EVS Blog Part IV: Community-Clinic Partnerships to Promote Exercise as a Vital Sign


Latifat Apatira

Read Part I
Read Part II
Read Part III
Read Part V
Read Part VI 
Read Part VII


This post is the fourth in a seven-part series that explores Exercise as VitaSign (EVS), a clinical initiative designed to systematically ascertain patient-reported exercise levels at the beginning of each outpatient visit.  By focusing on frontline clinical experience, policies and organizational practice, I intend to shed light on an important clinical strategy to address obesity and physical inactivity. In this installment of the blog series, I focus on how health care delivery systems can create partnerships with community- based organizations and services to promote physical activity for patients.

As a physician learning about EVS, I’ve come to realize that it’s so much more than two questions asked about exercise frequency and duration. It’s a large scale initiative that aims to integrate physical activity with health care by supporting patients, regardless of their age or level of fitness. EVS is about translating knowledge about the health benefits of physical activity into consistent action.

The Community-Clinic Partnership

Many health care practitioners, including myself, believe that changing our culture of inactivity will be much more powerful in protecting health than anything we currently do in organized medicine. EVS is just the first step towards this change. However, for EVS to succeed, health care providers need help connecting patients with the incredible diversity and wealth of resources, programs and initiatives in the communities where they live – outside of the exam room.

Dr. Robert Sallis, the physician who brought EVS to Kaiser Permanente, compared collecting exercise vitals to taking a temperature reading: “Taking the temperature alone doesn’t make the fever go down; you have to try an intervention to lower it.” That’s where community-clinic partnerships come into play.

Help Patients Find Their Thing

Working with organizations and resources in the communities in which our patients live, work, learn and play is key to making physical activity available, accessible, integrated into everyday life, and perhaps most importantly, thoroughly enjoyable.

I mention enjoyable because it’s futile encouraging members to engage in physical activities they don’t like doing. For example, I hate going to the gym.  I find the process of running in place, getting sweaty indoors on a treadmill just…unnatural. Sure, working the Stairmaster is an awesome form of exercise, but it just isn’t for me. As a result, you’ll never find me in a gym.

EVS encourages community connections and gives providers the opportunity to help patients find the local activity that inspires them to move and be active. Here are a few examples of community-clinic integration that Kaiser Permanente is exploring, as well as my own ideas of how to link patients to community resources. Physical Activity is medicine. The best medicine. As health care leaders, we must be active in prescribing it.

  • City/Community Listings – Most official city websites have listings for activities that support physical activity. I browsed for the first time through my own my own midsized suburban city’s site and I found a walking and biking map, a list of outdoor activities, low- cost things to do, information on parks and recreation, YMCA, and my local pools.
  • Parks Prescription – A movement to strengthen connections between the health care system and United States public lands, Park Prescription works with providers to encourage patients to get physically active at their local public parks. The program uses innovative incentives to strengthen participation.
  • YMCA’s Diabetes Prevention Program – Based on effective efforts researched by the National Institutes of Health, the YMCA’s Diabetes Prevention Program helps patients learn about and adopt the healthy eating and physical activity habits that have been proven to reduce the risk of developing type 2 diabetes.
  • Let ’ s Go! Program –This site is a partnership between teachers, doctors, childcare providers, and community organizations to encourage healthy behaviors in kids, including regular physical activity.
  • Patient Engagement Technologies — There’s an app for that! There are literally thousands of health and fitness apps available. In this era of mobile technology, a list of available Kaiser Permanente-vetted mobile applications that members can refer to is a must for a complete After Visit Summary, a synopsis of the clinical visit that provides patients with actionable information and instructions. Someone just needs to put it together.
  • Everybody Walk  — This site is an online public health campaign that promotes the health (and enjoyable) benefits of everyday walking… an activity people used to do. The website, Facebook page, and Apple/Android apps share health information from experts, walking maps, details on local working groups, news stories, inspirational videos and a pledge form to walk!

The idea of community-clinic partnerships to promote healthy lifestyles seems to be gathering momentum. There’s definitely room for existing relationships to mature and new relationships to form. Do you have any ideas on how to connect patients to community resources to increase physical activity? Share!

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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