Asking patients about their exercise habits was associated with weight loss in overweight patients and improved glucose control for patients with diabetes, according to a recently published study in the Journal of General Internal Medicine.
The health improvements identified from implementation of the Kaiser Permanente Exercise as a Vital Sign program in Northern California were small, but clinically significant. Overweight adult patients with a body mass index of 25 to 29 lost an average of 0.2 more pounds if they received care in one of the four pilot medical centers compared to another nine medical centers that had not yet implemented the program; those with diabetes saw a 0.1 percent greater decline in their HbA1c levels.
Although individual weight loss was modest, when applied to the entire population of overweight Kaiser Permanente members in Northern California, the overall projected weight loss was estimated to exceed 46,000 pounds.
The study examined medical records of adult Kaiser Permanente patients in Northern California after implementation of the Exercise as a Vital Sign pilot program in four medical centers between April 2010 and October 2011. Medical assistants ask patients about their exercise habits and enter this information into the patient's electronic health record. Researchers looked at more than 1.5 million visits by 696,267 adults to 1,196 primary-care providers.
"Exercise is the cheapest prescription for health," said Richard W. Grant, MD, MPH, research scientist with the Kaiser Permanente Division of Research and the study's lead author. "Asking these questions about exercise is raising awareness with both the patient and the health care provider. It gets patients thinking about how much they are exercising and reminds physicians to have that conversation with their patients."
Kaiser Permanente is the first -- and largest -- health care organization to implement an Exercise Vital Sign in a patient's electronic health record. The functionality was launched in Kaiser Permanente Southern California in 2009 and has since been implemented across the organization. As part of these efforts, during routine outpatient visits patients are asked how many minutes per week they exercise and their responses are included in their electronic medical record, along with other traditional vital signs such as blood pressure, pulse and temperature.
Kaiser Permanente physicians who identify patients who may benefit from additional physical activity can refer them for telephone health coaching, appointments with behavioral-change specialists and other programs that promote healthy lifestyles.
Lisa Schilling, RN, MPH, vice president for the Kaiser Permanente Care Management Institute, said that Exercise as a Vital Sign program helped raise the value of exercise so that it's equal to other vital signs, prompting important conversations between individuals and their providers.
"Asking an individual about how much daily physical activity he or she has helps our providers learn about what matters to our patients and prompts patients to think about healthier habits," said Schilling. "It also allows us to connect the individual to resources and habits that promote better health."
- Richard W. Grant, Julie A. Schmittdiel, Romain S. Neugebauer, Connie S. Uratsu, Barbara Sternfeld. Exercise as a Vital Sign: A Quasi-Experimental Analysis of a Health System Intervention to Collect Patient-Reported Exercise Levels. Journal of General Internal Medicine, 2013; DOI: 10.1007/s11606-013-2693-9
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