I commend Silva et al. for their work toward integrating primary care and public health to promote exercise participation and healthy lifestyle change among low-income ethnic minority populations.1 Establishing strategic partnerships with institutions such as the YMCA extends low-income individuals access to high-quality, community-centered wellness facilities that might otherwise be unaffordable. However, I have several concerns regarding the design of the project. Rather than invest resources into an observational “natural experiment” to merely examine utilization patterns, employing a more robust intervention may have maximized participation rates, improved facility utilization, and more effectively leveraged the partnership with the local YMCA. A strong evidence base already suggests that low-income minority populations face unique barriers to leisure-time exercise participation (e.g., family obligations, logistical challenges, heavy work hours) that may necessitate a more holistic approach to impact their physical activity behaviors.2 In addition, strategies such as providing free access to facilities still rely primarily on individual volition to be successful. As such, these strategies may favor the most fit and internally motivated to exercise and discourage (or even alienate) less fit, sedentary individuals who have not prioritized regular physical activity and have difficulty navigating barriers.3–5 Interventions that extend access to key resources as well as address individual, social, and environmental determinants of behavior (e.g., social support, rapport building, cultural norms, follow-up and accountability) may elicit stronger and more sustainable physical activity behavioral changes.6 First, I identified two complementary strategies that could have been incorporated to strengthen the project design: placing a follow-up call or an e-mail to all individuals issued a referral to determine whether they had visited the YMCA or not and providing counseling to those that did not use their referral. Second, individuals who opted into the membership could have undergone a brief orientation (e.g., gym tour, brief assessment, goal setting) and been assigned a peer accountability partner or “gym buddy” as part of their initial intake process. Employing these strategies may have established rapport between providers, patients, and the YMCA facility3; engendered a sense of belonging and community in the patients; and encouraged patients to make the best use of the resources provided. In light of our nation’s growing obesity problem and the obesogenic society in which we live, we as health practitioners must take full advantage of all opportunities that arise to engage high-risk populations in strategies that address multiple barriers to physical activity participation.
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Oct 28, 2024
Emmanuel Stamatakis + 10
Open Access