The term "select populations" used to be reserved for the inactive, the overweight or the cardiac rehabilitation patient. When introducing these select populations to an exercise program—with their doctor's permissions— the goal simply was to hope for "the happily ever after" outcome, whether that meant a healthier quality of live or prevention of reoccurrence.

Fortunately times have changed and the exercise goals of select populations have become more aggressive. Select populations now encompass a broad spectrum of individuals and ailments and includes individuals and ailments, such as diabetes, cardiac rehabilitation, hypertension, stroke, arthritis, osteoporosis, cancer, renal disease, cystic fibrosis, muscular dystrophy, asthma, pre/post natal, stress management, youth fitness and older adult fitness.

Most fitness professionals do not need to be convinced of the growing need to serve select populations and the impact this growing group can have on a personal training business. Consider some of the following statistics: More than 14 million individuals suffer from diabetes in the United States; More than 40 million women over the age of 60 suffer some degree of osteoporosis; Twenty five percent of Americans have one or more forms of heart or blood vessel disease; Eighty-five percent of men and women over 70 have some form of osteoarthritis; The average life expectancy in the early 1900s was 47 years of age, but now is approaching 90.

Although many special population conditions are physiologically different, the goals for training these groups today are similar. These goals include education and improving daily living while helping to limit reoccurrence or relapses. Fitness and wellness professionals should have a primary goal of education before, during and after the onset of these conditions.

For healthy, apparently healthy and at-risk individuals (according to American College of Sports Medicine classifications), fitness professionals play an important role in generating awareness of these conditions, and how consistent exercise and lifestyle management can help prevent them. For those who have had or are currently afflicted with an ailment or disease, fitness professionals should establish reactive goals that aim to improve daily living and help limit reoccurrence or relapses. Important here is trying to curtail the disease spiral that often occurs when secondary conditions emerge after the diagnosis of one condition. Common cases are people afflicted with both hyperlipidemia and diabetes, or older adults with osteoporosis and poor balance who fall and fracture a bone.

When preparing to meet the demands of these new populations, fitness professionals should consider the benefits of adding this clientele.

Expanded referral system: Properly marketed, the ability to work with select populations can enhance referrals from health care professionals, existing clients and new select population clients or their families. Typically, the more referrals generated, the greater the business result over time.

A new profit center: Personal training and group training have become partially or even fully reimbursable through many insurance providers and companies, thereby expanding the number of clients who can take advantage of this service. In addition, select populations in fitness facilities can purchase other services as well, such as massage, food and social programs.

Increased staff and facility efficiency: Historically, fitness professionals typically book the majority of clients during early morning and evening hours. Select populations can help fill the gap between these times, and facilities may choose to add a select memberships for these groups. In addition, new clients with select needs can challenge staff with the opportunity to develop and implement new, innovative programs.

When working with select populations, there are a number of ways to enhance the comfort of these clients in a facility. For instance, flooring transitions between stairs, carpeting, tile, wood and rubber flooring should be smooth and well marked. Water fountains or coolers at comfortable-to-use heights, easily accessible water controls and sufficient water pressure should be strategically placed throughout the facility.

Elevators and ramps should be in accordance with city code. Heated pools with proper pool lifts will allow for many new select population programs. Locker room facilities should be designed with designated ADA code showers. Reserving lower and easily accessed lockers for select populations is helpful as well.

Numerous choices of equipment exist. Before purchasing or recommending the purchase of new equipment, assess what you currently have and determine how it will work with the types of programs you plan to implement. On what market(s) are you focusing? Which equipment will satisfy the needs of all of the programs populations? Specifically for strength training equipment or resistance tools, do they promote functionality in terms of daily living movements, such as standing from a chair or putting items on a shelf overhead? Do the machines limit range of motion? Are the lever arms and starting weight appropriate for the elderly and female populations, and what are the load increments? How difficult are the seat settings and weight settings to change, and can this be done from the seated position?

First impressions are critical for first-time facility users, particularly those with select needs. When showcasing your facility, be aware of staircases, water fountain crowding, opening doors and narrow pathways. Establish a path that a wheel chair, walker or oxygen tank can easily navigate.

The following logistical layout laws should be considered when designing a workout area to serve select populations: Treadmills should have three feet behind the moving belt and be placed at least 12 inches apart from each other. Place a few treadmills where they can be mounted from the side rather than from the back, and always secure electrical or network wires. Stationary bikes need three feet between each other and should have one to two feet of space in front. Strength machines, both selectorized and plate-loaded, should be two to three feet apart and be front mountable for wheel chair and oxygen tank users. Free weight benches should be six feet apart and placed in front of the dumbbell racks for easy transport of the weights. Free weight Olympic bars should have three feet between the ends of the bars. Weight trees should be accessible from all angles and weight plates should not exceed 45 pounds.

As far as the order of the machines, be creative, but keep in mind the programs you are conducting and how they share the available space. Circuits can be push-pull, lower body, upper body, torso-focused or any other grouping that is practical.

Once your facility is ready to accommodate select populations, it is important to establish relationships with allied health organizations to help build your business. Focus on primary markets of interest and with whom you feel comfortable and certified to assist. Hospitals can be a great referral system for a facility or a trainer; the nurses, therapists, as well as exercise physiologists are prospective resources.

When selecting doctors as part of your referral system, think of more than just the primary care physician. Cardiac surgeons, physiatrists, oncologists, optometrists, orthopedic surgeons and any other allied health professional that may treat your select populations all are valuable referral resources.

You may initiate these relationships by inviting qualified health professionals to be part of a medical advisory board. With their expertise, the board members can serve as consultants for staff and a third-party review body for programs.

To document results and help grow business over time, fitness professionals training select populations should gather and share data in the form of testimonials or changes in sets, reps, heart rate, blood pressure, body composition, bone density, medication, joint flexibility and overall pain reduction.

As the population paradigm shifts, the goals of this new population change. The new goal is to improve the quality of life as much as possible. The need is ever growing to embrace these select populations and grow business around their requirements.