What is “Exercise Is Medicine®” (EIM)?
We frequently associate exercise with the idea of “losing weight” or “toning up.” Many people consider exercise as primarily a way to control one’s appearance, with health benefits applying mainly to obesity.
In reality, researchers have been telling us for years that the health benefits of exercise go far beyond what we might expect.
As it turns out, regular exercise can help prevent or improve countless chronic diseases across almost all body systems: cardiovascular disease, hypertension, type 2 diabetes, osteoporosis, certain cancers, dementia, anxiety and depression, injuries from falling, and many other medical conditions. And we’re not talking about hours upon hours at the gym. Just 150 minutes of exercise per week, or about 30 minutes a day five days a week, is enough to improve health and well being.
In other words, exercise is a powerful medicine.
That’s the premise behind the American College of Sports Medicine’s Exercise is Medicine (EIM) global health initiative. EIM’s goal is to encourage health care providers to make exercise a component of regular medical treatment. This means asking patients about their activity levels regularly and even writing exercise prescriptions.
“Sixty percent of American adults and 85% of older adults have one or more chronic medical conditions, – that’s pretty alarming,” says EIM’s vice president, Robyn Stuhr. A more active lifestyle across the population could reduce these numbers. The need for change is urgent, but change doesn’t come overnight, especially in a society that often enables sedentary lifestyles.
Can we overcome the inertia of physical inactivity and help more people meet the weekly physical activity guidelines? It will take the combined efforts of health care providers, fitness professionals, and individuals working within their communities to get our society up and moving for the recommended 150 minutes per week, but Stuhr and many others believe it can be done.
What are some practical steps to make this vision a reality?
How Fitness Professionals Can Support EIM
Fitness professionals play a crucial role in getting the American populace moving. They have the skills to develop personalized activity plans and to guide clients through the initial hiccups of an exercise regimen, such as learning body cues and managing aches and pains.
A good place for fitness professionals to start, says Stuhr, is to ensure that their services feel accessible to clients with a wide range of physical abilities, not just those already comfortable with regular physical activity.
Gyms are often stereotyped as the domain of ripped bench-pressers who can lift twice their own weight. This “gymtimidation” can scare away someone who’s just getting started. In fact, some women-only gyms have been capitalizing on gymtimidation for years by advertising themselves as a safer, friendlier exercise space.
While gyms should indeed serve those who are physically fit, they should also feel comfortable to those with more modest activity goals.
“A lot of people who could benefit from going to fitness facilities don’t feel welcome there,” Stuhr says. “If we really want to serve people who can benefit the most, we need to provide places where they feel comfortable, and have staff who are qualified to work with them.”
If you’re a fitness trainer and/or gym owner, Stuhr recommends that you review how you advertise your services. Do social media posts, signage, and ads reflect bodies of all sizes and ages, or do they feature only the young, the slim, and the muscled? Is a healthy lifestyle part of your value proposition, or is it all about maintaining a certain appearance? Clients seeking regular physical activity for health reasons need to know that you value those goals too.
Also consider whether you and/or your staff have the right training to serve a population with health needs. A bachelor’s degree in a field related to health or exercise science is a good place to start. You might also consider hiring a staff member with a background in physical therapy. You or a staff member could pursue ACSM certification and the EIM credential. Arm yourself with knowledge so that when a patient with health concerns walks in the door, you’re ready to help. Whether or not you qualify for the EIM Credential, you can take the EIM online course to learn more about working with individuals with common chronic medical conditions.
If you’re passionate about implementing fitness plans for those who need it most, obtaining the EIM credential will allow you to become an EIM community partner. Primary care physicians and nurse practitioners who give exercise prescriptions will often refer patients to EIM community partners for help implementing their treatment plans. Visit Exerciseismedicine.org to learn more.
To earn the Exercise is Medicine Credential, you must:
- hold a bachelor’s degree in exercise science or related field
- Attain an NCCA-accredited certification (includes ACSM)
- Complete a 14-hour online course leading to EIM credentials
A great way to help build an active community is to forge relationships with local health providers whose patients might need your services.
“It’s about trying to make connections as best you can in the community,” Stuhr says.
Take every opportunity to make those connections:
- If you regularly see a health care provider in the gym or at another workout space, pick their brain. Ask what types of exercise programs their patients need. Find out if they make referrals to fitness experts.
- Attend community health education programs and introduce yourself to the presenting physician(s).
- Find out whether there’s a Walk With A Doc program in your area. These physician-led walking groups can be a great place to meet providers who share your love of an active lifestyle.
- Offer your facility to host a local health group or event. Some large healthcare systems have population health programs serving specific demographics, such as patients diagnosed with hypertension, and need a large area for hosting.
- Reach out to physical therapy providers and offer yourself as a referral source. Many patients who graduate from physical therapy are still in the process of building back their full strength, and could benefit from a continued exercise program that falls somewhere between PT and a regular workout.
When you connect with health providers, says Stuhr, it’s important to give them context about yourself, your educational background and your interest in public health. Demonstrate that you understand the health benefits of exercise and the modifications necessary when working with certain types of clients. Providers will also want to know whether your services are welcoming to individuals of different physical abilities.
Matthew Silvis, MD, agrees. Silvis is the medical director for Primary Care Sports Medicine at Penn State University, and will moderate a panel on the challenges of EIM implementation at this summer’s EIM World Congress.
Silvis says doctors will want to know three basic things about a fitness professional: your background, your understanding of exercise as a health tool, and, he quips, “that you won’t break the patients.” In other words, you’ll know how to build their endurance slowly and modify routines in light of health conditions and/or injuries.
Some patients, in fact, may not be willing or able to start at the recommended 30 minutes of activity five days per week. Starting small and working your way up gradually is still a win, says Silvis. Even fifteen minutes two days per week is a place to begin.
How Health Care Providers Can Support EIM
The health care industry faces the considerable task of educating the public about the extensive connections between exercise and health outcomes. Silvis advises health care providers to ask about their patients’ exercise habits at every appointment. Make a physical activity assessment part of the vital signs recording process. Sometimes, just broaching the topic is enough to inspire patients to be more active, Silvis says.
Health care providers who suggest or prescribe exercise need to be familiar with exercise resources in the community. These might include gyms, classes or groups, safe walking and biking areas, swimming pools, Silver Sneakers programs for seniors, Walk With A Doc, and others.
“I think there’s a lot of opportunity for [connection],” Silvis says, “but it has to begin by asking the question.”
Silvis also urges health care and fitness providers to make sure patients understand that even small amounts of exercise help—and it doesn’t have to happen in the gym.
“The perception that you have to exercise for hours each day to get benefits is a fallacy,” he says. Any moderate activity throughout the week counts toward the 150-minute weekly total. That includes things like taking a walk over lunch, taking several flights of stairs to the office, or even playing in the back yard with kids in the evening.
By asking about a patient’s schedule, lifestyle, motivation, and preferences, health care providers can help patients identify a fitness routine that works for them. An introvert who loves early mornings, for example, might thrive on solo morning jogs, while a social night owl might prefer an evening dance class. Those who need external motivation could try joining a 5k run/walk for charity. Others might just want a simple option they don’t have to think about, like a 30-minute elliptical routine after work.
The idea, says Silvis, is to deconstruct the myth that exercise has to be long, hard, and complicated. The more accessible it feels, the greater the chance that patients will give it a try.
What about the rest of us?
If you’re not a fitness provider or a health care worker, there’s still much you can do as an individual to make your community more active.
- Change the conversation about exercise. “The data’s pretty clear that you derive health benefits from exercise whether or not you lose weight,” Silvis says. It’s crucial to broaden the public’s perception of exercise beyond weight loss to include the vast health benefits of movement. This can be a powerful motivator for anyone, regardless of shape, size, or previous physical activity level.
- Support local infrastructure that makes outdoor activity easier. Bike lanes, sidewalks, maintained trails, and well-kept parks make a huge difference to the wellbeing of a community. Let your local government officials know that these things are priorities.
- Host an ACSM speaker at your next event. Speakers affiliated with the American College of Sports Medicine are often available to attend private or community events to help educate others about the connection between health and exercise. Contact the ACSM for more information.
- Start an activity group. Find like-minded individuals in your community and start an activity group that is open to others. This could take the form of a walking group, a yoga class, a gardening group, casual tennis or volleyball matches, or other activities of your choice.
- Make small, active choices every day, and encourage others to do the same. “I think where people have some power and control are in the day-to-day decisions they make,” says Silvis. “You go to buy groceries, don’t park near the door. Park all the way out and make yourself walk. Don’t hit the automatic door opener. Take the stairs, not the elevator. Those little actions day to day, they add up.”
“Think of the day as a treasure hunt and look for opportunities to move,” says Stuhr. Her term for this is “physical activity snacking”; just as you might munch on fruit, chips, or mixed nuts between meals, you can find small ways to increase movement throughout the day.
“There are a lot of options out there for people to tap into movement in ways they can control without relying on all of society to change,” Silvis says. “We shouldn’t wait for that to happen to get people moving.”
With the work of health care providers, fitness providers, and health-minded citizens, active lifestyles can once again become the norm. And we will be healthier for it.