How To Get Patients To Exercise More

You can relax. This is not a story about how much exercise you should be getting. (Although just writing that line made me get up off my chair and take full advantage of my stand-up desk.)

Instead, it's a story about the power of asking — and measuring. Kaiser Permanente ran a pilot program at four of its 15 medical centers in Northern California and reported Thursday that patients who were asked about exercise lost slightly more weight than patients who weren't.

Disclaimer: we're not talking big amounts. Overweight patients in the pilot group lost 0.2 pounds more than those not in in the program. Patients with diabetes had a 0.1 percent greater decline in their blood sugar levels — known as the A1C test. These are not big numbers individually, but the study points to something bigger — the power of an organized system to improve patients' health.

Dr. Richard Grant with Kaiser's Division of Research is lead author of the study. He said being able to get patients to exercise regularly is the "holy grail" of primary care. This is the "first step, but certainly not the last step, to get people to exercise more," he added.

Here's what they did: When you visit the doctor, a medical assistant or nurse first measures vital signs. You have your blood pressure checked, you get on the scale — and in this program, patients were also asked about exercise habits. How many days a week did they get "moderate to strenuous" exercise?  How many minutes per day at that level? ("Moderate" activity was defined as something that would make you break a light sweat — walking fast, biking, mowing the lawn all counted.) That was all charted. Then, in some of those cases, it would spark a conversation with the doctor.

Grant and colleagues then compared what happened to patients at the four pilot sites against its patients at the other 11 Kaiser sites, or nearly 700,000 adult patients visiting more than 1,000 doctors. They found the small weight loss and the small improvement in blood sugar levels described above. But when they extrapolated that small weight change to all overweight Kaiser members in Northern California, it could mean 23 tons of weight loss.

But remember that even the small amount, the 0.2 pounds, was an average weight loss. "There's some subset of people that lost lost 5-10 pounds," Grant said.

Grant says his next step is to try and identify those people. "Who are the patients who reported zero activity at baseline," he wondered, and went on to become very active. "What we are interested in looking at next is who are the people who really benefited."

Lisa Schilling, vice president of Kaiser's Care Management Institute, credited Grant's research with giving her the hard data to be able to roll out "exercise as a vital sign" to all Kaiser sites nationwide. This study "proved that just talking to people and measuring makes an impact."

"It's not a magic pill," Grant said, "but it's a step in the right direction, it's a system-level step."