Interview with Ellen Burton about Exercise is Medicine

Ellen Burton graduated from Boston University with a master’s degree in public health and is a Certified Health Education Specialist. She has a lengthy history in health and wellness with prior engagements that include serving as the Director of the Money Follows the Person Program with the Indiana State Division of Aging, as well as the Director of the Maryland Association of County Health Officers with the Johns Hopkins Bloomberg School of Public Health. She is currently the Program Officer for Exercise is Medicine®, a multi-organizational initiative coordinated by the American College of Sports Medicine.

Here are my 5 questions with Ellen and my summary of her answers:

1) The current chair of Exercise is Medicine® Dr. Robert Sallis stated, “Regular physical activity, at the correct intensity, is so powerful in maintaining and improving health that it should be prescribed, just as a medicine or drug would be.” It is quite clear that empirical evidence backs this up. The government has recently come out with ChooseMyPlate to help influence dietary choices and Let’s Move! to help influence children to increase their physical activity. These are primarily passive programs. Why is it important that your doctor or primary medical provider take an active role in your fitness regimen?

There is a significant amount of research indicating that people who discuss exercise with their health care provider as an important part of their overall health and wellness are more likely to start routine physical activity. Exercise is Medicine rolls this into an actual prescription because getting and filling a doctor’s prescription is a familiar process for people. There are numerous studies indicating that people tend to engage and adhere to prescriptive exercise compared to self-started programs (Decision Making Versus Decision Implementation: An Action Control Approach to Exercise Adoption and Adherence), so empowering doctors to use the prescription referral process to assign exercise makes sense.

As you highlighted in the quote from Dr. Sallis, there is significant scientific data that shows one of the best ways to prevent and treat disease is to get at least 150 minutes of moderate-intensity physical activity each week. Our aim at Exercise is Medicine is to make this powerful concept a part of every discussion about health and well-being. With that in mind, it becomes essential that your doctor or primary medical provider plays an active role.

2) One of the many important areas that Exercise is Medicine is focusing on is benefit reimbursements and legislation initiatives related to health improvements through exercise. There are inflation-adjusted per capita health savings estimates as high as $544 per year (Costs and Benefits of Bicycling Investments in Portland, Oregon) for individuals that exercise regularly. Are there any ideas being executed that use this economic incentive to help with patient adherence?

It’s widely known that disease treatment is also an economic concern. As you’ve said, there are numerous studies that point to the economic benefit of disease prevention. We like to couple the discussion of physical activity with the discussion of fiscal responsibility. We are fortunate to live in a time where one’s life expectancy continues to increase. However, per capita health expenses continue to increase as well, and medical entitlements are a consistent part of the debate over national budget reform. We are working to influence national policy based on the evidence that exercise can reduce the cost of disease. We are also working with insurance companies and other health care associations to encourage referral reimbursements. This effort involves including exercise as part of one’s documented medical history, and we are seeing it documented more in people’s electronic medical records (EMRs). There are no pass-throughs yet (that reach the patient) in terms of economic gain, with the notable exception that the data shows they are likely to spend less on medical care in their lifetime if they adhere to the established federally mandated exercise guidelines.

3) With regard to the established federally mandated exercise guidelines, within the current Exercise is Medicine fact sheet it is stated that four out of every ten U.S. primary care doctors, and more than one third of U.S. medical students are failing to meet the minimum requirements. Further, physically inactive doctors are less likely to provide exercise counseling to patients and provide less credible role models for the adoption of healthy behaviors. What strategies are being used to help doctors understand that physical activity (at the right intensity) is a valuable prescription, for themselves and their patients?

We are employing several different strategies to improve these statistics. Our website features the Exercise is Medicine Health Care Providers’ Action Guide and also provide supplemental materials to tell physicians and health care providers about the evidence supporting exercise prescription. We also have developed strategic partnerships with health advocacy groups, such as The Institute of Lifestyle Medicine, who create training courses for health care providers and physicians.

We are also working to ensure that exercise education becomes part of the standardized curriculum at medical schools. Reaching doctors before they begin practicing is one of the most effective approaches to improving these statistics. It is critically important that doctors understand that they are role models and their behavior is proven to have an impact on patient outcomes. Therefore, it is important that doctors understand the role exercise plays in preventative medicine.

4) Exercise is Medicine’s approach seems to be focusing their effort on establishing a connection between medical practitioners and their patients. In an era where some people are choosing to have more personal influence over their own health care, are there strategies in place to help provide influential advice through information channels that cater to this segment of the population (ex. WebMD, Healthline, Wikipedia, etc.)?

We understand you do not need to talk with your doctor to know walking is good for you. Our focus at Exercise is Medicine is incorporating the idea that exercise is a medicinal tool, which needs to be properly addressed with health care providers and their patients. It is something that should start with the doctor, potentially get passed along to the engaged health-and-fitness professional, and ultimately adhered to by the patients themselves. We are quite aware that, for instance in pharmaceutical sales, direct-to-consumer marketing can influence patient behavior. To the extent that we can pass along information to consumers about the benefits of exercise, we will do that. Our overarching goal for all audiences is to make physical activity an integral part of every discussion about the prevention and treatment of disease.

5) With innovations such as FitBit, BodyBugg, and BodyMedia there are ways of tracking physical activity and progress through technology, in turn providing positive feedback loops that can assist with patient adherence. To what extent do you see the importance of technology playing a role in achieving Exercise is Medicine’s mission?

We are always exploring ways to use technology effectively. We have partnered with Interactive Health Partners of PCE Fitness to create technology that improves the way patients connect with doctors and health care providers. The software lets doctors risk-stratify patients by determining their activity levels, and it assists them in providing personalized exercise prescriptions that are medically precise. It will also help doctors in the next step of the referral process by giving them access to a database of qualified health-and-fitness professionals. If the prescription can be self-monitored by the patient, the software will enable patients to log exercise results and track outcomes and other valuable metrics.

We are also currently redesigning our own website, which includes several micro-sites. There will be behavioral tools, ways to track physical activity online, and other applications to help users create positive feedback loops.

It is important to note however, that as great as technology is, not everyone has access to it or the inclination to use it. For many families, the gym, Internet service, and unfortunately even medical care, might be cost-prohibitive. We are cognizant that if we rely on technology too heavily, we could potentially exclude a segment of the population. In that regard, we are careful to make sure that we include initiatives that can cast the widest net and help everyone.