Kaiser Physicians Incorporate Exercise into Every Visit
October 31, 2012 – Physicians working for Kaiser in Oregon and California are now treating exercise as a vital sign. That is, patients are asked how much exercise they get per week, for both routine checkups and acute care visits – regardless of the nature of the visit.
“I think patients were a little startled by it or confused by it initially,” said Dr. Keith Bachman, an internist with Kaiser in Oregon. Unlike California where Kaiser physicians have been asking this question since 2009, the physicians in Oregon have only incorporated exercise as a routine part of appointments since last year, giving patients a chance to anticipate it. “They know that we're asking this question and are ready to give us the positive news that they're exercising more,” Bachman said.
Kaiser's efforts in California were compiled into a research study published in the journal Medicine & Science in Sports & Exercise earlier this month. It was part of a multi-organization initiative coordinated by the American College of Sports Medicine and the American Medical Association to encourage primary care physicians to include exercise in treatment plans for patients.
Bachman said the two-item survey is “not perfect” but provides a useful springboard for a deeper discussion about a patient's lifestyle. It also made sense to include it because so many common conditions – such as diabetes, hypertension and joint pain – are linked to decreased activity. Now, a patient's answers to questions about whether they exercise, and how many minutes per week they exercise, are added to their electronic medical records, so providers can note history and changes with each visit.
“Like anything else, once we measure something, then we can manage it,” Bachman said.
Only about one-third of the patients surveyed in the published study are meeting recommended guidelines for physical activity (currently, for adults age 18 to 64, two hours and thirty minutes of moderate-intensity aerobic activity per week, plus two days per week strength-building activity).
Another third aren't exercising enough – and the final third isn't exercising at all.
The major barrier, Bachman said, is time – with long car commutes and crunched workdays coming up in many conversations with patients.
He often recommends that patients start small – either with short walks during the work day, taking the stairs instead of the elevator at the work, or biking for at least part of the daily commute – but also finding activities the patient enjoys.
“Make it fun, do what you like. Make it social, do something you enjoy. Exercise shouldn't be drudgery,” Bachman said.
Kaiser also offers discounted gym memberships and exercise classes for seniors, as well as promoting Sunday Parkways during the summer.
But measuring the amount of time people exercise isn't just about pushing inactive people to get active, Bachman said. “We also like to give people who are active a pat on the back.”