This is the second in a series of articles that will offer health clubs simple and practical ways to make fitness happen at the community level.
Imagine, if you will, a fitness utopia. In this mythical place, virtually everyone exercises regularly, and those who don’t are considered social misfits. Sidewalks, trails and bike lanes are in abundance and used heavily. Fitness centers have become the hub of social life and are brimming with members. Students enjoy daily physical education (PE) in school. The prevalence of chronic diseases such as heart disease, diabetes and osteoporosis has taken a nosedive. Health insurance premiums have dropped precipitously, making health care much more affordable for both employers and employees. In fact, most companies fully subsidize fitness center memberships for their employees and families. Messages advocating the benefits of physical activity are everywhere—in newspapers and on billboards, radio and TV. Sounds nice, doesn’t it? While it is doubtful that we will ever achieve a fitness utopia, we can be certain that if we continue in the direction we are headed now, we will end up in more of a fitness nightmare. Is the fitness industry up to changing the course?
At its essence, the problem of physical inactivity seems pretty simple: People should exercise, but they don’t. They either don’t start, or they start with vigor and enthusiasm but quit soon thereafter. Ever catch yourself thinking, “If only these people just had an ounce of willpower, they could do it”? In some cases this logic holds true, but behavior change is much too complicated to be thought of in such simplistic terms. Influencing a person’s ability to adopt and maintain a regular exercise program are a number of individual factors, including time commitments, competing responsibilities of work and home, lack of enjoyment with exercise (hard to believe, isn’t it?), physical ailments and mental/emotional stress, to name a few. What’s more, while these individual concerns are important, they aren’t the only factors. Behavior is influenced on a number of other levels—sometimes without the person even realizing it.
By taking a step back and looking at the bigger picture, we can get a better understanding of the broader factors that need to be addressed. The social-ecological model of health promotion provides a framework to help us understand the complex nature of the physical inactivity problem. According to this model, there are five levels of influence that affect an individual’s success at adopting and maintaining healthy lifestyle changes (McElroy et al. 1988):
1. the public-policy level
2. the community level
3. the institutional level
4. the interpersonal level
5. the individual level
Each of these factors is just a piece of the behavior pie, and we need to address all the pieces if we are to turn the tide of inactivity, obesity and chronic disease.
When the 1964 Surgeon General Report: Reducing the Health Consequences of Smoking came out, 50% of the U.S. population smoked. Forty years later, that number has been cut in half. This is considered one of the greatest achievements in the health industry, but it took four decades of hard work and billions of dollars to come to fruition. The key to the success of the antitobacco movement was the approach that advocates took. They realized early on that neither putting warning labels on cigarette packs nor telling people that smoking is bad for their health was going to have enough of an impact. So after taking a good, hard look at the multiple levels of influence on smoking behavior, they came up with a broad but focused game plan that addressed all levels of the social-ecological model. The American Cancer Society’s “Communities of Excellence in Tobacco Control: A Community Planning Guide” lists some of these methods, including
- placing high taxes on tobacco and restricting its sale to minors (public policy);
- running public-education campaigns, restricting tobacco advertisements and establishing tobacco-free public places and worksites (community and institutional); and
- establishing smoking cessation services (interpersonal and individual).
Physical Activity and Health: A Report of the Surgeon General was published in 1996. At that time, 30% of adults were completely sedentary, and almost 65% did not engage in the recommended amount of physical activity. Cutting these numbers in half will probably take the same amount of time, effort and money as the antitobacco movement took to achieve the same degree of success. So the reality is that we are just in the infancy of the “antisedentary” movement.
What priority areas and strategies can we begin to address? Here are just a few of the steps that have been identified by various organizations and task forces, divided according to the social-ecological model.
- Provide tax incentives for employers who offer employees health- and exercise-related services or financial support (e.g., subsidies or reimbursement for fitness center memberships, or reduced costs for health insurance).
- Direct transportation funding to projects that create or modify street systems to make them friendlier to walkers, runners and bikers.
- Create—or enhance access to—places for physical activity, such as sidewalks, trails and park facilities (CDC 2001).
- Encourage activity through informational outreach programs that utilize large-scale, high-intensity, community-wide campaigns with sustained visibility (CDC 2001).
- Design high-density, mixed-land- use communities that facilitate walking and biking to work and shopping areas.
- Activate worksite health promotion programs that provide incentives to employees who adopt and sustain a physically active lifestyle.
- In schools, modify PE curricula and policies to increase the amount of moderate or vigorous activity, the time spent in PE class, or the time students are active during PE class (CDC 2001).
- Implement the Coordinated School Health Program in school systems (see “Resources” on page 9).
- Use point-of-decision prompts to encourage activity; for example, by placing signs at elevators that encourage stair use (CDC 2001).
- Encourage physicians to assess their patients’ physical activity participation during checkups; to prescribe exercise; and to refer patients to existing community resources.
- Use social-support interventions in community settings to build, strengthen and maintain social networks that provide supportive relationships for physical activity (e.g., buddy systems, walking groups, etc.) (CDC 2001). For example, fitness facilities could start community walking programs and have instructors lead group walks with varying degrees of difficulty at different times and in different parts of town (see “Resources, below”). Using existing social networks—such as service organizations (Kiwanis, Rotary Club, Optimists, etc.), faith-based organizations and even neighborhoods— to facilitate physical activity would be even more efficient.
- Design behavior change programs that are individually adapted to meet a person’s readiness for change or to appeal to a person’s specific interests (CDC 2001).
- Make fitness facility memberships and services eligible for a tax write-off. (Although this strategy would need to be implemented on the public-policy level, its impact would be felt on the individual level.)
If all this seems overwhelming, you’ve gotten the point. Neither you nor the fitness industry as a whole can take on all of these issues—at least not alone. A diverse group of professionals and organizations is needed to tackle such a monumental task. Again, we can take notes from the antitobacco activists. The success of their plan depended on forming coalitions with local community groups that had broad representation. These groups included medical and health professionals, environmental groups, law enforcement agencies, the media, parents’ groups, community advocates, elected officials, youth, seniors, business leaders, people from different neighborhoods and population groups, religious leaders and others. For the physical activity movement to be successful, we must form similar coalitions.
The fitness industry certainly has a lot to offer. We have facilities, equipment, programming, expertise, trainers, instructors and (one would hope) the passion to contribute significantly to the movement. But to succeed, we must seek out partnerships with a diverse group of stakeholders on the community level. Many organizations now realize the benefit of grass-roots efforts to ignite significant and lasting change. And haven’t most significant societal shifts occurred from the ground up?
As we look to become more integrally involved in our communities, we must identify the key players who should be invited to the movement. These include, but are not limited to, other fitness facilities, YMCA/YWCA/JCCs, parks and recreation departments, organizations that serve the aging, local health departments, transportation officials, elected officials, youth, seniors, medical professionals, walking/biking clubs, schools, the media, law enforcement agencies, employer groups, businesses, ethnic-specific community groups, and community advocates. Are you mentally scratching out some of these names? If so, then maybe you aren’t quite ready to work with such a diverse group. But we all need to get ready if we are to make an impact. After all, it has been 10 years since the Surgeon General’s Report on Physical Activity was first published, and the antitobacco movement took 40 years to cut the smoking population in half. The year 2036 is right around the corner.
In the next article we will explore barriers that exist within the culture and mindset of many fitness centers and that keep them from collaborating with other community organizations and making the best of their valuable resources. We will also identify some ways to overcome these barriers.