University of Iowa researchers recommend asking patients how much they exercise

IOWA CITY — Research for years has linked exercise with long-term health benefits, but a new University of Iowa study highlights ways to capitalize on the connection in a health care setting.

The study — led by UI Health and Human Physiology Professor Lucas Carr — involved just two questions about exercise asked to more than 7,000 UI Health Care patients during annual wellness appointments between November 2017 and December 2022:

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By cross-referencing patient answers with individual health metrics stored in electronic medical records — including things like blood pressure and prescriptions — researchers were able to link inactivity with an increased risk for chronic disease.

“And so, for these patients, many of whom report insufficient activity, we need options to easily connect them with supportive services like exercise prescriptions and/or community health specialists,” according to Carr, the study’s corresponding author.

Carr answered questions from The Gazette about the research.

Q: What are you and your fellow researchers recommending, based on the study’s findings?

A: In an ideal world, we would treat physical activity like any other vital sign. You go to the doctor, and they have you step on the scale, and they measure your weight, they measure your blood pressure, your heart rate, and your temperature. And they do that for every single patient, for every single visit. And we do that because those markers are very predictive of a lot of different health outcomes.

Well, physical activity is as powerful as a predictor of health as anything else that we know of. … And so I think my recommendation is that we treat it the same way — we add these two very simple questions to every patient intake visit, and we take that information very seriously.

Q: What would it look like to take that information seriously?

A: So when patients are inactive, it's important that their doctor has a very brief conversation, at the very least, alerting the patient to the fact that they are not meeting the guidelines and that could potentially put them at increased risk for all these different health conditions.

Q: Your research found that those who reported the highest level of activity — meaning they exercised moderately to vigorously at least 150 minutes a week — were at a statistically lower risk of developing 19 chronic conditions. What are examples of those conditions that exercise can help prevent?

A: They are listed in the study, but include cancer, cardiovascular disease, respiratory disease and diabetes.

Q: What resources might doctors be able to provide patients — in addition to the education that inactivity could increase their risk for a variety of health conditions?

A: If possible, we can we have resources available where the provider can provide them a very simple exercise prescription — which just gives them a simple goal from an exercise standpoint of what they need to do to meet those guidelines.

Q: What is an “exercise prescription?” Does that already exist? And, if so, what does it look like and involve?

A: It exists. The American College of Sports Medicine … has free resources that are available. They have an entire health care action kit. And the exercise prescription is very simple. It's just a one-page document that could easily be uploaded into a patient's electronic medical record. … It'll talk about aerobic exercise and muscle strengthening exercise — the two primary forms of exercise that we recommend.

Q: What are the recommendations, specifically?

A: From an aerobic standpoint, people are supposed to get 150 minutes of moderate to vigorous intensity activity per week. And then, from a muscle strengthening standpoint, you're supposed to do some muscle strengthening exercises at least twice per week. So it's really basic. It's really simple. And this prescription is written in a very simple format. And it just has providers check a couple of boxes.

Q: How often are these physical activity questions being asked in health care settings currently?

A: There's just not very many major hospital systems that do this. And certainly in the Midwest, I think there are none. And it just seems to me that there's no reason why the University of Iowa couldn't do this.

Q: Why do you think more health care systems and providers aren’t talking about exercise and activity?

A: A big reason why all this stuff doesn't happen in health care, unfortunately, is because there's just not a whole lot of money in prevention. For a provider to do what I just described — to take a few minutes out of their business to talk about exercise — for a visit that’s 20 or 30 minutes long, a lot of times there's just not enough time in that visit to get into it. And in order to for a doctor to bill for exercise counseling, they would have to dedicate a minimum of 8 minutes talking about exercise in that visit in order for insurance providers to reimburse for that.

Q: You were involved in a related study published last month in the “Journal of Physical Activity and Health“ that looked at insurance reimbursement rates when health care providers did bill for exercising counseling. What did you find?

A: There are a couple of billing codes available that would allow providers to bill for exercise counseling. And what we wanted to know was, within our hospital system, is anybody using them? And, if they do bill with those codes, do insurance providers reimburse the hospital? Because it’s completely unknown. There's no research published on this topic at all. And we found that, at least within our hospital over a 12-month period … that when the codes that are recommended are used, they do get reimbursed at a really high rate. There's only a 5 percent denial rate. So they do get paid.

Q: So the reimbursement rate was high, but how often are doctors billing for that counseling and seeking that reimbursement?

A: We asked our billing department to pull all of the charges that have been used over 12 months using those codes, and we came up with like 19,000 charges over 12 months. Which sounds like a lot. Collectively, it accumulated to a few million dollars worth of charges. But when you think about how many patients we actually see in our hospital system in a 12-month period, it’s a tiny fraction of the number of visits that we actually have. I mean, family medicine sees 30,000 patients a month. And that’s just one clinic.

Q: So, in addition to adding the two-pronged question to the patient check-in process, what would you like to see changed in this area?

A: It really comes down to our health care policies. Unfortunately, there are some problems with who can bill for that. The doctor is eligible. But some of the folks who are probably best suited to do this kind of work don't qualify as a person who can bill for that type of conversation. So we need to make some changes, I think, some tweaks to the policies so that specialists who are qualified and probably have the time to counsel on exercise are eligible to actually do that.

Q: Is there research showing benefits of exercise on mental health too? And do you think counselors and therapists should be prescribing exercise and billing for reimbursement?

A: Absolutely. One of the outcomes that we found that's connected to physical activity is depression. Both depression and anxiety are two outcomes that have consistently been shown to be improved with physical activity. And people who are inactive are at a higher risk for both those mental health outcomes. So there's definitely a connection there and I think a place for other health care specialists, including mental health specialists, to have a role here.

Comments: (319) 339-3158; vanessa.miller@thegazette.com