The main critical issues of the gym environment in an Italian city.

BACKGROUND: The lack of a consistent national regulation regarding gym facilities, combined with the growth and transformation of the world of fitness, has led to an uncontrolled situation, where, especially in metropolitan areas, low cost gyms are continuously popping up, often not respecting the structural and hygienic requirements. AIM OF THE STUDY: Objective of this study is to evaluate the results of a monitoring programme about the gym environment, to highlight the main critical issues. METHODS: In 2018 a randomized sample of 90 gyms was inspected in Milan, using a checklist with three sections of inquiry and the resulting data were analysed through a series of multivariate regression models. RESULTS: As per the various aspects analysed, many outcomes with low scores concerned franchised gyms, which have shown to be unsatisfactory in many respects; in addition, the lack of L. pneumophila risk containment procedures has been observed in the facilities without a swimming pool, compared to those with it. CONCLUSIONS: The study results offer a clear picture of the gym environment, identifying many inadequacies for different hygienic and safety aspects; therefore, it has been possible to understand which issues need particular attention in order normalize the situation, which should be checked by future investigative steps.

Understanding dignity: experiences of impairment in an exercise facility.

Dignity, as an essential quality of being human, has been overlooked in exercise contexts. The aim of this interpretative phenomenological study was to understand the meaning of dignity and its importance to exercise participation. The experiences of 21 adults (11 women and 10 men) from 19 to 65 yr of age who experience disability, who attended a specialized community exercise facility, were gathered using the methods of focus-group and one-on-one interviews, visual images, and field notes. The thematic analysis revealed 4 themes: the comfort of feeling welcome, perceptions of otherness, negotiating public spaces, and lost autonomy. Dignity was subjectively understood and nurtured through the respect of others. Indignities occurred when enacted social and cultural norms brought dignity to consciousness through humiliation or removal of autonomy. The specialized exercise environment promoted self-worth and positive self-beliefs through shared life experiences and a norm of respect.

Hygienic and sanitary requirements of gyms in force in Italy: national issues and analysis of regional regulations.

In recent years, the awareness of the importance of physical activity for human health is growing, as people practicing it; the number of gyms has also substantially increased. Currently, in Italy there is not a consistent regulation regarding hygienic and sanitary requirements of gyms. Several Italian regions issued laws about this topic. The authors analyse the standards required by the Italian Olympic Committee (CONI) and the regional laws, highlighting the numerous issues, among which the possible location of gyms in semi-basements and basements. They eventually call for a national regulation that should clearly transpose the hygienic and sanitary requirements of gyms into a satisfactory rule of law.

Community fitness center-based physical activity interventions: a brief review.

Sedentary lifestyle is associated with cardiovascular and metabolic diseases. A compelling body of evidence demonstrates the amelioration and prevention of such conditions with increased levels of physical activity (PA). Despite this evidence, many public health initiatives aimed at increasing PA have failed to demonstrate clinically relevant effects on public health. It has been hypothesized that the highly controlled environments in which PA and health research is conducted limits its replicability in real-world community settings. This review aimed to evaluate the effectiveness of community fitness center-based interventions on inactivity-related diseases in adults. Data from 11 investigations highlighted 3 factors: (1) a lack of community-based PA studies, (2) a lack of clinically relevant data, and 3) further reliance on self-report and rudimentary measurements. It is concluded that the current laboratory-based evidence for PA and health is to be replicated yet in real-world settings and that rigorous and clinically relevant naturalistic research is required.

Universal accessibility of "accessible" fitness and recreational facilities for persons with mobility disabilities.

This study descriptively measured the universal accessibility of "accessible" fitness and recreational facilities for Ontarians living with mobility disabilities. The physical and social environments of 44 fitness and recreational facilities that identified as "accessible" were assessed using a modified version of the AIMFREE. None of the 44 facilities were completely accessible. Mean accessibility ratings ranged between 31 and 63 out of a possible 100. Overall, recreational facilities had higher accessibility scores than fitness centers, with significant differences found on professional support and training, entrance areas, and parking lot. A modest correlation was found between the availability of fitness programming and the overall accessibility of fitness-center specific facility areas. Overall, the physical and social environments of the 44 fitness and recreational facilities assessed were limited in their accessibility for persons with mobility disabilities. Future efforts should be directed at establishing and meeting universal accessibility guidelines for Canadian physical activity facilities.

Women's views about breast cancer prevention at mammography screening units and well women's clinics.

Background: Women attending mammography screening units (msus) and well women's clinics (wwcs) represent a motivated cohort likely to engage in interventions aimed at primary breast cancer (bca) prevention. Methods: We used a feasibility questionnaire distributed to women (40-49 or 50-74 years of age) attending msus and wwcs in Halifax, Nova Scotia, to examine■ women's views about bca primary prevention and sources of health care information,■ prevalence of lifestyle-related bca risk factors, and■ predictors of prior mammography encounters within provincial screening guidelines.Variables examined included personal profiling, comorbidities, prior mammography uptake, lifestyle behaviours, socioeconomic status, health information sources, and willingness to discuss or implement lifestyle modifications, or endocrine therapy, or both. A logistic regression analysis examined associations with prior mammography encounters. Results: Of the 244 responses obtained during 1.5 months from women aged 40-49 years (n = 75) and 50-74 years (n = 169), 56% and 75% respectively sought or would prefer to receive health information from within, as opposed to outside, health care. Lifestyle-related bca risk factors were prevalent, and most women were willing to discuss or implement lifestyle modifications (93%) or endocrine therapy (67%). Of the two age groups, 49% and 93% respectively had previously undergone mammography within guidelines. Increasing age and marital status (single, separated, or divorced vs. married or partnered) were independent predictors of prior mammography encounters within guidelines for women 40-49 years of age; no independent predictors were observed in the older age group. Conclusions: Women attending msus and wwcs seem to largely adhere to mammography guidelines and appear motivated to engage in bca primary prevention strategies, including lifestyle modifications and endocrine therapy. Women's views as observed in this study provide a rationale for the potential incorporation of bca risk assessment within the "mammogram point of care" to engage motivated women in bca primary prevention strategies.

Health promotion profile of youth sports clubs in Finland: club officials' and coaches' perceptions.

The purpose of this article is to examine the current health promotion orientation of youth sports clubs in Finland in view of the standards created previously for the health promoting sports club (HPSC). Ninety-seven youth sports clubs participated, and 273 sports club officials and 240 coaches answered the questionnaires. To describe clubs health promotion orientations, an HPSC index was created. The HPSC index was formulated on sub-indices by factor analysis. The sub-indices were: policy, ideology, practice and environment indexes. The results indicate that youth sports clubs are fairly health promoting in general. On average, the clubs fulfilled 12 standards for HPSC out of 22. Every fourth club was categorized as higher health promoting (> or = 15 fulfilled standards), and every third as lower health promoting (<11 fulfilled standards). The variation between clubs was wide. The clubs that had been recognized as exemplary and hence certified by the Young Finland Association were more likely to recognize health promotion than non-certified clubs (OR = 2.36, p = 0.016). The sports club officials were twice as likely to evaluate their clubs as higher health promoting than the coaches (OR = 2.04, p = 0.041). Under the sub-indices, ideologies were recognized best, others less. These findings indicate that minority of the youth sports clubs have realized health promotion comprehensively as a part of their activities. There is a lot of need for development, especially in the area of health promotion policies and practices. The instruments used proved valid and reliable and can therefore be recommended for international use.

Impact of applying different resting blood pressure cut-points to clear for maximal exercise.

OBJECTIVE: The purpose of this study was to examine the impact of applying six commonly-used and two proposed resting blood pressure (BP) cut-points to clear individuals for maximal exercise in non-clinical health, wellness, commercial fitness agencies and physically demanding occupation test sites. METHODS: Participants (n = 1670) completed the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and had their resting BP measured. Individuals with a BP >160/90 mmHg were further screened for contraindications to exercise using the ePARMed-X+ (www.eparmedx.com), all 1670 were cleared. There were no adverse events during or post exercise. RESULTS: The percentages of participants cleared for each BP cut-point were: <130/80 mmHg (85.3%), <140/90 mmHg (93.4%), <144/90 mmHg (94.6%), <144/94 mmHg (96.3%), <150/100 mmHg (98.6%), <160/90 mmHg (95.6%), <160/94 mmHg (97.8%) and <160/100 mmHg (99.5%). Individuals who would not have been cleared without further screening were significantly older, had a higher BMI, or had a lower maximal oxygen consumption. CONCLUSIONS: Conservative or lower resting BP cut-points currently applied to clear individuals for maximal exercise provide an unnecessary barrier. For individuals categorized as low-to- moderate risk by evidence-based screening tools such as the PAR-Q+ and ePARmed-X+, we recommend a resting BP cut-point of <160/94 mmHg to clear for maximal exercise until sufficient evidence is amassed to support the increase to <160/100 mmHg.

The accessibility of fitness centers for people with disabilities: A systematic review.

BACKGROUND: Fitness centers could be ideal places for people with disabilities to engage in the recommended levels of physical activity for healthy well-being. However, one of the primary barriers to participation at fitness centers is an inaccessible built environment. OBJECTIVE: This review study aimed to evaluate the accessibility of public indoor fitness centers for people with disabilities. METHODS: We searched electronic databases and web based search engines using keywords and synonyms for fitness centers, people with disability and accessibility. Observational studies that used standardized measures to evaluate fitness centers were included and critically appraised using a modified version of the checklist for randomized and non-randomized studies developed by Downs and Black. We analyzed the data descriptively. This systematic review protocol is registered in PROSPERO (ID:CRD42016043945). RESULTS: A total of 533 fitness centers were evaluated for accessibility across 14 studies. Ten (85%) of the 14 studies were undertaken in the United States of America. Instruments (n = 2) used to evaluate fitness centers were based on the Americans with Disabilities Act compliance legislation and measured domains of physical access (e.g., bathrooms, equipment, parking) and system access (e.g., policies, programs, professional behavior). We calculated weighted percentage mean scores per accessibility domain. The least accessible domain was "hot tubs/whirlpools/saunas/steam rooms" at 33%, with "programs" being the most accessible domain at 68%. CONCLUSIONS: Fitness center accessibility for people with disabilities remains poor. Adopting the principles of universal design in legislation would achieve equitable access for all, thereby allowing people with disabilities to participate actively in their communities with dignity and autonomy.

Modeling sport services in Greece: a re-evaluation of outcome dimension.

The Service Quality Scale, developed to evaluate perceived service quality in sport services in Greece, was administrated to 389 participants, 208 men and 181 women. Their mean age was 36.4 yr. (SD = 8.7). A confirmatory factor analysis did not support the prior five-factor solution. When the outcome dimension was removed, a four-factor model appeared an adequate fit. Practical implications are discussed.

Building on a YMCA's health and physical activity promotion capacities: A case study of a researcher-organization partnership to optimize adolescent programming_.

School-based physical activity programs are only effective for increasing adolescents' school-based physical activity. To increase out-of-school-time physical activity, complementary community programs are warranted. Partnerships between universities and community organizations may help build the capacity of these organizations to provide sustainable programs. To understand capacity building processes and outcomes, we partnered with a YMCA to build on their adolescent physical activity promotion capacity. Together, we designed and implemented means to evaluate the YMCA teen program to inform program planning. For this qualitative case study, emails and interviews and meetings transcripts were collected over 2.5 years and analyzed using inductive and deductive thematic analysis. Findings illustrate that the YMCA's workforce and organizational development capacities (e.g., evaluation and health promotion capacity and competence) were increased through our partnership, resource allocation, and leadership. We responded to YMCA partners' perceived needs, yet guided them beyond those needs, successfully combining our complementary objectives, knowledge, and skills to generate an integrated program vision, rationale, and evaluation results. This provided YMCA partners with validation, reminders, and awareness. In turn, this contributed to programming and evaluation practice changes. In light of extant capacity building literature, we discuss how our partnership increased the YMCA's capacity to promote healthy adolescent programs.

Low compliance with national standards for cardiovascular emergency preparedness at health clubs.

There is heightened concern that older adults and individuals with occult or known heart disease are exercising at fitness facilities that do not provide adequate cardiovascular screening and emergency procedures, as outlined in contemporary recommendations. To evaluate adherence to these standards, we surveyed 122 randomly chosen fitness clubs in Ohio (53% response rate; n = 65) that included > 110,000 total members. Special programs for older adults, cardiac patients, or both, were offered at 52% of these clubs. More than one fourth of the clubs (28%) failed to employ pre-entry screening to identify members with signs, symptoms, or history of cardiovascular disease, even though 17% reported one or more cardiovascular emergencies (ie, acute myocardial infarction, sudden cardiac death, or both) in their facility during the past 5 years. Moreover, a majority of the clubs (53%) had no written emergency response plan and 92% failed to conduct emergency response drills as described in published national standards. Only 3% of the centers reported having automated external defibrillators. These findings indicate that staff at public fitness facilities must work to identify members with signs, symptoms, or history of cardiovascular disease and prepare for prompt and appropriate responses to cardiovascular emergencies as described in contemporary national recommendations. Such risk management procedures may reduce exercise-related cardiovascular events among the escalating number of moderate-to-high-risk adults who are being mainstreamed into health and fitness facilities.

Screening, staffing, and emergency preparedness at worksite wellness facilities.

PURPOSE: The purpose of this survey was to examine compliance of worksite health and fitness facilities with the American Heart Association/American College of Sports Medicine (AHA/ACSM) recommendations for cardiovascular screening, staffing, and emergency policies for health and fitness facilities. METHODS: A survey was developed and sent to 529 worksite health and fitness facilities. RESULTS: A total of 221 surveys were returned (42% response rate). Twelve percent of facilities had no staff supervision. Among facilities with staff, 12% were not certified in basic life support, and 6% had no national professional certification. Ninety-two percent of facilities followed a health history screening policy although 13% of these facilities administered it irregularly or not at all. Of a total 187 responding facilities, 122 (65%) defined "at risk" as two or more risk factors for heart disease. Of these, 97% either required or recommended new members obtain physician clearance before participation. Four (3%) responding facilities did not require physician clearance. Twenty-five percent of facilities experienced at least one emergency that required ambulance support in the previous year. CONCLUSION: Although this was a low response rate, most responding worksite health and fitness facilities appear to be in compliance with the AHA/ACSM recommendations yet have inconsistencies in some specific practices. There appears to be a need for further consistent implementation of these recommendations into worksite settings.

ADA compliance and the accessibility of physical activity facilities in western Oregon.

OBJECTIVES: One of the mandates of Title III of the Americans With Disabilities Act (ADA) is to address the accessibility of public facilities for all people. The aim of this study was to determine how compliant physical activity facilities in western Oregon were with regard to Title III of the ADA. Comparisons were also made with the findings of a study conducted 5 years prior in a different geographic region. METHODS: On the basis of direct observations and physical measurements taken during on-site visits to 50 physical activity facilities located in western Oregon during 2000-2001, facility compliance with Title III of the ADA was characterized in terms of 10 structural domains. RESULTS: No facility was found to be 100% ADA-compliant. Exterior entrance/doors (90%) and telephone accessibility (88%) were the areas where compliance was highest, whereas accessibility to and around exercise equipment (8%) and customer service desk (37%) were areas lowest in compliance. Relative to a previously published study, the facilities in western Oregon showed greater rates of ADA compliance in six of the 10 structural domains evaluated. CONCLUSIONS: There is an on-going need and legal mandate for increasing the accessibility of physical activity facilities. Furthermore, from a social-ecological perspective, the environmental constraints identified in this study might be limiting factors in efforts aimed at increasing individuals with disabilities' physical activity involvement.

Development and validation of AIMFREE: Accessibility Instruments Measuring Fitness and Recreation Environments.

PURPOSE: The purpose of this study was to develop and validate a series of 16 survey instruments measuring fitness and recreation accessibility, collectively referred to as AIMFREE (Accessibility Instruments Measuring Fitness and Recreation Environments). General domains of assessment included the built environment, equipment, programmes, policies, and training and behaviour. METHODS: Fitness and recreation professionals (n=35) assessed fitness centres/swimming pools (n=35) in nine regions across the US. Rasch analysis was used to assess the psychometric properties of the instrument. RESULTS: The AIMFREE evidenced adequate to good fit to the Rasch model and adequate to good internal consistency (r=0.70 - 0.90). Test-retest reliability ranged from 0.70 (entrance areas) to 0.97 (swimming pools). Analysis of differential item functioning indicated that item calibrations generally did not differ significantly between urban and suburban environments. CONCLUSION: The AIMFREE instruments demonstrated adequate to good fit to the Rasch model with several of the subscales demonstrating well to excellent separation of facility accessibility.

Experience and meaning of user involvement: some explorations from a community mental health project.

With an increased interest in and policy commitment to involving service users in the planning and delivery of health service provision, there is a clear need to explore both the rhetoric and realities of what user involvement entails. In the present paper, by drawing upon an evaluation of a community-based exercise facility for people with mental health problems, the authors explore ways in which the reality of user involvement is subject to a range of configurations within health services. The paper describes a piece of qualitative research that was undertaken within a participatory framework to explore the nature of user involvement within the facility. The data have been analysed using a grounded theory approach to provide insights into: the organisational context in which user involvement takes place; factors which encourage meaningful participation on the part of service users; perceived barriers to user involvement; and issues of sustainability and continuity. This research approach has enabled the authors to explore the views and experiences of users, service providers and referral agencies in relation to the nature and potential for user involvement. The findings illustrate ways in which user involvement may take place under both flexible and formal arrangements across a variety of activities. The present paper provides an account of some of the meanings and experiences of what 'successful' user participation may involve and the conditions which underpin 'success'. The authors conclude that successful and meaningful user involvement should enable and support users to recognise their existing skills, and to develop new ones, at a pace that suits their particular circumstances and personal resources. This process may require adaptation not only by organisations, but also by service providers and non-involved users.

Comparison of service member and military spouse satisfaction with installation fitness facilities and exercise programs.

Satisfaction with fitness facilities has long been accepted as a positive contributing factor to physical activity, readiness, and overall quality of life for military families. Our findings are based on a random sample of military families surveyed at 38 installations worldwide and at remote locations. A total of 8,572 service member and 3,493 spouse (55% and 32% response rate, respectively) questionnaires were completed and returned. Overall, members were satisfied with fitness facilities and programs, but spouses were less satisfied and more unfamiliar with these facilities. Most valued programs were fitness centers and swimming pools. Members reported that elimination of fitness facilities would greatly decrease the quality of life on installations, particularly at sites outside the continental United States, whereas spouses reported that this would not have a dramatic effect. The results of this study could be used to direct funding allocations, improve the health and fitness of military families, and suggest areas for further research.