The Health Care Integration Opportunity

Ten years ago, Natasha Ford, the owner of three American Fitness Institute (AmFit) facilities in Greenwich, Norwalk, and Stamford, Connecticut, began to include in her membership appli- cation a question that asked each of her new members to give her the name of their personal physician. As a result of this one step, and with the permission of each of her members, Ford created a network of community-based, primary care physicians. Over the years, she kept them contin- ually informed about health promotion programs at her club, and about the myriad health benefits of exercise. Most importantly, she has kept the physicians appraised of their patient's progress in the health promotion programs at her club.

Today, there are over 400 physicians in AmFit's community health promotion network.

Not everyone can be as prescient as Ford was about the potential value to a health club of strong ties with the local medical community. But as of July 11, 1996, the day that the U.S. Surgeon General's Report on Physical Activity and Health was released to the public, no fitness club manager can any longer afford not to take this value seriously. On that day, the highest medical authority in the U.S. affirmed what hundreds of research reports had already proven: that physical inactivity was a serious health hazard to every man, woman, and child in the U.S.

In that document, every American citizen was counselled to engage in moderately vigorous cardiovascular exercise for at least one half hour every day of the week, and to engage in strength training activities at least two times each week. In the body of that report, physical inactivity was defined as a health hazard in many ways comparable to, and substantially more prevalent than, smoking. In subsequent studies, the health benefits associated with beginning a program of regular exercise have been shown to be even more powerful and protective than the health benefits associated with giving up cigarettes.

The publication of this Surgeon General's Report culminated more than 20 years of research on the health risks related to physical inactivity and, conversely, on the health benefits of regular physical

activity. Previously, such public health organizations as the Office of Prevention at the Center for Disease Control (CDC), the National Institute on Health (NIH), and the Federal Department of Health and Human Services, had all authorized publicly-funded research on the subject. In addition, many of the country's foremost private-sector health organizations, including the American Medical Association, the American Heart Association, the National Arthritis Foundation, the American Dietetic Association, and the American Cancer Society, had already undertaken major public awareness campaigns.

One need only consult the websites of any of these organizations to observe how explicitly and consistently each expresses its commitment to the promotion of physical activity.

LEVERAGING THE MEDICAL CONNECTION

With each passing year, the entire infrastructure of American medicine, which in some ways sets the standard for the worldwide practice of medicine, is becoming progressively more and more articulate and insistent in endorsing the health club industry's primary product-regular exercise. Scarcely a week goes by without publication in a major medical journal of yet another study validating and extending the depth of scientific knowledge of the benefits of exercise. As this knowledge becomes more accessible to every practicing physician, and as its conclusiveness is demonstrated in new ways, prescribing regular exercise will come as naturally to a physician as counseling against smoking.

To give but one recent example, in October, 1998, the U.S. Center for Disease Control (CDC) increased its budget to promote physical activity and healthy nutrition from $46 million in 1997 to more than $112 million in 1999-an increase of more than 240% (Figure 17.1).

Today, every American HMO (Health Maintenance Organization), as well as every major U.S. indemnity insurer, continually encourages insureds to increase activity levels. The U.S. Department of Health and Human Services is so strongly committed to exercise that its Healthy People 2010 project has already established a formal objective to have at least 50% of American physicians regularly prescribe physical activity.

Research published in the Annals of Internal Medicine indicates just how important such physician support can be in motivating sedentary people to become physically active. When such patients were asked to register their level of agreement with the statement, "If my doctor advised me to exercise, I would follow his or her advice," 35% strongly agreed, 58% agreed, and only 8% disagreed

THE IHRSA INSTITUTE ON EXERCISE AND HEALTH

In 1996, IHRSA initiated a program to take advantage of the medical community's support, and to make sure that information relating to the health benefits of exercise gets into the hands of as many current and prospective club members as possible. Thanks to a sponsorship from Technogym, the IHRSA Institute on Exercise and Health (IIEH) has already started a program whereby the results of every new research report on the health benefits of physical activity can be faxed and/or e-mailed to all participating clubs. These reports are also e-mailed or faxed to every major health and lifestyle editor in the U.S.

Over 40 of these reports were released in 1998. The headlines of IIEH faxes from a single month in 1998 provide a glimpse of the type of powerful information that the Institute continually provides:

· "Children Benefit from Heart Health Education" (August 5, 1998)

· "Exercise Reduces Death Risk in Elderly" (August 14, 1998)

· "Weight Train for Stronger Bones" (August 17, 1998)

· "Exercise Program Promotes Long-Term Health" (August 25, 1998)

IHRSA initiated this service on the assumption that no group in the world has a greater vested interest in disseminating such information than do the leadership facilities within the worldwide health club industry. Nor does any other group have a greater vested interest in packaging and promoting this material than does this industry. Further, as more primary-care physicians orient their patients toward prevention-based health strategies, and as more physicians counsel their patients to become more physically active, the number of adult exercisers is destined to increase.

The impact of such physician support has been amply documented by the Centers for Disease Control. Data compiled from individuals in seven states and Puerto Rico found, regardless of an individual's his- tory, that a higher percentage of people engaged in more physical activity after receiving a recommenda- tion to do so by a physician (Figure 17.3).

In this environment, the opportunity for clubs to develop complementary and synergistic relationships with primary care physicians and with medical specialty groups has never been greater. It also can be expected to increase with each passing year. As but one indicator as to how rapidly this process is moving, IHRSA's data base now lists over 300 hospitals or medical practice groups that have devel- oped their own fitness facilities or are in the process of partnering the development of such facilities with existing fitness venues.