Making Fitness Essential

Fitness professionals don’t need evidence that we are essential to the healthcare ecosystem. To truly Inspire the World to Fitness^®—and secure our future success—it’s vital that we promote this viewpoint beyond our clients and industry partners and gain the attention and support of governments and public health professionals.

As an essential first step, 2022 IDEA^® World Convention featured the session “Becoming Essential: Next Steps to Align and Advance the Exercise Profession.” Its focus: How to learn from other allied healthcare providers, identify future opportunities for our industry and chart a path forward.

This article reflects a digest of the live panel discussion, which was recorded and transcribed. It highlights the questions, answers and insights that emerged during the 90-minute roundtable about fitness being essential. The quotes have been edited for brevity and clarity and, in some cases, answers from similar topics have been grouped together. For the full video recording, which includes many other compelling and often encouraging insights on what’s being done by these panelists and the organizations they work with and within, visit www.ideafit.com/webinar/becoming-essential-next-steps-to-align-and-advance-the-exercise-profession.

Introducing Our Panelists

Brian Biagioli, EdD, is graduate program director in applied physiology at the University of Miami. He is also executive director for the National Council on Strength and Fitness and chairman of the board for the International Confederation of Registers for Exercise Professionals. He has 20 years of research expertise in professional standard settings, where his work is represented across several national and international initiatives in the health, fitness and sport sectors.

Graham Melstrand is executive vice president of community health and wellness for the American Council on Exercise and an ACE-certified personal trainer. He serves as the president of the board for the Coalition for the Registration of Exercise Professionals, which operates the US Registry of Exercise Professionals™, and he is president of the board for Washington, D.C.–based Activity Alliance.

Francis Neric, MS, MBA, leads the development and administration of ACSM’s state-of-the-art certification programs. He serves on the boards of the Coalition for the Registration of Exercise Professionals, the Committee on Accreditation for the Exercise Sciences and the International Confederation of Sport and Exercise Science Practice. He also has presented on exam development, educational certificates and digital badging with the Institute for Credentialing Excellence.

Michael Stack, MPh, is founder and CEO of Frontline Fitness Pros and serves on the board for the Michigan Fitness Club Association. He is also a clinical professor for the University of Michigan’s School of Kinesiology and creator and host of The Wellness Paradox podcast (well nessparadoxpod.com/about). Michael is also the founder and CEO of Applied Fitness Solutions, a Michigan-based fitness company transitioning to a medical fitness center.

The Problem of Misperception

Graham Melstrand: Obviously, we’ve learned an awful lot through this experience that we’ve all been through globally with COVID. It’s created an opportunity for some conversations, not just among ourselves as individuals within the exercise profession and the fitness industry, but with public health, with government and with health care. And we’ve got some lessons that we’re looking to share with all of you today.

How do others perceive the fitness industry and what would they like to see from us instead?

Michael Stack: At the beginning of the pandemic, we were clearly in the health crisis of our lifetime and our industry, internally. We view [the industry] as being essential to health, but very, very quickly we saw from the government, both at the state and the local level with our closures and our extended closures, that clearly the policymakers did not view us as that. I think what a lot of the policymakers envisioned was the gyms of the 1980s—you know, think Arnold Schwarzenegger in “Venice Beach.” We had an individual who was a state senator who was also a member of an Orangetheory®. And he was instrumental in having some conversations to educate people. But it’s very clear that what we’ve evolved into as an industry—versus what people view us as—is still kind of stuck in the dingy gyms of the 1980s and not in the contemporary facilities of today.

In answer to your question: What people want to see, I think, are outcomes-driven programs by professionally educated practitioners that actually can drive a positive change on health and then also on the pocketbook of the healthcare economy.

Francis Neric: If you want to work in health care, you’ve got to look at it the same way as nursing. I think that includes three components: How do I prepare for the workforce? How do I get independently assessed, regardless of whose institution I go to? And then the registration part: Where can [the public go to find me]? Because if you want to be a professionalized industry, you have to hit all three of those marks.

Brian Biagioli: You have to have policies and procedures, and then you have to have objective criteria by which they’re evaluated that we can prove. A lot of you have gone through education programs, certification programs that do those things. If we do those things, we have consistency. And with that consistency, we’re going to have the real positive outcomes we’re looking for.

What do public health officials, government groups and others want to see from the professionals in our space?

Graham Melstrand: If you look at the demographics of our audience, they identified that we were a gathering place for larger groups of people who are primarily white, affluent and highly educated. [We’re] private clubs for people who like to pick up heavy things. [During the pandemic officials saw] that there were options available [to this audience,] other than going to a facility to consume those services.

[Officials would] like to see greater community engagement beyond the four walls of the facilities, greater diversity in the populations that we are serving, but also greater diversity in the practitioners. The practitioners and the facilities should resemble the communities where they’re located.

The [American Medical Association and Centers for Medicare and Medicaid Services want to know]: What are the programs and services that are being delivered? How are they scalable so that they’re cost-effective and accessible? You want these things to be broadly available because individuals who are on the wrong side of health equity are less likely to be physically active [and] to be able to engage with [people in our profession]. So the Physical Activity Alliance is working on the [health insurance] coverage determinations: What are the programs and services that would be covered? Which ones would be reimbursable? What are the qualifications of the individuals who would be identified as deliverers of those services on a continuum that’s, again, broad-based to be inclusive?

Brian Biagioli: Policymakers want to know who the stakeholder is because if [the stakeholder] doesn’t vote for them, they don’t care. So [when] you say, “Oh, my gym’s going to close,” [policymakers are] like, “Well, we’re really sorry about your personal economics, but you’re just one voter.” When we talk about having consideration for everybody who’s within a particular constituency, now, all of a sudden [the politicians] listen. Policymakers will invest in programs that are evidence-based and have efficacy. If [we] can’t show that those programs work, then they’re not going to invest in [them].

Francis Neric: One of the big things that’s really kind of missing right now is the quantified cost savings of exercise. I’ll give you an example of the quantified benefit. If I go to a cardiac rehab program and I get readmitted, the calculation is $37,000. And that’s just for cardiac rehab. That’s not looking at pulmonary rehab, exercise oncology, diabetes or obesity. You start piecing it together. The most effective way to [reduce associated costs is] through exercise. And I think that’s the next major step: [to show] the value. What are we bringing to the table?

Brian Biagioli: And everything has to tie back to a real role that’s recognized by our government [by the U.S. Bureau] of Labor Statistics. If you’re an integrated flexibility specialist at back flips, that doesn’t exist. We have to really define the specific roles of who can provide what services and what standard that they [must] meet.

See also: The Essential Role of Fitness and Physical Activity: Hope for the Future

Essential Fitness: The Education and Research Equation

What can we learn from other healthcare-adjacent professions about certification, consistency and clarifying what we are able to provide?

Francis Neric: If you think about nurses, all the registered nurses are trained the same way, but there are specializations underneath it, right? If I’m in nursing and I want to work in oncology, first I become an RN and then I specialize in oncology. This [structure] goes from LVN all the way through to nurse practitioner. There are stratifications, depending on the level of care they’re delivering.

It’s the same with exercise professionals—from somebody who’s working on the floor all the way to somebody who works in cardiac rehab. There’s a stratification or continuum of where those individuals are. We know this as an industry, but nobody else does. I think within our jobs now [we need to] consolidate what those things mean.

Graham Melstrand: If you think about the very early stages of cardiac rehab, that’s physician-supervised. A physician is physically present in the room when those services are delivered. And then if you’re active in athletics, whether it’s high school, college or professional, it’s physician-cleared. You have to pass your athletic physical to participate. And then you’ll have others that are physician-referred. And the last one, which is open to very broad portions of the population, is physician-recommended. What [we need] is those individuals who are [fitness-related] practitioners to have clarity around which audiences they can and should serve and still practice at the highest level of their credential.

Brian Biagioli: I’m part of a task force that had the opportunity to work with the World Health Organization. They brought us in under the sector of “sports,” and people were upset. Like “We don’t do sports—we could do so much more.” And I said, “But guess what? For the first time ever, the fitness industry was brought into the World Health Organization. And so now we have a voice.” Now we have nothing but opportunity to raise the bar to be recognized in the way other groups are recognized. We just have to find where we fit.

What do you see as the biggest research gaps or opportunities in the fitness industry?

Brian Biagioli: We have a responsibility, coming out of academic medicine, to aggregate data sets that will support ongoing programs that are aligned with health behaviors and related outcomes. We have to do a better job in those particular areas. We have to get better in our space about collecting data and then voicing the evidence to the policymakers.  >>

Francis Neric: There are reams and reams of data that say exercise is great. But how much [money] do we save [when people exercise regularly]? We have zero research that I’ve seen so far to date. So that’s the part where it’s like [we need to twist] the screws on more researchers [so we can] get people to buy into that.

[But the responsibility can’t all fall on one organization.] Just one research paper that comes out of Deloitte is about $500,000. So [research] has to come from the industry, not just from any particular organization. [That means] the American Heart Association, the fitness organizations, employers, etc., [getting together] to actually contribute to a single piece of research for the exercise industry [that shows] what we bring to the table.

Brian Biagioli: And then we would have the chief financial officers analyzing that data for the hospital systems to show where those points of either contention or opportunity are, like saving $37,000 per person by keeping them out of the hospital.

Michael Stack: From the grassroots level, we need to start being more diligent about the data we collect [in facilities and individually]. We are very good at collecting body composition data. But there’s all these other outcome metrics that we can be measuring: strength, qualitative scales of mental health and anxiety, quality of life. If we want to be considered part of health care, we have to be collecting that outcome data, but it can’t be monolithically focused on body composition.

Collecting data on how fitness is essential can be time-consuming. How can fitness facilities and professionals benefit from doing that, beyond using it to customize programming?

Francis Neric: [It’s] a wonderful marketing opportunity. If you can go, “Look, we’ve reduced their blood pressure, their anxiety’s down, look at all these things we’ve done,” and then give that [data] to your clients to give to their physicians, what a wonderful marketing opportunity [that is] for exercise professionals.

Michael Stack: We’ve done it at our own facility. You provide that fitness assessment on a nicely printed PDF letter, and you say, “Hey, take this to your doctor.” You only need one primary care physician who sees that and buys into what you’re doing to completely change your business. Because one primary care physician is going to have a thousand patients. You can become their trusted community resource just by doing something as simple as that.

Brian Biagioli: I was in a think tank a number of years ago, and one thoughtful PhD said, “Okay, but what’s our scope? How do we defend our territory?” I said, “It’s prevention.” Let the healthcare model do the pathologies, and we’ll do the prevention, because the savings is in reoccurrence. For example, take someone who’s got emotional distress and depression: [We know that] physical activity frequency reduces the recurrence of those depressive states. So, I think we get around the things that we already do and just reinforce those and that model of prevention and well care.

Michael Stack: And that’s how you build trust, right? You build trust by putting more value into the world than what you extract.

See also: Fit Pros and the Healthcare Continuum

The Power of Networking

How else can fitness professionals build trust and partnerships with physicians and others in the medical community?

Graham Melstrand: [When we fly in an airplane,] we assume that that pilot and that copilot are qualified to sit in that seat, and that the mechanics who checked the plane did their part—and even the techs who weigh the fuel. Consumers who are participating in [fitness] programs assume that somebody is doing that in this space as well. And when something [very rarely] does go wrong, that’s causing, on occasion, some terrible gaps in confidence and trust for our space. So we, as individuals, [need to] take responsibility for our own credentials, or if we’re in a position for hiring decisions, [we can choose to hire only people who have the necessary credentials.]

Francis Neric: I think [the next step is developing] a National Exercise Referral Framework like Ireland is working on. [In the 93-page PDF by Woods et al. 2016,] the very first part is just like, “Exercise is great.” Then there’s a schematic of “How do you get certain patients to the right [fitness professionals]?” and that’s the meat. If a patient is at the lowest risk, okay, you can work with anybody. At the highest level of risk—say, somebody who just had a heart attack and finished cardiac rehab—they would need to work with somebody with a higher level of competency.

Michael Stack: Also, physicians don’t like to refer someone to get a gym membership, right? That’s a very off-putting thought for many people. But they will refer to programs because they’re familiar with the concept of programs [for] physical therapy, cardiac rehab. Fitness professionals can provide an 8-week program for back health or a 12-week program for cardiometabolic benefits. [And when you sign up participants,] you can get baseline measurements, you can record measurements throughout, and you can actually have that outcome data [to promote your future programs].

Francis Neric: I think the last one is building a very strong network of professionals. I think a lot of the perception is: If I connect my clients to another professional, I’m going to lose them. But, actually, you build greater clientele that way [because they will also connect you to their clients]. So [connecting with a dietitian] is one, but then how do you get connected to a physical therapist or a family physician? Creating that very tight network, I think, is an opportunity to have those breakthroughs.

Michael Stack: I also think we need to do a better job building connections with the people who are in our facilities. I used to think, “I’m not into politics. It’s just too crazy.” And then I realized, “If I’m in business, I’m in politics.” Funny enough, I had members of our facility who were county commissioners and [other] people who were involved in politics. And you better believe I was calling them up when I was shut down, but there was no proactive relationship.

What else can we do with our consumership to improve our standing in the fitness community as essential?

Brian Biagioli: There’s a requisite level of professionalism. We have to get rid of the stigma, like when you watch reality TV shows and [someone is] dating their personal trainer. We can’t have that. No one’s going to take [our industry] seriously. So that’s where showing up, being professional, talking professionally and wearing the right hat at the right time can go a long way.

Michael Stack: I think it’s important for us to realize as professionals that we thought of ourselves as part of health care, but other people didn’t see it like that. And you kind of have to ask yourself “Why?” And I think it’s this paradigm shift to realize: If we want to be considered part of health care, we have to act like healthcare providers. We have to dress like healthcare providers. We have to talk like healthcare providers. We have to prepare like healthcare providers. It has to be a complete paradigm shift. You can’t say out of one side of your mouth [that] you want to be considered part of health care, but out of the other side of your mouth say you’re not willing to do the things that are commensurate with that level of professional skills. So I think there has to be that paradigm shift for all of us.

Francis Neric: I think one of the big things is just making [the information] tangible for people to understand. I think we make things so complicated, whether it’s the nutrition side or the fitness side—almost like the finance industry. Like if I make it as complicated as possible, you’re going to have to come to me so you can trust me—versus I’m going to say it in a very simple way so you understand, and I can build trust with you that way.

Michael Stack: There are the things that Graham and Francis and Brian [and their organizations] are working on, but they’re going to take a little bit of time to manifest themselves. Those aren’t an overnight solution, but there are things that we can be doing when we go back to our clubs that can actually make an impact.

There are things that you as fitness professionals who are on the front lines can be doing. Getting out beyond our four walls and reaching out into the community, hiring more diverse staffs, being more inclusive. (See below for more ideas.)

And I think that’s so important for you to remember: If you take one of the things away that we’re talking about today and actually start to make that change in your own environment, that’s how we can really spread this, not just from the top down, but from the bottom up. At some point we are going to meet in the middle.

See also: How To Create a Workout Community