Should Patients Be Screened for Physical Inactivity?

Physical inactivity increases the risk for diabetes, other chronic diseases, and premature death and should be screened for and managed, new research suggested.

“There is nearly irrefutable evidence on the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases, including diabetes,” Louis Carr, PhD, Iowa Bioscience Innovation Facility, Iowa City, Iowa, told Medscape Medical News. “The only way to know if a patient is inactive is to ask them.”

The analysis of electronic medical records of more than 40,000 patients showed that active patients had a lower risk for 19 inactivity-related comorbid conditions, including obesity, diabetes, depression, hypertension, and valvular disease.

Furthermore, those screened for inactivity had significantly lower rates of several comorbid conditions than those not screened for inactivity.

The study was published online in Preventing Chronic Disease.

Two Quick Questions

“We conducted this study as a pilot project to explore whether it is feasible to screen patients for physical inactivity and whether patient-reported physical activity predicts risk for chronic diseases,” Carr said.

Researchers compared the health profiles of patients screened for inactivity with those of patients not screened for inactivity and the health profiles of inactive, insufficiently active, and active patients as measured using the Exercise Vital Sign (EVS) tool.

The tool comprises two questions that patients answer on a tablet: 1) “On average, how many days per week do you engage in moderate to vigorous exercise (like a brisk walk)?” (0-7 days) and 2) “On average, how many minutes do you engage in exercise at this level?” Carr said the tool takes less than 30 seconds to complete and shouldn’t interfere with a patient’s visit.

The study sample included adult patients attending a wellness visit at the University of Iowa Health Care from November 2017 through December 2022. Researchers analyzed data on demographics, patient characteristics, resting pulse, encounters, and disease burden. They compared 7261 patients in the EVS cohort (those who were screened for inactivity) with 33,445 patients in the comparison cohort (those who were not screened for inactivity). Patients in the EVS cohort were slightly younger (median age, 40 years) than those in the comparison cohort (median age, 42 years).

Compared with the comparison cohort, the EVS cohort had significantly lower values for body mass index, systolic blood pressure, diastolic blood pressure, resting pulse, triglycerides, and A1c. However, the between-group differences generally were small and not clinically significant.

Of the 7261 patients in the EVS cohort, 60% were considered active, 36% were insufficiently active, and 4% were inactive. Insufficiently active patients generally reported engaging in 2 or 3 days of activity per week and 30 minutes of activity per day. Active patients reported engaging in 5 days of activity per week and 60 minutes of activity per day.

The team conducted further comparisons between screened patients reporting 0 minutes (inactive), 1-149 minutes (insufficiently active), and ≥ 150 minutes (active) minutes per week of moderate to vigorous physical activity.

Patients screened for inactivity had significantly lower rates of comorbid obesity, diabetes, and hypertension than those not screened for inactivity.

Compared with inactive and insufficiently active patients, active patients had significantly healthier cardiometabolic profiles and a lower risk for up to 19 inactivity-related comorbid conditions, including obesity, mild liver disease, psychoses, chronic pulmonary disease, depression, weight loss, uncomplicated and complicated hypertension, uncomplicated and complicated diabetes, anemia deficiency, peripheral vascular disease, neurologic disorders affecting movement, neurologic seizures, autoimmune disorders, hypothyroidism, valvular disease, congestive heart failure, and drug abuse.

The authors acknowledged that patients attending annual wellness visits included in the study were more active and healthier than the typical patient treated at the University of Iowa Health Care and likely reflect “the worried well” — a sample that is not representative of the typical patient population.

“Patients who have the opportunity and motivation to come in for annual wellness exams likely engage in other healthy behaviors as well,” Carr said. “But our findings suggest that of those who come in for annual wellness exams, active patients are at significantly lower risk of several diseases. If we were to screen all patients for inactivity, it’s likely that our findings between physical activity and health outcomes would have been even stronger.”

“This pilot study was our first attempt to test whether we could screen patients for inactivity without disrupting the clinical process in a major way and to test whether this additional information is valuable to clinicians,” Carr noted. “Based on our findings, I think we can now say that we can collect this data without disruption and that there is indeed value in understanding a patient’s physical activity status.”

“Public health recommendations clearly state inactive adults should be prescribed exercise by their provider or referred to a local specialist for help,” he said. Clinicians and healthcare leaders should “treat physical inactivity like a vital sign and screen all patients for inactivity during all visits.”

‘A First Step’

“Physical inactivity is fortunately a modifiable risk factor and so regular screening for a sedentary lifestyle can translate into a wide range of clinical benefits and is recommended,” Hanna Lee, MD, an endocrinologist at Montefiore Health System in New York City, told Medscape Medical News.

With regard to diabetes, she said, “Exercise can enhance glucose uptake and decrease insulin resistance. Over the long term, regular physical activity can lead to healthy weight loss, with improvements in multiple cardiovascular risk factors, including cholesterol levels and blood pressure. Exercise also has been shown to positively benefit mental health and emotional well-being.”

Regular screening for physical inactivity can be the first step in raising awareness among patients and promoting the many health benefits of exercise, she suggested.

“The subsequent steps of what to do with the information and how best to effectively and efficiently implement an individualized activity program are important, and more research in this area will be helpful,” she noted. “Resources such as time and access to behavioral counselors who can supervise a structured program, for example, are limited and are frequently not readily available.”

The authors received no external financial support for the research, authorship, or publication of this article. Carr and coauthors declared no potential conflicts of interest.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.