Fitness-focused medicine: Physical activity reduces chronic disease risk

Researchers at the University of Iowa have called for a universal practice of surveying patients about their physical activity levels. The proposal is based on findings that highlight a powerful relationship between regular exercise and a lower risk of chronic diseases. 

The study, led by Lucas Carr, an associate professor in the Department of Health and Human Physiology, focused on more than 7,000 patients at the University of Iowa Health Care Medical Center. 

Physical activity and chronic disease

The research team compared self-reported physical activity data with medical records. They found a significant connection between higher levels of physical activity and better health outcomes. 

Moderate to vigorous exercise for at least 150 minutes a week was linked to a reduced risk of developing 19 chronic illnesses. These included cardiovascular disease, respiratory disease, diabetes, and various forms of cancer.

Those who reported doing little or no exercise were more prone to develop these chronic diseases, emphasizing the pressing need to address inactivity among patients. 

Physical activity surveys and exercise prescriptions 

Drawing on these results, the Iowa researchers suggest that health care systems should incorporate physical activity surveys into patient visits and offer relevant health and wellness services to those at greatest risk.

“In our health care environment, there’s no easy pathway for a doctor to be reimbursed for helping patients become more physically active,” said Professor Carr. 

“And so, for these patients, many of whom report insufficient activity, we need options to easily connect them with supportive services like exercise prescriptions and/or community health specialists.”

Lowering the risk of chronic diseases 

This study originated from a desire to better understand how physical activity might affect overall health outcomes. 

Collaborating with Dr. Britt Marcussen, a family medicine physician at UI Health Care, Professor Carr introduced a physical activity questionnaire for patients visiting for annual wellness exams. 

Between November 2017 and December 2022, individuals answered two simple questions: how many days per week they performed moderate to vigorous exercise, and how many minutes in total they exercised at that intensity.

Data from more than 7,000 participants showed a significant gap between people who met the recommended thresholds for weekly exercise and those who were mostly sedentary. 

The group of patients who exercised 150 minutes or more per week appeared to be at notably lower risk for the range of chronic illnesses examined. Meanwhile, those reporting limited or no exercise had a higher propensity to develop these diseases.

Observations about the study population

In addition to analyzing participants who took the survey, the research team also considered a group of 33,000 patients who did not receive the questionnaire. 

The investigators found that those who responded to the survey tended to be younger and healthier than the non-responders, potentially reflecting a tendency for individuals who attend annual wellness exams to be more engaged in healthy behaviors overall.

Still, the central takeaway remains that reported physical activity levels correlated closely with the presence or absence of various chronic diseases, validating the essential role of regular exercise in promoting long-term health and well-being.

“We believe this finding is a result of those patients who take the time to come in for annual wellness exams also are taking more time to engage in healthy behaviors, such as being physically active,” Carr said.

Promoting physical activity in medical settings

Identifying patients who are largely sedentary is just one step, according to the researchers. They also propose that health care systems implement practical methods to help these individuals become more active, such as referrals to exercise programs, community health resources, or professional exercise prescriptions. 

The experts point to a lack of structured pathways for physicians to be reimbursed for providing exercise guidance, which hinders widespread adoption of this type of support.

In a related investigation, published in the Journal of Physical Activity and Health, Carr’s team discovered that insurance providers reimbursed almost 95 percent of claims for exercise counseling when health care providers billed for it. 

“Our findings suggest the recommended physical activity billing codes are reimbursed at a high rate when providers submit them for reimbursement, which reinforces the idea to make physical activity surveys and counseling services available,” explained Professor Carr.

Moving toward a healthier future

This series of studies underscores the value of easily administered questionnaires for identifying patients who may be at elevated risk of chronic diseases, as well as the importance of follow-up measures that connect sedentary individuals with services to help them become more active. 

The results are consistent with a broader body of evidence linking regular physical activity with reduced risks of many major health conditions.

By advocating for a simple, rapid, two-question survey, the researchers at the University of Iowa demonstrate how such a tool can fit seamlessly into routine medical appointments without overburdening patients or clinicians. 

They believe this approach provides not only valuable data on patient health but also a means to intervene and lessen the impact of chronic conditions.

The authors argue that widespread integration of physical activity questions in clinical settings could bring noticeable public health benefits, particularly if paired with robust exercise counseling and resources for those who need it. 

With the knowledge that insurance often reimburses exercise counseling, physicians and hospital administrators may find it easier to build these options into patient care, helping fight the epidemic of chronic disease and fostering healthier lifestyles overall.

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