On the east side of the 65,000-square-foot fitness center, Indiana Pacer Haywoode Workman is shooting hoops on the regulation NBA-size basketball court. A few long strides away, a member of the Indianapolis Fire Department is lifting weights as part of a personal fitness campaign which could very well save his life and those of his fellow firefighters some day. Circling all the activity on the indoor one-seventh-mile track is a 68-year-old woman who, on closer observation, is breathing supplemental oxygen.
This is a typical scene that can be observed daily, if not hourly, at The National Institute for Fitness and Sport (NIFS), located at the edge of the IUPUI campus. What makes NIFS different from other exercise centers is its medically based exercise program in collaboration with the IU School of Medicine.
NIFS is a nonprofit organization committed to enhancing human health, physical fitness and athletic performance through research, education and service. All of the fitness staff are degreed and certified health fitness professionals.
The collaboration between NIFS and IUSM was a natural. In 1985, community leaders laid the plans for opening a fitness center with a broader focus than the typical workout center. Grants from Lilly Endowment, Inc., the State of Indiana, and the City of Indianapolis made it possible. NIFS opened its doors in 1988 and since that time has focused not just on fitness but on wellness. Its motto: Providing wellness solutions for the community, business and sport.
The collaboration with IUSM made the center's goal possible with the establishment of a variety of medically based fitness programs. Currently, the five main collaborative programs, instituted over the past three years, are cardiac and pulmonary rehabilitation; corporate health and wellness; weight management; and diabetes research. More programs are on the drawing board.
One of the first medically based fitness programs was REACH (Respiratory Efficiency and Cardiac Health) For Life. Pulmonologist Michael Busk, MD, MPH, is medical and research director of NIFS. He works with Paula Puntenney, RN, program director of REACH. Dr. Busk is extremely pleased with the success of the program, designed for individuals who have various forms of cardiac and pulmonary disease.
"Unlike fitness center programs, which are geared toward primary prevention, the purpose of REACH is to keep individuals with chronic disease as healthy as possible and prevent progression of the disease," Dr. Busk says.
REACH is the second step toward health for people with cardiopulmonary disease. The first step is a six-to-twelve-week structured program called WIN (Wishard and IUSM at NIFS). After release from the hospital, individuals interested in a medically based fitness program can join WIN to receive education and supervised exercise. For many, it is a way to boost their self-confidence after a life-threatening experience.
Persons interested in enrolling in WIN or REACH, as well as many of the other medically based programs, must first get their doctor's permission. Cardiopulmonary rehabilitation has a proven track record with a reduction in stress, mortality, hospitalization and emergency room visits. The annual medical cost savings to the nation approaches $80 million over a twenty-one-month period. WIN, like other medically based programs at NIFS, combines assessment, education (including nutrition, use of medications, stress management, CPR training and respiratory techniques) and fitness components. The camaraderie that develops between the participants is a dividend. REACH gives participants more independence and is primarily focused on medically monitored, long-term maintenance.
The IU Center for Weight Management is under the guidance of Barry Gumbiner, MD, medical director, and exercise physiologist David Creel, RD, program director.
"Fifty-five percent of the population is overweight or obese," said Creel. "Our program is designed to handle people with medical problems related to weight."
Patients enrolling in the program receive medical, nutrition, behavioral and exercise evaluations before the educational process begins. At week thirteen of the twenty-four week program, participants receive an "exercise prescription."
Dr. Gumbiner said he knows of only a handful of programs nationwide as comprehensive - with medical management, counseling and personalized exercise programs - as the IU weight management program.
"There are a lot of causes underlying obesity, so it takes a multidisciplinary approach to effectively treat overweight or obese patients," Dr. Gumbiner said. "Diet alone doesn't work. Exercise alone doesn't work, and behavior therapy alone doesn't work."
Primary prevention is the focus of one of the newer additions to the line-up - corporate health and wellness, including executive physicals. Medical screening for early detection of disease, combined with an assessment for a personalized fitness program, makes this a win-win program. Designed to meet the unique needs of corporate executives, the goal is not only to improve the health of the individuals but also of the corporation. The program is definitely user friendly for the busy executive; phones and fax machines are available in the executive lounge. And, as with the sports medicine examination, the tests and examination are all done within the confines of NIFS, making the program a one-stop shop.
If health is the watchword of the NIFS-IUSM collaboration, education may well be the key. One cannot modify or change destructive behavior without knowing what is harmful and what is healthful. Regularly scheduled seminars are a component of the educational process. They address a multitude of topics such as nicotine dependence, nutrition, stress management and prevention of lower back injury.
A women's wellness initiative is under way at NIFS offering quarterly conferences and fitness management programs for the busy mother/professional. Fit-n-Go, an individually tailored exercise regimen, can be done at home with progress evaluations completed every six weeks at NIFS.
The women's initiative is expanding to include other special health issues related to women. A post-menopause exercise and wellness program to assist women with exercise and nutrition programs to prevent weight gain and osteoporosis is in the planning stages. A cardiovascular risk reduction program also is planned. It will combine medical therapy, nutrition and exercise for the prevention and treatment of disorders such as elevated cholesterol, diabetes and hypertension.
Clinics opening this spring include hand and carpal tunnel, physical therapy, and orthopaedics for children. A spine injury clinic is coming soon. And an exercise and education program for people living with cancer is already in place. Living for Life is a twelve-week program that provides individualized fitness assessments and exercise. The program is designed with the individual's health needs in mind and focuses on improving cardiorespiratory endurance, general muscular strength through regular aerobic exercise, and resistance training. Educational lectures on a holistic approach to physical and psychological health are a component of the wellness program.
Research also is a part of the NIFS-IUSM effort. The Diabetes Prevention Program (see Indiana University Medicine, Fall 1998), which is investigating the role of exercise, diet and pharmacological intervention in preventing diabetes in adults, is housed at NIFS. Other research projects include studies on the effects of strength training on knee osteoarthritis, exercise-induced asthma, and geriatric asthma rehabilitation.
Unique to medically based fitness center programs are services for those who cannot afford them. The WIN and REACH programs provide for the indigent through special assistance from Wishard Hospital and IU Medical Group, respectively.
"We provide this for everybody regardless of financial resources and that's something I'm very proud of," Dr. Busk says. Honorariums he garners speaking across the country go to fund a scholarship program for REACH participants who cannot afford membership fees at NIFS.