3. Respondent Overview One might assume that due to the EIM initiative and the prevalence of physician-related programs through organizations such as the Institute of Lifestyle Medicine (ILM) and the American College of Lifestyle Medicine (ACLM) that all fitness facilities would realize the potential of PRPs. However, of the 191 survey respondents, only 24% reported having a PRP. Types of Fitness Facilities Reporting Physician Referral Programs (45 Reporting)

4. Types of Physician Referral Programs in Fitness Facilities The following are the responses of those facilities reporting an active physician referral program. Multiple responses were allowed. 1) Program Specific Of those facilities offering physician referral programs, 71% provide specific programs such as diabetes, weight management, and arthritis. The most common offerings are shown in the table below. Weight management, diabetes and cardiac rehab are the most frequent programs reported.

6. Types of Physician Referral Programs in Fitness Facilities 2) Time Specific Forty-nine percent (49%) of reporting facilities offer time-specific programs such as 30, 60, or 90 days. An example of this type of program is the ACAC Fitness and Wellness Centers, P.R.E.P / Physician Referred Exercise Program® (p.r.e.p). Since its inception in 2007, more than 1,200 people have enrolled in the program, and 67% of participants continue to exercise at ACAC, on their own, or at another facility. The program includes a 60-day membership for $60. www.fitmarc.com [email_address]

8. Overview of Physician Involvement www.fitmarc.com [email_address]

10. Physician Specialties Family Practice is the primary physician specialty referring to fitness facilities. Of note, however, is that a wide range of physician specialties find power in the prescription pad . Fitness facilities should consider seeking a physician champion within every specialty in the community. Multiple responses were allowed.

15. Electronic Medical Records (EMRs) The use of Electronic Medical Records (EMRs) is gaining acceptance within the healthcare community. However, connecting electronically to providers in a patient’s support system is not widely used by fitness centers due to limited knowledge of the technology; lack of staff time to launch a system; privacy concerns; and, perceived costs. The chart below shows that a very small percentage of facilities are tied into physicians through an EMR system. To address this need Interactive Health Group of PCE Fitness , and Exercise is Medicine® are collaborating to develop an online system that will link healthcare providers, patients, and exercise professionals and make physical activity a standard part of disease prevention and treatment.

16. Measuring Outcomes Does a facility know the impact its programs and services have on clients, patients, and members? Measuring and tracking outcomes has been a challenge for the fitness industry. However, the majority of respondents, 80%, indicate that they do track program outcomes. The most common outcome measurements tracked are shown in the table below. Multiple responses were allowed.

18. Staff Involvement with Physician Referral Programs Facilities generally engage personal trainers and exercise physiologists more than other professionals as leaders and facilitators of physician referral programs.

20. Financial Overview FITNESS IS A BUSINESS . Determining revenue and expenses for all facility programs is important in order to be financially successful for the short- and long-term. However, only a small number of respondents track return on investment at any level for physician referral programs. Twenty-three (23) respondents indicated that they were “Unsure / Don’t Know” how many physician referrals converted to a full facility membership once the program had been completed.

21. Financial Overview The table below shows the number of conversions to facility memberships reported by those who do track the information (15 reporting). Responses were reported as a number in some cases and as a percentage of total referrals in other cases. 2010 2011 (as of September 1st) 20 No response 150 100 25 Unsure 56 38 25 55 28 20 13 No response 3 3 6+ 30 632 468 XXX 105 7% 15% 20% 20% 42% 40% All All

22. Return on Investment Respondents were asked what was the return on Investment (ROI) for the physician referral program. In other words, were revenues and expenses calculated? Of the 37 reporting, 32 responded “Unsure/Don’t Know” on ROI. Depends Total for one year $35,000 Not measured beyond participation and cost per participant Assessing as the program develops 100% Respondent Comments

23. Resources Exercise is Medicine® (191 Reporting) The Exercise is Medicine (EIM) initiative launched in 2007 by the American College of Sports Medicine (ACSM) and the American Medical Association (AMA) calls on healthcare providers to assess and review every patient’s physical activity program at every visit. The majority of facilities, 91%, do not use the complimentary toolkits and resources provided by EIM that will assist them in connecting to physicians in their community.

24. Resources Institute of Lifestyle Medicine (191 Reporting) The Institute of Lifestyle Medicine (ILM) was founded in 2007 by Spaulding Rehabilitation Hospital and Harvard Medical School to reduce lifestyle-related death and disease in society through clinician-directed interventions with patients. The ILM is a non-profit professional education, research, and advocacy organization. The majority of facilities, 97%, do not use the ILM resources.

25. Community Outreach If developed, 60% of respondents (191 reporting) would like to have their facility included in a local, regional and national registry so that physicians and the community can connect to the facility’s physician referral program.

26. Marketing Respondents were asked if they used social media to market programs. Fitness facilities use a variety of social platforms with Facebook the predominant marketing tool. Multiple responses were allowed.

28. Facility Certification Since 2008 there has been a mechanism in place for fitness facilities to benchmark programs and services against standards and guidelines developed specifically for medically integrated facilities. The Medical Fitness Association’s (MFA) Medical Fitness Facility Certification defines standards of quality and safety. One of the primary goals of the certification is to elicit trust and confidence within the healthcare system, and the community, for the fitness industry. In addition to the MFA Medical Fitness Facility Certification, a nationally represented group consisting of various segments of the fitness industry has been hard at work to develop a broad set of voluntary standards for all health and fitness centers. NSF International, an independent, nonprofit organization, oversees the NSF Joint Committee on Health Fitness Facilities Standards . The committee, that includes organizations such as the American College of Sports Medicine (ACSM), the American Council on Exercise (ACE), IHRSA, the Y, and MFA, is assisting with the development of standards that will lead to a national certification if approved. The majority of facilities, 90%, reporting in this survey are not certified as a medical fitness facility by MFA (191 reporting).

33. Responding Facilities By Center Size