Commentaries on Physical Activity and Health
Preaching What You Practice: Physical Activity Promotion in Healthcare
A Conversation with Liz Joy, MD, MPH, FACSM
Medical Director, Community Health and Food & Nutrition, Intermountain Healthcare
Physical inactivity continues to have major consequences and cost for the American healthcare system. Meanwhile, the healthcare sector offers a unique, and critical, environment for successful physical activity promotion. The NPAPA discussed the role of the healthcare sector, along with the specific challenges faced in the promotion of physical activity, with Dr. Liz Joy, Medical Director of Community Health and Food & Nutrition at Intermountain Healthcare in Salt Lake City, Utah.
Physical Activity Promotion as Part of the Changing Healthcare System
“As the healthcare industry moves from a volume based, fee for service environment to a value based, cost reduction system we are forced to consider the biggest value proposition - is it treating or preventing disease? For example, the cost of caring for someone with diabetes is enormous, which is why we’ve seen huge growth in diabetes prevention programs – of which physical activity is a huge part. If we can successfully prevent, or delay diabetes, there are significant cost savings that ripple throughout our society. This connection between physical activity and reduced diabetes risk becomes a really strong message to healthcare providers. We need to be looking at physical activity not only through the health promotion and disease prevention lens, but also tying it to improved health outcomes and enhanced quality of life for people with established conditions such as diabetes, depression, and low back pain.”
Focusing on Physical Activity Promotion in Healthcare – The WHY and the HOW
“If healthcare providers are active themselves they are more likely to counsel their patients on the importance of physical activity to promote health, prevent disease and manage existing chronic conditions. This is strongly supported in the scientific literature, looking at both medical students and physicians in practice. Efforts to promote physical activity to healthcare providers, such as Exercise is Medicine® (EIM), do so not only because it improves providers' own personal health, but also the type of care they provide in their clinical practice enhancing patient health outcomes. Exercise is Medicine® gives healthcare providers the tools and processes that make it easier to assess and promote physical activity. EIM recommends implementation of physical activity as a vital sign (PAVS). The PAVS allows healthcare providers to assess the physical activity of every patient at every visit, the same way that we measure weight and blood pressure. EIM has also worked with health and fitness professionals with a goal of connecting patients to community-based fitness professionals so they can “fill” their exercise prescription.”
The Key Role of Leadership
“The Exercise is Medicine® messaging and initiative is grounded in the knowledge (even truth), that you preach what you practice; and this ripples throughout the entire healthcare organization. For example, a physically active healthcare CEO is the more likely to prioritize resources within the level of support healthcare system that support physical activity promotion. You really need to look at the culture of organization - all the way from the C-suite down to front line care deliverers. When you have that level of support you are more likely to acquire the resources needed to establish a PA vital sign in the electronic medical record (EMR), or resources towards the development of medical fitness centers, wellness clinical care, and employee wellness programs.”
Challenges for Physical Activity Promotion in the Healthcare Setting
“Despite solid rationale, and leadership support, physical activity promotion initiatives in healthcare often face challenges to widespread implementation.
- Insufficient integration: Physical activity has still not been fully integrated as a vital sign into electronic health records. This is an important piece of this work. If you don’t give people appropriate tools to assess and promote physical activity, they will not be very effective or efficient. This insufficient integration creates a situation where physical activity promotion is ignored.
- Insufficient reimbursement: Practitioners struggle for sufficient reimbursement of physical activity prescription, advice, and counseling. Counseling takes time. Writing a medication prescription is pretty easy these days. We zip it off to the pharmacy through the electronic health record in less than a minute; but it takes more than a minute to meaningfully counsel someone on physical activity, and reimbursement strategies for healthcare providers are currently insufficient for the amount of time and effort it takes.
- Access to Professionals: If I write a prescription for a medication, it goes to a pharmacy and a pharmacist, a highly-educated person with a PharmD fills it for them. But if I write an exercise prescription for a patient, who is the equivalent of the PharmD – who helps them fill their exercise prescription? The healthcare industry needs to be better connected with the health and fitness community so that people fill their physical activity prescriptions.”
It Takes a Village, The Entire Healthcare Village
“It will take engagement of the entire healthcare village to move the needle on physical activity of Americans. It’s not just up to physicians and primary care practices. We need to think across the aisle to other healthcare professionals, such as:
- Registered dieticians: We need to work closely with RDs, who may be seeing people for weight management, to ensure that they are also talking about physical activity in addition to diet.
- Physical therapists are seeing people for neuromuscular or musculoskeletal conditions. They need to have strong competencies in transitioning patients from rehabilitation to community-based physical activity.
- Cardiopulmonary rehab. People with established cardiopulmonary conditions benefit from participation in regular physical activity. However, people often don’t participate for a number of reasons, one of which is fear of adverse outcomes associated with exercise. Interestingly, this fear is often present on both sides of the patient and doctor relationship, serving as a barrier to regular physical activity. When in fact, the most dangerous thing for that person to do is sit on the couch.”