Kaiser Permanente study finds efforts to establish exercise as a vital sign prove valid

(Press-News.org) PASADENA, Calif., Oct. 17, 2012 — Kaiser Permanente has created a new electronic Exercise Vital Sign initiative to systematically record patients' physical activity in their electronic health records. The new feature is successfully compiling accurate and valuable information that can help clinicians better treat and counsel patients about their lifestyles, according to a Kaiser Permanente study published in the journal Medicine & Science in Sports & Exercise.

The study examined the electronic health records of 1,793,385 Kaiser Permanente Southern California patients ages 18 and older from April 2010 to March 2011 and found that 86 percent of all eligible patients had an exercise vital sign in their record. Of those patients who had an exercise record, one third were meeting national guidelines for physical activity, and two thirds were not meeting guidelines. Of those not meeting guidelines, one third were not exercising at all.

"Embedding questions about physical activity in the electronic medical record provides an opportunity to counsel millions of patients during routine medical care regarding the importance of physical activity for health," said study lead author Karen J. Coleman, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation. "In addition, the Exercise Vital Sign has the potential to provide information about the relationship between exercise and health care utilization, cost and chronic disease that has not been previously available."

Kaiser Permanente is one of the first — and largest — health care organizations to implement an Exercise Vital Sign in patient health records. The initiative was launched in the organization's Southern California region in 2009 and has since been implemented in several of Kaiser Permanente's regions. As part of these efforts, patients are asked about their exercise habits during routine outpatient visits and their responses are included in their electronic medical record, along with other traditional vital signs such as blood pressure, pulse and temperature.

The U.S. Department of Health and Human Services recommends that Americans engage in at least 150 minutes per week of moderate-to-vigorous intensity physical activity, such as brisk walking, to receive maximal health benefits. The guidelines state that regular physical activity reduces the risk of many adverse health outcomes.

The Exercise Vital Sign is part of Exercise is Medicine ®, a multi-organizational initiative coordinated by the American College of Sports Medicine and the American Medical Association to encourage primary-care physicians and other health care providers to include exercise when designing treatment plans for patients.

"Given that health care providers have contact with the majority of Americans, they have a unique opportunity to encourage physical activity among their patients through an assessment and brief counseling," said Coleman. "Future studies will examine if adding a physical activity assessment during clinic visits actually leads to higher rates of physician counseling and eventually increases the rates of physical activity in our patients."

Researchers validated the findings of the study by comparing exercise levels reported by the Kaiser Permanente Southern California adult patients with those reported in U.S. population surveys. The researchers also examined the ability of these reports to discriminate between groups of patients with differing demographics and health status. The patient reports of physical activity were lower than national surveys, but followed similar patterns to those reported in the scientific literature: Members who were older, female, obese, belonging to a racial or ethnic minority, or had more chronic health conditions were more likely to be inactive.

This study and the Exercise Vital Sign initiative are parts of ongoing efforts at Kaiser Permanente to conduct research on and highlight the health benefits of physical activity. Kaiser Permanente partners with several other organizations on Every Body Walk!, a public awareness campaign about the health benefits of walking. Kaiser Permanente also works to increase public awareness of the prevalence and effects of obesity in the United States. Earlier this year, Kaiser Permanente partnered with HBO (Home Box Office), the Institute of Medicine, the National Institutes of Health, the Centers for Disease Control and Prevention and the Michael & Susan Dell Foundation to launch one of the most ambitious public education campaigns addressing America's obesity epidemic to date, including the documentary series The Weight of the Nation on HBO.

### Kaiser Permanente can conduct transformational health research in part because it has the largest private electronic health system in the world. The organization's integrated model and electronic health record system, Kaiser Permanente HealthConnect®, securely connect 9 million people, 611 medical offices, and 37 hospitals, linking patients with their health care teams, their personal health information, and the latest medical knowledge. It also connects Kaiser Permanente's researcher scientists to one of the most extensive collections of longitudinal and medical data available, facilitating studies and important medical discoveries that shape the future of health and care delivery for patients and the medical community.

Funding for this research was provided by the Southern California Permanente Medical Group.

Other authors of the paper include: Eunis Ngor, MS, Kristi Reynolds, PhD, MPH, Virginia P. Quinn, PhD, Corinna Koebnick, PhD, and Deborah Rohm Young, PhD, of the Department of Research & Evaluation, Kaiser Permanente Southern California; Barbara Sternfield, PhD, of the Division of Research, Kaiser Permanente Northern California; and Robert E. Sallis, MD, of the Department of Family Medicine Fontana Medical Center, Kaiser Permanente Southern California.

About the Kaiser Permanente Southern California Department of Research & Evaluation The Department of Research & Evaluation (R & E) conducts high-quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiology, health sciences and behavioral research as well as clinical trials. Areas of interest include diabetes and obesity, cancer, HIV/AIDS, cardiovascular disease, aging and cognition, pregnancy outcomes, women's and children's health, quality and safety, and pharmacoepidemiology. Located in Pasadena, Calif., the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general population. Visit www.kp.org/research.

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We serve approximately 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to www.kp.org/newscenter. END