Ec onom ic B enef its of P hysi cal

Ac tivi ty

La rry R. G ettm an

NAT IONA L HEA LTH CAL L CEN TER GRO UP

ORIGINALLY PUBLISHED AS SERIES 2, NUMBER 7, OF THE PCPFS RESEARCH DIGEST.

HI GHLI GHT

“P u bli sh ed re sea r ch in vest iga t in g t h e ec on om ics of p h ysic a l

a c t ivi t y h a s re p ort ed im p rov ed h e a lt h a n d lo wer h e a lt h ca re

co st s, a b sen t eeis m , a n d d i sa bi lit y a s soci a t ed wi t h ex erci se a n d

fi t n es s p r ogra m s.” 

A NOTE FRO M TH E ED ITOR S

Many of the papers in this volume have focused on the health benefits of physical activity.

For example, a previous issue summarized the many health benefits reported in the Surgeon

General’s Report on Physical Activity and Health. It is health benefits that led public health

experts to include a national health goal for the year 2000 relating to employee worksite

physical activity and fitness programs. Though health benefits are the principal reason why

employees benefit from such programs, there are other benefits that come to employers who

establish worksite physical activity programs for their employees. Specifically, data are now

available to show that employee physical activity programs can save employers money. In this

paper, Larry Gettman, one of the leading authorities on the economic benefits of worksite

physical activity and wellness programs, summarizes the literature relating to the economic

benefits of physical activity programs. This information can be useful in persuading

employers to establish programs and meet national health objectives by increasing the

availability of worksite activity programs.

IN TROD UCTI ON

Because health care costs in this country have increased at alarming rates in recent years, with

the estimate that they will exceed $1 trillion by the year 2000, there is a concern by

corporations, government, and individuals in controlling these costs. One way to cut costs is to

influence how health care is delivered—the treatment side of the equation. The other way to

cut costs is to prevent health problems before they arise thus avoiding the treatment costs in

the first place. This is where physical activity and health promotion fit into the prevention

formula. And therefore the question naturally arises, “Is physical activity economically

beneficial?”
TH E EC ONOM IC B ENEF ITS OF P HYSI CAL ACTI VITY 

The most widely used measure of the economic benefits of physical activity programs is the

benefit/cost ratio. The benefit is expressed in amount of dollars saved from lower medical

costs, less absenteeism, or reduced disability expenses. The costs in the equation refer to the

cost of the physical activity program. The ratio is money saved divided by the money spent.

For example, a benefit/cost ratio of 3.43 would mean that $3.43 were saved for each $1.00

spent. Benefit/cost ratios reported in the literature for physical activity programs range from

.76 to 3.43 (see Table 17.1).

Of course, physical activity is just one part of worksite health promotion, which may also

include health risk assessment and behavior modification strategies for nutrition and weight

control, stress management, stop smoking, blood pressure control, etc. There are many other

studies reporting positive benefit/cost ratios ranging from 1.15 to 5.52 for a variety of health

promotion programs (Messer & Stone, 1995). Some of those benefit/cost studies were

conducted on comprehensive health promotion programs that included physical activity

along with stress management, weight control, nutrition education, stop smoking, etc. These

studies were not included in Table 17.1 because the specific benefit/cost ratio for isolated

physical activity was not reported. It should be noted as a reminder, though, that all

benefit/cost ratios reported for comprehensive health promotion programs are positive,

meaning that the benefits of health promotion outweigh the costs of the program.

In addition to benefit/cost studies, there are health risk appraisal publications that have

reported lower annual medical claims costs for exercising individuals (low risk) compared to

sedentary (high risk) individuals (see Table 17.2). However, the differences between the high

risk and low risk medical costs reported by Bertera (1991) and Yen et al. (1991) in Table

17.2 are statistically non-significant.

IN FLUE NCIN G HE ALTH CAR E CO STS WITH FIT NESS 

IN TERV ENTI ONS

Additional information is provided in this section to supplement the evidence cited in Tables

17.1 and 17.2.

■In a study that spanned 14 years, Cady (1985) showed that the fittest employees had only

one-eighth as many injuries as the least fit employees and that unfit employees incurred

twice the amount of injury cost.

■Baun (1986) showed that exercisers in a Tenneco fitness program had $553 lower health

care costs per person compared to non-exercisers.

■Gettman (1986) found that physically active employees at Mesa Petroleum Co. spent $217

per person less on medical claims and had 21 hours per person less of sick time than

sedentary employees.

■Describing an Army staff project, Karch (1988) noted that participants who logged the most

hours of exercise had the greatest decrease in the number of health services used.

■Tsai et al. (1988) showed that injury rates and costs associated with injuries decrease as

physical activity levels increase.

■Shore et al. (1989) reported that back fitness improved in municipal workers after six

months of exercising and that injury-related absences dropped 0.25 day while

nonparticipant absences increased 3.1 days.
■Shephard (1992) reported a zero increase in medical costs for a company with a fitness

program and a 35% increase in medical costs for a company with no fitness program.

■Connors (1992) reported that GE Aircraft employees who were members of the fitness

center for three years lowered their average annual health care costs from $1044 to $757

per individual. In contrast, nonmembers increased their average annual health care costs

from $773 to $941 per person.

It has been established that physical inactivity increases the risk for several health

problems and diseases (Blair et al., 1992). Logic tells us that if a person is inactive (sedentary)

and develops more health problems than an active person, the sedentary, unhealthy, or

diseased person is going to spend more dollars on health care than the healthy, active person.

Therefore, physical activity that leads to healthier living will be economically beneficial

because fewer dollars will be spent on health problems.

TA BLE 1 7 .1 

Worksite fitness programs and benefit/cost evaluations.

St udy/ Aut h or (s )/ Ye ar

Pu r pos e

Be nefi t / Co st Ra t i o

Ca nada Lif e Co mpar e me dica l co sts in a com pany wit h a fitn ess prog ram to a 3.4 3 S heph ard, 

19 92 c ontr ol c ompa ny w ith no f itne ss p rogr am.

To ront o Mu nici pali ty Ev alua te a fit ness pro gram des igne d to red uce job- rela ted inju ries 1. 41

Sh ore et a l., 1989 an d ab sent eeis m.

Me sa P etro leum Ex amin e re lati onsh ip b etwe en p hysi cal acti vity lev el a nd m edic al 0 .76 (198 2)

Ge ttma n, 1 986 cost s an d ab sent eeis m. 1. 07 ( 1983 )

Pr uden tial Fit ness Ev alua te e ffec ts o f wo rksi te f itne ss p rogr am o n he alth car e an d 1. 93

Bo wne et a l., 1984 di sabi lity cos ts.

TA BLE 1 7 .2 

As soci atio n b e twee n an n u al m e dica l cl aim s co sts p e r p e r son an d th e

se den t ar y r i sk fa ctor .

Study/ Sedentary Author(s)/ High Risk Active Low Year Cost Risk

Cost Difference

Du Pon t Co . $3 335 $3 205 $1 30 n s Be rter a, 1 991

St eelc ase $ 870 $ 479 $3 91 n s em ploy ees Ye n et al. , 19 91

Mi llim an & $1 248 $1 152 $ 96 n s Ro bert son Busi ness & H ealt h, 1 995
A CONS ERVA TIVE CON SENS US S TATE MENT 

The consensus statement published by the Association of Worksite Health Promotion

indicates that worksite health promotion, including physical activity, may produce health care

cost savings making the programs economically beneficial (Kaman, 1995). This conservative

statement is based on criticism directed at past health promotion research. Despite the

consistent finding that worksite health promotion is effective, critics claim that weak research

methods were used. Study groups have been self-selected and biased, and there has been a

lack of control groups and a lack of random selection in comparison groups. In addition,

there are other factors besides health promotion that may reduce health care costs, and

research is needed to identify the specific independent influence that health promotion has on

health care costs.

While some of this criticism may be warranted and while research on any topic can always

be improved, we cannot negate the consistent findings of the wide variety of investigative

approaches that have reported the positive economics of worksite health promotion, including

physical activity. R.J. Shephard, a pioneer in worksite fitness research and one of the most

respected professionals in the field, states that “large, randomized, double-blind, controlled

experiments are not feasible in the context of worksite exercise programs” (Shephard, 1996).

And, as an additional point, randomly selecting individuals into groups for research purposes

raises some sensitive ethical questions. For example, randomly selecting a person into a

sedentary control group and then asking that person to remain sedentary for the sake of good

research denies that person the opportunity to change behavior, become active, and reap the

rewards of a healthier lifestyle. Most of the past research conducted on the economics of

physical activity have used observational methods and descriptive statistics. In the opinion of

this author, it is not weak research to observe what happens in a group of people over time

and then report the descriptive statistics.

CO NCLU SION 

Considering the evidence presented through a wide variety of studies, it is concluded that

physical activity is economically beneficial. Future research should continue to document the

specific relationship between physical activity and the economic costs related to health care

and sick time.

MA JOR SOUR CES OF I NFOR MATI ON

Acknowledgment is given to five excellent review documents that summarize the research

related to the general topic of health promotion and its associated economics. The reader is

strongly encouraged to review these documents.

■Shephard (1996) examined the methodology of 52 studies on worksite fitness and exercise

programs and concluded that participants in these programs show improvements in healthrelated fitness, a reduction of cardiac risk factors, and a containment of illness. Health

promotion practitioners should encourage the development of fitness and exercise programs

for both large and small companies and foster employee participation. Researchers should

explore further the association between changes in fitness and the economic benefits to the

employer.
■Messer and Stone (1995) provided a thorough review and analysis of the studies reporting

positive benefit/cost ratios for worksite fitness and health promotion programs. The state of

the art in benefit/cost analysis is increasingly rigorous and defensible. Ultimately, benefit/cost

analysis may provide the framework for establishing the economic viability of worksite

fitness.

■Kaman (1995) edited the second major volume on the topic of worksite health promotion

economics sponsored by the Association for Worksite Health Promotion. The consensus

statement in this book details the current knowledge on the impact of health promotion on

health care costs.

■Opatz (1994) edited the first major volume on the economics of worksite health promotion

sponsored by the Association for Worksite Health Promotion. Part I of the book addresses the

problems in trying to measure the costs and benefits of health promotion; Part II describes

the proper techniques for evaluating programs; and Part III profiles programs at specific

worksites.

■Pelletier (1993) published the second in his series of articles that summarize the impact of

health promotion programs on health and cost. From 1980 to 1991 there were 24 published

studies indicating positive health benefits and economic results and from 1991 to 1993,

another 23 studies indicated the same. Pelletier states, “When anyone cavalierly dismisses

[these] studies with the glib dismissal of ‘there is no evidence,’ they are simply ignorant of

more than 13 years of increasingly sophisticated research with documentation of both health

and cost outcomes.”

R EF ER EN CE S

Baun, W.B., Bernacki, E.J., & Tsai, S.P. (1986). A preliminary investigation: Effect of a corporate fitness

program on absenteeism and health care cost. Journal of Occupational Medicine, 28, 18–22.

Bertera, R.L. (1991). The effects of behavioral risks on absenteeism and health-care costs in the workplace.

Journal of Occupational Medicine, 33, 1119–1124.

Blair, S.N., Kohl, H.W., III, Gordon, N.F., & Paffenbarger, Jr., R.S. (1992). How much physical activity is good

for health? Annual Review of Public Health, 13, 99–126.

Bowne, D.W., Russell, M.L., Morgan, J.L., Optenberg, S.A., & Clarke, A.E. (1984). Reduced disability and

health-care costs in an industrial fitness program. Journal of Occupational Medicine, 26, 809–816.

Cady, L.D. (1985). Programs for increasing health and physical fitness of firefighters. Journal of Occupational

Medicine, 27, 110–114.

Connors, N. (1992, March). Wellness promotes healthier employees. Business & Health, 66–71.

Gettman, L.R. (1986). Cost-benefit analysis of a corporate fitness program. Fitness in Business, 1, 11–17.

Kaman, R.L. (Ed.) (1995). Worksite health promotion economics: Consensus and analysis. Champaign, IL:

Human Kinetics Publishers.

Karch, R.C., Newton, D.L., Schaeffer, M.A., Zoltick, J.M., Zajtchuk, R., & Rumbaugh, J.H. (1988). Cost-benefit

and cost-effectiveness measures of health promotion in a military-civilian staff. Washington, DC: American

University, National Center for Health Fitness.

Messer, J., & Stone, W. (1995). Worksite fitness and health promotion benefit/cost analysis: A tutorial, review

of literature, and assessment of the state of the art. AWHP’s Worksite Health, 2, 34–43.

Milliman & Robertson, Inc. (1995). The cost of unhealthy behavior. (In Workplace prevention: The state of the

nation.) Business & Health, Vol. 13 Supplement, 20–25.

Opatz, J.P. (Ed.) (1994). Economic impact of worksite health promotion. Champaign, IL: Human Kinetics

Publishers.

Pelletier, K.R. (1993). A review and analysis of the health and cost-effective outcome studies of comprehensive

health promotion and disease prevention programs at the worksite: 1991–1993 update. American Journal of

Health Promotion, 8, 50–62.
Shephard, R.J. (1992). Twelve years experience of a fitness program for the salaried employees of a Toronto life

assurance company. American Journal of Health Promotion, 6, 292–301.

Shephard, R.J. (1996). Worksite fitness and exercise programs: A review of methodology and health impact.

American Journal of Health Promotion, 10, 436–452.

Shore, G., Prasad, P., & Zrobak, M. (1989). Metrofit: A cost-effective fitness program. Fitness in Business, 4 ,

147–153.

Tsai, S.P., Bernacki, E.J., & Baun, W.B. (1988). Injury prevalence and associated costs among participants of an

employee fitness program. Preventive Medicine, 17, 475–482.

Yen, L.T., Edington, D.W., & Witting, P. (1991). Associations between health risk appraisal scores and

employee medical claims costs in a manufacturing company. American Journal of Health Promotion, 6, 46–54.