Your medical chart could soon include exercise minutes

Lindsey Tanner / The Associated Press /


Published Jan 8, 2013 at 04:00AM / Updated Nov 19, 2013 at 12:31AM

CHICAGO — Roll up a sleeve for the blood pressure cuff. Stick out a 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 some other medical systems are doing it, too.

Here’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,’” said Dr. Robert Sallis, a Kaiser family doctor. He hatched the vital sign idea as part of a larger initiative by doctors groups.

He said Kaiser doctors generally prescribe exercise first, instead of medication, and for many patients who follow through, that’s often all it takes.

It’s a challenge to make progress. A study looking at the first year of Kaiser’s effort showed more than a third of patients said they never exercise.

Sallis said some patients may not be aware that research shows physical inactivity is riskier than high blood pressure, obesity and other health risks people know they should avoid. As recently as November a government-led study concluded that people who routinely exercise live longer than others, even if they’re overweight.

Zendi Solano, who works for Kaiser as a research assistant in Pasadena, Calif., says 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, in a family of diabetics and had elevated blood sugar. She sometimes did push-ups and other strength training but not anything very sustained or strenuous.

Solano, 34, decided to take up running, and after a couple of months she was doing three miles. Then she began training for a half marathon — and ran that 13-mile race in May in less than three hours. She formed a running club with co-workers and now runs several miles a week. She also 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 about three years ago after 2008 government guidelines recommended at least 21⁄2 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.

A recently published study of nearly 2 million people in Kaiser’s southern California network found that less than a third met physical activity guidelines during the program’s first year ending in March 2011. That’s worse than results from national studies. But promoters of the vital signs effort think Kaiser’s numbers are more realistic because people are more likely to tell their own doctors the truth.

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.

“There are some real opportunities there to kind of shift patients’ expectations about the value of physical activity on health,” Joy said.

NorthShore University HealthSystem in Chicago’s northern suburbs plans to start an exercise vital sign program this month, eventually involving about 200 primary care doctors.

Dr. Carrie Jaworski, a NorthShore family and sports medicine specialist, already asks patients about exercise. She said some of her diabetic patients have been able to cut back on their medicines after getting active.

Dr. William Dietz, an obesity expert who retired last year from the Centers for Disease Control and Prevention, said measuring a patient’s exercise regardless of method is essential, but that “naming it as a vital sign kind of elevates it.”

Figuring out how to get people to be more active is the important next step, he said, and could have a big effect in reducing medical costs.

Several medical systems are making it routine, just like any check of your vital signs, and encouraging doctors to comment in hopes of improving physical activity among the population. A recently published study of nearly 2 million people in Southern California found that less than a third met government physical activity guidelines.

Few Americans know all the risks of obesity, poll says

Heart disease and diabetes get all the attention, but what about the many other ways obesity can damage your health?

Carrying too many pounds may lead to or worsen some types of cancer, arthritis, sleep apnea, even infertility. But a new poll suggests few Americans realize the links.

Only about one-quarter of people think it’s possible for someone to be very overweight and still healthy, according to the poll by The Associated Press-NORC Center for Public Affairs Research.

Ask about the most serious consequences, and more than 7 in 10 Americans can correctly tick off heart disease and diabetes. Heart disease is the nation’s leading killer, and diabetes and obesity are twin epidemics, as rates of both have climbed in recent years.

The other consequences aren’t so well known.

“People are often shocked to hear how far-reaching the effects of obesity are,” said Jennifer Dimitriou, a bariatric dietitian at New York’s Montefiore Medical Center.

Only 7 percent of people surveyed mentioned cancer, although doctors long have known that fat increases the risk of developing cancers of the colon, breast, prostate, uterus and certain other sites. Plus, being overweight can make it harder to spot tumors early and to treat them.

Then there’s the toll on your joints, especially the knees. About 15 percent of people knew obesity can contribute to arthritis, a vicious cycle as the joint pain then makes it harder to exercise and shed pounds.

High blood pressure, high cholesterol and strokes were fairly low on the list. Infertility didn’t get a mention.

Also, 5 percent put respiratory problems on the list. Studies show people who are overweight are at increased risk of sleep apnea and asthma, and that dropping pounds can help improve their symptoms.

Knowing more about the myriad ways obesity affects health could help motivate people to get more active and eat better before full-blown disease strikes, Dimitriou said.

“Most people want to become healthier. It’s the know-how and understanding what the consequences are,” she said.

But only 52 percent of those surveyed said they’ve discussed the health risks of being overweight with a doctor.

In another complication, the AP-NORC Center survey found that about half of people think their weight is just about right, and only 12 percent of parents think their children are overweight. That’s even though government figures show two-thirds of U.S. adults, and one-third of children and teens, are either overweight or obese.

If you’re surrounded by overweight people, especially in your family, “then that’s all you know, and that to you is normal,” Dimitriou said.

— The Associated Press