Utilization of a Free Fitness Center-Based Exercise Referral Program Among Women with Chronic Disease Risk Factors

Abstract

Physical activity (PA) reduces the risk for a number of chronic diseases including heart disease, hypertension, hyperlipidemia, and diabetes mellitus type 2. However, most Americans do not meet expert recommendations for exercise, and minorities and low-income persons are the most inactive. Community-based approaches to promoting PA include primary care exercise referral programs. This study examines patient characteristics associated with utilization of a community health center-based exercise referral program. Adult female patients of a community health center with an affiliated fitness center, in Boston, MA, were included in the study if they received a referral to the fitness center from their primary care provider. Demographic and medical information was abstracted from the medical chart, and fitness records were abstracted to measure activation of a fitness center membership (creation of an account denoting at least an initial visit) and utilization over time. Overall, 503 (40%) of the 1,254 referred women in the study sample activated their membership. Black women were almost 60% more likely to activate their membership (adjusted OR 1.6, 95% CI 1.2-2.2), and women with higher co-morbidity counts were almost 45% more likely to activate (adjusted OR 1.4, 95% CI 1.0-2.0). Once activated, a minority of women participated at levels likely to improve cardiometabolic fitness. Of the 503 activations, 96 (19%) had no participation, 359 (71%) had low participation, and only 48 (10%) had high participation. No independent predictors of participation were identified. These findings suggest that program design may benefit from developing activation, initial participation, and retention strategies that address population-specific barriers.

Linking patients with community resources: use of a free YMCA membership among low-income black women

“…Although Waterman et al [15], drawing from an urban CHC, found that female patients at risk for chronic disease had low rates of membership activation and usage, rates of usage were notably lower in our study. It is conceivable that women in Shape had to travel farther to use facilities given the rural setting, and that distance needed to travel to the YMCAs was a barrier to use.…”

“…Yet, few studies have provided study participants with access to community-based exercise facilities, and it is not yet known if people will use these resources if made available. Waterman et al determined that 50 % of female community health center (CHC) patients at high risk for cardiovascular disease in Boston, Massachusetts activated a free 3-month membership at an exercise facility affiliated with their CHC [15]. The majority of the sample was black (83.6 %) and black women were 58 % more likely to activate their memberships than were women classified as Bother.^Use of the exercise facility postmembership activation was low; 19 % of participants had no subsequent visits and 71 % were classified as having low attendance (1-17 visits) over the 3 months.…”

A Randomized Comparative Effectiveness Trial for Preventing Type 2 Diabetes

“…Recent studies of referral from primary care to a free-of-charge community-based lifestyle intervention resource show that realistic estimates of uptake may be only about 30% for any participation and as low as 5% for participation at a level believed necessary for improving fitness. (23, 24) In RAPID, we assumed based on our own pilot research that as few as 50% of referred patients may enroll in YDPP and about 70 to 75% of that subgroup (i.e. 35% to 38% overall) would participate at a meaningful level.…”

How Does Counselling in a Stationary Health Care Setting Affect the Attendance in a Standardised Sports Club Programme? Process Evaluation of a Quasi-Experimental Study

“…The 49% recruitment rate into the JACKPOT programme is fairly consistent with findings from other studies recruiting people through the health care setting into a supervised exercise programme. For example, the recruitment of women with chronic disease risk factors into a three-month free-of-charge fitness centre prescribed by primary care providers was 40% [ 25 ]. A similar recruitment rate (41%) was achieved among overweight and obese patients for their participation in a standardised exercise programme referred by mainly outpatient departments [ 18 ].…”