Adherence to and effects on physical function parameters of a community-based standardised exercise programme for overweight or obese patients carried out by local sports clubs.

OBJECTIVES: To evaluate the adherence to a sports-club-based standardised real-life exercise programme for overweight or obese patients. The effects on physical function parameters, anthropometry and quality of life were also assessed. STUDY DESIGN: Within this prospective cohort study data from patients in Austrian sports-club-based programmes were analysed. METHODS: Sports-club-based programmes were held twice a week and carried out by local trainers. The target group was overweight or obese patients. Adherence was determined after 2 and 6 months, and physical function parameters were evaluated at baseline and after 2 months. RESULTS: A total of 71 patients (age: 52.0; standard deviation [SD: 12.1] years; body mass index [BMI]: 37.3 [SD: 8.2] kg/m2) took part in the study. Within the first 2 months the adherence rate was 62%, while 20% (14/71) participated in ≥75% of all offered sessions. After 6 months, 49% (17/35) of the retained sample still participated regularly in an exercise class. At baseline, muscle strength represented only 70% of the age- and sex-specific reference values and could be increased in a range from +4.0% (1.3 [SD: 3.0] kg; muscular endurance for the pectoral muscles) to +22.5% (16.1 [SD: 17.5] kg) (muscular endurance for the lower limb muscles). Concerning endurance capacity, the heart rate for a constant submaximal workload decreased from 126.4 (SD: 21.7) beats per minute at baseline to 120.9 (SD: 21.1) after 2 months (P < 0.001). CONCLUSIONS: Sports clubs, as a non-clinical setting, can offer attractive standardised exercise programmes for a minority of overweight or obese patients. Long term changes in life-style, that result in sufficient levels of health enhancing physical activity still remain a huge public health challenge.

Regional health care systems: implications for health care reform.

Not only should there be payment reform, but health care delivery should be redesigned to achieve the triple goals of access to services, quality improvement, and cost control. The authors review the forces that have formed multihospital and health care systems in the past, and the seven stages that health care systems traverse toward competency. They briefly discuss the implications of those realities for reform implementation. One premise is that the natural evolution of such health care systems toward competency will take a longer time than most nonproviders expect.

Strategic capital planning scenarios for the future.

Hospitals have traditionally looked to income from operations, depreciation, debt, and philanthropy as their major source of revenue. This viewpoint, however, is changing as hospitals move from being the hub of the healthcare provider network to being spokes in an integrated delivery network (IDN), and the traditional tools of debt financing and revenue optimizing become less effective.