A total of 221 surveys were returned of 529 sent (42% response rate). The geographic distribution was: north central (19.9%), northeast (26.7%), mountain/western (15.5%), south central/southwest (18.4%), southeast (17.9%), and international (1.5%).
The mean number of members per facility was 1024 ± 1644 (range 7–14,000, median = 600). The mean size of facilities was 10,381 ± 13,767 ft2, (range 350–100,000, median = 6650). The ratio of members per ft2 was 1:10. Mean staff per facility was 5.9 (range 1–49). The mean number of members per staff was 171. Staff per square foot ratio was 1: 1730. Thirty-five percent of facilities allowed only employees to participate. Eleven percent of facilitieswere open to employees, spouses, retirees, and the community. The remaining 54% were open to employees and spouses, and/or retirees only. The mean cost of an annual membership was $109 ± 139 (range $0–$975).
Among responding facilities, 88% had onsite staff supervision, whereas 12% did not. Of all the staff included in the study (1302), 62% of staff were employed full-time (802) and 38% (500) were employed on a part-time basis. Three facilities (1%) had staff with no formal education beyond high school (bachelors, masters, or doctorate degrees), whereas 13 facilities (6%) employed staff with no professional certification (for example ACSM or ACE). Among staff who had achieved professional certification (not including BLS/CPR), the type of certification varied (Table 1), with 25% of staff certified by ACSM. With respect to basic life support (BLS) or cardiopulmonary resuscitation (CPR) training, 88% of staff were certified.
Ninety-two percent of facilities had a written policy statement addressing health history screening, whereas 8% had no health screening policy. Among facilities that used a health screen, 48% used a self-developed questionnaire (Table 2) of which its origin or basis was unknown. Eighty-seven percent of facilities that used a health screening questionnaire administered it to new members all of the time. Thirteen percent of facilities administered it irregularly, or not at all, to new members.
The health history-screening questionnaire was administered in 50% of facilities by staff with a college degree. Other facilities varied as to who administered the health-screening tool (Table 3). Similarly, staff with a college degree most commonly reviewed the questionnaire (Table 4). In 9% of facilities, the health-screening questionnaire was reviewed by a desk person or a staff person without a college degree, and 4% of facilities responded with “other.” The frequency that the health history screening was administered is shown in Figure 2.
Seventy-five percent of facilities required physician clearance for members that they identified as “clients at risk for heart disease,” and 18% recommended clearance. Two percent did not require or recommend physician clearance. Sixty-five responding facilities (35%) defined “at risk” as one or more risk factors. Of these, all facilities either required or recommended physician clearance. A total of 122 (65%) responders defined “at risk” as two factors or more. Of these, 118 (97%) either recommended or required physician clearance, and 4 (3%) did not require clearance. For clients with a known medical condition, 82% of facilities required physician consent (or exercise was not permitted), whereas 12% recommended physician consent. Six percent said that consent did not affect exercise participation. For new members with hypertension, 80% of respondents required physician consent to participate, whereas 20% did not.
Ninety-four percent of facilities reported that emergency procedure practices were part of their staff training/orientation, whereas 6% said it was not. Twenty-six percent of responding facilities did report practicing their procedures at least quarterly; however, 15%, 37%, and 22% reported practicing their emergency procedures semi-annually, annually, and every 1–3 yr, respectively. Fourteen percent of facilities did have defibrillators onsite and used them in training. However, 75% of facilities reported neither having a defibrillator onsite nor having it as part of their training. A further 9% had a defibrillator but did not have it as part of their emergency training, whereas 2% of facilities had no defibrillator but did have access to one during training. Twenty-five percent of facilities reported at least one emergency that required ambulance support in the past year. One facility reported 10 such emergencies.
Although multiple follow up attempts and strategies were employed, only 42% of facilities responded to the survey. Therefore, the discussion is based only on those responding facilities. It is difficult to infer these results to the general health and wellness facility population, particularly considering that nonresponders of this survey are even more likely to be noncompliant with such standards. Although the results of this study are consistent with a previous study conducted in Massachusetts (response rate of 54%) on health and fitness facilities (with the majority of centers seemingly adhering to the ACSM guidelines and principles concerning written policies and screening) (4), compliance with some of the set policies and standards is less than optimal.
Twenty-five percent of staff were certified by the ACSM and 6% did not have any national professional certification. Although most staff did possess BLS/CPR certifications, 12% did not. In addition, 12% of facilities reported no supervision. This is concerning for two reasons. It appears that although 94% staff are professionally certified, only 88% possess a BLS/CPR certification. Second, the potential for a medical emergency always exists, and 25% of facilities in this study experienced at least one medical emergency that required an ambulance in the previous year. The AHA/ACSM statement recommends that all supervisory staff should have a national professional certification and be certified in BLS. AHA/ACSM also recommends quarterly emergency practices; however, in the present study, only 26% of the respondents fulfilled these requirements. Interestingly, AWHP does not provide certification and professional guidelines.
The ACSM suggests that “a facility must offer each adult member a preactivity screening that is appropriate to the physical activities to be performed by the member”(6). In addition, the AHA/ACSM joint statement recommends that “all facilities offering exercise equipment or services should conduct a cardiovascular screening of all new members and/or prospective users”(1). Seventeen facilities in the survey (8%) did not have a health history screening policy. Of those facilities that did have a health history screening, 24 (13%) administered it irregularly (Fig. 2).
A large proportion of facilities (48%) developed their own health-screening questionnaire. It is understandable that facilities may wish to develop their own screening questionnaire due to the individual nature of their practice; however, it is hoped that they are based on already established questionnaires or practices such as the PAR-Q (23% of respondents), the AHA/ACSM screening questionnaire (22% of respondents), or an M.D. physical (5% of respondents). Unfortunately, the results could not confirm whether or not this was the case. In 9% of facilities, the health history screening was reviewed by desk personnel or staff having no college degree. Whether or not new members are being adequately screened is difficult to determine, but these data leave open the possibility that they may not be in some cases.
According to the AHA/ACSM recommendations, fitness facilities (like those in the present survey) offer high-intensity physical activity (1). This is why the recommendations ask for physician clearance for those with two or more risk factors. ACSM guidelines do not call for physician clearance for moderate risk groups (older or with two or more risk factors, but without signs, symptoms or known disease) if they plan to engage in moderate intensity physical activity.
In the present study, it is interesting to note that the criteria for determining “at risk” clients varied among survey responders. Thirty-five percent of facilities used a threshold of only one risk factor to identify “at risk” clients, despite the fact that ACSM requirements state two risk factors must be present to classify an ‘“at risk” client (1). These results suggest an opportunity for further education and communication on identification of “at risk” clients by ACSM.
The sample from which the study population was selected was from the AWHP membership directory. Ten members returned the survey because they were not associated with a facility. This may explain one possible reason for the low response rate. In addition, these worksite settings (which include members of this organization) may not be a true reflection of all health and wellness facilities in the United States and worldwide. Therefore, the results of this survey may not be generalizable to commercial and other types of health/fitness centers.
The 42% response rate is an acknowledged limitation of this study. In addition, the responses were by self-report. The results presented here may underestimate the level of noncompliance among all worksite health and fitness facilities because facilities that respond may be more likely to be compliant with current recommendations. Further, these data in no way represent practices of public health clubs.
Most responding worksite health and fitness facilities followed recommendations issued by the AHA/ACSM. However, the results of this study underscore the need for further implementation of the AHA/ACSM recommendations into worksite settings.
We gratefully acknowledge Anita Prazak and all staff at the Dan Abraham Healthy Living Center for their assistance with the data collection for this project.
Address for correspondence: Michael A. Morrey, Ph.D., 200 First Street SW, Rochester, MN 55905; E-mail:morrey.michael@ mayo.edu.
1. Balady, G. J., B. Chaitman, D. Driscoll, et al. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Med. Sci. Sports Exerc. 30: 1009–1018, 1998.
2. Maron, B. J., J. Shirani, L. C. Poliac, R. Mathenge, W. C. Roberts, and F. O. Mueller. Sudden death in young competitive athletes. JAMA 276: 199–204, 1996.
3. Mcinnis, K. J., S. Hayakawa, and G. Balady. Cardiovascular screening and emergency procedures at health clubs and fitness centers. Am. J. Cardiol. 80: 380–383, 1997.
4. Morrey, M. A., and D. D. Hensrud. The risk of medical events in a supervised health and fitness facility. Med. Sci. Sports Exerc. 31: 1233–1236, 1999.
5. Peberdy, M. A., J. P. Ornato, R. Frank, C. J. Schmeil, A. Heffner, and P. Kamilakis. Physician office preparedness for medical emergencies: “Is your doctor’s office prepared to treat a cardiac arrest?”. Circulation 96 (Suppl. 8): I561, 1997.
6. Tharrett, S. J., and J. A. Peterson. ACSM Health/Fitness Facility Standards and Guidelines, 2nd Ed. Champaign, IL: Human Kinetics Books, 1997, pp. 6.
7. Thompson, P. D. The cardiovascular complications of vigorous physical activity. Arch. Intern. Med. 156: 2297–2302, 1996.
8. Thompson, P. D., E. J. Funk, R. A. Carleton, and W. O. Sturner. The incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA 247: 2535–2538, 1982.
9. Van Camp, S. P., and R. A. Peterson. Cardiovascular complications of outpatient cardiac rehabilitation programs. JAMA 256: 1160–1163, 1986.
10. Van Camp, S. P., C. M. Bloor, F. O. Mueller, R. C. Cantu, and H. G. Olson. Nontraumatic sports death in high school and college athletes. Med. Sci. Sports Exerc. 27: 641–7, 1995.
Keywords:© 2002 Lippincott Williams & Wilkins, Inc.
HEALTH PROMOTION; WORKSITE HEALTH AND FITNESS; HEALTH HISTORY SCREENING