Should exercise be considered a fifth vital sign — along with blood pressure, pulse, body temperature, and breathing rate? A new Kaiser Permanente study suggest the answer is an emphatic “yes,” and details a new electronic system for doctors to easily evaluate a patient’s activity levels.
The study, published in the journal Medicine & Science in Sports & Exercise, reports that Kaiser Permanente has become one of the first healthcare organizations in the nation to establish a systematic method for recording patients' physical activity in their electronic health records.
The new electronic Exercise Vital Sign initiative compiles accurate and valuable information that can help doctors and clinicians better treat and counsel patients about their lifestyles.
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The study examined the electronic health records of nearly 1.8 million Kaiser Permanente Southern California patients — ages 18 and older — from April 2010 to March 2011 and found that 86 percent had an exercise vital sign in their record. Of those patients who had an exercise record, only one-third were meeting national guidelines for physical activity, and two thirds were not. Of those not meeting guidelines, one-third were not exercising at all.
"Embedding questions about physical activity in the electronic medical record provides an opportunity to counsel millions of patients during routine medical care regarding the importance of physical activity for health," said lead researcher Karen J. Coleman, of the Kaiser Permanente Southern California Department of Research & Evaluation. "In addition, the Exercise Vital Sign has the potential to provide information about the relationship between exercise and healthcare utilization, cost and chronic disease that has not been previously available."
Researchers validated the findings of the study by comparing exercise levels reported by the Kaiser Permanente adult patients with those in U.S. population surveys. The Kaiser patient reports of physical activity followed similar patterns to those in national reports: People who were older, female, obese, belonging to a racial or ethnic minority, or had more chronic health conditions were more likely to be inactive.
"Given that healthcare providers have contact with the majority of Americans, they have a unique opportunity to encourage physical activity among their patients through an assessment and brief counseling," said Coleman. "Future studies will examine if adding a physical activity assessment during clinic visits actually leads to higher rates of physician counseling and eventually increases the rates of physical activity in our patients."
In recent years, many health experts have urged doctors to consider exercise a fifth vital sign used to evaluate overall health.
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The U.S. Department of Health and Human Services recommends that Americans engage in at least 150 minutes per week — about 20 minutes a day — of moderate-to-vigorous intensity physical activity, such as brisk walking, biking, or swimming to reduce the risk of many adverse health outcomes. Children need about twice that much. And more is better, with increasing amounts providing additional benefits — from lowered risks for cancer, diabetes and cardiovascular disease to improved mental health, stress reduction, and bone health.
For most people, the American Heart Association recommends an exercise target heart rate ranging from 50 percent to 75 percent of a person's maximum heart rate, which is calculated by subtracting your age from the number 220. (For instance, a 50-year-old has a maximum heart rate of 170 and should count between 14 and 21 beats in 10 seconds while exercising and not exceed 28 beats.)
Earlier this year, an international panel of experts concluded exercise should be considered a critical fifth vital sign, based on the many studies showing regular participation in sports or exercise has clear benefits for physical and mental health.
"Low fitness is a better predictor of mortality than obesity or hypertension, which are health risk factors afforded far greater emphasis than fitness by the media and most health professionals," said Karim Khan of the University of British Columbia, one of experts who made the recommendation in a report published in the journal The Lancet.
The researchers suggested regarding exercise levels as a vital sign would allow healthcare professionals to provide more help for patients to adopt workout regimes, in the same way that smoking-cessation advice has resulted in reductions in the number of people who smoke.
Other vital signs, and guidelines:
BLOOD PRESSURE: Doctors monitor this vital sign by two readings — systolic pressure (the top number), which is the maximal contraction of the heart, and the lower diastolic (bottom number) or resting pressure. A typical blood pressure reading is 120 (systolic) over 80 (diastolic) millimeters of mercury (mmHg). A range of readings is considered "normal" — generally between 90/60 mm/Hg to 120/80 mm/Hg. High blood pressure (hypertension) is associated with greater health risks. Causes of high blood pressure can include too much salt in the diet and underlying illnesses. Treatment typically involves changes in diet, including lowered sodium intake, exercise, and medication.
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BREATHING RATE: Most healthy people take between 12 and 18 breaths per minute. Higher, or lower, rates can be a sign of respiratory problems. Children and infants have respiratory and heart rates that are faster than those of adults.
PULSE: This is a measurement of your beating heart rate, which rhythmically expands the arteries in drum-like syncopation. For most healthy people, the normal range is between 60 and 100 beats per minute, while at rest. A newborn or infant typically has a heart rate of 130-150 beats per minute. A toddler's heart will beat about 100-120 times per minute; for older children 60-100 beats; adolescents around 80-100; and adults from 50-80.
TEMPERATURE: Core body temperature can vary person to person and even in a single person, by day or hour. In general, the normal range is between 97.8 and 99.1 degrees Fahrenheit, with the average 98.6 degrees. Temperature regulates a number of chemical reactions in the body. High temperatures (fever) can indicate an infection or inflammation. They can also result from hyperthermia, or "heat stroke," which can be life threatening. On the other hand, low body temperature can be a sign of hypothermia.