Screening patients for physical inactivity can decrease risk of chronic illness, study says

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Screening for physical inactivity during routine medical visits can play a pivotal role in the identification of patients at risk for chronic diseases, according to a study published in Preventing Chronic Disease, a journal of the U.S. Centers for Disease Control and Prevention (CDC). Using the Exercise Vital Sign (EVS), researchers found that patients screened for physical activity had healthier profiles and fewer comorbid conditions than those who were not screened.

A tool to address physical inactivity

Physical inactivity is a major medical risk factor behind major leading causes of death, including cardiovascular disease, cancer, respiratory disease and diabetes. Despite this, assessing physical activity levels is not standard practice in many health care settings. The EVS is a simple two-step questionnaire, intended to bridge this gap by assessing patients’ weekly exercise habits. The questions included in the EVS 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).

Researchers examined data from electronic medical records (EMRs) of adults attending annual wellness visits between November 2017 and December 2022. Patients were classified into two groups: those screened using the EVS and a comparison group who were not screened. By comparing health outcomes between these cohorts, the study aimed to evaluate the utility of the EVS and its potential to inform preventive care.

Key findings

Data used in the study came from the EMRs of adult patients seen during annual wellness visits in a family medicine clinic at a large, public Midwest university hospital system. The study included 7,261 EVS-screened patients and 33,444 unscreened patients. Those screened were slightly younger—with a median age of 40 vs. 42 years—and had marginally better health markers, including lower body mass index (BMI), blood pressure and hemoglobin A1C (HbA1c) levels. Although these differences were statistically significant, they were not deemed clinically meaningful.

Screened patients also exhibited a lower prevalence of several chronic conditions, including obesity (15% vs. 18%), hypertension (22% vs. 28%) and diabetes (5.9% vs. 8.5%). Additionally, patients identifying as Black/African American or Asian were more likely to be screened, while Hispanic/Latino patients were less likely.

Among those screened, 60% reported meeting recommended guidelines for physical activity, defined as 150 minutes or more of moderate-to-vigorous exercise per week. In comparison, previous studies, such as one conducted by Kaiser Permanente, reported just 30% of patients achieving similar activity levels. 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.

Broader implications

The study’s findings highlight the potential of integrating physical activity screenings into primary care. While previous research suggested that screened patients were less healthy than their unscreened counterparts, this study found the opposite, possibly the result of differences in screening practices. In the Midwestern university hospital system, the EVS was primarily administered during wellness visits, which likely attract generally healthier and more proactive patients.

The researchers emphasized the importance of expanding screenings to a broader range of patients, including those seen in specialty clinics for chronic conditions including diabetes, obesity or cardiovascular disease. “Limiting inactivity screenings to specific populations or specific clinical visits decreases the number of opportunities for early intervention or prevention of inactivity-related diseases,” the authors of the study wrote.

The study concludes with a strong recommendation for treating physical inactivity as a vital sign in health care, and specifically during primary care visits.

“Inactive patients are at higher risk for up to 19 inactivity-related comorbid conditions,” the authors wrote. “These findings support calls to treat physical activity as a vital sign by regularly screening patients for inactivity and providing inactive patients with resources to promote physical activity.”

As health care systems continue to prioritize preventive care, integrating tools like the EVS could help reduce the burden of inactivity-related chronic diseases, improving overall population health outcomes.