Many studies show exercise may lower your risk of many cancers, but it also can help people heal after they get cancer. As such, some health clubs have been offering personal training to people recovering from cancer, and encouraging their trainers to pursue certification specifically relating to the needs of these clients.
According to the National Cancer Institute, 38.5 percent of people will be diagnosed with some form of cancer in their lifetime. Many of them would benefit from staying active after diagnosis, particularly under the supervision of a fitness professional. However, it can be daunting for club owners to triangulate whether or how to offer personal training to this population.
Cancer survivors risk many side effects if the trainer does not have specialized knowledge, said Andrea Leonard, a cancer survivor herself and creator of the Cancer Exercise Training Institute (CETI). Osteoporosis, kidney problems and damage to the heart and lungs are among the most commonly occurring side effects. With mastectomies, considerations such as range of motion and lymphedema—swelling in the part of the body that has received radiation or has had lymph nodes removed—often are overlooked as well, she added.
“It is preventable but can often progress untreated, and exercise can actually make it better or worse, so education on safe progression is critical,” she said.
Opportunities for Club Owners
Trainer Carol Michaels, who is the author of the Cancer Recovery Specialist course offered by the National Federation of Personal Trainers, has worked with cancer survivors for 25 years. Newer cancer treatments allow patients to live longer after a diagnosis, so having programs specifically for them means ample opportunity for clubs to gain new members, she said.
People from all over the country call Michaels to share that they have had a mastectomy, but no one in their gym knows how to work with them, plus many of them are afraid of injury or aren’t sure how to manage side effects that can linger for a year or two after a surgery.
“Gyms are losing those people to, frankly, people like me,” Michaels said.
Leonard’s program offers continuing education courses for trainers on 25 types of cancer. Club owners need to better understand how to serve this population in several ways—and that includes from a profit-center perspective, she said.
Like Michaels, Leonard seldom has interaction with club owners.
“From a business perspective, there is a huge potential for new clients, and cancer is overlooked,” she said. “[Gyms] are scared of it.”
They avoid it out of fear of liability, she said, and it’s “just not enticing for the personal trainer” who often pays hundreds of dollars out of pocket to take her course, which is the standard price for a course offering this many CEUs. They may not realize the opportunity to not only build their client base but also to make a difference in the quality of someone's life, she added.
"Cancer strips you of everything and leaves you feeling as if you have no control over your body," Leonard said. "As a cancer exercise specialist, we are able to help them take a bit of that control back."
For Mike Alpert, CEO of The Claremont Club, Claremont, California, partnering with an area hospital was the best approach to help this clientele. Since 2005, his club’s Living Well After Cancer (LWAC) program has run a 13-week program every winter, spring and fall in partnership with Pomona Valley Hospital Medical Center.
By the end of May 2018, LWAC will have put more than 1,000 people through the program, which is primarily focused on breast cancer. (It also offers a yearlong pediatric and young adult cancer program in partnership with City of Hope hospital in California that is an offshoot of LWAC; kids can even bring their best friend for support.)
Offering cancer wellness programs will change everything, he said.
“It will improve your staff retention, member retention and the way you’re viewed in the community,” he said. “I feel very strongly that our clubs should all be inclusive, easy to enter and comfortable for people with chronic injury and chronic illnesses.”
At the Jewish Community Center in Bridgewater, New Jersey, five personal trainers became certified as cancer exercise specialists (CES) through CETI in October 2017, said fitness director Joy McIntyre.
Its facility created a private studio for one-on-one training for cancer patients and survivors, giving clients a special place to focus, re-learn proper movement, and enhance their range of motion in a comfortable and supportive environment, McIntyre said.
“Our JCC is a second home to many, including myself,” she said. “It is devastating when a member I’ve known for so long is diagnosed with cancer, and I see how it affects them and their family and friends.”
Since 2010, a free 16-week program at Riverbrook Regional YMCA in Wilton, Connecticut, has offered a cancer-specific exercise program that also includes support groups, meditation Reiki and massage. Open to both YMCA members and non-members, the program is paid for by donations that come from a wide range of sources including an annual drive, private individuals and past participants.
The Y wants to keep its program free because “most survivors do not have a lot of disposable income to spend on personal training,” said Mary Ann Genuario, director of health and fitness and chronic disease prevention program coordinator at the Y. The program’s staff are trained to work with cancer survivors, she said, via the CES training run by Leonard, and they are compensated at the same rate as if training any other client, Genuario said.
The monetary return on investment for the Riverbrook YMCA is minimal, she said, but at the end of the program, non-member attendees are encouraged to become members of the YMCA.
“The reward in all of this is being able to be a part of their journey to recovery,” Genuario said.
At Fort Bliss, a U.S. Army post headquartered in El Paso, Texas, the return on investment has been great, as any help training those with cancer goes beyond the monetary cost, said Doug Briggs, director of human performance for U.S. ARMY/FMWR.
“It’s great to see the positive effects on loved ones and employees, as well as the person with cancer,” Briggs said.
The base started offering cancer-specific training in June 2017 after seven of its staff members were certified through CETI.
Health clubs don’t need to purchase extra equipment for any cancer-specific exercise program, Leonard and Michaels said. Light weights, bands and tubing can go a long way. Some gyms may want to make occasional use of a group exercise studio or yoga room for added privacy, however.
“They might want to have a little area for cancer survivors who want to exercise without a wig,” Michaels said. “It’s so hot, and some people don’t like to move with it.”
The most important thing is hygiene and that the equipment is clean, Leonard said, because participants may have impaired immune systems. Many immunosuppressive drugs and chemotherapy make the immune system less able to ward off infection.
“I recommend cancer patients wear exercise gloves or wash their hands often, put a clean towel on top of exercise mats, and don’t drink out of water fountains,” she said. In addition, trainers should not work with clients who have compromised immune systems if the trainer is the slightest bit sick whether that be with a cough, cold or the flu.
The Claremont Club has trainers, group exercise instructors and a registered dietitian who work with program members. They start with a support group, then move on to cardio, strength and conditioning, Pilates and massage. A dietitian coaches them about how to eat, cook and shop.
All of the instructors have a background and a degree in health sciences, plus a nationally recognized certification from either National Strength and Conditioning Association or the American Council on Exercise. They also attend ongoing educational lectures and webinars with hospital physical therapists that specialize in oncology.
Challenges to Starting a Program
Although club owners may see benefits to serving this population, many of them are reluctant to do so because club operators are afraid to take money from cancer patients, Leonard said. People in the midst of cancer treatments sometimes are unable to work and, therefore, have financial strains, Alpert said. Although Leonard understood the desire to be compassionate toward this population and not charge for the service, she said a club owner is still providing an important, specialized service that is a business opportunity like any other business opportunity. Still, no one should be turned away due to inability to pay, Leonard said, so club owners could offer a sliding-scale payment option.
Despite this option, some operators, such as Claremont Club, do offer the cancer programs for free by forming a 501c3, which helps with the challenge of funding the free programs. Alpert solicits donations and enjoys seeing the community come together to support the club’s efforts.
“It’s amazing to explain to people how much these programs have changed people’s lives. It’s been powerful, to say the least,” Alpert said.
Some club owners might be tempted to charge more for these programs due to the special training required to work with these clients, but Leonard cautioned against charging more than the average personal-training client would pay. However, for trainers hoping to earn more from the specialty certification, club owners may consider offering incentives to trainers for assembling small groups to train, as these groups could potentially bring in more revenue per hour than a group-exercise class.
Privacy, Insurance Considerations
Interaction between a patient’s medical practitioner and trainer is another challenge club owners must be familiar with before starting a cancer-specific exercise program. At the Claremont Club, a patient’s doctors are involved “all the way,” Alpert said, and all HIPAA information gathered on an attendee is stored in a locked cabinet or digitally encrypted.
HIPAA requirements prevent trainers and club owners from talking to the patient’s doctor, but if the trainer goes with the client to the doctor, such meetings can get the trainer a foot in the door to earn referrals. Leonard also recommended trainers inquire about speaking with support groups in hospitals. This gives the trainer great exposure, offer valuable advice and may lead to future clients.
Each club owner should check his or her insurance policy, but general liability insurance should cover most issues that could arise related to injury, Leonard said. Trainers should get a medical clearance form from the participant’s doctor, and the participant should sign a liability release.
Several agencies offer certifications and training for trainers who want to work with people recovering from cancer. The American Academy of Health and Fitness, the American Council on Exercise; the Certified Professional Trainers Network, the National Federation of Personal Trainers, PTA Global/PTonTheNet.com and World Instructor Training Schools are currently either offering CETI courses developed by Leonard or are in the process of launching them, she said.
Leonard continues to teach live workshops if there is interest and demand in a given city. The American College of Sports Medicine (ACSM) offers a similar CET program for ACSM trainers.
CETI offers a Breast Cancer Recovery BOSU Specialist course and is developing a PoundPoms for Recovery course, both of which address specific issues that commonly arise post-surgery/treatment for breast cancer patients.
“We create a fun environment that takes them into the fitness recovery mentality and out of the clinical mentality,” Leonard said.
In addition, MedFit Network has a directory of fitness professionals who are trained to work with people who have chronic conditions. They work with cancer organizations to refer people to their directory to find trainers. The non-profit organization also is offering education sessions at its Medical Fitness Tour events around the country.
Across the board, CETI's CES course runs roughly $400 and includes four handbooks, totaling 500 pages; four video modules; and four tests of 25 questions. Upon completion, the certified trainer is listed in the cancer exercise specialist directory. They also receive a one-year membership and listing with MedFit Network. Participants have 180 days to complete the course, and both home study and live workshops are offered. For the latter, participants get two days of training as well.
Some individuals, such as Michaels, are critical of re-credentially every few years because of the cost to trainers who already struggle to earn a living:
However, Leonard said that, cancer survivors are understandably cautious about forging a relationship with a trainer. They want a trainer who has stayed on top of his or her education, has a credible certification or training, and has remained interested in maintaining their education. Some courses don’t require any continuing education, but knowledge about how to treat cancer is evolving rapidly so not keeping up with that knowledge is dangerous, Leonard said. She updates her curriculum every two years. She cautioned trainers against taking “cheap courses” that have sprung up due to competition among the various certifying bodies.
“There is no such thing as a cookie-cutter workout for cancer patients,” Leonard said.