Exercise is Medicine® at Holy Cross Health — A Physician’s Perspective

In my everyday sports medicine practice, I have patients of every age who want to improve their exercise habits but just don’t know where to begin. They don’t want to take the 7-10 medications they’re on for hypertension, type 2 diabetes, hyperlipidemia, coronary artery disease, CHF, COPD, osteoarthritis, osteoporosis, depression and anxiety. They feel like they don’t have an alternative. But they do!

In a comprehensive review published in 2015, Pedersen et al. effectively argue that exercise IS medicine. At Holy Cross Health, we have made a multidisciplinary commitment to spreading ACSM’s gospel, the Exercise is Medicine® (EIM) global health initiative. This starts with taking exercise vitals at physician office visits and writing an exercise prescription in the form of a referral to the EIM program. Once the referral is made, exercise professionals do a comprehensive fitness screening, which includes musculoskeletal and cardiovascular surveys. A 12-week customized exercise program is developed, which is supervised by ACSM Certified Exercise Physiologists®. Fitness benchmarks and physician updates are used to evaluate progress and ensure patient safety.

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Efforts to integrate EIM at Holy Cross Health in Fort Lauderdale began just before the COVID-19 pandemic but hit a wall as the health system dealt with that health crisis. However, we were able to reopen our wellness center in July 2021 and have been growing the program ever since.

EIM was first introduced to primary care, then sports medicine and cardiology, and participation by physicians and other providers has expanded organically through word of mouth, as well as through patient requests. (Program marketing cards are strategically placed in each clinic.)

Providers enter an exercise prescription (frequency, intensity, time and type — FITT) in their EIM order. Exercise physiologists access a referral list in the EHR, contact patients to begin their program and send progress notes at entry and at 4, 8, and 12 weeks (discharge).

To date, the program has been a monumental success. Some of the feedback we’ve received from wellness center staff is shared below:

• “Our EIM program is going exceptionally well. Daniel, Joe and Justin daily are working diligently on getting new EIM referrals set up, working one-on-one and getting great health results with their patients. The patients are really enjoying their workouts, and I receive praise for each one of them on a weekly basis. In addition, they are maintaining their other tasks in Wellness. It takes a lot of planning, scheduling and communication, but we’re learning each day. It is very encouraging for us to see the patients really shine and embrace a new healthy lifestyle.” — Victor Schindler, EIM Program Coordinator
• “The program is going great! The morning group usually needs a little more hands-on attention. Most of my afternoon folks are working and function more independently. All the patients love the gym and the program!” — Joseph Gatz, Exercise Physiologist
• “We are consistently processing referrals on a weekly basis from physicians and scheduling multiple EIM assessments every week. We have also noticed that because of the direct one-on-one attention we give to each of our patients, the retention rate for EIM patients is much higher than they have been before. Our EIM patients speak very highly of the [exercise physiology] staff, and our efforts to provide the best care we can to promote a long and healthy lifestyle.” — Justin Koshy, Exercise Physiologist

I am extremely proud of our team and the great work they are doing for our patients. They are the true reason Holy Cross Health is becoming the champion for exercise in Southeast Florida!

Fernando J. Manalac, M.D., MMM, is the medical director of Holy Cross Primary Care Sports and Exercise Medicine and an affiliate clinical professor at the University of Miami Miller School of Medicine.