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Roy, Brad Ph.D., FACHE, FACSM; Gallagher, Jim M.S.

ACSM'S Health & Fitness Journal: March/April 2011 - Volume 15 - Issue 2 - pp 26-30
doi: 10.1249/FIT.0b013e31820b548d

LEARNING OBJECTIVES: From this article, the reader should understand the following concepts:

* The start of medical fitness centers in the United States.

* The origin of the Medical Fitness Association.

* Significant events in the 20-year history of the Medical Fitness Association.

The Medical Fitness Association celebrates 20 years of service to medical fitness professionals and centers. This article reviews the background, origin, and significant milestones in the history of the Medical Fitness Association as well as future challenges and opportunities.

Brad A. Roy, Ph.D., FACSM, FACHE, is an administrator/vice president at Kalispell Regional Medical Center and oversees The Summit Medical Fitness Center, a 114,800-ft2 medical fitness center located in Kalispell, MT. He is the editor of the Medical Fitness Association's Standards and Guidelines for Medical Fitness Center Facilities and a past board chairman for the Medical Fitness Association.

Jim Gallagher, M.S., served as the interim executive director for the Medical Fitness Association from August to December 2010. He also served as an MFA board member from 2005 to 2010. He has managed several medical fitness centers during his career.

Figure. No caption a...

The Medical Fitness Association (MFA) celebrates 20 years of service to medical fitness professionals and centers in 2011. Twenty years ago, less than 100 medical fitness centers (MFCs) were scattered throughout the United States and Canada. Today, more than 1,000 medically integrated centers serve an estimated 3.8 million members (3). During the past two decades, the MFA has given a voice to the medical fitness movement and continues to help medical fitness centers become successful.

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Although the concept of medical fitness can be traced back to 4,000 B.C., the U.S. medical fitness industry emerged in the 1970s, when several visionary hospitals recognized the impact fitness/wellness centers could have on the health of their growing older adult and physically challenged populations. This group of innovative health care pioneers, realizing that prevention was the future of health care, envisioned that MFCs would serve as a bridge to connect prevention and sick care and create loyal relationships with the people they care for. A paradigm shift occurred in 1968 when Dr. Kenneth Cooper published his book, Aerobics, followed by the 1970 opening of the Cooper Aerobics Center in Dallas, TX. In 1975, Holy Redeemer Hospital Health & Fitness Center in Meadowbrook, PA, was opened a few years later by the Pacer Fitness Center, a part of Integris Health system in Oklahoma. The Prevention of Atherosclerosis and Coronary disease through Education and Rehabilitation (PACER) opened in 1978 as a cardiac rehabilitation facility and later added a fitness component for employees of Baptist Medical Center. Today, PACER serves more than 3,500 patients, employees, and community members.

Ongoing reimbursement challenges and tougher state and federal regulations led hospitals to look outside the traditional health care model for service strategies that provide additional mission-driven revenue and preventive outcomes. Innovative hospitals recognized that their aging populations would benefit from nontraditional fitness and wellness services. Early centers, such as the Pacer Fitness Center, often were an outgrowth of cardiac rehabilitation programs or purchases of commercial health clubs by health systems, a pattern that continued through the early 1980s. Large integrated medical fitness centers began to emerge in the mid-1980s, further fueling the growth of medical fitness. Although growth slowed slightly during the early 1990s, it has rebounded phenomenally in the last decade. Since the beginning of the new millennium, the number of medical fitness centers has almost doubled from 550 to 1,074 in 2010. Steady growth is projected to continue into the foreseeable future.

MFCs today often are highly integrated facilities with direct access to physician offices, imaging technology, retail health services, and other specialty services, such as health risk appraisals, medical monitoring, and therapeutic exercise for special populations. Because of these characteristics and health care reform's focus on disease prevention and management, integrated medical fitness is well positioned to become the primary referral source for physicians and other health care professionals working with aging patients, individuals with health challenges, and those at increased risk of developing disease.

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As the number of medical fitness centers increased throughout the 1980s, the need for an association to represent the industry arose. The MFA, originally "The Association for Hospital Health and Fitness Centers," began as a privately owned organization in 1991. The purpose of the association was to ascertain and respond to the needs of fitness centers affiliated with U.S. hospitals. According to Bob Brosmer, past president of the MFA from 1999 to 2000, MFA's rise gave a name to the movement of hospital-owned centers, created a model for the professional delivery of medically integrated health and fitness programming, and granted the medical fitness industry credibility and a voice (H. Boerner, electronic communication, November 2010).

Perhaps the purpose of MFA is best described as follows:

"The Medical Fitness Association was created to serve as a resource to the growing hospital wellness and fitness center industry and to promote the medical fitness difference. It continues to fulfill that vision today. The MFA assists medically integrated fitness centers in enhancing member programs and services; works to establish protocols and professional standards; acts as a resource for information and education; communicates with public and governmental bodies; renders public relations and marketing support; and encourages ethical business practices that can help improve efficiency and maximize revenue" (4).

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Medical fitness centers have a distinctive signature in that they typically offer a broad range of health-related services, programs, and clinical staff not routinely available at private clubs. This clinical integration differentiates centers from their commercial counterparts and includes medical supervision, highly credentialed staff, wellness and rehabilitation services, and a personal approach to program design. These attributes, combined with an emphasis on safety, cleanliness, and customer service, contribute to the positive difference MFCs make in their communities. Services may vary from center to center, but clinical integration programs frequently include cardiac and pulmonary rehabilitation, physical and occupational therapy, sports medicine, occupational medicine, and disease management.

The Association of Hospital Health and Fitness Centers 1991 Survey and Directory (1) stated that "From the beginning, most hospital health and fitness centers have begun with purposes markedly different from those of private clubs. Hospitals have created centers primarily to:

* promote good health in the community and among employees,

* enhance the hospital's public image,

* convey a commitment to preventive medicine,

* diversify hospital services,

* provide rehabilitation services,

* increase patient referral, and

* produce a profit."

Nine years later, the Medical Fitness Center Industry Guide noted that "the medical fitness industry has evolved into a new retail business for hospitals and other health care organizations. This new wellness/fitness industry has demonstrated its ability to capture the enormous older age inactive adult market, as well as individuals with special medical needs" (5).

The medical fitness model clearly distinguishes itself from its commercial and institutional counterparts through its ability to unite a highly trained staff with special programming that focuses on the therapeutic and fitness needs of an older population that desires safety, supervision, and personal service. Today, the aging population combined with continued acceleration of health care costs has brought disease management, prevention, and a focus on wellness to the forefront of the health care agenda. Medical fitness centers continue to forge new frontiers in integrating preventive care, encouraging positive lifestyle choices, and serving the needs of older adults and special medical populations.

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In the year 2000, a group of dedicated and passionate board members purchased the individually owned association to ensure that the MFA would operate as a member-owned and -run organization. These visionaries unanimously agreed that the industry needed a voice that was unified and strong enough to support an association long-term.

Laura Neiberg, MFA President from 1998 to 1999, pointed to the change in leadership as a significant milestone, as the new structure spurred growth and unification across the country (L. Neiberg, oral communication, November 2010). The association became directly accountable to the industry through an elected board and growing committee structure. MFA's primary focus shifted to the centers themselves and how to keep them fresh, relevant, and integrated, a focus that continues today, along with serving as a resource for the development of new centers.

In 2003, the MFA conference partnered with club industry to colocate the annual conference. This continued until 2007, when MFA partnered with Athletic Business (AB), to colocate at the AB annual conference. The new venue provided MFA members with an opportunity to attend other educational sessions and participate in a world-class trade show.

That same year, MFA began implementation of regional chapters and conferences. The association entered into an agreement with the Southeastern Hospital Health and Fitness Alliance (SEHFA), allowing SEHFA to serve as the sole southeastern regional affiliate of the MFA. In addition to SEHFA, the MFA established chapters for the Northeast, Central, South Central, West, and Florida regions of the United States. Regional chapters were established to provide educational and networking opportunities for the staff members of all centers.

With the SEHFA agreement as a model, MFA continued to explore affiliations that would enhance value to the membership. In 2005, MFA and the American College of Sports Medicine (ACSM) formed a strategic alliance to enhance member benefits to both organizations and strengthen the health and fitness industry. As part of that agreement, the organizations maintain a joint presence at major educational events, including ACSM's Health & Fitness Summit & Exposition and the MFA annual conference. ACSM's Health & Fitness Journal® became the official journal of the MFA the following year. Each issue, a section of the Journal features articles that focus on different facets of the medical fitness industry.

In 2007, MFA published an initial online version, followed in 2009 by the first print edition of its Standards and Guidelines for Medical Fitness Center Facilities, setting the gold standard for MFC operations and management. Publication of the facility standards and guidelines established a set of nationally derived parameters that are applicable to the design and operation of a medical fitness facility. The guidelines provide basic parameters for the prudent operation of a medical fitness center (4).

The Standards publication set the stage for the 2008 launch of MFA's signature benefit, an exclusive unique-to-the-industry medical fitness facility certification program. The certification program is a key strategy in improving the quality and safety of programs and services that medical fitness centers perform, one that further differentiates them from their commercial counterparts. "With their focus on medically sound prevention and rehabilitation programs, medical fitness centers play a key role in the health and wellness of all Americans," said Brad Roy, Ph.D., FACHE, FACSM, and immediate past president of the MFA. "The MFA facility certification is an important step toward recognizing this health care contribution and raising the bar on the quality of services provided by the health and fitness industry," he said (4). Hank Boerner, M.S., MFA president from 2007 to 2008, sees the MFA facility certification as a tremendous accomplishment for the promotion and continuous quality improvement of our facilities (H. Boerner, electronic communication, November 2010).

In 2009, the MFA launched the inaugural Medical Fitness Institute to address the growing need to develop talented individuals to manage medically integrated health and fitness centers. The institute provides managers, directors, and rising star employees with the information, training, and resources they need to be effective and skilled medical fitness leaders," stated John Caliri, MFA board member and director, First Health Centers for Health and Fitness (2). The Medical Fitness Institute also is an important training program for new and prospective wellness directors.

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The future looks promising for the MFA as health care reform's focus on wellness and prevention will drive the growth of medical fitness and medically integrated fitness centers. Initiatives such as ACSM's Exercise is Medicinereg; and those of the American Medical Association encourage physicians to recognize physical activity as a vital sign. Physicians and other health care providers are being asked to assess physical activity levels in patients and to "treat" as appropriate, including referral to medical fitness centers for coaching and other clinical services.

Stronger alignment with physicians and other medical providers, especially communicating in an effective way, will be critical to the success of centers and in helping the people they serve achieve significant outcomes. Strong outcome and quality measures are key components of MFCs and will require stronger behavior change strategies that focus on coaching to successfully guide clients along the continuum of wellness.

Traditionally, health care has focused on diagnosing, treating, and rehabilitating disability and disease. "The future will see growth of a fourth component - prevention. Ten years from now, we will see programs that focus on prevention through facilities that focus on prevention," contends Doug Ribley (D. Ribley, oral communication, November 2010). As an example, the Akron General Health System in Ohio has announced that its strategic plan is to spend its extra resources on building wellness centers that promote prevention. The focus is on keeping people out of beds. Ribley feels that the "MFA is perfectly positioned to support organizations to positive health outcomes in their community."

Medical fitness centers will be a key strategy as hospitals and health care organizations strive to meet the wellness initiatives of health care reform and keep people out of the hospital. The long-term future of the MFA remains bright because the association continues to provide services, support, education, and networking opportunities that help member centers thrive.

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The Medical Fitness Association (MFA) started in 1991 and is celebrating 20 years of service to medical fitness professionals and centers in 2011. Twenty years ago, less than 100 medical fitness centers were scattered throughout the United States and Canada. More than 1,000 medically integrated fitness centers exist today. Medical fitness centers will be a key strategy as hospitals and health care organizations strive to meet the wellness initiatives of health care reform and keep people out of the hospital. The long-term future of the MFA remains bright because the association continues to provide services, support, education, and networking opportunities that help member centers thrive.

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1. Greene JP. Association of Hospital Health and Fitness Centers 1991 Survey and Directory. Chicago: MFA Publication, 1991, 123 p.
2. Caliri J. MFA Press Release, January 26, 2009.
3. Medical Fitness Centers Benchmarks for Success 2010. 8th ed. Richmond (VA): MFA Publication; 2010, 60 p.
4. Medical Fitness Association's Standards & Guidelines for Medical Fitness Center Facilities. Roy BA, editor. Healthy Learning, Monterey, CA; 2009.
5. Medical Fitness Center's Industry Guide 2000. 4th ed. Schuette R, editor. Evanston (IL): MFA Publication; 2000.

Medical fitness centers; Medical fitness professionals; History; 20th Anniversary; Health-related services

© 2011 American College of Sports Medicine.