Exercise reduces risk for most chronic diseases, improves health in those with longstanding conditions, and when done properly, has no adverse effects. It’s powerful medicine. So why aren’t more doctors “prescribing” it?
“Doctors give general recommendations—walk, stretch, take a yoga class, things like that. But they typically don’t make specific referrals. People are left on their own, and many don’t know where to turn,” says Rich Farina, co-founder of the Medical Fitness Academy. MFA has produced a series of how-to videos, based on their years of real-world clinical experience, that help health care professionals develop and launch fitness programs in their offices.
Common reasons clinicians give for not prescribing exercise include: Lack of time; doubts about patients’ willingness; fear of medicolegal consequences; poor understanding of exercise physiology; and lack of a good referral base. Many practitioners simply don’t know where to send patients—especially those with medical conditions who won’t be comfortable at commercial gyms.
These are all legitimate concerns, but they’re no reason to neglect one of the best 
remedies for metabolic syndrome, obesity, cardiovascular disease, depression, and more. All of these concerns can be addressed, says Mr. Farina, who teaches practitioners how to implement office-based fitness programs.
Where Medicine & Fitness Merge
Clinicians who have their own on-site fitness facilities no longer have to worry about where to send their patients for exercise. Nor do they have to be concerned that patients will hurt themselves, because the workouts can be carefully tailored to each patient’s needs and abilities, and they can be monitored so nobody over-does it. It also allows clinical staff to gauge a patient’s progress, and feed that info back to the patient, which can be very encouraging.
“Right now, in most practices, there’s a big abyss between the clinic and the gym. The benefit of an on-site fitness program is that it closes this gap,” says Mr. Farina, who with his partner, Rita Bryan, has been helping practitioners develop clinic-based exercise systems. The goal is two-fold: to make exercise accessible, enjoyable and safe for people who would never set foot in one of the many image-oriented commercial gyms, and to create new revenue streams for cash-strapped clinics.
These need not be full-scale gyms, with hundreds of thousands of dollars’ worth of hi-tech workout equipment. In most settings, all that is needed is 1,000-1,500 square feet of dedicated space, and some refurbished equipment, which can often be obtained at great prices. “There are huge stockpiles of excellent equipment available, because the commercial health clubs turn over their equipment quite often,” said Mr. Farina.
Having a workout facility in the clinic makes it easy and convenient for patients to follow an exercise recommendation. It also helps people stay connected with the practice and creates a culture of health and wellness in and around your office. Clinic-based fitness programs “play very well with nutrition counseling services,” and can often be set up as group activities focused on specific conditions. That way, patients with particular disorders—obesity, diabetes, osteoporosis, etc—can exercise together and benefit from group support.
Physical Fitness = Fiscal Fitness
A medical fitness center can provide an excellent return on investment. Mr. Farina said many of the practices he’s worked with are bringing in up to $60,000 per month. Overhead costs typically eat 30-40% of that, putting a solid $36,000-42,000 additional income to the practice’s bottom line each month.
Generally, these practices charge patients monthly membership fees of around $100, and very few of them find it necessary to market their fitness services outside of their existing patient populations. “If you have 5,000 to 10,000 active patients, all you need to do is send out mailings to your patients, and you’ll be able to build a very nice business around this.”
The key to making a medical fitness center work is to have good trainers. They’re also a big part of the ongoing overhead, but someone who’s good at motivating patients will return the investment quickly.
Finding the Right Trainers
“You don’t want the big-muscle types, because this is not about glamour and vanity. You need real people who are good at communicating with other ordinary people. This is not about coercion or pressure. It’s about empowering people to take real steps toward better health,” says Mr. Farina.
“Some of the best people we’ve worked with have been nurses aides who’ve gone on
for additional training in fitness or exercise physiology. They make great instructors and they have excellent relational skills.”
Ideally, a trainer working at a medical fitness center should be a college grad, with some sort of advanced training and certification in exercise physiology, kinesiology, health coaching or a related discipline.
A number of organizations now have certifications for medical fitness instructors. The Medical Fitness Association has established a comprehensive curriculum and certification program for people who want to become coaches in a medical fitness context. Likewise, “Exercise is Medicine,” a major initiative launched by the American College of Sports Medicine, offers a wealth of resources to help bring physicians and fitness professionals together into stronger working relationships and to make it easy for clinicians to “Rx” exercise.
“As patients experience the benefits of an on-site medical fitness program, they will feel and look better and will most likely continue on with it indefinitely. They will also share their positive experiences with friends and family who will directly see their progress,” Mr. Farina told Holistic Primary Care. “The program becomes one that is self-perpetuating, and the result is ongoing, recurring monthly revenue stream for the practice, and better health outcomes for the patients.
