May 9, 2012

Kaiser Permanente was about fitness before fitness was cool

The Kaiser company sponsored a women's basketball team during the Richmond Shipyard days. Bancroft Library photo.

Getting regular exercise plays a key role in staying physically and mentally healthy. A given in 2012, the relationship between physical activity and good health has only been well understood for the past few decades.

While work once involved physical labor for a majority of Americans, early 20th century technological advances changed most jobs into something requiring much less exertion. Henry Ford introduced the assembly line into his Detroit factory to produce cars more rapidly, and mechanization spread to other industries, including farming.

Getting workers into ship-shape

The man behind California’s Richmond Kaiser Shipyards understood the value of good health. Industrialist Henry J. Kaiser knew that keeping workers and their families healthy and happy was vital for the success of his business. Competition among Kaiser teams to produce the most ships at the fastest pace was intense.

Richmond Shipyards shopfitters baseball team during World War II. Bancroft Library photo.

To keep workers fit, and to boost morale, the Kaiser Shipyard management provided many opportunities for employees to be active. Softball and basketball games were scheduled so that day, swing, and graveyard workers could participate. And bowling, skating, swimming, tennis and horseshoes were available any time.

Most able-bodied American men were away fighting on the war front, so women workers (who became collectively known as “Rosie the Riveter” and “Wendy the Welder”) took on jobs that in peaceful times would have been considered men’s work. The work was demanding — and early on women found their jobs requiring more strength and stamina than they could muster.

When shipyard gynecologist Hannah Peters recognized many of the women were resigning because the work was too hard, the yard began providing them with strength training. The women learned how to climb ladders, lift loads, and how to combine the two skills to climb with loads.

A mid-century check-up

By the early 1950s, the effect of industrialization began to show, and Americans were judged to be less physically fit than previous generations. “Muscular Fitness and Health,” a 1953 article published in the Journal of the American Association for Health, Physical Education, and Recreation, asserted that the sedentary 20th century American lifestyle had led to a loss of muscle tone in this country’s citizens.

Co-authors Hans Kraus, MD, and Bonnie Prudden cautioned that Americans needed to adopt physical fitness regimens to regain the level of fitness of earlier generations who used their feet to get around and sweated through their work day.

Kraus and Prudden's message gained traction when mainstream publications such as Newsweek, U.S. News & World Report and Sports Illustrated picked up on a study Kraus had done that showed American youth to be significantly less fit than their European counterparts.

John and Jackie Kennedy on the cover of Sports Illustrated, Dec. 26, 1960

In the early 1950s Kraus studied students between the ages of 6 and 16 and measured their strength and flexibility as they performed sit-ups, leg lifts and toe touches.

A startling 56 percent of the 4,400 American students tested by Kraus and his colleague Sonja Weber, MD, failed at least one of the fitness components. In contrast, only 8 percent of the 3,000 European students (who hailed from Switzerland, Italy or Austria) failed even one part of the test.

Kraus blamed the American students’ poor showing on their pampered lifestyles: Their parents typically drove them to school, and they did only light chores and played within their own neighborhoods. Their European peers, on the other hand, typically walked miles to school, rode bicycles and performed strenuous chores such as chopping wood.

When President Dwight D. Eisenhower suffered a heart attack in 1954, America received a lesson in preventive care from Dr. Paul Dudley White, the president’s physician. Dr. White used television — 65 percent of Americans had a TV at home by 1955 — to tell Americans they could stave off heart attacks by exercising more, giving up cigarettes, and by eating healthier food, and less of it. President Eisenhower followed his doctor’s advice and went on to establish the President’s Council on Youth Fitness in 1956.

Sowing the seeds of a fitness revolution

In December 1960, then President-elect John F. Kennedy spearheaded a public awareness campaign promoting physical fitness. In “The Soft American,” an article he wrote that appeared in Sports Illustrated, Kennedy cited the results of the Kraus-Weber Test as well as an annual physical fitness exam at Yale University: 51% of the class passed in 1951, 43 percent passed in 1956 and 38 percent passed in 1960. 

“Physical fitness is not only one of the most important keys to a healthy body; it is the basis of dynamic and creative intellectual activity,” wrote Kennedy. “The relationship between the soundness of the body and the activities of the mind is subtle and complex. Much is not yet understood. But we do know what the Greeks knew: that intelligence and skill can only function at the peak of their capacity when the body is healthy and strong; that hardy spirits and tough minds usually inhabit sound bodies.”

Once he took office, President Kennedy’s message reached an even wider audience via a public awareness campaign, President’s Council-sponsored pilot projects to test children’s fitness levels, clinics and educational films and booklets.

Outdoor aerobics class led by registered nurses in Hawaii, 1982

When Kaiser Permanente (KP) opened the doors of its Health Education Research Center in Oakland in 1969, its overarching educational theme was, “You have only one life to live — live it in good health.” The experimental center featured a patient health library and health exhibits. “Story of Life,” one of the most popular displays about human reproduction and family planning, used life-size, three-dimensional models and color slides.

Another area of the center presented information about health hazards: weight problems, smoking, venereal disease, cancer, and alcohol and drug abuse. The “Pathway to Positive Health” exhibit focused on how visitors could stay well by paying attention to nutrition, dental hygiene and the physical, mental, emotional and social aspects of good health.

The Health Education Research Center was an outgrowth of a pilot project that explored education’s role in increasing the effectiveness of preventive care. This was a new approach to prevention; it spread through the Kaiser Permanente system and beyond. By 1987, 85 percent of all U.S. hospitals offered health education programs.

From aerobics to yoga — 1970s ushered in fitness craze

Unofficial estimates in the early 1980s suggested that more than half of all Americans pursued some sort of recreational exercise, such as bicycling, swimming, tennis or running. This new dedication to physical activity signaled a change.

“Until recently, modern generations of Americans by and large failed to act on a compelling accumulation of knowledge linking individual lifestyle with individual health. As a nation, our eating habits violated accepted standards of nutrition. We shunned devoting our leisure time to regular physical exercise,” declared the writers of Kaiser Permanente’s 1984 annual report.

Fitness guru Richard Simmons leads a class in aerobics.

During the 1970s and 1980s many Americans got swept up in the fitness craze. Wearing leotards, neon spandex and leg warmers, they headed to health clubs and performed leg lifts and side bends and hoisted dumbbells to upbeat music. Or they popped Jane Fonda’s Workout in the video cassette recorder (VCR) and worked up a sweat at home. Others jogged their way to good health after reading Jim Fixx’s 1977 bestseller The Complete Book of Running.

Americans had different motivations to exercise, according to a 1978 Harris poll. Twenty-four percent of regular exercisers cited their reason was to strengthen their heart and/or lungs, 41 percent sought to lose weight, 24 percent wanted to become healthier, and 45 percent hoped to stay healthy.

A 1976 Centers for Disease Control and Prevention study of the 10 leading causes of death in the United States looked at the importance of four factors. Lifestyle, including exercise and diet, figured most prominently at 51 percent, followed by heredity (20 percent), environment (19 percent) and inadequate access to health care (10 percent).

Garfield’s Prescient Total Health Care Project

KP founding physician Sidney Garfield’s crowning achievement, the Total Health Care Project, came towards the end of his life in 1984. Among the Total Health Care Project’s goals was “to provide comprehensive primary care services for both wellness and illness and to provide incentives to professional staff to keep members well rather than just treating them when they are sick.”

An aggressive outreach plan to new members encouraged them to schedule a health evaluation appointment to review their current health and to develop a personalized Health Improvement Plan (HIP).

Colorado KP employees and members participate in an aerobics class. Kaiser Permanente 1984 Annual Report photo.

Members received a mailing with the instructions: “If you are feeling fine, we also want to see you to make sure you are in good health and assist you in preventing future problems. We really think the BEST time for you to get acquainted with us is when you’re feeling good, without the pressure of illness.”

Members who visited the Total Health Care Center for initial and periodic examinations assessed their own health via a questionnaire. They were asked about their eating habits, their lifestyle and how frequently and intensely they exercised. Part of the assessment was a treadmill endurance test to determine cardiovascular fitness.

Through the Total Health program, the center staff guided members in their quest for good health. Handouts offered tips such as how to select an activity that you will stick with as well as how to take your own pulse.

In the 1980s, popular health books included Pritikin Program for Diet & Exercise, Better Homes & Gardens’ Good Food & Fitness and Covert Bailey’s Fit or Fat? Fitness programs and initiatives began to take root throughout Kaiser Permanente’s regions. For instance, in 1984, the Ohio Region launched its “Annual Frost Belt Classic,” a series of five-, 10-, and 15-kilometer cross-country ski races. The race drew 500 skiers in 1987.

In the early 1980s, every KP region sponsored or supported a race or fun run. As part of its Dr. Wizardwise health education program, the Hawaii region sponsored a run for children.

Also in the 1980s, Kaiser Permanente’s Northern California Region established partnerships with about 15 local health clubs, enabling its members to join for a low or no initiation fee and a reduced monthly rate.

The current picture of health

Members of the Kaiser Permanente Dragon Boat Team, the KP Dragons. KP 2007 Annual Report photo.

Today medical assistants in Kaiser Permanente's Southern California, Northern California, Colorado and Northwest regions ask patients about their exercise habits as a matter of course. Exercise as a Vital Sign was launched in Kaiser Permanente’s Southern California region first in 2009 to capture information about members’ physical activity.

Medical assistants routinely ask two questions: 1) On average, how many days a week do you engage in moderate or greater physical activity (like a brisk walk)? 2) On those days, how many minutes do you engage in activity at that level? Those answers are entered into the KP member’s computerized health record, and his or her physician can view that information along with the rest of the patient's vital signs.

Kaiser Permanente also promotes healthy living through its Every Body Walk!, Thrive Across America, Healthy Eating Active Living and KP Healthworks programs and by sponsoring walks, runs and cycling events and offering an array of fitness classes at its medical centers.

Weight of the Nation - HBO series on obesity

With Exercise as a Vital sign in the exam room and a broad array of healthy living initiatives, Kaiser Permanente’s longtime fitness message endures: regular exercise is one of the cornerstones of preventive care and ultimate good health.

Kaiser Permanente was one of the sponsors of the HBO documentary series “Weight of the Nation,” which covered the issue of obesity in America. The 4-part series aired in May 2012.