Prescription to Exercise – Fitness Clubs Assisting With Preventative Health Measures

The American Medical Association (AMA) recently announced a major policy change where patients will be encouraged to visit the gym as a way to improve their lifestyle. As such, Fitness Industry Council of Canada (FIC) believes that bridging the medical and fitness community is ideal in the prevention of many health issues, including obesity, in Canada as well. FIC is currently in conversation with the Canadian Medical Association (CMA) to speak about how we may join forces to encourage more doctors and fitness facilities to work together to strive for a public health benefit.

“Promoting physical activity and healthy weights in Canada will be a challenge, as it involves overcoming many barriers that now exist. However, it is a challenge that the CMA believes should be urgently met, through a long-term, well-funded national strategy incorporating both individual behaviour change and healthy public policy.” – Canadian Medical Association, CMA Policy: Promoting Physical Activity and Healthy Weights.

In Alberta, doctors are writing prescriptions for exercise. Doctors working in the primary care network have signed on to the Prescription to Get Active program and have the ability to officially prescribe physical activity to their patients including a one-month free membership to a local recreation centre. Since the program launched November 2011, hundreds of patients have received prescriptions. The Prescription to Get Active program is based on a similar program called Green Prescription in New Zealand where instead of resorting to drugs as medicine, the program uses physical activity as medicine. Research showed that realizing the importance of exercise provided a better sense of well-being and assisted individuals who face chronic health problems and risks (such as diabetes, obesity, heart disease, and high blood pressure).

In a pilot project the Mosaic Primary Care network in North East Calgary has partnered with the Cardiac Wellness Institute of Calgary to improve cardiac rehabilitation attendance in their patients with heart disease by providing a convenient location at the Sunridge World Health Club for program services to take place.  Participants attend the program at the fitness facility two times per week for twelve weeks under the medical supervision of the Cardiac Wellness team of physicians, ACSM Clinical Exercise Specialists and registered nurses. The program has now been expanded to include family members of the rehabilitation participants and efforts are made to accommodate exercise maintence plans for patients. The goal of this collaboration is to provide an opportunity for people who have heart disease or who are at high risk an opportunity to engage in structured exercise in a fitness club setting.  By providing this opportunity, individuals will become familiar with the fitness culture and be comfortable exercising on their own when they are done with the program.

Hopefully, these Alberta projects will lead the way for the rest of the country to develop the use of exercise in the prevention of chronic diseases. FIC was able to connect with World Health Calgary in order to speak to them about their program for this addition of FitNews.

Connecting with the Medical Community at World Health Calgary

FIC connected with Scott Wildeman, the Senior Vice President of World Health Calgary in order to provide the following information regarding their prescription to exercise program:

How did World Health originally connect with the medical community?

World Health partnered with the Cardiac Wellness Institute of Calgary (CWIC) in 2010. The CWIC runs an Alberta Health Services funded cardiac rehabilitation program out of the Talisman Centre for patients in Calgary who have heart disease or experienced a heart event. In 2010 Talisman Centre underwent a significant renovation, displacing the exercise program from this site. The CWIC approached World Health as the MacLeod Trail club is relatively close to the Talisman Centre and had a large enough space to accommodate the majority of the participants. A second temporary site was also started in a recreation centre in North Calgary.

World Health was eager to partner with the CWIC as they believed a health club setting would benefit the patients. As a health club, they aim to offer an inclusive, upbeat environment for members from all fitness backgrounds. Their belief is by having the patients perform their 12 week program in the club, they would see many of them continue on after the program as they would feel comfortable in a health club setting. Many of the participants are very new to exercise and active living, and would be intimidated to enter a health club on their own.

In 2011, the CWIC moved back to the Talisman Centre, but were appreciative of the hospitality they received while at the MacLeod Trail World Health location. They continued to work with World Health Club to offer exercise options for patients upon graduation of the rehabilitation program.  Subsequently, a need arose from the Mosaic PCN pilot to have a second location for medically supervised exercise in North East Calgary, where a higher rate of heart disease and events occur relative to the population. CWIC approached WH again to see if our Sunridge club would be suitable to accommodate a program.

The Sunridge program quickly grew and expanded to spouses of cardiac patients, as they too may have risk factors sharing lifestyle habits and or genetics with participants.  So the program now has participants who were there to not only support their spouses, but prevent any future incidents.

The doctors providing referrals to the program are also now sending people who have risk factors for heart disease, but have not yet had a heart disease – which is promising, as this may contribute to a decrease incidence of risk factors and heart disease in the community over time. The doctors are all family physicians practicing in North East Calgary and are part of the Mosaic Primary Care Network, which helps physicians coordinate their efforts in their communities.

How does the program work?

Clients attend a 12-week supervised exercise program, two times per week for one hour. They are encouraged to engage in two to three exercise sessions on their own as appropriate.  Exercise intensity and volume are derived from baseline exercise test results as well as patient exercise and medical history Participants are provided an individualized target heart rate and associated MET level to gauge exercise intensity while using equipment such as the treadmill, cycle ergometers or elliptical machine. The 1-h CR sessions are supervised directly by exercise specialists and registered nurses who assisted the patient in safely attaining their appropriate exercise intensity.  Patients wear heart rate monitors and the employees ensure that the participant is exercising within their prescribed target range based on heart rate, RPE and talk test.  Staff also monitors symptoms, blood pressure, and blood sugar as needed. Each patient has their own health coaching team on the supervising staff that assist patients in defining and reaching their heart health goals. A physician is also available onsite for managing medical emergencies and optimizing medical therapy as needed.

Some participants have progressed to light resistance training using tubing or free weights.

World Health employees simply circulate the club and try to make all of the participants feel at home and welcome in the club. This goes a long way to ensure they are treated as regular members and not patients.

At the end of the 12 week program, they are discharged from the program. World Health offers a no contract membership offer for these participants, but in the end their choice to stay as members or workout elsewhere is theirs to make. Often people believe they are “cured” and do not wish to continue any exercise. This is where it becomes important to continually educate the participants on lifestyle and exercise for the rest of their lives.

World Health CWIC and Mosaic have agreed to participation based reimbursement model. All patients check into the front desk using a special CWIC membership scan tag, not disclosing their name to protect patient privacy World Health does not collect or store personal information of program participants.

How can other clubs create a similar program for themselves? What would be the steps?

  1. Approach local chronic disease management programs like cardiac rehabilitation and open your doors to their staff and their patients to accommodate city wide access to services.
  2. Talk to your members about hosting the program. Note that “regulars” may be irritated by having all these new people showing up and using “their favourite piece of equipment”. Educate the regulars about the upcoming program and gain their support. If the program gains in popularity, it is then beneficial to reserve some equipment for the program, and ensure that your members also have equipment to utilize.
  3. Offer the program during non-peak hours allowing the program to operate with adequate equipment availability and not inconvenience members at the same time in the mornings, where your club will not be as busy as after work sessions. The patients are off work, so they are more flexible with their time.

Why is it important to encourage other clubs to promote a similar program?

These types of programs have to inspire life-long physical activity – clinical settings simply to do not inspire this behaviour. Once people graduate a clinical setting they may feel they are “cured”. The key is to encourage them to be integrated as “regular members” and feel that they need to continue. One of the major barriers to exercise is lack of convenience. Club are also convenient for individuals as they are open at all times of the day.

How can clubs connect with the medical community?

Open your doors to patients. Talk to your community chronic disease program and discuss setting up a non-member usage program. Discuss the program with your members and the positive impact you can have on your local community.

What will be the future of this program?

Chronic disease is becoming more prevalent in our aging population and occurring at earlier stages of life. Government and health care professionals are searching for feasible solutions to facilitate their programs and encourage community involvement to support graduates of their programs. Health Clubs are well positioned to create models that can support healthy lifestyle by providing safe, accessible, and effective exercise programming to meet the needs of future participants who are looking for preventative measures.