The fitness industry and what really matters

Last night, I watched BJ Miller’s TED talk on “what really matters at the end of life.” Miller is a palliative care physician who, when he was 19, was in an accident that resulted in the loss of both legs and an arm. He poignantly discusses what matters to his patients as life winds down and how people nearing death can be better supported. “…namely, we need to lift our sights, to set our sights to well-being, so that life and health and healthcare can be about making life more wonderful, rather than just less horrible. Beneficence.”

I often feel conflicted about the fitness/movement/wellness industry. It’s prescriptive in nature, just like healthcare is prescriptive. Step by step exercises are to be done to fix/strengthen/tone/improve. Perhaps the bigger issue is the fact the step by step exercises and the prescriptions are created with the people who already exercise and move in mind. That number is remarkably small—in the US, 23.5% of the population meets the weekly minimum recommended amount of physical leisure time activity. According to the World Health Organization, that’s 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous intensity aerobic physical activity per week and muscle strengthening activity involving major muscle groups on two or more days per week. This means 7.5 out of 10 people aren’t meeting these requirements..

Yet, the health and fitness industry is a 30 billion dollar industry that’s grown 3-4% annually for the last decade. There is a disconnect, somewhere, and it suggests the people who prioritize health and fitness are willing to spend money on it, likely because it’s a hobby and a lifestyle, while the people who aren’t participating in leisure time physical activity are left to flounder, confused by the information that exists, afraid of hurting themselves, tired of feeling bad about what they aren’t doing.

I fall into the movement is a lifestyle category, and I am grateful there are people willing to teach people like me how to writhe across the floor, arm balance, and vault. I find movement fascinating, I like to feel strong, I like to have endurance, and so it is a priority, but over the years I have worked with many people who don’t love exercise and would much rather be eating a frozen yogurt than feeling the sensation of their muscles working or focusing on how they are moving a specific body part.

I first became aware of the discrepancy between people who like to move and people who struggle with it in college. My junior year, one of my many jobs was in a laboratory, performing follow up interviews with women who had participated in a weight loss program the previous year. I questioned them about their physical activity, charting what their activity levels looked like over the course of a week.

I remember the first woman I interviewed. She had sad eyes, and looked away as I asked her if she had done any aerobic activity in the last ten days. “No,” she answered.

“What about spending time on your feet moving around?” I asked. “Did you park far away from the entrance the last time you went grocery shopping?” (I was trained to ask about all possible physical activity if they weren’t doing anything structured.)

“No,” she answered. “Wait—I take that back. I did vacuum for twenty minutes last weekend.”

By this time, she was clearly feeling uncomfortable and guilty, and I was surprised and unsure of how it was possible to not do anything physical with the exception of vacuuming. I was also 21, working 3 jobs, a full time college student, and I worked out at least five times a week. Exercise kept me calm, and so it was part of my routine, but, I was learning, that didn’t mean it was part of everyone’s day, nor did everyone want it to be.

There is an element of punishment that exists in traditional exercise settings. You work out, push hard, sweat, perform 3 sets of 10 or to failure, whichever comes first. And yes, it’s true, these things make you stronger, but if you look around a gym, people who are exercising by themselves don’t look like they are having fun. They have a look of determination, of “I will suffer through this and get it done,” a willpower that not everyone has and many don’t want.

After the lab project ended, I got a job at an obesity clinic. I still had my job teaching spin and personal training at a local gym, my job at a corporate facility helping teach group exercise and doing administrative work, and my waitressing job, but I was busy exploring career possibilities and figuring out what I wanted to do when I graduated in the spring.

The obesity clinic, like the lab project, was eye opening. It was run directly following the cardiovascular therapy program and overseen by a doctor who came in once a week. She met with patients to discuss options for weight loss, including pharmaceutical interventions. There were two of us present at any given time, monitoring blood pressure, guiding the aerobic exercise, and helping those who expressed interest with strength exercises. The patients were, for the most part, kind and motivated to move. It became clear to me early on that, unlike a traditional gym setting, most of the patients felt safe exercising there. No one judged them and no one cared what anyone’s pants size was.

I started around the same time as a patient I’ll call Greg. Greg weighed over 500 pounds and wore a garbage bag wrapped around his right knee because he couldn’t find a knee brace large enough to fit him. He was quiet, shy, and always looked away when he was having his blood pressure taken with the thigh cuff, because the regular arm cuff didn’t fit.

He began walking on the treadmill. It was extremely challenging for him. He walked slowly, but consistently, three times a week, rarely missing a day. He lost over 20 pounds in the first month, water weight, the supervisor explained to me. “The weight loss will slow, but he will continue to lose if he’s consistent,” she said.

And improve he did. When I left ten months later after graduating to go work at a country club in central California, he had lost almost one hundred pounds. He kept showing up, and though he never opened up, he seemed to like the gregarious personalities that came through the clinic, chatting and laughing, creating a sense of community. Maybe more importantly he appreciated the fact that it wasn’t a traditional gym setting. No one cared about how fast/how hard/ how long he went. As long as he showed up, that was good enough for the staff.

The obesity clinic taught me that, while the act of moving is important, treating people like people and taking the time to listen and to ask questions about their families and lives or to simply let people be if that’s what they wanted created a different type of experience. A lack of judgement coupled with compassion seemed to go a long way in keeping people returning, even when they didn’t want to.

Miller says, “And believe me: almost everyone who gets into healthcare really means well—I mean, truly. But we who work in it are also unwitting agents for a system that too often does not serve.” I got into fitness to make a difference in people’s lives. I became frustrated with the lack of resources I had available to create experiences that were meaningful for people, so I looked elsewhere, searching for tools that would help me make the act of moving more interesting. I found what I was looking for in systems that take more environment based approaches, including dance, gymnastics, MovNat, and Parkour. I also found it buried in motor control research and psychology research, but perhaps the most important lesson I have learned is if you want to make a difference, you need to connect with the person, in some way, whether that means listening, not judging, or throwing in things the person enjoys in addition to the things you think the person needs.

I also accepted, somewhere along the way, that not everyone needs to love movement to reap the benefits of strength, mobility, and variability, but most people enjoy a challenge. Making life more wonderful, as Miller says, can be done through connecting with others, connecting with the environment, and connecting with the self. Movement is a way to create connections and the side effects of regular movement make life more full and, ultimately, more wonderful.

I trained a woman for four years who began seeing me after her knee replacement. She was not athletic. She didn’t really like the idea of sweating or moving in a dynamic way, but she did want to feel less wobbly and more capable. She was intelligent, active with the community, and, at 75, still interested in living a fulfilling life.

I trained her once a week on Tuesdays at 10. She was incredibly consistent and willing to do what I asked. She taught me about British Royalty (she was English). I taught her how to use her entire foot to balance and made her navigate obstacle courses. She shared with me stories about her mother and moving to Canada where she got her PhD. I helped her gain strength and feel confident picking things off of the floor.

She would come in occasionally, excited. “Jenn, I worked out in the garden for the first time in 3 years. I wasn’t worried about falling,” or, “Jenn, I was able to wear two inch heels and not feel tottery. They look much better with my dress pants than the flats.” These little things, I hope, enriched her life.

Over the course of our time together, she would have stomach upsets. The doctors did colonoscopies, but other than polyps that were to be watched, never found anything wrong.

She e-mailed me on a Monday in December to let me know she wouldn’t be in. “I seem to have a bug. I feel extremely weak and doubt I would make it up your stairs,” she wrote.

She was admitted to the emergency room later that week. An ultrasound of her abdomen revealed cancer throughout her organs. She died 6 week after her original e-mail, on my birthday.

Creating an environment that supports movement for people fo all ages and abilities is not only necessary, it’s where the fitness industry is failing. Life is experiential and about so much more than the perfect set/rep scheme or the most effective way to work your core. Creating less dogma and more compassion would benefit the fitness industry and maybe, just maybe, help us reach the 80% whose lives could be enriched if they felt better.

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