When Amy Langer, co-founder of Salo, a financial staffing firm based in Minneapolis, built herself a treadmill desk and began walking while working, her employees thought the whole thing was a little quirky. But later on, when the company started rolling in manufactured treadmill workstations as part of a new workplace study and participants starting losing weight, other employees jumped on the treadmills themselves to try it out. Now "walking while you work" is a common mantra at Salo--No. 1387 on the Inc. 5000 list.

Langer's treadmill was inspired by a theory that just a little movement conducted throughout the day could enhance weight loss and maintain health. The theory was the brainchild of Mayo clinic's obesity expert Dr. James Levine whom Langer eventually contacted to discuss how this idea can be used in the workplace to increase the well-being and productivity of Salo's employees. That correspondence lined Salo up to become the Mayo clinic's first workplace case study.

The study was conducted over six months from September 2007 to March of 2008. The work environment was redesigned to include the treadmill workstations, a pool table, foosball, a meditation room, and a Nintendo Wii "Fit" exercise video game. Participating employees were encouraged to be mildly but continuously active throughout the work day using this new environment. At the end of the study the 18 employees who took part collectively lost 156 pounds and achieved an average 37 percent reduction in bad cholesterol, among other markers that spoke to the program's unquestionable success. Management has also noticed that employees increased their energy levels, creativity, and engagement in their jobs.

Innovative methods to building a business, such as Salo's approach to wellness, are a staple for companies throughout the 2008 Inc. 500|5000 list. Companies on this year's list have created a wide range of health-related programs, from bringing supportive facilities and specialists into the workplace to employing monetary and social incentives to creatively aligning their trade with healthy activities, all while still keeping an eye on the bottom line.

The Costs of Getting Physical

Websites and program press releases for wellness and preventive healthcare programs consistently cite independent studies and experts claiming these programs result in reduced health costs, lower absenteeism, increased productivity, and reduced turnover. But what are the costs and what bottom line effect do these programs really have?

This year, the Alliance for Wellness ROI's 3rd annual survey on corporate wellness programs found that 81 percent of companies pay less than $250 per employee per year, putting costs within reach for most company budgets. The actual published ROI's in the nation, however, ranged anywhere from break even to a $20 return for each dollar spent, making return expectations elusive.

Safe Handling, a truck-to-rail transportation services company with offices in Maine and Pennsylvania, analyzes costs based on insurance claims to steer and measure their wellness program. The company -- No. 4,902 on the Inc. 5000 list -- found that even employees with only moderate risk health assessments cost them four times as much in insurance claim pay outs as low risk individuals. The assessments identified exercise, nutrition, and quitting smoking as the primary areas that the company would need to address to bring the overall health risk levels down; in turn, the company would also be reducing its direct cost of health care.

Even when drawing direct cause and effect parallels is difficult, management at most companies says it will still pay directly for programs because it has seen the increases in energy levels, creativity and involvement in their staff, even if it's been difficult to quantify. At Bodybuilding.com, an online health and fitness store and a source of more than 20,000 web pages of related information, money speaks louder than nagging -- the company hands out $50 bonuses for written reports on carefully chosen health books. The company also reimburses employees for gym memberships and offers significant discounts on company products for employees who take part in the site's social and goal-oriented health and bodybuilding network, BodySpace. Bodybuilding.com is No. 2148 on the Inc. 5000 list this year.

Otis Technology, developers of gun cleaning systems in New York and No. 1287 on the Inc. 5000 list, pays for 100 percent of the cost of smoking cessations programs for its employees. And at Tarte Cosmetics, No. 1887 on the Inc. 5000 list, a personal trainer is brought in twice a week at the company's expense and a nutritionist is retained for consultations.

As for how the wellness programs affect a company's bottom line, Salo's overall company performance during the Mayo study would indicate that significant revenue increases can be accomplished even with radical culture changes and significant time, energy, and monetary expenditures. During the first quarter of 2008, which corresponded with the last three months of the six-month study, Salo saw a 10 percent increase in revenue. Also, the company recorded its highest-ever monthly revenue in January 2008, right in the middle of the study.

Getting Health Programs to Stick

Still many companies are not seeing results even approaching the success level of Salo's. A study conducted in 2008 by Maritz, a provider of services related to motivating employees, supports the conclusion that wellness programs are directly associated with increased health and productivity but notes that low participation is making many programs ineffective.

According to the Maritz study, without some kind of incentive, only 16 percent of employees participated in programs at least once a week, while 36 percent never participated. With incentives those statistics rose to 23 percent participating once a week or more, but still, 21 percent neglected to try them out at all.

So what did Salo do differently that had all 18 study participants stick with the program for the full six months with no incentives beyond constant communication and education? It revamped the work environment to be fun and active and integrated activities into the work day so staff did not have to take valuable time away from family and outside interests to participate.

Real Watersports, a North Carolina retailer and school for kite boarding and other water sports, also accomplishes this with a policy that provides a means for daily exercise while keeping the focus on the company's core products. All 62 employees are expected to get out and play in the water every day. "When employees get into a rut and say they are too busy to hit the water they get hoisted in their chair and escorted out of the building to the water," said the company's co-founder Trip Forman. The company is No. 2626 on the Inc. 5000 list this year.

Bob and Russ Shay, co-founders of the No. 4446 company, Surefoot, makers of custom ski boots and orthotics, consciously built their business to give their staff the flexibility to live an active lifestyle and participate regularly in their beloved sport, skiing. The company even arranges all-company meetings and training sessions to include skiing on the agenda.

Dealer.com, the largest online marketing services company for the automotive industry and No. 980 on the Inc. 5000, built a "playground" to support its wellness program in its new Burlington, Vermont headquarters. The space is equipped with a state-of-the-art weight training facility, full-size basketball and tennis courts, a ping pong table, and an organic foods cafe. They also organize BBQs and parties to encourage fun in the workplace.

These companies are only a small sample of the possible wellness in the workplace programs that can be devised. With the growing mountain of evidence that health and wellness support in the workplace directly and significantly impacts aggregate worker costs and increased productivity, we will likely see more variety and innovation as successful businesses continue to develop this relatively new cost saving tool.