This post is the seventh in a seven-part series that has explored Exercise as a Vital Sign (EVS), a clinical initiative designed to systematically ascertain patient-reported exercise levels at the beginning of each outpatient visit. I’ve attempted to your draw attention to clinical experiences, innovative development processes, organizational practices and research on EVS’s clinical strategy to address physical inactivity. I thank you for participating in the conversation and I leave you now with a few closing remarks.
I will soon complete residency at Kaiser Permanente San Francisco Medical Center. One thing I have learned these past four years is that simply informing patients that, “You should try to be more physically active,” without any plans, follow-up, or resources does not work.
To help reverse the epidemic of inactivity, providers have a duty to evaluate each patient’s physical activity habits. The entire heath care sector is uniquely and quite powerfully positioned to do more to encourage physical activity. Health care is evolving beyond emphasis on diagnosis and treatment to prevention, with a focus on early intervention and wellness.
Prompting important conversations about physical activity between individuals and their providers is essential. Kaiser Permanente’s Exercise as a Vital Sign initiative is a pioneering organizational practice change — on a large-scale — toward that very goal.
Beyond the Exam Room and Toward Healthy Defaults
There is a limit to what the medical profession can realistically do to help patients adopt healthier lifestyles. I described in the first post of this series how physical activity has been engineered out of our daily lives. I don’t believe that our departure from active living stems from a lack of individual will-power. I also don’t believe that physical activity should be considered a chore.
The built environment, the very way we design the places in which we live, work, learn and play, is one of the strongest predictive factors of whether we decide to walk or drive five blocks to the mall.
To combat inactivity, we need programs like EVS. But we also need changes in our policies, built environments, and culture to reframe the role physical activity plays in our lives every day. Activity has to become an “optimal default;” a thing we do not only because it’s the healthy choice, but because it’s the easy choice, the comfortable choice, or the fun choice.
It’s Going to Take Time and Effort
Physical inactivity is a complicated problem. Change is going to take time. Exercise as a Vital Sign “champion”, Dr. Robert Sallis, reminded me during our chat that we didn’t see large drops in smoking rates the year after
Kaiser Permanente started asking people if they smoked. It took 20 years, but we have seen dramatic improvements since. Although some people still smoke and some people will always be sedentary, with the information generated and conversations sparked by EVS, I’m hopeful we can keep push the bar and encouraging people to thrive.
I know this seems daunting, but the movement toward change has already begun! I’m excited. Health care providers are moving in the right direction with efforts to work closer with community partners on a wide range of initiatives aimed at promoting physical activity and healthy lifestyles.
The health benefits of physical activity and the harms of physical inactivity are very clear. It makes sense for us to strategically expand our scope of practice beyond our clinic and hospitalwalls and to support efforts and access to places and programs where people can be physicallyactive in a healthy, safe, and enjoyable way. The conversations and patient engagement inspired by Exercise as a Vital Sign are an important part of that strategy.
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Latifat T. Apatira, MD, MPH is a fourth year Internal Medicine and Preventive Medicine Resident at Kaiser Permanente San Francisco Medical Center