Improving our fitness through better health care
Can fitness centres make our health better? Can centres improve our mental wellbeing, or are they simply just places to enhance our bodies? In this article we might review our thoughts about fitness centres being regarded as simple gyms filled with equipment. They are not and this is why I talked to Daley Denning (shown), manager of the LED centre at Seaton, to find out more about his service, career, and training.
LED provides 13 fitness and gym centres in East Devon, offering a variety of activities from the traditional gym set up to swimming and tennis. The coastal town of Seaton, where Daley works for most of his time, has a larger population over the age of 50. Therefore, he considers the average age of his fitness centre is around 50. The total local population of Seaton is 8882; females are slightly greater (4713) than men (4169). Over 65s account for 3855 (43%), which surprised me given that I would have estimated that age group to be around 60%. According to Statista.com there has been a 58% growth in gym/fitness centres over the last 10 years up to 2020. The personal trainer industry is valued at £684 million, and according to a 2019 report, there are about 57,000 fitness instructors in the UK. [IBISWorld – 2019-20] with 47% found around London.
The whole concept of personal trainers engages with the apparent question do we all need one? What comes to mind is safety and appropriate activity for those not so fit. High blood pressure, overweight, respiratory disease, postoperative care and musculoskeletal problems can all be singled out. The centre has an automated defibrillator AED and is checked religiously every single day. All staff are qualified to use the defibrillator and CPR and first aid. I wondered how Daley and his team approached new customers and registered with The Chartered Institute for the Management of Sport and Physical activity (SIMSA) as a governing body for fitness professionals. Once registered, external personal training is allowed.
How did he get into the role of a personal trainer?
When he started his career in fitness, he pointed out that it was common that people gave the reasons for wanting to keep fit, as losing weight in the main. However, while he enjoyed this connection, his passion went deeper. “I focus more on rehabilitation training. I prefer working with the elderly and those recovering from illness and accidents. I have a couple of clients that have recovered from critical illness, and also some have disabilities as well, which I have more of an interest in and I feel I can make more of an impact on those people.”
Daley found that his GP referral training helped him with the medical side. He explained that the centre has a chief referral lead with Level 4 training. When he first arrived at LED her knowledge helped him understand that there was more to it than just telling people how to use machines. And so he undertook his GP referral first, which is a Level 3 qualification. Although not a natural academic at school he was always into sport. As is so often the case, studying becomes more enjoyable as we mature
The process toward better health
There are several stages to taking on clients and of course, many just join the centre as a gym type facility. Still, as Daley describes taking referrals, the process is structured into the following components.
- Planning a bespoke programme
With the community GP services now providing an all-time low in face-to-face contact, gyms are not an ideal characterisation for their potential contribution to the community. However, having observed the fitness centre for over 3 years and talked to most staff, I felt this formal discussion was timely.
“At LED, it starts with an initial consultation where we get a thorough idea about people, what they’ve got going on, what their goal is, how they think they’re going to achieve it, and how we think we’re going to achieve it, so working together, working in SMART objectives as well.”
He discusses injuries, medication related to any impact on exercise. With injuries, Daley says they can point their clients in the direction of different instructors after building an excellent rapport to customise a programme after the induction process, fitness assessment, in-body assessment, and nutrition appointments. Of course, all this depends upon what the clients want. There are the usual forms, tick boxes, waivers for those who do not wish to embark on intensive programmes from the start. My impression is a service that exists but without mandation. Those experienced at using the type of facilities that LED offers can work alone, although help is always available. However, even when signed by experienced users, the team likes to ensure people are safe and working correctly. Induction is the first step where equipment is demonstrated. After this, Step 2 follows within the first two to four weeks of the initial induction to develop a custom programme.
“We tell clients what they should be doing, what sort of rep ranges of work and time spent on equipment, what weight (resistance) they should be using. We then book them in for a review (Step 3). The review is to assess how the programme is progressing. Then, in Step 4, we review that again and build body assessments (see below), which we try to do with everybody. This informs the client exactly what’s going on within their body. And then, we book a nutrition appointment which comes off the back of this ongoing monitoring. When we find that people’s ‘in bodies’ assessments aren’t quite so good, we need to do something with their diet and exercise. So that comes into it as well.
The term ‘in body’ assessment might confuse readers, but this is also called ‘segmental analysis’. This is a section from my article last year when I submitted it to an in-body assessment. The client is provided with a chart to show the analysis and can use this to work toward improvement.
“Having a scientific background, measurements and statistics intrigue me. I admit I have a bit of a midriff stomach excess and had already done a crude measurement. This suggested I had about 15% body fat. Was my measurement accurate? Does fat matter to us apart from looking better for low fat? Are we at risk from our health if we carry weight?”
Looking at one of Daley’s case histories
“I have a lovely 87-year-old gentleman. He’s amazing, absolutely amazing. I think if you ask somebody when he exercises how old you think he’d be, I think they’d say 70. I believe he came into the centre 20 years ago as pre-diabetic. He reversed his diabetes. His blood sugar is now back to a normal level for his age. He’s lost an awful lot of weight. He worked on his hip replacements and is now a lot stronger. We do a lot of work on balance because that’s something he feels he’s not great at and something that’s he’s finding difficult in his everyday life. He can stand on one leg for 10 times the time of an average person of his age.”
AUTHOR NOTE: Proprioception is the name we give to movement without being aware of our surroundings because the information from joints, tendons and skin all play a part in providing automatic positioning so we do not fall through nerves that act as motion sensors . One of the aims of physiotherapy is to retrain our joints and muscles to exert better balance and improve proprioception to avoid falls. This becomes even more important as we age and stiffen up with muscle weakness. Falls are one of the most frequent causes of early deaths and deterioration in the elderly. See article on falls
Referral schemes to improve our health care
The referral scheme is not just for GPs, but also for other health professionals. Referrals are made from physiotherapists, the NHS, and the private sector. When referred, they’re signed off and deemed safe to exercise. After that, they go straight to the chief referral lead. She’ll make an appointment and then start putting a programme together for that person.
FORCE, the cancer charity, is based around Exeter and the Royal Devon and Exeter Hospital and is a community-based programme. Those referred from oncology are free of charge. There’s also a discounted rate for the GP referral scheme at £4.10 per session and £22[i] for an assessment. The assessment involves before and after, which takes an hour each time run three times a week; Monday, Tuesday and Friday at £4.10 each time and they can come to one of those or all three of those. Without a referral from the GP, the price is £7.50 per session. If someone comes in with a medical condition, they need to be referred back to a health professional to get a signature to say they’re safe to exercise, to cover us and obviously to cover them as well. Certain medical conditions are out of the centre’s scope of practice, and these need to be signed off if physical activity is going ahead.
The centre receives about three to four referrals a week and a report is maintained for every person that comes for screening beforehand. General things like blood pressure, peak flow for lung function, and the Edinburgh Warwick scale for mental health are used to measure how that person feels. At the end of the scheme, the process is repeated. Each scheme runs for 12 weeks unless the client is not thought to be safe exercising on their own if this happens, the scheme is extended. I asked about the most challenging features from people using the centre and maybe he would like to change? “Some people don’t want to know, they don’t want your help, which is understandable. A lot of people will come in and don’t like to be interrupted. It’s just gauging really who wants the help, who wants to be spoken to and who doesn’t. People come in for lots of different reasons. Some people come in just to switch off and crack on. Some people come in for the social aspect, they come in to chat. It’s just trying to find that balance really as to who you speak to. Obviously we try and speak to everyone but who wants an in-depth conversation, who wants just a hello, and who wants to crack on really.”
Mental health problems
Daley’s Level 4 mental health qualification training was at Exeter University through the Wright Foundation. He became pretty enthusiastic at this point and considered it a fantastic experience and probably his best course so far. For work experience, he went to Dawlish Mental Health Hospital. “It’s a forensic setting, so they’re certified by the courts to go to the hospital. So I can’t disclose too much, but in that setting, I was working in the gym environment there. So with the qualification, you can work with quite severe mental health conditions.”
Daley points out that it would be rare to have anyone come in with a severe mental health condition but generally concludes anxiety and depression are more common today. He believes everyone has some sort of mental health battle, especially after the COVID pandemic. We talked about the latest concern that has awoken our society around gender identity. I asked if this was something taken on by the fitness centres? He felt it was not something he had experienced and didn’t feel qualified to comment presently, although he recognised the question’s value.
Fitness centres are not just gyms!
It is clear from Daley that the fitness centre does not just offer one type of health programme but contributes to physical fitness in improving the medical side of health, supporting cancer recovery and mental health support. It is reasonable to say that a well-staffed and trained fitness centre is more than a gym and should be considered part of the national healthcare system. Over my three years of using this centre, it is more than a gym, and I have made it part of my weekly routine. The staff are engaging and always have time to discuss any aspect of the centre’s health. I am grateful to Daley and LED for providing this interview conducted on 26th July 2021. There are many similar organised centres in each town and city to offer advice and help. You can read more articles about the activities of this author and the fitness centre on consultingfootpain.
During 2020 I took a look at the gym or fitness centre and hope that some of these topics might be helpful. These include an article by Barney St Anton, another LED fitness instructor who has written about calories.
- It’s a fitness centre not a gym
- Am I Fit to Use the Gym?
- Calories You and Your goal by Barney St Anton
- Calories and all that we do in the gym
- The idea of crashing a gym session
[i] The prices given in this article were correct at the time of publication but may change.
Thanks for reading ‘CAN FITNESS CENTRES CONTRIBUTE TO BETTER HEALTH CARE?’ by David R Tollafield
Published by Busypencilcase Communications. Est. 2015
3rd January 2022