As most PTs know, the line between rehabilitation and fitness is a fine one. It is a line that Matt Slimming, PT, CSCS, not only crossed, but blurred when he opened Star Fitness Center in September 2006. The 11,000-square-foot facility serves as both an upscale fitness club and as a physical therapy center.

The merger of the two seemingly different types of businesses made sense to Slimming for two reasons. First, reimbursement for physical therapy has continued to decrease, making it difficult to run a physical therapy-only practice. Second, the focus on prevention and healthy lifestyles, which has become a byword in medicine over the last few years, seemed a natural niche for Slimming and his staff to fill. "It was a natural move to fitness and disease prevention," Slimming says. "Physical therapists are the ideal [members of the medical profession] to promote a healthy lifestyle aimed at getting patients to their maximum health."

The idea also appealed to Slimming—who has been in business since 2001—for personal reasons. "I have had an interest in fitness for a long time," he says. His diverse physical therapy practice focuses on sports, orthopedic, workers' comp, and geriatric patients. In addition to the Star Fitness Center, he also runs two other physical therapy-only offices.

The fitness center idea was a good one, but Slimming had a lot of work ahead of him before he could lay the cornerstone of his facility.

PLANNING

Star Fitness Center is located in Covington, La, an upscale bedroom community of New Orleans. The residents are predominantly families and retirees, with the adults skewing into middle age.

To see if there was even a need for the type of business he was proposing, Slimming performed a feasibility study. He found that his concept was embraced fairly well, so he and his business partners commenced with building it.

One of the most important things Slimming had to determine during the planning stages was the nature of the facility—who it would serve and how. "It's hard to make money if you're only catering to injured customers, so we designed protocols for fitness and tried to get mainstream [uninjured] customers," he says.

It was this level of planning that caused Star Fitness Center to have a distinctive look and atmosphere that attracted fitness customers and kept rehab patients around from the day the doors opened.

EXECUTION

To serve his particular customer base, the club had to have a distinctive look. "We had to make it look very upscale both in the interior and exterior," Slimming says. The exterior is distinctive with large signage and a gracefully curving awning in front of its yellow and ruddy façade. The front of the building has large windows, allowing natural light to pour in. Inside, the club is filled with state-of-the art equipment, a juice bar (that serves a signature "Star Fitness smoothie"), and all of the amenities that come with the best clubs.

But the design was not chosen in a vacuum. "We didn't want our customers to be intimidated," Slimming says.

Star Fitness Center is designed for a very specific fitness population—the 30-year-old and older customer who is "looking for an efficient workout," Slimming says. This design was a reflection of the established Covington fitness market, which includes one of the top 10 fitness centers in the United States. The market already had gyms catering to the bodybuilding community and to families (though Star Fitness does offer child care), and Slimming wanted to serve a community that both lived in Covington and who were not necessarily the focus of other gyms.

While determining the makeup of the fitness side of the center, Slimming was careful not to forget that he also had a physical therapy business to run as well. The result has been a balance between the two. "The two sides tend to support each other," he says. For instance, he adds, several particular groups are well served by the combination—including cancer patients, obese children, and people with heart conditions.

The physical therapy patients work out alongside the fitness customers, but each business is a completely separate entity. "They're two separate businesses," Slimming explains. "It's in the best interest of our clients and the patients to move from one side to the other to optimize [our resources] and get them to their highest health potential."

Fitness clients have a variety of classes to choose from, including Pilates, yoga, and "seniorcize" classes. The center also offers a variety of personal training packages. On the physical therapy side, treatment outside the gym environment is handled in a salon-like, soothing setting designed to make patients feel relaxed while they are being helped.

Matt Slimming, PT, CSCS, instructs the patient on proper form and movement.

After an in-depth evaluation (a free consultation is also available for new patients), treatment can include massage, ultrasound, electrical stimulation, stretching, traction, or computed assisted conditioning. The physical therapy patients are also offered a core-strengthening program, which allows the therapists the ability to find out the exact area of weakness in the patient and strengthen those areas with scientifically proven exercises. During the program, patients have their progress recorded and analyzed against normal fitness values.

While the salon-esque therapy business helps patients get back on their feet in a relaxed manner, working out in the gym side-by-side with able-bodied patients gives them strong psychological motivation to get better and, hopefully, continue improving their fitness after their rehab is done.

While the majority of Star Fitness Center's space—8,000 square feet—is given over to the fitness side of the business, Slimming's focus is definitely on maintaining his stature as a well-respected PT. "The good side of [our business model] is that it doesn't require the owner to be involved in the managing of the operation," he says. "Hiring a general manager for the fitness side of the business is essential for any physical therapist who does this. It's not good to take yourself away from patient care."

EQUIPMENT

Fitness equipment has played a big part in the success of Star Fitness Center. Slimming did not have a particular fitness equipment vendor in mind during the planning stages of Star Fitness. He surveyed several types of machines from several vendors and then decided to go with the Nautilus brand. "It's really great equipment," he says. "It looks great and holds up."

The decision to go with one vendor was also partially aesthetic. Slimming liked the design of the equipment and the idea of it all being uniform in look and design. "It's really easier to go with one vendor," he says.

All of the fitness equipment was bought at the same time, requiring financing as part of the start-up. This was not a problem because Slimming had already established a relationship with a local bank. This put Star Fitness in a good position on opening day. "It allowed us to have a good strong launch, since everything was ready," Slimming says.

Slimming closely observes his patient's upper-body technique.

Star Fitness Center has a wide variety of Nautilus fitness machines, including: the treadclimber, treadmill, and elliptical for cardio exercises. For resistance training, Star Fitness features the Nautilus Nitro Plus and the Nautilus XP load and free weights.

On the physical therapy side, the patients have access to all of the fitness machines, but also, for those with spinal problems, they may be treated with MedX spinal-strengthening equipment. There is also a host of other, more traditional physical therapy equipment available to the therapists, including ultrasound and electrical stimulation devices, iontophoresors, paraffin baths, and Anodyne infrared equipment.

With the facility, programs, and equipment in place, Slimming had only one problem left—getting customers.

MARKETING

Slimming credits the immediate success of Star Fitness to his marketing plan, which, he says, he implemented "day one." The plan included targeting past patients, referring physicians, and the surrounding population.

The fact that he offers a fitness component makes him stand out in the sea of other PTs for physicians, and it gels with current medical philosophy. "Everyone loves the idea of fitness," he says. Slimming meets with the physicians one-on-one to encourage them to refer patients to both the physical therapy practice and the fitness center.

In terms of the general population, Slimming takes more of a shotgun approach, taking opportunities to market to potential members in a variety of ways. These include direct mail, articles in the local paper, promotions, health fairs, and block parties. Because the focus is on fitness, the fitness staff will attend those events, freeing Slimming to provide physical therapy for his patients.

Appealing to these diverse audiences has been a success, but Slimming is quick to note that the formula for success has a particular scale.

SMALL SCALE?

Could a small physical therapy clinic replicate the success of Star Fitness by buying a few pieces of fitness equipment and offering memberships? Slimming doubts it. He notes that the formula for success in the fitness center business is having one member per 1 square foot of space. In a small space, this number could reach capacity very quickly. "And you can't be a facility of excellence, and that will dilute your brand," he says.

He also notes that because a small footprint is not very lucrative, it would work against expanding the center. There would be no compelling motivation to do so. He does say that in the case of a small center, success would be less about the equipment and all about the level of service the PTs could provide.

While the small-scale approach would probably not be very lucrative, Slimming has an idea that he hopes to implement with other PTs—a fitness partnership.

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PARTNERSHIP

Slimming and his partners have developed a program that offers both know-how and financing to allow PTs to transform their practices into the model that is proving to be a financial windfall. And, in his opinion, it is the future of physical therapy. "This is the next step for physical therapy—to become more involved in patients' lives," he says.

As part of their partnership services, Slimming and his group will provide a feasibility study that will determine the proper size of the fitness facility and the price point that should be charged for a membership. The partnership is a turnkey arrangement, providing all of the management of the fitness facility—the PT will be able to continue providing therapy and leave day-to-day issues to the manager. Management services include all of the hiring, training, marketing, and establishing the fitness protocols.

By partnering with Slimming, the PT will be getting his expertise and will avoid some of the pitfalls that Slimming experienced. For instance, one of the biggest lessons he learned was that he spent much more time on training than he expected when he doubled his staff from 25 to 50.

The reality about starting a fitness center is that it can be very expensive. To that end, Slimming has developed relationships with groups of investors who are interested in contributing to physical therapy-based fitness businesses.

The result, Slimming says, is not just a lucrative adjunct to the physical therapy clinic, but a feeder for it. For his own business, he has seen this as the case, with a more significant increase in patients, making him more established in the community and more likely to get referrals. "It makes you more secure and more necessary and visible in the community," he says.

C. A. Wolski is a contributing writer for Physical Therapy Products. For more information, contact .