Nearly 18 million cancer survivors live in the United States, and worldwide that number is nearly 50 million. According to the National Institutes of Health, the aging population is contributing to the rise in the cancer survivor population since the incidence of most cancers increases with age. According to the National Cancer Institute, 39.5 percent of men and women will be diagnosed with cancer at some point during their lifetimes.
What does this mean to the fitness industry?
First, health club operators are missing an opportunity to fill an unmet need within your community while creating a new revenue stream by providing oncology exercise programs.
Second, there's a good chance that up to one-third of your club members are cancer patients or survivors. If your fitness staff has not received comprehensive training in oncology exercise, they may be harming those members.
1. Certain types of chemotherapy drugs can increase resting heart rate, blood pressure, and the risk of cardiomyopathy and congestive heart failure. The ACSM recommends 150 minutes of low-moderate intensity or 75 minutes of high-intensity cardiovascular exercise per week. Every cancer patient will have a different response to treatment; therefore, understanding the perfect balance of frequency, intensity and duration will ensure the safety and efficacy of cardiovascular training. Different levels of intensity must be utilized for those who are lower functioning, those undergoing active treatment, and those who have completed treatment.
2. External beam radiation alone or combined with lymph node removal places the patient at risk for lymphedema. Lymphedema is the swelling of the extremity or affected area from damage to, or removal of, the lymph vessels and nodes. Lymphedema can be functionally limiting, painful and disfiguring, and it is a potentially lifelong affliction. Understanding the proper progression of cardiovascular and strength training exercises is critical to avoid putting a strain on the lymphatic system. Doing too much too fast could bring on lymphedema. In addition, lymphatic drainage exercises should be added during each workout session along with educating the patient about signs and symptoms to be aware of.
3. Cancer surgery and radiation therapy can lead to scar tissue and adhesions as well as localized muscle spasticity. Range of motion limitations must be identified and addressed with corrective exercise programming. Patients should achieve at least 90 percent of the range of motion norms in any plane of motion prior to adding a load or extra resistance.
4. Once full range of motion is achieved, the fitness professional must be able to identify hypertonic/hypertrophic muscles. Certain exercises may exacerbate muscle imbalances and lead to pain and joint degeneration if they are not addressed appropriately. One of the most common examples is upper-crossed syndrome post-mastectomy. With the pectoral muscles shortened and possibly spastic, exercises like a chest press, push-ups, and even planks should be avoided until muscular balance is achieved.
5. Clients who experience peripheral neuropathy from chemotherapy and/or diabetes may have difficulty with their balance as well as performing fine motor skills with their hands. People with neuropathy in their feet should avoid activities that carry a risk of falling (treadmill) as well as anything high impact. Balance training is essential but should be practiced in the safest way possible. For people with neuropathy in their hands, holding dumbbells or bands can pose a threat to both the client and the trainer.
6. Both men and women who are undergoing hormonal ablation therapy are likely to gain upwards of 25 pounds. This extra weight increases their risk of lymphedema, diabetes, heart disease, lymphedema and future cancers (all of which carry an increased risk after chemotherapy as well). It is critical that these clients be referred to a registered dietitian who specializes in oncology. It is out of the scope of practice of fitness professionals, and the lack of understanding about which herbs and foods may interfere with treatment efficacy could place the patient in harm’s way.
7. Nearly 100 percent of patients undergoing cancer treatment will experience severe fatigue. Energy levels may change from minute to minute during a workout session and the fitness professional needs to be extremely attentive. A complete understanding of appropriate levels of intensity is required to keep the patient safe.
8. Patients who are undergoing or who recently completed chemotherapy may be immunocompromised as well as at a higher risk for bleeding and bruising. All precautions should be taken to minimize risk of infection. Patients should avoid public swimming pools, lakes, rivers and oceans.
9. Patients who have a PICC line in place must avoid exercising that part of their body. They should avoid high-impact sports as well as swimming or soaking because of the open lumens.
10. When offering group exercise classes for cancer patients, you should follow a protocol prior to their entry into the class in order to optimize the experience for each participant. A complete understanding of program implementation, assessment and evaluation, and constant evaluation by the instructor are required.
Many operators of medically based health clubs have recognized the need for and advantage of having trained cancer exercise specialists within their facility because they understand the need as well as the opportunity within their community. Unfortunately, they can only help a small percentage of the overall cancer patient/survivor population, leaving the majority to go it on their own or with untrained fitness professionals.
By offering programs with trained professionals to cancer patients and survivors, you not only give back to your community, serve a huge unmet need and help people through one of the darkest times in their lives, but you also generate a new revenue stream and utilize the facility during slower parts of the day. Most cancer patients and survivors are middle-aged and older with many already retired. They have different priorities, and place a great deal of importance on their health, well-being and quality of life, all while having the time and the means to take advantage of cancer recovery programming.
COVID has changed the face of the fitness industry with many clubs and studios closing their doors forever. Gyms that have survived have an unprecedented opportunity to meet a growing community need, increase membership and increase personal training sales. The majority of medical professionals do not have the training or the time to prescribe appropriate exercises to their patients. They simply tell them to exercise. Many patients will avoid exercise out of fear, while others will embark on an exercise program that may place them at risk for injury.
As a club owner or manager, you may want to consider offering a free membership for those currently in cancer treatment. Many people suffer huge financial challenges and are unable to pay for any extra services. This allows you to show good will toward your community as well as providing a plethora of marketing opportunities through free local and regional media attention. You can also have a needs-based pricing structure that allows for a sliding scale on both membership and personal training services.
Fitness professionals who have completed intensive coursework are at the top of their game and should be compensated as such. This is not to say they should charge more for cancer patients specifically, but they should be charging more than their counterparts with limited or minimal training.
From a strictly dollars and cents perspective, providing a certain number of free memberships will not typically cost the club anything. The doors are already open, the electricity is on, and the facility is already staffed. Another option would be to charge the normal fee but donate a percentage to a local cancer-related charity. According to Forbes Magazine, “Giving back increases engagement by sharing a mission and purpose with your customer base.” The 2018 Cox Business Consumer Pulse on Small Businesses survey polled 1,100 consumers and found that 71 percent of people who responded said they would spend more money at a small business if it supported a positive social or environmental cause. Inc. Magazine stated that consumers appreciate and support socially conscious businesses. It causes them to become emotionally invested, and they are 85 percent more likely to buy a product from that business.
It is a win-win situation that combines passion and purpose while increasing profit as well. "The industry is now embracing and accepting the space between medicine and fitness," said Lisa Dougherty, founder of the MedFit Network.
Are you ready to get on board and bridge the gap between fitness and medicine?
Andrea Leonard is president and founder of the Cancer Exercise Training Institute. The cost to go through the cancer exercise specialist training offered by CETI ranges from $549 to $999 for the course (500-page handbook downloads, more than 30 videos and practice quizzes, final examination, private Facebook community, business coaching and branding, and listing on the international directory). Continuing education credits are offered for ACE, AFAA, Canfitpro, CIMSPA, ISSA, NASM, NSCA, and more. Group discounts are available, and training can be conducted through live training at your facility, virtual ZOOM training or self-paced home study. For more information, reach out to Leonard at [email protected] or call 1-503-502-6776.