Successful Implementation of Exercise is Medicine™ at the Worksite

Lynn JS, C Winters, J Urda, L Marriner, C Fengl, and S Buckenheimer

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• Individualized programs were undertaken for 6 weeks, meeting twice per week• The exercise professional focused on building a relationship with the participant• A variety of motivational techniques and communication efforts were used

including text messages and shared lunches at the cafeteria to discuss healthy eating opportunities

• Pre and post fitness assessments were encouraged • A questionnaire was completed at the end of six weeks which included

questions about plans to continue exercise and a program evaluation

Summary of Program Program Impact

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 individual’s daily routine

to help prevent and manage diseaseResearch evidence supports the premise that the success rate of health behavior change

programs is higher when the physician is involved.

Department of Exercise & Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA

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 participant’s, not yours.• Link participants to their own social support network when possible (friends, family)• It’s 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 I’m

done.”• “EIM has motivated me to be physically active again after stopping for a long time.”• “I lost 5 pounds…I have more confidence in myself…I loved working with my

trainer.”• “EIM program is not just for people who are overweight or unhealthy, it’s for

everyone.”• “The trainers are knowledgeable, helpful, and professional and make the most out of

the experience. I love EIM.”

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.

Abstract

Background

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 6:00am to 11:00pm. 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.

Evaluation Plan

1. The number of patient screenings was quantified to examine the ability of the health care providers to conduct screenings during office visits

2. Participant compliance was analyzed for the 6-week program3. A comparison of participant exercise self efficacy at the beginning and end of the program

was made4. Changes in volume of physical activity from pre-program to the end of the program were

evaluated5. Observation and anecdotal reports from participants and exercise professionals were

carefully documented to qualitative review

1. During the 6-week analysis period, 90% of student health center office visits included “Exercise” screening/counseling

2. Of the patients who did not accumulate 150 minutes of physical activity per week, 10% accepted the referral to the program

3. Twenty participants (age = 24.6 ± 12.6; 4 males, 16 females) with no regular exercise program completed the program

4. 100% of participants completed at least 12 prescribed sessions, and 85% of the sessions were completed within the 6-week time period

5. 100% of participants reported increased exercise self efficacy6. 100% of participants had a detailed plan to continue exercise at the end of the program 7. 100% of the participants changed behavior by increasing physical activity 8. Qualitative feedback from participants and exercise professionals is below

Examples of texts between participants and the exercise professional