Employers must work out ways to pump up fitness program participation

Low participation undermines value to employers, research shows

The latest research on workplace fitness programs suggests they often are just a high-profile way to spend money and help the company look like it is committed to improving fitness, with only a small fraction of the work force utilizing the programs on a regular basis and achieving significant results. But even with that discouraging analysis, experts still say occupational health professionals should continue to encourage fitness programs in the workplace.

Rather than giving up on the idea because the track record is less than exemplary, experts suggest focusing more on increased participation than on other aspects like the specific configuration of the program and the equipment. It is more beneficial to provide a modest fitness facility that has high participation than to have a world-class gym, which serves only a few members of the work force, says Nicholas DiNubile, MD. DiNubile is an orthopedic surgeon in Havertown, PA, and director of sports medicine and wellness at the Crozer-Keystone Healthplex in Springfield, PA.

"Only a small percentage of employees usually will get involved in a workplace fitness program, and that may discourage some employers and providers," he says. "That’s a problem, but we know the benefits of fitness. We have to concentrate on how to get more people involved."

That idea is supported even by those whose research has demonstrated the low levels of participation in most workplace fitness programs — for example, Roy Shephard, MD, PhD, DPE, professor emeritus of applied physiology at the University of Toronto. His recent research confirms the benefits of workplace fitness programs but also documents that the level of participation and the measurable benefits probably won’t be what employers and occupational health professionals expect.1

Nevertheless, Shephard tells Occupational Health Management there is no reason for occupational health professionals to discourage employers from creating or continuing workplace fitness programs.

"There is a benefit to those who participate, even if it is not at the level we would desire," Shephard says. "My research may not be what a lot of people would like to hear about workplace fitness programs, but it only shows that expectations were unrealistic in some cases. It doesn’t mean that fitness programs are not worthwhile, only that it may be time to look at ways to improve the results we achieve from them." (For advice on increasing participation in workplace fitness programs, see related story, p. 51.)

Low participation, modest results for most

Workplace fitness programs have long been a staple of occupational health management, and there is little doubt they are beneficial to those who participate consistently. The latest research, however, suggests that the overall benefits are more modest and affect fewer employees than employers might expect.

Shephard’s research, for instance, indicates that workplace fitness programs chiefly attract employees with a favorable attitude toward work and health. It’s not likely that the obese, chain-smoking employee with a bad work attitude is going to become an enthusiastic, long-term participant in the fitness program.

"Only a fraction of employees avail themselves of work site facilities, a very small fraction, especially after the first few months in which interest is high," Shephard says. "You usually start off with about 60%, and after six months you’re down to 20%. So when you see health benefits in those 20% and compare them to the time and expense you put into the program, you have to remember that you should divide those benefits by five to apply it across the work force."

For those participating, workplace fitness programs do result in decreased body fat; increases in aerobic power, muscle strength, and flexibility; enhanced mood state; reduced medical insurance claims; decreases in absenteeism; and increases in productivity. Shephard analyzed 26 previous studies of workplace fitness programs and found definite, but relatively small health benefits. The statistical analysis found there was a mean effect of 0.11 standard deviations when measuring the improvements in fitness.

"This is equivalent to increasing the success rate from the chance expectation (an improvement of physical activity in 50% of subjects and a worsening in the remaining 50%) to an increase in 56% and a worsening of 44%. [That is] a benefit that remains far from significant despite the use of 8,800 subjects," he says.

The analysis found no significant effect from offering or not offering incentives, duration of the intervention, or the average age of the participants. Fitness program participants typically experienced a 1% to 2% decrease in body mass, but the companywide impact was negligible. Body fat typically decreased 13% for participants, but the companywide impact was only a 2% decrease. Aerobic power could increase up to 20% over three months for enthusiastic participants, but companywide benefits were more likely to average 7.4% for women and 4.4% for men.

Medical claims typically decreased $100 to $400 per year for participants, but notably, back education programs did not seem to reduce the number of back injuries.

Another interesting finding of both Shephard’s and DiNubile’s research is the benefits of a workplace fitness program do not rise proportionately with the money invested in the program. "Neither program participation nor wellness response rises in direct proportion to the capital invested in wellness personnel, programs, facilities, and equipment," Shephard says.

DiNubile’s research also suggests that the way you solicit participation in a work site fitness program is more important than whether you bought the latest computerized gizmo for the gym.2

"It’s a wise investment for any employer to somehow encourage the work force to be more fit and active," he says. "It doesn’t have to be a health club at the workplace, though that’s ideal. But even then, it’s a mistake to get carried away with all the money you’re spending on the equipment and surroundings. Provide a good workout center and then concentrate on encouraging participation."

One occupational health provider suggests that a precise determination of how much benefit comes from money invested in a workplace fitness program may miss the point of why some employers implement them. While they certainly desire a healthier work force and all the financial benefits that would entail, some employers see a workplace fitness program more as a general employee benefit, says Judy Colby, RN, COHN-S, CCM, program director of The Workplace at Simi Valley (CA) Hospital and Healthcare Services.

"Sometimes they’re implemented from an employee relations perspective rather than as a pure aspect of health benefits," she says. "That often tempers their expectations in terms of real, tangible financial benefits, so I don’t see any reason that this research should discourage an occupational health provider from recommending a fitness program and advising the employer about how to best set up one."

Shephard also points out that low levels of participation don’t have to be accepted. There are ways to increase participation, and he suggests that participation may increase as the general population starts to pay more attention to health needs.

"I liken it to the campaign to end smoking," he says. "It’s taken 50 years to get across to even 70% of the population that smoking is a bad thing. There has been consistent propaganda on smoking, and it took a very long time to get the message across. It may take as long to get across to the population that exercise is a good thing."

[For more information, contact:

Roy Shephard, P.O. Box 521, Brackendale, BC V0N 1H0, Canada. E-mail: Royjshep@mountain-inter.net.

Judy Colby, P.O. Box 801164, Santa Clarita, CA 91380. Telephone: (805) 583-3200.]

References

1. Shephard RJ. Do work-site exercise and health programs work? The Physician and Sports Medicine 1999; 27: 48-70.

2. DiNubile NA, Sherman C. Exercise and the bottom line: Promoting physical and fiscal fitness in the workplace: A commentary. The Physician and Sports Medicine 1999; 27: 37-46.