The Special Populations Opportunity

When asked about their highest priorities in life, Americans say that family is No. 1, their current health is No. 2, and their future health is No. 3. Yankelovich Monitor, 1998

hen President Dwight D. Eisenhower had a heart attack 40 years ago, his Boston-based cardiologist, Dr. Paul Dudley White, recommended the unthinkable. Rather than con- fining his patient to a bed, until then a universally accepted therapy for heart attack patients, White recommended that the President begin a regimen of sustained, daily exercise. Reasoning that the heart is a muscle, and that muscles strengthen through use, rather than rest, White determined that the best medicine consisted of a progressive program of walking and biking.

Today, as you enter the world headquarters of the American Heart Association in Dallas, Texas, you will find a replica of the office from which Dr. White bucked conventional wisdom in prescribing a program of regular exercise for President Eisenhower. This replica ought to serve as a shrine for the fitness industry in the coming decade.

For we now know that White started a revolution that subsequently has been preserved and energized by a host of leading medical men and women. Dr. Ken Cooper, Dr. C. Everrett Koop, Dr. Ralph Paffenberger, Dr. Steven Blair, Dr. Joanne Manson, and Dr. William Haskell have shown that a careful- ly calibrated program of regular exercise is central to recovery not only from heart disease, but from an ever-broadening spectrum of chronic illnesses and injuries.

EXERCISE AS MEDICINE

Over the past 40 years, research relating to the health benefits of regular exercise has proceeded down two channels. The first channel pertains to prevention. More specifically, it pertains to what the Surgeon General's Report calls the "dose-related protective efficacy" of regular exercise in preventing the development of a broad spectrum of chronic diseases. Evidence on this score is widely understood and becomes more conclusive every year.

Less well known is the second channel, pioneered by White, pertaining to the role exercise plays in recovery and rehabilitation from an equally expanding range of physiological and psychological health concerns. Whether the condition is stroke, cancer, obesity, heart disease, arthritis, diabetes, depression, anxiety, hypertension, chronic lower back pain, high cholesterol, osteoporosis, or urinary incontinence, a program of regular exercise is fundamental to recovery. There are seven reasons to believe that the recuperative power of regular exercise presents an almost incalculable opportunity to the American health club industry.

First, the very size of the populations with one or more chronic conditions is enormous. Consider the following:

· Over 50 million Americans (one in four adults) are hypertensive
· More than 37 million have arthritis
· 16 million suffer from diabetes; 40 million are insulin resistant
· 26 million are at risk for osteoporosis
· 18 million struggle with chronic lower back pain
· 95 million have cholesterol (LDL) over 200 mg/dL
· Over 100 million are overweight
· 58 million are obese
· 59 million have some form of cardiovascular disease
· 17 million suffer from some form of depressive illness each year
· 40 million suffer from sleep disorders


Collectively, the depth of this market surpasses, by many multiples, the traditional sports and fitness markets toward which health club marketing has, until recently, been exclusively focused.

Second, most of these conditions are, to a significant degree, age-related. Baby boomers are now moving into that part of their lives when they are more susceptible to incurring one or more of these conditions. Every segment of the special populations spectrum is projected to grow significantly in the decade ahead. For example, the number of men and women who are projected to incur some form of arthritis is expected to increase from the current 37.9 million to approximately 59.4 million by the year 2020 (Figure 10.1).