The Ohio State University Wexner Medical Center (OSUWMC) Exercise is Medicine® (EIM) program was launched in 2015 at The Ohio State University Health and Fitness Center, within the Philip Heit Center for Healthy New Albany. The 25,000-square-foot fitness center includes a warm-water therapy and lap pool, general fitness and studio space. The Philip Heit Center is also home to OSUWMC and the ambulatory services wing of Nationwide Children’s Hospital, making it an integrated medical fitness center. Also located in the building is Healthy New Albany, a nonprofit organization focused on community health, wellness and outreach. The Heit Center serves as an anchor institution in the community, dedicated to improving overall health and well-being.
Participation in the EIM program requires a referral to be placed by a physician or advanced-practice provider through the electronic medical record. The primary goal of the EIM program is to increase physical activity to help prevent and aid in the treatment of chronic disease. Throughout the program, participants are provided with tools to help reduce barriers to exercise, as well as a personalized and safe exercise program. The OSUWMC EIM program consists of three one-on-one and 16 group sessions over the course of 11 weeks. The one-on-one and group sessions are led by an American College of Sports Medicine® (ACSM) credentialed EIM specialist. The EIM program also allows participants full access to the fitness center during program participation. The out-of-pocket cost for the program is $200. Upon program completion, participants can join the fitness center, or are provided with updated exercise prescriptions for use at home or elsewhere.
Figure 1 below shows referral, participation and completion rates over time. The program experienced major setbacks due to the COVID-19 pandemic, but upon restarting in-person programming in late 2020, demand has exceeded historic levels. To meet this demand, the program has expanded to six additional locations, making a total of seven sites across the Columbus metro area (Figure 2). These sites include several community partners and internal OSUWMC facilities.
Designed originally as a pilot program to connect OSUWMC Family Medicine and Sports Medicine clinics to the fitness center, the OSUWMC EIM program has matured significantly. With the growth in referrals, the complexity and scope of the diagnoses likewise grew. While EIM is generally focused on typical chronic diseases, demand for specific health conditions arose. With input and support from many clinics across the medical center, we have added several condition-specific programs, including post bariatric surgery, arthritis, pre/postnatal, postural orthostatic tachycardic syndrome (POTS), post COVID recovery, diabetes prevention, Parkinson’s disease and cancer survivorship. This type of condition-specific programming has the potential to change the standard of care for many chronic conditions, significantly improving peoples’ long-term health and well-being.
In early 2020 we received funding via a Patient Care Innovation Award from OSU Physicians to modify and expand OSUWMC EIM programing to address health disparities in the 43203 zip code, a historically marginalized community. We partnered with the Eldon and Elsie Ward YMCA and the City of Columbus Recreation and Parks Department (CRPD), which also serve as anchor institutions for community health and wellness and were essential to increasing community participation and trust. The grant provided the opportunity for participants at these locations to enroll in the program at no cost, in addition to training opportunities and ACSM certifications for community-partner staff.
To measure the impacts of the physical activity intervention, biometric, mental health and quality of life measures are collected at multiple time points: program start, program end, and both 6 months and 12 months post program. Our outcomes show that the EIM program produces significant improvements in physical activity levels (with long-term adherence), biometric values (body fat, weight, hip and waist circumferences, BMI, blood pressure), depression (PHQ-9), perceived stress (PSS), and mental and physical health indices (SF-36). Preliminary results show that when comparing the grant-funded sites (YMCA and CRPD) with other suburban sites, there are significant differences in improved body fat percentage, weight, physical activity levels, mental health and perceived stress.
In addition to participant outcomes, we have identified many benefits to the medical center due to EIM programming. For example, OSUWMC sports medicine physicians have reported that most patients are struggling to make their physical therapy appointments due to increasing out-of-pocket and gas/transportation costs. Patients are adapting to rising costs by not starting or completing therapy. Instead, they request more advanced imaging or injections that may not be needed. Connecting ambulatory and hospital clinics to the community via EIM, especially in low-income communities, helps reduce economic burden by providing supplemental continuum-of-care services, meeting participants where they are, at low or no cost. We are currently conducting a cost-effectiveness evaluation of the EIM program to better understand the true value of this low-cost programming. We hope to use the results of this analysis to establish long-term funding solutions that will allow the EIM program to be offered at no charge to the populations with greatest needs and fewest resources.