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|Issue 56||October 2012|
A Systematic Review: Effects of Health Plan-Sponsored Fitness Center Benefits on Physical Activity, Health Outcomes, and Healthcare Costs and Utilization
Regular physical activity has many positive health benefits, while lack of physical activity is associated with higher healthcare costs and utilization. However, many Americans do not get the recommended levels of physical activity, and Veterans who use the VA healthcare system are less likely to meet physical activity recommendations and more likely to be physically inactive compared with Veterans who do not use VA healthcare. Multiple personal, social, and environmental factors influence participation in physical activity. Providing memberships to fitness centers may increase physical activity and the positive health outcomes associated with such activity. Therefore, health plan promotion of and coverage for fitness center memberships has the potential to address multiple barriers to physical activity (e.g., cost, access).
Investigators with the VA Evidence-based Synthesis Program (ESP) Center in Durham, NC conducted a review of the published literature from database inception through May 2012, in addition to searching www.ClinicalTrials.gov for completed but unpublished studies in July 2012. After reviewing more than 3,500 citations, investigators identified four articles -- one main paper and three associated papers -- representing one unique study. This retrospective, observational cohort study, rated fair quality, assessed a health plan-sponsored fitness center membership benefit (known as the Silver Sneakers program) among adults 65 years of age and older who were enrolled in a Medicare Advantage plan. These articles were used to address the following questions:
Physical Activity Participation
Two companion articles provided information on other factors associated with fitness center membership uptake and frequency of use. As expected, enrollment was less likely among people living farther from gyms. Additionally, greater distance from fitness centers and history of depression reduced frequency of use for those who enrolled in fitness centers.
Physical Health Outcomes
Health Care Costs and Healthcare Utilization The main study and one companion article reported the effects of health plan-sponsored fitness center memberships on healthcare costs and utilization. Total healthcare costs were not different between Silver Sneakers participants and non-participants by the end of the first year. By the end of year two, participants incurred significantly lower total healthcare costs (-$500), likely due to fewer inpatient admissions and lower inpatient care costs compared with controls. There also was evidence of a dose-response by average number of health club visits. Compared with participants who attended fitness centers less than one time per week, participants had lower healthcare costs if they averaged 2 to < 3 visits per week (-$1,252) or = 3 visits per week over two years (-$1309).
In another paper, Silver Sneakers participants with diabetes had lower total healthcare costs (-$1,633) compared with matched non-participants with diabetes after one year of enrollment in the fitness center program. This cost savings was likely due to fewer hospitalizations and lower inpatient costs. In year two, participants accumulated lower total healthcare costs, but these savings were not statistically significantly different from non-participants with diabetes.
No identified studies addressed this question.
No identified studies addressed this question.
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers -- and to disseminate these reports throughout VA.
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This Management eBrief is a product of the HSR&D Evidence Synthesis Program (ESP). ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of the HSR&D Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers - and to disseminate these reports throughout VA.
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