UW study: Prescribe more physical activity, shrink health care costs
Widespread medical efforts to prescribe more physical activity or more regularly check in on patients’ activity levels could significantly reduce the nation’s health care costs, according to a new study from the University of Washington’s School of Medicine.
The findings, published this month in the Journal of Physical Activity and Health, show that “sufficiently active” UW Medicine clinic patients who were surveyed between January 2018 and December 2020 were much less likely than inactive patients to visit a primary care doctor, go to an emergency room or be admitted to the hospital. Researchers went a step further in their analysis: If more adults in the United States were more physically active, our country’s health care costs would shrink.
“Even though physical activity is known to be so beneficial for health, it’s just sort of forgotten in the health care system,” said Dr. Cindy Lin, a UW clinical associate professor of sports and spine medicine and lead author of the paper. “A lot of treatments for chronic conditions are focused on prescribing medications, yet there’s great evidence that physical activity and lifestyle changes can make a huge difference.”
In the U.S., Lin said about 53% of adults meet national physical activity guidelines, or practice moderate exercise at least 150 minutes per week as recommended by the U.S. Department of Health and Human Sciences. Only about 23% meet guidelines for both aerobic and muscle strengthening — a figure that’s worsened during the pandemic as commute times shrank for many and lifestyles grew more sedentary, she said.
Of the nearly 24,000 patients surveyed in the UW Medicine study, those who were considered sufficiently active, about 37.4% of the group, faced about 34 fewer emergency room visits, 19 fewer hospital admissions and 38 fewer primary-care visits per 1,000 patient-years (patient-years are often used in clinical research and represent the total combined number of years all patients were followed).
If inactive patients, about 28.5% of the group, were to hit national physical activity guidelines, researchers estimated ER costs would shrink by more than $34,000 per 1,000 patient-years, assuming each average visit exceeds $1,000.
The team utilized a system called the Physical Activity Vital Sign, or PAVS, which asks patients how often they practice “moderately strenuous” exercise (like a brisk walk) and for how long. The system can be embedded into electronic health records, helping medical teams better understand how physically active someone is, Lin said.
The trend remained consistent even when researchers controlled for patients’ sex, race/ethnicity and body mass index. For those who were older or had underlying medical conditions, the association was even stronger between increased physical activity and fewer health care visits, she added.
There are other factors that impact how physically active a person is — including socioeconomic status, where they live, ability level and job flexibility, among other things — though identifying why or why not a person might seek out a health care visit is more difficult and would require further research, Lin said.
“We can’t change people’s age or past medical history,” she said. “But physical activity is something we can change. Our health care systems are very great at treating people once they have a condition, but what we’re finding is even if people do small amounts of physical activity at home, like breaking up prolonged sitting time or going for a walk after dinner, that all adds up.”
UW Medicine started using PAVS through a pilot program several years ago, though other health care systems, like Kaiser Permanente, have implemented the system to more regularly track patients’ physical activity, Lin said.
“[There’s] a misunderstanding of what physical activity means,” she said. “Historically, this means you have to go to a gym for 30 minutes several times a week for it to count as a workout. But more research has been coming out recently that shows even five to 10 minutes of fitness or movement breaks show important health impacts. Every movement counts.”
At The Sports Institute at UW Medicine, where Lin is the associate director of clinical innovation, staffers offer a wide-ranging list of potential physical activities to incorporate into people’s daily lives, including those that are free and can be done at home.
If your job keeps you at home in front of a computer, get up every so often and walk around, Lin said. Activities like wall sits, chair dips and desk pushups can be done at home, too, according to The Sports Institute website. The institute also suggested people look into free fitness apps, like FitOn or Johnson & Johnson’s Official 7 Minute Workout app.
“We need to make it simpler for people, she said. “And make sure we’re not just giving people pills for medical conditions, but also talking about physical activity and prescribing it.”