"Non-Essential" Never Again
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Eric Durak, MS
Many in the health club industry are reeling as to the temporary and some permanent closings of health clubs and studios across the United States. They are blaming a virus or city/state officials who have imposed a quarantine on their livelihoods and forced some out of business. The mantra of this dystopian situation is because health clubs were classified as "non-essential" service providers by those in public health, city government and state bureaucrats early on during the national shutdown.
According to those in the business, it's because government doesn't understand the power of exercise in promoting health and reducing the burden of disease. This, of course, is true, but how has it been conveyed by the profession to medicine, public health and government? In most cases, it hasn't. Many people in cities, big and small, see health clubs as a place where you rent time on exercise machines or in a group exercise class, period. The case for making health clubs stay open during any situation of this type was never considered, because health clubs never positioned themselves as the lifestyle enhancer, or the remedy for those with medical conditions, or the answer for a healthful active aging process, or as a competitor to other allied health programs that manage pain, improve function and work synergistically with doctors.
Dan Zeman, MS
So, when the hammer came down across the nation in March of 2020, health club owners, fitness centers and membership organizations had no proof that they could or should be deemed essential. Keep in mind, they didn't doubt any of the medically-proven health benefits of regular physical activity; they simply didn't believe daily attendance to health clubs or fitness centers guaranteed health benefits.
The COVID-19 pandemic has been called the great "reset" in American society. But, that "reset" button has not been shown to prioritize those who offer a solution to those at risk of acquiring the COVID-19 virus. Specifically, improving immune function, reducing co-morbidity rates of obesity, hypertension or coronary heart disease. Anyone with any powers of observation will see that fast food restaurants and coffee houses were the first to "re-open," followed by higher-end dining establishments who had the luxury of outdoor seating. Professional sports teams have defaulted to a "bubble" approach to playing while also forcing limitations to the number of fans in attendance. All of these industries figured out a method of re-opening which allowed them to begin to get back to their normal of providing entertainment and socialization.
But, what about the health and fitness industry? Well, in most people's eyes, they are still a "non sequitur" in that, if they do open their doors, they will be seen as the place where a handful of community members go to sweat and train for a 10K or lose those pesky 20 pounds. They haven't figured out that, after 40 years, they should be seen as one of the nation's leading purveyors of health promotion, disease prevention and risk management. They haven't been able to because they have not provided the one thing that medicine, behavioral health, physical therapy and chiropractics have been able to provide, and that is outcomes.
You see, the first phase of medically-based fitness came in the late 1970s with practitioners such as Dr. Neil Sol developing some of the first medically-based cardiac rehab programs. By the mid-decade, those programs affiliated with medical centers were receiving reimbursement for up to three months of supervised exercise. On the downside, most exercise professionals had to wear lab coats. This was followed in the late 1980s with programs for exercise in diabetes, pregnancy and hypertension. In the 1990s, obesity, cancer care and neurology came into clubs. One of the big boosts for the industry was the work of Dr. David Nieman from Appalachian State, looking at conditioning programs and the immune system. This gave a lot of credibility into the physiological adaptation of exercise to improved medical conditions. Today, the application of exercise and the lengthening of the chromosomal telomere again shows the impact on exercise on our biological systems. Exercise may really enhance our ability to live longer.
But, where were the pre- and post-diagnostic criteria? Outside of body fat and 1 RM max lifts, most in the industry were not that keen on developing programs based on criteria such as blood labs, pain levels, postural defects and neurological efficiency. Over the last 30 years, individual programs have been developed, and health clubs do have their share of programs for post rehab and metabolic wellness, but since there are very few outcomes-based studies, there is little attention given by medicine and public health to health clubs as "providers" of quality medically-based exercise and health promotion services.
A recent study, Marshall, Groves, et al, looked at outcomes for supervised exercise for six sub-categories of exercise (bariatrics, cancer wellness, cardiac exercise, diabetes, MoveWell joint replacement and Parkinson's Disease) with over 380 participants over a multi-month standardized exercise program. Results yielded improvements in health assessments (body composition, submaximal exercise testing and self-reported behaviors). What is interesting about this program is: it is in health clubs, it is performed by trainers, and each subset of medical patients had specific outcomes tailored to their conditions.
This is considered the first population health study to come from the health club environment. Dr. Jay Groves and colleagues should be applauded for their great work. Most in the health club world didn't notice. Other studies looking at cardiac rehab, cancer care, diabetes and exercise and cellular repair have all happened in the health club setting. There are thousands of dedicated trainers and coaches performing post-rehab programs daily on clients that have no bearing on healthcare, because they have no method to publish their findings.
This scenario recently changed with the launch of the "Healthy Stats" Outcomes Platform from Welld Health Corporation in Charlottesville, VA (www.welldhealth.com). This platform looks at a variety of health assessments, including nutrition, biometrics, and behavioral. It includes a simple daily exercise routine that can be plugged in by trainers and patients in less than a minute, and it offers a post-program assessment that includes the above mentioned and includes data entry for blood labs.
This portal has the ability to change the course of the industry because trainers on many levels of instruction (personal trainers, health coaches, Pilates and yoga instructors, and exercise physiologists) can use the portal to glean data on single person outcomes and log onto data for entire populations for research and outcomes purposes. This platform is also a large step forward for exercise science departments at universities in which graduate students can now tackle data on a large scale. The collaborative and research purposes for any subset of exercise (from HIIT training to medical yoga, exercise equipment to pool conditioning) can now be used in an outcomes-based fashion for submission to high impact medical journals and strengthen the ability of health clubs to provide medically-based exercise for an industry that needs to get back on its feet quickly and find its legs within a healthcare paradigm in the U.S. that is in desperate need of an overhaul. I see no better overhaul than a quality exercise program.
A recent report by Hank and colleagues also looks at the use of precision wellness modalities (in this case, cellular repair technology using Nano Vi equipment) to enhance the wellness status in Alzheimer's disease. The use of precision tools such as hypobaric chambers, cryotherapy and compression therapy will add yet another positive dimension to the mix of wellness services that can by applied within the health club setting, thus boosting their status as a bona fide provider in the industry, both fitness and medicine.
Our current national situation may yield unprecedented opportunities, but health clubs need to look at not just having clean clubs but also look at using Welld's national outcome platform to allow them to perform their own "electronic wellness records" on patients coming into their program. The exercise profession has been involved with clinical exercise and testing for decades. We have seen improvements in the industry but also some foot dragging because "we are not in the medical business." The time has come to make the decision regarding outcomes, otherwise the status of your facilities may be permanently "non-essential."
To view the list of References for this article, please go to bit.ly/clubinsider101.