What Factors Influence Participation in an Exercise-Focused, Employer-Based Wellness Program?

By Abraham, Jean M.; Feldman, Roger et al. | Inquiry, Fall 2011 | Go to article overview

What Factors Influence Participation in an Exercise-Focused, Employer-Based Wellness Program?


Abraham, Jean M., Feldman, Roger, Nyman, John A., Barleen, Nathan, Inquiry


Following the recent introduction o fan incentive-based, exercise-focused wellness program at a large public: university, this paper investigates the factors that influence employees' behavior with respect to participation and regular exercise. Results suggest that an employee's probability of signing up for the program is related to her exercise behavior prior to the program's inception, the time cost of exercise, taste for fitness center exercise, and attitudes about the benefits and barriers of exercise. Employees who are older, male, and were regular fitness center exercisers prior to the program's inception are more likely to be regular exercisers.

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Employers provide health insurance to approximately 157 million nonelderly individuals in the United States (De-Navas Walt, Proctor, and Smith 2010). Between 1999 and 2009, employer-sponsored health insurance premiums more than doubled, with average annual premiums reaching $4,824 and $13,375 for single and family coverage, respectively, in 2009 (Kaiser Family Foundation 2009). Looking for long-term strategies to address rising costs, employers are implementing health promotion and wellness programs that encourage employees to make positive lifestyle choices, including getting regular exercise.

A healthy lifestyle is important because the prevalence of obesity and overweight status has been rising over the past two decades. Current estimates indicate that 68% of the adult population and almost half of full-time workers are either overweight or obese (Flegal et al. 2010; Finkelstein, Fiebelkorn, and Wang 2005). Obesity has serious health and economic effects. For example, Finkelstein et al. (2009) found that obese adults had annual medical expenditures that were 41.5% higher than those of normal-weight individuals.

An active lifestyle, including regular physical activity, can reduce the risk of obesity. In addition, regular physical activity has been shown to lower a person's risk of developing or dying from heart disease, type-2 diabetes, stroke, osteoporosis, and certain forms of cancer (U.S. Department of Health and Human Services 2002). Regular exercise also can reduce depression and anxiety, sleeping problems, and medical care costs (Haskell et al. 2007; Sherrill, Kotchou, and Quan 1998; Griffiths 1996). Pronk et al. (1999) found that each additional active day per week was associated with 4.7% lower health care spending over an 18-month period among a sample of employees ages 40 and older. Despite these benefits, almost half of the U.S. adult population does not exercise regularly, according to the 2009 Behavioral Risk Factor Surveillance System.

In addition to having a strong incentive to control health care costs, employers provide a useful environment for promoting behavior change among the working-age population because individuals share a common purpose and culture at the workplace (Goetzel and Ozminkowski 2008). These complementary factors strong incentives and an environment conducive to promoting behavior change-have encouraged many employers to offer employee wellness programs. In 2010, approximately 74% of all firms that offered health insurance as a fringe benefit to their employees offered at least one wellness program, up from 58% in 2009 (Kaiser Family Foundation 2010). Exercise-focused initiatives are among the wellness programs most commonly offered by employers.

Although varied in design, a growing proportion of employer wellness programs use financial incentives to encourage employee participation and achievement of specific outcomes.I The key issue for employers is whether investment in an incentive-based exercise program yields a positive return on investment (ROI). That is, do financial incentives motivate employees enough to make sustained changes in behavior that they otherwise would not have made, and are decreases in medical expenditures and increases in productivity enough to offset the cost of the incentives? …

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