Here’s a statistic every gym owner should sit with for a minute. The latest Health Survey for England found that 46% of adults aged 16 and over have at least one longstanding illness or health condition. The most common are musculoskeletal conditions, mental health and neurodevelopmental conditions, heart and circulatory problems, diabetes and other metabolic conditions, and respiratory conditions. The same research found that 26% of adults live with chronic pain.

That’s almost half the adult population. So the question for our industry is simple: does what we’ve built actually feel designed for them?

I’m not saying everyone with a long-term condition needs a specialist gym, or can’t use a conventional one. “Longstanding condition” covers a huge spectrum, from things that barely affect daily life to illnesses that change what someone can do entirely. That’s exactly the point. If nearly half of adults live with some kind of long-term condition, maybe the “average member” we’ve always designed gyms around doesn’t really exist any more.

I also see this from a very personal angle now. I’ve spent more than 25 years in fitness, but I also live with ME/CFS, and that has changed how I think about exercise more than almost anything I’ve learned in my career.

When You Work in Fitness, Exercise Always Looks Like the 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 physical activity brings.

Then you live with a chronic illness yourself, and it all gets more complicated.

ME/CFS has shown me how difficult your relationship with exercise can become when your body stops responding the way you expect. Some days I want to train and feel mentally ready to. Twenty-five years in fitness tells me to get on with it. But I also know that what I do today can have consequences tomorrow, or the day after.

One of the defining features of ME/CFS is post-exertional malaise (PEM). NICE describes it as a worsening of symptoms after activity, whether physical, cognitive, emotional or social. It can be delayed by 12 to 48 hours and last for days or even weeks.

For someone whose career is fitness, that’s a frustrating relationship with exercise. We’re trained to think about progression: one more rep, a bit more weight, five more minutes, beating last week. Usually those are sensible principles. With ME/CFS, the smartest decision is sometimes not to push.

That’s taught me something I think our industry needs to understand much better: exercise is incredibly powerful, but it isn’t one universal prescription.

“Just Exercise More” Isn’t Good Enough

The updated UK Chief Medical Officers’ physical activity guidance reinforces the huge benefits of activity. Some of the biggest health gains come from helping inactive people become more active, and maintaining strength and balance matters more and more as we age.

But population-level guidance and what’s right for an individual with a specific condition aren’t always the same thing.

ME/CFS shows this clearly. NICE advises that people with ME/CFS shouldn’t simply be told to go to the gym or exercise more, because it can make symptoms worse. It also advises against programmes built on fixed incremental increases in activity, including graded exercise therapy. Where exercise is appropriate, it has to respect the person’s current energy limits, symptoms and medical situation.

The answer isn’t for gyms to be scared of helping people with health conditions. It’s for our industry to get better educated about where and how we can help, what expertise we need, and where our professional boundaries are.

Long-Term Health Conditions Aren’t One Market

We also need to stop talking about people with chronic conditions as if they’re one group.

Someone with controlled high blood pressure has completely different needs from someone with severe chronic pain. Arthritis isn’t recovery from cancer treatment. Depression isn’t COPD. Someone on GLP-1 medication isn’t someone living with ME/CFS. Even two people with the same diagnosis can have completely different capabilities.

Sport England makes the same point: this isn’t a single, uniform group. Barriers include confidence, cost, time, not knowing where to go and a lack of suitable options, and people with long-term conditions or disabilities are far more likely to be inactive.

So bolting on a “chronic conditions membership” isn’t the answer. Personalisation has to be at the centre.

Ask Better Questions at the Start

Traditional fitness assessments focus on goals, weight loss, exercise history, current fitness and how often someone plans to train. All useful. But supporting someone with a long-term condition needs a wider conversation.

How does activity affect them afterwards? What makes symptoms better or worse? What do a good day and a bad day look like? Are they nervous about exercise? What has their healthcare team advised? And most importantly, what does success actually mean to them?

Success might not be losing three stone or running a 10K. It might be climbing the stairs without stopping, playing with the grandchildren, getting back to the garden, getting out of a chair more easily, shopping independently, or simply having the confidence to leave the house.

For someone with ME/CFS, what happened during the workout may tell you very little. The real information comes 24 or 48 hours later. Did that session improve their life, or did recovering from it take over the rest of their week?

That’s a very different definition of a successful session, and probably a better one.

Is Our Fitness Marketing Speaking to These People?

Think about how much gym marketing still revolves around getting ripped, burning calories, pushing harder, smashing goals and “no excuses”. There’s a market for that language, and I’m not saying scrap it. But it doesn’t speak to everyone.

Imagine you’re 58, living with chronic pain, and haven’t exercised in 15 years. Or you’re 70 and worried about losing your independence. Or you’ve just finished cancer treatment, you’re struggling with depression, or your energy swings dramatically from day to day.

Does “NO EXCUSES” make you feel understood? Probably not. It’s more likely to confirm that gyms aren’t for people like you.

That’s why I think we need to stop just selling fitness and start selling what the right kind of activity makes possible.

An experienced 25-year-old mostly wants access to equipment. Someone with a long-term condition may be looking for independence, confidence, strength, mobility, energy, connection, support or a better quality of life. They might want to keep working, play with their kids, walk the dog or stay independent at home as they get older.

Those are powerful outcomes, and gyms already have most of the tools to deliver them. We just need to package and communicate them differently.

Build Pathways, Not Just Memberships

One of the biggest opportunities for established gyms is to stop assuming everyone should come in through the same membership journey.

Why not 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 need to be permanent membership types. They could be six, eight or twelve-week supported pathways that bridge the gap between doing nothing and becoming a confident regular member.

A pathway might include an initial consultation, simple baseline measures, straightforward programming, coached sessions, regular check-ins, progress reviews and a managed move into mainstream membership.

You haven’t changed the gym. You’ve changed how people enter it.

Onboarding Matters Far More Than We Think

For an experienced exerciser, onboarding might be a key fob and an app login. For someone who hasn’t trained in 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 won’t look stupid, someone to notice when they don’t turn up, and early proof that it’s working. Above all, they need to feel that someone actually cares whether they succeed.

I’d build a structured first 90 days around that: an initial consultation, a coached first session, a follow-up in week one, a two-week check-in, a 30-day review and regular progress reviews after that. The goal isn’t to make them exercise more. It’s to support them better, and to adapt that support to the person rather than expecting the person to adapt to the system.

Technology and Human Contact Should Work Together

Technology makes this scalable. Your CRM knows when someone joined. Your access control knows if they’ve visited. Your app knows what they’ve done, and your automations can spot changes in behaviour and send the right message.

If someone who normally comes twice a week hasn’t been in for ten days, something should happen. That might be an automated check-in. Better still, it might create a task for someone on the team to call them. The system makes sure nothing is missed; a human provides the conversation.

That’s where technology really earns its keep. Automate what should be consistent and personalise what should be human.

You could go further and, where appropriate, track energy, symptoms, recovery and perceived effort, not just sets, weights and calories. Sometimes the most important question isn’t “How much did you do?” but “How did it affect you?”

Programming Doesn’t Need to Be Complicated

Fitness professionals sometimes confuse complexity with quality. A programme isn’t better because it has 14 exercises and clever periodisation.

For someone coming back to activity after years away, simple is valuable. Five exercises and 20 minutes. Machines to start. Once a week. A walk or a small group. And a programme that flexes depending on how they feel and what suits their condition.

For some conditions, including ME/CFS, a conventional progressive programme may not be appropriate at all without specialist clinical oversight. That’s where professional competence matters.

Sometimes the best fitness professional isn’t the one with the cleverest programme. It’s the one who knows when they aren’t the right person to provide it.

Strength Could Be One of Our Most Important Products

We’ve spent decades selling resistance training through bodybuilding, aesthetics and performance. But strength is about far more than looks. It’s getting out of a chair, carrying the shopping, climbing stairs, keeping your balance and staying independent.

That gives us a completely different way to market exactly the same kit. Instead of “build muscle”, how about “stay strong enough to keep doing the things you love”?

The equipment hasn’t changed. The conversation has, and so has the market you can reach.

GLP-1s Create Another Big Opportunity

The rapid growth of GLP-1 weight-loss medication makes this even more relevant. People losing a lot of weight need support to maintain strength and muscle and build sustainable habits.

That’s a growing group of people actively investing in their health, many with little exercise experience. They need help getting stronger, accountability, sustainable routines and an environment that doesn’t judge them.

Gyms are well placed to help, as long as we stay within our scope. That doesn’t mean prescribing medication or giving clinical advice. It means building credible exercise and lifestyle support, and partnering with healthcare professionals where it makes sense.

Beginner Classes Should Feel Like Beginner Classes

Look at a typical timetable: HIIT, Bootcamp, MetCon, Body Blast, Extreme Conditioning. Now imagine you’re 65, living with arthritis, and have never really exercised. Where do you start?

Keep the high-intensity classes, but put something alongside them: Beginner Strength, Move Better, Back to Exercise, Strength for Life, Healthy Ageing, Low-Impact Fitness, Introduction to the Gym, Mobility and Movement.

The exercise itself often doesn’t need to change much. The perceived accessibility does. People should be able to look at your timetable and immediately see where they belong.

Our Teams Need Different Skills Too

If we’re serious about this market, team development is critical.

Technical knowledge matters, but so do empathy, listening and communication. Can your team comfortably talk to a nervous 70-year-old beginner? Explain an exercise without jargon? Understand that someone with a fluctuating illness might manage something one week and struggle the next? Spot red flags and know the limits of their scope?

Most importantly, can they listen without assuming they already know the answer? Living with ME/CFS has taught me how much that matters. The person living with the condition knows things about their body no textbook can teach. Listen to them.

Fitness and Healthcare Need to Work Together

This could be one of the biggest long-term opportunities for our sector. Fitness and healthcare still work too separately, even though the right physical activity plays a big 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, health charities, pharmacies and employers?

The aim isn’t for gyms to become hospitals. It’s for fitness businesses to become trusted partners in helping people get and stay appropriately active. That trust has to be earned through qualified staff, clear referral pathways, professional boundaries, safeguarding, evidence-based programming and measured outcomes. It also means being willing to say, “This person needs support beyond what we can safely give.”

That’s not failure. That’s professionalism.

Don’t Underestimate Community

Gyms can offer something that has little to do with equipment: human connection.

For someone whose illness has affected their work, confidence, mobility or social life, being part of a community can be hugely valuable. Walking groups, coffee mornings, beginner clubs, small-group training, social events, workshops and buddy schemes all help. Not everything has to involve sweating.

Often what keeps someone coming isn’t their programme. It’s knowing someone will notice if they don’t. That matters on a human level, and it has a real impact on engagement and member retention.

There’s a Serious Commercial Opportunity Here

This isn’t just social responsibility. There’s a strong business case.

If 46% of adults in England live with a long-term condition, that’s an enormous slice of the population. Support, expertise, accountability, personalisation and community all have value, and they open the door to premium memberships, specialist programmes, small-group training, personal training, corporate health partnerships and longer customer relationships.

They also create differentiation. If your offer is just equipment, access and price, someone can always build a bigger gym or charge less. If your offer is “We specialise in helping people who don’t think gyms are for them”, you’ve built something much harder to copy.

Stop Fighting Over the Same People

Our industry spends a fortune competing for people who already like exercise. We advertise to existing gym-goers, take members from competitors, lose them back, discount, give away free months, add more kit and repeat.

Meanwhile, millions of people sit outside the traditional fitness market. Some don’t like gyms. Some don’t know where to start. Some are intimidated, some have tried and failed, and some live with conditions that need a different approach.

I don’t see that as a problem. I see it as one of the biggest opportunities our industry has.

How My Own Experience Changed My View

I’ve spent decades talking about the benefits of exercise, and I believe in them as much as ever. But living with ME/CFS has given me a perspective I never expected.

I know what it’s like to want to train and know there may be a price to pay. I know the frustration of remembering what you used to be capable of and accepting what you can do today. And I’ve learned that some days, doing less isn’t laziness; it’s management.

Most of all, I understand how wrong “push through it” can be for some conditions. That doesn’t make me anti-exercise. It’s made me far more interested in how we make activity work for the individual, rather than forcing the individual into our idea of what exercise should look like.

Time to Redefine What a Gym Is

For decades we’ve built gyms around exercise. Maybe the next step is to build them around health, capability and quality of life, with exercise as one of the tools.

The outcome might be strength, confidence, mobility, mental wellbeing, connection or independence. It might be staying in work, playing with your kids, walking the dog or staying independent as you age. For someone else, it might be finding a relationship with movement that works with their condition instead of against it.

Almost half of adults in England live with at least one long-term condition. That should be a wake-up call. Not because they all need gyms, or because exercise fixes everything, or because every trainer is qualified to work with every illness. But because it should make us ask whether we’re designing fitness businesses for the population that actually exists, or mainly for people who are already healthy, confident and knowledgeable enough to walk in without help.

The opportunity is bigger than getting more people exercising. It’s about listening better, personalising more, developing our teams, working with healthcare, using technology well, respecting professional boundaries and creating the right ways in. Above all, it’s about meeting people where they are, not where we think they should be.

Do that, and the fitness industry becomes far more than a place to work out. It becomes a real part of how this country helps people live healthier, stronger and more independent lives. From a human and a business point of view, that’s an opportunity we’d be crazy to ignore.

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Want help putting this into practice in your gym? Black Raccoon Consulting are gym and fitness business consultants with over 25 years’ industry experience in sales, marketing, member retention and operations. Book your free 45-minute business call or explore our services.

Ryan Charlesworth, Founder, Black Raccoon Consulting