"Medically Exercise Servicing:
Ten Steps for Launching a Quality Profitable Program"
-Wendy Williamson, PhD

Once patients leave their doctor’s office or physical therapy office, do they know what to do?  Will they follow a plan provided to them?  Are they ready to return to their daily, recreational or sport activity?  They may or may not be ready. Perhaps, their insurance has determined that their allowable number of visits has expired.  What quality services are available to them?  Have personal trainers elevated their skill-sets, education and problem solving techniques to address the needs?

Fitness professionals must be prepared to receive such patients for potential clients. The programming options are available.  Since 1992, Dr. Mike Jones has led and developed the American Association of Health Fitness and Rehabilitation Professionals (AAHFRP).  In addition, this program was reinforced by the American Council on Exercise Clinical Exercise Specialist (CES) which was recently replaced by a new certification titled: Advanced Health and Fitness Specialist (AHFS).

Specialty trained and certified fitness professionals can provide a safe and effective bridge for the patient when crossing from the structured clinical treatment, or rehabilitation environment to the mainstream community or home-based exercise. (IDEA Fitness Journal, Dec. 2007)  MES is a programming option that supplements the medical practitioner.  It is never positioned to interfere with the scope-of-practice of a medical practitioner.

Mapping the territory Strategic Business Plan Marketing Strategy Medical Advisory Board Networking/Referral Program Specialty Development Professional Development Professional Communication HIPPA Law and Medical Release Documentation and follow-up

Linda Wargo, Physical Therapist from DeFuniak Springs, Florida stated: “Medical Fitness is more than a certificate. It is being able to recognize deficits (and understanding that) the whole body is connected.”

The need for medical fitness professionals is indicative with the costs spent for healthcare. Musculoskeletal conditions account for over $254 billion a year loss in associated healthcare costs, loss productivity and medical research.  The impact of human dysfunction, malalignment and associated pain cost the United States $695 million per day. (IDEA Fitness Journal, Jan. ’08) John McCarthy, former executive director of IHRSA, stated that medical fitness is one of the top four reasons why the industry will prosper and grow. Are there adequate fitness professionals elevating their skill-sets, and knowledge to address the specialty?

It is a fact that non-profit facilities are present.  In 2004, the Medical Fitness Association reported that over 700 medical fitness facilities serve nearly two million members. In addition, during the last 20 years, there has been a 1,000% increase in the number of hospital-owned or physician-sponsored wellness or fitness centers.

The opportunity is ever present for the fitness professional, but where do they begin, what should be considered, and who should be involved?  A qualified fitness professional needs to prepare, plan and lay the foundation in providing a quality program before ever indulging in such an endeavor.

Many components of developing a quality medical exercise program should be considered. The ten components of the necessary plan are provided to assist in establishing and creating a quality medical exercise program.

1. Mapping the Territory.  When considering a location for a medical fitness facility, consideration the proximity of hospitals, clinics and ancillary services, including physical therapy.  Will the location be within a medical corridor or “out-of-way” of any other services?  Ideally, the location needs to be easily accessible and near other medical servicing.  If not, the location may be a detriment to the development and growth.

2. Strategic Business Plan.  The plan of your business must be written. It is critical to have a vision of your direction and growth.  As the strategic plan is developed consult with the staff who currently work in the “trenches” to seek their input as they are daily involved with the clientele. Establish a mission statement for the business determining the purpose, goals, etc.  Establish the financial goals now and in the future.  
   
   Who is the target market?  Before establishing the target market, three questions may have to be asked, such as 1) what are the market needs, 2) is the target market large enough to achieve the set financial goals, and 3) what attributes make up an “ideal” client and a not so “ideal” client?
   
   Personally evaluate the service and ask, “What sets me apart from other fitness professionals that want to launch a medical exercise servicing business?  The business needs to have an edge on the market, ie, customer service, specialty training, etc. What obstacles might be encountered?  Expect a few “curve balls” when establishing a new business, because unfortunately, they will happen.

3. Marketing Strategy. Obviously, this is critical and the focus and priorities need to be set.  Servicing the member professionally is the most important component.  The client comes first. If possible, quality marketing to a large number of people within the focus target market will be extremely beneficial. Attracting additional members from outside the target market will lead to future clients as well. However, never forget that the referrals from established relationships within the medical community will also serve the business well.  Continuing to massage these relationships will also assist in the progress of the business.
   
   Finally, an evaluation of the marketing strategy action plan needs to occur quarterly and annually.  Comparing the original financial goals to the actual business will keep a business on course or if need be, revising the plan.
   
   In 2007, IHRSA reported that in 2006, there were over 47 million club memberships in the U.S.  Baby Boomers (age 44-62) account for 25.1 of these members. If just 10% of baby boomers buy 15 personal training sessions per year at $80/session, there is over $201.6 million dollars in revenue. Baby Boomers are reaching the age where they may have injuries, imbalances or needs advanced level of training, ie medical exercise servicing.  Their conditions may include some of the following conditions: knee pain, hip pain, back pain, shoulder pain, obesity, diabetes, heart disease, etc. (IHRSA 2007, The IHRSA Profiles of success: the annual industry data survey of the health and fitness club industry.)

4. Medical Advisory Board.  When interacting with the medical community, a key component is the advocacy from the board. This can alleviate problems, provide direction and can take the business to the next level.  A wide variety of medical professionals should be considered, such as sports medical doctors, general practitioners, massage therapists, physical therapists, surgeons, etc.  When considering members for the advisory board, several questions may need to be asked, such as, who is willing to attend a meeting quarterly? Who will be  supportive of this endeavor? This board should have synergy between fitness professionals, community and peer medial professionals.

5. Networking/Referral Program. Establishing and developing networking relationships is a vital key component. Crucial to maintaining and growing the business, there are often reciprocation referrals, especially once the credibility has been established.  A respectful medical professional will often reciprocate the referral if their patient has received quality service. Fitness professionals need to position their selves for the networking opportunity.  Whether it is a social event, open house, sporting event, etc., continuing to network and establish relationships will enhance the networking and referral program.

6. Specialty Development. Marketing trends may dictate what the specialties may demand. However, the Baby Boomer conditions quoted (Question #3) from the IHRSA 2007 report is generally indicative of the common conditions. In addition, because it is so difficult to master exercise programming for every special population, most medical fitness professional specialize. Common specialties may include the following: balance and gait, sports performance, orthopedic injuries/conditions, neuromuscular disorders/injuries, metabolic disorders, cardiac rehabilitation, immunological disorders, etc.

7. Professional Development. To focus on medical exercise servicing, the fitness professional needs to be in constant professional development to continue to stay educated and be able to provide the most current programming appropriate for the client. The Medical Fitness Association recommends that the MES professional have the following:
• Associate or bachelor’s degree in exercise science or related field.
• At least one current national certification (accredited by the National Commission for Certifying Agencies)
• Current certification in cardio-pulmonary resuscitation and the use of automated external defibrillators (CPR/AED)
  
  In addition, there should be assessment and movement screen proficiency, program design comprehension, and problem solving capabilities.

8. Professional communication. In order for the fitness professional to establish rapport with the medical professional, formal correspondence is necessary.  Not only should communication initially be written in letter format, and/or e-mail, but also in terminology, with medical staff, follow-up, etc.  A suggested format for communication via letter is as follows:
• Provide information the client provides
• Provide information gathered during the assessment and screenings
• Provide the potential plan of action
  
  “Medical fitness professionals need to demonstrate competence and responsibility in every professional interaction.” (Williamson, 2007) The fitness professional’s direction should be in accordance with the medical professional guidance.
9. HIPPA Law and Medical Release Program. The client must sign the medical release for the fitness professional to obtain additional information and direction from the medical professional.  The fitness professional might develop multiple types of medical release forms specific to the medical condition so that the general exercise prescription can already included on the form.  In order for the form to be returned from the medical professional, it is important for the mailing address, fax number, and comment section be included for ease of return.
   
   Administratively, the fitness professional should have an efficient filing system so that these important documents can be easily maintained and placed under lock and key between exercise sessions.

10. Documentation and Follow-up. To maintain a quality training program, documentation of client progression should be maintained.  Specifically, training logs, medical releases and other medical correspondence, goals and S.O.A.P. notes should be kept in a client file. 

Medical exercise servicing has enormous potential as third party reimbursement continues to decline, and as Baby Boomers continue to age.  The market is available, the resources are available, and it is the critical time for the fitness professionals to position them selves to be prepared.  Many fitness professionals have tried to position themselves, but those with the edge in preparation and advancement training have not. Individuals with accomplished medical exercise servicing credentials are few. The need is great. The plan has been set. Who will be the next to emerge?

Neitlich, A. (2004) Write a business plan that works, Sitepoint, www.sitepoint.com
www.cwc.org/market/mkt4.htm, How to develop a strategic business plan
IDEA Fitness Journal, December 2007
IHRSA 2007, The IHRSA Profiles of success: the annual industry data survey of the health and fitness club industry.
Medical Fitness Association, 2004
IDEA Fitness Journal, Jan. 08 (United States Bone and Joint Decade, 2002)