Association Between a Physical Activity Vital Sign and Cardiometabolic Disease in High-Risk Patients.

OBJECTIVE: To determine the association between the physical activity vital sign (PAVS) and markers of cardiometabolic disease. DESIGN: Patients were assessed through the PAVS, a validated tool self-reporting the frequency and duration of physical activity. Patients were categorized into 3 groups: inactive (0 minutes per week), underactive (1-149 minutes per week), and active (>150 minutes per week). Associations were tested between the PAVS and the cardiometabolic disease biomarkers of body mass index, hemoglobin A1c (A1c), blood pressure, and low-density lipoprotein (LDL) using one-way analyses of variance. SETTING: High-risk family medicine residency clinic. PARTICIPANTS: Two thousand three hundred twenty-one adult patients (age ≥ 18 years). RESULTS: Participants reported a mean of 97.87 (SD = 149.35) minutes per week of exercise. Overall, 50.1% reported physical inactivity, 25.7% were underactive, and 24.3% were active. Younger individuals (P < 0.001) and men (P < 0.05) reported more physical activity than older individuals and women. Patients who reported being active were significantly less likely to be overweight (P < 0.05), obese (P < 0.05), or hypertensive (P < 0.05), but there was no association with A1c or LDL levels. CONCLUSIONS: This is the first investigation to examine the PAVS in a high-risk population. In these patients, reported levels of physical inactivity are 150% higher than other clinical settings, and the PAVS is only associated with improvements in 2 of 4 major cardiometabolic risk factors. For this group, self-reported levels of physical activity may need to be higher for cardiovascular benefits to be realized in all 4 cardiometabolic domains. The PAVS offers health professionals an opportunity to encourage lifestyle-based interventions to reduce cardiovascular risk, but refinements may be necessary to address this population.

Associations Between the Physical Activity Vital Sign and Cardiometabolic Risk Factors in High-Risk Youth and Adolescents.

BACKGROUND: The physical activity vital sign (PAVS) is a simple, validated tool for assessing physical activity in adults that has not been previously studied in pediatrics. HYPOTHESIS: Reported physical activity utilizing the PAVS in pediatric patients should vary according to known associations with physical activity, such as age, sex, blood pressure, and body mass index (BMI). STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: All patients within a family medicine residency clinic were assessed via the PAVS from October 1, 2015, to October 31, 2016, including 255 consecutive pediatric patients aged 5 to 18 years. Associations were examined between PAVS, age, sex, blood pressure, and BMI using 1-way analysis of variance. RESULTS: The average PAVS reported for youth (5-11 years) was 384.9 ± 218.1 minutes per week, with 69.5% reporting sufficient physical activity (≥300 minutes per week). Adolescents (12-18 years) reported a mean PAVS of 278.3 ± 199.6 minutes per week, with 51.1% reporting sufficient physical activity. Physical activity was lower in older participants (P < 0.0001) and was higher in male patients (P < 0.03). Higher BMI was associated with lower PAVS (P < 0.005), while lower systolic blood pressure was associated with a greater number of days per week of physical activity (P < 0.005). CONCLUSION: The PAVS successfully identifies accepted associations between age, sex, and BMI in a pediatric population. CLINICAL RELEVANCE: The correlation of the PAVS with age, sex, BMI, and blood pressure may inform future strategies to address and prevent cardiometabolic disease in pediatric patients.

Design and Implementation of a Lifestyle Medicine Curriculum in Undergraduate Medical Education.

While scientific evidence demonstrates conclusive associations between unhealthy lifestyle behaviors and increased morbidity and mortality related to noncommunicable chronic diseases (NCDs), most physicians are not formally taught the root causes of NCDs nor how to counsel patients regarding their lifestyle behaviors for disease prevention and treatment. Since its inception in 2012, the University of South Carolina School of Medicine Greenville has designed, developed, and implemented an innovative, formalized lifestyle medicine curriculum to provide required undergraduate medical student training with a graduating program-level goal to "Deliver total health care using lifestyle medicine to prevent and treat morbidity and mortality related to chronic diseases." The process was guided by the Association of American Medical Colleges' Core Entrustable Professional Activities (required for graduates entering residency) and aimed to satisfy the Quadruple Aim components of better outcomes, lower cost, improved patient experience, and improved physician experience. Four essential instructional design phases, Analysis, Design, Development, and Evaluation, were used as systematic steps to create and deploy the curriculum. This article describes the evidence-based approach used and offers guidance to other undergraduate medical schools that may wish to implement lifestyle medicine training to improve physicians' medical knowledge and clinical skills for optimum health care.