Designing and developing a wellness center whether it is an extension of a training studio or spa or as a fitness component of a medical practice presents some challenges. Decisions such as which educational workshops to offer and which integrated health care services to promote are issues that can create problems. The decision on whether the facility should be part of a hospital, a physical therapy building, a doctor's office or as a separate fitness facility centrally located to medical and alternative care professionals needs analysis and careful consideration.

            But before we consider "under one roof or not" wellness centers, we must recognize their influence on preventive care, as moving health care out of the acute hospital setting is quickly becoming a trend. According to author Joan Whaley Gallup, author of Wellness Centers: A Guide for the Design Professional, "Wellness centers are facilities that incorporate clinical and fitness components into a comprehensive health care center." This trend toward wellness is rapidly evolving as baby boomers have high expectations of living longer, healthier lives. The rise of alternative medicines as well as the mind/body approach to programming all point to the need for a change in health care. The focus now is on preventing disease.

            Greg Carlson, president and CEO of Owensboro Mercy Health System in Owensboro, Kentucky aptly asks: "What if the hospital of the future is a place you go when you are healthy?" And, what if we fitness and health care professionals joined forces to help make this happen?


The Beginning of Wellness Centers

            Wellness centers began in the 1970s with Ken Cooper's Cooper Aerobics Center in Dallas, Texas. The emphasis at this center was diet as it related to health. Today, there is a myriad of wellness center models from club-based, hospital-based to spa-based, offering much more than diet and exercise. Some wellness facilities are adjuncts of large wellness villages such as that developed by the Walt Disney Company as its Celebration Health Project; others are large hospital projects which include fitness, retail and complementary therapy components (such as Hospital 31 in Moscow); still others are small centers that are a part of a physical therapy program or a medical spa; and there are also freestanding centers offering educational workshops as an extension of their fitness programs.

            Choosing if the center is best "under one roof or not" depends on several factors: the center's mission and vision, the health care and fitness providers; the square footage and flexibility of the center's space, the inclusion of clinical programs; alternative, complementary, integrative therapies; the initial investment cost; and the expenses to maintain the center.


Which Model Is Best for Your Business?

            The factors above can best be answered as we look at three different wellness center models. The first is a center for fitness facility owners, personal trainers and/or alternative care providers. This model is easy to facilitate and offers room for growth. The second model is a much larger, very comprehensive center often hospital- or club-based "under one roof." And the third model is spa-based and can be housed either "under one roof or not."

            The first model is simple, affordable and allows for expansion.  It is a collaborative model designed for health-related mind/body workshops hosted by health care, alternative care and fitness professionals. Offering a variety of on-site educational programs at the physician's or physical therapist's office, hospital, spa or fitness center can open doors to developing a more comprehensive health care center. In this model, as the demands for more alternative workshops increase, so may the need for a more fully clinically integrated system.

            A more comprehensive wellness center under this model can evolve as workshops increase in size and when the joining of forces occurs.  The medical community is now more dynamically involved in the integrated care; for example, physicians conduct a battery of medical tests for patients and provide ongoing medical intervention and recommended plans of action. In this way, the physicians incorporate client nutrition concerns with a personal nutrition counselor, and they also refer the patients to their fitness team for a personal, systematic progression of exercises that uniquely match the patients' health goals. Patients visit the doctor's office for initial consultations, medical tests and follow-up visits; they meet with the nutritionist at a different location; and, finally, the patients' medical information is released to the fitness team at another location. If patients need further attention from any other holistic care provider, this model through its referral system allows patients to enjoy fully integrated supervision.


Advantages and disadvantages to model one:

  • It is simple and cost-effective. Expenses might include might include the formation of brochures, flyers and linking Web sites. Additional costs an LLC with the primary care physicians (as the center develops), ancillary advertising and mailings to new clients and current patients.

  • Square footage is usually not an issue. The more comprehensive the center, the more square footage can become an issue. Some programming may have to be

    outsourced in a school or church or even a hospital, depending on the number in attendance for an educational workshop.

  • Partnering with other professionals and including additional health care personnel over a period of time allows for flexibility and diversity to the program choices. Even in the comprehensive setting, the wellness center is relatively

    uncomplicated to manage and yet provides ongoing patient monitoring.

  • Because wellness centers encourage healing, the collaborative effort from health care and fitness professionals gives patients a variety of support, for example workshops on such topics as smoking cessation, diabetes, stress management and cancer. Whether the model is straightforward or more intricate in design, workshops require research and planning time. Integrating services such as spa and holistic therapies at other locations takes more planning, market research and client/community input. The more services offered, the more coordination and business managing is needed.

  • The building of a referral chain or network of health and exercise professionals helps in the delivery system of a well-rounded center.

  • Partnering with human resources in a corporation, a resort/hotel, medical spa or cruise ship spa are other ways for personal trainers, gym owners and health care

    providers to work in an environment that can provide fitness and wellness components.

  • It is difficult (not impossible) to match clinical and/or fitness programs in existing spaces and make them work.

  • Programming decisions can be complicated. Choosing which ones will work financially will influence how many services the center can support.

  • Linking medical information and patient profiles to health care providers and insurance companies makes communication easier, more dependable and more

    affordable. Some insurance companies and corporations are assuming partial reimbursements to patients for wellness care.

  • Program decisions need the consensus of all parties working in this health care model. Everyone has to "buy-in" to the project's goals, the schedule of events

    and the program itself.


                The hospital-based model "under one roof" is usually attached to a hospital or part of hospital systems. The most important difference: this center's ability to obtain financing and coordinate more fully with managed care companies. Some hospital-based centers also create more than community outreach and educational programs. They have constructed multipurpose rooms adjacent to workout areas designed for rehabilitation. They have designated other areas for recreation, like swimming, ballroom dancing and social gatherings. Larger centers are including small cafes, variety stores, juice bars, computer areas, meditation rooms and gardens, pharmacies, hair salons, massage, chiropractic and holistic therapies as well as diagnostic testing, such as for radiology. Here is a wellness model in its most all-inclusive and integrated configuration. Imagine the generation of wellness care that this model produces: physicians, physical therapists, chiropractors, fitness professionals and other holistic care-givers all working together as a dynamic team referring patients/clients to one another to heal the mind, body and spirit.


    Advantages and disadvantages of model two:

  • The referral chain is more readily available and convenient "under one roof." There is an atmosphere of credibility as the entire medical team and wellness experts respectfully work together consulting as a team, using all hospital resources. In this model, patients are able to move from injury to rehabilitation and to post rehabilitation in a setting where the availability of services is varied, age-appropriate and where immediate care and outpatient surgery truly complement each other.

  • Some hospitals provide meditation rooms, gardens, swimming pools, fitness centers, retail shops, computer labs and physical therapy rooms "under their roof." Programs for health-related services and educational programs are ongoing so patients can participate in seminars such as stress-reduction, smoking cessation, diabetes lectures, yoga, cooking classes and fitness classes.

  • Going to the hospital's wellness center as a place to stay "well" gives community members a place to support one another and meet on a regular basis, reducing the feeling of isolation for patients who, for example, are grieving a loss, or caring for aging parents, or just needing friends.

  • Driving and parking to visit physicians, fitness specialists and other alternative care givers is "one-stop shopping."

  • Holistic and eastern medicine work together as a complement in the healing process. The mind, body and spirit are considered in the patient's treatment. Specialists are called in when needed; and physicians become true "healers" and "wellness coaches."

  • Under this model, patients will continue to visit their physicians on a regular basis for physicals, but for example, they will also visit them to find out how "well" they are doing and how to continue the prescription for wellness and healing.

  • Financing is more obtainable and more insurance companies and employers are buying into some wellness programs that are under the supervision of physicians.


  • Designing and developing this model is costly.

  • Larger multipurpose space is needed for offices, workout areas, ancillary personnel and outpatient surgeries.


                The third model is the medical or day spa. This model can succeed either "under one roof or not." Anti-aging medicine is experiencing tremendous growth. Baby boomers want to look and feel their best. If that is so, what a perfect opportunity for a fitness professional to team up with a plastic surgeon or day spa providing fitness services in the spa or contracted out to a gym!  

                I partnered with a new spa for several reasons: its tranquil location, the spa's homey farmhouse building, its exceptional spa services, its guest accommodations, but, most importantly, it is adjacent to medical offices of facial, body and reconstructive surgeons. While this spa is approximately a twenty-five minute drive from my studio and the spa drawing rooms are small, we decided to offer a one-day "de-stress and rejuvenate" retreat outsourcing the fitness, nutrition and naturopathic services. Our day included a walk followed by exercises using bands, a choice of two spa services, a stress workshop, an emotional eating workshop, a session with the spa's Reiki master and a guided meditation to end the retreat.  


    Advantages and disadvantages of model three:

  • Whether the services are provided "under one roof or not," spa treatments and fitness programs complement each other.


  • New opportunities for career change or growth are available.


  • Medical spa physicians encourage clients to use all spa services, including the exercise component and the building of a referral base.


  • Allows for creative, innovative services that address health and fitness topics.


  • Not a costly model. There is a cost for advertising and mailings.

  • If the model is "under one roof," the client can easily move from service to service. If the model is "not under one roof," the spa service is offered on a day when exercise is not occurring.

  • Small rooms, shared space can limit the types of fitness/workshops offered. Be inventive. Services such as planning a client's daily, weekly or monthly exercise program is one way to act as a consultant during the retreat. Kitchens can be used by a nutritionist or chef giving cooking lessons or instruction on healthy eating. Personal trainers do fitness assessments or offer classes like Pilates mat, ball and band training and yoga.

  • The planning of spa/fitness/healing retreats takes time. Allow for several months of planning to allow for printing of materials, mailings and advertising.


                Whether a wellness center is under one roof or networked out to fitness or health care providers will depend on whether you are in an existing space, if you want to design a new center, network with health care and fitness professionals and subcontract experts, or work for a hospital- or spa-based wellness center. The best advice I can give to individuals thinking about designing and developing a wellness center is "keep it simple." Start with an uncomplicated model get involved in presenting educational workshops; then, collaborate with the medical and alternative care providers in your community. Or, contact a day or medical spa and start offering classes or participate in a day retreat. Finally, if there is a hospital-based wellness center in your area, there are opportunities for you to offer classes and personal training "under one