Updates from EIM

Exercise Is Medicine: Revisiting Its Vital Role in Healthcare Amidst Disappointing Trends in Physical Activity Advice

April 10, 2024 by Elizabeth Joy, MD, MPH, FACSM; Mark Stoutenberg, Ph.D., MSPH, FACSM

Recent results from a study analyzing 2022 U.S. National Health Interview Survey (NHIS) data found that only 22.9% of adult women and 17.8% of adult men had been advised to increase their physical activity level by a doctor or other healthcare professional.1 Percentages were higher among women in all age groups, with the lowest observed rates in adults 18-34 years (16% of women; 9.5% of men). These low rates come despite many disheartening statistics: 1) only 24% of US adults (18 and older) meet recommended levels of aerobic and muscle strength training; 2) 40% of US adults are obese; and 3) between the first quarter of 2020 and the end of 2022, prescription volumes for GLP-1 medications (a new type of weight loss drug) increased 300%.2

These statistics point to the fact that we are not moving the needle regarding the proportion of U.S. adults who are being engaged in discussions about physical activity by their physician or healthcare professional; in fact, we might be regressing. In 2000, 28% of a random sample of adults reported receiving advice from their physicians to engage in regular exercise.3 This points to an urgent need for new strategies and a renewed emphasis on engaging the healthcare sector in promoting physical activity as part of the U.S. National Physical Activity Plan.

For more than a decade, Exercise Is Medicine (EIM) has spearheaded efforts to improve physical activity assessment, prescription, and referral. The development, integration and validation of the Physical Activity Vital Sign (PAVS) has been championed in multiple health systems and continues to be validated in research studies across the country.4–6 More recently, the Physical Activity Alliance (PAA) has worked to develop a Physical Activity Implementation Guide through Health Level 7 (HL7) to establish standardized measures for physical activity assessment, prescription, and referral across all U.S. electronic health records.

Physical activity as a vital sign, which can be routinely collected at virtual and in-person clinical encounters, serves as an important prompt for healthcare providers to discuss physical activity as a key component of maintaining health and managing disease. Absent of knowing a person’s current physical activity levels, it is unlikely that a healthcare provider will routinely recommend that their patient start, increase, maintain or modify their physical activity to achieve health-related goals. Further, assessing physical activity levels serves as a catalyst for further counseling and referral.7

There are several challenges that impact physical activity promotion in clinic settings. The average primary care visit in the U.S. is less than 20 minutes;8 yet, clinicians are expected to fulfill an expanding list of tasks with their patients. A full-time primary care physician caring for 2500 patients would have to work nearly 22 hours a day to provide and meet preventive care, manage chronic disease quality metrics.9 Adding one more task, such as assessing and advising on physical activity levels, to their professional plate is often seen as untenable.

This is where team-based care must come into play. Each member of the extended healthcare team has a role. Medical/clinical assistants can be easily trained to collect and document physical activity levels using the PAVS. Healthcare providers can review and interpret the results (like they do blood pressure, heart rate, weight, BMI) and incorporate that information into treatment plans, which may include providing a physical activity advice (start, increase, maintain or modify), a physical activity prescription, and/or referral to an exercise program or professional.

There are innumerable reasons why we must do a better job in healthcare to promote regular physical activity across the lifespan. We challenge all ACSM members who work in and are affiliated with healthcare settings to find like-minded colleagues and leaders who can champion the clinical integration and adoption of the PAVS, enhance the integration of physical activity into the clinical workflow, and implement referral schemes to medical and community fitness centers or programs.

Not sure how to get started? The Exercise is Medicine Healthcare Providers Action Guide can serve as an initial roadmap. The Exercise is Medicine Toolkit for Health Care Systems is another excellent resource developed by Dr. Jennifer Trilk and colleagues at the University of South Carolina School of Medicine Greenville in partnership with Prisma Health and the YMCAs of Greenville. These tools, and access to experienced ACSM colleagues, are available to provide support and consultation. Let’s all make a commitment to significantly improve the proportion of U.S. adults who receive advice from their healthcare provider to increase physical activity the next time this study is conducted! 

References

  1. QuickStats: Percentage* of Adults Aged ≥18 Years Who Were Advised During the Past 12 Months by a Doctor or Other Health Professional to Increase Their Amount of Physical Activity or Exercise,† by Age Group and Sex - National Health Interview Survey, United States, 2022§. MMWR Morb Mortal Wkly Rep. 2024;73(6):137.
  2. trilliant health. 2023 Trends Shaping the Health Economy Report. Accessed April 5, 2024. https://www.trillianthealth.com/reports/2023-health-economy-trends
  3. Glasgow RE, Eakin EG, Fisher EB, Bacak SJ, Brownson RC. Physician Advice and Support for Physical Activity: Results From a National Survey. Am J Prev Med. 2001;21(3):189-196.
  4. Ball TJ, Joy EA, Gren LH, et al. Predictive Validity of an Adult Physical Activity “Vital Sign” Recorded in Electronic Health Records. J Phys Act Health. 2016;13(4):403-408. doi:10.1123/jpah.2015-0210
  5. Coleman KJ, Ngor E, Reynolds K, et al. Initial Validation of an Exercise “Vital Sign” in Electronic Medical Records. Med Sci Sports Exerc. 2012;44(11):2071-2076.
  6. Lin CY, Gentile NL, Bale L, et al. Implementation of a Physical Activity Vital Sign in Primary Care: Associations Between Physical Activity, Demographic Characteristics, and Chronic Disease Burden. Prev Chronic Dis. 2022;19:E33.
  7. Stoutenberg M, Shaya GE, Feldman DI, et al. Practical Strategies for Assessing Patient Physical Activity Levels in Primary Care. Mayo Clin Proc Innov Qual Outcomes. 2017;1(1):8-15.
  8. Neprash HT, Everhart A, McAlpine D, et al. Measuring Primary Care Exam Length Using Electronic Health Record Data. Med Care. 2021;59(1):62-66.
  9. Raffoul M, Moore M, Kamerow D, et al. A Primary Care Panel Size of 2500 is Neither Accurate nor Reasonable. J Am Board Fam Med. 2016;29(4):496-499.
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