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Senior Man On Cross Trainer In Gym

Exercise and Wellness and Their Role in Injury Reduction and Prevention

For many exercise professionals, the goal of training and educating clients is to improve health, increase strength and performance, and improve fitness parameters. The concept of reducing injuries may not be high on their radar screens.

Active seniorsHowever, in American business, the aspect of doing anything that will reduce injuries (and health insurance costs) is of utmost importance. So much so that many businesses, universities, and manufacturing companies are hiring wellness professionals as part of their efforts to reduce heath care costs.

One aspect of providing a wellness program to companies is to define your services. Will you be performing ergonomic analysis?
Is a comprehensive stretching program part of your offerings?
Will employees be able to train in a health club environment?
Will there be any post –rehab therapy services available?

Many wellness programs segregate their services from ergonomics – which is a certified practitioner who may perform intrinsic (body mechanics), or extrinsic ergonomics (fitting proper equipment to the employee). Wellness programs are also not athletic training or rehabilitation, but may incorporate some of the elements of each of these disciplines.

Wellness services concentrate on sound basic exercise, stress management, aerobic conditioning (walking/machines), massage therapy, weight management, smoking cessation, and general health services (coaching, phone follow ups, etc.).

Perhaps the most important aspect of wellness programs (other than great instruction) is defining outcomes. HOW will employees lose weight? Will gaining core strength reduce total lost days? Can stretching and balancing programs reduce total medical payments for low back pain?

Outcomes will make a program successful. Results from university programs show that regular exercise programs may reduce back pain levels by up to 50%. Workers who have less pain won’t mind coming into the office more often. These same programs help reduce total low back injuries (many by over 75%).  Most importantly – these programs save money. From the Steelcase programs in the mid-1980s to programs today – people who are actively engaged in regular exercise, range of motion, massage therapy (chair massage), core training, balance training, nutritional intervention, relaxation training, smoking cessation, and regular health monitoring (body weight, body fat, blood pressure, specific blood lab values) improve health, reduce health risks, and save appreciable dollars over companies that do not provide these services. It is not uncommon for the return on investment to be higher than 4:1. This is remarkable considering most wellness programs have a modest budget.

Speaking of a modest budget – many wellness programs can be done well even if inexpensively. For a staff of 200 employees – approximately $2,500-3,000 can be spent on fitness balls, rubber tubing, dumb bells, stretch mats, and flyers can suffice to produce good results. Other equipment that may be used would include relaxation CDs, or a machine called Resp E Rate, which is a biofeedback unit that works to reduce heart rate through specific music programming. TENS units and chair massage may be used for pain management. Although these modalities are usually found in a PT office, they can be used anywhere where staff experience chronic pain levels that are not threatening.

Doctor showing a woman a part of a spineThe power of the wellness practitioner may also be the power to refer. When an employee experiences high levels of pain, depression or anxiety, or an injury or condition (blood pressure) that will not normalize – they need to be referred to medical personnel. It’s actually a great feeling to have a network of providers that can assist in bringing an employee to a more healthful and productive place in their work status.

In closing – the field of injury reduction and prevention is one of the fastest growing areas of health promotion – and should be investigated thoroughly. Some resources below may give wellness instructors some insight into the area of injuries, safety, and certifications. Remember, too that employers in private sectors companies may pay well for services that save them money. This is yet another reason to look into this interesting and challenging health promotion field of the future.

Resources: www.resperate.com; www.stretchwell.com

Eric Durak is President of MedHealthFit – a health care education and consulting company in Santa Barbara, CA. A 25 year veteran of the health and fitness industry, he has worked in health clubs, medical research, continuing education, and business development. Among his programs include The Cancer Fit-CARE Program, Exercise Medicine, The Insurance Reimbursement Guide, and Wellness @ Home Series for home care wellness.


The Rise of Consumer-Based Blood Testing: A Huge Step Forward for the Medical Fitness Profession

A recent report in Forbes Magazine by writer Unity Stokes discusses the recent issues concerning the validity of blood tests results from a Silicon Valley lab company called Theranos. Theranos was founded by a 30-something Elizabeth Holmes, who garnered over $5 billion from investors to launch her company that promised blood from finger sticks vs. whole venous blood draws. This year her company was investigated by the Department of Justice for investor fraud. Today Theranos has little investor value, but Ms. Holmes helped launch the consumer based blood lab model – in which patients can order blood labs from online companies when they want – essentially taking away a physician-ordered medical procedure.

While it may not mean too much for medical fitness professionals today – it should. There are two reasons. Even though Theranos is not the top dog in the blood lab industry now – they have changed the way we think of blood labs in general.

The big picture here, as explained by Stokes in his article, is that whatever the endpoint is for Theranos, consumer based lab testing is here to stay and will be one of the fastest growing areas of healthcare.

Simply put – consumer based blood lab companies allow patients to log onto web sites and essentially become “members” of an online community. Their membership allows them to receive blood labs independent of their physician referral.

Why is this important? For the Medical Fitness Professional – it is the game changer that they have been waiting for. Over the past 25 years they have pushed the terms “post rehab exercise” and “clinical exercise” to allow trainers to move into the health care environment.

While performing duties that may in some cases seem similar to physical therapy (in the eyes of the uneducated observer) they are now able to have a piece of health care that they can use to further their development of the clinical exercise realm.

Blood labs will allow personal trainers, health coaches, health nurses, sports conditioning coaches, and exercise physiologists to refer their clients and athletes to blood lab companies online and directly test the effects of an exercise and sport program on their health.

According to StepOne Health CEO Craig Brandman, MD – over 90% of healthcare decisions are make by the results of blood labs, and in sports medicine – we can only imagine looking at blood labs on an on-going basis to see how our prescribed exercise (or sport) program is doing on blood lab parameters.

Take diabetes for instance – in athletics or health improvement, the basis for medical decision making is in two critical areas – fasting and post blood glucose testing with a home monitor and long term care regarding the glycosylated hemoglobin (A1c). These tests are crucial to seeing how improvements are doing in overall diabetes health. The first test – the home glucose monitor – can be used in any health club and by anyone. The A1c test is a lab test and is usually prescribed by a doctor – until now.

Dr. Brandman and myself have been in communication for some time to bring StepOne Health into the realm of the health and fitness profession. As a former medical researcher – I can’t agree more. With cancer patients, weight management, hormone management, cardiovascular risk patients, and most others, the ability to manage blood labs may be the most important element in showing others in health care the benefits of exercise and sports training at any level.

Sports training programs rely on physical performance markers, injury status, range of motion, and other elements to see the improvement in athletes. Blood testing allows them to not only measure acute markers (blood glucose, lactate, etc.), but to look at markers such as Creatine, Testosterone, and BUN levels and prescribe fitness accordingly.

How will this come to pass? In my conversations with Dr. Brandman – we are working on two fronts. First is to enhance the education of health and wellness professionals as a whole. The Blood Lab Wellness Specialist course was launched in February of 2016, and it allows heath and wellness professionals to have a baseline understanding of the blood lab process. Second – StepOne Health will be creating a referral-based system whereby Medical Fitness Professionals and coaches can directly refer clients to the StepOne Health portal and become part of the referral family. This will include discount rates on blood panels, referral fees for professionals, genomic testing profiles, and online coaching when needed. In my opinion, it is the single most important step in bringing wellness and fitness into today’s health care system as any single faction.

I recently had the opportunity to interview Dr. Brandman about the issues concerning healthcare. In his opinion, health and fitness professionals SHOULD be referring clients to blood work. The more clients know about how their fitness impacts their overall health status, the better. See the interviews with Dr. Brandman on my medhealthfit YouTube Channel here:


Lastly – the profession of medically based exercise is steeped in our tradition of sports medicine. Allowing for blood lab data (under HIPPA guidelines of course) to steer the course of exercise programs makes for formidable outcomes measures and research. It will allow practitioners to absolutely have clear cut outcomes on the programs they are teaching and will only strengthen the association with medical practice groups, hospitals, and health plans, who are looking for the best opportunity to work with providers at the best possible pricing. It is a win for all parties – especially patients, who can see how exercise truly affects their health status.

For more information – log onto www.steponehealth.com and look over the web site.

For more information on the Blood Lab Wellness Specialist, visit medhealthfit.com/health-lab.

Eric Durak is a pioneer in the post rehab movement. He has worked in personal training, medical research, environmental health, and is the author of numerous industry certification courses, such as the Cancer Fit-CARE program / coaching program, Fitness Medicine, Wellness @ Home, The Insurance Reimbursement book for wellness professionals, and recently – the Blood Lab Wellness Specialist. See all of his programs at the medhealthfit.com web site.






The Nutrition Debate: Enough is NEVER Enough

A recent issue of the Annals of Internal Medicine tried to put a nail in the coffin of nutritional supplements. “Unregulated, not safe, harmful, and no benefits” shouted the authors of the Letter to the Editor of the journal. Yet another attempt by physicians and the pharmaceutical industry to put a damper on the use and sale of vitamins and minerals.


The Rise of Consumer-Based Blood Testing: A Huge Step Forward for the Exercise Physiologist

A recent report in Forbes Magazine by writer Unity Stokes discusses the recent issues concerning the validity of blood tests results from a Silicon Valley lab company called Theranos. While reading about the validity of blood tests may be considered more important for healthcare professionals such as a medical doctor or a nurse, it is time that exercise physiologists as health and fitness professionals take a moment to think about it and what it may mean to their practice.

Yoga Exercise

Using Exercise to Reduce the Waste in Healthcare Dollars

$750 billion is a lot of money. It is more than the GDP of many countries. And, according to a recent article published on Medical Consultants Network – it is the amount of money wasted each year by our fabulous health care system. Unimaginable as it may seem, the report from the Institute of Medicine found that the amount of money wasted (roughly 30 cents on every medical dollar) is more than the budget of Medicare ($716 billion per year).

Senior woman with help of physiotherapist

Cancer Wellness Within Healthcare – A Date With Destiny

There are three distinct areas of exercise as it relates to healthcare – and reimbursement. Most trainers and fitness professionals are aware of cardiac rehab, which actually began in the US in the 1960s, but gained ground as a reimbursable health care service in the 1980s. At that time there was a lot of good exercise and sports medicine research available in peer reviewed publications, and there was a push on the part of health care to include cardiac rehab as part of rehab and health promotion services. The fact that most cardiac programs were reimbursed up to 36 sessions was a plus.

The second area of healthcare that is relatively new is the Silver Sneaker’s program – started in Arizona in 1994, it quickly grew to the nation’s leading reimbursable wellness program for seniors. It was accepted by Medicare Plus Choice, and a host of other health plans across the nation – so that within a few years of its inception, seniors from anywhere in the US could take advantage of free exercise and health classes at area health clubs, YMCAs, and JCCs. The program was recently sold to Healthways health systems from Nashville for over $400 million – a testament to the interest of such programs within the healthcare industry.

The third area is the use of exercise therapy in worker’s compensation programming. Over the past decade there are some significant programs implemented that contract with large employer groups and HMOs to use exercise both in a preventive and therapeutic format. These programs include strength and aerobic training geared to improve functional strength, reduce WC costs and reduce lost work days. Clearly these areas of clinical exercise have set a precedent regarding both the use of fitness programs in healthcare, and reimbursement for these programs through third parties.

Active seniorsEnter Cancer Wellness. There were few programs for cancer survivors for any type of health program in the early 1990’s. A few health clubs and hospitals had specialty exercises for persons with cancer, but programs really started to grow when Dr. Meryl Winningham from University of Utah began publishing the first sports medicine research in the field in the 1980’s (which became more widely read in the mid 1990’s), and champion cyclist Lance Armstrong made his remarkable comeback from cancer in the late 1990’s. Over the past decade the number of health clubs and hospital wellness centers that offer cancer exercise programs has grown exponentially. There are now hundreds of programs in existence nationally – in clubs, private training centers, Pilates studios, and hospitals. More are interested, but the main question remains – is this program reimbursable?

For those in health promotion who haven’t noticed – reimbursement has changed dramatically in the past 10 years. Programs that historically received reimbursement (such as cardiac rehab), have been cut dramatically (while, ironically, cardiac operations and prescription medication costs have escalated three-fold). However – that doesn’t mean that reimbursement doesn’t exist for health programs, you just have to know where to look. An example is smoking cessation classes. Instructed by counselors and physician assistants, most of the reimbursement for these classes (and nicotine replacement therapy) is funded by state tobacco settlement grants and initiatives, which is very helpful in terms of passing along savings to patients.

Is reimbursement possible for cancer wellness? Select groups from areas in the US are working with local health plans, or pharmaceutical companies to capture their markets in terms of offerings to patients. For those who are interested in looking towards reimbursement for their program – here is some advice for getting started:

  1. Find out how many persons in your region are cancer survivors. Your local cancer treatment center should have statistics. Most areas have well over 1,000 new cases per year. You may also market to persons who have had cancer diagnosed years before. They may still attend support groups, or be on mailing lists from the same cancer centers.
  2. Establish a relationship with a local oncologist or treatment center. You may be able to hold exercise programs on-site and bill through your community local oncology or rehab clinic. This is similar to billing for group therapy or physical therapy. However – it should be remembered that this is a wellness program, and there are specific wellness codes that physicians and billing departments can bill under.
  3. Know your billing codes. In order to receive any form of reimbursement – you should know the system you are working in. There are resources that may assist you in learning coding for wellness programs, and you should take advantage of them (see resource section).
  4. Know what outcomes you are interested in reporting. For many cancer patients, a reduction in lymphedema, less pain and fatigue, and increases in fitness parameters are an excellent way to show that the program is working well. Improving these outcomes will also boost attendance, which is another important aspect of the program (compliance).
  5. Look for local sponsors. A proposal to local pharmaceutical reps may increase your odds of receiving reimbursement – through a third party such as a pharma company. They often set aside money in their budgets for health programs, and cancer wellness may fit the bill very well.

Health Care Collage Words Medicine BackgroundWhat to do once you’re up and running? In the first year it’s important to have a working budget. This may only lend itself to 3-5 patients coming to your program to start. Once they experience the benefits of exercise and wellness, they will quickly tell their fellow patients. It’s also important to spread the word via small group lectures and fitness demonstrations. Since most cancer centers have monthly support groups, it’s a great place to conduct a 30 minute lecture and demonstration for local survivors. Next – a couple of sample articles for the local newspaper (perhaps a series) on the benefits of exercise for cancer survivorship. There are new research reports out each month. Lastly – call your local radio show and book a time to discuss exercise for cancer survivorship. They would love to have a topic like this for their time slots.

The initial year is a “make or break” one for survivor programs. In my experience with many of my national programs – those that got some funding, and did some promotion have programs that have grown. Those who relied solely on patient membership fees in many cases have not been able to grow their programs. Funding is important, and reimbursement may be a part of patient’s health plans, so it would benefit you to contact local health plan reps to see if they cover the cost of post rehab exercise, and/or health club membership for their members.

Cancer Wellness is one of a handful of growing wellness programs in this country that health specialists AND physicians are looking to for avenues of increased reimbursement, or sponsorship. There are many local and regional resources (cancer treatment centers, non profit organizations and foundations, pharmaceutical companies, and regional HMOs) that may be interested in funding such programs. It is up to you to start looking for financing as you start your education program. This will ensure future success at both the educational AND financial levels.

Written by Eric Durak, Medical Health and Fitness ©2011-2014. Eric Durak is the President of Medical Health and Fitness, and Director of the Cancer Wellness CEU Program in Santa Barbara, CA. He is also the author of The Reimbursement Book for Health and Fitness Instructors . Contact him at edurak@medhealthfit.com / 805-451-8072. www.medhealthfit.com

Durak, EP. The important link between exercise and cancer. ACE Matters. Pg. 13, Sept. 1999
Author – Exercise reduces cancer treatment side effects. Health News. 12(9):pg.8, 2006
Jones, LW, Denmark-Wahnefried, W. Diet, exercise, and complementary therapies after primary treatment for cancer. Lancet Oncology. 7(12):1017-26, 2006.
Korstjens, I, Mesters, I, et al. Quality of life of cancer survivors after physical and psychosocial rehabilitation. European Journal of Cancer Prevention. 15(6): 541-7, 2006.