Q&A: Exercise is Medicine® Past, Present and Future of the Initiative
By Robert E. Sallis, M.D., FACSM
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. As chair, Dr. Sallis coordinates content planning for the EIM World Congress, the second of which will be held in conjunction with the 58th ACSM Annual Meeting in Denver from May 31 – June 4. Dr. Sallis graduated from the U.S. Air Force Academy and earned an M.D. from Texas A&M University. He completed his residency in the department of family medicine at Kaiser Permanente Medical Center in Fontana, Calif., where he has continued his medical career and now co-directs their sports medicine fellowship training program. Since 1988, he has been head team physician at Pomona College. Dr. Sallis is the founding editor-in-chief of ACSM's Current Sports Medicine Reports journal.
In recognition of May as Exercise is Medicine Month, SMB invited Dr. Sallis to share his perspective on the past, present and future of this major ACSM initiative. “Enlisting every medical care provider in making physical activity assessment and exercise prescription an integral part of every patient's health care” is fundamental to the EIM vision (for background, see the Exercise is Medicine website). A key event at the Inaugural World Congress on Exercise is Medicine in 2010 was the announcement of the EIM Global Charter (see current charter), calling for multi-national, multi-organizational efforts to bring a physical activity and exercise focus to improve the health of patients around the globe, in both traditional and non-traditional health care settings.
SMB: Briefly, can you share your thoughts on how EIM originated and how it developed?
Dr. Sallis: The idea for EIM originated from my experience as a family physician coupled with my long-term involvement with ACSM. After more than 20 years as a family physician, I have observed the effects exercise has on the health of my patients. No matter the age, gender, race or ethnicity, patients who exercise are healthier and live longer than those who are sedentary. I have also seen that patients who suffer from chronic diseases, like diabetes, have much better control of their disease when they exercise regularly. This has led me to think of exercise as the first-line therapy to treat and prevent many conditions I see each day in my practice.
At the same time, my involvement with ACSM has made me keenly aware of the growing scientific evidence supporting the benefits of regular physical activity on health. Study after study – most done by my ACSM colleagues – has been published in mainstream medical journals to clearly document the connection between exercise and good health. These studies have not been hidden in obscure journals; rather, they have been published in the esteemed medical journals I rely on daily to make treatment decisions for my patients. What better evidence could I ask for? Everything I was observing in my daily practice had been clearly proven in well-designed research studies!
The idea for EIM really crystallized after listening to Steve Blair deliver the Joseph B. Wolffe Memorial Lecture at the 2006 ACSM Annual Meeting. In that lecture, Steve presented a very sound scientific argument for why exercise is medicine. Walking out of the lecture hall that day, I realized if Steve had presented this kind of data on a pill or a medical procedure, I would be heading home with a plan to prescribe this to all my patients. So why should it be any different with exercise? At that time, I happened to be the incoming President-Elect of ACSM, and I knew EIM was what I wanted to do with my opportunity to lead this great organization.
SMB: What have been the keys to the success of EIM thus far?
Dr. Sallis: The early keys to the success of EIM were the great collaborations established by ACSM under the guidance of Jim Whitehead and Adrian Hutber. EIM was launched in 2007 as a collaboration between ACSM and the American Medical Association (AMA), with Dr. Ron Davis, who was then its physician president. Other key collaborators have been the CDC (Mike Pratt and Jackie Epping), the President’s Council on Physical Fitness, Sports & Nutrition (Melissa Johnson and now Shellie Pfohl), the California Governor’s Council on Physical Fitness & Sports (Jake Steinfeld and Kenny Rogers), U.S. Surgeon General Dr. Regina Benjamin, and former U.S. Surgeon General Dr. Steve Galson.
Another key to the success of EIM has been the chance to field test this concept at Kaiser Permanente in California, where I practice as a family medicine and sports medicine physician. KP is the largest Health Maintenance Organization (HMO) in the world with more than six million patients in California alone. In our system, the healthier we keep our patients, the more successful we are. For that reason, our forward-thinking physician leaders have invested heavily in prevention, and it has paid off in a big way. Our patients live longer and suffer less with chronic disease, and it costs less to care for them in the long run. The leadership of Kaiser Permanente in Southern California, under Dr. Jeff Weisz, realized if we could get our patients to be even a little more active, it could have a tremendous effect on their health. So they agreed to implement my idea for an exercise vital sign (EVS), in which every patient is asked about his or her exercise habits at every visit, regardless of the medical provider. By using the EVS, we have a clear opening to talk about exercise with every patient we see.
Physicians are encouraged to congratulate patients who report doing 150 or more minutes of moderate-intensity exercise (like a brisk walk) each week and to encourage patients who are doing less to change their exercise habits. The EVS has been very well-received and is now being implemented in Northern California. We are also in the process of spreading it to Kaiser regions outside of California.
SMB: What are current and future priorities to move EIM forward successfully?
Dr. Sallis: The current priority for EIM is to establish the EVS as a standard of care (see British Journal of Sports Medicine, May 2011). I want to see the exercise habits of every patient recorded in their medical records and for all medical providers to advise patients to meet the U.S. Physical Activity Guidelines recommendation of 150 minutes per week of moderate-intensity physical activity to improve their health. And as we make this the standard of care in the U.S., we are working hard to spread this idea around the globe. With the help of great industry partners like Coca-Cola, Technogym and Anytime Fitness, we have established six Regional Centers (see below for an announcement of the European Regional Center) around the world to help with the globalization of EIM. This will provide a tremendous opportunity for collaboration and the sharing of best practices from around the world. Our efforts will be on display this month at the 2nd World Congress on EIM held in conjunction with the 2011 ACSM Annual Meeting in Denver.
A key future priority is to engage the fitness world with EIM. After attending my first ACSM Health & Fitness Summit & Exposition a few years ago, I came away believing we must merge the fitness industry with the health care industry. I need to be able to refer my patients to a fitness professional, just as I refer them to other medical specialists. I wouldn’t think of managing my diabetic patients without the help of a dietitian to advise them on a proper diet, so why shouldn’t I send them to a qualified fitness professional to help them become more active? To do otherwise would be a disservice. I will be working with many others through EIM to help make additional progress in linking the health care world to the fitness world. A referral system to fitness and exercise professionals, to other relevant allied health professionals and to additional community resources will make a breakthrough difference in improving patient and public health. I look forward to collaborating with all of you toward that end.
NOTES: For Dr. Sallis’s podium comments at a news conference about the EIM initiative, see this October 29, 2008 YouTube video. For more about EIM, see the fact sheet.