December 16, 2019 Imagine you’re at your annual wellness exam. You get your blood pressure checked and your respiratory rate measured. You chat with your provider about your eating and drinking habits, how well you’re sleeping and how stressed you feel. Then comes a seemingly basic question: How much physical activity are you getting each week? Turns out, this question can have huge implications for your health. By hearing how you respond, your provider may suggest ways you can incorporate more exercise into your life — even going so far as to actually prescribe you exercise. Measuring exercise as a vital sign According to the World Health Organization, physical inactivity is the fourth leading risk factor for mortality in the world. Studies show that a sedentary lifestyle can contribute to health conditions like obesity, heart disease, certain cancers, stroke, type 2 diabetes and depression. That’s why national physical activity guidelines recommend at least 150 minutes of moderate-intensity physical activity per week and muscle strengthening exercises at least two days a week. “The big problem is that 80% of Americans do not meet the physical activity guidelines,” says Cindy Lin, MD, Associate Professor of Rehabilitation Medicine and Assistant Director of Clinical Innovation for The Sports Institute at UW Medicine. “And based on our own research findings, as well as King County data, a large percentage of the local population is not sufficiently physically active and this can impact health.” To help address this issue, Lin and colleagues — including Dr. Nicole Gentile, an instructor in family medicine, and Dr. Mark Sederberg, a resident physician in rehabilitation medicine — piloted Exercise is a Vital Sign (EVS), a recommendation of the American College of Sports Medicine’s Exercise is Medicine initiative. “It’s the concept that patients should be asked about physical activity as a vital sign, just like when they get their blood pressure and heart rate checked,” Lin explains. “It started as a quality improvement project in sports medicine clinics in 2016 and that led to its integration through several pilot UW Medicine clinics.” When a medical assistant asks an EVS, patients estimate how much physical activity they’re getting each week. From there, patients and their providers can discuss the importance of movement for health and different strategies to incorporate more of it into their daily lives. To date, EVS has been recorded in more than 65,000 UW Medicine patient visits. Making exercise accessible to all While asking about a patient’s activity levels is a helpful way to start the conversation about exercise and health, providers still need easy and fast ways to encourage patients to take the next step. If exercise is considered medicine that can “cure” a sedentary lifestyle, there should be a simpler way to prescribe it. In spring 2019, The Sports Institute launched Exercise Rx to help do just that. Exercise Rx is a website featuring more than 230 free or low-cost exercise resources across 39 cities in the Greater Seattle area. It also includes online and home-based options. “We really want Exercise Rx to serve our patients that cannot afford gyms or private fitness classes and connect them to exercise resources in our community,” Lin notes. “We hope to help support everybody of any age or ability level in finding a way to get moving.” Developing innovative exercise prescriptions Lin and the team at The Sports Institute are working on new ways to support patients on their journeys from sedentary lifestyles to active ones. For example, they believe that patients might be more invested in making healthy lifestyle changes if the exercise is prescribed, tracked and involves motivational feedback from the healthcare team. To help with this, the team is collaborating with the Ubiquitous Computing Lab at the Paul G. Allen School of Computer and Engineering to develop the Exercise Rx app that can monitor a patient’s step count and offer virtual encouragement and feedback. They’re also updating and expanding the resources available on Exercise Rx. Eventually, with support, The Sports Institute hopes they’ll be able to broaden the website’s scope to serve the entire state and WWAMI region. “I think UW Medicine offers really unique opportunities for innovation because of our close linkage to the UW main campus and how that brings faculty and students together from different backgrounds,” Lin says. “We have opportunities to work collaboratively with computer science, population health and others to tackle big, challenging problems facing our healthcare system.” To learn more, get involved and contribute resources to Exercise Rx, contact firstname.lastname@example.org.