Fitness and Medical, can they co-exist?

[Footballa_19]

Hey guys, I was recently discussing this topic with a fellow trainer who just returned from the ACSM research conference in Seattle. He said a major topic was the relevance of fusing the medical community with the fitness industry. He said the majority of the medical community was ready to try and incorporate more of the fitness industry into its programs, but they don't think the fitness industry is ready for that. The majority of the reason being that "fitness" is now more interested in making people "look good" over "healthy" and "curing disease". He even pointed out that in Oregon, they are pushing an insurance code through that would allow personal training to be paid for by insurance, even medicare and medicaid. This could be HUGE for our profession if more states followed.

For example I have recently looked into teaming up with a bariatric surgeon and handful of orthopeadic surgeons in my home town to try implementing a program that requires personal training programs for patients undergoing surgeries to learn and maintain weight loss lifestyle changes through exercise and education. It has been very stressful though. It requires an almost impossible amount of research and work to design these protocols for such special populations.

I feel this is the right thing to do, but can't help feeling like sometimes it's a moot point. Would more gyms and PT's be willing to bring these programs to average joe gyms, or is this just wishful thinking. It is something that is happening in the background of the health industry right now, and I believe it would be awesome to see happen more often.

Thoughts or comments?

[SFT]

Hey guys, I was recently discussing this topic with a fellow trainer who just returned from the ACSM research conference in Seattle. He said a major topic was the relevance of fusing the medical community with the fitness industry. He said the majority of the medical community was ready to try and incorporate more of the fitness industry into its programs, but they don't think the fitness industry is ready for that. The majority of the reason being that "fitness" is now more interested in making people "look good" over "healthy" and "curing disease". He even pointed out that in Oregon, they are pushing an insurance code through that would allow personal training to be paid for by insurance, even medicare and medicaid. This could be HUGE for our profession if more states followed.

For example I have recently looked into teaming up with a bariatric surgeon and handful of orthopeadic surgeons in my home town to try implementing a program that requires personal training programs for patients undergoing surgeries to learn and maintain weight loss lifestyle changes through exercise and education. It has been very stressful though. It requires an almost impossible amount of research and work to design these protocols for such special populations.

I feel this is the right thing to do, but can't help feeling like sometimes it's a moot point. Would more gyms and PT's be willing to bring these programs to average joe gyms, or is this just wishful thinking. It is something that is happening in the background of the health industry right now, and I believe it would be awesome to see happen more often.

Thoughts or comments?

Insurance coverage will not happen in my opinion. I honestly don't want it to happen. Personal training isn't a cost effective approach for most people. I think that employer sponsored programs are a better idea.

Insurance companies covering any fitness service will mean more paperwork, restrictions on who is eligible, and lower rates for our services. On top of that, I wouldn't be surprised if they made it so only people with BS in Exercise Science, or equivalent, could bill for services.

[WoofieNugget]

I think before that type of thing could happen there would have to be regulation within the fitness industry for PT's of some kind. In my country, you have to have a doctors' note to claim massage therapy and I would feel that doctors should be able to do the same with exercise. However, you can't have people walking into a chain gym with a doctors' note for a special condition and getting assigned a trainer who has been working for a month and has one weekend or online certification. There would have to be accountability.

I currently partner with lots of chiros, physios and osteopaths as well as medical doctors, although only a few cases are covered under insurance. In all cases I have to provide my qualifications and give regular updates of progress and methodology in order to justify them referring patients to me.

Insurance companies covering any fitness service will mean more paperwork, restrictions on who is eligible, and lower rates for our services. On top of that, I wouldn't be surprised if they made it so only people with BS in Exercise Science, or equivalent, could bill for services.

To me this is actually a good thing. It means our industry is more respected and less chucklehead idiot trainers can give us a bad name. I don't think they would be able to control the rate, so it would actually allow some trainers to justify charging more, not less.

[Endevorforever]

I think before that type of thing could happen there would have to be regulation within the fitness industry for PT's of some kind. In my country, you have to have a doctors' note to claim massage therapy and I would feel that doctors should be able to do the same with exercise. However, you can't have people walking into a chain gym with a doctors' note for a special condition and getting assigned a trainer who has been working for a month and has one weekend or online certification. There would have to be accountability.

I currently partner with lots of chiros, physios and osteopaths as well as medical doctors, although only a few cases are covered under insurance. In all cases I have to provide my qualifications and give regular updates of progress and methodology in order to justify them referring patients to me.



To me this is actually a good thing. It means our industry is more respected and less chucklehead idiot trainers can give us a bad name. I don't think they would be able to control the rate, so it would actually allow some trainers to justify charging more, not less.

Nope trainers would get payed less, and they would probably lose their jobs to physical therapist. Part of the problem with many people is that they don't spend enough time in, or have never been to Physical Therapy.

[WoofieNugget]

Nope trainers would get payed less, and they would probably lose their jobs to physical therapist. Part of the problem with many people is that they don't spend enough time in, or have never been to Physical Therapy.

Part of the problem is also that many trainers act like they are physical therapists, telling clients they can deal with serious issues and they have no idea what they are doing. I'm not a fan of physical therapists in general, and you're right a lot of people should go there first, but a competent trainer can bridge the gap between physical therapy and properly progressed strength training.

[SFT]

I think before that type of thing could happen there would have to be regulation within the fitness industry for PT's of some kind. In my country, you have to have a doctors' note to claim massage therapy and I would feel that doctors should be able to do the same with exercise. However, you can't have people walking into a chain gym with a doctors' note for a special condition and getting assigned a trainer who has been working for a month and has one weekend or online certification. There would have to be accountability.

I currently partner with lots of chiros, physios and osteopaths as well as medical doctors, although only a few cases are covered under insurance. In all cases I have to provide my qualifications and give regular updates of progress and methodology in order to justify them referring patients to me.



To me this is actually a good thing. It means our industry is more respected and less chucklehead idiot trainers can give us a bad name. I don't think they would be able to control the rate, so it would actually allow some trainers to justify charging more, not less.

Woofie aren't you in the US? I cannot possibly see insurance leading to higher rates of compensation for personal trainers. Medicare and Medicaid generally pay considerably less than insurance companies do for the same services. They tell you what they are going to pay and you can either choose to accept it, or lose the business.

Some people seem to think that everyone should or would be eligible for these services. Think about what this would do to the government. Not to get too political here, but the government in the US is already bloated and spends far too much. If Medicare, Medicaid, and health insurance companies start offering personal training, get ready for more taxes and even higher insurance payments. The money has to come from somewhere...

I'm also not talking about good paperwork. When I say "good paperwork" I mean logging training sessions, goals, and other paperwork that helps you, your client, and would also aid in a court case. All good trainers do this paperwork already. I'm talking about excessive paperwork, notes of medical necessity, and just a lot of BS. Couple this with Medicare/Medicaid offering you $0.70 on the dollar, and you're looking at probably $30/hr with more paperwork.

In my opinion, the answer is small group training. That allows our fees to be similar, or even cheaper than a physical therapy copay. Even physical therapy continues to get knocked down. The service is simply to expensive, especially with all of these DPTs that want ever increasing salaries because they have been in school for 7 years. Who could blame them?

For older adults, maybe Medicare/Medicaid would cover inexpensive group exercise training. I couldn't see it covering anything more than $75/mo worth in my estimation. Exercise physiologists and personal trainers really don't have any huge organization pushing anything for us. We have a bunch of smaller organizations that can't get anything done.

All that being said, I like the idea of our profession becoming more well respected. However, we aren't even a licensed profession. I can guarantee you that if insurance reimbursement comes on the table ever, it will come with state licensure for fitness professionals. On top of that, personal training will not be covered. This is a luxury service that is no an efficient means to improving fitness. Physical, occupational, and speech therapy are often performed 1:1 because that is necessary for the tasks that they are working on. For example, a PT would have a hard time working on gait training with a group of 10 stroke patients. Good luck even getting those stroke patients there at the same time. Or how about working on bed mobility with 5 patients at the same time? Just not practical.

[KyleAaron]

I think the job of PT is better-suited to prevention rather than cure.

2/3 of knee and 1/2 of hip replacement operations are associated with obesity. In other words, the person's joints are suffering from carrying a heavy load all day just as a soldier does. Every obese person I've ever worked with has back problems. Being in the bottom third of strength rather than the middle or top third means 150% the chance of dying from cancer [Source]. And the association of decent though not high levels of cardiovascular fitness and reduced chances of heart disease are well-known. Most frailty in the elderly is associated more strongly with levels of activity than age itself.

That is, if we can help people get to a reasonable bodyweight, and get reasonable levels of strength and cardiovascular fitness, we can add years to their lives. Perhaps more importantly, we can improve the quality of their lives, what Dr John Sullivan calls in this video "the compression of morbidity". As Mark Rippetoe said to Dan John, "if you teach an older person to squat, you give them their life back." And he wasn't talking about squatting 405.

Many employers and insurance companies already offer subsidies for gym memberships. I met a gentlemen whose insurance company was paying for his gym membership; he was 72 years old, had been smoking since he was 12, had emphysema, and was still smoking. I met him once, I don't know if he decided to stay home or dropped dead the next day, most likely the former. The problem for the medical community is that even if by some miracle doctors and physiotherapists actually knew a damn thing about exercise, like us trainers they still cannot make the person show up and do something. There is no benefit to anyone in subsidising training people won't use.

Prevention is better than cure.

[SFT]

I think the job of PT is better-suited to prevention rather than cure.

2/3 of knee and 1/2 of hip replacement operations are associated with obesity. In other words, the person's joints are suffering from carrying a heavy load all day just as a soldier does. Every obese person I've ever worked with has back problems. Being in the bottom third of strength rather than the middle or top third means 150% the chance of dying from cancer [Source]. And the association of decent though not high levels of cardiovascular fitness and reduced chances of heart disease are well-known. Most frailty in the elderly is associated more strongly with levels of activity than age itself.

That is, if we can help people get to a reasonable bodyweight, and get reasonable levels of strength and cardiovascular fitness, we can add years to their lives. Perhaps more importantly, we can improve the quality of their lives, what Dr John Sullivan calls in this video "the compression of morbidity". As Mark Rippetoe said to Dan John, "if you teach an older person to squat, you give them their life back." And he wasn't talking about squatting 405.

Many employers and insurance companies already offer subsidies for gym memberships. I met a gentlemen whose insurance company was paying for his gym membership; he was 72 years old, had been smoking since he was 12, had emphysema, and was still smoking. I met him once, I don't know if he decided to stay home or dropped dead the next day, most likely the former. The problem for the medical community is that even if by some miracle doctors and physiotherapists actually knew a damn thing about exercise, like us trainers they still cannot make the person show up and do something. There is no benefit to anyone in subsidising training people won't use.

Prevention is better than cure.

The only thing that I will say add is that prevention is a continuum. Just because someone has hypertension doesn't necessarily mean we are just curing him. We could also be preventing dyslipidemia, diabetes, vascular diseases (heart, brain, or peripheral), among a variety of others that typically follow in sequence. Unfortunately we all know too well that people don't find prevention of disease to be all that interesting.

Quality of life is the biggest way to sell our services in my opinion. Some people care about hypertension, diabetes, and all that other good stuff, but most people would be more apt to changing their habits if you told them that they could resume certain activities, or that they can play with their kids without getting winded.

[ericmackcarter]

Insurance pay for personal trainers would be terrible.

I don't want:

1) someone else controlling my rates
2) clients that are only interested in my services because it isn't out of pocket
3) the headache/paperwork

No thanks. I'll charge what I want, keep self-motivated clients, and spend most my time training and not filing.

[SFT]

Insurance pay for personal trainers would be terrible.

I don't want:

1) someone else controlling my rates
2) clients that are only interested in my services because it isn't out of pocket
3) the headache/paperwork

No thanks. I'll charge what I want, keep self-motivated clients, and spend most my time training and not filing.

The sad thing is even some physical therapists are going to this model... Anyone who thinks that health insurance reimbursement is a good thing should go take a job in the medical field for a year or so.

[Endevorforever]

It figures. ACSM would be the organization to push something like this. Also the industry is not more interested in making people look good. All certifications speak to exercise science to benefit health not beauty. Clients however, gravitate to fitness because of its cosmetic side effects.

[KyleAaron]

The only thing that I will say add is that prevention is a continuum. Just because someone has hypertension doesn't necessarily mean we are just curing him. We could also be preventing dyslipidemia, diabetes, vascular diseases (heart, brain, or peripheral), among a variety of others that typically follow in sequence.

Excellent point, well said.

All certifications speak to exercise science to benefit health not beauty. Clients however, gravitate to fitness because of its cosmetic side effects.

Sure. But the pure looks clients never stick with it. Teh sixpact abz just isn't enough to motivate people to all that hard work. It's only when they get health or performance goals that they become seriously interested in it all.