A glimpse at what scientists, doctors, business innovators and exercise professionals are saying about our future.
The future of health care is becoming reality at a faster pace than any of us could have imagined. Over the next 30 years, accelerating advances in medicine and technology will allow the industry to radically recalibrate its focus toward health and wellness strategies. Fitness and wellness professionals will have front-row seats for this game-changing trend. With that in mind, IDEA Fitness Journal asked leaders in the fields of science, medicine, business and fitness to explain how the evolution of health care will affect our industry in the coming decades.
Changes in health care over the next 30 years will start at the genetic level with the emerging field of personalized medicine. This approach allows doctors to analyze an individual’s state of wellness and to focus on specific interventions that will make the person healthier, according to David A. Schwartz, MD, chair of the department of medicine at the University of Colorado. “What will probably happen is that when [people are] born, they will have their genome sequenced,” Schwartz says. When someone goes to the doctor, his or her genome will be matched against a database that can help the doctor provide precision-guided advice for preventing complications and changing how they eat and exercise.
The rapid move toward personalized medicine is driving a major shift in the way health care will be practiced in coming decades. “It is almost equivalent to the way they did medicine in Star Trek, but it is exactly the way we’re going to be doing medicine in the future,” Schwartz says. “I don’t see anything stopping it.”
He expects new devices for tracking our eating habits: “What we eat, how we eat and how often we eat. The physician and healthcare team—and I emphasize the team aspect of this—will be able to advise [patients] as to how they might consider changing their eating behavior or exercise behavior or other types of behaviors.”
As medicine gathers ever more data and develops ever-more-accurate predictive tools, the focus of health care will veer toward a wellness model and away from a disease model. These innovations will have profound effects on the opportunities available to fitness and health professionals and can most certainly be called game changers.
Professionals in the wellness and fitness fields will become more intricately woven into the process of keeping the country healthy, predicts Richard Cotton, MA, national director of certification and certified clinical exercise specialist for the American College of Sports Medicine. Cotton agrees that during the next 30 years, health care in the U.S. will shift more toward prevention and healthy lifestyle changes.
“We are at a real tipping point in our awareness of prevention and, specifically, physical activity in the prevention of disease” and improvement in quality of life, says Cotton, who salutes doctors and other healthcare professionals for integrating ACSM’s Exercise is Medicine™ principles into their work. Exercise is Medicine is designed to improve the well-being of the nation through a regular-physical-activity prescription from healthcare providers. The program, Cotton says, is “really a triangle of physicians, health and fitness professionals and healthcare consumers. The strategies involve the physicians asking their patients during each visit about their physical activity, the fitness professionals understanding the needs of their clients and using physical activity as a preventive measure and the consumers understanding the benefits of physical activity for their health.”
Cotton sees the growing integration of technology into health care as a way of spreading the Exercise is Medicine message to the public, especially to those who cannot afford to pay for services. “I think one of the weaknesses of our fitness industry is that we support those who can pay for services. ACSM is very conscious of health disparities for those who cannot hire a personal trainer or who don’t have access to a health club facility,” he says.
In the coming decades, Cotton says, the Internet will offer free services and information through organizations like ACSM to help people get started and stay with an exercise prescription. “ACSM is working on software for the physician’s office [that will give doctors] access to a database of certified fitness professionals. And I see fitness trainers integrating business strategies to include more people, to broaden their client base. We’ve certainly seen a change in small-group training already—two, three, up to five clients in a session—which substantially reduces the cost.” Additionally, he says, personal trainers are increasing the market for their services “by providing 10 visits over 6 months rather than over a 10-week period, for instance. This opens up a section of the marketplace that heretofore has never considered a personal trainer. Fitness clubs, too, are changing to support their membership by offering advice to clients on how to become more consistent in their physical activity,” he says.
The growth of wellness coaching is redefining the future of the fitness and wellness industry, and Cotton says coaching will eventually become integrated into personal training services. ACSM wants to help the fitness professional become more of a counselor or coach and less of a technician. “Coaching is about supporting the client to become independently empowered to support him- or herself. You’ve heard the phrase “location, location, location.” From my experience in coaching, it’s about “the client does the work, the client does the work, the client does the work.” We have to foster independence on the part of the patient or client, and we need to have a model where we’ll be able to provide a broad range of services in order to do that,” he says.
Another game changer, Cotton says, is a growing shift in cultural attitudes. “I think we are seeing a greater acceptance of integrating prevention activities, such as exercise, into one’s lifestyle. Our values are changing; it is the silver lining to the economic downturn. People are really thinking about what is important in their lives now and are making the connection between saving money, their quality of life and using exercise as a prescription for disease prevention.”
Helping people learn to be healthy will play a pivotal role in America’s changing healthcare landscape, says Scott Goudeseune, president and CEO of the American Council on Exercise. Goudeseune agrees that the opportunity to improve the wellness of Americans is at a critical turning point. He believes collaborations between organizations such as ACE, ACSM and IDEA are key to promoting the future of health and fitness in the U.S. “An organization like ACE can affect the lives of individuals who frequent health clubs and fitness facilities, but more importantly, we have the ability and the duty to affect the lives of those who may never go into these types of facilities,” he says.
Education, Goudeseune says, is a fundamental component. “People need to be educated about how they can change their habits and [need to] learn that they can make the choice to live a longer, healthier life.” Making that happen, he says, requires creating a spirit of inclusiveness and opportunity. “We need to offer people resources, such as free online programming like our ACE Get Fit™ initiative, and pair [consumers] with fitness professionals and community coaches to make physical activity and information accessible to as many people as we possibly can.”
The Internet can play a major role in that accessibility. “Organizations around the country are looking at ways to supply virtual training opportunities in a safe environment. The idea is to get people comfortable with movement so that perhaps over time they can be introduced to small-group training online, for example,” he says. The challenge, he believes, is how to keep the “personal in personal training when it becomes virtual.”
Goudeseune also says we need to concentrate on what’s best for our children and “really start spending the resources as a nation to begin educating children and give them the opportunity for change.” He suggests bringing physical education back into schools and educating parents and teachers by providing free resources, such as ACE’s Operation FitKids® curriculum. The fitness and wellness industries must continue to recognize this area as an important concern, he says, and collaboratively “drop their defenses, drop the competition labels and work together. The problem is bigger than any one organization can handle.” Organizations like the National Coalition for Promoting Physical Activity (NCPPA), which includes ACE, ACSM, the American Cancer Society®, IDEA and the President’s Council on Fitness, Sports and Nutrition, “are collaboratively working on trying to understand and solve specific challenges and act as preeminent forces to promote physical activity and fitness initiatives in this country,” Goudeseune says.
The coming changes will help medical professionals focus on what really matters. “I think for the first time, health care may actually focus on health,” says Mimi Guarneri, MD, founder and medical director of the Scripps Center for Integrative Medicine in San Diego, and recipient of the 2011 Inner IDEA® Inspiration Award. The dawning age of personalized medicine focusing on prevention and early detection is changing the medical paradigm, she observes.
Our “disease-driven system has resulted in a $310 billion pharmaceutical industry,” says Guarneri. “We are spending 17% of our gross domestic product on treating seven chronic diseases [heart disease, diabetes, asthma, some cancers, hypertension, stroke, and obesity] that can be shifted by lifestyle change.” The government, the payers, the insurance companies and hospitals are finally talking about how to keep people well. Until recently, the financial incentives have been in disease care.
“What’s going to happen in hospitals, for example, is that they are going to partner with Medicare and insurance companies in a different way. The focus will be on reducing costs by keeping people healthy,” she explains.
“Hospitals make money by keeping their beds full, doctors make money by doing things to people, and pharmaceutical companies make money by selling people drugs. That same model, which can best be described as ‘ill to the pill,’ is a disaster for chronic-disease management and does nothing for prevention,” says Guarneri, who received the 2012 Linus Pauling Functional Medicine Lifetime Achievement Award. She says the goal in the future will be to keep people healthy and keep them out of hospitals.
“This business about healthcare reform is all lip service right now. As far as I’m concerned, we’re rearranging the deck chairs on the Titanic. We need to do something radical if we’re going to turn this system around,” she emphasizes.
This is where the fitness and wellness industry becomes an important partner and a potent force in improving the nation’s health in the next three decades. “Health is about getting to the underlying cause of problems. It is about looking at what we eat, how physically active we are, do we sleep well at night, do we quit smoking, what kind of toxins are we exposed to and how resilient are we when we’re dealt a curve ball that leads to stress or depression. This is where the fitness and wellness industry has a very unique opportunity,” Guarneri says.
Fitness pros offer many things that health care is missing, but needs. “Fitness and physical activity will become more embedded in the healthcare system because programs will focus on keeping people well. If you have congestive heart failure, for example, you should walk every day and eat less than 1,500 milligrams of sodium [per day]. If you’re stressed, you should learn to meditate and do breathing exercises and yoga and tai chi classes.” These are evidence-based ways to decrease hospital stays, she says.
The demand for more-highly-trained fitness professionals will usher in a new model for the industry, she says. “We’re moving into an era where many fitness professionals will become health coaches and physician extenders, so studying disciplines such as behavioral medicine will become important,” says Guarneri. Accountable healthcare organizations like Medicare will begin to recognize that it saves money to keep people out of hospitals. “What is it going to take to keep somebody out of the hospital? It’s going to take a trained health coach. It’s going to take somebody calling them, interfacing with them on the Internet, asking, ‘What did you eat today? Did you walk? How much do you weigh?’ The physician will set goals with their patients, and the health coach will give the necessary support. The new model is going to be a multidisciplinary approach. I really see this as a great opportunity for those people in the IDEA community,” she says.
New companies are already at work on innovative, sustainable solutions to improve healthcare quality and reduce costs in the U.S. in the coming decades. One example is Whole Life Health. This company is the result of a merger between Guarneri’s integrative medical resources company with Habit Change, based in Pennsylvania, whose founder and CEO is Steve Baumgartner.
There is a business in breaking bad habits. Baumgartner and Whole Life Health are aiming to turn it into an industry. “Only 15% of us are able to shift behaviors on our own,” Baumgartner says. “I partnered with doctors and psychologists and researched how to move that 15% to 40% or even 60%.”
Habits “are so well established that we are barely aware of them,” says Baumgartner, who notes that even when we know our vitality depends on our ability to change how we eat, exercise, sleep, learn, relax and relate to others, we often find it impossible to shed our engrained habits. That’s where the Whole Life Health approach comes in, helping people replace unhealthy behaviors with life-promoting habits.
Baumgartner and his colleagues spent years creating a mind-body-spirit process to teach habit change. This process targets eight areas: resilience, nutrition, exercise, sleep, learning, friendship, simplicity and spirituality. When people begin to feel good, that becomes a major motivator, Baumgartner says. “As people get hopeful, they recover their will, they begin to work hard, and then they see physiologic shifts such as lower blood pressure and increased flexibility, which are a proven inspiration for ongoing habit change.” The company offers a step-by-step process that includes assessment tools, weekly educational meetings, a personalized life plan and ongoing communication with a life coach.
“We provide a ‘whole-life diagnosis,’ which is a way to really change a medical diagnosis and make it about the entire person—spiritual, physical, emotional, everything. Then we give people tremendous personal and technological support for change.” Tech support includes mobile applications for phones and tablets, online support and specialized programs that are now in multiple stages of development.
The programs will lean heavily on professional health coaches to help people change their ways. “Health coaching is a burgeoning phenomenon and is a big catalyst for everything we do,” Baumgartner says. “Within a decade, the trained coach will be regarded as a highly trained and valuable health professional.” The business will rely on people with specific skills like fitness and nutrition in the regions where the company operates, Baumgartner says.
Wellness pros will play a growing role in helping people cope with major medical challenges like managing chronic illness and chronic pain, according to Tomer Anbar, founder and former director of the Chronic Pain Rehabilitation Program at Scripps Mercy Hospital in San Diego, director of the Chronic Pain Associates R&D program and director of the Global Pain Institute.
“The future is really based on how we take the knowledge and wisdom base we have and make it accessible to people who need it and to patients at the appropriate time,” Anbar says. “After all, this is the cornerstone of good medicine and good health care.”
The need for new approaches to treating chronic diseases and managing chronic pain is becoming more urgent. According to the Institute of Medicine, chronic illness represents 75% of healthcare spending in the U.S. annually and “is steadily moving toward crisis proportions, yet maintaining or enhancing quality of life for individuals living with these illnesses has not been given the attention it deserves” (IOM 2012).
Typically, Anbar says, doctors treat chronic pain with a “biomedical approach,” using interventions such as drugs, surgery and physical therapy. While this might work fine for acute pain, it may not be the best course for chronic pain. “Those interventions very often exacerbate the condition,” contributing to an increase in chronic-pain syndrome, disability and overall cost of care, says Anbar.
Chronic-pain sufferers tend to experience sleep problems, depression, anxiety, and raised blood pressure and cholesterol levels, all of which cause their health to deteriorate. And unless these issues are effectively managed, people are likely to get progressively worse. “Ideally, the more you’re able to engage an individual in [his or her own] healing process, the more effective treatment will be. We want to empower people with the knowledge and understanding of how to get better. Historically, we haven’t been doing that,” Anbar says.
Technology will be integral to turning that around, Anbar says. “With the technology we have today, we are creating an interactive environment, an online system, in which a patient can manage and improve his health. This can be done through a website or a mobile device.” Anbar’s organization already operates a technological platform that can provide care through a computer, tablet or smartphone 24/7. This new technology will also offer a platform where fitness instructors, for example, can get trained and credentialed to begin to act as physician extenders and participate in the rehabilitation and long-term management of chronic conditions.
Anbar’s family background is in integrative and alternative medicine. His father, Dr. Abraham Isaac Anbar, founded and operated the Anbar Institute, Canada’s largest private healthcare organization, which focused on the connection between lifestyle and health. As a young person, Tomer Anbar met and worked with visionaries like Joseph Pilates and Moshe Feldenkrais, who taught him that proper exercise and nutrition are essential to good health and healing. The experience helped to shape his perspective on the future of health and wellness.
Anbar says an important component in treating chronic pain is human touch and human interaction. “Fit pros can be a major catalyst for change because they are already on the front lines. What you can receive from a good health and fitness instructor is lifesaving.” The idea, he says, is to create more of an interdisciplinary environment where everybody in health care is working together. “You will have fitness trainers and nutritionists working with physicians so that everybody is speaking an evidence-based language with an understanding that by doing the right thing, [they can reverse most chronic conditions],” he says.
Diana McNab believes in the transformative power of nature. All her forms of fitness now take place outside, says McNab, former member of the Canadian National Ski Team and a sports psychologist for the 2012 U.S. Paralympic Team this past summer in London. “I hike, bike, walk, ride my horse, ski, garden and do yoga outside. I believe we regenerate by being outside. We’re lonely on our computers and in our office cubicles; we need eye contact and conversation, and we need to learn the art of play.”
At her Epic Sports Experience camps in Aspen, Colorado, McNab counsels people on how to “optimize their potential” and bring a sense of balance to all aspects of their lives. McNab believes the key to making that happen is to move out of indoor environments and begin, where possible, to exercise, think and play more in the outdoors.
The majority of her work and her vision for the future revolve around educating, motivating and communicating peak performance skills and strategies to Olympians, professional athletes, spouses of elite athletes and especially young athletes and their parents, using an experiential approach that anyone can use. An adjunct professor at the University of Denver, McNab encourages her workshop participants “to move their bodies and put down their smartphones.” She says spirituality is also a part of becoming a whole, fit person. “It is learning how to do a gratitude prayer, connecting with people and nature and being thankful for what you have. It is about being humble and learning how to listen.” She begins her 5-day seminars with an introduction to meditation and mindfulness. “True fitness has to do with the mind and how it controls the body,” she believes.
During the summer, she offers mind-body sports camps for young people ages 9–12 and 13–18 and works with them to instill self-confidence, self-esteem and the art of balancing school, sports, friends and family life. McNab says childhood obesity is fast becoming an epidemic because “we’re out of touch with ourselves, our bodies. Our kids just aren’t moving enough today. I teach young people to love their bodies whether or not they are 20 pounds overweight. During our camp experience, we pack a healthy lunch, go hiking for 3 hours in the mountains and along the way collect rocks and stop and meditate.” She says when the young participants get out of breath, the group stops and does a target heart rate and an elevation check. “They are outdoors having fun and learning about their bodies. Self-confidence comes from acquiring skills and accomplishing things,” she says.
An emerging field in modern science that will have an impact on the health of future generations is the study of epigenetics. “A simple definition of epigenetics is how our environment impacts our genetics,” says Brian O’Connor, PhD, immunologist and epigenetic scientist at National Jewish Health® in Denver. “We have inherited genes from our parents—our genetic makeup—but that is only part of the picture,” he says. “The environment has an enormous impact on who we are and our susceptibility to disease.”
O’Connor explains that everybody’s particular environment and the choices they make—diet, exercise and exposure to sunlight and stress—feed back into their state of health. “It is an intricate dance between the genes and our environment that really, in the end, determines who we are at the genetic level.”
The potential of epigenetics, O’Connor says, “is really to say that we are going to be able to tell you that if you eat a certain way or do a certain amount of exercise or live next to a factory that pollutes the air, your epigenetic profile will tell you how these things will impact your life and your health. I think the more striking thing is that we now understand that environmental factors not only affect you but also affect your children and your grandchildren.”
O’Connor says that current research already shows that if you smoke, especially if you are a regular smoker, the chances of getting lung cancer or lung disease “shoots up radically.” The example, he says, “is that if the grandparents smoked and the parents never smoked and the grandchild never smoked, that grandchild still has a higher susceptibility for lung disease than a grandchild whose grandparent never smoked. So then you extrapolate and ask, ‘If you’re growing up in a family where for two or three generations fast food has been a regular staple of your diet, maybe [with] no exercise and maybe a sedentary lifestyle, are you already predisposed to becoming obese before you are born?’” He says research has not given a definitive answer to questions like these, but “we are beginning to ask those questions” and search for answers.
O’Connor says U.S. healthcare problems can be attributed to practicing a “form of medicine where we are reacting to and treating symptoms. We wait for somebody to get sick and then respond with treatment. But that’s not getting to the underlying mechanisms, the preventive mechanisms.”
The future promise of analyzing people’s genetic and epigenetic profiles using a personalized-medicine approach is that we can move beyond this reactive phase and identify the underlying cause of disease before people become chronically ill. More important, we will have the potential to influence the outcome not only with medical interventions but also with targeted behavioral changes, such as following a proper diet, practicing mindfulness and getting sufficient exercise. This personalized approach gives people unparalleled opportunities to take control of their own health and wellness.