A Prescription to Move: Three Ways Health Care Providers Can Promote Active Living

By Sengyeon Lee, Kaiser Permanente Institute for Health Policy, and Athan Bezaitis, Kaiser Permanente

Feature Story
screen shot of Kaiser Permanente member Sandra Mendez
Sandra Mendez

When Sandra Mendez’s physician, Diane Pham, MD, informed her that she was pre-diabetic and at risk of a heart attack and stroke, Mrs. Mendez realized that she had to take control of her health. She started exercising regularly, changed her diet and even brought her enthusiasm to work by swimming with the disabled adults that she sees at her job at Easter Seals, Southern California. Over the years, she has maintained low blood sugar levels and inspired family and friends to also adopt a healthier lifestyle. Mrs. Mendez’s story shows how physicians like Dr. Pham can be powerful advocates for active living, but her experience is not the norm.

Consider this alarming statistic: in 2010, research found that about one in three adults received physical activity counseling from their physician or health professional. Likewise, only half of Americans meet the recommended 150 minutes per week of moderate aerobic activity. To help get people moving, health care providers need to become better health champions. The first step is spreading the word, which is why the Kaiser Permanente Institute for Health Policy and American College of Sports Medicine are offering three strategies as part of their Prescription to Move campaign (#Rx2Move) for health care leaders to promote physical activity and to shape environments that support active living. These include: encouraging physical activity in conversations with patients, redesigning health care environments and investing in communities.

Infographic, Make Physical Activity a Vital Sign. Woman putting on walking shoes in middle, Infograhic on right, green on left, How can health care providers encourage physicial activity

  1. Having a Conversation about the Importance of Fitness
    As experts in health, care providers are in a unique position to discuss the importance of physical activity with patients. Kaiser Permanente is encouraging primary care teams to take the lead with its Exercise as a Vital Sign (EVS) initiative. Providers screen patients for physical activity with two basic questions. First, they ask how many days per week an individual exercises. Second, they ask how long a person exercises on those days. Responses from these questions may lead to a physical activity “prescription,” in which the care provider recommends a specific amount of exercise. These prescriptions are becoming more common in hospitals and clinics. The American College of Sports Medicine is motivating more physicians to refer their patients to certified health fitness professionals with its Exercise is Medicine® initiative. Other health care providers are starting to hand out park prescriptions to increase use of public parks for activity. In Boston, there is a unique “Prescribe a Bike” program, which gives low-income patients discounts on the membership fee – it costs just five dollars per year to access community bikes around the city. These efforts provide focused attention to patients and empower them to take up an active lifestyle.
  1. Designing Active Health Care Environments
    The gym is not the only place for exercise. Even hospitals can be places of physical activity for patients and employees. Health care systems are using a “design for health” approach, which encourages the addition of stairs, bike lanes, walking paths and trails in and around buildings to help their employees build bursts of fitness into their days. Some health care systems have focused on stairs by providing motivational signage placed near elevators and escalators to promote their use. In Fresno, California, the Veterans Administration Medical Center hired a local artist to paint murals on the stairway walls. The interesting artwork, along with a stair-climbing challenge, have led to increased and regular stair use among employees. Kaiser Permanente has adapted this approach by creating accessible walking and biking options to its facilities; they have also built green spaces and gardens so that patients and employees can hold outdoor meetings or take walks during the day. A handy toolkit from the Centers for Disease Control and Prevention provides information about how to begin the design process.
  1. Investing in the Community
    Health care providers are part of the larger community and can endorse physical activity among their community members. Seattle Children’s Hospital has revamped pedestrian walkways and bike lanes. The children’s hospital is also encouraging their employees to use these resources with incentives, such as free bikes and shuttles between work and public transit stations. Kaiser Permanente is also focusing on active transportation for children. It has invested in the Safe Routes to School National Partnership, which is increasing opportunities for safe walking and biking for young people on their way to school. Logansport Memorial Hospital in Indiana is working on creating outdoor recreational spaces. Their foundation raised $700,000 to build trails and parks for the community, including the River Bluff Trail, which has more than 4,000 users per week. The challenge that lies ahead is to make more communities walkable and bike-friendly while changing the culture of neighborhoods to make physical activity a priority.

Health Outside of the Doctor’s Office

Much of what influences health happens outside of the doctor’s office. But it can be that one important conversation with a trusted health care provider that forever changes a person’s life. Just ask Sandra Mendez. Physicians such as Dr. Pham are at the forefront of a movement to help their patients develop and maintain healthy habits. Health care systems can support their providers to take on this leadership role, and commit to creating healthier environments where people live, learn, work and play.