Hospitals Capitalize on Physical Fitness
Watkins, Robert, THE JOURNAL RECORD
Tactics and emphasis may vary from place to place, but the goals are essentially the same - recovery for the sick and riddance of destructive habits known to shorten productive lives.
The proffered remedies range from the physician-oriented SCORE system at St. Anthony Hospital to the prevention and treatment of athletic injuries at HCA Presbyterian Hospital's Oklahoma Center for Athletes.
Pacer Fitness Center, operated by Baptist Medical Center, has recorded phenomenal growth - from 250 members last April to 900 by the end of the year. At Mercy Health Center, where two dozen or more cardiac patients have been accommodated, a newly opened performance center has a capacity to run fitness programs for as many as 375 people.
In SCORE, an acronym for Specialized Center of Rejuvenation and Exercise, the intent from the beginning in late 1983 was to limit enrollment, thus enabling the designers to tailor each program to fit individual needs and have it supervised by a physician.
In every case, however, an important part of the mission is to achieve measurable gains in cardiac function. A parallel goal is the prevention of coronary disease through diet and exercise.
A consistent pattern throughout is a gradual shift from sedentary to active lives.
Dr. Tom C. Coniglione, who designed SCORE with his colleague, Dr. Darryl R. Fisher, puts it this way:
"Basically, we take people in when a serious event has occurred. But we're looking for people before they've had an event - heart attack, emphysema, or stroke."
SCORE also is a longitudinal program. Entrants get a physical examination, including laboratory and exercise testing, and undergo a comprehensive nutritional analysis which measures not only total caloric intake but such dietary factors as caffeine, B12, niacin and fat.
"It is not a package deal," observes Coniglione. "We do the baseline evaluation, then design a program for the individual."
After 12 weeks, the procedure is repeated. A physiologist looks at the changes, then maps a continuing program for the participant.
Don Schneider, director of the Pacer Fitness Center, assesses the approach there as essentially preventive in scope and geared to "the maintenance of general health."
"We get people who can't walk for two or three minutes," says Michele Stokes of the Mercy Fitness Center. "These people do get back to work sooner; they aren't as afraid; and most end up in better shape than before."
Stokes, a registered nurse with a master's degree, acknowledges that heart disease poses the most serious problem, psychologically as well as physically, and not for the patient alone. Families also are affected.
The Mercy program, which began in September 1986, features telemetry monitoring. Heart rhythm records are forwarded to the physicians who are caring for the center's patients.
Over time, a growing data base here will yield important information on the value of local fitness programs from a health perspective and, possibly, some hard facts as well about the economic impact. SCORE already employs a computer and Pacer is preparing to install a system.
St. Anthony's Ron Cunningham, director of administrative services, makes the point even now that every coronary bypass procedure that can be deferred or avoided means a minimum saving of $20,000. The hospital bill alone may reach $15,000 and the physician's charges could run from $3,000 to $6,000. But continuing medication costs will add thousands more to the bill.
SCORE's computer exercise reporting system - patients mail the information in each week - relies heavily on compliance.
Admittedly, said Cunningham, attemps to modify or limit individual behavior place a strain on the patient's ability or willingness to comply. …