A patient arrives at your practice interested in learning more about how to get started with your medical fitness program. In sitting down with them to conduct your motivational interview and detail the benefits of your program, you discover that…
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The biggest question fitness trainers need to ask themselves is “Why do you want to work with the chronic populations?” Is it because:
a) The stats (IDEA, IRHSA) out there say it is the fastest growing population/market?
b) You really want to help people that tend to have multiple issues because it is rewarding?
c) You feel drawn to it because one of your clients now has a condition?
d) You like figuring out puzzles?
e) All of the above.
All of the above factors play a role in working with chronic conditions. It takes a much different approach than working with the general population. For starters, what defines a chronic condition, besides something that is ongoing?
The Center for Managing Chronic Disease defines it as such:
“A disease that persists for a long time. A chronic disease is one lasting three months or more, by the definition of the U.S. National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear. Eighty-eight percent of Americans over 65 years of age have at least one chronic health condition (as of 1998). Health damaging behaviors – particularly tobacco use, lack of physical activity, and poor eating habits – are major contributors to the leading chronic diseases.”
What I find so fascinating is in the last sentence: “health damaging behaviors”. That is the core of working with chronic conditions; you want to impact a person’s or client’s health damaging behavior. If they are coming to you with a condition, we already know they have one, if not more, behaviors that need to be addressed and changed. This means you not only have to work with the biomechanical/physical implications of their condition, but the emotional/psychological aspects of it as well. Welcome to the world of medical exercise, a very rewarding and extremely challenging area of the fitness industry–a part where you will need to wear several different hats: health coach, sleuth, guide, emotional supporter, cheerleader, and fitness professional. Therefore, you need to be prepared.
Start by deciding which medical conditions you are interested in; a great list can be found at Chronic (Medicine) on Wikipedia. Next, find out if any of these support organizations offer a certification–National MS Society, Arthritis Foundation, and Cancer Training Institute are some out there. Visit websites and request information. Most support organizations have a lot to offer on their websites, or try googling the condition itself. It may take some time, since with search engines today advertisements tend to come up first. Research support groups in your area, and ask to attend a meeting. This will expose you to the emotional side as well as the physical limitations of their condition, and what difficulties they face on a day to day basis. This will aid you in designing an appropriate exercise program for their specific needs. Read, read, and read some more, and then be critical. A lot of information is very general; dig deep, and if an article or website does not have the information you need, ask a professional.
Create a Board of Advisors
As a certified fitness professional, I did not go to medical school or physical therapy school, nor do I have a degree in nutrition. But I have learned a lot over my 20+ years working with special populations–and as a person who has fibromyalgia–but I don’t come close to knowing enough. As clients with conditions come through my door, many on numerous medications with eating habits that would make most trainers cry, medical questions come up. For example, “Can I eat dairy products if my medication says not to take calcium supplements with it?” Or “I find every time I walk upstairs I get out of breath–does that mean it is my condition or am I just out of shape?” And “Have you heard that Maltitol is bad for you, and what is Maltitol?” At this point, unless I feel there is a huge medical issue that needs addressing (then they get sent to their doctor immediately), I contact the appropriate person on my board and ask them the question. The board also helps with disseminating and understanding clinical test results that clients give me, or any other physiological question that is beyond my knowledge. It also builds your credentials as a professional when dealing with the medical community.
Scope of Practice
Most fields in the medical community are clearly defined by a scope of practice. From having spoken with more than a few doctors, they are very hesitant to refer to personal trainers, mostly because of injuries as a result of improper exercise programming or what they have observed in the gym. In the medical fitness industry, it is even more imperative to be precise and transparent with what you are doing. When a new client comes to me, I contact their doctor or physical therapist–usually via e-mail or letter–detailing what I have found from my assessment, the condition, and what kind of program I am designing. This gives them the opportunity to comment or change it accordingly. It also opens up lines of communication. The professional knows I am not going to have a spinal fusion client performing kettle bell swings right out of the gate; they will see my progressions and know that if something is off, I will refer back to them.
One of the hottest issues in the fitness industry is licensing; for it, against it, I am not going to argue it here, but as a fitness professional, I need to make sure I do not prescribe or diagnose. Even if I am 99.9% sure a person has impingement syndrome because of all the presenting symptoms, I am not going to say it. I am going to refer them to a medical professional. Especially with this population, there are a lot of cross over issues, and it is not our responsibility to diagnose but to help manage and improve their condition.
Empathy and Trust
Working with chronic conditions requires a lot of empathy and the ability to set boundaries. You need empathy more than sympathy; if you cannot get inside what they are going through pain- and limitation-wise, it will be hard to establish trust. Establishing trust is the biggest tool you can develop–my clients trust I will not hurt them, make them worse, or ask them to do anything they cannot accomplish. If you get the opportunity to attend a support group or speak with people who have chronic conditions, most want to get better, but don’t know how. They are afraid of making things worse; even the avid exercisers who have tried to “fight through the pain” find it doesn’t work, and are at a loss as to how to proceed. You have to understand how life changing their condition is, where they started, and where they are right now. It can help to take courses in health coaching or read up on behavior modification– even better if you can find something geared toward the specific condition you are dealing with.
Avoid the “over-empathy” trap, because people with chronic conditions can use it as a crutch, too. Balance in sessions is important; include activities they really like to do in with the exercises they hate.
I guarantee the exercises they hate are the exact ones they need to do the most! Offer rewards, if they do their homework exercises, or it could be just to get through a session. It can be difficult to manage both their emotions and their physical selves; if you don’t feel prepared, refer to an outside professional. Yes, you may lose your client, but in the long run, it gains you credibility and more trust.
Recharging and recovering are the new buzz words in the health and fitness industry. It is even more important in the chronic condition realm, for both clients and professionals. More than in any other population, chronic conditions will sap your energy, your strength and sometimes your emotions. Most of this community will not see huge improvements like general exercisers; in some instances you will observe regression. They will have good days and bad days; they have challenges every day of their lives–just getting out of bed and getting ready for the day can seem like climbing a mountain. Then we come through the door and want them to do exactly the last thing on earth they want, which is to move more. They may be cranky, and in the case of depression or mental illness, downright nasty, leaving you to pull all your happy tools out just to make it through the session. In this case, what do you do to recharge your batteries? Funny as it seems, pay attention to the advice you are giving your clients–often times it can go both ways. I tell my clients to meditate, get a massage, plan a fun outing, or simply review their happy journal. These are the exact activities that recharge me!
It is easy to work, work, work, and this clientele is more demanding of our time and attention. Don’t ignore yourself; make sure you work in time to rebalance. Put it on your calendar as faithfully as you do your workouts or doctor’s appointments. All work and no play will bring on the exact condition in yourself that you are working hard to alleviate. If you really want to serve the chronic condition population, lead by example, and make time to recharge.
Sharon Bourke is an MFN member and the owner of Life Energy Fitness. At Life Energy Fitness, her goal is to identify where the compensations are and to help your body relearn proper movement patterns. The results are more energy, less chronic pain, an ability to participate in activities you love, and to prevent other problems from forming.
The Active Wellness Membership Teams compiled our top sales best practices to ensure a successful sales year ahead.
1. Create a Monthly Action Plan
A monthly action plan should include who, what, when, where, why and how for each action item ensuring your plan is set and ready for execution. Every plan should answer how you will obtain tangible leads to turn into sales.
2. Set Daily & Weekly Numbers
Understanding your daily and weekly numbers will help you strategize and plan for a successful month ahead. These goals will help you determine how many appointments are required, calls needed, etc. Our rule of thumb is to have at least 2x as many appointments as your daily goal with the theory in mind that 50% of appointments will be closed.
3. Create a Fluid Pipeline
Sales representatives cannot only rely on marketing to deliver leads. Your membership team should always be looking for referrals. They can obtain referrals at point of sale from their new member, member retention calls, outreach opportunities such as health fairs and local events, and corporate leads.
4. Understand your Client/Prospect
It’s critical for your membership team to understand their client’s goals, interest, and needs. Learning these three things will allow you to learn more about your client, empathize with their best interests in mind and build trust to steer the conversation and tour.
5. Follow the 80/20 Rule
It is very important for your membership sales team to practice the 80/20 Rule which is 80% listening /20% speaking. Listening to your client is key to building trust and understanding their goals and interests.
6. Role Play, Role Play, Role Play
Your team should role play and practice various scenarios as much as possible to build confidence and help your team be prepared for any request or objection. Consistent role-playing will also help them be more prepared and focused on the end result – the sale.
7. Ask for the Sale
The worst thing a Membership Representative can do is to not ask for the sale. There are two things that happen when you ask for the sale. The prospect either joins or has an objection which allows for another opportunity to walk through the objection with the prospect to ultimately signing. If you don’t ask, you lose on both these great opportunities.
Originally printed on the Active Wellness blog. Reprinted with permission. Written by Jerry Cardinali of Active Wellness.
Active Wellness is a specialty management company passionate about building active communities through fitness and wellness. Their mission is to BUILD AND INSPIRE HEALTHIER, ACTIVE LIVES through high touch interactions and technologies that support a better quality of life.
Looking at the Use of CPT Coding for the Wellness Profession. A Revised Look at Integration of Health Promotion within Healthcare.
It has been over 24 years since I wrote my first book on Medical Insurance Billing for the Health and Fitness Profession. The book was based on my years as an exercise therapist who used CPT coding for sessions with diabetic patients. Our use of proper billing, follow up letters, and reasonable pricing allowed our physician practice to bill out for some exercise sessions for over two years.
I have been asked recently to discuss the issue of reimbursement in our current system. Over the past 50 years the system has worked for physicians, and some allied health professionals, who have developed procedures that they will get paid for – and they usually perform specific types of services within their practice that allow them maximum reimbursement.
The times are changing, though. As they have since the mid 1990s when managed care tried to curb the amount of fee for service payments for specific services. If you talk with physical therapists, you would see that they have been concerned over a decade that they are unable to bill for the same amounts per service that they once did. A sign of the times? Perhaps – but in the wellness profession we need to dig a bit deeper to see how the system (that is not built for us) can work for us.
Billing for a Fee For Service Method
All healthcare agencies that use CPT coding to some degree. How they use them is a different situation. Some medical practices will submit bills to CMS or health plans and wait for payment. It is based on where they live, and what these agencies pay on an average for the particular service. Medical professionals will “bundle” a number of different procedures together for each payment in hopes of getting a higher payout. However – using CPT codes are also valuable for health promotion professionals to understand the “language” of health care. Let’s look at some examples of how these codes may work well for wellness programs.
Success Stories in Contracting
Perhaps one of the biggest success stories of working with healthcare is the Silver Sneakers program. They don’t bill directly for FFS – they have used specific CPT codes to negotiate for contracts for their wellness programs. Another example is Wellquest – the east coast company that competed in the senior wellness space with Silver Sneakers. They were also successful in negotiating contracts with regional health plan. They didn’t use CPT codes – but specific types of programming to convince health plans to buy into their model. There are a few companies that use versions of coding to help injured athletes come back to work. One is the Industrial Athlete in Detroit, MI. This company has been delivering preventive and therapy services to companies since 1989. Companies look to specific CPT codes to detail the particular type of program they are delivering. Of course – they may want to know what type of reimbursement is being delivered in their area, but many in the health club setting look to costs of personal training, which may range from $30-150 per session depending on the location. Let’s look at the types of codes that have been historically been used for exercise-related services. There are other worker’s compensation programs that are billing directly for personal training with staff that have been to the Occupational Medicine doctors, and now want to get back to work. With chronic exercise, many of them reduce their risk for future back injuries by almost 100%.
What are the Codes?
When I started investigating CPT billing codes, I uncovered what I thought was the Holy Grail for many allied healthcare personnel. They thought that because they studied an allied healthcare curriculum in school, and passed a state board licensure exam – they were entitled to receive reimbursement based on these skills. However – when I spoke with the American Medical Association (the national body that owns the © the CPT codes used by all healthcare professionals), I received a different story. The codes are merely descriptors of services. They are copyright of the AMA, and they are licensed to others to use them directly. For our purposes, we will be discussing CPT codes that have to do with exercise therapy, and some health education procedures.
Exercise therapy falls under the physical medicine section of the CPT coding book. They may be used for exercise prescription if an MD or other licensed professional wishes to incorporate these services in their practice. Specific codes for these services are as follows:
*Physician or therapist is required to have direct patient contact.
97110 – Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion, and flexibility. This code is used for limited visits, such as exercise training for rotator cuff therapy, or general use of aerobic machines. This type of training may encompass a one or two-week period, and be billed out ≈ 3-5 times.
97112 – Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, & proprioception. This code is used primarily by Physical Therapists and Massage Therapists for patients with neuromuscular deficits that require movement along with physical manipulation of body parts (along with pressure point work, etc.). This code would not be used for therapeutic exercise procedures, but specific movement programs such as shoulder or hip movement post stroke, or shoulder movements post breast cancer surgery.
97113 – Aquatic therapy with therapeutic exercises is used for any therapeutic activity involving water. Aquatic therapist and inventor of the Hydro-Tone equipment Dan Solloway of Oklahoma used this code for all of his work with patients referred to him for aquatic exercise therapy for over two decades.
97116 – Gait training is again used for persons who have orthopedic limitations with movement. It is used infrequently (or not at all) by most exercise therapists, but could be used in the expanding market of senior gait and balance prevention exercises.
97150 – Therapeutic procedure(s), group (2 or more individuals). This code is used for classroom programs, such as T’ai Chi, yoga, chair aerobics, therapeutic step classes, etc. This is designed for practitioners who teach in the group setting – especially with special population classes. One of the top codes that could be used in wellness.
97530 – Therapeutic activities, direct (1 on 1) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes. It replaces the old Kinetic Activities code that was used primarily for exercise therapy procedures. This code should still be used most by exercise therapists for 2-4 segments of 15 minutes each
97535 – Self care/home management training (e.g., activities for daily living [ADL] and compensatory training, meal preparation, safety procedures, and instruction in use of adaptive equipment) direct 1 on 1 contact by provider, each 15 minutes. This code is used primarily in the PT/OT settings, where patients need to regain day-to-day skills, as opposed to general strength and aerobic capabilities. Community Training (97537) is an extension of the self-care coding used primarily by PT and OT. However – now that more trainers and coaches are training in the home, this code may have a benefit relating to home care fitness and wellness programs.
97537 – Community/work reintegration training (i.e.: shopping, transportation, money management, vocational activities and/or work environment/modification analysis, work task analysis), direct 1 on 1 contact by provider, each 15 minutes.
97545 – Work hardening/conditioning; initial 2 hours. It is used for applying exercise to rehabilitate a person after an injury or accident, allowing return to competitive employment. The role of the exercise specialist would be to provide specific work-related exercises, and education principles to patients in these rehab settings (low back, carpel tunnel syndrome, lifting techniques, etc.).
97546 – Work hardening/conditioning; each additional 1-hour
97750 – Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes. It is used to measure strength and aerobic performance, and should be used for all testing procedures that do not require physician supervision or monitoring equipment (such as ECG). This is a good code to use for pre and post testing.
90900 – Biofeedback training; by electromyogram application (e.g., in tension headache, muscle spasm) is used by persons applying low intensity exercise and breathing techniques (Ayurvedic medicine, Hatha yoga, etc.) using EMG applications in the clinical setting. It is used by some exercise physiologists who perform relaxation exercises with patients.
90904 – Blood pressure regulation (e.g., essential hypertension) may be used for programs that offer stress reduction for hypertensive patients. Does not have to include monitoring equipment, but would necessitate improvements in BP control over time independent of pharmacological agents.
93015 – Cardiovascular stress test using maximal or sub-maximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report. It is used for cardiac and pulmonary testing, using ECG and monitoring equipment, physician supervised. This code should be used in the clinical exercise setting when performing testing services on patients who are involved in cardiopulmonary rehab services.
96150 – Health behavior assessment (e.g. – health focused clinical interview, behavioral observations, health-orientated questionnaires), each 15 minutes, face-to-face – initial assessment. Mostly for counselors, but could be used with health coaching programs.
Where is the Future?
Since reimbursement is harder to obtain for most licensed health care practitioners – it certainly won’t be something that anyone in the exercise community will be able to obtain simply by becoming licensed or accredited. The system is in a transformation mode. Most of the methods for obtaining reimbursement or contracting dollars will come from outcomes-based programming. Companies such as Optum are moving into this realm by their executive summaries relating to data analytics, outcomes, and ROI. Health and fitness professionals should do well to read the recent report by Marshall et. al. on outcomes in the health club setting. It has set the stage relating to the opportunities to work with clinical populations, and sets the stage for developing relationships with third party payors through a contract mechanism that will satisfy the needs of both parties.
CPT codes are the language of health care procedures, and they were made for physicians. However – that language can help health and wellness professionals to negotiate contracts that will help pay for memberships, personal or group training, nutrition, and mind/body health programs through the health club industry. After 25 years – I think that the disruption in the health care industry is big enough that smart health club companies and training programs will be able to offer comprehensive wellness services that will be reimbursed at some level. We see it as the next logical step in the progression of the industry.
Reprinted with permission from Eric Durak.
Eric Durak is President of Medical Health and Fitness, and has been involved with exercise and health care since the 1980s. He has worked with the insurance billing system with both physicians and physical therapists. He is the author of over 20 books on health and wellness, one being the Fitness and Healthcare Reimbursement Guide.
- Durak, EP, Shapiro, AA. The Fitness and Healthcare Reimbursement Guide. 7th edition, 2016. Medical Health and Fitness Publishers, Santa Barbara, CA
- Towards Better Outcomes. Optum Executive Summary Report. Optum.com/frostreport. 2016.
- Marshall, TF, Groves, JR, Holan, GP, Lacamera, J, Coudhary, S, Pietrucha, RJ, and Tjokro, M. Feasibility of Community-based Supervised Exercise Programs to Engage and Monitor Patients in a Post-Rehabilitation Setting. 2018. Am. J. Lifestyle Med. 13(1):DOI: 10.1177/1559827617750385
- Nieves, PN. How a synchronized approach addresses key drivers of change in the industry. Optum.com report, 2016.
Disclaimer: Medical Health and Fitness and the American Medical Association are not responsible for any claims filed by individuals or group practices using the five-digit numeric Physician’s Current Procedural Terminology, 6th Edition codes, service descriptions, instructions and/or guidelines are copyright as part of the publications of CPT as defined in the Federal Copyright Law, American Medical Association. All rights reserved. CPT (current procedural terminology) is a listing of descriptive terms and five-digit numeric identifying codes and modifiers or reporting medical services performed by and for physicians.
This representation includes only CPT descriptive terms, identifying modifiers for reporting medical services and procedures selected by Medical Health and Fitness for inclusion in this publication. The most current edition is available from the American Medical Association. No fee schedules, conversion factors, or scales or components are therefore found in CPT.
Medical Health and Fitness has selected certain CPT codes and service procedures descriptions and assigned them to various specialty groups of a CPT service or procedure descriptions and its code number in this publication not restrict its use to a particular specialty group.
Any procedure in this publication may be used by designated the services by a qualified health professional. “The American Medical Association assumes no responsibility for the consequences attributable to or related to an use of or the interpretation of any information contained or not contained in this publication”.
If you’re going to have a successful fitness center, you need a knowledgeable and enthusiastic team of employees working in your center. Like any business, a fitness center relies on customer satisfaction to survive and thrive, and customer satisfaction ultimately comes down to good customer service. Your employees may be providing fitness instruction or scheduling clients for yoga classes….
As a trainer, you wear many different hats during a typical work week. In turn, you are pulled in many different directions among family, friends and clients. If you are focusing on too many topics at once you cannot be in the moment, which can lead to a lack of client retention.
Being in the moment.
There is a lot of competition in the studio market and potential members/clients like to belong to a gym – and stay with a gym – where they feel comfortable. That puts the limelight on personal trainers to generate the positive client experience that is so important to retention.
This is why being in the moment is vital to gaining new clients and retaining current ones. If trainers are distracted this may be apparent through body language. Members may perceive being distracted as receiving bad customer service.
Members decipher up to 93% of what is said through body language.
When you think of excellent customer service, which companies come to mind? What makes them stand out from their competition? The employees that work for these companies are mindful and in the moment. They anticipate the needs of the client and help them accordingly. Being in the moment means that your body language and what you say conveys the same message. This is important to note for customer service and member retention.
The importance of not ‘zoning out.’
Members are constantly making decisions on how they want to spend their money. When trainers work with clients they should be mentally and physically present for each session. If a trainer zones out the trainer leaves their client wondering if the session is important to them. Trainers also miss out on potential new clients who may have wanted their services.
Clients will typically get your attention first by asking if there is “something else you need to do”. This should be a clue that they know you are not in the moment. You want to fix this quickly before the client stops training at your facility. Potential clients also watch to see how focused and attentive you are. I once had a member watch my training sessions for 5 months before deciding that he wanted to hire me. He said that he was looking at my training style, personality and attentiveness. He passed up two other trainers because they seemed uninterested.
When you and/or your staff have better self-awareness you are able to anticipate the needs of your members easier. You will also notice that more clients would like to train with you. By being in the moment every day your clients feel like they had an experience that they want to share with friends and family.
Do you know what message you’re conveying?
Nonverbal communication involves facial expressions, gestures, eye contact, posture, voice, and touch -and is actually more important then what is said verbally. Trainers are communicating non–verbally with clients and members all of the time and when mixed signals are sent, clients have to try to figure out how you actually feel. You may be speaking to your client and sound present and in the moment but is your body language communicating otherwise?
Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 18 years of experience in medical based fitness.
The Space Between Fitness and Medicine: Where “the Good You Do For Others” Brings the Reward you Deserve | Part 3
If you’ve been following this article/series since Part 1, here’s what you now realize:
There is a massive market of adults in “need” of exercise and nutritional interventions to rediscover the health they’ve moved away from.
Although the conventions of the medical field are poorly equipped to reverse chronic disease, and the conventions of the fitness field primarily offer protocols for training healthy individuals (even the “special pop” certifications address safety more than an aggressive approach toward dis-ease reversal), there is MASSIVE OPPORTUNITY for you to prosper in working with this “unwell” market.
In traditional marketing to the medical community, personal trainers most often mail flyers or brochures that describe the trainer’s qualifications and what kind of programs they offer. They may even personally drop the promotional material off at the medical office hoping to snag a bit of the medical professional’s time to talk about the program they could offer patients.
Looking first at direct mailings, the average response in 2017 was 4.4% (Pulcinella, 2017), which is actually a bit higher than it has been in previous years. However, mailings can be costly, and you should always consider where your marketing money is best spent.
As for dropping off material and hoping to catch the professional on the fly, not much chance there. Schedules are tight and the likelihood of them having time to chat when you happen in is very low. Even if you try to make an appointment to introduce yourself, you are unlikely to get a meeting. Your best bet may be to get to know the receptionist (this may take multiple drop bys), explain who you are and what kind of results you can offer to patients, and have the receptionist push the idea to the medical professional.
Reverse marketing is a little different. In reverse marketing, you are not going to the medical professional to sell yourself and your services. You are going to medical professional to have them sell you. Picture this, you are a new personal trainer in town. You know the value to your clients when you can refer them to the right professional when they need something that falls out of your scope of practice. You are interviewing doctors, physical therapists, chiropractors, massage therapists, registered dietitians, etc. to find the best people for your clients. In essence, you want to send patients to them. That makes finding time to talk with you a whole lot more interesting.
Now, when you do meet with the medical professional, it’s not a trick to talk about yourself. You should, indeed, interview them with the idea of finding someone you can refer your clients to. Come prepared. Bring a list of questions that you want to ask and take notes as you interview them. Questions might include, “How frequently do you recommend physical activity to your patients?” and “Of those that you do make that recommendation, how many do you think follow through with it and become more physically active?” More than likely, they will be curious about you and at some point will ask what exactly you do with your clients and what you offer. But, even if that doesn’t happen at the moment, when you do send them clients they will be thinking of you, and, when they are in a position to refer a patient to a fitness professional, yours will be the name that comes to mind.
So, as you try to get referrals from the medical community, reverse the standard thinking and build your network by finding the best people for your clients through your own interview process. If you send people to them, they will be that much more likely to send some to you.
Mark Nutting, CSCS*D, NSCA-CPT *D, ACSM HFD, ACSM CEP, is the Owner/Master Trainer at Jiva Fitness in Easton, PA. Mark is the PFP 2016 Trainer of the Year Legacy Award and NSCA’s 2009 Personal Trainer of the Year. He holds 12 certifications in the field, 38 years in personal training and health club management, and has been educating and coaching Personal Trainers for 36 of those 38 years.
Why Direct Mail Marketing Is Far From Dead, Steven Pulcinella, Forbes, 2017 August