Vital Signs of Health

blood pressure heartRoll up your sleeve for the blood pressure cuff. Stick out your wrist for the pulse-taking. Lift your tongue for the thermometer.Report how many minutes you are active or getting exercise.

Wait, what?

If the last item isn’t part of the usual drill at your doctor’s office, a movement is afoot to change that. One recent national survey indicated only a third of Americans said their doctors asked about or prescribed physical activity.

Kaiser Permanente, one of the nation’s largest nonprofit health insurance plans, made a big push a few years ago to get its southern California doctors to ask patients about exercise. Since then, Kaiser has expanded the program across California and to several other states. Now almost 9 million patients are asked at every visit. And the trend is spreading among other medical systems.

30-Minutes-ExerciseHere’s how it works: During any routine check of vital signs, a nurse or medical assistant asks how many days a week the patient exercises and for how long. The number of minutes per week is posted along with other vitals at the top the medical chart. So it’s among the first things the doctor sees.

All we ask our physicians to do is to make a comment on it, like, ‘Hey, good job,’ or ‘I noticed today that your blood pressure is too high and you’re not doing any exercise. There’s a connection there. We really need to start you walking 30 minutes a day,'” says Dr. Robert Sallis, the Kaiser family doctor who initially hatched the vital sign idea.

A study looking at the first year of Kaiser’s effort showed more than a third of patients said they never exercise.  Many patients were not aware that physical inactivity is riskier than high blood pressure, obesity and other health risks people know they should avoid. Few know that those who routinely exercise live longer than others, even if they’re overweight.

Take Zendi Solano, 34, who works for Kaiser as a research assistant in Pasadena, CA. She always knew exercise was a good thing, but until about a year ago, when her Kaiser doctor started routinely measuring it, she “really didn’t take it seriously.”  She was obese, and had elevated blood sugar. She sometimes did push-ups and other strength training but not anything very sustained or strenuous.

joggers-in-track-suits-running1So she decided to take up running and after a couple of months she was doing three miles. Then she began training for a half marathon, formed a running club with co-workers and started eating smaller portions and buying more fruits and vegetables.  She is still overweight but has lost 30 pounds and her blood sugar is normal. Her doctor praised the improvement at her last physical in June and Solano says the routine exercise checks are “a great reminder.”

Kaiser began the program after 2008 government guidelines recommended at least 2 1/2 hours of moderately vigorous exercise each week. That includes brisk walking, cycling, lawn-mowing — anything that gets you breathing a little harder than normal for at least 10 minutes at a time.

Now other health systems are following suite. Dr. Elizabeth Joy of Salt Lake City has created a nearly identical program and she expects 300 physicians in her Intermountain Healthcare network to be involved early this year.  NorthShore University HealthSystem in plans to start an exercise vital sign program this month, eventually involving about 200 primary care doctors.

All of which is good news. Figuring out how to get people to be more active could have a big effect in reducing medical costs and improving health. Here at SRxA’s Word on Health we’ll be working on our Exercise Minutes.  Will You?

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