The Healthcare and Fitness industries, which had previously defined complementary, but distinct market segments, will soon be competing for customers as technologies transform and disrupt their traditional markets. The contest may seem like a David vs. Goliath drama, but as in the biblical tale, David will enjoy important advantages. Goliath is the Healthcare Industry, one of the largest segments of the US economy at over $1.5 trillion. It includes nearly 900,000 medical beds in 5,564 registered hospitals that in 2016 processed over 35 million admissions. Medical facilities, including clinics and private practices, are staffed from a population of 916,264 licensed physicians, 3.1 million Registered Nurses (RNs), and millions of supporting health scientists and technicians. On the technology front, the American medical technology industry is the largest in the world, with over 6,500 companies operating in a $148 billion market. Interestingly, they are largely small to medium size enterprises, with 80% having 50 or fewer employees.
The fitness industry is more difficult to quantify, largely because it depends on how it is defined and measured. The most common metric is the fitness club market, which in 2015 was estimated at nearly $26 billion, a small fragment of its healthcare counterpart. This difference may be a strength because it reflects the much lower building and operating costs of health clubs, which translate into more facilities, a larger customer base and more frequent customer engagements. According to the International Health, Racket & Sportsclub Association (IHRSA), as of May 2017 there were 36,540 Health Clubs in the U.S., serving 57.3 million members who make more than 5 billion visits each year. An important distinction is that people join and visit fitness clubs because they want to, while patients visit hospitals and clinics because they need to; one is a choice, the other a necessity.
Fitness clubs generally offer health and fitness related services such as personal training, dieting and weight reduction, and health checkups. Larger clubs have professional staffs that include personal and sport trainers, dietitians, physical and massage therapists, and specialists in a variety of training disciplines such as Pilates and Yoga. According to Bureau of Labor Statistics surveys, as of 2014, there were 279,100 Fitness Trainers and Aerobic Instructors, 25,400 Athletic Trainers, 66,700 Dietitians and Nutritionists, 210,900 Physical Therapists and 128,700 Physical Therapist Assistants and Aides supporting the health and fitness industries. The increasing interest in fitness is reflected in an emerging nursing specialty, Fitness Nursing. According to Guide to Nursing Degrees, a fitness nurse is a Registered Nurse (RN) “who recognizes a strong connection between physical fitness, a state of wellness, and the prevention of disease. A fitness nurse combines the science of nursing with the art of personal training.” Employment data for fitness professionals and the emergence of fitness nursing suggest that there is an extensive, growing pool of professionals available to fitness clubs wishing to offer more extensive fitness and health services.
The fitness technology market, unlike its medical counterpart, relies on customers voluntarily purchasing products such as fitness trackers and heartrate monitors. Trends in this market more accurately reflect shifting attitudes towards fitness and health, given that consumers pay for their devices and can forego or delay purchases without putting their health at risk. In this context, indicators point to growing interest based on increasing demand for fitness technology products in general and wearable technologies in particular. For example, International Data Corporation (IDC) reported in December 2016 that US shipments of wearable fitness technologies had reached 23 million during the third quarter, reflecting a 3.1% growth year-over-year. MarketsandMarkets similarly projected the global wearable market to expand at a 13.7% Compound Annual Growth Rate (CAGR) between 2016 and 2022.
Bridging health and fitness
Hi-tech systems like Skulpt, RunScribe and Athos fall between medical equipment and most consumer grade fitness devices in capabilities and sophistication. One distinction is that fitness devices do not require Food and Drug Administration (FDA) certification. Manufacturers also recognize that laymen lack the support, knowledge and training to interpret raw measurements, so they use mathematical models, sophisticated algorithms and user friendly software to analyze, interpret and translate measures into customer useful information.
Most data produced by these systems are stored in manufacturer specifc cloud databases. There is at this time only limited integration of data from different devices and manufacturers, which is a barrier to delivering contextual trends and cross-system analysis. For example, an integrated system would consider blood pressure trends in light of changing body weight, individual activity levels and changing sleeping patterns. Similarly, stroke risk analysis may interpret EKG readings in part by considering blood pressure trends. Expanding access and cross system integration will greatly improve the value and capabilities of these systems in delivering comprehensive fitness and health assessments.
Emerging wearable technologies will soon be capturing and analyzing blood and sweat samples, thus adding body chemistry to physiological data sets created by existing wearable devices. According to Drs. Sam Emaminejad and Wei Gao, postdoctoral scholars at Stanford and UC-Berkeley, a sweat-analysis wearable device is already being tested that will provide “more information than the currently commercialized wearable sensors. It provides insight about an individual’s physiological state at molecular levels.” The device measures skin temperature, glucose, lactate, sodium and potassium in sweat, and transmit the readings to a smart phone.
Augmenting physiological analysis are devices that will measure and monitor brain activities known to correlated with emotions. Brain monitoring may be useful in detecting seizures, loss of consciousness, confusion and patterns indicative of neurological trauma. As with other sensors, researchers and engineers will be able to integrate brain activity with other physiological factors in near-realtime to deliver a wholistic view of health and fitness.
Replacing sporadic medical monitoring with continuous physiological and brain function surveillances promise to revolutionize preventive health practices, while promoting fitness. Increased reliance on analytical methods and models will likely shift preventive care from traditional medical services to less costly, more convenient options. Market data suggest that the fitness industry represents a well-established, extensive, mature infrastructure capable of delivering targeted fitness and health services more cost-effectively than medical clinics and hospitals. Health clubs are also well positioned to provide services that focus on preventing injuries and the onset of chronic diseases related to life-style choices and physical inactivity. These are the subjects of upcoming posts in this series.
 Healthcare industry statistics, Statistics Brain, accessed June 1, 2017, http://www.statisticbrain.com/health-care-industry-statistics/
 The medical technology industry in the United States, Select USA, accessed June 1, 2017, https://www.selectusa.gov/medical-technology-industry-united-states
 Health & fitness clubs statistics & facts, Statista, accessed June 1, 2017, https://www.statista.com/topics/1141/health-and-fitness-clubs/
 Fitness Trackers in the Lead as Wearables Market Grows 3.1% in the Third Quarter, According to IDC, December 5, 2016, International Data Corporation, accessed June 1, 2017, http://www.idc.com/getdoc.jsp?containerId=prUS41996116
 Wearable fitness technology market by product, Global forecast to 2022, MarketsandMarkets, accessed June 1, 2017, http://www.marketsandmarkets.com/Market-Reports/wearable-fitness-technology-market-139869705.html
 Wearable device detects, analyzes real-time changes in chemical composition of sweat, Stanford Medicine News Center, January 16, 2017, https://med.stanford.edu/news/all-news/2016/01/wearable-device-detects-real-time-changes-in-composition-of-sweat.html