The Essential Role of Fitness and Physical Activity: Hope for the Future
From a world of disruption, fitness professionals can emerge as leaders in the next evolution of health and well-being.
If there’s one characteristic fitness professionals can claim, it’s the ability to observe and quickly take action based on new information. A client has a limp? Modify. Participants not following the choreography? Simplify. A new gym opens down the street? Upgrade. Pandemic? Reinvent.
During most of 2020, the need to stay at home and close businesses to control the spread of the COVID-19 virus resulted in an unexpected gift: time to sit still and think. It may not have felt like a gift at the time, as fitness was deemed “nonessential,” with ensuing business closures and job losses. However, creative fitness professionals soon began considering next steps. And where did their thoughts go? Likely to that word essential, which suddenly appeared in every news report. The definition of essential includes phrases such as “absolutely necessary” or “extremely important,” which raises the question: How essential is fitness?
The Fitness Imperative
Over the past century and more, an avalanche of research has buried any doubt about the value of physical activity and exercise for promoting physical function, mental health and overall well-being (Kandola et al. 2020; Nieman & Wentz 2019; HHS 2018a). Physical activity is so important that the World Health Organization, the governments of many countries and a host of organizations have issued guidelines recommending it (WHO 2020a; HHS 2018b; HHS & USDA 2015; CSEP 2020).
In particular, regular physical activity is one of five lifestyle factors—along with healthy eating, normal body weight, no history of smoking and low-risk (moderate) alcohol intake—that contribute to longer life expectancy and prevent or manage chronic conditions like diabetes, obesity and heart problems (Li et al. 2018; Loef & Walach 2012). The importance of exercise for physical and mental health has been so well documented that some medical practitioners use physical activity as a vital sign (Sallis et al. 2016; Bowen et al. 2018).
Given the evidence, it’s clear that physical activity and exercise are, indeed, essential to overall health, functional ability and well-being.
Essential Fitness in the COVID-19 World
The value of physical activity did not disappear because of the pandemic. In fact, staying active may be more important now than ever (Nuvance Health 2020). As Sallis and Pratt (2020) reminded us, exercise improves immune system functioning and reduces inflammation. Physical activity won’t prevent anyone from catching the virus but could reduce its severity.
In addition to improving sleep and helping to maintain functional abilities, exercise (both cardio and strength training) offsets depression and anxiety, each of which the pandemic has engendered or elevated in some people (Michigan Medicine 2020). Along with healthy eating and good sleep, physical activity can relieve virus-related stress (Stevens 2020; CDC 2020a). Unfortunately, many people reduced their physical activity or stopped altogether as COVID-19 spread (Constandt et al. 2020).
Before the coronavirus, noncommunicable diseases (NCDs)—such as diabetes, obesity, cardiovascular illness, arthritis, cancer and asthma—dominated public health agendas. Globally, about 41 million people die from NCDs annually (WHO 2018). The recent edition of the Global Burden of Disease surveillance study found that the increase in chronic NCD conditions could be attributed to rising rates of obesity, hypertension, high cholesterol and blood sugar, and more tobacco use (The Lancet 2020). Unfortunately, people who live with chronic illness may also face an increased risk of more serious illness or death if they contract COVID-19 (The Lancet 2020; CDC 2020b).
It’s likely that many fitness professionals, whether group leaders, personal trainers or coaches, work with people who have one or more chronic health conditions. Since medical systems in most countries have directed their resources overwhelmingly to people with COVID-19, medical management of chronic illnesses has declined or halted. The effects on people with NCDs may include less physical activity, more social isolation and an increase in unhealthy eating (Chang et al. 2020; Palmer et al. 2020; WHO 2020b).
Physicians see the problem. For example, 86% of U.S. physicians said chronic conditions that worsened when people delayed care during the pandemic will be the biggest strain on the health industry in 2021 (The Physicians Foundation 2020; Heath 2020). Physical activity, nutrition and healthier lifestyle choices continue to be key in both preventing and managing chronic conditions and may aid people recovering from the coronavirus. Can fitness professionals help fill the gap?
Fitness and Health Care: Finding Common Ground
Simplified, the medical model is based on treating illness and disease, while the wellness model is based on promoting health and well-being through lifestyle choices. In reality, people generally follow both models, visiting a doctor as needed or eating more vegetables. Exercise is a component of both approaches.
The value of physical activity as prevention and treatment is so well established that some integrated healthcare teams include evidence-based exercise in treatment programs (e.g., for cardiac and pulmonary rehabilitation). Under the direction of a medical professional or therapist, exercise leaders plan and supervise training programs that patients need for recovery. The demand for such services is expected to increase, since people who recover from COVID-19 do not always regain all their functional abilities (not to mention that heart and lung problems were common prior to the pandemic).
“I firmly believe that exercise professionals and health coaches should be part of the healthcare team,” says Cedric Bryant, PhD, president and chief science officer at the American Council on Exercise. “It’s time for health care to really test investment in physical activity interventions that are referred by healthcare providers in the clinical setting but delivered directly where people live, learn, work, play and pray. It is my hope that health care will embrace the idea that there is a role in primary and preventive care for nontraditional interventionists (medical exercise specialists, personal trainers, health coaches and group fitness instructors) who are appropriately qualified, trusted and credentialed to work alongside traditional care providers and enable the system to help more people sooner and at a lower cost.”
Under the banner of medical fitness or medically integrated fitness, patients and the general public access exercise, nutrition counseling, health education and stress management, along with other healthy lifestyle options. Somewhat integrated with the medical model, these programs are successful, in part, because of the quality of the fitness staff.
Authors in a recent Club Industry report on the integration of fitness and health care are optimistic that medical fitness is a viable and valuable business. Among their recommendations is partnering with physicians who are already positive about lifestyle and wellness, such as integrative health practitioners or lifestyle medical professionals. These clinicians tend to look at the whole person and include multiple dimensions of wellness in their care plans (Club Industry 2020).
An example of this partnering is the wellness program offered by Aegis Therapies as a companion to therapy services. “In my opinion, speaking as a physical therapist, fitness/wellness and medical rehabilitation can fit hand in hand,” says Brian Boekhout, PT, vice president of wellness services at Aegis Therapies/EnerG by Aegis. “The services that are provided within therapy, for example, can tie into fitness and wellness as an adjunct to, or a follow-up from, skilled rehabilitation services. When we discharge individuals from a medical therapy plan, follow-up and maintenance are often a challenge for our patients. Having other professionals who can support and intervene to ensure continued success will only help the individuals we care for.”
The Behavior Change Hook
While personal trainers design exercise programs and encourage clients to eat healthy foods and sit less, health and wellness coaches focus specifically on behavior change. Trained in motivational strategies, behavior change theory and communication techniques, coaches lead clients to improve their health in the context of daily life. Both coaches and trainers are essential, but for different reasons, believes Leigh-Ann Webster, NBC-HWC, CPT, executive director of the National Board for Health & Wellness Coaching.
“It’s so important that people have trained and qualified professionals they can turn to during this unpredictable time,” says Webster. “We need health and wellness coaches more than ever because it’s important for people to be in tune with their minds and bodies and to develop good coping skills for dealing with all of the unexpected stress we are experiencing.
“I definitely feel that fitness and wellness professionals have a role in health care. After a physician diagnoses the issue, the health and wellness coach and/or fitness professional can help serve as a catalyst for change . . . , which would lead to improved health.”
Considered an allied health professional, a board-certified health and wellness coach may work as a member of an integrated healthcare team. The profession was recently awarded three distinct Category III CPT Codes for Health and Well-being Coaching by the American Medical Association. While payers can opt to reimburse for these codes, they typically wait until codes have Category 1 approval; however, having a code at all is an important point of progress (see “Preventive Health Services,” below, for more points of progress).
Sorting Through Essential Fitness Qualifications
What “qualifies” a fitness professional to work alongside healthcare providers?
It’s no secret that there are hundreds of certifications and numerous degrees—2-year, 4-year and advanced—attached to the words exercise, fitness, mind-body and other terms. It’s confusing for a new person entering the field, so imagine how perplexing it is for those in the medical and allied health professions.
Following a literature review, De Lyon, Neville & Armour (2017) pointed out that although the need for physical activity as a foundation of health has been widely publicized, too few people do it, resulting in high rates of obesity and disability. While acknowledging that fitness professionals could be an important link in encouraging physical activity, the authors report that education and training of fitness professionals varies, so their practices and capabilities are not adequately defined. The reviewers urge further research and development of a theoretical framework that could match the knowledge of fitness professionals to working within healthcare fields.
That assessment was reinforced by a survey of 412 primary care and sports medicine physicians. Many had a positive view of health clubs and personal trainers, but fewer recommended either clubs or trainers, due to cost or inconvenience (Pojednic et al. 2018). Additional barriers included physicians’ lack of confidence in prescribing exercise and doctors having only seconds of time to discuss diet and exercise (Jattan & Kvern 2018). A lack of standard guidelines and operating procedures can also be a barrier to referrals (Smock & Alemagno 2017).
Due to her work in both the clinical and fitness environments, Jessica Matthews, DBH, MS, NBC-HWC, director of the Master of Kinesiology in Integrative Wellness program at Point Loma Nazarene University, believes most physicians do understand the role of physical activity in health care. “What really is the challenge is that the qualifications of exercise professionals are not well aligned with those of other allied health professions.”
Bryant agrees. “Among the most important things that exercise professionals and health coaches can do to be recognized and trusted as valuable team members by medical professionals is to demonstrate levels of competency and credibility that are similar to other healthcare professions.”
The qualifications of allied health professions are familiar to doctors and others in the healthcare fields, since these are a combination of formal education and certification or licensure. There are many types of allied health professionals, ranging from physical and occupational therapists to diabetes educators and dental hygienists. Exercise physiologists and athletic trainers may be included in allied health.
To clarify the confusion and approach standardization, several models have sought to organize fitness-related degrees and certifications according to the population groups with whom the fitness professional should be qualified to work.
Such a model was published in the journal of the College of Family Physicians of Canada (Warburton et al. 2013). Noting that the risks of inactivity were greater than the risk of well-designed, supervised exercise, the authors outlined core competencies and education for qualified exercise professionals who wish to work with moderate- to higher-risk conditions.
Another model has been available through the American College of Sports Medicine’s Exercise is Medicine® Credential, which qualifies exercise professionals and allied health professionals based on client/patient illness or rehabilitation needs. Within this framework, exercise professionals can earn two levels of credential. One lets them work with generally healthy people, while the other allows them to serve those with a health condition who have been cleared for exercise by a physician. A third level signifies the ability to work with people who need clinical support and monitoring (ACSM n.d.).
The Coalition for the Registration of Exercise Professionals (CREP) listings include exercise professionals with certifications accredited by the National Commission for Certifying Agencies (NCCA) or by American National Standards Association ISO 17024. Designed as a place to verify certification status, the registry does not state which populations the listed professionals are qualified to teach (USREP n.d.).
Matthews suggests that to bridge the gap between health care and fitness, it would be helpful to create a system that identifies fitness professionals who truly understand how physical activity is utilized in a healthcare setting. This might require a unifying standard, like the board certification established for health and wellness coaches, which brought many organizations together to set the standard (Wolever 2016).
Certification agencies have individually labeled their certifications as basic/foundational, advanced or specialized. Some have gone to a nonfitness group like the NCCA to establish the value of their certificates. Overall, the sense is that industry leaders prefer to regulate themselves than be regulated by a government or outside authority.
Essential Is as Essential Does
Since physical activity is essential, are fitness professionals also essential?
Balancing public health with economics is a complicated equation. The classification of businesses as “essential” flows from a country’s administration, through regions and down to officials at local levels. One consequence is that rules and procedures vary considerably.
Some states follow a definition from a federal security agency (CISA 2020; Torpey 2020), while others set their own standards. As a government decision, classification applies to an entire group, since making exceptions would be difficult. It’s more realistic to rule all indoor dining must close, rather than open Restaurant X, which has excellent protocols and ventilation, and close Restaurant Y, which does not.
There is no checklist that health club owners and workers can tick to say they are essential, says Helen Durkin, JD, executive vice president of public policy for the International Health, Racquet & Sportsclub Association. Another approach is to replace essential with a different word. “We [at IHRSA] have been talking about exercise as vital,” says Durkin. “What does the industry need to do so people understand physical activity/exercise is so vital that clubs have to be open so people can exercise? [That is] a little bit of a different argument.”
By the time this article is printed, fitness businesses may or may not be open for indoor services and may or may not be using the word essential to determine this. More to the point, do fit pros feel their work is vital and essential? As a fitness instructor or personal trainer, you bring a lot to the table:
- You help others benefit from fitness and gain knowledge to make appropriate recommendations.
- You motivate clients/groups to add physical activity to their daily routines (e.g., rake leaves instead of using a blower) and plan progressive exercise regimens.
- You’re skilled at customer service, listening, problem-solving and communicating.
- You’re experienced at using a variety of equipment and technologies, from the screen on a treadmill, to the activity tracker attached to a wrist, to attendance systems and accounting software (O*Net 2020).
- The work you do with individuals, partners and groups provides the social interaction that is so necessary to health.
There is personal reward when a participant improves balance or excitedly relates a new ability to walk a mile. You see how your guidance helps participants lose weight and gain strength, endurance, agility and probably a new dose of self-confidence. If you believe these outcomes are important and necessary—and you consider all that you offer—then your work is essential. It’s time to reinvent how you give people hope about their health.
A Closed Door Creaks Open
While that word essential may seem like an obstacle, it’s best to look beyond a single word. Fortunately, fitness people have demonstrated resilience and adaptability during previous disruptions. In the short term, the pandemic has caused a lot of pain in the fitness community. But the long-term outlook could be brighter. As Durkin observes, “The recognition of the role physical activity plays in medicine is growing, the industry is really coming together and talking to each other, and the highest world authority on health [WHO] says promoting physical activity remains an important goal. I think longer term, it feels like fitness professionals will achieve better recognition once we’re through the immediate crisis.”
In the past, fitness has largely been based inside buildings. Matthews suggests that adapting to the peri-pandemic world requires looking to new business models outside of buildings. “Let’s put our collective brain power together in this time of constraints and ask: How do we evolve our services and processes? If we all come together, we could reimagine how and where to offer fitness in our communities.”
Doors closed during the pandemic. Some will stay closed, but others are opening. Your passion to lead others to better physical and mental health remains. Today more than ever, people need your direction and motivation.
Author’s note: This article was written in late 2020. The issues surrounding the COVID-19 pandemic are evolving and changing, as is the label “essential” in reference to businesses and workforces. Nonetheless, opportunities to integrate fitness with health care, to train virtually, and to reinvent the location and structure of fitness and wellness sessions will continue.
Fitness Industry Trends in A Covid-19 World
Even if/when the pandemic is controlled, its aftermath will continue, and the disruption will have repositioned the fitness industry. Expect to see the following trends, some already in motion before the pandemic:
The number of fitness facilities will decline. By the end of 2020, a significant number of indoor-only gyms and studios had closed permanently because of stay-at-home orders. In the fall, the International Health, Racquet & Sportsclub Association projected that 25% of clubs would close by year’s end (IHRSA 2020a). Once the remaining facilities reopen, consumers may not return, or at least not in the numbers they did pre-pandemic (Gough 2020; King 2020; Club Industry 2020).
Fitness centers that do remain will have repositioned themselves, embracing a physical and financial model that anticipates fewer participants, delivers more health-oriented services, and forges partnerships to provide medical fitness and corporate fitness (Club Industry 2020).
Facing less competition, these centers will stand out as safe places for physical activity, education and camaraderie.
Virtual/online exercise options will keep growing. Technology and fitness have successfully integrated, with sessions and classes streaming across screens. In 2019, the global online/virtual fitness market was about $6 million, according to Allied Market Research, and the value is expected to jump to about $60 million by 2027 (Rake & Gaikwad 2020).
Remote delivery of services will likely be a cornerstone, since rapid deployment of technology for virtual meetups, exercise and doctor visits will remain in demand. Training sessions over Zoom, home videos from a club’s or studio’s instructors, subscriptions to commercial video exercise sessions, and YouTube channels will provide opportunities to find work or build a brand.
The exercise equipment that’s been filling homes will provide new opportunities for fitness pros. In 2020, consumers bought exercise equipment at a rapid pace. Free weights, cardio and strength machines, and mirrors furnished living rooms and garages. Consumers embraced instructor-led and equipment-mounted digital experiences. In the first month of stay-at home orders, sales of free weights increased by 181%, exercise bikes by 170% and yoga mats by 146% compared with the year before (The NPD Group 2020). On eBay, sales of dumbbells jumped nearly 2,000% in March and April 2020 compared with the same period in 2019 (Germain 2020).
Fitness professionals who train remotely or outdoors can take advantage of clients’ capacity to progress their programs using these tools. Plus, teaching people how to use home equipment has potential.
The outdoors is in—and will likely stay in. Experts recommend going outdoors for exercise because time in nature has value in itself (Calogiuri & Chroni 2014; Gladwell et al. 2013; Graham 2017). During a pandemic, outdoor exercise is considered safer than indoor exercise. With more experience in the outdoors, exercisers will probably want to stay there when weather permits, implying that outdoor fitness clubs, boot camps, walks and rides in a variety of locations will gain traction.
Workplaces will change, but fitness will remain. Fitness professionals are employed at a number of the companies functioning during and after the pandemic. Virtual fitness companies, therapy providers, fitness equipment companies and active-adult communities are examples of places that are hiring, according to listings on Indeed.com and Monster.com. Office buildings are likely to remain half-full as companies embrace a hybrid workforce of in-person and remote employees. This creates a whole new category for creative fitness pros.
Preventive Health Services
Like the cough and wheeze of a motor starting on a cold and wintry night, healthcare systems and insurers are slowly shifting to prioritize preventive health services. The research evidence is indisputable, but prevention is a long-term business, and the medical model still relies on treatment for illness. This is particularly the case in the United States, where physical activity/exercise is usually not reimbursed through insurance (but medical treatment is). Many people are not willing to pay for fitness.
Change can happen. For the U.S. Healthy People Objectives 2030, leading health indicators will focus on “upstream” risk factors and behaviors (like physical inactivity and unhealthy diet) instead of disease outcomes, among other criteria (HHS n.d.). The objectives cull data from many sources, and data is what grabs the attention of policymakers and insurers.
This growing awareness among policymakers and health insurers that physical activity/exercise is an essential part of health promotion may imply a larger role for fitness professionals who gain the education and experience needed to work close to or within health care.
The Fitness Industry Fights to Reopen
Although physical activity is essential for health and well-being, the places where it happens had to close when the virus hit. Industry associations immediately leapt into action to explain that indoor fitness facilities following recommended protocols for enhanced cleaning, physical distancing, masks and improved ventilation were safe places for people to maintain their fitness—needed for mental as well as physical health during a pandemic.
The International Health, Racquet & Sportsclub Association, representing health club and studio owners, solicited support for a federal health club relief bill, petitioning legislators, commissioning research, and explaining how clubs and studios could safely admit clients (IHRSA 2020a; IHRSA 2020b). Fitness alliances across the states, as well as independent owners, likewise petitioned officials to allow them to open.
Released in October 2020, an IHRSA survey of 1,171 current health club members and those who had recently canceled memberships because of COVID-19 found that more than half of respondents (57%) said they were less physically active when their club/studio was closed and 59% missed their fitness center “a lot.” Among those who returned to gyms once they reopened, 88% felt confident in the safety precautions and standards of cleanliness (Rodriguez 2020).
Social Isolation: A Parallel Pandemic?
A risk factor for poor health that emerged during the pandemic is social isolation, meaning few or infrequent social contacts. Research has shown that social isolation is associated with poorer overall health and well-being, poorer cognitive function, and greater risk of type 2 diabetes and alcoholism. Isolation has been connected to increases in body mass index and blood pressure (Holt-Lunstad 2020; Novotney 2019).
Not surprisingly, engaging in physical activity and improving sleep quality can help counteract these negative impacts. That’s where fitness professionals can make a difference, using their communication and motivation skills to connect with people, whether online or in person.
Brian Boekhout, PT, vice president of wellness services at Aegis Therapies/EnerG by Aegis, believes fitness and wellness professionals can have a major impact. “I see two additional pandemics emerging out of the isolation and quarantine from COVID-19. These are the pandemics of deconditioning and depression/social isolation. Nonclinical wellness can have a profound influence in these areas to minimize the negative impact of this public health emergency.”
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