What Your Gym Needs to Know About Physician Referral Programs

In most developed markets, health clubs reach fewer than 20% of the population. This leaves a large number of people who could benefit from exercising in your health club but aren’t currently.

As the world copes with an ongoing viral pandemic—one that has hit people with chronic health conditions and obesity the hardest—the importance of regular physical activity has become even more apparent. People with—or at risk for—chronic, noncommunicable diseases like high blood pressure, diabetes, and cardiovascular disease especially benefit from regular physical activity.

Yet too few people are getting enough physical activity, a problem that only worsened during stay-at-home orders around the world. The most common barriers to physical activity before COVID-19 included time, intimidation, cost, and low self-efficacy. Post COVID-19, uncertainty about the risk of coming to a gym is a new, added barrier.

So what can you and your club do?

Educate the Community About the Safety of Your Facility

Consumers and physicians alike may have preconceived notions about the cleanliness, safety, and other components of a gym environment (and they won’t all be positive). Provide information about your club’s safety measures and cleaning protocols. Make it easy for people to see how your club looks and how a visit will work by showing them with videos or photos. Make sure this information is easy to find when customers visit your website or search for you online.

Use Physician Referrals to Get More People Active

There are multiple studies supporting the positive impact physician referrals can have for exercise programs. A randomized controlled trial published in BMJ Open found that patients who were referred to a community-based exercise program emphasizing social support increased their physical activity—and stuck with it—for an additional 15 months following the original program.

Another study published in BMJ Open reported people who completed the Northumberland exercise referral plan—which included motivational consults and supervised exercise sessions at a leisure facility of their choosing—were more active after six months, though they did not achieve the recommended 150 minutes of moderate exercise per week.

Then there's the study published by the U.K. National Institute for Health Research that found exercise referrals increased the likelihood participants would meet the recommended 90-150 minutes of weekly exercise by 12%.

During a 2018 review of 13 studies published in BMC Public Health involving a variety of exercise types and modalities, researchers found referral programs most commonly used personal exercise sessions based in a gym environment, and that longer programs—lasting over 20 weeks—resulted in better health outcomes and higher physical activity prescription adherence than programs lasting 8-12 weeks. Referral programs had positive effects on heart health measures like blood pressure in people with cardiovascular disease.

Evidence also suggests that community-based exercise is an essential component of exercise prescription. A 2015 study in Preventive Medicine Reports comparing Exercise is Medicine recommendations with and without a community-based exercise program found that those who received the community-based exercise program had much higher physical activity uptake—adding 250 minutes of exercise per week compared to just 38 minutes for non-participants.

The evidence supporting physician referrals for exercise is clear, yet there remains a disconnect.

Physicians See The Benefit, But Need a Safe ‘Pharmacy’ to Fill the Exercise Rx

According to a 2012 survey of U.K. health professionals, 92% of primary care physicians and 99% of nurses agreed or strongly agreed that promoting physical activity is important. Yet, only 32% were confident their advice would lead to behavior change. A survey of U.S. physicians belonging to the American College of Sports Medicine (ACSM) found that 74% regularly recommend physical activity, 66% discuss exercise in patient visits, and 49% include it as a vital sign.

So what can you and your club do?

Educate the Community About the Safety of Your Facility

Consumers and physicians alike may have preconceived notions about the cleanliness, safety, and other components of a gym environment (and they won’t all be positive). Provide information about your club’s safety measures and cleaning protocols. Make it easy for people to see how your club looks and how a visit will work by showing them with videos or photos. Make sure this information is easy to find when customers visit your website or search for you online.

Use Physician Referrals to Get More People Active

There are multiple studies supporting the positive impact physician referrals can have for exercise programs. A randomized controlled trial published in BMJ Open found that patients who were referred to a community-based exercise program emphasizing social support increased their physical activity—and stuck with it—for an additional 15 months following the original program.

Another study published in BMJ Open reported people who completed the Northumberland exercise referral plan—which included motivational consults and supervised exercise sessions at a leisure facility of their choosing—were more active after six months, though they did not achieve the recommended 150 minutes of moderate exercise per week.

Then there's the study published by the U.K. National Institute for Health Research that found exercise referrals increased the likelihood participants would meet the recommended 90-150 minutes of weekly exercise by 12%.

During a 2018 review of 13 studies published in BMC Public Health involving a variety of exercise types and modalities, researchers found referral programs most commonly used personal exercise sessions based in a gym environment, and that longer programs—lasting over 20 weeks—resulted in better health outcomes and higher physical activity prescription adherence than programs lasting 8-12 weeks. Referral programs had positive effects on heart health measures like blood pressure in people with cardiovascular disease.

Evidence also suggests that community-based exercise is an essential component of exercise prescription. A 2015 study in Preventive Medicine Reports comparing Exercise is Medicine recommendations with and without a community-based exercise program found that those who received the community-based exercise program had much higher physical activity uptake—adding 250 minutes of exercise per week compared to just 38 minutes for non-participants.

The evidence supporting physician referrals for exercise is clear, yet there remains a disconnect.

Physicians See The Benefit, But Need a Safe ‘Pharmacy’ to Fill the Exercise Rx

According to a 2012 survey of U.K. health professionals, 92% of primary care physicians and 99% of nurses agreed or strongly agreed that promoting physical activity is important. Yet, only 32% were confident their advice would lead to behavior change. A survey of U.S. physicians belonging to the American College of Sports Medicine (ACSM) found that 74% regularly recommend physical activity, 66% discuss exercise in patient visits, and 49% include it as a vital sign.

A qualitative interview of health professionals found that while many viewed physical activity promotion as important, many also felt it was outside of their expertise, and less important than other health promoting activities like quitting smoking. Some physicians felt a referral for exercise was as a holistic alternative to medication with possible added social benefits, while others reported concern that it would have limited reach and exacerbate existing health inequalities.

Healthcare professionals noted geographic isolation and uncertainties about patient selection criteria, medico-legal responsibilities, and a lack of feedback about patient progress as barriers to referring them to exercise programs. Concern about referring to indoor exercise is presumably also a concern for physicians in certain areas.

A healthcare provider’s own activity level can play a crucial role in whether or not they refer. In the same study, interviewees linked their decisions on whether to recommend physical activity to patients to their own physical activity levels and their subjective assessments of patient motivation. Another review found consistent evidence indicating physically active physicians and other providers are more likely to advise their patients on physical activity and can be powerful physical activity role models.

In the survey of ACSM physicians, admittedly a subsection of physicians already familiar with exercise, the majority reported being familiar with health clubs, viewing them favorably, and seeing them as an appropriate place for their patients. Only 41% reported recommending health clubs to patients, citing expense and convenience as the largest barriers.

Doctors have significant power to influence their patient's behavior, so developing a successful relationship with the medical professionals in your community is key if you want them to refer patients to your club.

Key Practices for Clubs

Many U.S. health clubs have found success implementing a 60-day exercise referral program called P.r.e.p. Originally designed by acac Fitness & Wellness and implemented by clubs across the states, P.r.e.p. leverages a few key components to address barriers and facilitate uptake and referral:

1. Moderate cost: The program is only $60 for 60 days—or just $1 a day—making it an affordable option for physician referred members. Throughout the program, participants deal with health and fitness professionals, not sales staff.
2. Building confidence and social support: The twice-weekly small group training provides a comprehensive introduction to the club over eight weeks, building confidence and self-efficacy as well as fostering a supportive environment. Consider how you will enforce physical distancing or leverage virtual sessions to keep participants safe.
3. Provider education: Physician Liaisons educate healthcare providers about the program and benefits of the club, and invite them to experience it for themselves before referring. The club also offers healthcare providers an opportunity to go through the program themselves.
4. Regular feedback to physicians: The club uses HIPAA compliant software, enabling them to report back to physicians—addressing one of the several barriers noted to their referrals.

Many people physicians refer may be visiting a health club for the first time or the first time in many years. So, offering a dedicated program that provides education and support and builds self-efficacy can help ensure the person feels comfortable and well-adjusted in your club, making them more likely to join at the end of the program or trial period and continue exercising for the longer term.

While many physicians recognize the benefits of physical activity, fewer appreciate the added benefits of doing so in a health and fitness club, and COVID-19 has given them another reason to ignore these benefits. But as Dr. Gregory Degnan, Chief Medical Officer at acac Fitness and Wellness told Dr. Amy Bantham on the Move to Live More podcast recently, “Until we have a vaccine, and we are six months at best from that, COVID isn’t going away. In six months, I can lose a fair amount of weight. I can get my diabetes pretty well under control. I can get my hypertension pretty well under control in six months. If we look at this as the long game, at the end of the day, one thing COVID has demonstrated to us, no matter what comes around, it hits people with chronic disease harder. And health clubs are the solution for chronic disease.”

IHRSA has free resources available to help you create your club's medical wellness program and connect with local health professionals.