According to the June 26, 2005 edition of the Sun Sentinel in Florida, "The fitness industry is one of the fastest-growing fields in the country! The desire to stay fit and healthy is greater than ever, so it’s not surprising that the need for qualified professionals to assist others with their fitness goals is rapidly growing.” While I agree with this statement, the irony is that we cannot currently keep up with the demand for experienced fitness professionals. Just ask the majority of club owners and fitness directors out there with understaffed fitness programs!
If you are reading this article, you are doing so because you have made a conscious decision to enhance your professionalism and your technical skill sets so you can expand your ability to increase your income potential. In other words, you want to make money!
Before you read any further, please answer the 10 questions in the EFGI High Risk Client Questionnaire at the bottom of this article. If you score better than 80% on this questionnaire, you have probably already incorporated Medical Exercise Services (MES) into your service offerings, and you don’t need to read any further. However, if you scored less than 80%, please keep reading.
As of July 2005, MES is still an untapped revenue source that has not only been ignored by fitness professionals but also by clubs as well. While personal training is still ranked as the most profitable of all of our club programs, MES offers a potential “high-quality fit” to our programming mix (see "What Conditions are Included in MES Programs" below).
What Conditions are Included in MES Programs
- Immunological/Hematological Disorders
- Cancer, Arthritis, AIDS, Lupus, Chronic Fatigue Syndrome
- Neurological Disorders
- Fibromyalgia, Gait and Balance, Multiple Sclerosis, Parkinson’s Disease, Stroke
- Orthopedic Pathology
- Acute Low Back Pain, Low Back Pain and Sciatica, Shoulder Impingement Syndrome, Rotator Cuff Pathology, Hip Replacement, Full Knee Replacement, ACL, Meniscus Pathology, Patello-Femoral Syndrome, Osteoporosis
- Cardiovascular Disease
- Hypertension, Coronary Artery Disease, Peripheral Vascular Disease, Alular Heart Disease
- Pulmonary Disease
- Chronic Obstructive Pulmonary Disease [COPD], Asthma, Bronchitis, Emphysema
- Metabolic Disease
- Diabetes Mellitus, Obesity, Blood Lipid Disorders
The MES programming concept, developed and launced at the American Association of Health, Fitness & Rehab Professinals (AAHFRP) by Mike Jones in 1992 and reinforced by the American Council on Exercise Clinical Exercise Services (CES) Certification Program, has provided an incremental boost to personal training revenue for both clubs and for its more experienced fitness staff members who are providing these services. Pre-habilitation, post rehabilitation and programming for special populations is the foundation of MES.
The only way that MES programs can succeed is if they are positioned as a programming option that supplements the work of licensed medical practitioners. MES is never positioned to interfere with the scope-of-practice of licensed medical practitioners.
Why MES Programs?
The demographic profile of club members has been evolving over the years because of the following:
- According to IHRSA, “the population of older health club patrons has skyrocketed by 343% since 1987, to nearly 7 million members in the 2002/2003 period. The segment of Baby Boomers has mushroomed by 180% to 14.8 million in 2003.”
- The IHRSA May 2005 Get Active America (GAA) Initiative was directed at not only the 40% of the US population that is inactive but also directed at the 129 million Americans who are overweight and who are outside of our health club system.
- Baby Boomers have been classified as “self care” practitioners. As such, they will do whatever it takes to stay healthy. This includes the following:
- Actively seeking health information
- Eating healthy foods
- Staying independent and self-sufficient as long as possible
- Treating themselves before seeing a doctor
- Participating in programs and activities that will keep them away from their doctors’ offices. Remember, most of these Baby-Boomers have not only been active but also probably have belonged to our clubs. Now, however, they are starting to “break down” from a succession of overuse injuries and are looking for “solutions” to their new problems. To the extent that our clubs and our fitness professionals can address their needs is the extent they will stay at our clubs as active members.
- According to the IHRSA January 2004 Trend Report, the growth of “empty nest” homes, where adults are no longer “tied to” the needs of their growing children, is accelerating. These individuals are (1) looking for experiences outside their homes with others “like themselves” and (2) are in search of services that can address their service needs. Fortunately for experienced personal trainers, these “empty nesters” have a series of pent-up, MES-type programming needs that were never addressed because they had stayed at home.
- The IHRSA January 2005 “I Lost It at the Club” weight loss initiative was designed to assist current and prospective members in fulfilling their New Year’s resolutions.
- The "100 Million by 2010" IHRSA Initiative was designed to attract 100 million non club members into clubs worldwide in general but with 50 million specifically targeted to be recruited into American health clubs. The majority of these individuals are within the American health care system and outside our club system.
The IHRSA January 2004 Trend Report also states that there will be a $1.6 trillion increase in healthcare spending, with aging Baby Boomers contributing heavily to the total over the next decade. At least 50% of adults between 50-64 years of age live with at least one chronic condition. More than 44% of US consumers take at least one prescription medication daily, and the 50+ age group accounts for nearly three quarters of spending on prescription drugs. The most common prescribed drugs for 40- to 60-year-old adults are for high cholesterol, gastrointestinal disorders, diabetes and hypertension.
As more non club members who actively participate in the US healthcare system join our clubs seeking solutions, the more we need to position our programs and facilities to address their non-traditional needs. As with any other business, we must change, modify and refocus our service delivery system as our customer profile and the associated service needs change.
MES Service Delivery Training Format
MES program services are all fee-based and can be structured as follows:
- One-on-One, 60 Minute Program Sessions
- One-on-One, 30 Minute Program Sessions
- Small Group, 60 Minute Program Sessions
- Small Group, 30 Minute Program Sessions
MES programs, depending on your facility, can be provided as both land-based and water-based programming options. Depending on the employee’s employer benefits plans and/or healthcare providers, either all or part of these medically directed services can potentially be reimbursable. Some examples of insurance carriers that recognize the credibility of MES-type programming services for reimbursement purposes have been Liberty Mutual, Blue Cross, AETNA and The Ohio Worker’s Compensation Bureau.
MES service providers are fitness professionals who have a comprehensive knowledge of special populations and can do the following: strength training and physical conditioning, proprioceptive and balance training, joint mobility and stability training, neuromuscular re-education, muscular endurance training and stimulate improvements in cardiovascular function.
As a minimum, the personal trainers who participate in the MES program will usually have a combination of the following credentials:
- Undergraduate college degree
- Graduate college degree
- Certifications from at least 2 of the following nationally recognized organizations: NSCA, ACE, ACSM, NASM and AAHFRP
- Completion of the club’s Special Population Training Curriculum
- Completion of an additional 30 hours of continuing education training per year
While credentials are indeed important, the ability to translate this knowledge into client-specific program design and training progression processes is the real professional test.
We fully recognize that the development, implementation and management of an MES program does indeed have a certain amount of risk associated with it. However, this level of risk is no greater than having an inexperienced personal trainer attempt to service your members who may be candidates for MES program services. Both AAHFRP and ACE have developed quality control administrative tools that minimize liability concerns. The AAHFRP risk-management tool, the Medical Exercise Assessment, Protocol & Progression System (MAPPS) and the ACE 10 Step Decision Making Process (see "10 Step Decision-making Approach" below) provide fitness professionals with the administrative support needed to service these clients.
10 Step Decision-making Approach*
- Step 1. Perform pre-exercise health risk assessment
- Step 2. Obtain Physician Clearance
- Step 3. Identify Exercise Benefits and Goals
- Step 4. Determine Acute Exercise Risks
- Step 5. Prepare for Medical Emergencies
- Step 6. Obtain Informed Consent
- Step 7. Plan baseline “fitness” testing
- Step 8. Design Exercise Program
- Step 9. Plan Exercise Program Implementation
- Step 10. Double Check Established Guidelines
*Developed by the American Council on Exercise
MES Program Profiles
Of the many clubs that have implemented MES-type programs across the United States, we will profile the one at the GENESIS Health Clubs in Wichita, Kansas.
At GENESIS, a four club multi-service operational club group, the MES program is being managed and serviced by Carissa Palacioz, Fitness Director and the following senior personal trainers: Wendy Williamson, Presten Petersen and Kin Dinell. What makes this program unique at GENESIS is that these professionals are four of the only 678 personal trainers in the United States who are certified as ACE Clinical Exercise Specialists. As such, they bring a level of expertise to GENESIS that most clubs in the United States do not have access to.
In support of his MES Program, GENESIS owner Rodney Stevens, had established a strategic partnership with the Via Christi Regional Medical System in Wichita. This partnership quantified the two-way flow of post rehabilitative hospital patients to the GENESIS MES program and the reciprocal flow of club members to the hospital system. Based on the results of several inter-company meetings, GENESIS also had negotiated the following:
- Direct access to the Via Christi Network of 225 Physical Therapists
- The opening of two Via Christi Physical Therapy Centers within two GENESIS locations
- The relocation of the Via Christi medically based weight management program into two GENESIS locations
- The positioning of the Via Christi medical staff as continuing education providers for the GENESIS MES staff
The following MES Program Guidelines have been developed and incorporated into the successful MES programs:
- The diagnosis for each client must be determined and quantified by the client’s medical practitioner. Under no circumstances will any diagnosis be provided by the health club or it’s fitness staff.
- The personal trainers who participate in the MES Program serve as Life Style Change Facilitators and Personal Coaches.
- Because of the special skill sets that are required to provide comprehensive customer service to program participants, only those fitness professionals who have completed the Program educational pre-requisites will be allowed to provide MES Program services.
- Each participating personal trainer will adhere to the current club documentation requirements and HIPAA guidelines that have been established by their MES Program Administrator.
- If pain, swelling, radiating pain, loss of function, numbness/tingling or decreased ROM are present or develop during the fitness, health and wellness program, the client should be referred back to the referring, licensed medical professional.
Is MES Worth My Time Financially?
I believe the answer is yes. To answer this question fully, I will profile two fitness professionals in two distinct marketplaces: myself in Boca Raton, Florida and Wendy Williamson in Wichita, Kansas.
Bob’s MES Profile:
- Training Status: Independent Contractor
- Trains 30-1 Hour Sessions Per Week = 120 Sessions Per Month
- 100% of Clients are MES Candidates (Pre-habilitative, Post Rehabilitative & Special Population)
- $75.00 Per Single 60 Minute Session; $50.00 Per Single 30 Minute Session.
Wendy’s MES Profile:
- Training Status: Employee
- Trains 25-1 Hour Sessions Per Week = 100 Sessions Per Month
- Trains 25-30 Minute Sessions Per Week = 100 Sessions Per Month
- 65% of Clients are MES Candidates (Pre-habilitative, Post Rehabilitative & Special Population)
- $70.00 Per Single 60 Minute Session; $50.00 Per Single 30 Minute Session.
From a career-path perspective, MES programming is a natural extension of what we do as fitness professionals. My career started, as did most fitness professionals, by training apparently healthy individuals and then by training athletes. From there, I started training special population classified individuals who were at the “low end” of the high risk spectrum. This then grew to training individuals who were at the “high end” of the high risk spectrum. I’m the first to agree that being an MES-focused fitness professional is not for everyone. But speaking for those of us who have been very successful, I can honestly say I wouldn’t give it up for the world.
The EFGI High Risk Client Questionnaire
- A 45-year-old female has drank 6 cans of soda a day for the past 6 years. Her weight is normal according to standard height/weight tables. HIGH RISK: YES__ NO__
- A 50-year-old female with a high-stress job drinks at least 3 cups of coffee a day. HIGH RISK: YES__ NO__
- Your client had just received the results of a recent bone scan. Her T-Score was –4. HIGH RISK: YES__ NO__
- Your client’s Bone Density Test quantified her T-Score at 0.11 for her Left Hip. HIGH RISK: YES__ NO__
- Your new client is 30 years old and her BMI is 45. HIGH RISK: YES__ NO__
- Your client has a BMI of 31 and her blood pressure is 170/100. HIGH RISK: YES__ NO__
- Your client has a BMI of 47. Does she need an EKG before she begins her weight program to lose 130 pounds? HIGH RISK: YES__ NO__
- Your new client had a laminectomy in L3, L4 & L5 three years ago. He never had physical therapy because the surgeon said he didn’t need therapy. He hasn’t stretched in 3 years. He has a numbing sensation down his left leg. His sneakers and shoes are worn in the front end on both feet. HIGH RISK: YES__ NO__
- Your client has worn a weight belt to train for the past three years. She is is 48 years old and has had 3 cups of coffee a day for the past 10 years. HIGH RISK: YES__ NO__
- Your client is a 50-year-old marathon runner. She has been involved in her sport for 15 years. Her TFL is short on her right side. HIGH RISK: YES__ NO__
Questionnaire Answer Key*:
*Each question is worth 10 Points.