What Is Medical Fitness in Japan,
and What Are Its Benefits?

Medical fitness, a fitness regimen that incorporates medical elements, is a system that is attracting a great deal of attention in Japan's hyper-aged society. Medical fitness in Japan also offers many advantages for medical institutions and other businesses. However, many people have heard of medical fitness but do not know what kind of exercise it actually is or what is required to start a business in Japan. 

In this article, we will provide some basic knowledge about medical fitness in Japan and the benefits of opening a medical fitness center in Japan.

• What is medical fitness? 
• Benefits of medical fitness 
• Types of medical fitness facilities and certification standards 
• Points to note when opening and operating a medical fitness facility 
• Summary

The term “medical fitness” was first used by a medical device manufacturer in the 1980s. The definition of what kind of exercise medical fitness is generally understood in the narrow sense as "fitness run by medical institutions" and in the broad sense as "fitness that incorporates medical elements."

When expanded in a broader sense, medical fitness can be practiced not only in facilities run by medical corporations and medical institutions but also in fitness clubs, personal gyms, osteopathic clinics, and treatment centers.

The services offered by medical fitness cover a very wide range of areas. Specifically, they range from rehabilitation, nursing care/care prevention, lifestyle-related disease improvement, metabolic syndrome and locomotion prevention, and health maintenance and promotion to strengthening and performance enhancement for athletes such as Olympic athletes.

In some cases, you may also be able to receive professional guidance from a qualified physical therapist or health and exercise instructor.

Medical fitness is based on the premise that instruction is provided in cooperation with medical institutions and incorporates medical elements. Based on information such as the user's age, gender, body composition data, lifestyle habits, and medical history, instruction on exercise and training appropriate for everyone is provided, and a solid support system for users is ensured.

In response to these efforts, the Minister of Health, Labour and Welfare has certified facilities where people can safely and appropriately engage in exercise to promote health as exercise-based health promotion facilities.

In addition, after acquiring a health promotion facility, by meeting certain conditions, it will be possible to acquire a designated physical therapy facility, which means that the usage fees for the physical therapy facility will be eligible for medical expenses.

Let's take a closer look at the benefits for both users and providers.

As mentioned in the features of medical fitness, there is a system to certify facilities that can safely and appropriately provide exercise for health promotion as exercise-based health promotion facilities. If certain conditions are met, the facility is designated as a Designated Exercise Therapy Facility, a facility suitable for providing exercise therapy.

At designated exercise therapy facilities, the fees are considered medical expenses and are therefore deductible as medical expenses. This is a great advantage for users.

When abnormalities are detected early in medical checkups and physical examinations, one-stop fitness based on guidance for the prevention of serious illnesses and health promotion is provided.

From the user's perspective, being able to receive support from doctors, nurses, and medical equipment allows them to exercise with peace of mind.

From the facility's perspective, it is also easier to gain the trust of patients because they are able to deal with them on a consistent basis.

A medical corporation can advertise medical fitness by obtaining approval for ancillary services for a Medical Act 42 facility. Aggressive marketing may make a difference in recognition in the community compared to other medical corporations.

MEDICAL JAPAN will feature many products and services for rehabilitation, nursing care and prevention, lifestyle-related disease improvement and prevention, and health maintenance and promotion.

The following section describes the types of medical fitness facilities and laws that apply to medical fitness facilities, as well as the criteria for facility types and accreditation.

Medical Fitness Laws and Systems

We have already mentioned Article 42 facilities of the Medical Fitness Law in the previous chapter, but we will explain them in further detail.

• Regulations for Certification of Exercise-Based Health Promotion Facilities

In 1988, the Ministry of Health, Labour and Welfare (MHLW) established the Regulations for Approval of Exercise-Based Health Promotion Facilities for the purpose of promoting the health of the public and started ministerial certification of Exercise-Based Health Promotion Facilities.

• Medical Care Law

In 1992, the Medical Care Act was amended to allow medical corporations to open exercise facilities as ancillary businesses.

Article 42, Item 4 of the Medical Care Law states the following:

Establishment of a facility that provides aerobic exercise (physical exercise with continuous intake of oxygen to maintain or restore physiological functions related to overall endurance; the same applies in the next paragraph) for the prevention of disease, has a medical clinic attached, and its staff, facilities, and operating methods comply with the standards set by the Minister of Health, Labour and Welfare.

There are several types of facilities offering medical fitness services. The characteristics of each are described below.

• Hospitals/clinics

Hospitals/clinics are operated as an ancillary business of medical institutions in accordance with Article 42 of the Medical Care Act. By working with patients from disease prevention, the scope of contribution to community healthcare is expanded. In addition, if hypertension, hyperlipidemia, or diabetes is the main disease, a lifestyle-related disease guidance and management fee can be calculated. In addition, income from the use of fitness gyms can be expected.

• Nursing homes/care-related businesses

By offering medical fitness, nursing care facilities can face the challenge of extending the healthy life expectancy of their residents. The facility can also expect management benefits by differentiating itself from competing nursing care facilities.

• Osteopathic clinics/treatment centers, etc.

When osteopathic clinics/healthcare facilities provide medical fitness, they may be able to clearly convey the significance of exercise because of the good compatibility between their usual treatment and preventive care exercise, etc. It is also expected to attract a stable customer base by utilizing treatment techniques.

• Municipalities

When a municipality provides medical fitness services, it is important to contribute to solving local health issues. To do this, it is necessary to utilize local resources and collaborate with community health maintenance and promotion projects.

The following is a description of nationally accredited facilities and their accreditation criteria.

• Exercise and Health Promotion Facilities

Exercise and health promotion facilities, as described in the section on medical fitness laws and systems, are subject to the following conditions for accreditation.

1. The facilities must be located in a way that allows aerobic exercise and strengthening exercises to be performed safely (all or part of the training gym, exercise floor, and pool, as well as ancillary facilities). 

2. Provision of equipment for physical fitness testing, exercise programs, and first-aid treatment

3. Provision of facilities for providing lifestyle guidance

4. Assignment of health and fitness instructors and other exercise instructors

5. Appropriate partnerships with medical institutions

6. Provision of appropriate guidance to regular users (health condition monitoring, physical fitness measurement exercise program)

• Designated Exercise Therapy Facilities

A facility that is suitable for providing exercise therapy among the health promotion facilities approved by the Minister of Health, Labour and Welfare. Users of facilities with this designation are eligible to have their fees deducted from their medical expenses. The conditions for designation are as follows:

1. The facility must be a health promotion facility approved by the Minister of Health, Labour and Welfare.

2. The physician in charge at the affiliated medical institution must be a certified health and sports physician by the Japan Medical Association.

3. A health and exercise instructor is assigned to the facility.

4. A fee structure for exercise therapy (not more than 10,000 yen per session) (revised as of April 1, 2022).

• Facilities under Article 42 of the Medical Care Act

Article 42 facilities under the Medical Care Act (disease prevention exercise facilities) are defined as “facilities that provide aerobic exercise for disease prevention and to which a clinic is attached. The following are the main criteria for certification as a disease prevention facility:

1. Personnel standards

(1) Assignment of health and exercise instructors (or persons with equivalent abilities)

2. Equipment standards

(1) Treadmills, bicycle ergometers, and other equipment for aerobic exercise

(2) Equipment for strength training and other strengthening exercises

(3) Back muscle strength testers, spirometry devices, and other devices for measuring physical strength

(4) Equipment to measure maximum oxygen uptake

(5) Equipment for providing first aid and aerobic exercise.

3. Operational standards

(1) The facility must be operated as a facility that provides appropriate health and exercise guidance to those suffering from lifestyle-related diseases and other illnesses, those with high blood pressure, the elderly, and others in high need of disease prevention.

(2) The clinic attached to the facility must be operated to provide appropriate medical management for users of the facility.

(3) Health checkups, health guidance, and exercise guidance are to be provided to members and other continuous users of the facility.

(4) Health record cards are to be prepared for continuous users of the facilities, and these cards are to be stored and managed appropriately.

There are a few things to keep in mind when opening and operating a medical fitness center.

• Procedures such as application to the Ministry of Health, Labour and Welfare and rewriting of the articles of incorporation are required.

When a medical institution operates a medical fitness center, it must be notified as an Article 42 facility (disease prevention exercise facility) under the Medical Care Act. Article 42 of the Medical Care Act (Article 42, Item 4 of the Medical Care Act) permits the operation of exercise facilities for disease prevention as an incidental business of medical institutions. One type of exercise facility for disease prevention is medical fitness.

In addition, a medical institution is required to amend its articles of incorporation if it wishes to open a medical fitness facility. Since the amendment of the articles of incorporation requires approval from the prefectural governor, it takes about one to three months from the provisional application to the final application and approval.

• Limited consultation services and explanatory information

Providing medical fitness requires knowledge of both the fitness facility and the medical collaboration. However, there are few cases that start out with knowledge of both from the beginning. Furthermore, there is not much information on consultation services.

To solve these problems, one option is to utilize the advice of a medical fitness expert who can consult from the perspective of the operating entity at the time of launching a medical fitness business.

• Need to secure fitness and marketing resources

It is also necessary to secure resources that match the medical fitness program. In addition to securing equipment, flow lines, machine layouts, and operational procedures for a fitness facility, it is also essential to create a medical coordination scheme and programs for medical fitness. It will also be necessary to hire dedicated fitness studio personnel and marketing personnel.

Medical fitness has the advantage of not only extending healthy life expectancy but also of providing support in cooperation with medical institutions, with fees for use sometimes being deductible as medical expenses. For the facility side, there are also benefits such as revenues from membership fees and aggressive advertising.

Medical fitness will be increasingly needed in Japan's super-aging society in order to realize healthy and active local communities.

Comment from the supervising physician

Medical fitness has been expanding, especially in urban areas, partly due to a change in the law that allows for partial use of health insurance. In the past, people used fitness clubs mainly to prevent physical decline due to aging, but in recent years, more and more people are using them to improve their health, and there is a great need for them. Compared to general fitness clubs, the support provided by physicians and other professionals is a very attractive advertising feature, and we may see an increase in the number of users.

MEDICAL JAPAN will feature many products and services for rehabilitation, nursing care and prevention, lifestyle-related disease improvement and prevention, and health maintenance and promotion.

Editor Information

Supervisor: Masanori Goh
Supervising physician: Masanori Goh

Biography

Graduated from the Department of Medicine, Faculty of Medicine, Kagawa University in March 2011.

He received his initial clinical training at Tokushima Red Cross Hospital in April of the same year and joined the Department of Anesthesiology at Tokushima Red Cross Hospital in April 2013. Qualifications include ICLS course director certification by the Japanese Association of Emergency Medicine and certified physician and specialist in anesthesiology by the Japanese Society of Anesthesiologists.

[Licenses and Qualifications]

Board Certified Anesthesiologist, Japanese Society of Anesthesiologists, ICLS Course Director, JB-POT

[Books and Articles]

Book of Systemic Management for Nurses and Residents

[Affiliation]

Tokushima Red Cross Hospital