title: Exercise as a vital sign: a quasi-experimental analysis of a health system intervention to collect patient-reported exercise levels.
abstract: BACKGROUND
  Lack of regular physical activity is highly prevalent in U.S. adults and significantly increases mortality risk.
  
  
  OBJECTIVE
  To examine the clinical impact of a newly implemented program ("Exercise as a Vital Sign" [EVS]) designed to systematically ascertain patient-reported exercise levels at the beginning of each outpatient visit.
  
  
  METHODS
  The EVS program was implemented in four of 11 medical centers between April 2010 and October 2011 within a single health delivery system (Kaiser Permanente Northern California). We used a quasi-experimental analysis approach to compare visit-level and patient-level outcomes among practices with and without the EVS program. Our longitudinal observational cohort included over 1.5 million visits by 696,267 adults to 1,196 primary care providers.
  
  
  METHODS
  Exercise documentation in physician progress notes; lifestyle-related referrals (e.g. exercise programs, nutrition and weight loss consultation); patient report of physician exercise counseling; weight change among overweight/obese patients; and HbA1c changes among patients with diabetes.
  
  
  RESULTS
  EVS implementation was associated with greater exercise-related progress note documentation (26.2 % vs 23.7 % of visits, aOR 1.12 [95 % CI: 1.11-1.13], p < 0.001) and referrals (2.1 % vs 1.7 %; aOR 1.14 [1.11-1.18], p < 0.001) compared to visits without EVS. Surveyed patients (n = 6,880) were more likely to report physician exercise counseling (88 % vs. 76 %, p < 0.001). Overweight patients (BMI 25-29 kg/m(2), n = 230,326) had greater relative weight loss (0.20 [0.12 - 0.28] lbs, p < 0.001) and patients with diabetes and baseline HbA1c > 7.0 % (n = 30,487) had greater relative HbA1c decline (0.1 % [0.07 %-0.13 %], p < 0.001) in EVS practices compared to non-EVS practices.
  
  
  CONCLUSIONS
  Systematically collecting exercise information during outpatient visits is associated with small but significant changes in exercise-related clinical processes and outcomes, and represents a valuable first step towards addressing the problem of inadequate physical activity.
authors: Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 20th floor, Oakland, CA, 94612, USA, Richard.w.grant@KP.org.
authors: Richard W
authors: RW
authors: Grant
authors: Julie A
authors: JA
authors: Schmittdiel
authors: Romain S
authors: RS
authors: Neugebauer
authors: Connie S
authors: CS
authors: Uratsu
authors: Barbara
authors: B
authors: Sternfeld
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D061345:Early Medical Intervention / Q000379:methods* / Q000639:trends; D057286:Electronic Health Records / Q000639:trends; D015444:Exercise / Q000502:physiology*; D005260:Female; D006308:Health Systems Plans / Q000639:trends; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D050177:Overweight / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D057566:Self Report; D055986:Vital Signs / Q000502:physiology*; D015431:Weight Loss / Q000502:physiology