Write an exercise Rx to improve patients' cardiorespiratory fitness
Assessing physical activity is an opportunity to encourage lifestyle-based tactics for reducing cardiovascular risk. These handy tables serve as practical guides.
PRACTICE RECOMMENDATIONS
› Encourage children and adolescents (6 to 17 years of age) to engage in 60 min of moderate-to-vigorous physical activity, including aerobic, muscle-strengthening, and bone-strengthening endeavors on most, if not all, days of the week. A
› Encourage adults to perform approximately 150 to 300 min of moderate or 75 to 150 min of vigorous physical activity (or an equivalent combination) per week, along with moderate-intensity muscle-strengthening activities on ≥ 2 days per week. A
› Counsel patients that even a small (eg, 1-2 metabolic equivalents) increase in cardiorespiratory fitness is associated with a 10% to 30% lower rate of adverse events. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
SBIRT: Screening
An office visit provides an opportunity to understand a patient’s level of physical activity. Often, understanding a patient’s baseline level of activity is only asked during a thorough social history, which might not be performed during patient encounters. As physical activity is the primary determinant of cardiorespiratory fitness (CRF), some health care systems have begun delineating physical activity levels as a vital sign to ensure that the assessment of physical activity is a standard part of every clinical encounter. At a minimum, this serves as a prompt and provides an opportunity to start a conversation around improving physical activity levels when guidelines are not being met.
The exercise vital sign. Assessment and documentation of physical activity in the electronic health record are not yet standardized; however, Kaiser Permanente health plans have implemented the exercise vital sign, or EVS, in its HealthConnect (Epic Systems) electronic health record. The EVS incorporates information about a patient’s:
- days per week of moderate-to-strenuous exercise (eg, a brisk walk)
- minutes per day, on average, of exercise at this level.
The physical activity vital sign. Intermountain Healthcare implemented the physical activity vital sign, or PAVS, in its iCentra (Cerner Corp.) electronic health record. The 3-question PAVS assessment asks:
- On average, how many days of the week do you perform physical activity or exercise?
- On average, how many total minutes of physical activity or exercise do you perform on those days?
- How would you describe the intensity of your physical activity or exercise: Light (ie, a casual walk)? Moderate (a brisk walk)? Or vigorous (jogging)?
PAVS includes a fourth data point: The physician–user documents whether the patient was counseled to start, increase, maintain, or modify physical activity or exercise.
EVS and the PAVS have demonstrated validity.9-11
Continue to: Cardiorespiratory fitness as a vital sign
