Nutrition Knowledge Among Exercise Science and Wellness Students

Transcription

1 Nutrition Knowledge Among Exercise Science and Wellness Students By Brandon Lee In partial completion of the requirements for a Master of Science degree in Nutrition and Dietetics SUNY Oneonta April 12 th, 2018

2 Table of Contents Abstract 1 Background..2 Introduction..3 Review of Literature..13 I. Nutrition Knowledge of Exercise Professionals..13 II. III. IV. Credentials of Exercise Professionals..14 Scope of Practice of Exercise Professionals...17 Nutrition Resources Utilized by Exercise Professionals...20 V. Collaboration Between Exercise Professionals and Registered Dietitians...21 Methodology..23 Results 25 Discussion..31 Conclusion and Implications for Practice...32 References...34 Appendix A Needs Assessment Questionnaire..36 Appendix B Outcomes Assessment Evaluation Tool...45

3 Abstract Introduction The participants of the study included students enrolled at Dutchess Community College (DCC) in the Exercise Science and Wellness (ESW) program. The purpose of the study was to identify whether the enrolled students of DCC in the ESW program had an adequate level of nutrition knowledge and intervene on any nutrition-related problems. A thirty-question questionnaire was used for the needs assessment. The results of the needs assessment showed that the participants had the least knowledge about carbohydrates, protein, fat, nutrient utilization during exercise and nutrition before, during and after nutrition. The project goal was to increase knowledge about these nutrition topics in the participants. Methodology In order to address the needs of the participants fifty-minute nutrition classes were conducted once a week per class and section for five weeks. To measure whether objectives were achieved, ten-question nutrition knowledge quizzes were distributed at the end of each nutrition education class. Results Week one of the nutrition intervention focused on carbohydrates, with a 34.4% knowledge increase. Week two of the nutrition intervention focused on protein and showed a 74.83% knowledge increase. Moreover, week three and four of the nutrition education classes focused on fats and nutrients utilized during exercise and had 58.2% and 48.3% knowledge increases, respectively. The last week of the nutrition education classes focused on nutrition before, during and after exercise and the data showed a 44.8% knowledge increase on the subject 1

4 material. The participants had a 52.1% mean nutritional knowledge increase from the five weeks combined. Conclusion Nutrition education classes proved to be an effective method for increasing nutritional knowledge among ESW students. Those in the field of exercise science should be exposed to more nutrition education courses in the future. Considering the little nutrition education that most exercise professionals currently receive it would be advantageous for them to collaborate with Registered Dietitians more often to provide clients seeking healthier lifestyles the best possible service. Background The United States spends about $2.7 trillion dollars on health care each year (U.S. Health Care, 2012). Today s modern trends focus on losing weight, feeling better, looking better and these ideas are communicated primarily through social media (e.g. Facebook, Instagram) and other forms of communication that become more convenient every day. With access to the vast internet that most people have; finding information on health, nutrition and fitness is easy. However, there is question about the reliability of the information being given (Cockburn, 2014). In the field of exercise science, physical fitness and personal training there are currently more than one hundred organizations that can certify exercise professionals. Very few of them require much formal training. If a fitness instructor or personal trainer has been certified by the American College of Sports Medicine (ACSM), Aerobics and Fitness Association of America (AFAA), National Strength and Conditioning Association (NSCA), American Council on Exercise (ACE) or National Council on Strength and Fitness (NCSF) then they are considered to have sufficient credentials to teach fitness. In addition, exercise professionals in the field with a 2

5 degree in exercise physiology, kinesiology or exercise science have been found to be more reliable and knowledgeable. Exercise professionals should be selected by consumers based on academic preparation and practical experience (Fahey, 2011). Exercise professionals do not receive specialized training on nutrition or sports nutrition. No training is provided on chronic disease or underlying nutrition related metabolic functions and are not supported by their certification association to provide clients with nutrition information beyond national dietary guidelines (Barnes, 2016). In the field of nutrition and dietetics the demands are higher and the education is more extensive. The gold standard credential in nutrition and dietetics is Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN). Currently the requirements to become a RD/RDN are to (1) complete a bachelor's degree in nutrition or dietetics through an accredited program, (2) get matched to an accredited supervised practice dietetic internship program, (3) pass the Commission on Dietetic Registration's dietetic registration exam, and (4) gain licensure in the state of practice, if applicable. In addition, RD/RDN s are required to maintain up to date knowledge and credentials- much like certified exercise professionals (Winterfeldt, 2014). Introduction The participants of the study included students enrolled at Dutchess Community College (DCC) in the Exercise Science and Wellness (ESW) program attending the following classes: ESW 101, ESW 201, ESW 202 and ESW 203 in the fall of 2017 and spring of The participants were introduced to the study and its purposes and then explained the details of the consent forms. A questionnaire was used to assess the needs of the target population (see Appendix A). The participants were told the details of the questionnaire and asked if they had 3

6 any questions or concerns about the consent forms or questionnaire. The questionnaires were then passed out to the participants. Only participants that signed the consent forms received a questionnaire and all participants that accepted a questionnaire completed it. The needs assessment was conducted on Monday November 13 th, 2017 at 10:00am (ESW 201), 12:00pm (ESW 202); Thursday November 16 th, 2017 at 9:30am (ESW 201), 2:00pm (ESW 203) and Monday November 20 th, 2017 at 11:00am (ESW 101). The purpose of the study was to identify whether the enrolled students of Dutchess Community College in the ESW program had an adequate level of nutrition knowledge, level of understanding of the scope of practice for personal trainers/ exercise professionals and identify the common nutrition related sources referenced by the participants. Needs Assessment Results The questionnaire administered to the participants (see Appendix A) contained thirty questions, twenty of which were focused on sports nutrition knowledge, two focused on scope of practice related to nutrition for exercise science professionals, two focused on nutrition resources utilized, four focused on population survey information and one survey question on nutrition references used by the participants. The sports nutrition knowledge section of the questionnaire asked questions about carbohydrates, proteins, fats, vitamins, minerals, hydration, ergogenic aids, nutrition for before, during and after exercise and fad diets. The only scored questions were #5-29. Questions #1-4 and #30 were used to gain additional information about the population. The results of the questionnaire showed that 5 out of 53 participants or 9.4% were in their 1 st semester at DCC and 5 out of 53 participants or 9.4% were in their 2 nd semester. 4

7 Moreover, 27 out of 53 participants or 50.9% were in their 3 rd semester and 16 out of 53 participants or 30.1% were in their 4 th semester (see Figure 1). Furthermore, the results showed that 25 out of the 53 participants or 47.1% had taken or were currently taking the DCC Bio 122 nutrition course and 28 out of 53 participants or 52.8% had not taken the Bio 122 nutrition course (see Figure 2). If a participant did take the DCC nutrition course, then this likely influenced how well he or she did on the questionnaire. Question #3 of the questionnaire asked What are your career goals? and provided the participant with the option to circle all options that applied to them. Overall, very few participants chose more than one career option. The results showed that sixteen participants selected personal trainer, eight selected physical education for teaching, eleven selected athletic training, two selected exercise physiology, one selected kinesiology, thirteen chose physical therapy, four chose nutritional science and fifteen selected other (see Figure 3). The other option provided the participant with a line so that they could write in their career goal; write ins included speech pathology, emergency medical technician, small gym owner, human services, sports psychology, coaching and exercise science for teaching. Furthermore, the results showed that 33 out of 53 participants or 62.2% of the participants felt that he or she had good nutritional habits in regards to USDA guidelines. However, 20 out of the 53 participants or 37.7% of the participants felt that he or she had poor nutritional habits in regards to USDA guidelines (see Figure 4). 5

8 Figure 1 Figure 2 6

9 Figure 3 Figure 4 7

10 In the questionnaire, question #30 asked Which of the following nutrition references do you use for yourself/clients/family/friends?. The most popular nutrition references cited by the participants were knowledge/notes from college courses (e.g. Bio 122), textbooks and nutrition organizations (e.g. Academy of Nutrition and Dietetics). The least used nutrition references by the participants were commercial business employees (e.g. GNC employee), popular magazines and peer-reviewed literature (see Figure 5). While peer-reviewed literature may be one of the most credible sources of nutrition information but was one of the least used. However, the most used nutrition references were all from credible sources, showing that the participants know how to properly research for nutrition information on a superficial level. Figure 5 8

11 The mean score for the questionnaire was 49.1%. The areas of the questionnaire with the highest scores were questions 25, 27, 28, 19 and 17, with scores of 90.5%, 86.7%, 84.9%, 75.4% and 67.9% respectively (see Figure 6). The questions focused on scope of practice, nutrition references utilized, nutrients of concern for female vegetarian athletes and the timing of sodium replenishment during exercise. Furthermore, the areas of the questionnaire with the lowest scores were questions 10, 13, 22, 6 and 23, with mean scores of 3.77%, 7.5%, 7.5%, 30.1% and 32% respectively (see Figure 6). The questions focused on protein functions, food sources of fats, nutrient utilization during exercise, types of carbohydrates and nutrition before, during and after exercise. The needs assessment shows that the target population suffers from a lack of knowledge within sports nutrition and have adequate knowledge of their scope of practice in regards to nutrition and what reliable nutrition resources to utilize for evidence-based nutrition information. Figure 6 9

12 In the questionnaire question #10 asked What type of athlete has the highest protein needs?. The focus of this question was meant to evaluate the knowledge of types of athletes and their nutrient requirements, specific to protein. Next, question # 13 asked What are good sources of mono- and polyunsaturated fats?. The focus of this question was meant to evaluate the knowledge of types of fats and the food sources that they are most abundantly found in. Moreover, question #22 asked Which of the following activities has the greatest fat burning percentage?. This question was meant to evaluate knowledge about how and which nutrients are utilized for various physical activities and sports. Question #6 asked True or False? Long chains of sugar units arranged to form starch or fiber; also called polysaccharides can be defined as simple carbohydrates. This question attempted to evaluate the knowledge about the types of carbohydrates and their definitions. Question #23 asked 2-3 hours before a sports competition how many kilocalories show be consumed?. The focus of this question was meant to evaluate the knowledge of nutrition before sports competitions. The CHIP interventions focused on carbohydrates, protein, fat, nutrient utilization during exercise and nutrition before, during and after exercise. The classes will cover these topics because these were the areas of nutrition that the participants had the least amount of knowledge about. Nutrition Problems Identified 1. Food- and nutrition-related knowledge deficit related to unsupported beliefs/attitudes about food, nutrition, and nutrition-related topics as evidenced by provides inaccurate written responses to questionnaire/written tool, no prior knowledge of need for food- and 10

13 nutrition-related recommendations and demonstrates inability to apply food- and nutrition-related information. 2. Unsupported beliefs/attitudes about food or nutrition-related topics related to lack of prior exposure to accurate nutrition-related information as evidenced by food faddism. Project goal: To increase knowledge about carbohydrates, protein, fat, nutrient utilization during exercise and nutrition before, during and after exercise in DCC students enrolled in the ESW program. Project objective: After attending the series of five nutrition education classes for DCC students enrolled in the ESW program, those who attend will be able to demonstrate increased knowledge and score higher on the post-test nutrition knowledge quizzes when compared to the pre-test questionnaire. If there was additional time and resources several other nutrition problems could have been identified. Additional nutrition problems that could be identified would have included disordered eating pattern, undesirable food choices and poor nutrition quality of life. These additional nutrition problems would have a different focus that the nutrition problems identified. These potentially identifiable nutrition problems would focus more on the personal practices of the individuals and trying to change their nutrition related eating habits in the intervention whereas the nutrition problems identified focus on knowledge and beliefs and trying to modify those. Disordered eating patterns as a nutrition problem may be applicable to this population due to their beliefs, attitudes, thoughts, and behaviors related to food, eating, and weight management, including potential eating disorders that negatively impact health. The target population are students that focus heavily on exercise and/or sports and will also focus on 11

14 nutrition. Target populations such as these tend to have a low amount of nutritional knowledge and practice eating habits unsupported by scientific evidence. A potential PES statement could have been Disordered eating pattern related to environmental-related obsessive desire to be thin as evidenced by fear of foods or dysfunctional thoughts regarding food or food experiences, food and weight preoccupation, knowledgeable about current diet fads, fasting, irrational thoughts about food s effect on the body and inflexibility with food selection. Undesirable food choices may be another applicable nutrition problem to this population due to their food and/or beverage choices that are inconsistent with dietary reference intake standards (e.g., Dietary Reference Intakes), national food guidelines (e.g., U.S. Dietary Guidelines, MyPlate) or diet quality index standards (e.g., Healthy Eating Index). This is indicated in question #4 of the questionnaire that asks Do you feel that you have good nutritional habits and eating patterns in regards to USDA guidelines?. The results showed that 33 out of 53 participants answered yes to this question, resulting in 62.2% of the participants feeling that he or she had good nutritional habits in regards to USDA guidelines. However, 20 out of the 53 participants answered no to this question, resulting in 37.7% of the participants feeling that he or she had poor nutritional habits in regards to USDA guidelines. This is an unacceptable number of individuals with poor nutritional habits, especially coming from future personal trainers and/or exercise science professionals. A potential PES statement could have been Undesirable food choices related to lack of prior exposure to accurate nutrition-related information as evidenced by estimated intake inconsistent with national food guidelines (e.g., US Dietary Guidelines, MyPlate) and inaccurate or incomplete understanding of the guidelines. Poor nutrition quality of life of may be another applicable nutrition problem to this population with the root cause being a food and nutrition knowledge-related deficit. A potential 12

15 PES statement could have been Poor nutrition quality of life related to food and nutrition knowledge-related deficit as evidenced by inability to change food- or activity-related behavior and concerns about previous attempts to learn information. Additional tools and methods that would be needed to confirm the aforementioned nutrition problems would include diet history forms, twenty-four recall forms, diet record forms, food frequency forms, smartphones (for photography food logs) and focus groups. Review of Literature I. Nutrition Knowledge of Exercise Professionals Maxwell et al. reviewed the nutrition knowledge and advice given by certified CrossFit trainers. Using an online survey, 289 subjects that participated had to answer 17 sports nutrition knowledge (SNK) questions. The median score of correct answers was 11 and the mean was 11 ± 2.1, equivalent to answering the 65.3% ± 12.4% of the questions correctly. The SNK questions were divided up into four sections: hydration, energy needs/recovery, macronutrients and micronutrients. The results show that the participants were most knowledgeable about energy needs/recovery (75% correct) and least knowledgeable about macronutrients (50% correct). Micronutrients and hydration knowledge fell between the highest and lowest with scores of 70% correct and 55% correct, respectively (Maxwell, 2017). Cockburn et al. examined the sports nutrition knowledge of United Kingdom (UK) coaches via a knowledge questionnaire. The results showed the mean percentage of correctly answered questions were 60.3% ± 10.5%, incorrectly answered questions were 24.9% ± 7.1% and questions answered unsure were 13.4% ± 9.9%. This may be an accurate representation of the nutrition training and knowledge for coaches in the UK or the world overall (Cockburn, 13

16 2014). Having a personal trainer with baseline knowledge of nutrition is conducive to physical fitness learning and weight loss achievement. However, it seems as though most are not as knowledgeable as consumers hope they would be. Torres-McGehee et al. found that when student-athletes, coaches, athletic trainers (AT) and strength and conditioning specialists (SCS) were given a nutrition knowledge exam that the score was 68.5% ± The exam contained questions about micronutrients and macronutrients, supplements and performance, weight management/eating disorders and hydration. The micronutrient and macronutrient knowledge score was 62.6% ± 22.3, with the participants knowing the least on this subject material. Supplements and performance had a score of 78.7% ± 20.1, with the participants knowing the most about this subject material. Knowledge scores for weight management/eating disorders and hydration were 64.8% ± 23.2 and 67.7% ± 23.5, respectively. No statistical difference was found in nutrition knowledge between athletic exercise professionals and SCS s. In addition, it was the AT s and SCS s that had more adequate nutrition knowledge than the coaches and student-athletes. Overall, Torres-McGehee found that between all of the participants 45.1% had adequate nutrition knowledge and 55.9% did not (Torres- McGehee, 2012). II. Credentials of Exercise Professionals In addition, Maxwell et al. found that of the 289 CrossFit trainers that participated in their survey, 9% percent had completed high school or less, 17% completed an associate s degree and 53.5% had completed a bachelor s degree. Furthermore, 17.4% of CrossFit trainers had completed a master s degree and 3.1% had a doctoral degree. In addition, Maxwell et al. found that there is a positive correlation between the number of self-reported hours of nutritional 14

17 education and the overall sports nutrition knowledge, however these findings were not significant (r = 0.19; p < 0.01) (Maxwell, 2017). One Canadian study by Johnson et al. found that 54.3% of practicing exercise professionals, that participated in a survey on promotion of healthy eating and confidence with giving nutritional advice, had credentials to do so through the Canadian Society for Exercise Physiology (CSEP). However, 45.7% did not have such credentials (Johnson, 2015). Weissman et al. conducted a study to assess the sports nutrition practices of personal trainers. The study found that most of these personal trainers held a college degree (85.2%) but only one trainer had a nutrition degree. In addition, 44.2% of the personal trainers had a college degree in exercise science, exercise physiology or another related field. Moreover, 32.6% of the participants had a degree in a non-exercise related field and 7.8% with an unspecified major (Weissman, 2013). Furthermore, Weissman et al. found in their study about personal trainers and their sports nutrition knowledge that 24.8% of the participants had received certifications in at least one National Committee for Certifying Agencies (NCCA) accredited organization not including ACSM, NSCA, ACE or NASM. However, about 57.4% of personal trainers held at least one certification from either ACSM, NCSA, ACE or NASM. Moreover, results showed that about 14% of personal trainers were certified by at least one organization but not certified by the NCCA. Lastly 3.9% of the personal trainers were not certified. In addition, Weissman et al. found that 4.7% of the participants had certifications in nutrition but lacked licensure by the Academy of Nutrition and Dietetics (Weissman, 2013). Manore et al. explained that in the field of nutrition and dietetics the gold standard for the sports nutrition credential is to become a Board-Certified Specialist in Sports Dietetics (CSSD). The requirements to become a CSSD include (1) current status as an RDN, (2) maintenance of 15

18 RDN status for at least two years after original exam, (3) documentation of 1,500 hours in specialty practice areas as RDN in the last five years, and (4) completing/passing the national exam administered. This helps to maintain creditability in the field and ensuring that the RDN, CSSD working with athletes, teams or staff have prior experience (Manore, 2017). Proper credentials in the health care field are important because they convey a certain amount of competence in the profession and ensures the consumer that they are receiving at least adequate information on a particular topic. Barnes et al. found that those who had completed a diploma in fitness or a tertiary fitness related degree more frequently reported being confident in their sports nutrition skills, as opposed to those who only had completed a certificate 3 or 4 in fitness (x 2 = , P < 0.001) (Barnes, 2016). The American College of Sports Medicine (ACSM) personal trainer certification examination has an unknown percentage of what is focused on nutrition but topics such as the value of carbohydrates, fats, and proteins as fuels for exercise and physical activity and the USDA Food Guide Pyramid and ACSM-endorsed Dietary Guidelines (American Dietetics Association) are covered under Domain III: Leadership & Education Implementation Associated Job Tasks ( ACSM Certified Personal, 2017). It is possible that a specific percentage is not provided for the examination if the content and construct of the examination are continuously changing. Moreover, the National Strength and Conditioning Association (NSCA) personal trainer certification test is composed of 26% nutrition focused questions ( NCSA Certification Handbook, 2017). Furthermore, the specific percentage of nutrition focused questions of the American Council on Exercise (ACE) certification exam is unknown but does cover the following: 16

19 principles of nutrition and weight management and nutritional requirements before, during, and after physical activities. These topics are found (among others) in the Domain II- Program Design and Implementation which encompasses 33% of the test ( ACE Exam Content, 2017). In addition, of the National Council on Strength and Fitness (NCSF) personal trainer examination, 11% is nutrition focused ( Personal Trainer Certification, 2017). The National Council on Strength and Fitness (NCSF) course textbook and preparation courses cover energy yielding nutrients, non-energy yielding nutrients and nutritional supplementation making up 13% (3 out of 23 chapters) of the course information (Biagioli, 2007). III. Scope of Practice of Exercise Professionals Maxwell et al. researched the dietary recommendations given by 289 CrossFit trainers to their clients. The CrossFit trainers had to choose from seven different well-known diets or choose other. The diets included Zone diet, Paleo diet, Gluten-free diet, Mediterranean diet, Vegan diet, DASH diet and no recommendation given. The most two most common diets prescribed were the Zone diet (44%) and the Paleo diet (40%), while no exercise professionals recommended the DASH diet (0%) (Maxwell, 2017). Moreover, Cockburn et al. examined whether or not UK hockey and netball coaches provided their athletes with nutritional advice. Of the coaches, 57.1% provided advice while 39.9% of them did not. The main reason only slightly more than one third of the coaches did not provide advice was that they felt a lack of confidence with their level of knowledge on the subject matter (50.0%). However, of the coaches that did provide advice the most talked about subject were fluids (100%) and the least were supplements (15.1%) (Cockburn, 2014). 17

20 Johnson et al. explained that underneath the umbrella of Canadian organizations exercise specialists are allowed to promote healthy eating to their clients. Johnson et al. found that 85.1% of the individuals in the survey reported promoting healthy eating to their clients and of these, 44.7% had been doing so for greater than five years. In the study, 47.9% of the exercise professionals used the Canadian Food Guide (CFG) always or most of the time while counseling their clients. It was found that non-healthy-eaters used or recommended other diets such as the Atkins or South Beach diet as potential strategies for promoting healthy eating frequently compared to healthy eaters (P<0.001) (Johnson, 2015). The promotion of the Atkins diet may be risky as it drastically cuts carbohydrate intake, the main source of energy for the body. However, the diet does succeed in demonstrating the value of having strong intakes of protein and healthy fats which can lead to weight reduction due to increased satiety (Clark, 2014). The same study established the need for exercise instructors to refer to RD s when their clients require dietary counseling that is beyond their scope of practice (Johnson, 2015). Weissman et al. explained that when asked, personal trainers revealed to spending from 1-25% of time with their clients on nutrition discussions (69.8%) and on nutrition counseling (66.7%). In addition, 42.6% of the personal trainers confirmed that their fees included charges for nutrition counseling (Weissman, 2013). Manroe et al. examined the familiarity that Registered Dietitians Nutritionists (RDN) and different ACSM exercise professionals (including certified group fitness instructors and exercise physiologists) had with their scope of practice per their credential. The results showed that RDN s were either very familiar, familiar, aware that it exists but have not read it or not aware that it exists at 63.5%, 29.4%, 6.3% and 0.7%, respectively. It was found that of all the exercise professionals that participated, most were aware that certified group exercise instructors 18

21 had scope of practice guidelines but have never read them. However, the majority of exercise professionals were very familiar (46.1%) with the scope of practice for certified personal trainers. The ACSM exercise professionals were also very familiar (36.7%) with the scope of practice for certified exercise physiologists. In addition, ACSM exercise professionals were aware of the existence of scope of practice guidelines for certified clinical exercise physiologists (43.6%) and registered clinical exercise physiologists (48.9%) but have never read them before (Manore, 2017). Furthermore, Manore et al. found that 56.6% of RDN s found that guiding clients on a physical activity routine to achieve a client s goal was within their scope of practice. However, only 24% of all ACSM certified exercise professionals and 27% of ACSM degree holding professionals stated that this was in the scope of practice for RDN s (p < for both). Additionally, 58% of RDN s indicated that they discuss physical activity with their clients, whereas 64% of all ACSM professionals discussed healthy eating with more than half of their clients (Manore, 2017). Barnes et al. studied the self-perceived competence of Australian personal trainers in providing nutrition care to their clients. The scope of practice set by the International Confederation of Registered Exercise Professionals has limited the provision of nutrition care by personal trainers. Both Australian and international research shows that greater than 33% of personal trainers provide nutrition care beyond the recommended scope of practice. The study had four sections with sections two, three and four focusing on nutrition knowledge, nutrition skills and nutrition communication. The researchers found that 86% of personal trainers felt 19

22 very or extremely confident in their communication and counseling skills. In addition, the results showed that most participants (80%) agreed or strongly agreed that they needed further nutrition education to increase their effectiveness as exercise professionals (Barnes, 2016). Lastly, as stated by the ACE website, ACE fitness exercise professionals may not offer individualized meal planning/recommendations, conduct a nutritional assessment to evaluate individual nutrient needs and status or make specific recommendations for intake or specialty diets among other nutrition related activities. ACE guidelines deem these activities to be outside the ACE fitness trainers scope of practice (Nitschke, 2017). IV. Nutrition Resources Utilized by Exercise Professionals Maxwell et al. researched using a Likert scale (Always = 1, Sometimes = 2, Never = 3) to discover the most used resources by CrossFit trainers for finding sports nutrition knowledge (SNK). Results showed that the internet was the most cited format (1.92 ± 0.54) and that Registered Dietitians were the least likely to be used (2.13 ± 0.62), when compared to using either peer-reviewed research, other CrossFit colleagues and former coaches/trainers (Maxwell, 2017). Furthermore, Cockburn et al. examined UK coaches and discovered that most of the coaches researched sports nutrition information (80.4%). The coaches reportedly referenced the internet (61.1%), journal articles (48.9%), magazines (44.3%), lectures/seminars/courses (26.0%), and sponsors (1.5%) (Cockburn, 2014). Torres-McGehee et al. found that student-athletes used strength and conditioning specialists 16.2% of the time for nutritional information whereas coaches looked to athletic trainers 16.5% of the time for nutrition advice. Athletic trainers (AT) used academic journals 20.1% of the time for food and nutrition information and strength and conditioning specialists 20

23 (SCS) used academic journals 19.2% of the time (Torres-McGehee, 2012). These were the main references for nutrition information sought by these exercise professionals. As evidenced by this study, AT s are the only ones citing credible sources. However, since the study does not specify on how the academic journals were searched, (e.g. peer-reviewed, publication dates) accurate researching methods may not have been used. Stacey et al. found that exercise professionals used textbooks (81%), college class notes (80%), scientific journals (79%), workshops/seminars (78%), past experience (51%), colleagues (49%), and mass media (20%) as sources of information on weight control. In addition, participants with a doctoral degree (14%) were less likely to use mass media as a source of information than holding a master s degree or less (86%) (p = 0.04). However, participants with a master s or doctorate degree (61%) were more likely to use scientific journals as sources of information compared to individuals with a bachelor s degree or less (39%) (p = 0.008) (Stacey, 2010). V. Collaboration Between Exercise Professionals and Registered Dietitians Cockburn et al. found that 84.0% of UK coaches did not utilize outside professional sources for sports nutrition information. Those who did reference an outside professional they spoke with either a professional (14.7%), a sports nutritionist (66.7%), physiotherapist (50.0%), team trainer (37.5%), personal trainer (25%), registered dietitian/nutritionist (16.7%), academic (16.7%) and/or a doctor (8.3%) (Cockburn, 2014). Johnson et al. established that 90% of Registered Dietitians (RD) have been shown to recommend their patients to see a PT to participate in physical activity under guided supervision (Johnson, 2015). Moreover, Weissman et al. found that most exercise professionals (78.3%) 21

24 admitted to never collaborating with a consulting RD within the workplace. However, as many as 93% of exercise professionals in the study have expressed a willingness to attend a free nutrition workshop (Weissman, 2013). Manore et al. discovered that between RD s, ACSM-all and ACSM- degree requiring professionals, that more than 90% of them selected RDN s as the most credible source of information on healthy eating. More than 93% of all three groups selected stated that the most credible source for information on physical activity was ACSM certificants. In addition, 94.9% of RDN s cited themselves as the leader in weight loss information whereas the ACSM professionals stated that RDN s (46.1%) and ACSM certificants (41.5%) were the more credible sources (both statistically different from RDN s P<0.001) (Manore, 2017). Manore et al., also found that ACSM exercise professionals strongly agreed that RDN s provide credible information on healthy eating (64.3%) and weight loss (46.0%). Moreover, almost half of RDN s (48.3%) strongly agree that all ACSM professionals provide credible physical activity information. Lastly, the ACSM participants reported that they strongly believe that RDN s are valuable professional contracts and collaborators (55.0%) whereas only about one-third (35.7%) of RDN s felt the same toward ACSM exercise professionals (Manore, 2017). The world of nutrition and fitness expands daily and staying on the leading edge of this ever-growing area of interest is the only way to maintain success in either field. A fitness instructor or personal trainer must be certified by a nationally recognized organization (i.e. ACSM) then they are considered to have sufficient credentials to instruct clients in fitness. The gold standard credential in nutrition and dietetics is Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN). Several studies presented both here and in other publications have 22

25 well established that exercise professionals such as personal trainers, coaches, AT s and SCS s lack sufficient sports nutrition knowledge. In addition, these exercise professionals are likely outside of their scope of practice to provide nutrition counseling to clients and mostly reference poor nutrition sources. Furthermore, the studies show that most RD s may refer patients to exercise professionals to improve health outcomes but the reverse does not hold true. Exercise professionals such as personal trainers are essential to the health care model and by increasing their sports nutrition knowledge, ensuring proper credentials, educating them on scopes of practice, educating on evidence-based resources and strengthening collaboration with RD/RDN s the two fields of study can grow closer and improve the world s health. Methodology of Intervention In order to address the needs of the participants fifty-minute nutrition classes were conducted once a week per class and section for five weeks. The goal of the nutrition classes was to provide nutrition education- an experience designed to facilitate the voluntary adoption of nutrition related behaviors and knowledge conducive to health and health related professionals (Boyle, 2017). The classes covered topics including carbohydrates, protein, and fat, as well as nutrient utilization and nutrition before, during and after exercise. These educational areas were selected because needs assessment indicated the participants had the least amount of knowledge about them. The intervention portion of the study involved nutrition education classes with interactive activities in an effort to increase the nutritional knowledge of the college students studying exercise science and wellness. Each week a new nutrition topic was covered (see chart below). To measure whether objectives were achieved, nutrition knowledge quizzes were distributed at 23

26 the end of each nutrition education class. Prior to the intervention, this questionnaire was utilized as a pre-test and then after the intervention the quiz was utilized as a post-test. Intervention Week Dates Nutrition Topic 1 1/22/18 1/25/18 Carbohydrates 2 1/29/18 2/1/18 Protein 3 2/5/18 2/8/18 Fats 4 2/12/18 2/13/18 Nutrients Utilized During Exercise 5 2/26/18 3/1/18 Nutrition Before, During and After Exercise Purpose of the Evaluation The purpose of the evaluation was to determine the effectiveness of the nutrition education classes by using a post-test or outcomes assessment tool (i.e. nutrition knowledge quiz) to measure any increased nutritional knowledge. The evaluation was intended to assess whether or not nutrition education classes act as an effective tool for increasing the nutritional knowledge among exercise science and wellness college students. Evaluation Design The evaluation tool used as the post test was a five-question quiz based on the nutrition education lectures that week. Overall, the quizzes focused on major ideas and concepts of the nutrition topics presented to ensure that the students understood the most important information. The quizzes were distributed to the students after each of the fifty-minute nutrition education lectures. There were five different quizzes, one for each nutrition topic including carbohydrates (week 1), protein (week 2), fat (week 3), nutrients utilized during exercise (week 4) and nutrition 24

27 before, during and after exercise (week 5). The students were given five to ten minutes to complete the quizzes. Data collection and analysis were anonymous as no personal identifying information was obtained as part of the assessment tool. Outcome Results The needs assessment included several questions about various nutrition topics and the top five questions answered the lease correct were the ones selected for the intervention. The outcomes assessment had individual quizzes on the five nutrition topics and mean quiz scores were collected. The needs assessment and outcomes assessment were compared and analyzed to determine and detect for any knowledge increases after the intervention was completed (see Table 1). Table 1 Nutrition Topic Needs Assessment Data Compared to Outcomes Assessment Data n Needs Assessment Incorrect Needs Assessment Correct n Outcome Assessment Incorrect Outcome Assessment Correct Amount of Change in Accuracy of Answers Carbohydrates % 30.1% % 64.5% +34.4% Protein % 3.77% % 78.6% % Fats % 7.5% % 65.7% +58.2% Nutrients Utilized During Exercise Nutrition Before, During and After Exercise % 7.5% % 55.8% +48.3% 53 68% 32% % 76.8% +44.8% Mean Percent of Correctly Answered Questions = 16.1% Mean Percent of Change of Accuracy of Answers = +52.1% Mean Percent of Correctly Answered Questions = 68.2% 25

28 Week 1: Carbohydrates Week one of the nutrition interventions focused on carbohydrates. The needs assessment (pre-test) data shows a mean of 30.1% of the students answered the questions on carbohydrates correctly, while 69.9% of the students did not (See Figure 1A). The outcomes assessment (posttest) data shows a mean score of 64.5% on the carbohydrates quiz (See Figure 1B). There was a mean knowledge increase of 34.4% when compared to the pre-test. Figure 1A Pre-Test: Carbohydrate Nutrition Knowledge (n= 53) 69.9% 30.1% Questions Answered Correctly Questions Answered Incorrectly Figure 1B Post-Test: Carbohdyrate Nutrition Knowledge (n= 75) 35.5% 64.5% Questions Answered Correctly Questions Answered Incorrectly 26

29 Week 2: Protein Week two of the nutrition interventions focused on protein. The needs assessment data expresses that a mean of 3.77% of the students answered the questions on protein correctly and 96.23% did not answer them correctly (See Figure 2A). In the outcome assessment data, the mean score on the protein quiz was 78.6% (See Figure 2B). There was a mean knowledge increase of 74.83% when compared to the pre-test. Figure 2A Pre-Test: Protein Nutrition Knowledge (n= 53) 3.77% 96.23% Questions Answered Correctly Questions Answered Incorrectly Figure 2B Post-Test: Protein Nutrition Knowledge (n=73) 21.4% 78.6% Questions Answered Correctly Questions Answered Incorrectly 27

30 Week 3: Fats Week three of the nutrition educations focused on fat. The needs assessment results showed that a mean of 7.5% of the students answered the questions about fat correctly and 92.5% answered them incorrectly (see Figure 3A). Furthermore, for the outcome assessment the results showed a mean quiz score of 65.7% (See Figure 3B). The results expressed a 58.2% knowledge increase in the students. Figure 3A Pre-Test: Fat Nutrition Knowledge (n=53) 92.5% 7.5% Questions Answered Correctly Questions Answered Incorrectly Figure 3B Post-Test: Fat Nutrition Knowledge (n=59) 34.3% 65.7% Questions Answered Correctly Questions Answered Incorrectly 28

31 Week 4: Nutrients Utilized During Exercise Nutrients utilized during exercise was the primary focus of week four of the nutrition intervention. The needs assessment statistics reported a mean of 7.5% of who students correctly answered a question relating to nutrients utilized during exercise and 92.5% who did not (see Figure 4A). Moreover, there was a mean quiz score of 55.8% in the post-test (see Figure 4B). The post-test information expresses a 48.3% knowledge increase. Figure 4A Pre-Test: Nutrients Utilized During Exercise Nutrition Knowledge (n= 53) 7.5% 92.5% Questions Answered Correctly Questions Answered Incorrectly Figure 4B Post-Test: Nutrients Utilized During Exercise Nutrition Knowledge (n=48) 44.2% 55.8% Questions Answered Correctly Questions Answered Incorrectly 29

32 Week 5: Nutrition Before, During and After Exercise In week five the students were taught about proper nutrition before, during and after exercise. The data from the needs assessment expresses a mean of 32% of the students marked the correct answer on the topic and 68% did not mark the correct answer (see Figure 5A). However, the data from the outcome assessment shows a mean quiz score of 76.8% (see Figure 5B). This data shows a 44.8% knowledge increase on this topic. Figure 5A Pre-Test: Nutrition Before, During & After Exercise Knowledge (n=53) 68% 32% Questions Answered Correctly Questions Answered Incorrectly Figure 5B Post-Test: Nutrition Before, During & After Exercise Knowledge (n=58) 23.2% 76.8% Questions Answered Correctly Questions Answered Incorrectly 30

33 Discussion Overall the statistical information provided by the outcomes assessment demonstrates substantial improvement in test scores and represents an increase in nutritional knowledge on each topic reviewed. Week one of the nutrition intervention focused on carbohydrates, with a 34.4% knowledge increase. Week two of the nutrition intervention focused on protein and showed a 74.83% knowledge increase. Moreover, week three and four of the nutrition education classes focused on fats and nutrients utilized during exercise and had 58.2% and 48.3% knowledge increases, respectively. The last week of the nutrition education classes focused on nutrition before, during and after exercise and the data showed a 44.8% knowledge increase on the subject material. The participants had a 52.1% mean nutritional knowledge increase from the five weeks combined. Furthermore, RDN s are trained professionals in the field of dietetics and nutrition. It is not within the scope of practice for personal trainers, athletic trainers, coaches and other associated professions to provide nutrition education or counseling but it is within the RDN s scope of practice to do so. Moreover, RDN s must also meet certain standards of continuing education in order to remain a RDN. In addition, there are specialties in the field of nutrition, one of which is titled Board Certified Specialist in Sports Dietetics (CSSD). Those who are a RDN, CSSD provide sports medical nutrition therapy for those who exercise or play a sport recreationally or competitively. It is well established that personal trainers and coaches have not had formal education in nutrition but this formal education is necessary because nutrition often comes up in conversation between athletes/clients and their trainers. In this study, the certainty that the nutrition interventions of this study caused the results is questionable. There is no absolute certainty that the nutrition education classes that the 31

34 students attended were the sole reason for the considerable nutrition knowledge increases observed. In the needs assessment conducted, it was established that 25 out of the 53 participants or 47.1% had taken or were currently taking the Dutchess Community College Bio 122 nutrition course and 28 out of 53 participants or 52.8% had not taken the Bio 122 nutrition course. With almost half of the participants claiming to have taken or were currently taking a college nutrition course, the baseline knowledge of the students and its impact on study outcomes cannot be overlooked. It is important to note that the participants of the needs assessment and outcomes assessment were not exactly the same and the figures could be different for the different participants. However, there is strong confidence that the participants from the needs assessment appropriately represented the participants of the outcome assessment. Additionally, students in the study may have taken or could have been taking other nutrition related college courses such as Biology and Lifetime Fitness and Wellness that would also increase nutritional knowledge over the course of the study in addition to the nutrition intervention classes. Furthermore, nutrition references utilized by the students could have also positively or negatively impacted the results of the research. In the needs assessment it was discovered that the most popular nutrition references cited by the participants were knowledge/notes from college courses (e.g. Bio 122), textbooks and nutrition organizations (e.g. Academy of Nutrition and Dietetics). Validity, accuracy and reliability of these sources all impact the nutritional knowledge gained by students in this study and could have affected the outcomes. Conclusion and Implications for Practice Nutrition education can be defined as any set of learning experiences created to facilitate the voluntary adoption of eating and other nutrition-related behaviors conducive to health and 32

35 well-being (Nutrition Education, 2018). It is well understood that nutrition education can help to improve knowledge about various aspects of nutrition and research exploring the effectiveness of nutrition education on level of knowledge and behavior change is studied regularly. However, it is less common that sports nutrition education effectiveness is assessed. It is even less common to study this among college students in the field of exercise science and wellness. Those who are studying in the field of exercise science and wellness often have aspirations of going into Physical Education for Teaching, Athletic Training, Exercise Physiology, Kinesiology, Health and Wellness, Physical Therapy or Nutritional Science. Most of these however require little to no nutrition classes and therefore leaves these future working professionals with no point of reference in that subject. For those who study exercise science and wellness at the collegiate level will have little to no opportunity to learn about nutrition or more specifically sports nutrition; in the health field it is important that they understand what professional to collaborate with when assisting clients and athletes. Registered Dietitian Nutritionists (RDN) are trained professionals in the field of dietetics and nutrition. It is not within the scope of practice for personal trainers, athletic trainers, coaches and other associated professions to provide nutrition education or counseling but it is within the RDN s scope of practice to do so. The world of nutrition and fitness expands daily and staying on the leading edge of this ever-growing area of interest is the only way to maintain success in either field. A fitness instructor or personal trainer must be certified by a nationally recognized organization (i.e. ACSM) then they are considered to have sufficient credentials to instruct clients in fitness. The gold standard credential in nutrition and dietetics is Registered Dietitian Nutritionist (RDN). Several studies presented both here and in other publications have well established that exercise 33