It’s common sense that a certain level of regular exercise is vital to sustaining good health. Now, in physicians’ offices across the nation, amount of exercise is increasingly being included as a measurable “vital sign” during patient visits, right alongside blood pressure, pulse and weight, according to a recent article in the Wall Street Journal.
Exercise is Medicine, a program overseen by the American College of Sports Medicine, is the driving force behind a movement to encourage primary care physicians and other providers to include exercise in patients’ treatment plans.
For patients not logging enough time exercising during the week, physicians across the nation have begun prescribing physical activity to improve health in addition to drugs, physician referrals and follow-up visits, according to the WSJ. These prescriptions can include suggested amounts of exercise, and sometimes referrals to certified trainers to create exercise regimens, especially in cases in which patients have a medical condition that could limit their ability in certain activities, such as asthma or diabetes, according to the article.
Citing a 2011 study published in the American Journal of Preventive Medicine, only about 10 percent of U.S. adults actually met federal guidelines to engage in a minimum of 150 minutes of moderate aerobic activity per week, though 62 percent reported they did.
The actual amount of time the majority of Americans spend working out — or lack thereof —sheds some light on why the U.S. struggles so much with weight control.
According to The Journal of the American Medical Association’s most recent data (collected between 2011-2012) 34.9 percent (or 78.6 million Americans) over the age of 20 and 17 percent of children are obese. Those numbers are huge, and so are the associated health risks and costs of providing healthcare to treat conditions associated with obesity.
Overweight and obese people carry higher risk for developing coronary heart disease, type II diabetes, endometrial, breast or colon cancer, high blood pressure, stroke, sleep apnea and other chronic conditions, according to the Centers for Disease Control and Prevention.
There are various direct and indirect costs associated with obesity. For example, according to the Harvard School of Public Health obese employees miss more days from work due to short-term absences and long-term disability than non-obese people; insurance companies charge higher premiums for health insurance for obese people; and some studies found that obesity is associated with lower wages and lower household income.
Obesity directly affects the national economy as well. According to a report from the United Health Foundation and the American Public Health Association and Partnership Prevention, obesity is increasing at a faster pace than any previous public health issue in the U.S. Researchers project that 103 million Americans will be considered obese by 2018, and the U.S. is expected to spend $344 billion on healthcare costs associated with obesity by that year if rates continue to increase at the current pace.
These numbers are staggering, especially when you consider that the U.S. spends 17 percent of its GDP on healthcare costs — more than any other developed nation with comparable economies — which amounted to 3.8 trillion in 2014.
If you’re scratching your head thinking it’s rather obvious that obesity leads to increased risk for these complex chronic conditions that incur the highest healthcare costs, you might also be wondering, why haven’t physicians been more adamantly prescribing physical activity all along?
Recent federal changes that impact healthcare policy, mostly stemming from the Patient Protection and Affordable Care Act of 2010, have changed the physician reimbursement model from fee-for-service — one that compensates physicians based on the volume of services they provide patients —to a value-based model, in which physicians are reimbursed for providing high quality care to patients at lower costs. At the same time, both patients as well as health systems are realizing the incentives to overall population health, for less hospital visits and better control over chronic conditions means reduced healthcare spending, and of course, healthier people.
Programs such as Exercise is Medicine may be a bit overdue, but the good news is they seem to be working.
As a part of Oakland, Calif.-based Kaiser Permanente’s Exercise as a Vital Sign program, nurses or medical assistants log patients’ number of minutes of exercise per week into their electronic medical records while collecting traditional data, such as blood pressure pulse and breathing, according to WSJ. Physicians use these signs to identify patients who may benefit from more exercise, and from there determine what type of physical activity and additional support would be best for the individual.
Exercise as a Vital Sign was associated with weight loss in overweight patients and more controlled blood sugar for patients with diabetes during a pilot program between April 2010 and October 2011 at four Kaiser Northern California Centers, according to WSJ.
So, what does a “prescription” for exercise look like? Here are some examples from WSJ:
Type II Diabetes
- Four days a week of 20-60 minutes of moderate cardio
- Two days a week of low resistance, low-intensity strength training
- Consume 15 additional grams of carbohydrates before or after exercise
- Take frequent breaks
- Plan workouts for late morning when least prone to asthma attacks
- Extend warm-up and cool-down times
- Establish workouts over a period of six weeks, adjust to changes in weather
Anxiety and Depression
- Start slowly and incorporate five-minute-long aerobic sessions
- Build up to 20-60 minutes for four days a week
- Yoga and tai chi help reduce anxiety and enhance relaxation
*Editor’s note: These prescriptions are attributed to The Wall Street Journal and are not the ideas of the author of this article.