EXERCISE CONTRIBUTION TO HEALTH
Regular exercise contributes to good health. It strengthens the heart and the lungs, tones the muscles, prevents or mitigates weight gain and contributes to brain health and mental health fitness. It is undisputed that Individuals who exercise regularly are healthier, are less dependent upon medical intervention by their physician, require less intensive management of hereditary chronic disease conditions, have lower rates of hospital admissions and shorter lengths of stays, when hospitalized.
WHY IS EXERCISE “NOT” A HEALTHCARE TOPIC OF DISCUSSION?
However, the benefit of regular exercise to good health is rarely a topic of discussion that a primary care physician initiates during an office visit with a patient, even during the patient’s non-urgent “annual physical examination appointment.” This is, primarily, due to the fact that the primary “healthcare” services the physician provides are for the treatment of a patient’s physical discomfort and sickness, the management of the patient’s existing chronic disease conditions and the urgent treatment of the patient’s injuries and physical trauma. Physicians solve “health problems.” That is what physicians are educated and trained to do, how they are paid and how their performance is evaluated by the federal and commercial healthcare insurers that fund “healthcare” services. A physician’s inquiry of a patient’s good “health” habits and their advice regarding the adoption or continuation of these habits is not what is expected by their patients. It is not required by the “standards of care” established for the practice of medicine nor by the guidelines and policies for health insurance coverage of and payment for physician services.
ALL PHYSICIANS DO ACKNOWLEDGE “BENEFIT” OF EXERCISE
Nevertheless, all physicians acknowledge the benefit of self-motivated efforts and habits of patients for improving and preserving their health. Among healthcare professionals, these habits are generally described and categorized as “preventive health.” Foremost among these acquired “preventive health” habits is regular exercise. The “good health” benefit to a patient who regularly exercises is apparent to their physician during a patient appointment. This is based upon the patient’s physical appearance and the physician’s review of their vital signs which provide evidence of their current physical condition. It is well known among physicians that those patients who exercise have better health. The awareness and recognition, within the medical profession, of the health benefit of regular exercise, is also supported by a significant volume of published and peer reviewed medical research devoted to this topic.
PHYSICIANS “CAN INCLUDE” EXERCISE AS TOPIC OF DISCUSSION DURING A PATIENT VISIT
If patients rely upon, and are confident of, their physician’s advice, assistance and solutions for their health “problems,” and if physicians acknowledge the value and benefit of regular physical activity to the patient’s health, it seems reasonable to expect the physician to address the physical activity habits of the patient during a typical patient office visit at a reasonable level of frequency (eg. quarterly). This will enable the physician to become more actively involved in advising, motivating and managing even gradual increases in the regular physical activity habits of their patients, to the benefit of their overall health.
PHYSICIANS CAN IMPLEMENT PHYSICAL ACTIVITY QUESTIONNAIRE, TEST & MEASURE
The physician can begin the discussion regarding the physical activity habits of a patient, with a short, standardized multiple-choice questionnaire (eg. how often, how long, how hard do you exercise). The purpose is to raise the patient’s awareness of the importance of regular physical activity to their health and to encourage the patient to describe their current regular exercise habits in the form of the specific measurable responses required by the questionnaire. The physician’s review will also require a physical test which can provide a “measure” of the effect of the patient’s regular physical activity habits on their “overall” health. This would be comparable to the measurement of current “vital signs” such as the pulse and blood pressure of the patient. This test will measure the effect of exercise in the form of a range of values within a scale of acceptability (eg. bad, good, better, best).
The purpose for using a multiple choice, descriptive, “physical activity questionnaire” in combination with a separate physical measure or “vital sign” is to assess the consistency between each patient’s questionnaire responses and their actual physical test result. In addition, the test result will provide a ranking of “regular exercise sufficiency” to identify those patients who will require more active intervention and follow up by their physician.
THE GOAL — FORMALIZE PATIENT “EXERCISE” AS TOPIC AND MEASURE AT THE PHYSICIAN’S OFFICE
A patient’s “exercise habits” can be regularly assessed as a “preventive health” topic and requirement during an appointment with their primary care physician. As previously recommended, a short, multiple-choice questionnaire could fulfill this “preventive health” requirement: (How often do you exercise? How long is your typical exercise session? How hard are you working / breathing while exercising?) This practice would be no different from the typical review, at every physician visit, of the existing chronic disease conditions of the patient and/or the review of current medications which have been prescribed by the physician. By having the physician formally address a patient’s “regular exercise habits” as a “part” of their visit with the patient, this “preventive health” habit becomes a mutually acknowledged element of the patient’s “medical care.” It also implies that the patient’s “regular exercise” will be regularly monitored and addressed during a visit with their primary care physician. This is a necessary condition for assigning value to regular exercise, but it is not sufficient for establishing the implied “preventive health” responsibility and compliance by the patient
Therefore, an objective measure of the personal “fitness level” of the patient, as determined by their “regular exercise habits,” will also be required during their physician visit. This will identify the patient’s current level of “regular exercise compliance” based on a “research-validated” standard and measure. That standard is the patient’s Cardio-respiratory Fitness (CRF) level which can be easily measured, interpreted by their primary care physician and discussed with the patient during the physician visit.
THE SOLUTION — CARDIO-RESPIRATORY FITNESS AS THE STANDARD AND MEASURE OF “REGULAR EXERCISE”
Cardio-respiratory Fitness (CRF) describes the interdependence of the respiratory system (lung function) and the circulatory systems (heart and vascular function) to supply oxygen and nutrients to the large skeletal muscles of the body when those muscles are in active use during physical exertion (i.e. exercise). The measure of Cardio-respiratory Fitness is VO2max or “maximal oxygen uptake.” The formula is milliliters of oxygen per kilogram of body mass per minute (ml / kg / min). The measurement of cardio-respiratory fitness has already been adopted by athletes for improving their speed and endurance in individual sports competitions (eg. running, cycling and swimming). Within the exercise physiology profession, it is considered as the single best measure of aerobic fitness.
The currently accepted standard for measuring cardio-respiratory fitness is an exercise stress test that is performed while the body is under physical exertion. It requires the use of a treadmill or stationary bicycle, a heart rate monitor and a metabolic cart, which measures respiration. However, advances in heart rate monitoring (HRM) technology have also included the research and development of an embedded algorithm, within the heart rate monitor, for evaluating the “inter-beat interval” variability of the “monitored” resting heart rate. These advances have resulted in the development of a non-exercise Cardio-respiratory Fitness Test (neCFT). The neCFT requires the use of a heart rate monitor (HRM) that includes the embedded algorithm, which can provide an acceptable and reliable estimate of Cardio-respiratory fitness (CRF) while the individual is at rest. Consequently, the stress-free nature of the neCFT makes it the most practical, safe and risk-free “diagnostic test” for measuring the individual’s cardio-respiratory fitness (CRF) which reflects the individual’s “habitual” physical activity.
CARDIO-RESPIRATORY FITNESS AS “PREVENTIVE HEALTH”
During the past six (6) years, an increasing number of peer-reviewed medical research studies have proposed that a measure of a patient’s Cardio-respiratory Fitness (CRF) should be included as an additional “vital sign” that is assessed and documented at every patient / physician visit. A key finding and conclusion of these research studies is that a measure of a patient’s cardio-respiratory fitness provides the best indicator of the patient’s total body health. All of these studies have recommended the use of a non-exercise test as the most practical and acceptable method for establishing the “evaluation and management” of Cardio-respiratory Fitness (CRF) within a physician office setting. The collection of a measure of a patient’s physical activity habits will raise awareness regarding the importance of regular physical activity and will facilitate the regular review, discussion and intended patient compliance during a visit with their primary care physician.
The adoption and use of a non-exercise Cardio-respiratory Fitness Test (neCFT) as a “preventive health” evaluation tool and measured “vital sign” during a physician appointment can provide the basis for a meaningful and focused discussion between the physician and the individual about the importance of the individual’s regular physical activity to their health. The intended behavioral compliance by the patient, whether by the continuation of current “regular” physical activity habits or the necessity for, and challenge of, adopting reasonable and manageable levels of physical activity on a regular basis, can then become a “preventive care” component, of their “medical care,” which is regularly measured, monitored and positively influenced and guided by their primary care physician.
PHYSICIANS PROVIDING NON-EXERCISE CARDIO-RESPIRATORY FITNESS TEST AND PATIENT FITNESS COUNSELING
Implementation of this proposed “preventive care” service, will require the provision of the non-exercise Cardio-respiratory Fitness Test (neCFT) to the patients of primary care physicians at reasonable levels of frequency. It will also require the administrative and procedural support for the physician’s oversight and provision of equally, if not more, important physical activity counseling which will be provided to patients based on neCFT results showing low cardio-respiratory fitness levels. Health insurance coverage and payment for the neCFT will be required, subject to the submission of necessary applications. Similarly, coverage and payment for the professional counseling services of the primary care physician will also be required, subject to application. Both coverages will require the submission of a “preventive care service” application to the Centers for Medicare and Medicaid Services (CMS) within the Department of Health and Human Services (HHS). CMS has the authority and ability to approve fee-for-service coverage of “preventive care services” subject to the submission of an application.
EXERMETRX VALUE PROPOSITION
Our company can perform a non-exercise Cardio-respiratory Fitness test (neCFT) on an individual which will provide a validated and ranked measure of the individual’s regular physical activity habits. This will improve the health and health maintenance habits of the patient, as regularly evaluated by their primary care physician, reduce their need for medical intervention and reduce the cost of their medical care over time.
The non-exercise cardio-respiratory fitness test (neCFT) we are proposing is based on a research-validated algorithm which measures the resting heart rate variability of an individual. The “inter beat interval variability” of heartbeats within an individual’s resting heart rate is indicative of the degree to which their heart is exerted during any form of physical activity, the range of heartrate exertion, and the frequency and duration of the individual’s habitual physical activity over time.
Essentially, the neCFT evaluates and measures the most recent history of an individual’s habitual physical activity in the form of an age and gender stratified, single value, ranked score. Consequently, the test can provide an evidence-based measure and record of “regular exercise activity and sufficiency” for the individual, regardless of their age and current physical condition. The measure of the individual’s Cardio-respiratory Fitness (CRF) can be regularly monitored and managed by their primary care physician as a defined “preventive care” service requirement.
The non-exercise cardio-respiratory fitness test (neCFT) will be offered to primary care physicians as a testing service for their patients. It can be performed within an exam room in the physician’s office. Delivery of this service to patients at their primary care physician’s office is intended to ensure that it is a physician-directed and supervised “preventive care” service. Consequently, it will ensure the physician’s oversight and participation to directly influence patient compliance and accountability for their personal “regular exercise” habits. The objective is for the patient to achieve and maintain an acceptable level of Cardio-respiratory Fitness (CRF).
Additional details about our capabilities and comprehensive service to actualize the value, importance and health benefit of “regular exercise” as a component of the medical care services an individual receives from their physician care physician can be found here:
FEDERAL MINIMUM PHYSICAL ACTIVITY STANDARDS AND PATIENT PROGRESS MEASUREMENT
The physician’s review and discussion of each patient’s neCFT ranked score will also include the review of the Department of Health and Human Services (HHS) published Minimum Physical Activity Standards. These standards provide quantified measures of “regular” physical activity as defined by its duration (minutes), frequency (weekly) and intensity (heart rate beats per minute). The “intensity” measure is determined in the form of a percentage of the individual’s age-specific maximum heart rate. The standards are intended to serve as a guideline for the recommended, reasonable, amount of time and energy required by any individual, on a weekly basis, to devote to regular exercise. Fortunately, advances in personal wrist-based heart rate monitors (HRM) can provide effortless recording and reporting by the individual of the quantified measures of physical activity (frequency, duration & intensity) to facilitate exercise planning and standards compliance. These HRM’s also provide “real time” feedback to the “exercising individual” for measuring personal progress and for confidence building.
INCREASING PATIENT PHYSICAL ACTIVITY – THE “PHYSICIAN-GUIDED” BEHAVIORAL MODIFICATION PROCESS
Patients demonstrating sufficient habitual physical activity, based on their neCFT ranked score, may be requested to provide a description of their “regular physical activities” during their physician visit and will be encouraged to continue those habits. Patients with neCFT ranked scores below acceptable limits will be further questioned by their physician regarding the time they currently devote to physical activity and will be issued a “physical activity prescription.” The “prescription” will require patient input regarding their preference as to type of physical activity and the initial levels of “exercise” frequency, duration and intensity that are achievable by the patient. The involvement of the patient in the creation of the physical activity prescription is intended to ensure the anticipated behavioral change compliance by the patient in their adoption of regular and reasonable physical activity habits.
A follow-up visit for these low scoring patients will be pre-scheduled with their physician, following a reasonable interval of time (eg. 3 months), to allow the patient to fulfill the requirements of the prescription. This visit will be preceded by a follow-up neCFT. At that follow-up visit, the neCFT ranked score will be reviewed, compared with the patient’s prior neCFT and discussed with the patient. The discussion will include the patient’s self-attested efforts in fulfilling their initial physical activity prescription and their concerns and expectations, going forward, regarding their continued commitment to, and progress with, their “regular” physical activity habits.