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The Medical Fitness Model: Facility Standards and Guidelines

Roy, Brad A. Ph.D., FACSM, CHE

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doi: 10.1249/01.FIT.0000257709.92115.f2
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Across the country, medical fitness centers are defining the nature of professionally administered health and fitness services to a nation whose health-care services are increasingly challenged by an aging population, individuals who have chronic disease and experience pain, and youth who place minimal value on the importance of physical activity and preventative health habits. Recognizing the importance of preventing disease and improving the health status of the communities they service, medical fitness centers have brought a higher level of medical resources, monitoring, and accountability to the fitness industry. Beginning in the late 1970s, the medical fitness industry has grown from 79 centers in 1985 to 875 in 2006 and continues to expand at a rapid rate.

The Medical Fitness Association (MFA), a nonprofit organization, was formed in 1991 to serve as a resource to the growing medical fitness industry. The association supports member facilities by establishing protocols and professional standards, providing networking and educational opportunities, communicating with public and governmental bodies, responding to the needs of member centers, and defining and promoting the medical fitness difference.

Rapid growth of the medical fitness industry has resulted in confusion regarding what sets a medical fitness center apart from a traditional commercial club. In 2004, responding to member requests for clarification and a set of standards, the MFA Board of Directors commissioned a task force to research, develop, and implement standards and guidelines for the operation of a medical fitness center. MFA board member Brad A. Roy, Ph.D., FACSM, CHE, was asked to chair the task force, and contributors were invited to participate from a national list of experts (Table 1). The following process was undertaken to develop the guidelines:

Table 1
Table 1:
Facility Guidelines and Standards Task Force
  • telephone conferences to discuss the perceived need, set objectives, and identify individual and group tasks
  • half-day face-to-face workshop following the 2004 MFA conference in Orlando to identify and further clarify standards and associated guidelines
  • development of a written draft, subsequently circulated to the task force for critique, followed by a telephone conference to discuss necessary revisions
  • development and implementation of a Web-based member survey to validate and garner comments for each proposed standard and guideline
  • telephone conference to review survey results and outline recommended revision of the document
  • presentation of the final draft at the 2005 MFA conference
  • final revisions and February 2006 publication of The Medical Fitness Model: Facility Standards and Guidelines (1)

The standards and guidelines were designed to provide basic parameters for the prudent operation of a medical fitness center. The following objectives were identified by the task force:

  • Define the "medical fitness difference."
  • Provide a resource to facility directors/managers for
    • basic standards for operating a medical fitness center
    • providing facility participants a safe and medically sound experience that focuses on health improvement
  • Establish standards for future facility and program recognition.

The Medical Fitness Model: Facility Standards and Guidelines encompasses 14 standards organized into seven primary categories. Each standard is supported by a number of explanatory guidelines that illustrate how facilities can comply with the stated standard. Standards represent the minimum requirements that facilities must have in place to meet the definition of a "medical fitness center." The seven categories that the standards and associated guidelines fall under are as follows:

  • medical oversight
  • emergency response
  • programs and services
  • aquatics
  • staffing
  • quality management, performance improvement, and outcome measures
  • accessibility and safety

These seven sections are followed by a number of appendixes that provide resources and sample documents to assist the user. A checklist also is provided for each facility to undertake a self-assessment and identify areas of concern. Table 2 presents a sample standard and guideline.

Table 2
Table 2:
Medical Oversight

Importance of the Standards and Guidelines

For far too long, health/fitness clubs have been populated with the highly motivated, apparently healthy segment of society. Those who were overweight often shied away, too self-conscious to work out next to a streamlined body. The senior population often felt out of place, and those with health conditions were not encouraged and, in some cases, were afraid to participate. And, tragically, most facilities did not allow children.

The release of the 1996 Physical Activity and Health: A Report of the Surgeon General (2) began a slow but rapidly accelerating trend of encouraging all Americans to make daily physical activity a part of their lifestyle. The report emphasized the important role that daily physical activity plays in reducing the risk of dying from coronary heart disease and of developing diabetes, hypertension, colon cancer, and other chronic debilitating conditions and in enhancing mental and physical function, leading to a preservation of independence in older adults.

Today, the volume of individuals diagnosed and living with adverse health conditions is astounding, and many clubs/facilities across the country are attempting to position themselves to capture this growing market. Perhaps, John McCarthy, former International Health, Racquet & Sportsclub Association executive director, said it best in his July 2005 Club Business International column regarding the numbers of individuals living with adverse health conditions, "If anyone has ever had any doubts about the immensity of the medical fitness opportunity, these figures should dispel them completely. However, repositioning and realigning the industry to serve this market is not going to be easy…it will require a recommitment to greater professionalism and higher standards-a virtual renaissance of the entire industry" (3).

The Medical Fitness Model: Facility Standards and Guidelines emphasizes those higher standards and provides guidelines for facilities to improve the quality and safety of their programs to reach out and impact the health of the communities they serve. As John Caliri, operations director at FirstHealth Centers for Health & Fitness in Pinehurst, NC, commented in an email interview, "I see the standards and guidelines…as a road map helping hospitals and other organizations develop successful, medically integrated fitness centers…that benefit the individuals and communities they serve." Graham Melstrand, director of Educational Services, American Council on Exercise, stated by email, "The new standards and guidelines provide a road map for medically integrated fitness facilities that wish to truly set themselves apart with quality facilities, programs and professional staffing that meet and exceed the needs and expectations of consumers looking to enhance the quality of their lives through exercise."

The standards and guidelines also serve to clarify the differences between a "medical fitness center" and a traditional health and fitness club. These differences include the following:

  1. A focus that looks beyond exercise to lifestyle modification and health improvement programs, community service, and a healthy positive outlook for all involved
  2. Medical oversight, supervision, and guidance
  3. Close alliance with a hospital, physician(s), and paramedical personnel
  4. A high level of staff education/competency and certifications from recognized and highly respected organizations
  5. Programs that bridge the gap between acute hospital care and ongoing or long-term medical services, such as physical rehabilitation services, cardiac and pulmonary rehabilitation, pain management, and programs for those with diabetes, cancer, arthritis, and other health challenges
  6. A high level of staff proficiency in dealing with emergency situations

What Does the Future Hold?

The publication of The Medical Fitness Model: Facility Standards and Guidelines is the initial step in identifying the high standards of the medical fitness industry that facilities can strive to achieve. Recently, responding to member requests, the MFA Board of Directors and the Facility Standards and Guidelines Task Force began researching the development of a facility certification or accreditation process. More information on this exciting step will be available as MFA moves through the year ahead.

The Medical Fitness Model: Facility Standards and Guidelines resource is intended to be a living document that will periodically be evaluated and revised to improve its content and continuously raise the bar of professionalism and quality. The publication is not intended to supplant other published standards, such as ACSM's Health/Fitness Facility Standards and Guidelines (4), but to work in conjunction with such publications to improve the quality of health and fitness services offered to consumers. As part of the health-care continuum, it is imperative that medical fitness centers strive and achieve a level of quality and safety that truly makes a difference in the health of members and the communities served.


1. Medical Fitness Association. The Medical Fitness Model: Facility Standards and Guidelines. Richmond, VA: MFA, 2006.
2. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: CDC, 1996.
3. McCarthy, J. Memo from McCarthy. Club Business International, July 2005:108, 2005.
4. American College of Sports Medicine. ACSM's Health/Fitness Facility Standards and Guidelines. 2nd ed. Champaign, IL: Human Kinetics, 1997.

Accountability; Protocols; Resource; Quality; Safety

© 2007 American College of Sports Medicine