New study finds efforts to establish exercise as a vital sign prove valid

Kaiser Permanente has created a new electronic Exercise Vital Sign initiative to systematically record patients' physical activity in their electronic health records. The new feature is successfully compiling accurate and valuable information that can help clinicians better treat and counsel patients about their lifestyles, according to a Kaiser Permanente study published in the journal Medicine & Science in Sports & Exercise.

The study examined the of 1,793,385 Kaiser Permanente Southern California patients ages 18 and older from April 2010 to March 2011 and found that 86 percent of all eligible patients had an vital sign in their record. Of those patients who had an exercise record, one third were meeting national guidelines for , and two thirds were not meeting guidelines. Of those not meeting guidelines, one third were not exercising at all.

"Embedding questions about physical activity in the electronic medical record provides an opportunity to counsel millions of patients during routine medical care regarding the importance of physical activity for health," said study lead author Karen J. Coleman, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation. "In addition, the Exercise Vital Sign has the potential to provide information about the relationship between exercise and health care utilization, cost and chronic disease that has not been previously available."

Kaiser Permanente is one of the first—and largest—health care organizations to implement an Exercise Vital Sign in patient health records. The initiative was launched in the organization's Southern California region in 2009 and has since been implemented in several of Kaiser Permanente's regions. As part of these efforts, patients are asked about their exercise habits during routine outpatient visits and their responses are included in their electronic medical record, along with other traditional vital signs such as blood pressure, pulse and temperature.

The U.S. Department of Health and Human Services recommends that Americans engage in at least 150 minutes per week of moderate-to-vigorous intensity physical activity, such as brisk walking, to receive maximal health benefits. The guidelines state that regular physical activity reduces the risk of many adverse health outcomes.

The Exercise Vital Sign is part of Exercise is Medicine ®, a multi-organizational initiative coordinated by the American College of Sports Medicine and the American Medical Association to encourage primary-care physicians and other health care providers to include exercise when designing treatment plans for patients.

"Given that health care providers have contact with the majority of Americans, they have a unique opportunity to encourage physical activity among their patients through an assessment and brief counseling," said Coleman. "Future studies will examine if adding a physical activity assessment during clinic visits actually leads to higher rates of physician counseling and eventually increases the rates of physical activity in our patients."

Researchers validated the findings of the study by comparing exercise levels reported by the Kaiser Permanente Southern California adult patients with those reported in U.S. population surveys. The researchers also examined the ability of these reports to discriminate between groups of patients with differing demographics and health status. The patient reports of physical activity were lower than national surveys, but followed similar patterns to those reported in the scientific literature: Members who were older, female, obese, belonging to a racial or ethnic minority, or had more chronic health conditions were more likely to be inactive.

This study and the Exercise Vital Sign initiative are parts of ongoing efforts at Kaiser Permanente to conduct research on and highlight the health benefits of physical activity. Kaiser Permanente partners with several other organizations on Every Body Walk!, a public awareness campaign about the health benefits of walking. Kaiser Permanente also works to increase public awareness of the prevalence and effects of obesity in the United States. Earlier this year, Kaiser Permanente partnered with HBO (Home Box Office), the Institute of Medicine, the National Institutes of , the Centers for Disease Control and Prevention and the Michael & Susan Dell Foundation to launch one of the most ambitious public education campaigns addressing America's obesity epidemic to date, including the documentary series The Weight of the Nation on HBO.

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