Exercise is Medicine: How the Fitness Industry Can Support Patients with Chronic Illness


Exercise is Medicine: How the Fitness Industry Can Support Patients with Chronic Illness

Exercise is Medicine. In fact, I believe that it is the most powerful medicine we have today. If it were a pill, every physician would prescribe it and every pharmacist would dispense it. What makes it even better is that it is available to everyone at no cost. And we also know that there is a vast amount of medical research that confirms the positive effect that exercise has on so many chronic illnesses, including diabetes, obesity, hypertension, cardiovascular disease, and many types of cancer. It is also well known that immune function improves with regular physical activity, and those who are regularly active have a lower incidence, intensity of symptoms, and mortality from various viral infections.

So why is our healthcare system so broken? As a country, we spend more on health care per person than other major industrialized nations and despite this, we are ranked last in a study of the 11 major industrialized countries. And according to the World Health Organization (WHO), the United States is ranked 37th out of 100 in overall health care.

The system seems to be focused so much on big pharmaceuticals and treating chronic conditions with costly pills and procedures rather than focusing on activities and nutrition that help build and maintain strong immune systems and healthy, independent living. Why has there been a lack of effort by our state and national governments to educate the public about the benefits of regular exercise and proper nutrition? And why has it taken a pandemic like we have never lived through before to bring it into their focal lens?

Impact of COVID-19 on Health Club Industry

We all know of the devastating effect that COVID-19 has had on our industry: in the past 12 months, revenue is down 58%; 17% of health clubs have closed permanently and 44% of people in the industry have lost their jobs. Well, now there seems to be proof positive that Exercise really is Medicine!

Influence of Exercise on COVID-19 Patients


One of the largest healthcare providers in the country, Kaiser Permanente has completed a large study that today was published in the British Journal of Sports Medicine that looked at almost 50,000 adults in the U.S. that were diagnosed with COVID-19 infection between January and October 2020.

What the researchers found was that patients who had COVID-19 and were inactive or sedentary during the previous 2 years were much more likely to be admitted to the hospital; to require intensive care and to die from the infection than patients who had consistently met the U.S. Department of Health and Human Services recommended guidelines of 150 minutes each week of moderate to intense physical activity. Among patients in the study, 8.6% were hospitalized; 2.4% required intensive care and 1.6% died as a result of the infection. Those who were inactive were also 73% more likely to receive Intensive Care and 2.5 times more likely to die than those patients who were regularly active.

According to the study, “the risk for all outcomes associated with being consistently inactive exceeded the odds of smoking and virtually all the chronic diseases studied in their analysis, indicating physical inactivity may play a crucial role as a risk factor for severe COVID-19 outcomes.”

My good friend Dr. Robert Sallis, the study author says “This is a wake-up call for the importance of healthy lifestyles and especially physical activity. People who regularly exercise had the best chance of beating COVID-19, while people who were inactive did much worse.” He went on to say: “Exercise is Medicine that everyone should take – especially in the era of COVID-19. Walk 30 minutes a day, 5 days a week at a moderate pace and that will give you a tremendous protective effect against COVID-19.”

People are now able to get vaccinated and I believe that this will result in a meaningful return of members, including new members to our health clubs and gyms. People are hungry to get back to a more normal way of life. Make sure that your facility operates at the highest degree of cleanliness and safety. I also urge you to join the health club alliances in your area and get involved in legislative advocacy through our industry to promote the benefits of regular exercise and proper nutrition and the important role that your Club plays in helping to build and maintain a healthy community.

Thank goodness that health clubs are beginning to reopen after a year of being closed due to the COVID-19 pandemic. I know that people are hungry to get back to a more normal lifestyle and that will certainly mean a rush back to their Club that for many has become their “second” home. You are going to have real opportunities to grow your business, but I urge you not to simply look at what worked before but rather to look at what you need going forward to differentiate your club: and give you your competitive advantage. What can you do to make your club a more valuable asset to your members?

Don’t ignore the role Nutrition plays in Health & Wellness


COVID has changed everything. It has changed the way health care will be delivered in the future, meaning that there will be a shift from simply treating disease and illness to a focus on prevention and wellness solutions. It is referred to as Population Health: moving away from sick care to health care and taking responsibility for not just treating people in the hospital but keeping them from having to go to the hospital. And if they do need to be hospitalized, keeping them from having to return. This is where the health care system truly does come together working with health clubs and others in the community that promote exercise and wellness not just health care delivery or sick care.

Overall health includes nutrition as well as exercise and this presents a golden opportunity that most clubs miss and it is a billion-dollar business. Most of our focus as an industry continues to be on cardio and strength training with little, if any, on proper nutrition programming. A person can work out seven days a week and if they are not eating properly and eating healthy, they will not reach the ultimate goal of optimal health. Eating healthy and eating right are two different things and most people need a qualified professional to educate them, guide them and follow their progress and modify their plans as needed.

Merging HealthCare with Fitness


Now think about this concept as we move into the post-COVID world. Think of merging Health Care with Fitness and eventually 3rd party reimbursement for programs that are actually working and promoting overall health and wellness. Medical Nutrition Therapy is one program available for reimbursement to qualified Clubs. Think of how you can become an even more important resource to your members and your community. Consider building an educational library of videos and periodicals by physicians in your area on a host of topics like Exercise and Brain Health; Exercise and Cancer; Exercise and Diabetes; Exercise and Fibromyalgia, etc. The list is endless.

Today, more than ever, your members are seeking wellness solutions like never before. Why go to the Internet when they can access valuable information from the Club that they trust and support?

I have said in other articles that the Health Care system is broken and change is imminent. COVID has certainly made us aware of this. Health Care costs are having a major strain economically on our country. As a country, the US spends more on health care per person than other major industrialized nations and despite this, we are ranked last in a study of the 11 major industrialized countries. And, according to the World Health Organization (WHO), we ranked 37th out of 100 in overall health.

Become part of the solution and in doing so, you will continue to be a major force in helping to build and maintain health and wellness in your community.

Positive proof that Exercise is Medicine.

Role of Health Clubs in Prevention and Treatment of chronic illness


During the past several months I have listened to a lot of conversations and concerns about the long-term effect that COVID-19 will have on our industry. As with most discussions, there are two sides: those who feel that we will never return to the pre-COVID days and those who believe that we will come back stronger than ever. So do you choose to believe that the glass is half empty or is it half full? I believe that the glass is more than half full. Members are hungry for the socialization that takes place in the Club and many have suffered without it for too long now. I also believe that there needs to be more focus on prevention and wellness programming. And who better to create and deliver these programs than the HEALTH CLUB industry. And as my good friend Dr. Bob Sallis says: “Health clubs need to be places where it is more than how a person looks in a bathing suit. They need to be more about hearts and lungs than abs and buns.” Clubs will need to be able to offer these services both in the Club and Virtually.

We have been saying for years that the Health Care and Fitness industries need to be working together instead of independently.

Traditional medicine was not prepared for COVID where we saw hospitals, doctors’ offices, and clinics overrun with patients. In many cases, people who were in need of surgical procedures or treatment for chronic illnesses often were not able or willing to receive treatment. And more than a year later and there are still parts of the country and businesses that remain closed. We are yet to realize the financial impact that COVID has had on our country and the world. We simply cannot go down this road again!

Significance of Integrative Medicine

To begin with, as a country, we need to do a much better job of educating people on how to manage their health care and their healthcare costs. We must put more emphasis on exercise and nutrition. The numbers don’t lie: over 75% of the U.S. population is overweight and 40% of the population is clinically obese. If these statistics don’t send a scary message to our state and national governments, something is drastically wrong. And if we continue down this road, the costs to treat the chronic medical conditions that result from this are surely going to bankrupt the system. We must put more emphasis on exercise and nutrition and healthy living.

Medical Fitness addresses this by combining a blend of exercise, nutrition, education, and medicine. And Integrative Medicine is healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioners and patients. It is informed by evidence and makes use of all appropriate therapies. This can include relaxation, meditation, yoga, tai chi, vibration therapy, and other types of mind-body programming.

Digital Medical Solutions and Health Club Integration

Telemedicine is already part of the traditional medical paradigm. This is where a patient can call or go online and communicate their symptoms with the PA (physician assistant) or RN and get advice on whether they need to actually go in to see the doctor or if their symptoms can be treated at home. This helps to ease the patient overload that so many physicians struggle with today and allows the physician to spend time with more critically ill patients.

Through a Digital Platform, a physician can refer a patient to a Club/Health Coach/Personal Trainer or a Registered Dietician (RD) to deliver an exercise and nutrition program virtually. If the Club doesn’t have an RD, you could use one from another Club that does employ one. The RD will be able to take a picture of the members’ Insurance Card and then see what programs are available in their plan through the Affordable Care Act or Medicare under the Wellness provision and whether they are reimbursable. The member could be put on a bioimpedance scale like an In-Body or MyZone and all the data and progress can be pushed back and forth from the Club to the Physician Assistant/RN in an encrypted and HIPPA-compliant way and stored in the patient’s medical file.

Some qualified programs that are treating people who are diabetic or pre-diabetic; or have hypertension or cardiopulmonary disease are reimbursable and I believe that more will soon qualify for 3rd party reimbursement. Your Club needs to be positioned to benefit from what is coming.

Leadership is a lot of things but one thing is for sure: leaders are optimistic; they have a vision and do not depend on what worked yesterday to lead them forward; they are able to pivot and they lead with honesty, integrity, and compassion.

Position yourself to be ready to board the train before it leaves the station. Exercise is Medicine.

What is “ Exercise is Medicine “?

Although I do not know Cosmo Wollon, I want to thank him for reading my recent article and for taking the time to give his input and opinion on Exercise and Fitness. A counter perspective is always a good thing and we can certainly learn from them. After all, that is what makes our country so fantastic: people are encouraged to have different opinions on a subject or issue and we should all be open to listening and considering their point of view. We can then come to our own conclusion.

Let me start by saying that Exercise is Medicine is a term that I referred to back in the early 1990s when I was a Managing Partner at The Athletic Club of Bend, in Bend, Oregon. I saw the powerful effect that exercise had on children we were working with who were struggling with severe physical challenges. But actually, Exercise is Medicine is a joint initiative between the American College of Sports Medicine and the AMA that was started in 2007 by my good friend and colleague, Dr. Robert Sallis when he served as the President of ACSM. It has been endorsed by the US Surgeon General and is a trademarked phrase.

How are Nutrition and Exercise codependent on each other

In a previous paragraph of this article, I begin by saying that overall health includes nutrition as well as exercise. So I was not insinuating that nutrition was exercise, but rather, that it is and should be a part of a person’s overall fitness program in order for them to obtain optimal health. So many Club members don’t think that they need nutrition counseling because they are working out regularly. Yet over the years, I have seen the same members doing cardio and strength workouts; perspiring profusely and their body image never seemed to change. From talking with members over 30 years I would ask them if they had eaten and hydrated prior to their workouts and the high majority that did their workouts early in the morning or came to the Club after work would invariably say that they had not. Without fuel in the gas tank, the car won’t run and without food in your body, you will burn muscle instead of fat.

It is just my opinion, and one that I feel very strongly about that exercise and proper nutrition should go hand in hand. And Exercise is Medicine’s goal is to merge health care with fitness. It includes traditional medical care; integrated medicine; complimentary care; mental health; stretching and nutrition. It is the whole package.

Cosmo is spot on with his points on physician referrals. Doctors will be looking for highly credentialed specialists who they feel comfortable sending their patients to. It should not be about building your bottom line, but, rather, having the personnel and programs that will render positive outcomes in a safe and inviting environment. And it is critical to develop and maintain strong relationships with physicians, clinicians, and hospital CEO’s in your community. They need to be part of the continuum of care even after traditional care has been exhausted.

At The Claremont Club, we chose to develop our programs around people who were struggling with chronic injuries and chronic illnesses. One reason we did this was because we felt that these were people who needed us the most and could afford us the least. Many times I spoke with people who had lost their home or car and worried every day about how they would be able to feed their families or take care of their children. They had been forced to deplete so much of their earnings and in many cases were unable to work. So for far too many, money will be an issue and no matter how good your results might be, they will not be able to afford to be in the program. And they deserve and need to be. So you must do your best to work with a non-profit in your community and also be committed to doing your share of fundraising.

The good news is that in many cases, insurance is reimbursing for fitness and nutrition programs and I know that 3rd party reimbursement for at-risk populations with chronic health issues is coming soon!

So thank you Cosmo for your comments and input. I know you are fighting the good fight.

And, Exercise is Medicine, and it is the strongest medicine we have today.

We ran a panel discussion earlier on Merging Healthcare and Fitness. The panelists included experts from the healthcare and fitness industries, including Mike Alpert, Dr. Robert Sallis, Karen Wonders, Mike Feitelberg, and Dr. Amy Bantham.

Watch a replay of that discussion to find out what our expert panelists have to say about the need for merging healthcare and fitness and how club operators and healthcare professionals can work together to support people with chronic diseases.