To maintain health and prevent disease, the 2008 physical Activity Guidelines for Americans recommends adults attain a minimum of 150 minutes per week of moderate intensity physical activity each week. Children and adolescents are encouraged to accumulate 60 minutes per day of vigorous physical activity, according to the 2008 guidelines published by the U.S. Department of Health and Human Services. Failure to achieve these recommended levels of activity can lead to higher risks of obesity and chronic conditions such as diabetes, high cholesterol, heart disease and low back pain.
In fact, recently published data found that 1 in 10 premature deaths worldwide are directly attributable to physical inactivity.
Assessing Physical Activity
Think back to your last primary care office visit. Were you weighed? Was your blood pressure measured? More than likely, the answers are yes. However, if the question was whether your doctor assessed your physical activity level or counseled you to start, increase or maintain your current physical activity level, the answer would likely be no for at least two-thirds of patients.
There are many reasons for this, but the primary one is the lack of a clinical assessment tool for physical activity. To measure your weight, doctors use a scale; for blood pressure, they use a sphygmomanometer (blood pressure cuff). These “objective” measures provide valid, reproducible measures of health. Physical activity has historically been harder to measure. Doctors have objective tools like pedometers that measure steps, smartphone GPS sensors and a device called an accelerometer to measure activity patterns. However, there are significant limitations to these tools, making most assessments of physical activity subjective or self-reported. Physical Activity Vital Sign based on the recommendations from the Physical Activity Guidelines for Americans, we have created a two question Physical Activity Vital Sign (PAVS). Like other vital signs (weight, height, blood pressure, pulse), the PAVS is collected at each visit by a medical assistant or nurse before the physician sees the patient.
The questions are:
- On average, how many days a week do you perform moderate intensity physical activity or exercise, where your heart is beating faster and your breathing is harder than normal (such as a brisk walk)?
- On average, how many total minutes of physical activity or exercise do you perform on those days?
Once the PAVs is recorded in the electronic health record, it is interpreted by the physician much like weight of body mass index would be to determine if it is in the unhealthy or healthy range. For example, if the PAVs is 0 to 30 minutes a week, the physician would note that the patient is insufficiently active and recommend increasing physical activity levels to promote health and prevent disease. Depending on the amount of time available for counseling and other issues requiring attention during the office visit, time spent discussing physical and exercise may be quite brief, lasting less than a minute. however, for some patients, the discussion may last longer to help facilitate a more extensive discussion.
This approach to office-based physical activity promotion is supported by the Exercise is Medicine program, as well as the national physical Activity plan, both of which focus on implementing physical activity as a vital sign. Studies show use of a physical activity vital sign increases the proportion of patients who have their physical activity level assessed, and preliminary data from Kaiser Permanente, which uses an “exercise vital sign,” shows patients are also more likely to receive counseling for physical activity.
It will be interesting to see if this vital sign approach leads patients toward more physical activity, and, in turn, toward lower rates of chronic disease, less healthcare utilization, lower costs and more importantly, higher quality of life.
Walking the Walk
Finally, the most important predictor of patient physical activity counseling by a physician is the personal physical activity level of the physician! It’s not enough for physicians to simply talk the talk regarding exercise; they must literally walk the walk. The “active clinician campaign” within Intermountain’s LiVe Well program highlights clinicians who have successfully integrated physical activity into their lives and into patient care. These stories will hopefully help to motivate and educate other clinicians about activity, and about how to be not only successful at counseling patients, but also at improving their own health. So, What’s your physical activity vital sign?
And remember, when it comes to physical activity, “none is bad, some is good and more is better!”