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Seminar Title

“Untapped Markets – Ageing & Rehabilitation”

Summary

David Stalker, Executive Director of the Fitness Industry Association (FIA), set the scene

by highlighting the fact that the population of the United Kingdom is ageing at an

unprecedented rate. This creates a commercial opportunity for our industry. The issue

has never been higher up the policy agenda either, with the direct cost to the NHS of

strokes estimated at £3 billion every year, among a host of other diseases that affect the

general population. The FIA is leading the way on the agenda through its involvement in

the Department of Health’s Responsibility Deal for Physical Activity.

Jason McMahon, UK National Sales Manager for Balancemaster™, said that

Balancemaster™ had been originally designed to help prevent falls but now a wealth of

research supports its use in many other areas besides.1 The health and fitness sector can tap into the older market using the Balancemaster™ rotary device, which is a medical

class product.

John Searle – Chief Medical Officer, FIA

With experience as a Consultant Anaesthetist for over 35 years and now in his private

personal training practice, John emphasised that working with older adults was both

rewarding and fun, not to mention a massive opportunity.

To understand the older market, it is important to think in terms of life stage rather than

chronological age. John defined the life stages as:

• Transition, 50-64 years

• Older, 65-75 years

• Oldest, 75 plus years

• Frail!

To highlight the scale of the opportunity John pointed out that there are currently 9.6

million people over the age of 65. By 2015 there will be 12.7 million. The opportunity is

large and growing.

As we age, our bodies undergo physiological changes such as aerobic and cardiac

decline, decreasing lung and renal function, and decreasing muscle strength, cognitive

function and motor skills. We also become more prone to illness and diseases like heart

disease, stroke, cancer, arthritis, depression, dementia and osteoporosis.

Falls are a major problem for older adults and exercise is a major part of their

prevention, and rehabilitation after a fall. A study in Manchester found that of all those

that have a fall, only 14% had been to a falls prevention clinic.

Dementia affects one in three of us. Evidence shows that maintaining an active lifestyle

helps reduce the likelihood of it developing.

Exercise has general advantages in older age. For instance it helps maintain

independence, increases social interaction, and maintains cognitive function.

1 See www.balancemaster.co.uk/research

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Keeping active also decreases the risk of depression, dementia, diabetes, heart attack

and stroke, bowel cancer and falls. This has a number of knock-on effects:

• Maintains people’s health and independence

• Plays a vital part in the treatment of long-term disease

• Keeps people out of hospital

• Speeds recovery

• Reduces NHS and social service expenditure

To capitalize on the opportunity, John outlined the need for the fitness sector to improve

the following areas in particular:

• skilled trainers

• good customer service

• appropriate facilities

• provide social interaction

• work with doctors and health professionals

Bob Laventure, British Heart Foundation National Centre

Bob’s presentation covered a number of topics on segmentation of the older market,

effective messaging to reach them, the evidence of what keeps the consumer satisfied

and what else we need to do to reach and retain this untapped market.

The term ‘older consumer’ needs further refinement to be able to reach older consumers

effectively. Bob suggested other ways of segmenting the market such as:

• Health and functional status

• Disease/referral pathway

• Spending power

• Life-stage

• Stages of or readiness to change

• More detailed market segmentation e.g. Sport England

Each of these ways can be further broken down. For instance the World Health

Organisation created a health and physical function gradient which groups people

according to their physical activity and health status (WHO, 1997). Tools and insights

such as this should be used effectively target the older consumer.

The health and wealth inequality of people over the age of 50 is widening. It is important

to realise that although the over 50s spend £240 billion per annum, 31% of retired

people survive on less than £10k per year. (Family Expenditure Survey 1999 – 2000)

There are also important behavioural distinctions between older adults: ‘couch potatoes’

have a lower propensity to consumer fitness and leisure than the relapsed participants.

Messages need to be tailored to the older consumer. They have different likes and

dislikes, so their objectives for getting active are different. Generally they know it’s good

for them and their health. Older people want activities that they can see themselves

doing, that will make them feel good (immediate term – i.e. energy, long term – i.e. time

with the grandchildren), that will make them feel better (i.e. more confident, better

functional ability, better sex life...!) They also want choice, encouragement to try,

personal attention and guidance from “someone who knows” (John Lewis model), and

they want to be with other people.

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Older people put a lot of confidence in ‘significant others’, whose opinion and advice they

value very highly. ‘Significant others’ could include GPs, family, friends and peers - even

instructors. Personal relationships are absolutely key.

Gender differences may also be very significant. Men are more motivated by competition,

striving and challenge. They feel stronger. They are less realistic about their health.

Women by contrast are more motivated by relationships. Their previous history (esp.

childhood) is important. They are more likely to be caring for and supporting others. As

newcomers they have lower confidence.2

Bob continued to highlight the evidence on designing effective interventions, including

best practice around the Otago falls prevention scheme and the LIFE – P programme.

More information can be seen on Bob’s presentation or on the website

www.bhactive.org.uk.

David Rigg, General Manager for Rehab Works Ltd.

In David’s experience ageing is often used as a reason not to exercise, although it does

not necessarily imply decreased levels of fitness. The effects of ageing not produced by

disease are reversible, and functional ability may be maintained. “Optimal ageing” is the

idea of preserving function at the highest level and maintaining quality of life. This

incorporates physical, psychological and social state, as well as independence.

A comprehensive exercise programme should be tailored to the older adult, including

aerobic work, resistance training, flexibility and balance exercises, and power training.

Resistance training in particular helps to maintain muscle mass, enhance motor unit

recruitment, improved contraction coupling and calcium handling, relieve arthritis pain,

improve balance and reduced risk of falls, and strengthen of bones.

In terms of rehabilitation from injury, exercise can be used to:

• Control pain

• Restore Range of movement

• Restore Muscular Strength, Endurance and Power

• Re-establish Neuromuscular control

• Maintain cardio respiratory Fitness

• Restore Function

However exercise prescription is not without problems.

• Causes pain

• Person feels uncomfortable in the situation

• Low confidence with exercise

• Poor understanding of the condition

• Believes it will cause more damage

• Does not like exercise and never has

• Wants a quick fix

2 Sport England (2009) and the Women’s Sports Foundation (2006)

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The important thing both in ageing and

rehabilitation is to “Meet the person where the person is”, and use techniques to support

people depending on their abilities and ambitions.

Introducing The Biopsychosocial model, David explained that in classifying patients for

treatment, some factors can be identified which are purely physical and normal, whereas

other deeper psychological or behavioural factors may require an altogether different

treatment.

David went on to give some background to Cognitive Behavioural Therapy.

Summarising his approach, David set out the following key points as guidance:

• Physiological principles apply

• No template for prescription for – Age or condition

• Identify – Thoughts, Feelings, Beliefs and Motivation

• Apply the right model to the right individual

• Use a collaborative approach

David Sinclair – ILCUK

David is the lead author of the ILCUK report, The Golden Economy.

The population of the UK is ageing faster than ever before. That is to say that average

life expectancy is rising significantly. Maximum life expectancy is not changing

dramatically.

Ageing creates barriers to engaging. As we get older it becomes harder to shop or handle

money fore example.

Perhaps more important than how old people actually are, is how old they think they are.

‘Social ageing’ is what drives people’s perception of whether a consumable is suitable for

their life stage, and can also be a barrier to participation. “Is this form of exercise right

for me now?”

Research conducted by ILCUK for the Golden Economy report shows that although

participation in activity declines with age, older people would like to participate more.

Money is often not the issue. Other factors may be important, like whether a bus pass is

valid for travel at certain times of the day, or if an area feels unsafe due to crime.

Citing examples from other sectors, David showed that some companies discriminated,

either directly or indirectly against age. Indeed in our sector, some companies have

imposed an upper age limit in the past. In the advertising industry, ad agencies are very

rarely approached to target older adults. Not only are older adults ignored by many

companies, they also feel they have less choice!

Demography is an important factor in tapping into the older market. Other factors are

inclusivity of design and direct/indirect age discrimination. Even with the best product in

the world, if packaging (or signage etc) is not inclusive, older adults will not consume!

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David Smith – Paralympic Athlete and former Olympic Bobsleigh hopeful

David recounted his story, which is one of a journey through highly competitive sport and

rehabilitation on two operations following the discovery of a tumour the size of a tennis

ball in his spinal cord, which left him unable to use his arms or legs. Not one to be easily

defeated, David was quickly back training and is now training for the London 2012

Paralympics.

Following the first operation to remove the tumour, which involved replacing several

vertebrae with metal discs, David was eager to get back into training quickly. 10 days

later a blood clot developed and a further operation was required, again removing and

replacing the metal discs. This left David bed-bound in hospital for 1 month, and saw him

lose 3 stone of muscle mass and have to relearn how to walk.

Once out of hospital, David and his surgeon developed a fitness regime to get back into

form as quick as possible. This started with getting the strength and balance back to be

able to walk on crutches, and built up so that he could again do unsupported stand and

sits.

This was followed by a period of intensive training and work with a team of

physiotherapists at Bisham Abbey.

Prior to giving the presentation David had just returned from training for rowing in Spain,

where he had rowed 170km in just 10 days.

He is now starting his journey to training for the Paralympic Games in London 2012.

Read David’s blog here:

http://www.davidandrewsmith.net/

Ian Hobdell – Fitness Manager, Active Luton

Speaking of his experience working with older adults, Ian explained that service is about

meeting customers’ needs. The customer journey starts outside the gym, and, for older

people in particular, the service they receive once they get into the gym is particularly

important. Consistency is essential. It is therefore essential that front of house staff are

trained on how to provide service to older adults.

In his 7 facilities, Ian offers a range of activities suitable for older adults. This includes

short mat bowls, chair-based exercises, circuit training and Wii Fit.

Active Luton has embraced the Inclusive Fitness Initiative, meeting all level 1 and 2

criteria. They use BalanceMaster™ as part of their offering for older adults, and it is

mandatory that instructors show clients how to use the BalanceMaster™ as part of the

induction process.

Speaking about the commercial upside to working with older adults, Ian explained that

he is rebranding his activity providers under the ‘Full of Life’ brand used by the

Department for Work and Pensions. As part of it they offer exercise rehabilitation

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sessions for only £2.60. Older adults often take

out and pre-pay an annual membership, but he makes sure that memberships are very

flexible.

In terms of Upskilling the Workforce, a priority identified by the FIA TwentyTen

Commission, Ian asserted that skills for front of house staff are vital. Training doesn’t

have to be outsourced and it doesn’t have to be expensive. Ian’s ambition is employ a

greater number of older fitness instructors to cater for demand from older clients. Ian

also relies on older volunteers to act as buddies.

Marketing to the older consumer needs to use images of real people. Members should be

consulted when making decisions which affect them. Word of mouth is the best form of

marketing. A key tactic is to train members so that they become advocates. Sport

England’s market research provides a useful source of information and insight on older

consumers.

Older consumers attrition is very low at Ian’s facilities, staying at around 3%.