Clients and Patients come to us because they want something to change about their life. That change could be the removal of physical pain, dealing with emotional distress, changing their nutrition in order to lose weight, or decrease the effect of diagnosed disease on their overall quality of life.

Interestingly, one’s desire to change doesn’t always lead to change. Change is abstract in that the new state of being that is desired doesn’t exist yet. Change is about the future. One’s future is connected to the present, which is the result of the past. Newton’s Laws of Motion give us a reference for thinking about change. In general, a thing will stay the same unless a force or energy acts on that thing. Therefore, change requires energy – and often sacrifice. Change can seem overwhelming and there may be fear of what might happen when change occurs. Old habits are hard to break. Even bad ones.

How can a practitioner from any discipline assist their client or patient to move from wanting to change to actually changing?

Motivational Interviewing (MI) is a communication strategy with tactical aspects designed to help the practitioner encourage the adoption of change behaviors. Change is about learning – learning not just a new way of thinking, but a new way of behaving.

Here is the most current definition:

“MI is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.”  (Miller & Rollnick, 2013, p. 29).

What is the language of change?

Language (n.) – the principal method of human communication, consisting of words used in a structured and conventional way and conveyed by speech, writing, or gesture. (Oxford Language Dictionary)

Change (n.) – the act, process, or result of making different. (Merriam-Webster Dictionary)

Using the language of change can be as simple as speaking the synonyms for the word change within the questions and statements constructed in a conversation with your client or patient: alteration, difference, modification, redoing, refashioning, remaking, remodeling, revamping, review, revise, revision, reworking, variation

The definition of language includes the use of gestures as a part of the communication process.

Physical gestures reflect ideas that the speaker has about the problem, often ideas that are not found in that speaker’s talk.

“Gesture is an act of the body, and the body has been claimed to play a central role in cognition.” (e.g., Barsalou, 1999, Glenberg, 1997, Wilson, 2002, Zwaan, 1999).

So what part of our physical body can be used to create and display physical gestures?

The face, the eyes, the hands, the trunk, just about any part of your body can be employed.

What physical gestures would be useful to employ when conducting a motivational interview?

Find Out More…

Learn more about Motivational Interviewing! Join Greg Mack for his webinar, Motivational Interviewing to Drive Sustainable Behavior Change. Register Now »

Greg Mack is a gold-certified ACE Medical Exercise Specialist and an ACE Certified Personal Trainer. He is the founder and CEO of the corporation Fitness Opportunities. Inc. dba as Physicians Fitness and Exercise Professional Education. He is also a founding partner in the Muscle System Consortia. Greg has operated out of chiropractic clinics, outpatient physical therapy clinics, a community hospital, large gyms and health clubs, as well operating private studios. His experience in working in such diverse venues enhanced his awareness of the wide gulf that exists between the medical community and fitness facilities, particularly for those individuals trying to recover from, and manage, a diagnosed disease. 

You and your business are probably spending too much time competing in the “red ocean”.

You need to get out of the red ocean and head to safer waters.

I know what you are thinking… What is a red ocean vs. a blue ocean?

This concept comes from the book, Blue Ocean Strategy, and it is important to understand for career growth.

“Red oceans represent all the industries in existence today. This is the known market space.”

This is the market for generally healthy, “fit” clients.

“As the market space gets crowded, prospects for profits and growth are reduced. Products become commodities, and cutthroat competition turns the red ocean bloody.”

Sound familiar in your journey to find clients?

“Blue oceans, in contrast, are defined by untapped market space, demand creation, and the opportunity for highly profitable growth.”

“In blue oceans, competition is irrelevant because the rules of the game are waiting to be set.”

So what does this mean for you?

The red ocean in health and fitness is going after the 15% of the population who is generally healthy and looking for fitness solutions to get fit or lose some weight.

This 15% of the population is looking for great glutes and great abs and benefit from any basic fitness program…

…AND EVERY SINGLE FITNESS BUSINESS IS MARKETING TO THEM.

Hence, it’s the red ocean.

So, What’s the Blue Ocean?

The blue ocean, on the other hand, consists of the millions of people with existing conditions like arthritis, Parkinson’s, or Multiple Sclerosis, for whom the great glutes and abs programs aren’t appropriate

This group is not currently being bombarded with marketing messages about fitness.

These people are in need of fitness services delivered by a specialized professional (which you can become) who understands their condition AND knows how to make programs specific to their needs.

It’s time to start swimming in the blue ocean and get away the “cutthroat competition that turns the red ocean bloody.”

Learn more about the “blue ocean” by watching this free presentation from MedFit Classroom, The New Blue Ocean: Capitalizing on the Opportune Space Between Fitness and Medicine.  Industry veteran Phil Kaplan discusses this important topic and how you’ll benefit from targeting this untapped market.

With most, if not all health clubs and fitness facilities closed, or in a quasi-opened state, thank God that we live in the age of technology. For many of us, being “quarantined” does not have to stop us from conducting business as usual.

We know for a fact that exercise can help boost the immune system. This should be reason enough for EVERYONE to be moving, not using this time as…

I am reading a recent article by Jonathan Mike (in PFP Winter 2019 issue) regarding scope of practice for personal training.  I feel that I should respond to this for a couple of reasons – first to add some clarity to his foundation of SOP in wellness, and second…

At Active, we’ve partnered with MyZone to enhance our proprietary heart-rate based training program, The ZONE because we know how important heart-rate training is for our members, and it’s helping our bottom line as well. 

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.

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.

Recharge Yourself

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.