Active Voice: Exercise as a Vital Sign

By Karen J. Coleman, Ph.D. and Robert E. Sallis, M.D.

Viewpoints presented in SMB commentaries reflect the opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Karen J. Coleman, Ph.D., is a behavioral scientist with Kaiser Permanente. She received her bachelor of science in Zoology from Washington State University and Master of Science and doctortoral degrees in Biopsychology from the University of Georgia. Her primary research interests include behavioral, social, and environmental factors that affect obesity in children, adolescents and adults. Dr. Coleman is a member of ACSM as well as a number of organizations in public health, healthcare, and psychology.

Robert E. Sallis, M.D., FACSM, is a Past-President of ACSM and chair of the Exercise is Medicine (EIM) Task Force. He originated the EIM concept and has been its leading advocate from the beginning. Dr. Sallis earned an M.D. from Texas A&M University and completed his residency in family medicine at Kaiser Permanente Medical Center in Fontana, CA. He has continued his medical career with Kaiser and now co-directs their sports medicine fellowship training program. Dr. Sallis is the founding editor-in-chief of ACSM's
Current Sports Medicine Reports journal.

This commentary presents Drs. Coleman’s and Sallis’ views on the topic of a related research article which they and their colleagues published in the November 2012 issue of
Medicine and Science in Sports and Exercise® (MSSE).

What if there was a pill you took once a day that lowered your blood pressure, prevented diabetes, helped you maintain a healthy weight, improved your mood and protected against depression, increased bone density and prevented fractures, helped you remain independent as an older adult, enhanced your ability to think, and gave you more energy? Wouldn’t you be asking your doctor to prescribe it for you? This is the basic message behind the “Exercise is Medicine” (EIM) Initiative developed by the American College of Sports Medicine and the American Medical Association. Now that millions of Americans will have better access to preventive healthcare, physicians and other healthcare providers will have the opportunity to increase physical activity at the population level.

The first step in this effort is to incorporate physical activity as a key health indicator into the medical care setting as a “vital sign”, similar to blood pressure and body mass index (BMI). Kaiser Permanente, a large integrated healthcare system serving millions of patients throughout the U.S., has created such a “vital sign” in its electronic medical record. As reported in MSSE, we recently showed that the data from this vital sign provide the same information as national surveillance measures of physical activity, such as the National Health and Nutrition Examination Survey (NHANES). The Kaiser Permanente Exercise Vital Sign (EVS) was implemented over a two year period and is now regularly assessed in millions of adult members. The EVS effectively discriminated between sedentary and physically active adults and showed that physical activity declined with age, increasing BMI, and higher disease burden. Physical activity was lower for women and racial/ethnic minorities, similar to the trends seen for the nation as a whole in other studies. Establishing the EVS as standard of care is the first step in the “Exercise is Medicine” initiative and National Physical Activity Plan to facilitate the assessment and prescription of exercise in all patient encounters. Once physical activity is monitored regularly, healthcare systems can use this information to provide counseling and support to help patients become or stay regularly physically active. With the emphasis on preventive services in the new Health Care Reform Act, the EVS provides the perfect opportunity for physicians to “prescribe” exercise as a frontline strategy for preventing and treating chronic disease. Physicians and other healthcare providers can monitor the uptake of and compliance to exercise prescriptions much like they would any other medication. This has the potential to save the nation billions of dollars in healthcare costs through reductions in the need for medications, inpatient medical care for chronic illnesses, and expensive treatments such as dialysis.

Future research with the Kaiser Permanente EVS will focus on establishing the link between healthcare utilization and exercise, as well as using the EVS as an indicator of the success of a variety of system level efforts to promote physical activity.