Prescribing exercise to achieve the Triple Aim

Dec. 2, 2015 / By Steve Delaronde

It’s a fact: Americans have become more sedentary. This not only leads to greater susceptibility to obesity and chronic diseases, but also contributes to increased symptom severity for those with chronic conditions. Getting the entire nation off the couch and on their feet is a laudable goal for promoting overall health and quality of life. Given resource limitations, however, it would be best to focus on patient subgroups, particularly those that would experience the greatest benefit from physical activity while meeting the goals of the Triple Aim – better outcomes, improved patient satisfaction, and lower cost.

The healthcare system offers multiple treatment approaches for such chronic conditions as heart disease, diabetes, heart failure, osteoarthritis and cancer. For nearly every patient with one or more of these conditions, as well as those with precursors to these conditions (hypertension, high cholesterol, elevated blood sugar and obesity), physical activity is indicated, and achieves similar results as other interventions at lower or no cost.

A meta-analysis of 305 randomized controlled trials with 339,274 participants published in the British Medical Journal in October 2013 found that compared to drug use, physical activity was equally effective in the secondary prevention of coronary heart disease and diabetes and more effective in the treatment and prevention of strokes. The authors of the study conclude that exercise should be considered a viable alternative, or used alongside, drug therapy.

The Centers for Disease Control (CDC) recommends a minimum of 2½ hours per week of moderate aerobic exercise. While half of Americans report doing this, some studies have shown as few as 10% actually meet this minimum requirement. Furthermore, meeting minimum requirements may only be the beginning in realizing the health benefits of exercise. A study published in Circulation in October 2015 suggests that significantly lower heart failure risk can be achieved among those that engage in 2-4 times the recommended exercise minimum.

Since the risk factors for heart failure include coronary heart disease and all of the risk factors associated with CHD (e.g., hypertension, high cholesterol, diabetes, obesity), this group would experience the greatest benefit from targeted interventions to increase physical activity. There is ample evidence that patients who complete a physical activity program after a heart attack have a significantly decreased likelihood of experiencing a second heart attack.

Given the obvious benefits of physical activity in promoting overall health, as well as preventing and treating chronic conditions, the healthcare system needs to respond. Here are some suggestions:

1. Prescribe exercise – Exercise should be included in the treatment plan for most conditions. This should not only include visits to the physical therapist, but individual (and free or low cost) approaches that include walking, cycling, swimming, exercise classes, and resistance training.
2. Collect data – A simple pedometer can be used to measure the number of steps taken or patients can self-report time spent engaging in physical activities to their physician. This information can be collected with each healthcare visit and entered into an electronic health record the same way that blood pressure, weight, and other vital signs are entered and tracked.
3. Educate patients – Physicians need to offer and continually promote exercise as a first line viable alternative to traditional interventions. Pharmaceutical companies and device manufacturers are effective at promoting their products to physicians, but no one visits a physician’s office to discuss the treatment benefits of physical activity and exercise.
4. Expand coverage – Patients may see exercise as a viable alternative to medication if it is covered by health plans, at least in part, the same way as office visits, procedures, and medication.

The benefits of physical activity in both preventing and treating chronic conditions should not be underestimated. It may not be as interesting or as profitable as the next blockbuster drug, but it works. Steve Delaronde is director of consulting for populations and payment solutions at 3M Health Information Systems.

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