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Winters, Carena Ph.D., M.P.H., FACSM, ACSM-CES; Sallis, Robert E. M.D., FACSM

doi: 10.1249/FIT.0000000000000135

LEARNING OBJECTIVES This article demonstrates 1) how to develop and implement an Exercise is Medicine® On Campus (EIM-OC) program, 2) how to officially register with the American College of Sports Medicine as an EIM-OC institution and earn recognition for the university, 3) how a fitness professional not affiliated with a campus could connect with a local university for EIM, and 4) why a health fitness or other professional would develop an EIM-OC program.

This article provides five steps to starting Exercise is Medicine® on your campus and how ACSM can help. In addition, this article summarizes the launch of the Exercise is Medicine® on Campus Recognition Program and demonstrates how a university can earn recognition status

Carena S. Winters, Ph.D., M.P.H., FACSM, ACSM-CES, is an assistant professor at Slippery Rock University. Dr. Winters launched Exercise is Medicine® On Campus (EIM-OC) with Robert E. Sallis, M.D., FACSM, in May 2009. She is an ACSM Certified Clinical Exercise SpecialistSM with the EIM Level III Credential. Dr. Winters is a member of the EIM Advisory Board and is chair of the EIM-OC committee. Dr. Winters’ passion is sharing her knowledge of exercise physiology in the classroom and the community.

Robert E. Sallis, M.D., FACSM, is a family physician practicing at Kaiser Permanente Medical Center in Fontana, CA, and serves as codirector of its sports medicine fellowship program. He is a past president of the American College of Sports Medicine and currently chairs Exercise is Medicine®. He received his Bachelor of Science degree from the U.S. Air Force Academy, his medical degree from Texas A&M University, and completed his residency in Family Medicine at Kaiser Permanente Medical Center in Fontana.

Disclosure: The authors declare no conflicts of interest and do not have any financial disclosures.

Exercise is Medicine® (EIM) ( (2) is a joint global initiative of the American College of Sports Medicine (ACSM) and the American Medical Association. EIM constitutes a tracking and referral process (1), whereby health care professionals such as physicians, nurse practitioners, and/or physician assistants monitor physical activity (PA) as a vital sign. Those patients who do not meet the current recommendations of the accumulation of 150 minutes or more of moderate PA per week are prescribed exercise or referred to a qualified exercise professional for an exercise prescription (5). A university setting is an ideal location for EIM because college is a time when many individuals develop lifetime habits in terms of their personal fitness and the experts to lead the charge (faculty, recreation center directors, human resources directors, students, etc.) may already be providing similar services on campus.

Exercise is Medicine® On Campus (EIM-OC) was launched in 2009 as a means to provide resources and best practice for implementation of EIM and EIM PA programming in a college or university setting. The mission of EIM-OC is to foster collaborative relationships and leadership on campus between exercise, health, and other disciplines that support the EIM-OC vision and goals. The vision of EIM-OC is to see all campus and community members across multiple disciplines discover, share, and adopt the principles of EIM-OC that will help change the culture of chronic disease prevention and management campus-wide. The EIM-OC guiding principles can be found in Table 1. EIM-OC is rooted in the belief that no student should graduate from a college or university without a lifetime plan for fitness and that students, faculty, staff, and administrators engage in movement as a daily aspect of campus life. EIM-OC also has the distinct advantage of providing diverse programming options that extend beyond the monitoring and referral process to include education and awareness, screenings, and behavioral change programs. This also provides additional avenues of outreach because many institutions only offer health care to students on campus and not all students seek health care on campus. EIM-OC programming can target one or more of the following campus community members: students, faculty, staff, administrators, and local community members. Therefore, EIM-OC can take many forms, which encourages many creative and inviting options for those on whom you will be making an impact.



There are many reasons why EIM-OC will benefit your campus. You may have been charged with designing and implementing a wellness or PA program. You might already have a number of successful PA initiatives occurring on campus, but they are disjointed, and you are looking to create a unified approach. Placing all exercise or PA initiatives under the EIM umbrella, perhaps as an integral part of a wellness committee on campus, will provide greater visibility, outreach, resources, and continuity of programming efforts.

You may be a younger faculty member looking for service or scholarship opportunities. EIM can provide both service through education and awareness and scholarship with expertise in exercise prescription referral or program implementation. EIM could be the perfect platform to fulfill your ethical or professional obligation for developing healthy minds and bodies of all campus community members or to align the university with Healthy People 2020 PA objectives (3). See for specific PA objectives.

Perhaps you want to provide valuable experience to your students or you want to fulfill your university’s obligation to help students understand the importance of being physically active and help them develop a lifetime plan for fitness. Perhaps you want your institution to be recognized for its commitment to the global EIM initiative. Whatever your reasons for beginning an EIM-OC initiative, the following provides information concerning how:

  • an exercise or other professional can develop and implement an EIM-OC program
  • to register an EIM-OC program with ACSM officially
  • a college or university can earn recognition for implementing EIM-OC in their campus

Three essential steps have been identified when considering an EIM-OC initiative:

1. Planning 2. Implementation 3. Sustaining the effort

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The first step in planning an EIM-OC initiative is to establish leadership among individuals who believe exercise is in fact medicine and have the skills and passion to carry out programming consistent with that message.

These individuals will be responsible for:

  • identifying the leadership team to exact the EIM-OC initiative
  • creating and enacting the vision of EIM-OC at their given institution
  • officially registering the program with ACSM
  • facilitating sustainability for EIM-OC programming
  • applying for university recognition

If you are a health fitness professional who is interested in collaborating with a university to provide referral-based exercise prescription, these would be the individuals you might seek to establish a collaborative referral process. You will want to select your marketing approach carefully and provide evidence of the qualifications that make you the professional to accept referrals and provide appropriate exercise prescription. Some things to consider: What is your role in promoting EIM? What connections can you make? With whom can you collaborate? What networking can you do? Tables 2 and 3 provide considerations for university and health fitness professionals, respectively.





Essential to the EIM leadership team are licensed health care professionals and certified health fitness professionals. An EIM credential has been created that any NCCA-certified fitness professional can earn (4). The goal of the EIM credential is to identify who might be qualified to provide appropriate exercise prescription for clients/patients of varying health statuses. Qualified professionals can earn a level 1, 2, or 3 of EIM credential, which is dependent on the current certification held. For more information concerning the EIM credential, please visit Current EIM-credentialed professionals who are certified through ACSM can be found on ACSM’s ProFinder Web site at

Additional members of the leadership team should include a supervisor/advisor and a minimum of two student representatives. Please refer to the EIM-OC University Registration Process below for specific instructions on creating your leadership team. EIM-OC specific materials are available at

To assist you further, numerous EIM planning and implementation materials, including forms, letters, and evidence-based literature on PA and health, are available to both health fitness ( and health care professionals ( on the newly updated EIM Web site.

Once the professionals to lead the charge have been established, the next step would be to identify your proposed level of engagement. This may be determined by the resources you have available, the expertise of your EIM-OC team members, the specific charge or task identified by an administrator or supervisor, and/or the amount of time that can be committed. You may just be interested in or have the resources to provide education and awareness of the benefits of exercise as medicine or the risks of leading an inactive or sedentary lifestyle. You may provide health screenings for campus community members or provide exercise or other wellness interventions. You may be interested in implementing PA as a vital sign or be able to offer subsequent referral to certified health fitness professionals.

As you begin to consider how you might implement EIM-OC, it is essential to incorporate strategies for sustaining your effort during the planning stages. Having a plan for sustainability, as mentioned later in this article, is essential for continued success. In addition, this also could be an important marketing piece for buy-in from university administrators who could provide valuable support.

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As mentioned, the basic tenets of EIM® include the monitoring of PA as a vital sign and the subsequent referral of those who do not meet the current recommendations for PA to qualified exercise professionals for exercise prescription. This process can be implemented on a college or university campus in a number of ways, which might be guided by the current structure of your health and/or recreation services; your university size, location, and culture; your team’s vision; your resources; and a host of other variables. The On the Floor column in this issue highlights how a referral-based EIM-OC was implemented in one university campus.

The ability to create an on-campus referral system is not an option at some universities. Some might have a system in place, but they cannot accommodate everyone who would be a candidate for this service. Others might not have all the resources necessary to implement a referral-based EIM-OC system. These universities would benefit from enlisting the services of a local fitness professional as mentioned previously.

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Additional EIM-OC PA Programming Options

Alternatively or in addition to a referral-based EIM-OC program, EIM-OC PA programming initiatives also might include:

  • education and awareness of the benefits of exercise as medicine and risks of being sedentary or inactive
  • various health screenings
  • interventions
  • behavioral change
  • formal fitness testing and exercise prescription clinics run by qualified students or other professionals
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Education and Awareness

One way to promote EIM-OC easily is to provide educational and awareness opportunities for students, staff, faculty, and/or the local community. One of the advantages to this type of programming is the flexibility offered. These efforts could be one time, weekly, monthly, yearly, or ongoing. The topics can change with the needs, interests, and culture of the campus community; the programming can be spread among various professionals and appropriate students; and these efforts can be very time/resource friendly. Some examples might be highlighting the distinction between exercise, PA, and fitness. Those institutions that have a physical education or wellness general education requirement or offering could include EIM as part of the course content. Exercise Science/Kinesiology programs could include EIM as an integral part of their curriculum, both educating students on EIM and guiding them to be the student champions of EIM-OC. This provides opportunities for students to gain valuable experience in the field and provides an important service to the campus community. Table 4 provides some examples of education and awareness topics/formats.



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Screenings provide instant feedback to individuals concerning current markers of health. Monitoring exercise as a vital sign is one way to provide ongoing screening for campus community members and obtain valuable information concerning current campus trends in PA participation. This information can be used to provide specific programming based on the needs of the population. Table 5 lists several possible screening measures.



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Behavior Change (Lifestyle) Programs

For those professionals who have the time and resources available, interventions targeting behavior or lifestyle change can be implemented. These programs focus on the behavioral changes necessary to create positive health behaviors with the hope of sustaining these lifestyle changes after the intervention ends. Some examples of lifestyle programs can be found in Table 6.



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Regardless of your reasons for planning and implementing an EIM-OC initiative, you don’t want to lose the momentum and hard work that you have put into your EIM-OC programming efforts. The following represent potential sources for providing sustainability:

  • Integrating into the strategic planning of your college or university
    1. ○ Include as part of the current university mission (most include a wellness component)
    2. ○ Create as part of a university assessment measure
    3. ○ Garner administrative support
  • Securing internal or external funding
    • ○ Garner administrative support
    • ○ Means to support continued EIM-OC efforts
  • Incorporating EIM into your university or major requirements
    • ○ Provide students valuable EIM-specific experience
    • ○ Provide a valuable service to the campus community
  • Creating EIM-OC assessment and outcome measures
    • ○ Provide evidence of need when requesting resources
    • ○ Highlight EIM-OC programming success
    • ○ Provide insight for future EIM-OC planning and decision making
  • Accepting community referrals from local area physicians
    • ○ Conduct community outreach
    • ○ Assist with population health management efforts (see EIM-suggested reading)
  • Earning university recognition (see below)
    • ○ Emphasize your institution’s commitment to using exercise as medicine to create a culture of wellness on campus
    • ○ Provide an impressive PR opportunity for the institution

The final two steps involved in beginning an EIM-OC program at your institution are to officially register your university with ACSM and apply for university recognition.

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Recent updates to the Action Guide and registration process have been created by the EIM-OC committee to allow tracking of institutions that are engaged in EIM-OC programming and provide greater networking capabilities. The next phase of the new EIM Web site (set to launch this year) offers professionals the ability to view registered institutions on local, national, and global levels. Registered institutions also may include a link to their university program/EIM Web site, providing those interested additional information concerning their EIM-OC strategies. Information about registered institutions before this launch can be requested by emailing

To register your campus with ACSM officially, an EIM-OC leadership team must be created. The required team members are listed in Table 7. Registration with EIM-OC provides professionals additional resources for planning and implementation, as well as the opportunity to apply for recognition. For detailed information concerning EIM-OC registration, please visit



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The EIM-OC Recognition Program highlights the efforts EIM-OC institutions are taking in leading their campus and community to becoming healthier by increasing opportunities to be active physically and linking PA to university health care.

EIM-OC Recognition provides an opportunity for your campus to publicize its image as an academic environment of professionals who care about the health of their campus community members and emphasizes your commitment to using exercise as medicine to create a culture of wellness on campus.

A campus can earn one of three levels of EIM-OC Recognition:

  • Gold Level: Focuses on efforts to implement the EIM Solution. EIM-OC’s goal is to establish PA as a vital sign within the health care system and link health care professionals to fitness professionals to provide a referral system for appropriate exercise prescription.
  • Silver Level: Focuses on educational opportunities for campus and community. Education helps ensure that knowledge of the importance of PA to health is shared and incorporated into campus life. Silver campuses work to promote these ideals and work toward the ultimate goal of incorporating PA as a part of routine doctor visits.
  • Bronze Level: Focuses on PA promotion and awareness and opportunities to be physically active. Bronze universities and colleges aim to make PA a priority on campus and within the surrounding community, emphasizing the benefits that come with regular exercise.

Each level includes specific bulleted examples of requirements to earn that level of recognition. All registered EIM-OC institutions will receive the University Recognition Handbook and may apply for Recognition status. A self-evaluation checklist is completed by the applicant to determine the level achieved, and final approval is granted by the EIM-OC committee. For more information concerning the EIM-OC University Recognition Program and application process, please visit

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Exercise is Medicine® On Campus (EIM-OC) can take many forms — from a referral-based system to providing increased opportunities for a more active campus community. Implementing EIM-OC in your campus is a great way to fulfill a professional obligation to the members of your campus community, provide valuable educational experiences to your students, be part of the global EIM team effort, and have your university recognized as an official EIM-OC institution. To assist in your goal of creating and implementing an EIM-OC program, the updated EIM-OC Action Guide provides programming material and the new EIM-OC registration process provides an enhanced way to track institutions that are implementing EIM-OC and allows professionals the capability to connect and provide best practice for EIM-OC implementation. The newly launched EIM-OC University Recognition Program recognizes those campuses that have made a commitment to improving the health of the campus community by creating a culture that incorporates physical activity as a daily facet of life and provides great PR for any institution with a commitment to health and wellness.

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1. American College of Sports Medicine Exercise is Medicine Web site [Internet]. Indianapolis, (IN): American College of Sports Medicine; [cited 2013 Apr 23]. Available from:
    2. Exercise is Medicine Web site [Internet]. Indianapolis (IN): Exercise is Medicine; [cited 2014 Oct 7]. Available from:
    3. Health People 2020 Physical Activity Objectives Web site [Internet]. [cited 2014 Oct 1]. Available from:
      4. National Commission of Certifying Agencies Web site [Internet]. Washington (DC): National Commission of Certifying Agencies; [cited 2013 Apr 23]. Available from:
        5. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans [Internet]. [cited 2014 Oct 1]. Available from:
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        Recommended Readings

        Lobelo F, Stoutenberg M, Hutber A The Exercise is Medicine global health initiative: a 2014 update Br J Sports Med. [April 23, 2014] doi:10.1136/bjsports-2013-093080.
          Riebe D The Exercise is Medicine® Credential. ACSM Health Fitness J. 2012; 16 (2): 29–30.

            Exercise is Medicine®; exercise referral; university recognition; wellness programming; exercise

            © 2015 American College of Sports Medicine.