The Physician and Sportsmedicine
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Work-Site Workouts: Why Wait?


Regular exercise is an essential stressor for optimizing health and preventing disease. But our lifestyles have changed dramatically over the past few decades, and the priorities that compete for our time are so unrelenting that, for the average adult, exercise is often relegated to the bottom of a checklist. Personal and professional demands vie for attention: family, bills, community service, CME, evening meetings, weekend call, long commutes, and so on, endlessly. To arrive home in the evening with a list of must-dos that includes an hour of exercise fuels a certain rebellion within, aimed at preserving control and minimizing the feeling of locked-in rigidity.

Is exercise in the workplace the answer? In this edition, we examine the issues surrounding employer-sponsored exercise programs from two perspectives. Roy J. Shephard, MD, PhD, critically examines the evidence regarding cost-effectiveness of programs and their impact on employee health (page 48); Nicholas DiNubile, MD, discusses the importance of preventive efforts in decreasing national healthcare expenditures, including those shouldered by business (page 37). The wisdom in each of point of view can inform our opinions and, potentially, our actions.

My own experience is that work can be a safe haven. Many of us have time available at work to attend to some items of personal business—from answering e-mails to picking up the dry cleaning over lunch. If employees had the opportunity to exercise at work or during workday hours, and they were empowered by an employer-sanctioned program, I have no doubt that more Americans would exercise regularly.

But, as Shephard and DiNubile attest, workplace fitness programs and facilities cost money, and the employer is saddled with the cost. Success stories exist, but attempts to prove that the cost-benefit ratio is in the employer's favor have not consistently succeeded, in part because of constraints in research methodology.

One wonders what difference it would make, particularly in the short term, if the data on work-site exercise were strong. In theory, strong, positive findings could lead to the implementation of exercise programs in the workplace through legislation or government incentives. On the other hand, management generally would still see exercise programs as a low priority, and data might not change either the competing priorities or the American choice to keep government out of personal and business decisions. Even if we could assume that stronger evidence will be enough to trigger the broad adoption of workplace exercise programs, it will be at least another 5 to 10 years before such evidence becomes available.

Physicians need not wait passively, though, for science to deliver the goods. We have three avenues of influence to promote exercise in the workplace. First, clinical researchers can design good studies that will eventually move us from common sense to fact. Second, even without ironclad economic justification, we can vigorously lobby business to embrace the preventive medicine potential that exercise programs present. Such programs are simply an extension of the life-balancing opportunities afforded by flextime, on-site childcare, telecommuting, and other adaptations embraced by the modern workplace. Like these adaptations, fitness programs may help attract and maintain key employees. Finally and most directly, physicians can explore ways to implement fitness programs at their own work sites. We hope that the ideas provided in this issue can help you—and your patients and colleagues—in these efforts.

Gordon O. Matheson, MD, PhD