June 27, 2014

Daily physical activity key component of healthy lifestyle

Exercise as a vital sign prompts fitness conversations in the exam room

This graphic is from "Physical Fitness: A Self Assessment Guide," an eight-page handout prepared for the Total Health Care Program, 1981. Kaiser Permanente Heritage Resources archives

Contributed by Lincoln Cushing, Archivist and Historian

Thirty years ago, Kaiser Permanente founding physician Sidney Garfield, MD, was as anxious as anyone is today to encourage members to maintain a healthy lifestyle.

Dr. Garfield knew that people could better stave off chronic illnesses such as diabetes, heart disease and cancer if they ate healthy foods and exercised for weight control and cardiovascular health. He wanted them to achieve (what he called) Total Health — physical, mental and social well-being.

But how could he get people’s attention?

First, he had to round up members to help them assess their health status before they became sick.

The elegant electronic health records system Kaiser Permanente providers have at their fingertips today wasn’t invented yet. So Garfield and his collaborators had to do it the old-fashioned way:

First page of eight-page brochure for Total Health Care Program, 1981. Kaiser Permanente Heritage Resources archive
The benefits of physical activity are detailed in this illustration published in a brochure given to participants in the Total Health Care Program, 1981. Kaiser Permanente Heritage Resources archives

They mailed letters to new members and asked them to come in for a physical examination. Members completed the total health assessment questionnaire with pen on paper and handed the document to providers.

Members responded to questions such as: “Do you smoke? How many servings of fruits and vegetables do you eat each day? How many minutes do you exercise each day?” The lifestyle questionnaire content formed the basis for each individual’s preventive care plan.

Total health assessment continues

Today, the same process takes place, but advanced computer technology — Kaiser Permanente’s HealthConnect®, the organization’s electronic health records system — makes it easier, quicker and better.

With software available in KP HealthConnect®, physicians work with members to assess body mass and to have a conversation about the member's physical activity level.

At Kaiser Permanente, both BMI and exercise as a vital sign are considered “vital signs” as important as the traditional measures of blood pressure, pulse and temperature.

BMI calculation, a ratio of height to weight, has been part of the Kaiser Permanente clinical routine for about the past five years. Southern California Permanente physicians piloted and studied EVS results in 2009, and in 2013 the Permanente medical groups in all regions added the physical activity measure to the recommended clinical routine for all facilities.

EVS study results promising

In December 2013, Kaiser Permanente researchers published in the Journal of General Internal Medicine results of an 18-month study conducted at four medical centers in Northern California. Clinicians at the study sites asked patients how many days a week they exercise and for how many minutes.

Logo for Sidney Garfield's Total Health Care Program, 1983. Kaiser Permanente Heritage Resources archives
Logo for Sidney Garfield's Total Health program, 1983. Kaiser Permanente Heritage Resources archives

Researchers began collecting data in April 2010 and followed patients’ weight loss and blood sugar reduction progress through October 2011. The study involved more than 696,267 Kaiser Permanente members who were seen in more than 1.5 million office visits.

Investigators compared the members’ weight loss progress and blood sugar control at the four study sites with nine other medical centers that had not yet implemented exercise as a vital sign.

Even though patients who were asked the exercise question recorded a weight loss of only .02 more pounds than members of the control group, researchers were encouraged by the findings.

“Asking an individual about how much daily exercise he or she (gets) helps our providers learn about what matters to our patients and prompts patients to think about healthier habits,” said Lisa Schilling, RN, MPH, vice president for Kaiser Permanente's Care Management Institute.

Help for personalizing exercise choices

Currently, members who need help in starting a personalized exercise regimen can consult with a wellness coach by telephone, make an appointment with a behavioral-change specialist, and take advantage of online healthy lifestyle programs.

Kaiser Permanente is the sponsor of the public health campaign “Every Body Walk!” that encourages Americans to incorporate walking in to their daily fitness routine.

In his day, Sidney Garfield was indisputably a visionary in taking advantage of then-budding technology that he believed could improve medicine. As prescient as he was, he could never have predicted the changes that would provide the tools to realize his dream of Total Health. The current edition of The Permanente Journal carries an article about the status of Total Health that would make Garfield feel gratified.