Evidence-Based Fitness Programs
Stephen A. Black
Most fitness professionals depend on anecdotal information to establish exercise prescriptions for clients and members. Designing exercise prescriptions on antiquated formulas and the "one size fits all" ideology are fraught with error and dangerous not only for the healthy member, but especially for those "at risk." With the increasing number of at-risk individuals joining fitness centers, using the evidence-based method should be a no-brainer. Everyone is different, so dispensing generalized exercise advice to millions of individuals will not produce optimal results.
What's driving the trend?Several factors are contributing to the use of evidence-based practice in the fitness industry. One is that hospitals are experiencing a decline in net revenue due to changes in state and federal regulations, and they are looking outside their traditional model of sick care for reimbursement strategies. They are attempting to capitalize on what more than 15,000 fitness centers across the U.S. already know: Fitness/wellness is a prosperous industry. According to the annual report published by the Medical Fitness Association (MFA), there are an estimated 875 hospital-associated fitness centers currently in the United States and Canada. They have seen an average growth of 12 percent annually since 1985. MFA predictions estimate more than 1,150 centers by 2010.1 Obviously, hospitals use the evidence-based model for patient care, and when they become more involved in the fitness industry, they will incorporate this methodology into the operation of their fitness facilities.
Why evidence-based fitness?Improved quality of member care. One benefit of evidence-based fitness includes improved quality of member and client care. With a systematic and progressive approach based on independent clinical research, an appropriate periodized prescription can be formulated, progressing the client on an individualized, safe and guided course of improved health.
The promotion of critical thinking. Evidence-based practice requires that the professional evaluate each client individually, review the literature and find the best method to approach fitness needs. It is no longer acceptable to use a cookie cutter approach to clients' health and fitness. Through critical thinking and evaluation of the literature, the professional is able to apply up-to-date and valid interventions.
Third party reimbursement. One of the driving motives of the industry to incorporate evidence-based practice is third party reimbursement. Typically, health insurance companies will not reimburse for services unless they have proof the intervention was safe and effective in improving the health of their insured. This requires appropriate documentation, which will be reviewed according to evidence-based practice.
Building an evidence-based fitness programInitiating an evidence-based fitness program begins with the ability to collect data (member information). This is vital for two reasons. First, collection of members' health history and demographical information will allow staff to better create the exercise "experience" through comparison to the population-based scientific data, and use critical thinking to create the "perfect" exercise prescription.
Second, collecting client data and storing it according to specific groups, populations, disease risks, etc., allows that database to be queried for any number of purposes, including case studies, variable specific research and outcomes management. For those critical thinkers, this translates into gold, relative to third party payers, physician referrals and profitability. If the database is compared to the normative payer database and it reveals that your facility demonstrates fewer visits to lower cholesterol, blood pressure and body fat than your competitor, who do you think will get the referral and reimbursement faster? There is power in data, and an appropriately established database with flexible query capacity will produce valid and reliable data for a multitude of uses.
Embrace technologyWithout individualized information combined with evidence-based material, the member can become frustrated or injured with a typical exercise program. One example is members who keep losing the same 10 pounds every year because they have not had their metabolism tested and don't train with a heart rate monitor. Antiquated formulas based on age and erroneous algorithms just don't work. So why are they still used? The technology exists, so embrace it. Clients will get the desired results, be healthier, and send their friends, relatives and associates to your facility because you made a difference in their lives.
Software. A variety of products are designed to aggregate information and assist in the formulation of exercise prescriptions, health-risk identification and collection of exercise data. When selecting software to manage the evidence-based fitness program, the key is innovative solutions and ease of use. In what language is the software written? Does it interface with other software packages, such as Windows? Can it link to other programs that may operate within your facility? You can link multiple packages together, including hospital databases, to capture data, share it between facilities, and achieve more efficient communication with members, patients and physicians.
It is within the realm of current operations to have a medical provider pull a member's attendance, exercise prescription and adherence (heart rate, reps, weight lifted, weight lost, frequency of visits, etc.) while the member/patient is in the physician's office. The real power of the software comes from the relationships it can build, and customizing the modules to meet the demands of today and in the future.
Additionally, you must aggregate adequate demographic information. Fortunately, several companies in Finland and at least one in Italy recognized the necessity to collect, store and provide population-specific comparisons relative to health history, and cardiovascular and metabolic parameters. With the assistance of software and hardware, it is possible to create a member profile or specific populations within the membership for the purpose of comparing existing normative data and developing an individualized exercise prescription.
Heart rate monitors. No matter what their fitness level or goals, members must exercise at the proper intensity — not too hard, not too easy. The only way to correctly gauge intensity level while exercising is to physiologically test the clients, get their appropriate thresholds and monitor their heart rate. The most efficient and accurate way to do that is for them to wear a heart rate monitor during workouts. The technology currently exists to up/download critical data for analysis, comparison, storage and transmission. Additional technology is available to conduct a metabolic test and automatically upload the monitor with the appropriate values to calculate the appropriate training zones. It is also possible to monitor up to 30 individual heart rates (no cross-talk) within a radius of 100 yards on a laptop. Think of the practical use in circuit training, group cycling and special population programming. Appropriate heart rates are identified, the workout is performed and the data is stored. Ah, the science of success!
Equipment. On the strength side of the equation, computerized systems exist that attach directly to new or existing equipment (some is proprietary and others work with any equipment), adding an "intelligent" dimension to the workout experience. Artificial intelligence allows the system to learn the users' programs, and coaches them individually through their workout for better form, safety and confidence. It tracks their progress for that workout and over time.
On strength and cardio equipment, a touch screen and/or key displays the workout for that particular piece of equipment. The intuitive system coaches the client relative to speed, form, heart rate, etc., and tracks the workout session. Behind the scenes, the exercise data from each station is transmitted to a central database, providing access to a wealth of information on individual progress and a unique set of motivational tools. The system can be accessed on the workout floor, staff station or on the web.
Knowledge is powerThe volume of clinical knowledge has expanded exponentially over the past 40 years. More than 150,000 medical articles are published each month, and there are more than 20,000 biomedical journals — leaving many of us struggling to stay current with contemporary practice and research in our chosen fields. The key to successful evidence-based fitness it to translate quality improvement strategies into powerful and effective action. This takes planning, implementation and measuring the effectiveness of the evidence-based fitness programs within your facility.
It is incumbent upon the professional and the organization to implement evidence-based fitness to ensure the health and prosperity of their members, and secure their success in the industry. Fortunately, technology is keeping speed with the advances in healthcare and, in many scenarios, driving them.
Facility of the Week
Ithaca College Athletics and Events Center