As exercise professionals ranging from clinicians to personal trainers to researchers, we know that most adults in the United States are not getting enough moderate-to-vigorous intensity aerobic physical activity (MVPA). It is important for us to understand who may be at especially high risk of physical inactivity.

Prior studies have shown that there may be differences in MVPA participation by race and ethnicity. Yet, many studies tend to use very broad groupings of race/ethnicity, often “Black,” "White,” “Hispanic” and “Other.” Although these socially constructed categories may be useful for understanding some aspects of health, it is important to recognize that there is vast diversity within these subgroups. We believed it would be helpful to be able to understand the differences in MVPA participation in more specific subgroups.

The American Cancer Society has built a large cohort of over 303,000 participants from across the United States and Puerto Rico called the). (CPS-3). This dataset includes information on self-reported MVPA, race, ethnicity, and nativity (also known as country of birth, which is another important aspect of culture that may be related to physical activity behaviors). In our study, published in the July 2022 issue of Medicine & Science in Sports & Exercise_®, we used CPS-3 data to compare leisure-time MVPA participation in 18 different racial, ethnic and nativity groups.

We found that white participants born outside of the U.S. were the most physically active, and non-white (including Black, Indigenous and mixed race) Latinos born outside of the U.S. were the least physically active of all the subgroups we examined. The difference in leisure-time MVPA between white participants born abroad and non-white Latino participants born abroad was about 6 MET-hours per week, which is the equivalent of about 2 hours of brisk walking, or 1 hour of jogging, per week.

We were also able to look at differences in MVPA within the Latino subgroup. Latinos born in Puerto Rico were considerably less active (by about 7 MET-hours/week) than Latinos born in the U.S., Mexico or all other countries combined.

It is important to point out that many existing physical activity surveys were developed for and tested on predominately white participants. Therefore, results may be affected if these surveys are used in a more diverse study, like CPS-3. In prior work within CPS-3, we compared responses to our MVPA survey with accelerometer data in Black, Latino and white participants. We found that participants in these three racial/ethnic groups had similar agreement between survey-measured MVPA and accelerometer-measured MVPA. This work supports confidence in the current survey-based findings.

As exercise professionals, we should seek to understand why there is inequity in MVPA accumulation. With that information, we can work to find solutions to increase MVPA in all population subgroups. We can educate ourselves on cultural-specific barriers to MVPA; test culturally tailored interventions and messages; and provide thoughtful, appropriate, and inclusive physical activity programming to communities. We can also lobby for safe and free physical activity opportunities. 

Erika Rees-Punia, Ph.D., MPH, is a senior principal scientist at the American Cancer Society. Dr. Rees-Punia’s research focuses on the benefits of physical activity in those with a history of cancer, physical activity measurement, and the promotion of physical activity through digital interventions. She has been a member of ACSM since 2014.

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily represent ACSM positions or policies. Active Voice authors who have received financial or other considerations from a commercial entity associated with their topic must disclose such relationships at the time they accept an invitation to write for SMB.

Anastasia “Stacy” Fischer, M.D., FACSM, was installed as president of ACSM during last month’s annual meeting in San Diego. SMB editor Lenny Kaminsky, Ph.D., FACSM, asked Dr. Fischer several questions that may be of interest to ACSM members. We appreciate Dr. Fischer taking the time to provide the following answers.

Q: What can you say about ACSM’s annual meeting, the first in-person gathering of members since 2019?

A: The energy at the annual meeting was exhilarating! More than 4,000 friends and colleagues from around the world gathered in the lovely San Diego bayfront to enjoy premier science and discovery in the field of exercise science and medicine. The meeting ran smoothly and efficiently, the speakers were fantastic, and members enjoyed introductions and reunions alike. We were also able to provide a virtual meeting for those not able to attend, which has recently launched.

A: What particular challenges do you see ahead during your year as president of ACSM?

Q: ACSM continues to promote learning and member engagement during this post-COVID-19 era. We have members around the United States and world who are unable to travel for educational opportunities, so we continue to improve our website and online educational activities to meet their needs.

Q: What is your vision of what you hope to accomplish as president of ACSM? If this has changed in any way from the statement you expressed as a candidate for the position, explain why.

A: As chair of the program committee for the 2022 annual meeting, I was already able to accomplish some of my goals of celebrating Title IX and shining a spotlight on early childhood physical activity and wellness. Dr. Mary Lloyd Ireland gave an incredible D.B. Dill Historical Lecture at our annual meeting entitled “50 Years of Title IX: View through the Eyes of Athlete Turned Orthopaedic Surgeon,” where we learned how Title IX impacted Dr. Ireland and created the environment that many of us grew up in athletically and professionally. Dr. Karin Pfeiffer delivered the Joseph B. Wolffe Memorial Lecture entitled “The ABCs of Movement in Early Childhood: Building Blocks for Lifetime Physical Activity,” a fantastic lecture teaching us the importance of encouraging physical activity and play in our children, and how it helps to set them up for wellness for life.

I plan to continue to use my year to encourage all members to learn, research and provide good care to the youngest in our communities — and of course, spend the rest of 2022 celebrating Title IX!

Q: Is there anything else that you would like to share with your fellow ACSM members?

A: A sincere thank-you to all of our members who were able to make this year’s annual meeting a huge success both in person and virtually. Your continued engagement makes the college a great place to learn, grow, discover and make friends for life.

ACSM President Anastasia Fischer, M.D., FACSM, is a member of the Division of Sports Medicine in the Section of Ambulatory Pediatrics at Nationwide Children’s Hospital and a clinical associate professor of pediatrics at The Ohio State University College of Medicine. Dr. Fischer obtained a master’s degree in exercise physiology at the University of Georgia before attending medical school at The Ohio State University College of Medicine. She then completed a family practice residency at University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania, and a primary care sports medicine fellowship at Maine Medical Center in Portland, Maine.

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily represent ACSM positions or policies. Active Voice authors who have received financial or other considerations from a commercial entity associated with their topic must disclose such relationships at the time they accept an invitation to write for SMB.

The influence of cardiopulmonary rehabilitation (CR) participation on desirable patient outcomes is well established. Moreover, the role clinical exercise physiologists (CEP) and exercise physiologists serve in such programs is becoming better understood and desirable in many health care settings. Less understood, and perhaps more vital for substantiating the CEP’s role in health care, are the unseen benefits these professionals guarantee through high-quality CR services.

The purpose of CR can at times be oversimplified in an attempt to educate administrators and stakeholders. The goal of improving an individual’s fitness and quality of life often takes center stage. While this is a crucial component of optimal patient outcomes, it represents only a small window of the patient’s overall well-being and prognosis. For this reason, event-free survival should be the hallmark of CR and the driving design of the CEP’s services. Decreasing length of stay (LOS) and the elimination of 30-day readmissions should be front of mind to support patients in achieving event-free survival, improved physical conditioning and overall quality of life.

The operational impacts of decreased LOS and reduction of 30-day readmissions are often overlooked because these can be difficult to quantify. Despite the challenges, positive impacts in these categories can provide substantial cost-savings opportunities for health care systems. It should be said that the difficulty in such cost analyses are often only a matter of expertise and access to information. Generally, operational finance teams take the lead when determining the costs associated with prolonged LOS and 30-day readmission events.

For many organizations, LOS and 30-day readmissions are measures that drive reimbursement contracts. Poor performance in these areas can lead to penalties or reduced reimbursement. Therefore, the quantification of these variables is instrumental in preserving operational stability. Diagnosis related groups (DRGs) are the key component in determining the cost burden of both prolonged LOS and readmissions. DRGs represent the average expected bundled cost of a particular medical event. Insurance companies use DRGs to benchmark reimbursement and contract negotiations. If individual treatment codes are like groceries, DRGs would represent the final cost once the groceries have been bagged and given to the customer.

There are two LOS types that are important in deriving costs for a particular DRG. The first is facilities’ average length of stay (ALOS), and the second is a nationalized LOS average known as the geometric mean length of stay (GMLOS). The GMLOS is an important benchmark as it is the performance measure by which reimbursement is distributed to organizations.

Consider the six-month cost analysis of LOS and readmission events for a coronary artery bypass graft (CABG) performed at Generic General Hospital under DRG 233: Generic General performed 35 cases of DRG 233 with a reported ALOS of 12.1 days for a gross total of ~420 patient days (12.1 x 35). Finance declares direct costs for this DRG case load as $1,230,480 — or $2,930/day. 

The national GMLOS for DRG 233 is 11.4 days, 0.7 days lower than Generic General’s current performance. If Generic General were to decrease their ALOS to the GMLOS standard, the organization would save $82,040 = (0.7 x $2,930 x 35) for the six-month period. The annualized amount of $164,080 is a meaningful savings for any organization. This figure is even more substantial when combined with other applicable CABG DRGs.

Readmission cost analysis is calculated in a similar way. In this case, common readmission DRGs must be identified rather than treatment event DRGs. In this way, direct costs can be calculated and applied in the same manner of LOS where the associated readmission DRG cost multiplied by the average LOS for a particular readmission event yields direct and annualized costs for an organization.

The CEPs professional efforts will accelerate when health care administrators, legislators and insurance representatives grasp the financial implications of preventing the downstream cost burden associated with prolonged LOS and readmissions. Until the associated cost burdens are demonstrated, CEPs will continue to be professionally misunderstood and their scope of practice overlooked. The business case of the CEP’s worth may just be the prospect we have been awaiting.