How Sue Boreskie and Reh-Fit are revolutionizing what it means to be medically integrated and improving health outcomes in Manitoba, Canada.
Not that long ago, the concept of “exercise is medicine” was a foreign one.
“When I first started in the industry 40 years ago, we were trying to convince patients that exercise was safe to do,” recalled Sue Boreskie, the CEO of Reh-Fit, a state-of-the-art medical fitness facility in Winnipeg, Manitoba, Canada. “We were doing all of these safety precautions, because everyone was so worried that something bad would happen to the patient exercising.”
Things have since evolved thanks to the hard work of people like Boreskie and Dr. David Mymin, a cardiologist who became a proponent of “exercise is medicine” in the early 70s, and who served as medical director of Reh-Fit for years.
Reh-Fit began as a small, 250-square-foot stress test laboratory that operated out of St. Boniface Hospital in Winnipeg. In a revolutionary move at the time, Dr. Mymin started guiding his patients through exercise on the treadmill — with the intention of strengthening the patients’ cardiovascular systems.
As Dr. Mymin’s program became more formalized and interest grew, the group transitioned to a larger facility within the University of Manitoba. Eventually, it became its own stand-alone building in 1979 under the name The Manitoba Cardiac Institute (Reh-Fit) Inc.
Today, Reh-Fit spans 86,000 square feet and has earned a reputation as a driving force for fitness, health and wellness in the greater Winnipeg community. It was recognized as Canada’s first certified medical fitness facility by the Medical Fitness Association (MFA) in 2012, and was named “Facility of the Year” by the MFA that same year and again in 2020.
Being a certified medical fitness facility ensures Reh-Fit meets the highest global standards for programs, staff, safety and community service with medical oversight, certified professional staff, programs centered around disease management and prevention, assessment and outcome tracking, and more.
“Reh-Fit is highly innovative, exercising vigilance in offering the best possible facility, equipment, programs and staff,” said Boreskie. “The result is a real community of adherents to ‘exercise is medicine.’ The center’s success is a testimony to the visionary thinking of those who saw the need for it, and had the determination, dedication and persistence to work together to make it a reality.”
Reh-Fit is medically integrated in a variety of ways, including boasting a medical advisory committee and credentialed staff consisting of clinical exercise physiologists, rehabilitation practitioners, nurses, physicians, dietitians and massage therapists. The facility has also formed partnerships with healthcare systems, entities and foundations with the aim of improving health outcomes in the region.
An example of these collaborations in practice includes accessing electronic medical records as required, which allows Reh-Fit to reference a client’s medical history and gain a holistic view of their medical history. According to Boreskie, this information helps the team form a better understanding of a member’s health, and how exactly exercise can help.
Another collaboration is with My Health Team, a group of health care providers in Winnipeg. Together, Reh-Fit and My Health Team plan and deliver services in an effort to provide more coordinated, comprehensive patient care.
“We work with Reh-Fit in setting goals to really enhance the quality of life of residents in South Winnipeg and beyond,” said Natalie Imbrogno, the community area director of South Winnipeg Integrated Health and Social Services, and a member of My Health Team. “One of the goals for Sue’s team and ours is looking at primary prevention models, and how we can take someone who is at risk or potentially at risk and apply different modalities in changing that. We look at, how do we prevent chronic disease from exacerbating, and what can we do to get ahead of it?”
In addition to the partnership with My Health Team, medical professionals can refer their patients to Reh-Fit for exercise as a part of the “Exercise is Medicine” program — a one-time, eight-week program designed to help patients get started with physical activity.
“Medical referrals are designed to help doctors and health professionals quickly and easily connect their patients with the community support they need,” explained Boreskie.
However, Reh-Fit doesn’t just view itself as a space in which medical fitness and physical activity take place. According to Boreskie, the facility’s mandate is “being the leader in building community health,” which means outreach and education are also pillars of the organization.
A great example of this in practice took place during the COVID-19 pandemic. Like clubs in the U.S., Reh-Fit had to navigate multiple mandated shutdowns, forcing the center to get creative with how it would reach the community.
The solution was Fit Talks, a virtual series that brings experts from the fields of health and fitness together to educate, inspire and support the community. All sessions are held virtually and are open to the general public.
“This new format strengthened our public education initiative and community partnerships, while forging new relationships with experts in health care and research across Canada,” said Boreskie.
Another service launched during the pandemic that aims to support the community at large is Reh-Fit Anywhere, which offers a suite of programs to help people stay active and lead healthier lives.
“This ‘hybrid’ model — reaching individuals beyond the four walls of Reh-Fit — was already part of our 10-year vision,” explained Boreskie. “This is a model where all Manitobans, regardless of location, can be supported with individualized programs, coaching and accountability, whether they are home, traveling outside of Winnipeg, or here at the center.”
An additional important piece to Reh-Fit’s mandate is research — which Boreskie said is fundamental to building community health. “Research at the Reh-Fit informs evidence-based results of our exercise programs,” she explained. “Findings can also lead to broader advances in disease prevention and rehabilitation.”
There are five primary goals of research at Reh-Fit. In Boreskie’s own words, this includes the evaluation of existing programs and the prospective outcomes of new programs; the preparation and scientific examination of data on Reh-Fit members; the establishment of effective liaisons with appropriate university faculties; the enhancement of the facility’s integrity/credibility in lifestyle and cardiovascular disease management within the medical and government communities; and the advancement of the scientific knowledge base on prevention and rehabilitation.
Dr. Todd Duhamel, a faculty member of kinesiology and recreation management at the University of Manitoba and principal investigator at the St. Boniface Hospital Albrechtsen Research Center, recently worked with Reh-Fit on a research project surrounding cardiac rehab. Typically, cardiac rehab is completed after a person experiences a heart attack or heart surgery. Duhamel’s team — in partnership with Reh-Fit — looked at flipping that timeline on its head.
“When patients are told they need heart surgery, a lot of times they’re sent home and actually decondition over time while they wait for surgery,” explained Duhamel. “As a result, after their heart surgery, they take longer to heal and recover, and they spend more time in the hospital. This is a problem that needs to be addressed. So we’ve worked with Reh-Fit to start a pre-surgery, cardiac exercise program, to be able to help these people to exercise safely and actually maintain their health, and maybe even improve their health a little bit before they go into surgery.”
The program started as a small pilot with 12 participants, and has since been awarded a $650,000 grant to complete a larger-scale study.
Another recent example of Reh-Fit’s aim to build community health is the Women’s Heart Health Project, a new initiative that aims to reduce incidences of heart disease in women in Manitoba. Heart disease is one of the leading causes of death for women worldwide, according to the CDC.
Partnering with the Victoria General Hospital Foundation, Province of Manitoba and Winnipeg Regional Health Authority, Reh-Fit will develop and lead the program and be one of three sites to pilot the new program.
The referral-based program, according to Boreskie, will bring together a team of physicians, nurse practitioners, occupational therapists, social workers, chronic disease management clinicians and kinesiologists to help women who meet eligibility criteria improve risk factors for heart disease through lifestyle and behavior change. The three-year program is set to begin in January 2022.
Charlene Rocke, the recently retired executive director of Victoria General Hospital Founder and funder for the Women’s Heart Health Project, said the program is a great opportunity to tackle disease prevention and lifestyle management, and ultimately, decrease the number of women developing heart disease.
“We know cardiovascular disease and most chronic illnesses are what are really costing the healthcare system, both in direct and indirect costs,” said Rocke. “The project is really about educating and awareness, and giving people the tools so they don’t develop heart disease in the first place.”
The Women’s Heart Health Project, research initiatives, Exercise is Medicine program and more at Reh-Fit are all indicative of how far the medical fitness industry has come since the early days of Boreskie’s career, when she, Dr. Mymin and other associates were trying to convince people exercise was safe for healthcare patients.
“Now, close to the end of my career, everyone’s using exercise as a mode of treatment,” said Boreskie. “So it’s been really neat to see that journey.”
This journey is one Boreskie is sure will continue to evolve. In fact, it has reached a turning point as a result of the COVID-19 pandemic, with more and more people recognizing the value of health, fitness and physical activity.
As a result, Boreskie feels gyms have an opportunity to form partnerships with healthcare providers via medical fitness, and ultimately, improve health outcomes within the communities they reside in. This is something gyms can start small with and grow overtime.
“We’re quite large now, but we didn’t start that way 40-some years ago,” said Boreskie. “It won’t happen overnight. You’ve got to gradually build those programs and your reputation.”
This is where partnerships can be beneficial.
“If you’ve never done it before and you don’t have the staff in place, you can partner with organizations that are looking for a place to offer their medical fitness programming,” suggested Boreskie. “The Alzheimer Society and the Arthritis Society both have programs you can partner on, where you provide the physical activity expertise, and they provide the disease management expertise.”
In terms of additional advice for integrating medical fitness, Boreskie stressed the importance of gyms hiring credentialed staff who are qualified to work with clients with reduced mobility or who are managing chronic conditions.
Plus, Boreskie advised providing in-house training opportunities to employees to keep the team innovative and current. “Safety and trust in our staff and our programs and services are paramount,” she said.
Last but not least, Boreskie believes it’s vital for gyms to emphasize why physical activity is important in the first place — and the role it serves in improving health outcomes for the community at large.
“Do not forget about educating clients about the importance of physical activity in the prevention of chronic disease,” said Boreskie. “Position yourself as an important part of maintaining good health.”