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.
Similar content being viewed by others
References
Lee, I., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., & Katzmarzyk, P. T. (2012). Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. The Lancet, 380(9838), 219–229.
Britton, K. A., Lee, I. M., Wang, L., Gaziano, J. M., Manson, J. E., Buring, J. E., et al. (2012). Physical activity and the risk of becoming overweight or obese in middle-aged and older women. Obesity (Silver Spring), 20(5), 1096–1103.
Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., et al. (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Medicine and Science in Sports and Exercise, 43(7), 1334–1359.
Hamer, M., Ingle, L., Carroll, S., & Stamatakis, E. (2012). Physical activity and cardiovascular mortality risk: Possible protective mechanisms? Medicine and Science in Sports and Exercise, 44(1), 84–88.
Lee, D. C., Sui, X., Artero, E. G., Lee, I. M., Church, T. S., McAuley, P. A., et al. (2011). Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: The aerobics center longitudinal study. Circulation, 124(23), 2483–2490.
Pasiakos, S. M., Karl, J. P., Lutz, L. J., Murphy, N. E., Margolis, L. M., Rood, J. C., et al. (2012). Cardiometabolic risk in US army recruits and the effects of basic combat training. PLoS ONE, 7(2), e31222.
Sattelmair, J., Pertman, J., Ding, E. L., Kohl, H. W., 3rd, Haskell, W., & Lee, I. M. (2011). Dose response between physical activity and risk of coronary heart disease: A meta-analysis. Circulation, 124(7), 789–795.
Shiroma, E. J., & Lee, I. M. (2010). Physical activity and cardiovascular health: Lessons learned from epidemiological studies across age, gender, and race/ethnicity. Circulation, 122(7), 743–752.
National Center for Health Statistics. (2012). Health, United States, 2011: With special feature on socioeconomic status and health. Hyattsville, MD: National Center for Health Statistics.
US Department of Health and Human Services. (2008). 2008 Physical activity guidelines for Americans. Washington, DC. ODPHP Publication No. U0036.
Bauman, A. E., Reis, R. S., Sallis, J. F., Wells, J. C., Loos, R. J., & Martin, B. W. (2012). Correlates of physical activity: Why are some people physically active and others not? The Lancet, 380(9838), 258–271.
Dogra, S. (2011). Better self-perceived health is associated with lower odds of physical inactivity in older adults with chronic disease. Journal of Aging and Physical Activity, 19(4), 322–335.
Moore, S. M., Dolansky, M. A., Ruland, C. M., Pashkow, F. J., & Blackburn, G. G. (2003). Predictors of women’s exercise maintenance after cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation, 23(1), 40–49.
King, W. C., Engel, S. G., Elder, K. A., Chapman, W. H., Eid, G. M., Wolfe, B. M., et al. (2012). Walking capacity of bariatric surgery candidates. Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery, 8(1), 48–59.
Shuval, K., DeVahl, J., Tong, L., Gimpel, N., Lee, J. J., & DeHaven, M. J. (2011). Anthropometric measures, presence of metabolic syndrome, and adherence to physical activity guidelines among African American church members, Dallas, Texas, 2008. Preventing Chronic Disease, 8(1). Retrieved on July 20, 2011 available from, http://www.cdc.gov/pcd/issues/2011/jan/09_0229.htm.
Centers for Disease Control and Prevention. (2011). CDC health disparities and inequalities report—United States, 2011. Morbidity and Mortality Weekly Report, 60(Supplement), 1–116.
Conn, V. S., Hafdahl, A. R., & Mehr, D. R. (2011). Interventions to increase physical activity among healthy adults: Meta-analysis of outcomes. American Journal of Public Health, 101(4), 751–758.
Pavey, T., Taylor, A., Hillsdon, M., Fox, K., Campbell, J., Foster, C., et al. (2012). Levels and predictors of exercise referral scheme uptake and adherence: A systematic review. Journal of Epidemiology and Community Health, 66(8), 737–744.
Petrella, R. J., Kennedy, E., & Overend, T. J. (2008). Geographic determinants of healthy lifestyle change in a community-based exercise prescription delivered in family practice. Environmental Health Insights, 1, 51–62.
Shelton, R. C., McNeill, L. H., Puleo, E., Wolin, K. Y., Emmons, K. M., & Bennett, G. G. (2011). The association between social factors and physical activity among low-income adults living in public housing. American Journal of Public Health, 101(11), 2102–2110.
Thomas, S., Halbert, J., Mackintosh, S., Quinn, S., & Crotty, M. (2012). Sociodemographic factors associated with self-reported exercise and physical activity behaviors and attitudes of South Australians: Results of a population-based survey. Journal of Aging and Health, 24(2), 287–306.
Willey, J. Z., Paik, M. C., Sacco, R., Elkind, M. S., & Boden-Albala, B. (2010). Social determinants of physical inactivity in the Northern Manhattan study (NOMAS). Journal of Community Health, 35(6), 602–608.
Ajzen, I. (2012). The theory of planned behavior. In P. A. M. Lange, A. W. Kruglanski, & E. T. Higgins (Eds.), Handbook of theories of social psychology (Vol. 1, pp. 438–459). London: Sage.
Schmidt, M., Absalah, S., Nierkens, V., & Stronks, K. (2008). Which factors engage women in deprived neighbourhoods to participate in exercise referral schemes? BMC Public Health, 8, 371.
Pavey, T. G., Taylor, A. H., Fox, K. R., Hillsdon, M., Anokye, N., Campbell, J. L., et al. (2011). Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: Systematic review and meta-analysis. BMJ, 343.
Taylor, A. H., Doust, J., & Webborn, N. (1998). Randomised controlled trial to examine the effects of a GP exercise referral programme in Hailsham, East Sussex, on modifiable coronary heart disease risk factors. Journal of Epidemiology and Community Health, 52(9), 595–601.
Tobi, P., Estacio, E., Renton, A., Yu, G., & Foster, N. (2012). Who stays, who drops out? Biosocial predictors of longer term adherence in participants attending an exercise referral scheme in the UK. BMC Public Health, 12(1), 347.
Williams, N. H., Hendry, M., France, B., Lewis, R., & Wilkinson, C. (2007). Effectiveness of exercise-referral schemes to promote physical activity in adults: Systematic review. British Journal of General Practice, 57(545), 979–986.
Grundy, S. M., Brewer, H. B., Jr, Cleeman, J. I., Smith, S. C., Jr, Lenfant, C., American Heart Association, et al. (2004). Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation, 109(3), 433–438.
Resilient Families Resilient Communities. (2011). Codman square/four corners data profile. Retrieved on August 23, 2012 available from, https://docs.google.com/file/d/0ByGPxxu5zx5fNDFiMTM5MWQtMzY2NS00ODQxLWFkOGQtNTQxYTE2YWZiMzY0/edit?hl=en_US.
Hallal, P. C., Andersen, L. B., Bull, F. C., Guthold, R., Haskell, W., & Ekelund, U. (2012). Global physical activity levels: Surveillance progress, pitfalls, and prospects. The Lancet, 380(9838), 247–257.
Heath, G. W., Parra, D. C., Sarmiento, O. L., Andersen, L. B., Owen, N., Goenka, S., et al. (2012). Evidence-based intervention in physical activity: Lessons from around the world. The Lancet, 380(9838), 272–281.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Waterman, M.R., Wiecha, J.M., Manne, J. et al. Utilization of a Free Fitness Center-Based Exercise Referral Program Among Women with Chronic Disease Risk Factors. J Community Health 39, 1179–1185 (2014). https://doi.org/10.1007/s10900-014-9874-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-014-9874-2