Exercise is Medicine® On Campus (EIM-OC), a global initiative among college campuses, connects campus health providers with exercise professionals to provide an exercise plan for patients. The program at the University of North Carolina at Chapel Hill (UNC) was established in 2016 and recently was awarded “gold status” for its efforts by the American College of Sports Medicine. However, just as the UNC process was becoming streamlined, the COVID-19 pandemic reached the United States. By late March 2020, UNC and many other universities had emptied their campuses of students and switched to remote learning to limit the spread of the virus. These major changes prompted the UNC EIM-OC team to quickly adapt its model in order to remain an accessible and useful resource for the student body. We recently published an article outlining these adaptations in the Translational Journal of the American College of Sports Medicine. Here we provide a more informal overview of our changes and recommendations.
The EIM-OC referral program at UNC begins with the campus health provider, since one of the program’s key goals is to incorporate physical activity as a vital sign during medical appointments. To encourage these conversations, our EIM-OC team regularly educates providers on scientific literature that supports the use of exercise prescription for promoting physical and mental health. As the provider assesses the patient’s medical history and current physical state, they inquire: 1) how many times the patient exercises per week and 2) how many minutes long are these bouts of exercise. These questions give providers a quick, objective method to assess patient achievement of the physical activity guidelines (i.e., 150 minutes of moderate-vigorous physical activity per week). If the patient is not currently meeting guidelines, or if the health care provider believes a referral will be beneficial irrespective of current physical activity levels, the patient is referred to the EIM-OC team. Once a referral is made, the EIM-OC team reaches out to the patient via email to set up a consultation appointment.
During a consultation, the participant is interviewed by an EIM-OC exercise consultant, who has been trained to administer our standardized consult procedure. This procedure, which was developed by Alex Pomeroy, NASM C.P.T, and Lindsay Brookey, ACSM-RCEP, includes asking about the participant’s current level of exercise, interests (current and former) in any form of exercise or sport, limitations due to injury or disease, and any additional concerns. A standardized script, developed by a certified personal trainer and based on motivational-based interviewing and social cognitive theory, is used to guide the consultation. The outcome is customized individual goals (e.g. run a 5k without stopping, improve HbA1C levels, reduce symptoms of anxiety) which are listed on a resource sheet. The resource sheet includes a plan to help the participant achieve their goals and lists pertinent on-campus and local off-campus fitness centers, clubs, or trails.
A significant adaptation in response to COVID-19 took place in the exercise consultation process, which transitioned to a virtual platform using Zoom. This provided a way to consult with participants across the country while halting the risk of virus transmission from in-person meetings. Many students had moved away from the university, so time zones and recommendations based on local resources also had to be adjusted. Zoom meetings were well-received by participants; virtual meetings do not have a commute time, are more flexible to schedule and may even be less intimidating to certain participants.
UNC EIM-OC also changed its model for arranging follow-up appointments to the end of the initial consultation instead of in a follow-up email. This led to an enormous increase in follow-up appointments, which gave us information on the efficacy of exercise recommendations and the EIM-OC initiative. Within two weeks, many participants increased their physical activity levels, found new activities they enjoyed and took more walking breaks. Additionally, some participants reported that they appreciated having a source of accountability from the program after committing to a follow-up appointment.
UNC EIM-OC’s standard recommendations evolved to fit the reduction in resources available to students due to social distancing safety measures. UNC Campus Recreation was able to transition many of its in-person personal training and group fitness classes onto online platforms such as Facebook Live and Zoom. These virtual meetings balance social distancing with personalized training instruction and words of encouragement.
The increased prevalence of online, streamed or on-demand applications have also been useful in expanding access to at-home workouts. The UNC EIM-OC team researched affordable and reputable applications for student use, including cardio applications (e.g., Peloton’s cycle and Charge Running’s jogging programs), yoga applications (e.g., DownDog) and resistance training applications (e.g., Les Mills On Demand and Nike Training). Additionally, trail-finding apps (e.g., AllTrails) can locate nearby greenways for running, walking and cycling opportunities. These online applications, in conjunction with the UNC Campus Recreation adaptations , allow UNC EIM-OC to continue making diverse, personalized recommendations for all participants, regardless of their location.
UNC EIM-OC, along with UNC Campus Health and UNC Campus Recreation, have adapted to ensure the initiative is still viable during COVID-19. Significant changes in the consultation process included moving in-person meetings to online ones and scheduling the follow-up appointment during the initial consultation. Additionally, EIM-OC had to research many alternatives for closed gyms, group fitness classes and personal training, which included high-quality fitness applications, outdoor exercise opportunities, as well as online group training. These adaptations have provided UNC EIM-OC with a number of useful lessons, which will be preserved beyond COVID-19.