Health Services Need Integrative Fitness - Especially for Homeless Veterans

In the past few years, the term “Food Desert” – an area bereft of affordable grocery stores and markets stocked with fresh, nutritious food – has transformed into a handy descriptor for low-income communities systematically neglected by local government, ignored by private investors and, often, sabotaged by real estate interests.

Health activists now recognize that communities that lack adequate nutrition resources also often lack resources for exercise, another pillar of wellness and preventive health. Fitness Deserts – areas that lack gyms, parks or even sufficient physical education class in schools – symbolize what the investigative reporting organization City Limits calls “the emerging public health issue of access to exercise,” a phenomenon a colleague and I discussed in a presentation at last month’s National Health Care for the Homeless Council’s annual conference.

Though Fitness Deserts may lack exercise infrastructure, they certainly host their share of social service agencies, which provide vital case management, counseling, health care and other needs. And it is these existing agencies, which have successfully earned social capital among their clients and neighbors, that are uniquely positioned to integrate fitness programs into their services as a low-cost (not to mention fun and dynamic) preventive health measure that promotes community among staff and clients.

Recognizing Gaps

When I first decided to integrate exercise into my social work practice to better connect with clients and provide a necessary health service, several qualitative observations motivated me:

  • The vast majority of the formerly homeless adults with whom I worked in supportive housing experienced some combination of preventable illnesses related to obesity and poverty, such as diabetes, hypertension and asthma.
  • Most of them also had a diagnosed mental illness.
  • Few of them exercised.

As I began to incorporate exercise and health counseling into my work, I encountered two startling statistics:

  1. People struggling with severe mental illness – a large percentage of the homeless population – die, on average, 25 years earlier than the general population, typically due to some preventable illness.

  2. People who have experienced homelessness die, on average, between the ages of 42 and 52, compared to age 78 for the general population.

Fortunately, nonprofit organizations and government agencies already reach many people who experience or who have experienced homelessness. Therefore, we can deliver comprehensive, integrative fitness offerings – group exercise classes for clients and staff, personal training, workout planning, and fitness workshops – to better serve these individuals through such agencies.


Exercise: A Vital Therapeutic Tool

True integration into existing programs is vital for fitness services to succeed. Fitness providers must forgo a one-size-fits-all approach and instead seek input from client participants about what they want to accomplish and what activities they enjoy. Providers must also cultivate staff buy-in by framing the service as an asset for reaching clients.

Exercising along with clients adds another tool to the therapeutic toolkit. Pedaling stationary bicycles or holding planks side-by-side provides contrast to the traditional, seated and face-to-face counseling experience. It also alters the transference: Individuals often seem more comfortable talking while exercising and frequently share new information. For example, one client recently talked with me and his case manager about the anniversary of his brother’s death – a topic he never before mentioned – as we walked on treadmills together. Even clients who do not participate in exercise classes or who resist personal training routinely chat with me about their health goals and seek guidance on nutrition and exercise that they can incorporate into their daily routines.


Exercise Programs Build Community

Not only do exercise programs promote egalitarianism in the client-worker relationship, they also build community among staff and tenants. Put simply, typical barriers disintegrate when a case manager and client try to bust out one last push-up together. However, direct staff participation is not imperative for success. Often, social service staff are, understandably, either too busy, or a bit reluctant to exercise. However, fitness providers can still enhance client support by meeting with social service staff in order to exchange information about client needs and developments.

Over the past two years, I have implemented exercise programs at eight supportive housing sites throughout the Bronx, Brooklyn, and Northern Manhattan, and I have observed how these programs help not only improve health outcomes among clients, but also enable meaningful connections to the provider and foster community among clients and staff. Ultimately, such developments have generated a culture and awareness of wellness within the community.


Exercise Can Provide Connection for Veterans

Independence Day presents us with an important opportunity – amid the cookouts and fireworks – to reflect on the needs of our nation’s military veterans who continue to experience a significant rate of homelessness despite prominent efforts by the federal government and nonprofits to develop housing and end veteran homelessness. According to the Department of Housing and Urban Development, roughly 40,000 homeless veterans remain, as of August 2016.

Integration of fitness programs into existing social services can provide an effective tool for connecting with veterans who have experienced homelessness. Exercise promotes community and camaraderie for veterans who know the meaning of teamwork and who too often end up isolated after concluding military service. These men and women could greatly benefit from a group setting that integrates both mental and physical health.

Each day, 18-22 American veterans commit suicide, and 41% of veterans experience a mental or behavioral health issue. Veterans also smoke cigarettes and consume alcohol at higher rates than non-military peers. Mental illness (50%) and substance use disorders (70%) are rampant among veterans experiencing homelessness.

Exercise programs literally meet individuals where they are – the communities in which they reside and the agencies with which they engage – and they serve as as enjoyable gateway to expanded services.

We do not have to be doctors or public health experts to support neighbors in need. By integrating fitness programs into social service settings, we can take real, measurable actions to improve health outcomes among our most vulnerable neighbors.

David F. Brand is a licensed social worker, certified personal trainer and freelance writer based in Queens. David fuses fitness with mental health counseling at supportive housing sites for formerly homeless individuals throughout New York City. Learn more about his work at