Do insurer- or health-system–sponsored gym memberships, fitness benefits, or personal training programs reduce overall healthcare utilization or total healthcare costs?

Insurer- and Health-System–Sponsored Fitness Programs: Evidence for Cost Savings and Healthcare Utilization

Insurer- or health-system–sponsored gym memberships and fitness programs do reduce healthcare costs by an average of $344 per person per year, but these savings require comprehensive, multicomponent program design with high adherence rates, and the timeline to realize savings typically extends beyond 12 months. 1

Magnitude of Cost Savings

The most robust evidence demonstrates an average reduction of $344 per person per year in total healthcare costs associated with community-based comprehensive fitness programs, though this figure comes from nonrandomized trials and represents the upper range of documented savings. 1

• Cost-effectiveness analyses from the United Kingdom show a ratio of £12,111 per quality-adjusted life-year gained for national exercise referral programs, with significant cost savings occurring specifically in fully adherent participants (62% of the sample). 1

• Physical activity is associated with reduced medical costs, with these reductions becoming more significant with increasing age, particularly for women. 2

• Systematic reviews of worksite fitness programs demonstrate relationships between comprehensive health promotion programs and reductions in healthcare costs, absenteeism, and turnover when control groups are used. 3

Timeline for Cost Savings to Appear

The critical limitation in current evidence is that most documented improvements disappear by 6-12 months, making the timeline for sustained cost savings uncertain and likely extending well beyond one year. 4

• Short-term improvements in body composition and fitness appear at 2 months but typically disappear by 6 months in randomized controlled trials. 4

• Within-group analyses show fitness improvements (measured by 1-mile run-walk times) of approximately 2 minutes at 12 months, but these gains require ongoing program participation. 4

• The American Heart Association notes that physical activity counseling and referral strategies promote improvements in patients' physical activity for up to 12 months, suggesting this is the outer limit of documented short-term effects. 2

Critical Program Design Factors That Determine Success

Program effectiveness depends heavily on comprehensive, multicomponent design rather than simple gym membership alone. The evidence shows that free gym memberships without additional support produce minimal sustained benefits. 4

Essential Components for Cost-Effective Programs:

• Health education with supportive physical and social environments integrated into organizational structure. 1

• Linkage to related programs and screening with leadership support and partnership integration. 1

• One-on-one counseling with follow-up contact targeting at-risk populations to ensure programs benefit the greatest number of employees. 5

• Insurance coverage of participation costs, which dramatically increases program uptake—Montana's collaboration with Medicaid to reimburse program sites demonstrates this principle. 2, 1

Evidence Gaps and Important Caveats

A major pitfall is that fitness membership benefits may primarily attract healthier beneficiaries rather than improving health outcomes. Medicare Advantage plans offering fitness memberships enrolled beneficiaries who were 6.1 percentage points more likely to report excellent or very good health, 10.4 percentage points less likely to report activity limitations, and 8.1 percentage points less likely to report difficulty walking compared to earlier enrollees. 6 This favorable selection persisted at 2 years for activity limitation and difficulty walking. 6

What Remains Unknown:

• More evidence based on actual data is needed on costs and benefits of programs implemented in community or primary care settings, including cost-effectiveness, cost-utility ratios, and cost-benefit ratios. 2

• The relative effectiveness of programs delivered via Internet, email, apps, or social networking remains unclear. 2

• Studies should evaluate costs associated with recruiting eligible persons to participate, which may be high in both clinical and community settings. 2

Practical Implementation Recommendations

For programs to generate positive financial returns, they must be comprehensive rather than simple gym membership offerings:

• Programs should include 16 weekly core sessions followed by 8 monthly maintenance sessions, similar to the YMCA's adaptation of the Diabetes Prevention Program, which costs approximately $400 per participant. 2

• Clinical-community links augment effectiveness and help promote maintenance of intervention effects, as less than 50% of older adults report that physicians have recommended exercise. 1

• Target at-risk populations rather than offering universal benefits, as this ensures programs benefit those most likely to generate healthcare cost savings. 5

• Ensure at least 50% attendance at program sessions, as participants meeting this threshold show significantly greater improvements (104 minutes per week increase in moderate-to-vigorous physical activity) compared to brief counseling alone. 2