The Future Of Fitness

The development of the medically integrated health-fitness industry began with the inauguration of cardiac rehabilitation programs featuring heart-healthy exercises and education focused on the development of a healthy lifestyle.

While traditional gyms provided exercise programs, they rarely offered programming that supported lifestyle changes--a key ingredient to managing chronic disease and supporting long-term health improvements. Filling the void, hospital-based cardiac rehab classes began to spring up across the nation.

Simple exercises performed under the watchful eye of trained exercise therapists led to social networks and ultimately medically based fitness facilities, as rehab patients also attended hospital-based nutrition and smoking cessation classes, all of which were designed to encourage a healthy lifestyle.

This holistic approach to cardiac rehabilitation was combined with ”a perfect storm” that was sweeping the landscape of traditional healthcare. The advent of managed care, a drastic reduction in inpatient hospital days and a renewed focus on wellness supported the development of the medically based fitness facility, which fit neatly into a continuum of care designed to keep clients healthy, while moving them into the appropriate healthcare system when they weren’t. It also provided a revenue stream for healthcare providers who were feeling the fiscal pinch of dwindling inpatient days.

A New Market Emerges

The creation of successful, holistic, medically integrated health and fitness centers is both a science and an art, as architects and planners design more than a gym. “We have ‘blurred’ the connection of medical fitness and rehabilitation, and seek to appropriately link the two environments,” says Mike Corby, AIA, LEED AP, Executive Vice President of Design for Integrated Architecture, a Grand Rapids, Mich.-based architecture and engineering firm that has designed dozens of wellness and fitness facilities.

“Our approach is to expose the synergies of medical fitness, rehabilitation and educational uses in the environment. By understanding the dynamics of each subset--the fitness user, likes/dislikes, reasons to join/maintain membership; the rehab user, the attendant emotional and physical characteristics; and the educational opportunities for, and the importance of, understanding one’s body, one’s lifestyle and its impact on health--we design facilities that meet those needs, and are filled with energy and excitement. These are environments where users interact and connect,” Corby states.

The Fitness Centre at Celebration Health, which opened a decade ago, is an early example of an Integrated Architecture design and a medically integrated facility. Located within Florida Hospital Celebration Health, the Centre offers both specialized rehabilitation and traditional fitness activities, and is dedicated to the achievement of optimal health while responding directly to the hospital’s philosophy of simultaneously caring for the whole person--mind, body and spirit.

The Early Years

Florida Hospital Celebration Health--a one-stop healthcare shop--houses primary and specialty physicians, a full-service facility providing inpatient and outpatient services, 24-hour emergency care, maternity programs and The Fitness Centre.

The hospital-owned-and-operated wellness/fitness revolution hasn’t been limited to the health-focused, sun-kissed Florida crowd. Midwestern sensibilities also view the development of the medical fitness facility as a logical step.

In the late 1990s, the Mercy Regional Health System of Greater Cincinnati built two landmark structures called Centers for Health and Wellness. Located on the same campus as the local Mercy Hospitals, the multi-purpose facilities integrate traditional medical services with holistic therapies, fitness activities, physician offices and multi-purpose meeting/seminar space. They include children’s gymnasiums, day care and physician offices. Located in the suburbs of Cincinnati, they utilize identical design components to achieve economy while establishing a brick-and-mortar expression of the Mercy mind, body and spirit approach to healthcare that endures today.

“Our goal was to create a facility that attended to health and well-being of the whole person, physically, emotionally and spiritually. In our mind, the center wasn’t just about fitness. It was about fitness and the other dimensions of health and wellness, recognizing the roles that stress, relationships and meaningful work play in people’s lives, and how all of this impacts their physical health. The vision of the center was holistic attention to individuals,” says Sister Kathy Green, RSM, who was, at that time, Regional Vice President Mission Services and Community Wellness.

The mind, body, spirit approach to health and wellness was, for the Midwest, out-of-the-box thinking.

“At that time, and even today, it was a struggle, particularly in integrated medicine,” Green states. “It was a challenge to get the different components of the facility to be aligned, rather than ‘siloed.’”

If she were to do it again, Green would strengthen the integrated approach to all aspects of fitness and wellness.

“My recommendation would be to make sure that the people in charge of all the components--fitness, rehabilitation, education and acute care--are in alignment and planning the facility together. If you plan each piece individually, that is how it will function. Getting the components out of their silos is hard to do, but when you do, you’ve got a great product that will change the industry and really make a difference in people’s lives,” Green concludes.

A Model To Imitate

While the approach of the Cincinnati projects was all-encompassing, the rush to wellness was answered in the Chicago suburb of Aurora with the creation of The Rush-Copley Healthplex. Known as the Hospital for the 21st century, the Healthplex fuses fitness and clinical uses, merging pediatrics, cardiology, urology and sports medicine with one of the Midwest’s largest physical-enhancement environments.

“It's important to note that the Healthplex model is a physically large and operationally complex version of a medically based fitness center. It incorporates club-related sports, such as indoor and outdoor tennis, as well as significant clinical services, such as sports medicine and rehab. With all the latest fitness sub-services, the Healthplex has been formidable competition for all the new chain fitness clubs that have moved into our area over the last five years,” says Ed Buda, Senior Vice President and General Manager of Lakeshore Medical Fitness LLC/Rush-Copley Healthplex.

Besides offering the community health- and wellness activities, the Healthplex assists the hospital in its staffing efforts.

“The Rush-Copley Healthplex also serves as a recruiting tool and wellness program for all of the Medical Center's employees and physicians, who receive membership as part of their compensation plans," Buda says.

While the medically integrated health-fitness center was once exclusively part of a hospital or a healthcare system, that is not the case now.

“There’s an entire industry based on the whole health and fitness model,” Wing states. “The medically integrated facility is just a sub-segment. The new facilities aren’t necessarily associated with hospitals, and they are raising the bar by providing excellent programs designed to prevent and manage chronic diseases.”

While there is a variety of programs in today’s market, Wing explains that the Medical Fitness Association has established “Facility Standards and Guidelines,” and recently launched a Facility Certification program, based on the guidelines, which include requirements for a true medically integrated facility.

“Specifically, there must be a physician advisor or advisory board, a focus on outcomes and the prerequisite of health-risk assessments. The medically integrated facility offers more than exercise classes. It provides a mixture of programming, including nutrition and social interaction for all ages and stages of life.”

Future Front-Runners

For centers like the Mercy facilities, the future looks bright.

“Medically integrated health and wellness centers are poised for great success in the very near future,” says Michael Combes, Vice President of Mercy Healthplex. “Organizations, corporations and individuals are finding that prevention is the only way to effectively combat the health crisis facing our country today. Medically integrated health entities are finally embracing the comprehensive wellness theme that Sister Kathy Green envisioned more than a decade ago.”

Combes also believes that hospital-owned-and-operated medical fitness facilities will have a competitive advantage.

“As our facilities move swiftly towards a wellness culture, we'll finally effectively differentiate hospital-based clubs from typical gyms, as hospital-based entities are best positioned to provide the prevention component."

Who will win the wellness revolution--hospital- or community-based facilities? It may be a mixture. The transition from a traditional gym to a medically integrated health and fitness center isn’t that big a leap. Wing suggests that owners of community-based facilities begin by contacting local hospitals, local physicians and rehab practices to discuss the possibility of creating a medically integrated center.

Others see the fitness pie being divvied up by age and program offerings. Health Integration Partners LLC has been involved in the development of wellness facilities, and Managing Principal G. Curt Meyer, FACHE, has helped open 26 facilities. He sees a trend of hospital-based facilities attracting older members, while community-based recreation facilities often have a more multi-generational membership.

“We are seeing a continued demand from the consumer for family time that can be healthy for all members. These facilities--by working to improve the overall community health--have incorporated medical supervision, recreation and health coaching for all age groups,” Meyer says.

He believes that successful facilities, either hospital- or community-based, will offer programs that target chronic-disease maintenance and improvement within an engaging environment that supports special experiences to keep users of all ages active in the program.

Living Within A Budget

While programming is important for membership attraction, operational costs--that can significantly affect membership fees--often set the stage for a facility’s success or failure. Designing a facility to minimize operational costs requires knowledge and experience.

“Successful facilities don’t just happen. They are the result of careful planning that grows from a strong needs-assessment and the application of design principles, allowing the interrelationship of the respective components to strengthen the overall experience,” Corby explains. “It is important to explore visual/physical connections, positioning elements to minimize staff needs, and create visual connections that make the facility a rich and dynamic wellness environment.”

And it works. The David D. Hunting YMCA in Grand Rapids, Mich., designed by Integrated Architecture, opened with a membership of 9,500 in June 2005. A year later its membership stood at 20,000. A Cape Girardeau, Mo., medically integrated facility--the Southeast Missouri Health Point Plaza, owned by Southeast Missouri Hospital--reached its five-year projections in the first year, prompting the addition of a lap pool and a large aerobics room. That project utilized an existing, vacant, big-box retail structure, which assisted in reducing operating costs.

“We’ve had several projects where we used empty stores, and rehabbed them into vibrant wellness facilities, saving an average of 30 percent when compared to new construction,” Corby states. “Not only do these renovations work well for our clients, they also work well for the community, breathing new life into run-down strip malls and unoccupied chain stores.”

Besides utilizing a cost-effective building strategy, Health Point Plaza also offers community programming. A martial arts class rents space in the studios three times a week, serving 150-plus students, and high school sports training also extends the Health Point Plaza’s reach beyond the traditional wellness/education classes.

While today’s recreation centers often focus on hobbies and fun activities, the origins of the word come from the Latin , which means “a restoration to health,” and from “to create anew.” When you think about it, this is what the medically integrated fitness center is all about.

Trisha Spaulding is a Senior Associate at Integrated Architecture. For more information, visit