JUNE 2015. Over the past decade health clubs have positioned themselves to stand out in the crowd to let their communities know they have special services. Thus is the growth of "special population exercise". This isn't a new concept - as an article in the fall 1998 Fitness Management publication (Weaver) may have been the first published on this area of wellness.
Over this time there have been many articles written on how to develop programs for seniors, youth, obesity, diabetes, pregnancy, etc. These offer clubs the opportunity to program for persons who may not have been regular health club members, and increase revenues while hiring staff with exercise credentials and degrees in clinical health programs. In the most recent issue of Wellness and Fitness Entrepreneur, another article is presented on the topic of post-rehab fitness (Jones).
However, according to industry officials, membership sales are still the bottom line for the majority of clubs. Any program designed to attract new members must have the ability to attract enough persons who will pay for ancillary services in order to show a profit for such programs.
What will these types of programs be in the coming years? Let's first recap the types of programs that have been previously implemented in health clubs, and why (in my opinion) they did not succeed on a fiscal level. In the early 1990s - with the first edition of "Exercise and Pregnancy" published by Dr. Artal and colleagues, clubs developed programs for pregnant women. Although sound in its physiology and great in concept - most Gynecologists didn't know much about the effects of exercise on mother or baby - so decided not to refer. Those women who did participate in exercise did so mostly out of their own interest and background research.
Another area that has been developing over the past decade is senior fitness programming. Led by Arizona-based Silver Sneakers, the program is now in hundreds of fitness centers across the US. It is a boon for seniors, who as Medicare-Plus Choice, or other health plan members, can sign up and participate in free exercise programs sponsored through their clubs.
Many clubs have stated that they don't actually make money on these programs (although they do receive regular payments from the Silver Sneakers company). There is also no hard evidence detailing how effective the exercise program is in terms of attendance, risk factor reduction, and other medical aspects related to regular exercise. It would be interesting to see
published information on the effects of this unique program now that parent company Healthcare Dimensions has sold to a larger agency.
Area Number One
Does this mean that senior exercise will not continue to see growth? Absolutely not! This may continue to be the largest area of "special population" exercise in terms of instruction and post-rehab programming. However - The entrepreneureal trainer may see that since they won't be able to work at a Silver Sneakers program (HCD hires their own staff trainers to do the job), and many health clubs won't hire contract trainers (even those with post rehab credentials), where then will trainers be able to work with seniors? Why - senior centers, of course. The next big area of wellness growth will NOT take place in the health club, but in the retirement
community - of which there are over 10,000 such centers in the US, and growing every year. From senior care to assisted living centers, the opportunity for the post rehab trainer to work part time or full time with persons over 65 years of age (and in many cases over 85 years of age) will continue to grow as this demographic continues to expand.
Area Number Two
So - where will the growth in health and fitness for special populations come from. Diabetes? Not really. Since the age of diabetes and exercise research in the 1980s and early 90s, there has been no substantial clinical research studies in this area. Most research is concentrated on drug trials. The rise of obesity has also put a black eye on diabetes practitioners, who have seen a rise in the overall rate of type II (adult onset) diabetes significantly in the past decade, even in children. Since research shows that a significant change in lifestyle interventions can put a damper on type II diabetes development, one can only shake his/her head as
to why every pre-diabetic child in the US isn't given a medical prescription for exercise. Although there may not be growth in diabetes care, we will see big changes in the way obesity is treated in the US. One area in particular will be bariatrics care.
In 1997 there were just over 15,000 bariatrics surgeries performed in the United States. Last year there were close to 80,000. A report in MSNBC web site this fall states that there will be over 150,000 such surgeries in the next two years. This should tell fitness professionals that the rise in these procedures ushers in a new era in fitness instruction - the long term
lifestyle change of the post-bariatric surgery patient. The fact is that for every patient who is accepted into such a surgical program - three are turned away (but still need lifestyle changes in order to manage and reduce their weight condition).
Those in the bariatrics world are interested in having some aspect of long term care for their patients - and exercise may be the key to assisting patients on their long road to recovery. One patient in Chicago (32 years old, 298 lbs.) had surgery in 2002. Over the past four years she has had reconstructive plastic surgery to remove the skin after eight months and over 150 lost pounds. Today she trains 5-6 days per week like a body builder, and consumes many small meals per day - concentrating on the use of protein powder, very little meat, and holding calories to 3-400 per meal. This has allowed her to maintain her 118 lbs. on a 5'3" frame. Clearly
becoming trained in bariatrics will have benefits in working with obese persons who need chronic changes in their metabolism through strength training and aerobics to improve their overall condition.
How will it get paid for? Through existing contracts with Medicare and other payors of bariatrics procedures. Insurance pays up to $30,000 for surgery and after care programs for baratrics patients. There is no reason to assume that by negotiating contracts (existing and future) to include chronic lifestyle intervention programming at $1-3,000 that long term exercise, nutrition, and behavior modification could also be included. Current programs are looking into such contracts - and they may become a part of programming in the near future.
Area Number Three
A recent trip to the National Ergonomics Conference gave a stark indication of the level of wellness and fitness programming in corporate America. Zero. In many of the major companies in this country, ergonomics is used exclusively to promote external modifications in the work
environment (chairs, keyboards, etc.). Nowhere was there information on the power of exercise to reduce back injuries, pain levels, and worker's compensation costs.
The fact is that exercise may be the BEST low cost method for reducing musculo-skeletal disorders (MSDs) in the workplace. Reports for over 20 years in sports medicine indicate that regular exercise can reduce costs by over 50%, and show a return on investment for such programs from $2.50 up to $8.00. This is a huge cost savings, and something that most of the
major corporations in this country should have as a regular part of their work experience. Sadly - for those companies who presented at this year's expo - fitness programming was rarely (if ever) mentioned.
However - there were companies at the expo who did specialize in fitness and wellness programming, including my own where I work. Our Injury Prevention and Reduction Program has both a wellness and injury prevention component. We specialize in on-site fitness classes,
stretching, accident investigations, and equipment re-engineering for proper ergonomics. So far our program has saved over 100% in total lost employee days due to injuries. Other companies are looking into using personal training to improve health of employees at on-site programs (construction, landscaping, etc.). These represent a new and exciting are
for fitness professionals to get involved in - and will make their mark on the industry in a very short time.
Like many programs, information must be abundant to reach a diverse audience. Papers not just in medical journals, but newspaper features, magazine spreads, and other media represent the way that acceptance is forthcoming. However - there is abundent information in the
above-mentioned areas of fitness instruction for professionals to inquire and learn regarding making proposals to physicians, companies, and executives regarding adding exercise to their offerings for patients and employees. With some persistance and the right contacts, fitness pros can continue to carve out niches in ever-growing markets in wellness.
1. Weaver, G. Working with special population groups. Fitness Management. pg. 11-15, May/June, 1988