Co-locating healthcare and fitness to promote physical activity-how and for whom does it work best?

Numerous attempts have been made to address the burden of long-term conditions (LTCs) and multimorbidity through physical activity (PA) initiatives. As part of the 2012 London Olympic Legacy and National Centre for Sport & Exercise Medicine, National Health Service (NHS) clinics were co-located within leisure centres (or fitness centres). The main aims of this initiative were to promote PA as prevention and treatment through routine healthcare, increase awareness, normalise PA, and bring healthcare out of hospitals and into the community.

Despite numerous calls for co-location of healthcare in alternative settings, little empirical evidence exists to show how fitness centres might work as an appropriate environment.

As part of a two-phase realist evaluation, phase 2 of this research resulted in theories and evidence to show how, why, for whom and under what circumstances co-location of healthcare with leisure works (or not). Theories develop in Phase 1 were ‘tested’ through interviews with ten healthcare professionals and ten patients across four clinical services (including diabetes, pain management, musculoskeletal physiotherapy and podiatry) based in the co-located sites.

Five refined programme theories were developed suggesting that co-location works for people living with LTCs who are motivated to be active but need support. Co-location works for healthcare professionals (HCPs) that are active, knowledgeable and make time to discuss PA with patients. Co-location creates a salutogenic environment which enables patients and HCPs alike to become active.

Enabling contexts include aligned business models, shared clinical and PA scheduling and teamwork between HCPs and exercise professionals. Logistical challenges and individual motivations are barriers to co-location working to promote PA.

Co-location of healthcare and fitness centres, if implemented optimally, can result in promotion of PA through healthcare, helping people with LTCs to become physically active and help to reduce the burden of LTCs on society.

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