Excerpt

Regular physical activity has many positive health benefits, including protection against chronic disease, improved physical and mental health and cognitive function, and better health-related related quality of life. Moreover, lack of physical activity is associated with higher health care costs and utilization. Many Americans, however, do not get the recommended levels of physical activity. For Veterans, Veterans Affairs (VA) health care users are less likely to meet physical activity recommendations and more likely to be physically inactive compared with Veterans who do not use VA health care. Multiple personal, social, and environmental factors influence participation in physical activity. Providing memberships to fitness centers may be a viable option to increase physical activity and the positive health outcomes associated with such activity. Given that most Americans have access to some form of health insurance, health plan promotion of and coverage for fitness center memberships has the potential to address multiple barriers to physical activity (e.g., cost, access) and extend fitness center access to many Americans.

Our objective in this evidence synthesis was to summarize the results of diverse studies of health plan-sponsored fitness center memberships in an effort to understand how these benefits affect physical activity, clinical outcomes, health care costs and utilization, retention of plan members, and member satisfaction.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
  • RESULTS
  • RECOMMENDATIONS FOR FUTURE RESEARCH
  • CONCLUSION
  • ABBREVIATIONS TABLE
• INTRODUCTION
  • OBJECTIVE OF THIS REPORT
• METHODS
  • TOPIC DEVELOPMENT
  • ANALYTIC FRAMEWORK
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE SEARCH
  • STUDY CHARACTERISTICS
  • KEY QUESTION 1 What are the effects of policy/benefits packages that include vouchers, rebates, premium reductions, or other economic incentives to encourage physical activity through fitness center memberships on:
    (a) Physical activity participation rates among plan members?
    (b) Health outcomes demonstrated to be improved by physical activity (i.e., weight, pain, glucose, blood pressure, health-related quality of life)?
    (c) Overall health care costs and health care utilization?
  • KEY QUESTION 2 What are the effects of policy/benefits packages that include vouchers, rebates, premium reductions, or other economic incentives to encourage physical activity through fitness center memberships on satisfaction with the health plan and retention of members in the health plan?
  • KEY QUESTION 3 Do the effects of policy/benefits packages to encourage physical activity vary by specific characteristics of the package (premium vs. lump sum) or age, sex, and physical illness of participants?
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE
  • IMPLICATION OF FINDINGS
  • STRENGTHS AND LIMITATIONS
  • RECOMMENDATIONS FOR FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A SEARCH STRATEGIES
• APPENDIX B EXCLUDED STUDIES
• APPENDIX C DATA ABSTRACTION ELEMENTS
• APPENDIX D PEER REVIEW COMMENTS
• APPENDIX E GLOSSARY

Research Associate: Avishek Nagi, MS; Medical Editor: Liz Wing, MA

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Durham VA Medical Center, Durham, NC, John W Williams Jr., M.D., M.H.Sc., Director.

Suggested citation:

King HA, Gierisch JM, Williams JW Jr, Maciejewski ML. Effects of Health Plan-Sponsored Fitness Center Benefits on Physical Activity, Health Outcomes, and Health Care Costs and Utilization: A Systematic Review. VA-ESP Project #09-010; 2012.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Durham VA Medical Center, Durham, NC, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.