Written by Elizabeth Joy, M.D., MPH, FACSM
According to a recently released study, it’s estimated that half of all adults in the U.S. will be obese by the year 2030. The health consequences related to that number are staggering. Increasing rates of obesity would mean 7.8 million extra cases of diabetes, 6.8 million extra cases of coronary heart disease and stroke, and 539,000 extra cancer cases by 2030. That’s not to mention a $66 billion per year increase in health care costs by 2030. The underlying causes of our obesity epidemic are many, and our understanding of obesity is expanding. Yet our success in moving the population dial has been limited. It will take efforts from each sector in our society to make a meaningful difference in obesity rates.
The Exercise is Medicine® (EIM) initiative, spearheaded by ACSM, improves the role that health care providers and health care systems play in promoting physical activity in patients and communities. Starting in 2008 under the leadership of former ACSM President Robert Sallis, M.D., EIM has been enormously successful in highlighting the critical role health care providers play in promoting a healthy lifestyle and physical activity. EIM now has a global presence and is working with partners on several continents to spread a worldwide message about the importance of physical activity in promoting health and preventing disease.
Much of medical care in the U.S. is centered on the treatment of chronic disease. It’s estimated that lifestyle behaviors, including tobacco use, poor diet and “motion deficit disorder,” contribute to upwards of 40 percent of total health care costs. Yet, physicians spend little of their time in medical school, residency training and advanced fellowship training learning how to counsel patients on a healthy lifestyle. As a result, little time during a typical clinical encounter is spent dealing with the underlying causes of the chronic diseases plaguing the patient. To win the battle against obesity, chronic disease, and the associated morbidity and premature mortality, health care must develop, implement and test tools and systems that support diagnosis and treatment of unhealthy lifestyle behaviors.
This is where EIM comes in. The vision of EIM is to make physical activity and exercise a standard part of a global disease prevention and treatment medical paradigm. EIM advocates for physical activity to be considered by all health care providers as a vital sign in every patient visit and that patients are effectively counseled and referred as to their physical activity and health needs, thus leading to overall improvement in the public’s health and long-term reduction in health care costs. To achieve these goals, EIM:
- Creates a broad awareness that exercise is, indeed, medicine.
- Makes “level of physical activity” a standard vital sign question at each patient visit.
- Helps physicians and other health care providers become consistently effective in counseling and referring patients as to their physical activity needs.
- Leads to policy changes in public and private sectors that support physical activity counseling and referrals in clinical settings.
- Produces an expectation among the public and patients that their health care providers should, and will, ask about and prescribe exercise.
- Appropriately encourages physicians and other health care providers to be physically active themselves.
EIM is working with global partners to create tools and systems that will support health care providers in their role promoting physical activity. Efforts are underway to create a system that will facilitate patient referral to health and fitness professionals for comprehensive exercise prescription.
Central to the success of EIM is expansion of the evidence base for the role of physical activity in the prevention of disease and the role of health care providers in increasing physical activity levels of patients. The Diabetes Prevention Trial is a compelling example of how physical activity can prevent chronic disease. In this study, 11 percent of patients taking a placebo developed diabetes, nearly 8 percent of those taking metformin (a medication that promotes uptake of glucose into cells) became diabetic, but only about 5 percent of those who engaged in a 16-week lifestyle improvement program were diagnosed with diabetes. A central part of this program was 150 minutes per week of moderateintensity physical activity. Overall, the lifestyle intervention reduced the incidence of Type 2 diabetes by 58 percent compared to placebo.
Likewise, there is support for the role of clinicians in increasing physical activity in their patients. A recent analysis of several research studies revealed that advice and counseling of patients in everyday clinical practice increased physical activity by 12-50 percent for at least six months after the counseling session. Considering the complexity of health care, chronic disease and the competing demands that require clinician attention in a typical 15-minute office visit, health care systems are developing strategies to promote healthy lifestyle outside the office visit. The Keep Minnesota Active Trial enrolled older adults, age 50-70, from the HealthPartners health care organization in Minnesota. Subjects were randomized to an interactive physical activity support program or usual care and followed for a two-year period. The trial demonstrated that the telephone- and mail-based physical activity maintenance intervention was effective at maintaining physical activity in both the short-term (six months) and long-term (12 and 24 months) relative to usual care. Thus, health care providers can make a real difference in the lifestyle choices of their patients.
Lifestyle behaviors, including poor diet and physical inactivity, are leading to higher rates of chronic disease. EIM seeks to increase physical activity through efforts aimed at changing the health care environment to one that supports physical activity promotion. Making physical activity a vital sign in clinical office visits, providing clinicians and patients with educational materials, and linking them with health and fitness professionals are just a few of the efforts underway within EIM. ACSM encourages all clinicians and health and fitness professionals to counsel their patients and clients that exercise is, indeed, medicine.
View the full fall 2011 issue of the ACSM Fit Society® Page supported by Liberty Mutual online.