Doctors Routinely Miss Key to Ortho Health

Given doctors’ limited time and the lack of formal medical education regarding exercise and patient physical fitness, a growing number of sports medicine physicians, like Robert E. Sallis, M.D., co-director of Kaiser Permanente’s Medical Center in Fontana, California, are urging doctors to make fitness a centerpiece of their patient review.

But, how to discuss physical activity-related concerns with patients and when to refer patients, such as for physical therapy, exercise classes or even rehab in more extreme circumstances? Should physicians just ask patients or rely on activity tracking devices?

And here’s the kicker: no one disagrees that taking the time to assess physical activity as a vital sign will improve patient outcomes because it increases focus on one of the single most important aspects of an orthopedically healthy lifestyle.

A lack of fitness in an individual lags behind only smoking as a risk factor for predicting if a person will die early, according to Michael D. Schroeder, staff writer for US News. A sedentary life raises a person’s risk of developing everything from diabetes and heart disease to colon cancer and breast cancer.

More than 9 in 10 American adults may not meet physical activity guidelines, notes a paper in a review journal of the American College of Sports Medicine. The writer recommends getting 150 minutes per week of moderate intensity exercise. The Oakland, California-based Kaiser Permanente has made assessing and prescribing physical activity a standard part of care. This includes implementing a physical activity vital sign that could be routinely checked and recorded by doctors at every medical visit.

“Patients who are active and fit live longer, healthier, better lives, ” says Dr. Sallis. “They’re much less likely to suffer from chronic disease—we’ve just got study after study proving that. Yet we hardly pay attention to it in organized medicine.” Kaiser became the first major health organization in the country to incorporate exercise as a vital sign when it began phasing in the approach at its medical centers in 2009.

A major problem is developing a reliable measure of physical activity. Doctors have limited time and there has been little formal medical education devoted to exercise. Patients are not reliable reporters on their own physical activity. Activity tracking devices may provide a solution. Significantly, despite the problems associated with it, more and more providers of health care are using physical activity as a vital sign to get people to exercise more.