4"},"reference-count":50,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Background: The fitness sector has experienced significant expansion, with fitness instructors (FIs) playing a pivotal role. Given the demands of their profession, understanding their health profile is crucial. This study\u2019s purpose is to explore the prevalence of fitness instructors\u2019 occupational health-related problems. Methods: A questionnaire covering sociodemographic, occupational, and health-related items was administered. Statistical analyses, including Mann\u2013Whitney U and chi-square tests, Spearman\u2019s rho correlations, and logistic regressions, were conducted. Results: Fifty-nine FIs reported occupational health-related problems, with the majority occurring during instruction (66.1%), being muscular (32.2%), and knee (15.3%), the most common type and localization. Significant statistical differences were observed between injured and non-injured FIs, including sex (p = 0.012), years as an FI (p = 0.001), weekly days worked (p = 0.039), and daily hours worked (p = 0.013). Weak negative (\u22120.284 \u2013 \u22120.362) statistically significant correlations were found between health problems; weight; height; main activity; and FIs in the workplace. Logistic regressions identified significant models showing that having a sport\/physical exercise background and practicing it regularly were less likely to report bursitis (OR 0.018; p = 0.020) and hip injuries (OR 0.026; p = 0.037). Conclusions: Approximately one-third of FIs reported occupational-related health problems, predominantly musculoskeletal injuries. Sociodemographic, personal, and occupational factors appear to influence the prevalence of these health problems.<\/jats:p>","DOI":"10.3390\/healthcare12090877","type":"journal-article","created":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T10:34:05Z","timestamp":1713868445000},"page":"877","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Occupational Health-Related Problems among Portuguese Fitness Instructors"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1596-9685","authenticated-orcid":false,"given":"Ricardo Maia","family":"Ferreira","sequence":"first","affiliation":[{"name":"Social Sciences, Education and Sport Department, Polytechnic Institute of Maia, N2i, 4475-690 Maia, Portugal"},{"name":"Physioterapy Department, Polytechnic Institute of Coimbra, Coimbra Health School, 3046-854 Coimbra, Portugal"},{"name":"Sport Physical Activity and Health Research & Innovation Center (SPRINT), 4960-320 Melga\u00e7o, Portugal"}]},{"given":"Lu\u00eds Gon\u00e7alves","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Social Sciences, Education and Sport Department, Polytechnic Institute of Maia, N2i, 4475-690 Maia, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5752-5233","authenticated-orcid":false,"given":"Susana","family":"Franco","sequence":"additional","affiliation":[{"name":"Polytechinc Institute of Santar\u00e9m, School of Sports of Rio Maior, 2040-413 Rio Maior, Portugal"},{"name":"Quality of Life Research Center (CIEQV), 2040-400 Santar\u00e9m, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5124-2446","authenticated-orcid":false,"given":"Vera","family":"Sim\u00f5es","sequence":"additional","affiliation":[{"name":"Polytechinc Institute of Santar\u00e9m, School of Sports of Rio Maior, 2040-413 Rio Maior, Portugal"},{"name":"Quality of Life Research Center (CIEQV), 2040-400 Santar\u00e9m, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6522-7594","authenticated-orcid":false,"given":"Ant\u00f3nio Rodrigues","family":"Sampaio","sequence":"additional","affiliation":[{"name":"Social Sciences, Education and Sport Department, Polytechnic Institute of Maia, N2i, 4475-690 Maia, Portugal"},{"name":"Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, 4475-690 Maia, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"666019","DOI":"10.3389\/fpubh.2021.666019","article-title":"Occupational Disorders, Daily Workload, and Fitness Levels Among Fitness and Swimming Instructors","volume":"9","author":"Merati","year":"2021","journal-title":"Front. Public Health"},{"key":"ref_2","unstructured":"Active, E. (2023). European Health & Fitness Market: Report 2023, Deloitte."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1080\/17461391.2015.1062564","article-title":"Injuries and musculoskeletal pain among Norwegian group fitness instructors","volume":"15","author":"Myklebust","year":"2015","journal-title":"Eur. J. Sport Sci."},{"key":"ref_4","first-page":"S1169","article-title":"Fitness professionals: Narrative review","volume":"14","author":"Ramos","year":"2019","journal-title":"J. Hum. Sport Exerc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"621526","DOI":"10.3389\/fpsyg.2020.621526","article-title":"Job satisfaction of fitness professionals in portugal: A comparative study of gender, age, professional experience, professional title, and educational qualifications","volume":"11","author":"Ramos","year":"2021","journal-title":"Front. Psychol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1186\/s40337-021-00446-0","article-title":"Compulsive exercise and mental health challenges in fitness instructors; presence and interactions","volume":"9","author":"Gjestvang","year":"2021","journal-title":"J. Eat. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"150","DOI":"10.52403\/ijshr.20220422","article-title":"A Review on Musculoskeletal Pain and Injuries among Fitness Instructors","volume":"7","author":"George","year":"2022","journal-title":"Int. J. Sci. Healthc. Res."},{"key":"ref_8","unstructured":"Perista, H., Cardoso, A., Carrilho, P., Nunes, J., and Quintal, E. (2016). Inqu\u00e9rito \u00e0s Condi\u00e7\u00f5es de Trabalho em Portugal Continental: Trabalhadores\/as, Autoridade para as Condi\u00e7\u00f5es do Trabalho."},{"key":"ref_9","unstructured":"International Labour Organization (ILO) (2023, December 15). The Prevention of Occupational Diseases. Available online: https:\/\/www.ilo.org\/global\/topics\/safety-and-health-at-work\/resources-library\/publications\/WCMS_208226\/lang--en\/index.htm."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Eysenbach, G. (2004). Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES), Gunther Eysenbach Centre for Global eHealth Innovation.","DOI":"10.2196\/jmir.6.3.e34"},{"key":"ref_12","first-page":"281","article-title":"Guidelines for constructing a survey","volume":"34","author":"Passmore","year":"2002","journal-title":"Fam. Med. -Kans. City"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1176\/appi.ap.27.2.104","article-title":"How to do research with self-administered surveys","volume":"27","author":"Sierles","year":"2003","journal-title":"Acad. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1097\/ACM.0000000000002094","article-title":"Guidelines for reporting survey-based research submitted to academic medicine","volume":"93","author":"Durning","year":"2018","journal-title":"Acad. Med."},{"key":"ref_15","unstructured":"Pedragosa, V., Cardadeiro, E., and Santos, A. (2022). Bar\u00f3metro do Fitness em Portugal, Relat\u00f3rio Final. Centro de Estudos Econ\u00f3micos e Institucionais; Universidade Aut\u00f3noma de Lisboa."},{"key":"ref_16","first-page":"1","article-title":"Sampling techniques & determination of sample size in applied statistics research: An overview","volume":"2","author":"Singh","year":"2014","journal-title":"Int. J. Econ. Commer. Manag."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2325967120902908","DOI":"10.1177\/2325967120902908","article-title":"International Olympic Committee consensus statement: Methods for recording and reporting of epidemiological data on injury and illness in sports 2020 (including the STROBE extension for sports injury and illness surveillance (STROBE-SIIS))","volume":"8","author":"Bahr","year":"2020","journal-title":"Orthop. J. Sports Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.ecns.2014.07.005","article-title":"Making sense of methods and measurement: Spearman-rho ranked-order correlation coefficient","volume":"10","author":"Prion","year":"2014","journal-title":"Clin. Simul. Nurs."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"210","DOI":"10.4103\/IJPSYM.IJPSYM_193_19","article-title":"The P value and statistical significance: Misunderstandings, explanations, challenges, and alternatives","volume":"41","author":"Andrade","year":"2019","journal-title":"Indian J. Psychol. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"McCormack, J., Vandermeer, B., and Allan, G.M. (2013). How confidence intervals become confusion intervals. BMC Med. Res. Methodol., 13.","DOI":"10.1186\/1471-2288-13-134"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Cohen, J. (2013). Statistical Power Analysis for the Behavioral Sciences, Academic Press.","DOI":"10.4324\/9780203771587"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"528","DOI":"10.7547\/87507315-91-10-528","article-title":"Survey of the effects of aerobic dance on the lower extremity in aerobic instructors","volume":"91","author":"Smith","year":"2001","journal-title":"J. Am. Podiatr. Med. Assoc."},{"key":"ref_23","first-page":"580","article-title":"Incidence of injury in kickboxing participation","volume":"17","author":"Romaine","year":"2003","journal-title":"J. Strength Cond. Res."},{"key":"ref_24","unstructured":"International Labour Organization (ILO) (2023, December 15). Hazardous Work. Available online: https:\/\/www.ilo.org\/safework\/areasofwork\/hazardous-work\/lang--en\/index.htm."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1136\/bmj.318.7195.1397","article-title":"Occupational disease","volume":"318","author":"Cherry","year":"1999","journal-title":"BMJ"},{"key":"ref_26","unstructured":"Bernard, B.P., and Putz-Anderson, V. (2023, December 15). Musculoskeletal Disorders and Workplace Factors. A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back, Available online: https:\/\/stacks.cdc.gov\/view\/cdc\/21745."},{"key":"ref_27","first-page":"42","article-title":"VidaProFit: Caracteriza\u00e7\u00e3o dos Profissionais de Fitness em Portugal","volume":"17","author":"Ramos","year":"2021","journal-title":"Motricidade"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1519\/JSC.0b013e31816eb518","article-title":"Recovery from training: A brief review: Brief review","volume":"22","author":"Bishop","year":"2008","journal-title":"J. Strength Cond. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s40279-017-0796-x","article-title":"An evidence-based framework for strengthening exercises to prevent hamstring injury","volume":"48","author":"Bourne","year":"2018","journal-title":"Sports Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e000435","DOI":"10.1136\/bmjsem-2018-000435","article-title":"Are extreme conditioning programmes effective and safe? A narrative review of high-intensity functional training methods research paradigms and findings","volume":"4","author":"Tibana","year":"2018","journal-title":"BMJ Open Sport Exerc. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1007\/s40279-016-0628-4","article-title":"Chronic adaptations to eccentric training: A systematic review","volume":"47","author":"Douglas","year":"2017","journal-title":"Sports Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1080\/15438620500528380","article-title":"Review of exercise-induced muscle injury: Relevance for athletic populations","volume":"14","author":"Falvo","year":"2006","journal-title":"Res. Sports Med."},{"key":"ref_33","first-page":"e51450","article-title":"Morphological adaptations in response to chronic exercise across musculoskeletal tissues: A systematic review","volume":"21","author":"Mestre","year":"2023","journal-title":"Pensar En Mov. Rev. De Cienc. Del Ejerc. Y La Salud"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1080\/14015439.2021.1897671","article-title":"Vocal health of sporting, fitness, and wellness leaders in Northern New York and Vermont","volume":"47","author":"Gauvin","year":"2022","journal-title":"Logop. Phoniatr. Vocol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/S0892-1997(98)80039-8","article-title":"Voice problems and risk factors among aerobics instructors","volume":"12","author":"Long","year":"1998","journal-title":"J. Voice"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"261.e33","DOI":"10.1016\/j.jvoice.2016.04.014","article-title":"Vocal problems in sports and fitness instructors: A study of prevalence, risk factors, and need for prevention in France","volume":"31","author":"Fontan","year":"2017","journal-title":"J. Voice"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/S0892-1997(02)00072-3","article-title":"Vocal parameters of aerobic instructors with and without voice problems","volume":"16","author":"Wolfe","year":"2002","journal-title":"J. Voice"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"524.e11","DOI":"10.1016\/j.jvoice.2013.01.016","article-title":"Vocal problems of group fitness instructors: Prevalence of self-reported sensory and auditory-perceptual voice symptoms and the need for preventative education and training","volume":"27","author":"Rumbach","year":"2013","journal-title":"J. Voice"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"805.e13","DOI":"10.1016\/j.jvoice.2021.05.001","article-title":"A review of factors associated with voice problems in the fitness instructor population","volume":"37","author":"Venkatraman","year":"2023","journal-title":"J. Voice"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"127.e1","DOI":"10.1016\/j.jvoice.2015.02.007","article-title":"Vocal performance of group fitness instructors before and after instruction: Changes in acoustic measures and self-ratings","volume":"30","author":"Dallaston","year":"2016","journal-title":"J. Voice"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"786.e1","DOI":"10.1016\/j.jvoice.2013.03.012","article-title":"Voice problems of group fitness instructors: Diagnosis, treatment, perceived and experienced attitudes and expectations of the industry","volume":"27","author":"Rumbach","year":"2013","journal-title":"J. Voice"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.jvoice.2020.07.034","article-title":"Are indoor cycling instructors riding their way to vocal injury? acute effects of a single class on measures of voice production","volume":"36","author":"Mikhail","year":"2022","journal-title":"J. Voice"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/0021-9924(93)90007-W","article-title":"Vocal problems among aerobic instructors and aerobic participants","volume":"26","author":"Heidel","year":"1993","journal-title":"J. Commun. Disord."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"256.e25","DOI":"10.1016\/j.jvoice.2017.04.014","article-title":"Keeping the voice fit in the group fitness industry: A qualitative study to determine what instructors want in a voice education program","volume":"32","author":"Aiken","year":"2018","journal-title":"J. Voice"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"S406","DOI":"10.1097\/00005768-200007001-00005","article-title":"Is infection risk linked to exercise workload?","volume":"32","author":"Nieman","year":"2000","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_46","unstructured":"World Health Organization (WHO) (2021). COVID-19: Occupational Health and Safety for Health Workers: Interim Guidance, WHO."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"958063","DOI":"10.3389\/fpsyg.2022.958063","article-title":"Quality of life of fitness professionals in Portugal: Comparative and correlation study","volume":"13","author":"Vieira","year":"2022","journal-title":"Front. Psychol."},{"key":"ref_48","first-page":"61","article-title":"Tend\u00eancias do Fitness em Portugal para 2022","volume":"18","author":"Franco","year":"2022","journal-title":"Motricidade"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"401","DOI":"10.47197\/retos.v48.97094","article-title":"Tend\u00eancias do Fitness em Portugal para 2023","volume":"Volume 48","author":"Franco","year":"2023","journal-title":"Retos: Nuevas Tendencias en Educaci\u00f3n F\u00edsica, Deporte y Recreaci\u00f3n"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"242","DOI":"10.6018\/cpd.467381","article-title":"Tend\u00eancias do Fitness em Portugal para 2021","volume":"21","author":"Franco","year":"2021","journal-title":"Cuad. Psicol. Deporte"}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/12\/9\/877\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:32:50Z","timestamp":1760106770000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/12\/9\/877"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,23]]},"references-count":50,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["healthcare12090877"],"URL":"https:\/\/doi.org\/10.3390\/healthcare12090877","relation":{},"ISSN":["2227-9032"],"issn-type":[{"value":"2227-9032","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,23]]}}}