A Prescription for Wellness: Exercise Referrals at a Federally Qualified Health Center

Abstract

Introduction/Objectives: Physical activity (PA) improves quality of life and prevents chronic disease, but many adults are inactive. Planning with a health care provider in the form of an exercise “prescription” or referral may increase PA, but determinants of referral utilization are not well understood among underserved populations. This study examined sociodemographic and theory-based psychosocial determinants of exercise referral program utilization. Methods: Patients at a large, federally qualified health center with an on-site exercise facility (ie, “Wellness Center”) referral were eligible to exercise with a personal fitness advisor. Self-reported PA behavior, self-efficacy, and self-regulation strategies were measured via survey and merged with electronic health records and attendance data. Negative binomial regression was used to estimate the rate of Wellness Center utilization. Results: Patients with exercise referrals (n = 1136) were, on average, 45.6 ± 14.6 years, 78.8% female, and 78.0% Hispanic/Latino or non-Hispanic Black. Approximately half (593/1136; 52.2%) initiated exercise at the Wellness Center; initiators completed 8.8 ± 12.4 visits during follow-up. Older age was associated with higher utilization ( P < .001) and patients meeting PA recommendations had lower utilization than patients not meeting recommendations (incident rate ratio = 0.72, 95% CI 0.53-0.97; P = .03). Baseline self-efficacy ( P < .001) and self-regulation strategies ( P = .03) were significantly associated with follow-up PA, even after adjusting for baseline PA. Conclusions: In this racially/ethnically diverse patient population, older and less active patients at baseline had higher program utilization. Patients with higher self-efficacy and self-regulation strategies reported higher PA over time. Community health centers have a unique opportunity to support PA through exercise referral programs to public health priority populations.

Telephone-based support for physical activity: Results and lessons learned during the COVID-19 pandemic

“…As such, comparisons of an in-person exercise prescription program and a telephone-based prescription program can be useful for future resource planning. In our organization, we observed a slightly higher reach with the telephone program (59% vs. 52% [ 11 ]), but the in-person program had higher engagement and number of contacts with fitness advisors, as previously published [ 11 ].…”

“…Even beyond COVID-19 and exercise facility closure, other health centers may wish to implement telephone-based support for physical activity in the absence of an on-site exercise facility. Clinic-community partnerships for physical activity support can build on these findings and our prior work [ 11 ] to support health equity.…”

“…This race/ethnic distribution is in keeping with the overall patient population of the clinic system, and over 90% of patients live at or below 200% of the federal poverty guidelines. In this study, we surveyed patients about home resources and their environments because we previously described the community served by our clinic as an exercise desert , a built environment with limited walkability, green space, and affordable fitness facilities [ 11 , 36 – 39 ]. Limited access to safe outdoor spaces, coupled with greater life demands, negatively influence physical activity in low-income communities [ 38 – 40 ], and low-income adults and those from race/ethnic minority groups have been disproportionately affected by the health and economic effects of COVID-19.…”

“…In 2017, Waco Family Medicine established the Wellness Center, an on-site exercise facility, to address limitations in accessible and affordable physical activity opportunities as part of a community-centered health home approach to wellness and health equity. The program has been described previously [ 11 ]. Briefly, patients receive “prescriptions” or referrals to the Wellness Center from their health care providers, initiate a visit at the Wellness Center, and meet one-on-one with personal fitness advisors.…”

“…The Wellness Center program was designed to increase confidence for exercise and teach skills that support physically active lifestyles through one-on-one training sessions with fitness advisors [ 11 ]. Accordingly, social cognitive theory constructs, including self-efficacy and self-regulation strategies [ 18 , 19 ], were used as a framework and assessed via survey.…”