An overview James S. Skinner, Ph. D. Professor Emeritus Indiana University

What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? Would you prescribe it to your patients? Certainly Robert E. Sallis, M.D., FACSM Exercise is Medicine™ Task Force Chairman

Regular exercise or physical activity associated with beneficial effects to prevent and treat CHD & hypertension Metabolic disorders (e.g., Type 2 diabetes, obesity, metabolic syndrome) Colon and breast cancer Osteoporosis Anxiety and depression Problems associated with aging

Epidemiological studies and experimental studies: Exercise training improves risk factors & health-related factors Blood lipid profiles Blood pressure Body composition Glucose tolerance & insulin sensitivity Bone density Immune function Psychological function

Summary of Current Scientific Knowledge Benefits of exercise to prevent and treat chronic disease cannot be denied Overwhelming evidence: physical inactivity is a public health burden

PROBLEM How to translate overwhelming scientific evidence into an effective public health strategy and initiative ?

PROBLEM Health care providers (HCPs) continue to ignore evidence on exercise when formulating preventive plans and treatment plans for their patients

Physicians lack the training to effectively counsel patients about exercise Physicians lack the time to effectively counsel patients Why ?

Physicians are not adequately reimbursed for exercise counseling or referral No tangible success measures Why ?

SOLUTION

SOLUTION : Exercise is Medicine™ Exercise should be integrated into mainstream medical care as part of every HCP office visit HCPs should prescribe exercise to patients / clients or refer patients / clients to a qualified fitness or allied health professional for further counseling

SOLUTION : Exercise is Medicine™ Multi - organizational, Multi – national initiative launched by American College of Sports Medicine and American Medical Association November 2007

GOALS No patient / client should leave HCP office without: Assessment of physical activity Exercise prescription or referral to qualified fitness or allied health professional for further counseling

EIM : Based on Strong Science, Resources and Partnerships Set up Task Force M. D. s Ph. D. s Fitness Professionals People with strong knowledge of and influence with Industry Legislation & Policy Making

EIM : Based on Strong Science, Resources & Partnerships Create Educational Resources Teach HCPs to write exercise prescription Teach fitness professionals to work with HCPs and patients with most common chronic diseases Teach public to talk to HCP about exercise and how to hold EIM community events and activities

Action Guides ( Toolkits )

Physical Activity Assessment Form Part One: Current Exercise Habits Do you currently participate in regular physical activity? ______ Yes ______ No Describe your current physical activity habits List all of the physical activities you do in a typical week For each activity, list how many days each week What are the total minutes in the day that you are involved in the activity. How hard do you perform the activity? Light – equal to a strolling walk; easy to talk Moderate – equal to a brisk walk; heart rate and breathing increases slightly; you can talk but not sing Vigorous – equal to a slow jog or more; heart rate and breathing increases significantly; can’t talk or sing easily

Physical Activity Assessment Form Part One: Current Exercise Habits Type of Physical Activity Sample: Walking Number of days / week 3 Minutes per day 15 Total minutes per week 45 Intensitymoderate How much time each day do you spend sitting, reclining, or napping? Include time sitting at a desk and in meetings, working on a computer, watching TV and movies, playing video games, and commuting. watching TV and movies, playing video games, and commuting. Do not count the time spent sleeping during your usual sleep hours. _______ hours per day

 Yes  No Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?  Yes  No Do you feel pain in your chest when you do physical activity?  Yes  No In the past month, have you had chest pain when you were not doing physical activity?  Yes  No Do you have a bone or joint problem that could be made worse by a change in your physical activity?  Yes  No Is your doctor currently prescribing drugs (example, water pills) for your blood pressure or heart condition?  Yes  No Do you know of any other reason why you should not do physical activity? Part Two: Medical Readiness Exercise Preparticipation Checklist Name:________________________________ Date:________________________________ Check YES or NO.

Provides information and advice on exercising safely with health conditions Physicians and fitness professionals can recommend to patients / clients Includes titles such as: Exercising Following a Stroke Exercising while Losing Weight Exercising Following a Heart Attack Exercising with Alzheimer's Exercising with Anxiety and Depression Exercising with Atrial Fibrillation Exercising with Cancer Exercising with Low Back Pain Exercising with Peripheral Arterial Disease Exercising with Visual Impairment Exercising Following Coronary Artery Bypass Surgery All titles available for download at: “Your Prescription for Health” series

Additional Resources Action Guides for Health Care Providers & Fitness Professionals “Keys to Exercise” video series

SOLUTION : Implementing EIM Create HCP Coalition

Create HCP Coalition : Example of US Partners Example of US Partners Federal Partners President’s Council on Physical Fitness and Sports Public Health Partners US Office of the Surgeon General US Office of the Surgeon General US Centers for Disease Control and Prevention National Coalition on Promoting Physical Activity Professional Partners American Medical Association American Medical Association American Heart Association American Academy of Family Physicians American Academy of Orthopedic Surgeons American College of Preventive Medicine Industry Partners Coca-Cola Anytime Fitness TechnogymEASports NBA FIT US Professional Tennis Association USA Track and Field YMCA of USA

SOLUTION : Implementing EIM Create HCP - Fitness Professional Referral System

Referral to Health and Fitness Professional Name: ________________________________ Phone:________________________________ Address:______________________________ Website:______________________________ PHYSICAL ACTIVITY GUIDELINES & RECOMMENDATIONS 150 minutes per week of moderate – intensity or 75 minutes of vigorous – intensity physical activity or a combination of moderate- and vigorous – intensity physical activity Plus muscle – strengthening activities that involve all major muscle groups done on two or more days per week “Light” intensity: can talk or sing during exercise (i.e., walking slowly) “Light” intensity: can talk or sing during exercise (i.e., walking slowly) “Moderate” intensity: can talk but not sing (i.e., walking fast) “Moderate” intensity: can talk but not sing (i.e., walking fast) “Vigorous” intensity: can’t talk or sing (i.e., jogging, running) For more information, visit

ACSM ProFinder: NCQA - accredited associations: Physician Referrals to Fitness Professionals

SOLUTION : Implementing EIM Seek Industry Partners Help fund initiative Build public awareness Legislative & Policy Partners

Introduce EIM to universities Provide opportunity to support EIM Promote physical activity and health benefits on campus Provide opportunity to support EIM in local community Open dialog between university and public health officials on lifelong physical activity and EIM Goals for University Partners

Exercise is Medicine TM A Global Initiative Join international partners who share the belief that we must use the scientifically proven health benefits of physical activity to prevent and treat chronic diseases Improve public health of people worldwide

First World Congress in Baltimore, USA June 2010 Share information on latest research – to – practice discoveries Share information on how to translate science & philosophy into strategies & practices likely to be effective in political, economic, & cultural milieu of each country Exercise is Medicine (EIM) A Global Initiative

EIM Global Governance EIM Executive Council EIM US Advisory Council US Professional Organizations EIM International Advisory Council EIM Regional Center Latin America EIM Regional Center Europe EIM Regional Center Asia EIM Regional Center Africa EIM Regional Center Australia EIM Industry Advisory Council

EIM Globally North America USA, Canada Latin America Colombia, Mexico, Costa Rica, Brazil Europe Italy, France, United Kingdom, Portugal, Germany, Sweden, Spain, Hungary Asia China, Singapore, India Africa South Africa Oceania Australia

Legislation for counseling reimbursement Influence national policy (e.g., exercise as Healthcare Effectiveness Data & Information Set [HEDIS] measure) Influence medical electronic / health record companies to include exercise as a vital sign Future Goals

Organize research to show efficacy of exercise counseling & exercise and cost effectiveness of exercise Introduce exercise into U.S. medical schools and physician’s office Establish more global partners & regional centers Future Goals

Thank You Very Much Nagyon Szépen Köszönöm