Exercise: the New Doctor's Orders

Just tick off any of the commonly talked about chronic diseases and conditions: diabetes, cancer, heart disease, high blood pressure and obesity and you may well find an alarming link to physical inactivity.

Despite all the public service announcements about the benefits of exercise, including First Lady Michelle Obamas Lets Move campaign, Americans arent listening. According to a recent survey from Russell Research, 67% of Americans are overweight or obese, but only 52% of Americans believe they are overweight or obese. Our inattention computes to a reported $102 billion annually for physical inactivity associated illness.

To add more fuel to the fire, the World Health Organization reports physical inactivity is the fourth leading cause of death globally, with about 3.3 million deaths a year.

Experts warn that mankind is facing an inactivity epidemic. Exercise is Medicine (EIM), a multi-organizational initiative coordinated by the American College of Sports Medicine (ACSM), warns this epidemic is resulting in tremendous cost. That said, EIM is tackling the problem head on and the buck stops--and starts--with physicians, health care providers and, well, you.

EIM wants physical activity to become an integral part of the patient/doctor discussion during health-care visits. Patients could even be sent out the door with an exercise script or referral to fitness professional.

Physical fitness is fiscal fitness

Make no mistake about it: Fitness is as fiscal as it is a cornerstone of good health. EIM has such potential for reducing public health costs as well as improving quality of life, general well-being and workplace productivity, says Dan Henkel, ACSM spokesperson.

The idea of implementing a physical-fitness regime sounds simple, especially with the U.S. Federal Fitness Guidelines that came out in 2008 that suggests at least 150 minutes of exercise weekly which is equivalent to 30 minutes daily of a good brisk walk. The 2008 guidelines reflect the most recent major scientific review of the health benefits of physical activity and serve as a base for organizations like EIM to develop physical activity initiatives.

But many experts say these guidelines fall short and take the wrong approach to a healthy fitness level. In fact, some experts say more extensive health benefits can be attained by engaging in physical activity beyond these levels.

Solutions may vary, but the facts are clear.

According to EIM, 56% of American adults do not meet the recommendations for sufficient physical activity as outlined in the 2008 guidelines.

And in a 2008 study of older adolescents and adults in the U.S., participants spent almost eight hours a day in sedentary behaviors and as many as 36% of adults engaged in no leisure-time activity at all.

Even 40% of U.S. primary care doctors and 36% of U.S. medical students do not meet 2008 federal physical activity guidelines.

Physically inactive doctors are less likely to provide exercise counseling to patients and provide less credible role models for the adoption of healthy behaviors, says Ellen Burton, ACSM/EIM program officer. Not surprisingly, only 34% of U.S. adults report having received exercise counseling at their last medical visit.

The way wed been prioritizing makes no sense, says Dr. Robert E. Sallis, a Kaiser Permanente fellow and co-director of sports medicine at Kaiser Permanente in Fontana, Calif. We prescribe a drug which is outrageously expensive and marginally effective yet have done very little to get our patients exercising.

Exercise has repeatedly proven to make a dramatic difference in overall health and in the management of chronic diseases and conditions.

Studies have shown that it actually costs about one-third less to care for active patients than inactive ones, Sallis says. And an active 80 year old can be in better health and have a lower risk of death than an inactive person in his or her 60s.

Making to physical activity a medical priority

EIM, which was launched in 2007, seeks to make exercise a frequent topic in doctors offices. Through their own admission, providers have limited knowledge and expertise regarding physical fitness, and they may have only 20 to 30 seconds to talk to a patient during an appointment. Knowing these limitations, EIM brought fitness professionals on board to help make the conversations easier.

In addition to posting resources and guidelines on its website, EIM will launch an online database and zip-code driven registry of accredited fitness professionals this summer. The online tool will interface with a patients electronic medical record, enhancing a personalized script or referral. We want providers to be comfortable they are putting their patients in the best possible hands, Burton says.

Kaiser Permanente: Walking the talk

Kaiser Permanentes Exercise Vital Sign includes a tab on a patients electronic medical record and requires physicians ask patients how many minutes of physical activity they perform in a week. Its right up there with do you smoke and how many alcoholic drinks do you have each week, says Sallis.

According to Sallis, when the physical activity discussion is tied to a diagnosis or a disease that a patient is afraid of the discussion has the most value. He continues to say the fastest and most efficient way to get providers and consumers focused on physical activity is to tie the discourse to a directive surrounding standard of care.

Already, Medicares Outcomes or Star Ratings System, investigates whether a provider in fact asks Healthcare Effectiveness Data and Information Set (HEDIS) questions about exercise. A positive answer determines that a provider is operating to standard and influences Medicare reimbursementa result that has already been favorably demonstrated at Kaiser.

We want coach potatoes to do some activity. And, we are desperate to reduce health care costs, says Sallis.

EIM is also working with college campuses to keep students, faculty and staff fit by offering bikes and weight-loss competitions.

EIM is also making inroads on the federal level as well, working with the Centers for Disease Control and several Presidents Fitness Council members are on the EIM board.

Not stopping at U.S. borders, EIM is gaining footholds around the globe with six regional centers, essentially one on each continent. EIM is also currently working with several partners in Southeast Asia and the organization has also established 27 national task forces.