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Strategies for Partnering with Health Care Settings to Increase Physical Activity Promotion

King, Kristi M. Ph.D., CHES; Jaggers, Jason R. Ph.D., FACSM; Wintergerst, Kupper M.D.

doi: 10.1249/FIT.0000000000000486
Columns: Clinical Applications
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Kristi McClary King, Ph.D., CHES,is an associate professor in the exercise physiology program of the Department of Health and Sport Sciences at the University of Louisville in Kentucky and has a joint appointment in pediatric endocrinology with the Wendy Novak Diabetes Center. Dr. King is the principal investigator on multiyear research studies that focus on the improvement of health, specifically through physical activity and nutrition interventions and policies. Dr. King earned her Ph.D. at Southern Illinois University Carbondale and completed her postdoctorate training in Physical Activity and Public Health Research at the University of South Carolina’s Arnold School of Public Health and Centers for Disease Control and Prevention. She is a scholar of the Commonwealth Institute of Kentucky and a certified health education specialist.

Jason R. Jaggers, Ph.D., FACSM,is the assistant director of the Wendy Novak Diabetes Sports Medicine program within the Department of Pediatrics. His research interests are exercise testing and prescription for special populations, with a strong emphasis on HIV and diabetes (types 1 and 2). As a leading expert in clinical exercise science, Dr. Jaggers would like for his research to help establish the importance of increased fitness among clinical populations as a way to help manage the symptoms and side effects associated with chronic disease.

Kupper Wintergerst, M.D.,completed his pediatric endocrinology fellowship at Stanford University. In 2006, he moved to Louisville to take a position in the Division of Pediatric Endocrinology and became division chief in 2014. He is the director of TrialNet and Type 1 Diabetes Exchange Studies. In 2013, he was named director of the Wendy Novak Diabetes Care Center and became the Wendy L. Novak Endowed Chair of Pediatric Diabetes Care and Clinical Research.

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Engaging in regular physical activity improves health, reduces medical costs, and improves quality of life (1). The Physical Activity Guidelines Advisory Committee (2), representing numerous public health professionals, researchers, and leaders from public and private organizations, recently reviewed the latest research recommendations for physical activity and released the Physical Activity Guidelines for Americans,2nd edition (3). It is estimated that only 26% of men and 19% of women meet the minimal amounts of physical activity, 150 minutes of moderate-intensity aerobic physical activity and 2 days per week of muscle-strengthening activity, and only 20% of children meet the daily minimal amount of at least 60 minutes of moderate-intensity aerobic physical activity and 3 days per week of muscle-strengthening activity (4).

In response to the Physical Activity Guidelines, the Journal of the American Medical Association released a publication concluding that “health professionals and policy makers should facilitate awareness of the guidelines and promote the health benefits of physical activity and support efforts to implement programs, practices, and policies to facilitate increased physical activity and to improve the health of the US population” (5). Given that many sectors of society have a role to play in improving physical activity across the United States, the National Physical Activity Plan (NPAP) Alliance (6), a nonprofit organization that has a memorandum of understanding with the U.S. Department of Health and Human Services, identified nine sectors of society that are encouraged to promote physical activity — business and industry; community recreation, fitness, and parks; education; faith-based settings; health care; mass media; public health; sport; and transportation, land use, and community design (Figure 1). Strategies and tactics for promoting activity in each of these sectors are described in the NPAP (7,8). Ideally, each of these sectors will “work together” to support each other’s strategies of physical activity promotion. Within the NPAP’s health care sector, there are four strategies and 21 tactics outlined and aimed at increasing physical activity promotion (Table 1).

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TABLE 1

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Physicians and other health professionals can be influential sources of health information, and exercise counseling but, primary care physicians have been shown to increase patients’ participation in physical activity (5,8,9). Significant efforts are being made to include physical activity training into medical school curricula and medical practices; however, it is currently not standard practice across all curricula and health care settings (10–12). In fact, patients report receiving physical activity counseling in only 32% of clinical office visits (12), and physicians indicated that their limited confidence and lack of knowledge and skill prevent them from counseling patients about lifestyle interventions (11).

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PURPOSE

Health and fitness professionals can become integral partners within the clinical sector given that they have the knowledge, attitudes, skills, experience, and credentials necessary to develop, implement, and evaluate evidence-based physical activity interventions as well as conduct exercise testing and prescription. For the purpose of this Clinical Applications column, three strategies for partnering with health care settings will be described: 1) offering professional development opportunities for health care professionals, 2) providing referral information and services, and 3) incorporating technology into the medical practice.

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STRATEGIES FOR PARTNERING WITH HEALTH CARE TO INCREASE PHYSICAL ACTIVITY PROMOTION

Offer Professional Development Opportunities for Health Care Professionals

The NPAP suggests for the health care setting to “provide an array of evidence-based curricular resources to support physical activity education throughout all health professional training” (strategy 4, tactic 4) and to “include physical activity content in continuing education professional development programs” (tactic 5) (7). To assuage physicians’ and health care teams’ hesitancy to advise specific strategies for increasing physical activity, health and fitness professionals can provide educational opportunities for medical professionals regarding physical activity and exercise. For example, hosting a 1-hour seminar would be an excellent way to educate physicians regarding the latest research and evidence-based recommendations for physical activity and appropriate strategies for promoting physical activity. Providing a copy of an American College of Sports Medicine (ACSM) position statement, an Exercise is Medicine® (EIM) patient education brochure, or an article from ACSMs Health & Fitness Journal® can be tangible “takeaways” for health care professionals to read and learn more about physical activity.

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Provide Referral Information and Services

Health care providers can “partner with providers of community physical activity services to form referral networks that increase opportunities for physical activity and ensure equal access of their patients to community resources, including patients living in rural areas” (strategy 3, tactic 6) (7). A recent survey study of more than 400 physicians indicated that although physicians expressed a positive perception of health and fitness facilities, less than 50% referred their patients to these facilities and only 20% referred their patients to a personal trainer (13). Health and fitness professionals can develop and disseminate a list of affordable fitness facilities, community centers, and after-school programs in the area, along with contact information and fee schedules for health care providers to give to their patients. It also is important for health and fitness professionals to promote appropriately credentialed exercise professionals (exercise physiologists, personal trainers, or group exercise instructors). For example, health and fitness professionals may receive an EIM credential or an ACSM Clinical Exercise Physiologist® certification to demonstrate their ability to safely and effectively develop, implement, and lead exercise programs for patients, to work in collaboration with health care providers, and to help create sustained lifestyle and behavioral changes for people with acute and chronic diseases. Medical practices that include a credentialed health and fitness professional on staff for one-on-one counseling during patient visits can increase “physical activity assessment, advice, and promotion” (strategy 1).

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Incorporate Technology into the Medical Practice

Another recommendation by the NPAP is to “develop, implement, and evaluate strategies to integrate into health care settings objective measures of physical activity that are derived from wearable devices and smartphone apps” (strategy 1, tactic 5) (7). In order to achieve this objective, health and fitness professionals can collaborate with physicians to integrate accelerometry into the standard of care. Although medical professionals who discuss physical activity with their patients often rely on patients’ subjective, physical activity recall, objective, real-time monitoring may be a more ideal strategy for collecting accurate frequency, intensity, and duration of physical activity data. Appropriate increases in physical activity accumulations can ensure when baseline data are analyzed.

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CLINICAL APPLICATION

The strategies presented in this Clinical Applications column have been put into practice for children with type 1 diabetes in the Christensen Family Sports and Activity Program of the Wendy Novak Diabetes Center (http://novakcenter.com). Physicians and care teams discuss the importance of physical activity with their patients and refer them to receive a comprehensive fitness evaluation and education conducted by clinical exercise physiologists. Then, incorporating patient-based data collected from real-time physical activity monitoring via accelerometry, combined with patients’ continuous glucose monitors and insulin pump dosages, the collaboration among the clinical exercise physiologists and the medical care teams helps children anticipate the risk of hyper- or hypoglycemia during exercise as well as nocturnal hypoglycemia. The partnerships between health and fitness professionals and medical care teams are continually improving children’s ability to manage their diabetes better while being physically active or engaging in sports.

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CONCLUSION

Health and fitness professionals as well as health care providers have the shared goals of promoting and supporting patients’ health. Research findings support that partnerships should be encouraged to “bridge the gap between physicians and fitness professionals” (13). Health and fitness professionals can use the strategies described in this Clinical Applications column to partner with the health care setting. Advocating for physical activity promotion in the health care setting is critical to increasing awareness and support for physical activity promotion (14); however, building and fostering partnerships across multiple sectors of society will be essential in linking patients to community resources to support regular physical activity (7,8).

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References

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3. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans. 2nd ed. Washington, (DC).; 2017.
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© 2019 American College of Sports Medicine.