Authors: Steven R Simon
Publish Date: 2014/01/22
Volume: 29, Issue: 7, Pages: 1059-1059
Abstract
Five decades ago President Eisenhower launched and President Kennedy greatly expanded and popularized the President’s Council on Physical Fitness1 jumpstarting what later became “the fitness craze” of the 1980s2 Despite our apparent obsession with fitness only one in five Americans achieves recommended levels of aerobic and musclestrengthening physical activity3 leading to obesity diabetes and other comorbidities To counter this inertia Grant et al at Kaiser Northern California report the results of Exercise as a Vital Sign EVS4 a primary carebased intervention aligned with the Chronic Care Model designed to ascertain patients’ physical fitness levels and facilitate counseling and referral to tailored programs when appropriateIn an excellent example of not allowing perfect to be the enemy of the good the authors employed a quasiexperimental design to capitalize on a health system’s rollout of EVS This intervention empowered medical assistants to query primary care patients about their current activity level and to enter the data into a structured field in the electronic health record adjacent to weight and blood pressure easily visible to the clinician In less than 2 years this lowcost systemlevel intervention led to small but statistically significant—and clinically significant at least at a population level—improvements in clinical documentation of exercise patients’ report of physician counseling on activity weight loss and HbA1c changes in patients with diabetes Whether the improved outcomes resulted from the physician counseling or from the medical assistants asking about exercise juxtaposed with measurements of weight and blood pressure needs further studyThe authors conclude that EVS may serve as a catalyst for primary care counseling to lead to referral for behavioral health intervention presumably some form of healthcare supervised or endorsed physical activity program While this approach deserves consideration other strategies would include for example enhancing the clinicians’ own ability to deliver effective exercise counseling through education and training in motivational interviewing Moreover additional approaches that target and engage patients directly such as mobile health eg via texting or smartphone applications and other automated technologies5 could be linked to EVS to enhance the capacity of primary care to motivate physical activity
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