Don Jones, Ph.D., has worked in the hospital wellness and fitness industry for more than 20 years. He has also served as the director of rehab services for Sentara Hampton General Hospital. Don has worked for the YMCA and has extensive experience with parks and recreation departments. He has held such varied positions as athletic director, physical director, personal trainer, exercise physiologist and executive director. This extensive experience has enabled him to look at the club industry from a variety of perspectives. He currently serves as the executive director of The Fitness Centre & Day Spa at Florida Hospital Celebration Health and can be reached at donald.jones@flhosp.org

It is abundantly clear that our industry is not offering most of the general public what they want. We are only capturing 14 percent of available customers in most markets. Maybe as Michael Scott Scudder questions in his From the Lip column in Club Industry’s Fitness Business Pro, our model is out of date. If so, what can we offer the general public that is different and, more importantly, has value for the masses?

I would offer lifestyle medicine as an option for many clubs to consider. This idea will not work in clubs that concentrate on 30-minute circuits nor will it be successful in clubs that charge only $10 per month for membership dues. It is likely to work in clubs that already have a medical focus, such as hospital-based fitness centers and privately owned clubs that have a strong investment in the community.

First of all, we must agree as to what lifestyle medicine is and isn’t. It’s often a slippery slope. The word, medicine, in lifestyle medicine often implies that one must be ill before he or she can benefit from participating in a particular program. I would disagree and suggest that our members can benefit from the preventive aspects of lifestyle medicine. However, members with chronic illnesses and multiple risk factors that predispose them to illness and injury can also benefit from interventions by qualified staff who practice tenants of lifestyle medicine.

I would offer the following 10 elements, in no particular order of importance, as a starting point for those interested in starting a lifestyle medicine program.

1. Credentialed staff. First of all, if we are going to prescribe remedies for our members/patients ailments we must have staff members who are qualified to do so. Exercise physiologists, with appropriate certifications, should be the core of this staffing. In addition, it wouldn’t hurt to have access to a sports psychologist, dietitian and life coach.

Lifestyle medicine centers should and will be held to a higher standard. The public will pay more for their memberships but will also expect more in return.

2. Clinical integration coordinator (CIC). Some also call this position a patient coordinator or referral coordinator. No matter what you call the position, this person works with the various clinical departments within the hospital(s) and/or physician practices.

We have found that having this person attend the departmental staff meetings of physical therapy and cardiac rehab, for example, is an excellent way to engender trust and establish a good working relationship. In addition, this helps the CIC understand patients’ needs as well as learn which patients are getting ready to be released for referral to a home program or to your fitness center.

3. Patient referrals—hospitals. As mentioned above, the best way to get the various clinical departments to refer patients to you is to build trust by attending their staff meetings and learning about specific patient needs.

Once a patient is referred to you, act on the referral in a timely manner and keep the referring therapists in the loop. They will want to know how their patient is progressing.

4. Physician referrals—private practice. When you are dealing with a private physician practice, you will need to get the physician(s) support and trust. You would be surprised how many physicians are willing to refer patients to your center if you are willing to comply with their exercise-prescription recommendations—to the letter. There is not much room for creativity just yet. Do what they tell you to do and then, after you have built their trust, you can ask for some leeway if needed. This is also how physical therapists operate.

If you are having trouble getting in to meet with a physician group, schedule an appointment with their office manager and buy their staff lunch. You can then present your offer to them in a more relaxed atmosphere.

Do not just assume that by handing out prescription pads with your center’s name on them that you will get instant referrals. It’s not that easy.

5. Physician memberships. Do whatever you can to encourage the physicians in your immediate area to become members of your club. Once they are members, they will see how you operate and whether or not your club walks the talk.

I’ve seen this time and time again. If physicians use your club and you are providing necessary services for their patients, whether it be cardiac rehab, post-surgical rehab for physical therapy patients, they will want to refer their patients to you.

It’s up to you to find a way to get them in the door. I’ve known clubs to sponsor elaborate dinners at their clubs for physicians and their spouses. I’ve also known clubs to give away memberships to physicians, but be careful, there may be some enurement issues. Check with your club’s attorney.

6. Personal training. Personal training has become just that – personal. Things have definitely changed for the better. It’s no longer just about training to get bigger biceps or complete a marathon, although those are not necessarily narrow goals.

Personal training programs are including aspects of life coaching, also known as health coaching. The more your trainers know and truly understand their clients, the better able they will be to offer appropriate guidance for the client. There are many opportunities here.

7. Dietitians. Although the ideal would be to have a dietitian on staff, most clubs simply cannot afford this in their budget. You can, however, find a qualified dietitian who will work on a per diem basis and/or via a contract. I think the day will come when many/most clubs will include a dietitian as part of their staff and look back and wonder why they didn’t do it sooner. Until that day comes, be careful not to have your trainers work outside their scope of practice when discussing nutrition with their clients. It’s better to be safe than sorry by referring to a dietitian.

8. Medical director. It would be ideal as well to have a medical director on your staff. This physician will serve as your champion, and guide you and offer advice to help you fulfill your lifestyle-medicine mission.

If you can’t find that person, don’t despair. There are many qualified physicians, who are probably already using your club, willing to serve in that capacity. You just have to seek them out.

9. Equipment and facility design. Do you ever wonder whether or not your equipment is suited for specific patient needs? You should be. Most exercise equipment I’ve seen will not accommodate people over 400 pounds. And sadly, that means many bariatric patients are left out in the cold.

In addition, I’ve often wondered why more clubs don’t have indoor tracks. I’m not talking about tracks for sprint training. I’m talking about walking tracks.

One innovative facility in Virginia even put in a lounge area in the middle of their track. At first I was puzzled. Then the explanation came—de-conditioned members and/or cardiac rehab patients can only walk a lap or two without getting fatigued. The lounge area allows them the opportunity to rest for awhile and go back again for a few laps.

10. Transitions/resources. We’ve only scratched the surface here with regards to lifestyle medicine. Hence, I encourage you to look at the resources listed below for more information:

· www.lifestylemedicine.ucf Information on the recent collaborative effort by the University of Central Florida and Florida Hospital to establish an institute for the study of lifestyle medicine.

· www.rippehealth.com Dr. James Rippe is the Founder and Director of the Rippe Lifestyle Institute and the Rippe Health Assessment. He is also the Chairman for Lifestyle Medicine at the University of Central Florida.

·The book, Changing for Good by James O. Prochaska, Ph.D. describes what it takes to get people to change their lifestyles—once and for all.

Lifestyle medicine is still in its infancy even though it has been discussed in some form or fashion for centuries (there is evidence that the Greeks and Romans believed good health was dependent on diet and lifestyle). It’s now time for us as club managers and owners to present it to our members.