Physical inactivity: Another epidemic

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No one in the medical profession denies that there is an obesity epidemic in the United States. Certainly, the GLP-1 medications are a step in the right direction. Talking about “steps,” we need to get our patients moving and more active. Inactivity is a risk factor for cardiovascular disease, diabetes, and mental health problems such as depression and Alzheimer’s disease, and even mortality.

Screening for physical inactivity during routine medical visits can help identify patients at risk for chronic diseases. Researchers found that patients screened for physical activity had healthier profiles and fewer comorbid conditions than those who were not screened.

Assessing physical activity levels is not standard practice in many healthcare settings. A simple two-step questionnaire assesses patients’ level of activity. It identifies patients at risk because of inactivity by determining patients’ weekly exercise habits. The questions are:

1. “On average, how many days per week do you engage in moderate to vigorous exercise (like a brisk walk)?”
2. “On average, how many minutes do you engage in exercise at this level?”

From there, patients are categorized as either inactive (0 minutes of exercise per week), insufficiently active (1-149 minutes of exercise per week), or active (≥150 minutes of exercise per week).

Patients were classified into two groups: those screened using the questionnaire and a comparison group who were not screened. By comparing health outcomes between these groups, the study aimed to evaluate the utility of the questionnaire and its potential to improve preventive care.

Screened patients also exhibited a lower prevalence of several chronic conditions, including obesity. Physically active patients had healthier cardiometabolic profiles, including lower diastolic blood pressure, LDL cholesterol, and triglycerides. They were also at reduced risk for up to 19 inactivity-related conditions, including depression, chronic pulmonary disease (CPD), and heart failure.

The study concludes with a strong recommendation for treating physical inactivity as a vital sign in health care, specifically during primary care visits. Inactive patients are at higher risk for 19 inactivity-related comorbid conditions.

I recognize that we could have spent more time with patients in the past. Now employed physicians and those physicians in large group practices have less time to spend with patients. We are on a time crunch and have limited opportunities to discuss or complete additional questionnaires. However, we can add the two questions about physical activity to the health questionnaire that most patients complete before the physician or allied health professional sees them. If the answers indicate inactivity, this can be addressed during the doctor-patient encounter.

Bottom Line: Americans face many epidemics, obesity, loneliness, and viral infections that have not received proper attention. We can make physical activity a vital sign like blood pressure, weight, and pulse by regularly screening patients for inactivity and providing inactive patients with resources to promote physical activity.

Every doctor, including primary care doctors, needs to prioritize preventive care. Integrating tools like the two-question questionnaire can reduce the burden of inactivity-related chronic diseases and improve overall population health.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.