Almost Half of Adults Have a Long-Term Health Condition. Is the Fitness Industry Really Designed for Them?
There is a statistic that should make everyone working in the fitness industry stop and think. According to the latest Health Survey for England, 46% of adults aged 16 and over have at least one longstanding illness or health condition. The most commonly reported categories include musculoskeletal conditions, mental, behavioural and neurodevelopmental conditions, heart and circulatory conditions, diabetes and other metabolic conditions, and respiratory conditions. The same research found that 26% of adults reported chronic pain.
That's almost half of the adult population, and it raises an important question for our industry: does what we've built genuinely feel designed for them?
I'm certainly not suggesting that everyone with a long-term health condition needs a specialist gym or is incapable of using a conventional facility. "Longstanding condition" covers an enormous spectrum, from conditions that have relatively little impact on everyday life to illnesses that fundamentally change what somebody is capable of doing. But that's precisely the point. If almost half of adults live with some form of long-term health condition, perhaps the "average member" we've traditionally designed gyms around doesn't really exist anymore.
I also understand this subject from a very different perspective now. I've spent more than 25 years working in fitness, but I also live with ME/CFS, and that experience has changed my perspective on exercise more than almost anything I've learned during my career.
When You Work in Fitness, Exercise Seems Like the Obvious Answer
I've spent most of my adult life believing in exercise. I've built businesses around it, helped gyms grow and worked with personal trainers, operators, franchises and health clubs. I understand programming, progression, consistency and the enormous benefits that physical activity can provide.
Then you experience a chronic illness yourself and things suddenly become much more complicated.
Living with ME/CFS has shown me just how difficult the relationship with exercise can become when your body no longer responds in the way you expect. There are times when I want to train and mentally feel capable of doing so. Years of working in fitness tell me to get on with it, but I also know that what I do today can have consequences tomorrow or even the day after.
One of the defining characteristics of ME/CFS is post-exertional malaise, or PEM. NICE describes this as a worsening of symptoms following activity, which can be physical, cognitive, emotional or social. That deterioration can be delayed by 12 to 48 hours and can last for days or even weeks.
For somebody who has spent their career in fitness, that's a very different and sometimes incredibly frustrating relationship with exercise. We're conditioned to think about progression: another rep, a little more weight, another five minutes, greater consistency and improving on last week. In most circumstances those are perfectly sensible principles, but with ME/CFS, sometimes the smartest decision I can make is not to push myself.
That experience has taught me something I think our industry needs to understand much better. Exercise can be incredibly powerful, but exercise isn't one universal prescription.
"Just Exercise More" Isn't Good Enough
The updated UK Chief Medical Officers' physical activity guidance reinforces the enormous benefits of physical activity. At population level, some of the greatest proportional health gains can come from helping inactive people become more active, while maintaining strength and balance is increasingly important throughout life.
However, population-level guidance and what is appropriate for an individual with a particular medical condition aren't necessarily the same thing.
ME/CFS demonstrates that particularly well. NICE specifically advises that people with ME/CFS shouldn't simply be told to go to the gym or exercise more because doing so can worsen symptoms. It also advises against programmes based on fixed incremental increases in activity, including the approach it defines as graded exercise therapy. Where exercise is appropriate, the approach needs to recognise the individual's current energy limits, symptoms and medical circumstances.
The answer isn't for gyms to become frightened of helping people with health conditions. It's for our industry to become better educated about where and how we can help, what expertise we need and where our professional boundaries lie.
Long-Term Health Conditions Aren't One Market
We also need to stop talking about people with chronic conditions as though they're one demographic.
Someone with controlled hypertension may have completely different requirements from somebody living with severe chronic pain. Someone with arthritis isn't the same as someone recovering from cancer treatment. Someone living with depression isn't the same as somebody with COPD, and someone taking GLP-1 medication isn't the same as somebody living with ME/CFS.
Even two people with exactly the same diagnosis can have completely different capabilities.
Sport England has made a similar point in its work around health conditions: this isn't a homogeneous group. Barriers can include confidence, cost, time, uncertainty about where to go and a lack of appropriate opportunities, while people with long-term conditions or disabilities are significantly more likely to be physically inactive.
So simply adding a "chronic conditions membership" isn't the answer. Personalisation has to sit at the centre of the solution.
Perhaps We Need to Ask Better Questions
Traditional fitness assessments tend to focus on goals, weight loss, previous exercise experience, current fitness and how often somebody intends to train. They're all useful questions, but supporting someone living with a long-term condition may require a much broader conversation.
We may need to understand how activity affects them afterwards, what makes their symptoms better or worse, what a good day and a bad day look like, whether they're frightened of exercise and what their healthcare team has advised. Most importantly, we need to understand what success actually means to that individual.
Success doesn't necessarily mean losing three stone or running 10K. It might mean walking upstairs without stopping, playing with grandchildren, returning to gardening, getting out of a chair more comfortably, going shopping independently, maintaining strength while losing weight or simply having enough confidence to get out of the house.
For somebody with ME/CFS, measuring what happened during the workout may tell you very little. The important information might come 24 or 48 hours afterwards. Did that activity improve their life, or did recovering from it consume the rest of their week?
That's a very different definition of a successful exercise session, but perhaps it's a much better one.
Are We Marketing Fitness to These People Properly?
This is where I think the fitness industry needs to take a critical look at itself.
Think about how much fitness marketing still revolves around getting ripped, burning calories, pushing harder, smashing goals, having "no excuses" and transforming your body. There is a market for that language and I'm not suggesting we eliminate it, but it certainly doesn't speak to everybody.
Imagine you're 58 with chronic pain and haven't exercised for 15 years. Perhaps you're 70 and worried about losing your independence, you've recently completed cancer treatment, you're struggling with depression, or you're living with an illness that means your energy can fluctuate dramatically from one day to the next.
Does "NO EXCUSES" make you feel understood?
Probably not. In fact, it may reinforce the belief that gyms aren't designed for people like you.
This is why I think we need to stop simply selling fitness and start selling what appropriate fitness and physical activity can enable.
An experienced 25-year-old exerciser might primarily want access to equipment. Somebody living with a long-term health condition may be looking for independence, confidence, strength, mobility, energy, connection, support or a better quality of life. They might want to continue working, play with their children, walk the dog or remain independent in their own home as they get older.
Those are incredibly powerful outcomes, and the fitness industry already has many of the tools required to help deliver them. We may simply need to package and communicate those tools differently.
Create Pathways, Not Just Memberships
One of the biggest opportunities for established gyms is to stop assuming everybody should enter through exactly the same membership journey.
Why couldn't a club offer a Return to Exercise programme, Strength for Life, Healthy Ageing, Back to Movement, Beginner Strength, Move More or GLP-1 Exercise Support? These don't necessarily need to become permanent membership categories. They could be six, eight or twelve-week supported pathways designed to bridge the enormous gap between doing nothing and becoming a confident conventional gym member.
A pathway could include an initial consultation, appropriate baseline measurements, simple programming, coached sessions, regular check-ins, progress reviews and a carefully managed transition into mainstream membership.
You haven't necessarily changed the gym. You've changed how somebody enters it.
This is actually something we've already discussed in relation to the wider market. The fitness industry has traditionally spent considerable effort designing products for people already comfortable with exercise, while there is a substantial population who may require a very different route into the facility.
Onboarding Becomes Far More Important
For an experienced exerciser, onboarding may amount to an access card and an app login. For somebody who hasn't exercised for 20 years, that's nowhere near enough.
They need to know what to do, where to go and who to ask. They may need reassurance that they aren't going to look stupid, somebody to notice when they haven't attended and early evidence that what they're doing is working. Above all, they need to feel that somebody actually cares whether they succeed.
I'd build a structured first 90-day journey around that principle. It might include an initial consultation, coached first session, follow-up during the first week, two-week check-in, 30-day review and further progress reviews. The objective isn't necessarily to make them exercise more. It's to support them better.
And that support should adapt to the individual rather than expecting the individual to adapt to the system.
Technology and Human Contact Should Work Together
Technology has a huge role to play in making this scalable.
Your CRM knows when somebody joined. Your access-control system knows whether they've attended. Your app may know what they've done and your automation system can identify behavioural changes and deliver appropriate communication.
Imagine somebody who normally attends twice a week suddenly hasn't attended for ten days. Something should happen.
That might be an automated check-in, but it might also be an automated trigger that creates a task for somebody on the team to call them personally. The system identifies the change and makes sure it isn't missed, while a human being provides the conversation and support.
That's where I believe technology becomes incredibly powerful. Automate what should be consistent and personalise what should be human.
We could take this further. Where appropriate, technology could help record energy, symptoms, recovery and perceived exertion rather than only workouts, weights and calories. Sometimes the most important question isn't "How much did you do?" but "How did doing it affect you?"
Programming Doesn't Have to Be Complicated
Fitness professionals sometimes confuse complexity with quality. A programme isn't automatically better because it contains 14 exercises and sophisticated periodisation.
For somebody returning to activity after years away, simplicity can be incredibly valuable. Perhaps it's five exercises and 20 minutes. Maybe they start with machines, train once a week, walk or join a small group. The programme might need to change depending on how they're feeling and what is appropriate for their condition.
For some conditions, including ME/CFS, a conventional progressive exercise programme may not be appropriate at all without specialist clinical oversight. That's where professional competence becomes incredibly important.
Sometimes the best fitness professional isn't the one who knows the cleverest programme. It's the one who knows when they aren't the right person to provide it.
Strength Could Become One of Our Most Important Products
One area where I think the fitness industry has an enormous opportunity is strength.
We've spent decades marketing resistance training through bodybuilding, aesthetics and performance, but strength means far more than building muscle for appearance. It's about getting out of a chair, carrying shopping, climbing stairs, maintaining balance, preserving function and remaining independent.
That gives us a completely different way of marketing exactly the same equipment.
Instead of selling "build muscle", perhaps we sell "stay strong enough to keep doing the things you love."
The equipment hasn't changed. The conversation has.
And potentially, so has the market we're capable of reaching.
GLP-1s Create Another Significant Opportunity
The rapid growth of GLP-1 weight-management medications makes this discussion even more relevant. People losing significant amounts of weight may need appropriate support around maintaining strength, muscle and sustainable lifestyle behaviours.
Here is a growing population actively investing in improving their health, some of whom may have limited previous experience of exercise. They may need help becoming stronger, accountability, support establishing sustainable habits and an environment that doesn't judge them.
The fitness industry could be extremely well positioned to help, provided we stay within our professional scope. That doesn't mean gyms prescribing medication or straying into clinical advice. It means building credible exercise and lifestyle-support services and developing relationships with healthcare professionals where appropriate.
Beginner Classes Need to Feel Like Beginner Classes
Look at the average gym timetable: HIIT, Bootcamp, MetCon, Body Blast, Extreme Conditioning. Now imagine being 65, living with arthritis and having never exercised properly before. Where exactly do you start?
There's nothing wrong with keeping the high-intensity classes, but we could put something alongside them: Beginner Strength, Move Better, Back to Exercise, Strength for Life, Healthy Ageing, Low-Impact Fitness, Introduction to the Gym or Mobility and Movement.
Sometimes the actual exercise doesn't need to change dramatically. The perceived accessibility does.
People should be able to look at your timetable and immediately identify somewhere they feel they belong.
Our Teams Need Different Skills Too
If we're serious about serving this market, team development becomes critical.
Technical fitness knowledge matters enormously, but so do empathy, listening and communication. Can your team comfortably talk to a nervous 70-year-old beginner? Can they explain an exercise without jargon? Do they understand that somebody with a fluctuating illness might manage something one week and struggle with it the next? Can they recognise red flags and understand the limits of their professional scope?
Most importantly, can they listen without immediately assuming they know the answer?
Living with ME/CFS has taught me how important that last point is. The person living with the condition knows things about their body that a fitness professional cannot learn from a textbook.
Listen to them.
Fitness and Healthcare Need to Work More Closely Together
This could be one of the biggest long-term opportunities for our sector.
Fitness and healthcare still operate too independently of one another, despite appropriate physical activity playing an important role in preventing and managing many long-term conditions.
Why shouldn't more gyms build credible relationships with GP practices, physiotherapists, social prescribers, weight-management services, cancer-support organisations, local authorities, healthcare charities, pharmacies and employers?
The objective isn't for gyms to become hospitals. It's for fitness businesses to become trusted partners in helping people become and remain appropriately active.
But that trust has to be earned through appropriately qualified staff, clear referral pathways, professional boundaries, safeguarding, evidence-based programming, good data and measured outcomes. It also requires a willingness to say, "This person needs support beyond our competence."
That's not failure. That's professionalism.
Don't Underestimate the Power of Community
There is something else gyms can provide exceptionally well that has very little to do with equipment: human connection.
For somebody whose illness has affected their work, confidence, mobility or social life, becoming part of a community can be hugely valuable. Walking groups, coffee mornings, beginner clubs, small-group training, social events, workshops and member buddy schemes can all contribute.
Not everything has to involve sweating.
Sometimes the thing that keeps somebody attending isn't their programme. It's knowing that somebody will notice if they don't turn up.
From a human perspective that's incredibly valuable. From a business perspective, that sense of belonging can also have a significant impact on engagement and retention.
There Is a Serious Commercial Opportunity Here
None of this is simply about social responsibility. There is also a compelling business case.
If 46% of adults in England report at least one longstanding illness or health condition, we're talking about an enormous section of the population. Support, expertise, accountability, personalisation and community all have value, and they create opportunities for premium memberships, specialist programmes, small-group training, personal training, corporate health partnerships and potentially stronger long-term customer relationships.
They also create differentiation.
If your proposition is simply equipment, access and price, somebody can build a bigger gym or charge less. If your proposition becomes "We specialise in helping people who don't think conventional gyms are for them", you've created something considerably harder to replicate.
Stop Fighting Over the Same People
This connects with something I've written about previously. The fitness industry spends an enormous amount of money competing for people already predisposed to exercise. We advertise to existing gym users, take members from competitors, lose members back to competitors, discount, offer free months, install more equipment and repeat the process.
Meanwhile, millions of people remain outside the traditional fitness market. Some don't like gyms, some don't know where to start, some are frightened and some simply don't believe gyms are for people like them. Others have tried before and failed, while some live with conditions that genuinely require a different approach.
I don't see that as a problem.
I see it as one of the biggest opportunities our industry has.
My Own Experience Has Changed How I Think About Fitness
I've spent decades talking about the benefits of exercise and I believe in them as strongly as ever. But living with ME/CFS has given me a perspective I never expected to have.
I understand what it's like to want to train but know that training may have consequences. I understand the frustration of knowing what you used to be capable of and having to accept what you're capable of today. I've also learned that there are days when doing less isn't laziness; it's management.
Most importantly, I understand how inappropriate the traditional fitness mentality of "push through it" can be for some conditions.
That doesn't make me anti-exercise. Quite the opposite. It's made me far more interested in how we make physical activity work for the individual, rather than forcing the individual into our preconceived idea of what exercise should look like.
And I think there's an important lesson in that for our industry.
Perhaps We Need to Redefine What a Gym Is
For decades, we've largely built gyms around exercise. Perhaps the next evolution is to build them around health, capability and quality of life, with exercise as one of the tools we use to help people achieve those things.
The outcome might be greater strength, confidence, mobility, mental wellbeing, connection or independence. It might mean continuing to work, playing with your children, walking the dog, getting out of a chair or remaining independent as you age. For someone else, it might simply mean finding a sustainable relationship with movement that works with their condition rather than constantly fighting against it.
Almost half of adults in England report living with at least one longstanding illness or health condition. That should be a wake-up call for our industry, but not because all those people need gyms, exercise can fix every condition or every fitness professional is qualified to work with every illness.
It should make us question whether we're genuinely designing fitness businesses for the population that exists today, or whether we're still primarily designing them for people who are already healthy enough, confident enough and knowledgeable enough to walk through the door without much help.
The opportunity is much bigger than simply getting more people exercising. It's about listening better, personalising more, developing our teams, working more closely with healthcare, using technology intelligently, understanding our professional boundaries and creating appropriate ways for people to enter our facilities.
Most importantly, it's about meeting people where they are rather than where we think they should be.
If we can do that, the fitness industry can become far more than somewhere people go to work out. It can become an increasingly important part of how this country helps people live healthier, stronger and more independent lives.
And from both a human and a business perspective, that's an opportunity I think we'd be crazy to ignore.


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