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ACSM'S Health & Fitness Journal:
doi: 10.1249/

Design and Operation of a Medical Fitness Center: The Clinician's Perspective

Holm, Byron M.D.; Holm, Mary B.S., P.T.

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Byron Holm, M.D., a 1973 graduate of Indiana University, has been a family practice physician in Plymouth, IN, for the past 33 years. He is the county health officer and EMS services medical director. Dr. Holm has owned and operated the Holm Memorial Clinic since 1979.

Mary Holm, B.S., P.T., a 1970 graduate of Indiana University, began her career as clinical physical therapist in a variety of outpatient and inpatient settings, extended care facilities, home care, and private practice. She has been the owner and manager of The Fitness Forum since 1982. Both she and her husband are the visionaries and designers of LifePlex-opened in 2007, emphasizing disease prevention and active lifestyles.

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LEARNING OBJECTIVE: • Exploring motives and vision for building or operating a medical fitness center gives important direction to the essential business plan. This article explores ways to integrate design and function in the building process and then implement quality standards for operation along with your unique brand.

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Design of the initial medical fitness center grew out of necessity for a better way to make a lasting connection with our patients and the vast population who could be living healthier, more productive, and satisfying lives. Because of necessity, existing space was shared for a membership fitness population, physical therapy, and cardiac rehabilitation patients. It soon became apparent that this arrangement was both economically and philosophically desirable. Because of space constraints, health education and exercise-based special population programs expanded to community centers and outdoor parks. Designing a new LifePlex facility then became a plethora of past experience, new ideas for increasing services unique to our demographics, outstanding examples of facilities visited around the country, and brainstorming sessions on making the physical facility aesthetically pleasing and functionally efficient.

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Just as passion may be the fuel behind a service-oriented industry, a business plan is the steering wheel. As clinicians focusing on client needs, it is easy to forget the importance of business planning and the role a clinician plays in contributing to many aspects of the plan: mission and vision, developing facility design and function, programming and services, staffing, and features unique to the demographics or vision. Clinicians can advise from their perspective, an overview of the industry environment, a local review of competition, market segment and barriers, company strategy for growth, and ongoing management. An accountant's expertise in preparing a financial pro forma is vitally important to initial decision making as well as the future fiscal and service opportunities of the medical fitness center.

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LifePlex experienced several failures in financing over a 5-year period before a plan was in place. Because LifePlex is not affiliated with a health system and fitness is considered a high-risk endeavor, traditional financial institutions required 50% capital investment in the project. Investors were hesitant to invest capital for the same reasons. The final business plan greatly expanded the medical specialty lease space from the original, which made the investment more desirable to financial institutions and investors. Aligning ourselves with a construction management and design company with experience in investor-funded projects allowed us to partner with investors for half of the building primarily occupied by physicians with higher anticipated profit margins. Creative division of the property and building provided two separate corporations for ownership and resulted in loans for construction financed by two separate institutions, each incurring less risk than the whole.

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Photo courtesy of Li...
Photo courtesy of Li...
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LifePlex in its final design is an inspired vision for a paradigm shift from traditional medical care promoting health to the sick to a broad acceptance of health care, education, and wellness opportunities for the sick and the well alike. It combines recreation, fitness, rehabilitation, and commercial and health-care services for a new synergy to promote the realization of human potential in health. The center provides variety, convenience, and inspiration to promote the enjoyment of people to take an active role in their own health promotion. Through a mixture of traditional and nontraditional services, this facility serves as a community-based center for education, health care, fitness, positive recreation, and socialization for families, groups, schools, industry, and individuals of all ages, with or without disabilities or chronic diseases.

The LifePlex facility is designed for integration of medical, rehabilitative, fitness, recreational, support, and retail services. An open floor plan underscores the vitality and visually stimulating character of the facility. Natural vegetation and full-spectrum lighting creates a friendly and inviting environment. Three indoor water walls and an outdoor cascading fountain provide an ambience of peace and life. The main entrance features a spacious atrium lobby with immediate access to the reception, waiting areas, café, medical spa, conference rooms, child-care "playhouse," and other public areas. The conference room serves as space for community outreach and education, conferences, and a community meeting area.

Fitness and recreational areas include a variety of cardiovascular and strength training equipment, group exercise studios, and Kidzone for elementary programming. A second-floor walk/run track provides a view indoors and outdoors. Recreational options include racquetball courts, gymnasium, lap pool, and warm water therapy pool. The plush locker rooms with spa atmosphere offer a lounge, spa, dry sauna, and steam room.

True integration of services requires sharing staff, programs, and facility environments. The strength and cardiovascular training areas are used by members of Fitness Forum Sports & Wellness and patients in physical therapy services, cardiac and pulmonary rehabilitation, and other clinical exercise programs for management of lifestyle diseases. A classroom for clinical program instruction and support groups is located adjacent to the cardiovascular training area. The blending of patients with community members is financially more efficient than other models and promotes compliance with healthy lifestyles. Rehab patients using equipment alongside members encourages exercise for a healthier lifestyle beyond rehabilitation. Sharing space promotes communication of clinical and fitness staff for quality patient care.

Physician offices have a visual and physical connection to the main entrance and Fitness Forum Sports & Wellness. A complete Diagnostic Imaging Center provides services for primary and specialty care and screenings for preventive care and clinical programming. Physicians and other medical specialties emphasizing exercise and good nutrition for prevention and treatment of lifestyle disease find LifePlex a refreshing approach to hands on instruction and practical application of healthy lifestyle principles from professionals in the fields of physical therapy, exercise physiology, personal training, dietetics, aqua therapy, nursing, and education.

Physical therapy is located adjacent to fitness and aquatic areas with access directly to the warm water therapy pool equipped with ramp, lift, or stairs for entry; Badu Jet for resistance training; and underwater benches. Sharing the therapy pool with a variety of populations provides optimum space use.

Photo courtesy of Li...
Photo courtesy of Li...
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Photo courtesy of Li...
Photo courtesy of Li...
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Additionally, a large conference room is available. The medical community has access for conferences and educational meetings to foster superior care to the patient. Community Outreach Health Education is held in the LifePlex conference area as well as a variety of classes on lifestyle management. Business, industry, and community groups can use the conference center with the bonus of catering available onsite and day passes for fitness and recreation.

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In the midst of delays, decision, and daily temptation to get stuck in the building process and initial operation, three documents kept us on track: our own mission and vision, the Medical Fitness Association's (MFA's) The Medical Fitness Model: Facility Standards and Guidelines, and ACSM's Facility Standards and Guidelines. The MFA standards and guidelines provided a blueprint for design far beyond the physical plant. They continue to be a source for confirmation of what we are doing right and a focused challenge for areas where we can improve. Quality management, performance improvement, and outcome measures have been the most challenging of the seven areas of standards. Although we have not reached our high expectations of quality outcomes management as it relates to physician relationships, client motivation, and research contributions, we are committed to make this a priority. Integrated software systems are being developed to provide seamless information flow from sign-up, to assessment and health-risk appraisal, to physicians clearance, and finally, to orientation and continual motivation. As good as this sounds, the challenge has been twofold. Working with software companies and information technology to integrate programs and understand our clinical needs for efficiency and integrated data has been a time-consuming and slow process. Time and staffing constraints have been the greatest hindrance to developing the capabilities in purchased software and other tools. Ultimately, integrated data on progressive fitness assessments results, laboratory reports, dexa scans, V˙O2, and resting metabolic rate results will be graphed chronologically on the same screen with exercise history and accelerometer data for easy to read outcomes.

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Because the heart of our mission is stewardship, environment was an important issue in the design process. LifePlex by mechanical design is a very integrated facility. The HVAC Mitshibishi City multisystem is a totally electric system capable of cutting HVAC operation cost in half while moving heat or cooling within the building to various areas without going to the outside condensers. Insulation in walls and ceiling is designed for sound reduction and energy conservation. In the aquatic area, heat that is captured during cooling and dehumidification is used to heat the pool. The pools are treated with chlorine and ultraviolet filters. This system is effective in reducing chloramines and increasing comfort for staff and clients.

Motion sensors operate lighting in many areas. Saving watts is enhanced with computerized lighting controls to shut off concourse and outdoor lighting when not needed. Strategically placed sky lights and large window walls not only create energy and a sense of nature and spaciousness, but also minimize artificial light needed during daylight hours.

An aggressive recycling program encourages all employees and guests to conserve resources. The County Waste Management supplies containers and free drop-off facilities, making the partnership a model for other businesses. Approximately 100 trees have been planted in what was an open field to beautify the grounds and replenish the environment.

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Standards and guidelines provide necessary consistency and uniformity to our industry. Just as important to design and operation of a medical fitness center is development of unique offerings and design. Our story will be different than yours. Create and embrace your uniqueness.

LifePlex was conceived in a faith conviction. The cornerstone "Dedicated to the Stewardship of God's Grace and Gifts" suggests the responsibility and privilege we have in living our own life as mentors in service to others while teaching stewardship of body, mind, and spirit. Over the entrance, "Let Us Run With Endurance The Race That Is Set Before Us," is an inspiration to live each day, reaching clearly for the goal, both spiritually and physically.

LifePlex is unique in its ownership and location. The facility is privately owned by physicians and investors and not affiliated with a health-care system. Rising out of rural Indiana, LifePlex sets on the edge of Plymouth, with a population of 10,500-not very likely demographics for a 140,000-square foot medical fitness facility. The small market area has necessitated creative programming, desirable fee structures, and expanding the market beyond the statistical norms with destination offerings. Located on the edge of industrial park and a future technology park, LifePlex strives to become the area's wellness program provider and corporate fitness center.

Construction was purposefully designed to use local contractors because we wanted to create local ownership in the building project and contribute to local economy. The primary owners and visionaries brought years of practical experience in the medical, rehabilitation, and fitness fields to the project.

Recreational opportunities for creating compliance with active healthy lifestyles was a vision point. Unique partnerships made this component a success. A local junior college had no indoor athletic facility, so LifePlex partnered with them and provided the physical space for member and community court sports, concerts, dances, and expos. The town of Plymouth had no public indoor recreation center before LifePlex, so this partnership created a new market for exposure to medical fitness programming.

LifePlex Institute for Healthy Living (organized as a 501c3) is a resource that has been met with great enthusiasm from the staff. It was created as an avenue for the corporate and program profits to reinvest in scholarship for community wellness and for individuals to share in their own success in healthy living by encouraging others as donors and board members. Staff members have enthusiastically created donor campaigns and look forward to community members being scholarship recipients.

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Medical fitness facilities are increasing at an exciting rate. As an industry, we have mastered exercise, nutrition, smoking cessation, stress management, and a myriad of programming ideas. Yet 60% of the U.S. population is not active enough to reap the health benefits associated with regular exercise. Reaching this 60% is a primary challenge for clinicians. Decreasing attrition rates and partnering with physicians for patient care demands our health-care communities to work together for a healthier community at large. At LifePlex, one of our new paradigms will be rural health research to determine if the presence of a medical fitness center actually results in improvement of overall community health.

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Designing and operating a successful medical fitness center requires mission, planning, perseverance, expert resources, and clinical experience in medical care and fitness. An aesthetically exciting physical plant will be an attraction for staff and community involvement. Making a difference in your community, however, requires quality standards, exceptional staff, the latest technology, and innovations for the future.


Integrated Design and Operation; Resources; Standards and Guidelines; Stewardship; Uniqueness

© 2008 American College of Sports Medicine


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