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Self-reported exercise assessments offer clue to cardiometabolic risks
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Clinicians could glean additional information about patients’ cardiometabolic risk factors through routine clinical physical activity assessments, according to research published in Preventing Chronic Disease.
“A simple, two-question physical activity assessment performed in the clinic may give health providers additional information about their patients’ cardiometabolic risk,” Deborah Rohm Young, PhD, of the Kaiser Permanente Department of Research and Evaluation in Pasadena, California, told Endocrine Today. “If a person is consistently inactive, they are likely to have increased cardiometabolic risk, and the consistently active are likely to have the lowest risk.”
Deborah Rohm Young
Using electronic records from members of Kaiser Permanente Southern California (n=622,897), Young and colleagues examined the associations of Exercise as a Vital Sign (EVS) program categories with blood pressure, fasting glucose, random glucose and HbA1c.
For the EVS program at Kaiser, providers ask two questions at each outpatient visit — one regarding the number of days per week a patient engages in moderate to strenuous exercise, the other regarding the number of minutes a patient engages at this level.
“Health care providers can assess their patients’ physical activity and then either counsel them themselves to increase physical activity or refer them to counseling and/or effective programs,” Young said. “There needs to be a focus on how this information collected in the clinic can be leveraged to motivate patients to increase their physical activity.”
Adults aged at least 18 years with no comorbidities who had at least three EVS measures between April 2010 and December 2012 and who were not taking antihypertensive or glucose-lowering medications were included in the analysis.
The investigators compared patients who were consistently inactive (no exercise) with those who were consistently active (exercise ≥150 minutes/week) and irregularly active (exercise 1-149 minutes/week).
Separate linear regression analyses were conducted to control for age, sex, race/ethnicity, BMI and smoking status.
“Generally healthy regularly active and irregularly active patients have favorable cardiometabolic risk factors compared with their consistently inactive patients,” Young explained.
Women who were consistently active showed lower systolic (−4.6 mm Hg; 95% CI, −4.7 to −4.44) and diastolic (−3.28 mm Hg; 95% CI, −3.4 to −3.17) BP than those who were inactive. Active men demonstrated lower diastolic BP than inactive men.
Compared with consistently inactive patients, consistently active patients had lower fasting glucose (women, −5.27 mg/dL; 95% CI, −5.56 to −4.97; men, −1.45 mg/dL; 95% CI, −1.75 to −1.16) as did irregularly active patients (women, −4.57 mg/dL; 95% CI, −4.8 to −4.34 and men, −0.42 mg/dL; 95% CI, −0.66 to −0.19).
Consistently active and irregularly active men and women exhibited favorable random glucose and HbA1c measurements vs. those who were consistently inactive.
“It’s great that regularly active patients as assessed by these simple questions have favorable risk factors, but too many of the US population is inactive,” Young said. “Health care providers should consider regular physical inactivity as important a risk factor as the biological risk factors and treat it as such. We need to determine what types of counseling are most effective and who are the most effective deliverers of counseling.” – by Allegra Tiver
For more information:
Deborah Rohm Young, PhD, can be reached at the Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101; email: Deborah.R.Young@kp.org.
Disclosure: The researchers report no relevant financial disclosures.
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Sheri R. Colberg, PhD, FACSM
Young and colleagues address the important question of whether assessing patients’ physical activity levels (as “exercise vital signs,” or EVS) should be included as part of routine care. Their findings in healthy adults strongly suggest that by using EVS clinicians may be better equipped to detect cardiometabolic risk factors, such as elevated resting blood pressure and fasting blood glucose that may be responsive to lifestyle intervention. Abundant clinical trials have shown that regular exercise lowers both cardiovascular and metabolic risk, particularly in patients with chronic diseases like diabetes, and recent research has confirmed that exercise leads to positive changes in methylation patterns on some of the genes in muscle DNA and affects what proteins those genes express. Although this study is cross-sectional in nature and does not allow assumptions about causality, at a minimum we can rest assured that routine inclusion of clinical physical activity assessment will likely offer health care providers better information about their patients’ modifiable barriers to good health and how to best address them with lifestyle interventions. Exercise is truly strong and effective medicine, and it is about time for everyone to start viewing it as such.
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