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Exercise is Medicine

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Exercise is Medicine (EIM) is a nonprofit initiative co-launched by the American College of Sports Medicine (ACSM) and the American Medical Association (AMA), with support from the Office of the Surgeon General and the 18th Surgeon General Regina Benjamin, on November 5, 2007.

Overview and history

The Exercise is Medicine (EIM) initiative calls for physical activity to be included as a standard part of medical treatment and the patient care process.[1] EIM urges healthcare providers to assess the physical activity levels of their patients at every visit, provide physically inactive patients with brief counseling, and 'write' a basic exercise prescription. Before leaving the clinic setting, inactive patients should also receive a referral to available physical activity resources in the community to assist with becoming more physically active.

EIM was started by then ACSM President Robert E. Sallis, MD, FACSM in 2007, who has continued to serve as the Chair of the EIM initiative since its inception. Under the guidance of Dr. Sallis and the EIM Advisory Board, Adrian Hutber, PhD, served as the first Vice President of EIM and has overseen the global development of the initiative over its first decade of existence. From 2007-2017, EIM grew into a "global health" initiative with a presence in more than 40 countries worldwide. The initial five years of the initiative focused on increasing global awareness that "exercise is good medicine".[2] More recently, efforts have shifted toward the strategic implementation of the EIM Solution in healthcare systems.

Implementation

The Exercise is Medicine Solution is the practical implementation of EIM in a health system.[3] The EIM Solution is designed as a simple, brief four-step process that can be carried in the clinic setting in under five minutes by the entire healthcare team.

1. The first step, and initiator, of the EIM Solution is the systematic assessment of every patient's physical activity levels.[4]The Physical Activity Vital Sign (PAVS) is an evidence- and practice-based tool consisting of two questions to determine whether the patient is meeting the established physical activity guidelines. This tool for assessing patient physical activity levels has been successfully integrated into several health care systems including the Kaiser Permanente health systems of Northern[5] and Southern[6] California, as well as in Intermountain Health.[7]

2. The second step is to provide brief advice or counseling regarding the importance of regular physical activity, specifically relevant to that patient's medical history and situation. Several physical activity counseling models have been shown to be effective in increasing patient physical activity levels including the 5As,[8][9] motivational interviewing,[10] and the use of the transtheoretical model.[11]

3. The third step of the EIM Solution is to provide eligible patients (i.e., patients who are not completing 150 minutes of moderate to vigorous aerobic activity in a week) with a basic physical activity prescription, depending on the health, fitness level and preferences of the patient. Prescriptions can be given out in a number of different formats including exercise prescriptions entered into the electronic health record and provided to the patient in the after visit summary paperwork or a pad (a format patients are familiar with in receiving prescriptions for medications).[12] The first major exercise prescription program was the Green Prescription started by the Sport and Recreation New Zealand in 1998.[13]

4. The final, and perhaps most crucial, component of the EIM Solution is ensuring that all eligible patients receive a physical activity referral to supportive resources to assist them in engaging in greater physical activity levels.[14] Patients may be referred to existing physical activity resources within a health system (i.e., wellness programs, cardiac rehabilitation programs, physical therapy), self-directed programs (i.e., walking programs, smartphone apps), or community-based resources. Within the community setting, all physical activity places (i.e., YMCAs, JCCs, community fitness centers), and exercise professionals should be considered for inclusion in a physical activity network.

EIM supporters

Numerous health and professional organizations have signed as partners with the Exercise is Medicine initiative including: the American Association of Nurse Practitioners (AANP), the American Council on Exercise (ACE), the American Physical Therapy Association (APTA), the Foundation for Physical Medicine & Rehabilitation (FPM&R), the Medical Fitness Association (MFA), and the Preventive Cardiovascular Nurses Association (PCNA).

The EIM Global Health Network

Over its first decade of existence, EIM has expanded to include partners in more than 40 countries. The EIM Global Health Network consists of EIM Regional Centers in Chile (EIM Latin America), Germany (EIM Europe), and Singapore (EIM Southeast Asia) that help oversee the expansion and development of the initiative in their respective regions.

To establish an EIM National Center, national leaders in a country are required to enlist the support of a national primary care organization, a national sports medicine and/or exercise science organization, as well as a leading academic institution. It is also strongly encouraged that the national ministry of health is invited to participate as a part of the National Center. The National Center is hosted by a national institution (an academic institution, health organization, or other non-profit organization) under the direction of a National Center Director, acting on behalf of the National Center Advisory Board.

See also

References

  1. ^ Lobelo, Felipe; Stoutenberg, Mark; Hutber, Adrian (December 2014). "The Exercise is Medicine Global Health Initiative: a 2014 update". British Journal of Sports Medicine. 48 (22): 1627–1633. doi:10.1136/bjsports-2013-093080. ISSN 1473-0480. PMID 24759911.
  2. ^ Pedersen, B. K.; Saltin, B. (December 2015). "Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases". Scandinavian Journal of Medicine & Science in Sports. 25 Suppl 3: 1–72. doi:10.1111/sms.12581. ISSN 1600-0838. PMID 26606383.
  3. ^ Sallis, Robert; Franklin, Barry; Joy, Liz; Ross, Robert; Sabgir, David; Stone, James (January 2015). "Strategies for promoting physical activity in clinical practice". Progress in Cardiovascular Diseases. 57 (4): 375–386. doi:10.1016/j.pcad.2014.10.003. ISSN 1873-1740. PMID 25459975.
  4. ^ Sallis, Robert E.; Matuszak, Jason M.; Baggish, Aaron L.; Franklin, Barry A.; Chodzko-Zajko, Wojtek; Fletcher, Barbara J.; Gregory, Andrew; Joy, Elizabeth; Matheson, Gordon (May 2016). "Call to Action on Making Physical Activity Assessment and Prescription a Medical Standard of Care". Current Sports Medicine Reports. 15 (3): 207–214. doi:10.1249/JSR.0000000000000249. ISSN 1537-8918. PMID 27172086.
  5. ^ Coleman, Karen Jacqueline; Ngor, Eunis; Reynolds, Kristi; Quinn, Virginia P.; Koebnick, Corinna; Young, Deborah Rohm; Sternfeld, Barbara; Sallis, Robert E. (November 2012). "Initial validation of an exercise "vital sign" in electronic medical records". Medicine and Science in Sports and Exercise. 44 (11): 2071–2076. doi:10.1249/MSS.0b013e3182630ec1. ISSN 1530-0315. PMID 22688832.
  6. ^ Young, Deborah Rohm; Coleman, Karen J.; Ngor, Eunis; Reynolds, Kristi; Sidell, Margo; Sallis, Robert E. (2014-12-18). "Associations between physical activity and cardiometabolic risk factors assessed in a Southern California health care system, 2010-2012". Preventing Chronic Disease. 11: E219. doi:10.5888/pcd11.140196. ISSN 1545-1151. PMC 4273545. PMID 25523350.
  7. ^ Ball, Trever J.; Joy, Elizabeth A.; Gren, Lisa H.; Shaw, Janet M. (2016-02-04). "Concurrent Validity of a Self-Reported Physical Activity "Vital Sign" Questionnaire With Adult Primary Care Patients". Preventing Chronic Disease. 13: E16. doi:10.5888/pcd13.150228. ISSN 1545-1151. PMC 4747440. PMID 26851335.
  8. ^ Carroll, Jennifer K.; Fiscella, Kevin; Epstein, Ronald M.; Sanders, Mechelle R.; Williams, Geoffrey C. (2012-10-30). "A 5A's communication intervention to promote physical activity in underserved populations". BMC Health Services Research. 12: 374. doi:10.1186/1472-6963-12-374. ISSN 1472-6963. PMC 3506481. PMID 23110376.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  9. ^ Carroll, Jennifer K.; Antognoli, Elizabeth; Flocke, Susan A. (September 2011). "Evaluation of physical activity counseling in primary care using direct observation of the 5As". Annals of Family Medicine. 9 (5): 416–422. doi:10.1370/afm.1299. ISSN 1544-1717. PMC 3185466. PMID 21911760.
  10. ^ O'Halloran, Paul D.; Blackstock, Felicity; Shields, Nora; Holland, Anne; Iles, Ross; Kingsley, Mike; Bernhardt, Julie; Lannin, Natasha; Morris, Meg E. (December 2014). "Motivational interviewing to increase physical activity in people with chronic health conditions: a systematic review and meta-analysis". Clinical Rehabilitation. 28 (12): 1159–1171. doi:10.1177/0269215514536210. ISSN 1477-0873. PMID 24942478.
  11. ^ Stonerock, Gregory L.; Blumenthal, James A. (March 2017). "Role of Counseling to Promote Adherence in Healthy Lifestyle Medicine: Strategies to Improve Exercise Adherence and Enhance Physical Activity". Progress in Cardiovascular Diseases. 59 (5): 455–462. doi:10.1016/j.pcad.2016.09.003. ISSN 1873-1740. PMC 5350064. PMID 27640186.
  12. ^ Gallegos-Carrillo, Katia; García-Peña, Carmen; Salmerón, Jorge; Salgado-de-Snyder, Nelly; Lobelo, Felipe (February 2017). "Brief Counseling and Exercise Referral Scheme: A Pragmatic Trial in Mexico". American Journal of Preventive Medicine. 52 (2): 249–259. doi:10.1016/j.amepre.2016.10.021. ISSN 1873-2607. PMID 27939238.
  13. ^ Waterman, Megan R.; Wiecha, John M.; Manne, Jennifer; Tringale, Stephen M.; Costa, Elizabeth; Wiecha, Jean L. (December 2014). "Utilization of a free fitness center-based exercise referral program among women with chronic disease risk factors". Journal of Community Health. 39 (6): 1179–1185. doi:10.1007/s10900-014-9874-2. ISSN 1573-3610. PMID 24752958.
  14. ^ Murphy, Simon Mark; Edwards, Rhiannon Tudor; Williams, Nefyn; Raisanen, Larry; Moore, Graham; Linck, Pat; Hounsome, Natalia; Din, Nafees Ud; Moore, Laurence (August 2012). "An evaluation of the effectiveness and cost effectiveness of the National Exercise Referral Scheme in Wales, UK: a randomised controlled trial of a public health policy initiative". Journal of Epidemiology and Community Health. 66 (8): 745–753. doi:10.1136/jech-2011-200689. ISSN 1470-2738. PMC 3402741. PMID 22577180.
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