Physical Therapists and Exercise as Medicine

Physical Therapists = Exercise Specialists

• Physical therapists are experts in optimizing movement to improve human experience.
• They play a unique role in prevention, wellness, fitness, health promotion, and managing disease/disability.
• Their professional roles include helping individuals/populations improve health, prevent health conditions, promote wellness/fitness/health, manage disease/disability, and advocate for better health outcomes.

Exercise is Medicine

• Exercise is Medicine® was co-launched by the American College of Sports Medicine and the American Medical Association in 2007
• The vision is to make physical activity assessment & promotion a standard in clinical care.
• It connects healthcare with evidence-based physical activity resources for all abilities.
• Exercise and physical activity assessment & prescription is now a standard of care.

Partnership Between Healthcare Systems & Communities

• No patient leaves the clinic without an assessment of their physical activity (PA) level, and brief advice/PA prescription/referral to qualified professionals.
• Communities should provide accessible PA interventions, safe, inviting spaces for activities and active transport.

US 2021: Leading Causes of Death

• Top 10 leading causes of death in 2021 were heart disease, cancer, COVID-19, unintentional injuries, stroke, chronic lower respiratory disease, Alzheimer's, diabetes, chronic liver disease/cirrhosis, and nephritis.
• Physical inactivity is a major risk factor (RED = Physical INACTIVITY-related diseases)

Childhood Obesity

• Prevalence of obesity in children/adolescents in the US was 19.7% between 2017 and 2020, which is approximately 14.7 million children.
• Obesity rates vary by age, with the highest among adolescents (12-19) at 22.2%.
• Obesity increases the risk of chronic health problems: heart disease, high blood pressure, cancer, and asthma.
• Lack of activity and an unhealthy diet are major factors for childhood obesity.

Nearly half of Americans will have obesity by 2030

• The projected obesity rates in the US for 1990-2030 show a significant increase, particularly approaching 50-59% by 2030 in numerous states.

Contributors to Overall Health Status

• The major contributors to overall health status include exercise, smoking, diet, genetics, environment, access to medical care, and health behaviors.
• The percentage breakdown is 20% for exercise, smoking, and diet each, with 10% for genetics.

What Makes Us Healthy

• Only 4% of the nation's health care budget is spent on promoting healthy behaviors.
• The financial return on lifestyle interventions is long-term (3-10 years).
• Evidence for healthcare-based lifestyle interventions is limited.

Comparison of effectiveness of Exercise vs. Drug Therapy

• Meta-analysis of 16 studies showed no difference in mortality benefits for exercise and drug therapies in secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.
• For stroke rehabilitation, exercise interventions were more effective than drug therapies.

Their Conclusion

• Exercise interventions should be considered as a viable alternative or alongside drug therapy.
• Physical activity should become the prescribed “pill” of the future.

Recommendation for patients with cardiovascular disease risk factors

• The USPSTF recommends offering or referring adults with cardiovascular disease risk factors to behavioral counseling interventions to promote a healthy diet and physical activity.
• Commercial health insurance plans must cover these preventive services.

What Are We Aiming For?

• The emphasis is to achieve target health goals.

Physical activity (150-300 mins/week at moderate intensity)

• Reduces risk of new/existing chronic conditions (type 2 diabetes, hypertension, heart disease, stroke, osteoarthritis)
• Reduces risk of 7 types of cancer, lowers cancer mortality.
• Lowers dementia and anxiety, improves weight maintenance
• Reduces fall-related injuries in older adults.

Regular physical activity

• Improves sleep quality (reducing time to sleep, reducing awake time, increasing deep sleep, and reducing daytime sleepiness)
• Improves quality of life and physical function.
• Active individuals sleep better, feel better, and function better.

How do we integrate physical activity into health care?

• Using Screening, Brief Intervention, and Referral to Treatment (SBIRT) guidelines
• Implementation of Physical Activity Vital Signs (PAVS) is a routine part of health history

Benefits of the Physical Activity Vital Sign (PAVS)

• Physicians were more likely to document exercise in progress notes.
• Documentation of PA habits increased by 12%.
• Patients reported discussing exercise with their PCP 14% more frequently.
• Exercise referrals to patients increased by 14%.

Physical Activity Spectrum

• Activities of daily living, active transportation, lifestyle activities, and exercise (planned) are part of the physical activity spectrum.

The EIM Prescription Form

• Includes guidelines for aerobic and muscle strength training, as well as tracking these activities.
• A structured form for prescribing and tracking physical activity.

Developing Effective Partnerships

• Programs like Silver Sneakers, aquatic exercises, and other structured activities, as well as places like medical fitness centers, YMCAs, parks, etc., can increase access to resources.
• Coaching and self-directed activities such as apps, digital trackers, and professional guidance can be used to support the patient on their journey.

EIM Goal

• To build formal community partnerships.
• To create accessible and trustworthy physical activity resources.
• Health systems and population health programs should offer financial incentives for implementing lifestyle interventions.
• Collect data on participation and outcomes.

Policy Efforts

• Physical Activity Alliance works on creating activity integration into health care coding and communication standards.
• ACSM Task Force creates a pathway for clinical exercise physiologists to gain professional qualifications (QHP) for reimbursement.

Exercise is Medicine® Course & Credential

• A 15-hour interactive online course for earning the EIM credential.
• ACSM's EIM Credential educates exercise professionals to safely and effectively work with patients/clients having common chronic medical conditions.

EIM Online Course

• Modules cover working with the healthcare team, guiding patients with chronic disease/older adults, promoting physical activity, and facilitating group medical fitness interventions.

How can YOU get involved?

• Sign up for the EIM e-newsletter.
• Take the EIM online course (and apply for credential).
• Become a champion within your healthcare system.
• Form a leadership team.