Moving Toward a Community-Based Health Promotion Model: The Future Role of Fitness Centers
Given the proper guidance and direction from rehabilitation professionals, fitness centers are poised to become the future centers of health promotion for people with disabilities. I believe that the potential for a new market is quickly emerging.
Before this transformation can occur, however, there is an urgent need for fitness professionals to become more knowledgeable about disability. Based on my own experiences, most fitness professionals get very little training, if any, in exercise prescription for people with disabilities in their undergraduate and graduate program. The fact that there is such a lack of knowledge concerning how to work with people with physical, intellectual, and sensory disabilities is very troubling because it serves as a major barrier to participating in community-based fitness programs.
The Figure illustrates a conceptual model of health promotion for people with disabilities. This model takes into account the strong need to establish linkages between rehabilitation facilities and community-based fitness centers in order to extend the recovery process into the community. Fitness centers, with their ambiance and health-oriented focus, have the potential to become a logical extension of the rehabilitation continuum by offering a location in the person's natural environment to continue the recovery process, as well as serve as a bridge to other health promotion activities that often take place at these centers such as nutrition seminars, relaxation classes, and health fairs.
As the continuum of rehabilitation moves further into the community, physical therapists will have a growing number of opportunities to serve as itinerant consultants to local fitness centers. Although some physical therapists are beginning to rent space in more affluent fitness facilities, there is also a need to increase their involvement in the full range of public and private facilities, including senior centers, park districts, and local YMCAs. When the need arises to develop an exercise program for a new client with a disability, the physical therapist would assist in developing the program and would serve as the liaison between the primary care provider and the fitness instructor. The therapist would also be available to provide direct care if an individual needed specialized physical therapy services.
As shown in the conceptual model of health promotion presented in the Figure, the physical therapist and the fitness professional would work closely in providing the safest and most effective programs for people with disabilities along the entire health promotion continuum. The person would move from rehabilitation in an inpatient setting to clinically supervised health promotion after discharge, ultimately ending up in a local fitness center in close proximity to his or her home. Notice that the arrows pointing to physical therapy and fitness in the Figure are bidirectional. This illustrates that therapy and fitness may occur in any of the 3 settings. For example, some private physical therapy clinics hire exercise physiologists to implement fitness programs after an extensive evaluation is completed by the therapist. Several rehabilitation centers have fitness and sports facilities that are directed by physical therapists, exercise physiologists, or therapeutic recreation specialists. Many hospital-based and university-based fitness centers also employ physical therapists and exercise physiologists to direct cardiac rehabilitation programs.
In some instances, the person with a disability may not necessarily require physical therapy services, whereas on other occasions, a health club member without a disability may be referred for physical therapy by a fitness instructor. The major strength of this conceptual model is that the individual-with or without a disability-is offered the best care by qualified professionals. The arrows in the model also indicate that as a person's health shifts in either direction during his or her lifetime, the opportunity to receive inpatient acute care or community-based rehabilitation or fitness is always available.
For this model to successful, however, 3 things must occur. First, fitness professionals must strengthen their skills in health promotion and disability. A lack of knowledge in these areas will make it difficult to communicate with physical therapists and other rehabilitation professionals when providing services to individuals with disabilities. Steadward wrote that "expanding fitness professionals' knowledge about appraisal and exercise prescription will facilitate encouraging and increasing physical activity participation among people of all abilities."
Second, the rehabilitation profession must embrace the concept of extending its services into community-based fitness centers. A stronger relationship must be established between fitness professionals and physical therapists. Without the guidance and support of physical therapists, it will be difficult for fitness instructors to provide high-quality programs to people with disabilities. Physical therapists can enhance their visibility in community-based fitness centers by offering lectures at these settings so that fitness instructors become familiar with the local therapists and how they can be of assistance when developing programs for people with disabilities. Another way to bridge the relationship between therapy and fitness is to develop media-related materials that describe the role of physical therapists and how they can be of assistance to clientele who have a disability. This material can he disseminated to the managers of local fitness centers.
Third, because very few people with disabilities have the financial resources to join a fitness center, Medicaid and Medicare, insurance companies, and managed care organizations must be willing to pay for the membership and the consultative services of physical therapists who would work alongside fitness professionals in delivering health promotion programs to people with disabilities. Although in an era of downsizing this may sound improbable, the independent living movement and the freedom of choice over a person's health may lend support to the concept of receiving services in the community. Because space has become a premium in many hospitals, we may also begin to see more and more therapists providing rehabilitation in community-based fitness centers.