Programs That Make Exercise a Form of Medical Therapy for Large Segments of the Population

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A large body of scientific evidence shows that exercise is an effective medical therapy to prevent or manage dozens of medical conditions such as diabetes and heart disease. The Society of Behavioral Medicine (SBM) and the American College of Sports Medicine (ACSM) recently began a partnership to promote this message through ACSM’s Exercise is Medicine® initiative. The goal of this initiative is to promote the health benefits of regular exercise participation in a variety of medical settings.

Hospitals, employers, and insurers can play a significant role providing people with the environmental supports to engage in an active lifestyle that helps maintain health and a high quality of life.

A large body of scientific evidence shows that exercise is an effective medical therapy to prevent or manage dozens of medical conditions such as diabetes and heart disease. The Society of Behavioral Medicine (SBM) and the American College of Sports Medicine (ACSM) recently began a partnership to promote this message through ACSM’s Exercise is Medicine® initiative. The goal of this initiative is to promote the health benefits of regular exercise participation in a variety of medical settings.

The growing epidemic obesity has drawn attention to the benefits of an active lifestyle yet many people struggle to become more physically active. “I have asked my patients to consider healthy eating and physical activity for many years,” observed physician Michael Goldstein, “but only recently have health care-based programs and resources been available to help them to successfully follow through with these recommendations after their appointments.” As Americans have become increasingly sedentary and unfit, exercise has mostly been used as a rehabilitation strategy in medical settings.

A symposium held Friday, April 13 (8:45-10:15 am), at the Society of Behavioral Medicine’s 33nd Annual Meeting and Scientific Sessions in New Orleans will profile successful real world examples of evidence-based physical activity programs offered to large numbers of consumers. The symposium aims to review challenges to implementing large scale preventive programs and to provide medical practitioners and policy makers with lessons learned from implementing programs such as those advocated by Exercise is Medicine®. As symposium chair Dr. David Goodrich observed, “Hospitals, employers, and insurers can play a significant role providing people with the environmental supports to engage in an active lifestyle that helps maintain health and a high quality of life.”

Dr. Matthew Buman, a health researcher at the School of Nutrition and Health Promotion, Arizona State University explained the Exercise is Medicine® initiative and plans for ACSM to work with partners like SBM help shape the direction of medical care through medical research studies and consultation with health policy makers. The initiative has started to make exercise part of the conversation that patients have each time they go to see their medical provider. More recently, the initiative has identified the need to make changes in the healthcare system to support this basic goal. Dr. Buman commented, “Professional medical societies like ASCM and SBM have the expertise to facilitate the transformation of health care by sharing best practices.”

While technology may contribute to a sedentary lifestyle, panelist Dr. Caroline Richardson described how the internet can help patients improve their health. Dr. Richardson framed the problem of lifestyle change from the perspective of insurance companies and large health systems with a focus on cost and reach. She will present results from a large implementation of an online walking and weight loss program that incorporates pedometers, motivational messages, peer support, goal setting and substantial financial incentives to promote lifestyle change in a population. Preliminary results showed that internet mediated approaches can be successfully implemented and that while not everyone like the program, almost everyone participated. Dr. Richardson states “We have learned much about logistical, technical, ethical, medical and legal issues that must be overcome when implementing an internet mediated lifestyle change program. Additionally, we have documented the impressive reach and participation that financial incentives can produce when the implementation is successful.”

Dr. Kenneth Jones, the VHA National Program Director for Weight Management, subsequently summarized how the Veterans Health Administration (VHA) took a pioneering role in preventive medicine by implementing a comprehensive weight self-management program for Veterans called MOVE!®. “The prevalence of overweight and obesity has gradually risen to almost 77%,” Dr. Jones stated, “placing these Veterans at risk for diabetes, cardiovascular problem, cancer, and premature death. Annually, Veterans are screened by their body mass index, and those found at weight-related risk are offered several different MOVE!® self-management support options.” To date, over 380,000 Veterans have participated in MOVE!®, and VHA is working through a national Prevention Initiative to motivate patients to make healthy lifestyle changes through effective patient-centered communication. In addition, MOVE!® continues to develop more convenient options for participants to choose how, when, and where they will participate in weight management programming. As the largest weight management program offered by an integrated health care system, MOVE!® has begun to impact services in other domains such as Medicare and Medicaid.

Symposium discussant and past SBM President, Dr. Michael Goldstein put the symposium’s findings in perspective. Initiatives like the online walking and weight loss program described by Dr. Richardson, Exercise is Medicine®, and MOVE!® help empower patients to improve their health without expensive drugs or treatments. As Associate Chief Consultant for Preventive Medicine in the VHA, Dr. Goldstein acknowledged that initiatives like Exercise in Medicine® and MOVE!® have changed provider and patient perspectives about what healthcare can and should offer patients. In VHA, a new Health Promotion and Disease Prevention initiative embeds behavioral medicine specialists in primary care teams at all 153 VHA medical centers. Not only will these specialists take a role in training their peers about preventive medicine to improve patient care, they will serve as pioneering examples to other heath care organizations looking to put a greater emphasis on improving patient health outcomes through health behavior change.

The Society of Behavioral Medicine is a multidisciplinary organization of clinicians, educators, and scientists dedicated to promoting the study of the interactions of behavior with biology and the environment and the application of that knowledge to improve the health and well being of individuals, families, communities, and populations.

This study was presented during the 2012 Annual Meeting and Scientific Session of the Society of Behavioral Medicine (SBM) from April 11-14 in New Orleans, LA. However, it does not reflect the policies or the opinion of the SBM.

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David Goodrich
Society of Behavioral Medicine
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