Cost Effectiveness of Health

Michael Giardina: Why promoting a fitness approach like CrossFit should be a goal for all U.S. health systems

Fitness and healthcare are inextricably linked in ways that might not seem so self-evident. But the link becomes clearer when one considers the relationship between fitness and health.

April 21, 2023 4:27 pm
Michael Giardina

Healthcare organizations that are committed to value-based payment must focus on promoting health – within their patient populations as well as within their communities. And to successfully fulfill the value imperative and achieve the larger goal of cost effectiveness of health (CEoH), hospitals and health systems must partner with outside organizations that share their commitment to promoting health within their patient populations. That includes organizations dedicated to promoting health through fitness.

Michael Giardina, senior manager of health education for one such organization, CrossFit LLC in Washington, D.C., sees his organization’s mission as integral to the goal of achieving CEoH, not just for the select few who can afford health-club memberships but also for all Americans.

“What we’ve found is that the focus on improving your fitness as you age is what produces health,” Giardina said in a recent interview. “So it’s critically important for everyone.”


 What is CrossFit? Can you tell us about your purpose and philosophy?


CrossFit by definition refers to constantly varied, functional movements, executed at high intensity. It is more than just our company. It’s a philosophy that emphasizes the importance of training for life’s demands and achieving measurable and observable results. We use functional movements because they are found everywhere in life and can express great amounts of power. Examples are the squat, the deadlift (picking something up from the ground), the press (putting something overhead), running, jumping and throwing.

And with those movements there’s variance, which allows us to push out our margins of experience further and further to the points of failure to promote fitness.

Then the last part is intensity, which is the key to results both in training and life. What’s important in CrossFit is the idea of relative intensity: The goal is to always match it to somebody’s physical and psychological levels and then potentially go slightly past it so that there is some level of adaptation and improvement.

The result of all this is fitness: If I’m doing the right things and practicing the right behaviors — as in doing exercise and movement, eating well, prioritizing sleep, managing my stress — I will perform better in the gym in a way that’s trackable and correlates with better health outcomes. We start to see health markers improve as well. So this long-term focus on fitness and performance has a benefit of improving health.


Maintaining the health of all Americans is an enormous challenge for our nation. People who have access to healthier options are making unhealthy choices, and populations that are disadvantaged by things like social determinants of health lack opportunities to make healthy choices. And clearly, healthcare organizations have a central role to play in meeting these challenges. Would you say that’s where you and they share a mission?


Yes, absolutely! I think some of the most profound changes probably need to happen on a social and environmental level. One of the obvious ways is by improving accessibility to healthy foods by reducing food deserts. But it also means improving peoples’ ability to get the exercise they need. And two of the best ways to do that are through creating community-based programs that involve partnerships with healthcare providers and health-fitness specialists and by improving education on the importance of a healthy lifestyle. We are involved in those efforts through education initiatives working with other companies and the government, including private courses for military and federal law enforcement departments and work with local governments in helping guide community-based programs for their public health departments. But we also are working with healthcare professionals to get them on board on the value of CrossFit’s approach.

There’s a long list of examples of how the current environment works against people when it comes to making the right choices to create strong habits around health and fitness.

What’s needed to support peoples’ efforts to develop those habits is education and practical coaching, whether it be from a healthcare professional or a health coach. People need proper coaching to start to identify which habitual behaviors are actually becoming a detriment to their health. And then they need clear processes to develop the right habits and assume some level of accountability. I think within our healthcare system, there are probably multiple failure points, but not helping people establish accountability is probably a major failure point.


How does a fitness organization play an instrumental role in this effort and in promoting CEoH to help people to stay healthy so they don’t incur acute care costs?


One thing we’ve implemented is the CrossFit scholarship program, which provides certificates for foundational health and fitness education to populations in underserved areas. We’ve provided 501(c)(3) non-profit organizations with 17 group-scholarship courses and more than 300 individual scholarships for CrossFit level 1s.

We want to make a difference by catching people at younger ages to establish healthy behaviors earlier, when they tend to stick more.

So that’s involved partnering with school systems, recreational centers and other organizations to promote fitness and health education. We currently have 400 school affiliates.  We’ve also put a lot of effort into educating healthcare professionals on the efficacy of CrossFit for improving health based on our understanding that healthcare professionals because they are among the most trusted people out there and are essentially gatekeepers for the populations we want to reach. We hope there will be a pretty large trickle-down effect. When you can get healthcare professionals and physicians on board, and familiarize them with the CrossFit experience, they can see the results themselves and start to prioritize lifestyle-change interventions as a way to improve their patients’ health.

I think in the future — and it’s on the horizon — the opportunities to make a difference will grow. I’m not sure what that looks like yet, but opportunities will include working with government,  insurance companies and large companies to promote fitness through an approach and principles such as CrossFit.

And it will happen because there’s a strong incentive for embracing such an approach. By making it more accessible through these avenues and getting more people into it to experience improved health outcomes through improved fitness, we can go a long way toward reducing insurance spend and improving workplace productivity – and our nation’s overall cost for healthcare.

You also can use the ability of insurance companies and major health systems to track outcomes and corroborate the benefits of having people adopt the CrossFit philosophy.

But there’s no better way to get that message out than through people who are already seeing the benefits in their own lives. It may start with those who have the opportunity to access those kinds of services. But once the benefits become more apparent, more organizations will want to begin to find ways to make it available to people for whom it’s a little bit more of a financial challenge.


How can hospitals and health systems best partner with a fitness organization to begin playing a larger role in promoting health through fitness?


You can use that patient-centered care model that you see, for example, when a hospital partners with a cardiac rehab facility. In the same way, a hospital could partner with a CrossFit affiliate to incorporate training and education on nutrition and CrossFit-related habits and accountability into these patient-centered models. Because if you look at some of the outcomes from cardiac rehab, they have been pretty positive outcomes in terms of health outcomes and cost effectiveness.

And there are people doing it: I talked with a group in Michigan, the Barbara Ann Karmanos Cancer Institute, which operates cancer treatment facilities. They’re using CrossFit along with cancer treatment and recovery and reported getting some absolutely amazing results in a study called CAPABLE (Cross-Training and Physical Activity: A Better Life Experience). I don’t have access to the data because they have yet to publish their study, but they were convinced of the benefits of the approach.


How can a fitness organization support a hospital or health system in its value-based care arrangements?


Working with a fitness organization can help healthcare organizations begin to create a culture of fitness and health, which would include education for staff and patients. When you are focused on delivering value, it helps to focus not only on patient outcomes, but also the health of the healthcare professionals who are working within your organization. Especially these days, if you are being paid based on results for a population, then the people who are providing those results [need your support to keep them from being] burnt out.

I think partnerships with fitness organizations can also help hospitals and health systems deliver value through alignment of goals. Again, the idea is similar to cardiac rehab centers, but with the CrossFit methodology there’s a broader reach to promoting health of the whole population.

And the other part of it — possibly the most obvious part  — is that a fitness partner can provide data that can demonstrate the cost effectiveness of bringing in health and fitness specialists to enhance the health of a patient population.

Primary care has a pivotal role to play here.

Once a patient is in the hospital and being treated for something that raises the need for developing new healthy habits, you could argue it’s too late. For example, when you’re talking about cardiac rehab, the patient’s already had a heart attack, so there’s absolutely a sense of urgency: The patient needs to start changing their life habits now.

But it’s through the relationship with their primary care physicians that patients have that first connection with the healthcare system. So health systems might get value out of working through their primary care physicians to establish a relationship with a health and fitness specialist to which the physicians might routinely refer care patients, as appropriate.
And we’ve been working with that. One of our goals is to educate and work with primary care physicians, and to encourage CrossFit affiliates to reach out to healthcare systems, local clinics and physician practices to create relationships. It all starts with relationships. We often have to address misconceptions around CrossFit. We start by introducing ourselves to create the relationship, but then we also work to create the experience.

We have been able to do that with our level one and two educational seminars created specifically for physicians and other healthcare professionals. Our aim is to provide education, an experience and a network for them to continue to connect with and learn from each other — creating grand rounds, creating events where they can come in and listen to high-caliber speakers and specialists on how they are using CrossFit methodology to improve health outcomes.

Once you start to create that network of physicians and healthcare professionals, then we can start getting those referrals out.

Another possibility — and it’s an interesting idea that came to us from a family practitioner — is for practices to employ high-level coaches. CrossFit has a four-tier system, and a level three or a level four coach is someone who’s been coaching people for a long time and has undergone a rigorous path and achieved advanced credentials. And family practices can actually employ them as part of the clinical staff, so when somebody comes in, the doctor tells them, “Here are some behaviors I’d like you to practice more” whether it’s nutrition or fitness and all these things. But instead of being sent somewhere else, they can see a CrossFit coach there who can actually provide them something that they can start doing right away. And after that, they can be referred to local affiliates that the physician’s office has a relationship with. I think that that’s a really effective model.


What advice would you have for health system finance leaders regarding this issue?


I would encourage them to champion interventions that really help improve lifestyle habits — whether or not the intervention included the use of pharmaceuticals — because such interventions will undoubtably improve patient outcomes.

There are three clear benefits for their organizations from this approach:

  1. Greater reimbursements in a value-based care model from improved outcomes
  2. Less money spent on unnecessary treatments due to decreased patient readmissions
  3. A reputation for higher-quality care


Approximate number of CrossFit gyms in the world, in 155 countries.

Source: Gitnux, “Exploring the Explosive Growth of CrossFit 2023: A Look at the Statistics,” March 29, 2023.


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