June/July 2024 Issue
Focus on Fitness: Exercise Is Medicine
By Kelly Jones, MS, RD, CSSD, LDN
Today’s Dietitian
Vol. 26 No. 6 P. 38
Physical Activity’s Importance in the Care Plan
Due to the clear link between exercise and long-term physical health—as well as cognition and mental health—the Department of Health and Human Services released the Physical Activity Guidelines for Americans, with input from the American College of Sports Medicine (ACSM) and the CDC, to recommend adults fit in at least 150 minutes of moderate-intensity aerobic activities.
In addition to these recommendations, the guidelines cover muscle-strengthening activities at least two days per week.1,2 However, just as we see roughly 90% of Americans falling short of meeting fruit and vegetable requirements, less than one in four adults are meeting these minimum standards for movement.1,2 This article will explore exercise as medicine, its implementation, and potential opportunities that RDs can incorporate these practices.
Defining ‘Exercise Is Medicine’
Unlike a “food is medicine” philosophy adopted by some individuals in the nutrition and wellness world, Exercise is Medicine® (EIM) is a trademarked health initiative colaunched by the ACSM and the American Medical Association in 2007.3 The initiative isn’t intended to replace modern medications, but to encourage medical professionals to prescribe exercise as part of a patient’s treatment plan for noncommunicable diseases.
EIM is meant to make the promotion of physical activity a standard in clinical care, including a regular assessment, followed by a physical activity prescription in addition to referrals. Today, the practice is used globally in over 40 countries. The steps EIM medical teams and their health care providers follow include the following:
• the assessment of the patient’s physical activity level at every visit to determine if they meet the 2018 Physical Activity Guidelines;
• provide brief counseling, or an exercise prescription when a credentialed exercise professional is available; and
• referral to appropriate physical activity programs, places, professionals, or other self-directed resources.
EIM Implementation
Since its inception, EIM has built a network of partners and developed the ACSM EIM credential. Partners include health care associations such as the American Association of Nurse Practitioners, the North American Spine Society, and Preventive Cardiovascular Nurses Association, among others, who are dedicated to educating their members and playing a role in the advocacy of EIM.
These larger health care and community partners are integral to the EIM movement in order to better stay connected with the health care professionals who are capable of making the referrals. Programs that make this easier at the fitness club level include the Physician Referred Exercise Program (P.R.E.P.) developed by ACAC Fitness Club. Both health care centers and fitness clubs will develop a plan to onboard and aid any exercise referrals from physicians.
After contact is initiated, a fitness club member can schedule the patient a free appointment with a personal trainer for recommendations and specific fitness class suggestions specific to their disease state. Holy Cross Health in Fort Lauderdale and Augusta Health in Georgia are examples of EIM sites providing 12 to 16 introductory programs, while The Atlantic Club in New Jersey is another location offering a medical fitness program integrated with ACAC’s P.R.E.P.
With some programs, such as the one at ACAC and The Atlantic Club, the patient’s support may also include self-pay or insurance-supported meetings with an RD in individual or group settings, as well as free group nutrition classes or seminars.
Collaboration between RDs and personal trainers, as well as exercise physiologists in cardiac rehab settings, group exercise instructors, and other clinical fitness program directors, can be critical in providing patients with a team approach and a more robust plan to improve health.
Considerations for Chronic Disease
Nutrition professionals are well-versed in the benefits of physical activity for heart health, bone health, and blood sugar management. However, some may not be up to date on the scope of medical conditions exercise may be prescribed for, including those related to cognitive and mental health.
In 2018, ACSM’s recommended updates to the Physical Activity Guidelines included an acknowledgment of the role exercise plays in the development and progression of cancers at specific sites, multiple sclerosis progression, dementia, sleep, and, in older adults, risk of falls as well as functional status. Exercise can also play a role in quality of life, in addition to anxiety and depression, including postpartum depression.1
ACSM’s updated recommendations expand upon the many diseases the guidelines already acknowledged. Just as medical nutrition therapy addresses varied diseases in different ways, EIM has specific guidelines for over 30 medical conditions ranging from Alzheimer’s disease and cancer to liver disease and rheumatoid arthritis.
Opportunities for RDs
Since many diseases EIM supports can all benefit from medical nutrition therapy, it’s imperative that dietitians find ways to work with EIM professionals as well as any programs with exercise prescription referrals. Studies have shown that up to 91% of personal trainers spend time on nutrition counseling with clients and over 40% include nutrition as part of their fees for services. However, the average nutrition knowledge scores of personal trainers are under 60%, and in many states, they may not be permitted to offer medical nutrition therapy.4,5
For those with a passion for integrating exercise and nutrition, it may be wise to propose a nutrition position at existing EIM and P.R.E.P sites or to help fitness centers develop these programs with integrated nutrition offerings. In other cases, dietitians in private practice may find new referral sources for their business or consult fitness centers on clinical relationship building to drive their referrals.
In these proposals, dietitians should showcase the ways they’re able to work with fitness professionals and medical professionals to improve specific disease states and advance the success of patients. This, in turn, can enhance the retention of individuals in these programs, benefiting the health care center or fitness center’s revenue and marketing efforts. In addition, many fitness clubs may see opportunities for EIM and similar programs but lack the staff with clinical experience to network with their local providers or see long-term revenue benefits from their efforts in implementing and marketing the programs. Dietitians are uniquely positioned to step in and bridge this knowledge and communication gap as well as offer services reimbursable by insurance companies.
For dietitians working in acute clinical care without the ability to work with patients long term, advocating for EIM programming at their respective facilities can assist in patient outcomes and the success of their teams and professional goals.
— Kelly Jones, MS, RD, CSSD, LDN, is a board-certified specialist in sports dietetics and a media and nutrition communications expert who’s regularly featured in broadcast, print, and digital media. She and her private practice dietitians work with athletes at every level in individual and group settings. Jones also founded and oversees Student Athlete Nutrition.
References
1. US Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: US Department of Health and Human Services; 2018.
2. Lee SH, Moore LV, Park S, Harris DM, Blanck HM. Adults meeting fruit and vegetable intake recommendations — United States, 2019. MMWR Morb Mortal Wkly Rep. 2022;71(1):1-9.
3. What is exercise is medicine: a global health initiative. American College of Sports Medicine website. https://www.exerciseismedicine.org/about-eim. Accessed April 4, 2024.
4. Rx for health series: a series on today’s most common chronic conditions and their exercise prescriptions. American College of Sports Medicine website. https://www.exerciseismedicine.org/eim-in-action/health-care/resources/rx-for-health-series. Accessed April 4, 2024.
5. Weissman J, Magnus M, Niyonsenga T, Sattlethight AR. Sports nutrition knowledge and practices of personal trainers. J Community Med Health Educ. 2013;3:254.