Successful Implementation of Exercise is Medicine

1
Successful Implementation of
Exercise is Medicine
at the Worksite
Lynn JS, C Winters, J Urda, L Marriner, C Fengl,
and S Buckenheimer
Department of Exercise Rehabilitative Sciences,
Slippery Rock University, Slippery Rock, PA
Summary of Program
Program Impact
Abstract

• 1. Develop a relationship with health care
  provider(s)
• The health care providers at the student health
  center were educated about the Exercise is
  Medicine ideologies. They agreed to embed
  physical activity into their electronic medical
  record so that students who were being seen for
  non-urgent conditions were screened for their
  volume of physical activity as a 6th vital sign.
• Students not accumulating 150 minutes of physical
  activity per week were given the option of
  receiving a brochure on fun ways to exercise or
  being referred to the one-on-one exercise
  program.
• Local physicians were contacted about the program
  and are encouraged to refer their patients to the
  program.
• For a corporate wellness program, contacts would
  be made with health care providers caring for the
  employees.
• 2. Establish the venue or facility for physical
  activity interventions
• In the present case, the program has full access
  to the on-campus recreation center. Students do
  not pay extra to use the facilities, but
  referrals from off-campus physicians must
  purchase a membership.
• A corporate site with a fitness facility has a
  built in venue, but local fitness facilities or
  university facilities could be approached to host
  the exercise program.
• 3. Provide qualified exercise professionals to
  accept the referrals and run program
• Exercise Science students at the end of the
  curriculum provided the one-on-one
• exercise/wellness programming and reported
  to faculty.
• Interns collected referrals and contacted the
  patients/participants
• Participants completed an initial wellness
  questionnaire including health history and
  physical activity history and interests related
  to wellness
• Initial visit included wellness coaching and
  motivational interviewing to establish a plan

Organization Slippery Rock University (SRU)
offers a variety of undergraduate and graduate
programs for about 8,850 students. Approximately
950 faculty, staff, and administration are
employed at SRU. SRU has a relatively new
wellness commission which provides a variety of
health and wellness initiatives.   Summary of the
Primary Program Utilizing the Exercise is
Medicine model, employees and students are
referred by their Personal Care Physician or the
Student Health Center. Once referred, a qualified
exercise professional provides motivational
interviewing, comprehensive pre/post fitness
assessments, and individualized exercise
prescription, focused on creating SMART goals to
initiate behavior change and improve
self-efficacy.   Explanation of the evaluation
plan Adherence to the exercise program, pre/post
fitness assessment outcomes, self-efficacy, and
behavior change were measured over a 6-week
period.   Summary of the program impact Twenty
participants (age 24.6 12.6 4 males, 16
females) with no regular exercise program
completed the intervention. Participant
compliance was 85 within 6-weeks. One hundred
percent of participants reported feeling more
confident about exercising regularly, and 100
had a plan in place to continue to exercise. The
program was successful to increase physical
activity, self-efficacy, and positive behavior
change. Additionally, participants established a
plan to continue a regular exercise program.

• During the 6-week analysis period, 90 of student
  health center office visits included Exercise
  screening/counseling
• Of the patients who did not accumulate 150
  minutes of physical activity per week, 10
  accepted the referral to the program
• Twenty participants (age 24.6 12.6 4 males,
  16 females) with no regular exercise program
  completed the program
• 100 of participants completed at least 12
  prescribed sessions, and 85 of the sessions were
  completed within the 6-week time period
• 100 of participants reported increased exercise
  self efficacy
• 100 of participants had a detailed plan to
  continue exercise at the end of the program
• 100 of the participants changed behavior by
  increasing physical activity
• Qualitative feedback from participants and
  exercise professionals is below

Background

• Exercise is Medicine (EIM) is a global
  initiative created by the American College of
  Sports Medicine (ACSM), the American Medical
  Association (AMA), and numerous global partners
  with interests in health and wellness.
• The goals of EIM include
• Making exercise an important part of the accepted
  medical paradigm
• Bridging the gap between clinicians and exercise
  specialists to increase physical activity
• Making physical activity and exercise an integral
  part of the individuals daily routine to help
  prevent and manage disease
• Research evidence supports the premise that the
  success rate of health behavior change programs
  is higher when the physician is involved.

• Effective Strategies Cited by the Exercise
  Professionals
• Build the relationship first, then take care of
  the exercise prescription.
• Motivational interviewing and wellness coaching
  are keys to success. The plan must be the
  participants, not yours.
• Link participants to their own social support
  network when possible (friends, family)
• Its not all about the gym. Participant meetings
  were at the art gallery, the cafeteria, and
  outside on the walking path
• Statements from Participants
• It acts as stress relief and allows me to set
  goals and develop holistically.
• The program has given me all the tools I need to
  stay active and healthy when Im done.
• EIM has motivated me to be physically active
  again after stopping for a long time.
• I lost 5 poundsI have more confidence in
  myselfI loved working with my trainer.
• EIM program is not just for people who are
  overweight or unhealthy, its for everyone.
• The trainers are knowledgeable, helpful, and
  professional and make the most out of the
  experience. I love EIM.

Organization
Slippery Rock University includes numerous
buildings situated on a 660-acre campus in a
rural area 80 km north of Pittsburgh, PA. The
university offers over 60 undergraduate and 20
graduate programs to 8,850 students. Students
have access to a student health center which
employs nurse practitioners, nurses, and a
medical doctor. The university has an 82,000
foot comprehensive recreation center which is
available to all students from 600am to 1100pm.
In addition to the facility, the recreation team
offers group fitness classes, intramural sports,
outdoor adventures, and aquatic programs. The
Exercise Science Program at SRU prepares students
to work one-on-one with clients or patients in a
variety of settings. The curriculum includes
intensive training in wellness coaching,
motivational interviewing, and exercise
prescription for healthy and special populations.
In the penultimate semester, students have a
class in which they are assigned a client for
whom they must conduct assessments, shape
wellness/fitness goals, create goal driven
comprehensive exercise prescriptions, and guide
the program twice per week for 12 weeks. The
final semester includes a 12-week (480 hour)
internship.
Examples of texts between participants and the
exercise professional
Evaluation Plan

• The number of patient screenings was quantified
  to examine the ability of the health care
  providers to conduct screenings during office
  visits
• Participant compliance was analyzed for the
  6-week program
• A comparison of participant exercise self
  efficacy at the beginning and end of the program
  was made
• Changes in volume of physical activity from
  pre-program to the end of the program were
  evaluated
• Observation and anecdotal reports from
  participants and exercise professionals were
  carefully documented to qualitative review