There was language introduced to the 1996 NEC to include paddle fans in this section. The original proposal (don’t have that ROP at the time) was submitted by a wiring inspector and the concern was Paddle Fans (with lighting fixtures accessories) within reach of someone while in these locations (ouch!). The proposal was accepted but the 96 language excluded the term paddle and restricted all fans, recessed or pendant from the zone. It was corrected in 1999 by adding the word (paddle) type fans (hanging type).

I believe the zone is from the top of the tub rim, or the highest point in a shower stall.
The other types of fixtures were previously addressed in this section. The NEC likes 8’ above reach as a method of guarding (see 110.27 as one example).

If you have a handbook there is an illustration fig. 410.1 and some explanatory language to this section. Keep in mind that such examples in the handbook are not official interpretations, but I believe the information has merit. The handbook suggests that surface mounted (totally?)enclosed fixtures are permissible with in the zone and pendant type items listed in the paragraph would be acceptable if located 8’ above the rim of a tub( or the shower stall). If the fixtures or track do not penetrate the 8’ (hang below)they are out of the zone and need not consider the 3’ horizontal dimension.

Charlie