Robyn Stuhr

Exercise is Medicine® (EIM) is a United States-based health initiative coordinated by the American College of Sports Medicine (ACSM). EIM aims to make physical activity assessment and promotion a standard in clinical care and to connect health care with evidence-based physical activity resources for people of all abilities. In this interview, EIM Vice President Robyn Stuhr, MA, ACSM-CEP, RCEP discusses EIM’s background and the organization’s approach to promoting physical activity as a treatment for common health complaints.

Greg: What is the goal of Exercise Is Medicine?

Robyn: The vision of EIM is to make physical activity assessment and promotion a standard in clinical care, connecting health care with evidence-based resources for people everywhere and of all abilities. More simply put, every time we go to the doctor, we have our blood pressure checked, our weight measured, and we’re asked about smoking. EIM believes that patients should also be asked about physical activity as a “vital sign of health,” given its scientifically proven link to physical and mental health.

Patients should then be encouraged to be active and receive a prescription or referral to physical activity resources (programs, places, professionals or self-directed resources such as phone apps and activity trackers) that can help them meet the physical activity guidelines (150-300 minutes of moderate-intensity activity each week like brisk walking).

Greg: How did EIM get started?

Robyn: The American College of Sports Medicine under then-President Robert E. Sallis, M.D., FACSM, and the American Medical Association co-launched EIM in 2007. Dr. Sallis saw many patients come to his office who didn’t need a drug prescription to alleviate their health problems—but rather a prescription for exercise. This ACSM signature initiative was based on decades of research showing that regular physical activity and exercise have a powerful effect on health, playing a key role in the prevention and management of many chronic diseases and medical conditions. The 2018 Physical Activity Guidelines for Americans re-affirm and extend the scientific basis of EIM.

Dr. Sallis believed that every patient should have their level of physical activity assessed using two simple questions:

On average, how many days per week do you engage in moderate to strenuous exercise (like a brisk walk)? On average, how many minutes do you engage in exercise at this level? (See Physical Activity Vital Sign assessment below)

The answers to those questions determine whether a patient is meeting the national guidelines. The patient should then be provided with brief advice about physical activity and/or a prescription/referral to physical activity resources. Regular exercise is, in fact, as effective as many pharmaceutical agents in promoting optimal health—and it’s often cheaper, more fun and has fewer side effects!

Exercise Is Medicine Physical Activity Vital Sign (click to enlarge)

Greg: To what extent are the benefits of physical activity discussed in most medical school curriculums?

Robyn: The extent to which physical activity is integrated into medical school curriculums varies. Some incorporate minimal information, others offer a few lectures, other schools integrate physical activity throughout all systems and diseases. EIM has an Education Committee that has been working to a develop curriculum for medical students, but decisions about what is offered are currently made at the institutional level.

Greg: How does EIM bring together health care and fitness professionals to help patients?

Robyn: EIM calls upon health care systems and medical practices to establish partnerships with community-based fitness facilities and programs. The EIM Credential helps educate exercise professionals to work safely and effectively with referred patients and recognizes those with the education and certification that have prepared them to do so. EIM also provides action guides, referral forms and templates for health care providers and exercise professionals, as well as an Rx for Health series of patients handouts (currently being translated into Spanish). EIM offers a comprehensive toolkit that can be purchased to help health systems implement EIM in conjunction with community partners.

Greg: I understand it can be difficult for doctors to get patients to follow through with treatment recommendations. I believe only 50% of patients take their prescribed medication. It seems like exercise would have an even higher barrier for entry. How likely are patients to follow through with EIM-based recommendations?

Robyn: Making a lifestyle change is challenging, and behavioral support is especially important. There is ongoing research to evaluate the effectiveness of various types of interventions: physical activity vital sign (PAVS) alone, brief advice, a more complete exercise Rx, wearables, referral to a community-based physical activity intervention and a combination of the above.

Exercise Is Medicine Sit Less, Move More handout (click to enlarge)

Greg: You mentioned “physical activity vital sign” as a type of intervention being researched. Can just asking about a patient’s physical activity make a difference?

Robyn: Yes. For example, there was a study conducted by Kaiser Permanente in 2014 that showed that when the PAVS was in place, health care providers were more likely to ask about physical activity in their patients. In addition, overweight/obese patients had small but significant changes in weight and patients with diabetes had a greater reduction in hemoglobin A1C levels (a marker of blood glucose control). Just asking about something conveys its importance.

Greg: What has the response been like from physicians? What do they most appreciate about EIM? What challenges does it present?

Robyn: Many providers are overwhelmed and stressed out in the current health care environment, and given the time constraints, they have expressed initial concern about activating EIM in clinic. Physicians who adopt EIM have found that many patients appreciate the lifestyle approach to disease management. Plus, the tools provided by EIM help physicians deliver key messages in an efficient and effective manner. We know that health care providers who are more active themselves are more likely to counsel their patients about the benefits of regular physical activity. In health care practices that operate on a population health model where providers are incentivized to keep patients healthy, EIM provides an effective solution. EIM advocates for physical activity to become a quality measure and a reimbursed service within health care.

Greg: Have you heard back from any patients? What do they appreciate about EIM? What challenges do they see with the program?

Robyn: We are currently collecting patient feedback and testimonials from some of our EIM partners. Participating in an EIM community-based intervention has been life-changing for some and a tremendous source of support for others as they create a new, more active lifestyle.