Timely integration of specialist palliative home care (SPHC) for patients with congestive heart failure, chronic obstructive pulmonary disease and dementia: qualitative evaluation of the experiences of SPHC physicians in the KOPAL trial.

OBJECTIVE: Chronic non-malignant diseases (CNMDs) are under-represented in specialist palliative home care (SPHC). The timely integration of SPHC for patients suffering from these diseases can reduce hospitalisation and alleviate symptom burdens. An intervention of an SPHC nurse-patient consultation followed by an interprofessional telephone case conference with the general practitioner (GP) was tested in the KOPAL trial ('Concept for strengthening interprofessional collaboration for patients with palliative care needs'). As part of the trial, the aim of this study was to gain in-depth insights into SPHC physicians' perspective on care with and without the KOPAL intervention for patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and dementia (D). DESIGN: Qualitative evaluation of the KOPAL intervention from the perspective of SPHC physicians as part of the KOPAL trial. Thematic-focused narrative interviews analysed with grounded theory. SETTING: We conducted the KOPAL study and its qualitative evaluation in Lower Saxony and the greater Hamburg area, Germany. PARTICIPANTS: 11 physicians from 14 SPHC teams who participated in the trial were interviewed. RESULTS: A grounded theory of the necessity of collaboration between GPs and SPHC teams for patients with CHF, COPD and dementia was developed. From the perspective of SPHC physicians, patients with CNMD are generally difficult to manage in GP care. The timing of SPHC initiation is patient-specific, underscoring the need for collaboration between SPHC physicians and GPs. However, the primary mandate for healthcare should remain with GPs. SPHC physicians actively seek collaboration with GPs (eg, through the KOPAL intervention), viewing themselves as advisors for GPs and aspiring to collaborate as equal partners. CONCLUSION: Effective communication and the negotiation of future interprofessional collaboration are essential for SPHC teams. TRIAL REGISTRATION NUMBER: DRKS00017795.

Physical inactivity among American single-female caregivers: An analysis of the 2020 behavioral risk factor surveillance system.

BACKGROUND: Many adults in the United States do not reach the recommended levels of activity needed for health benefits. Single-female caregivers present a unique and vulnerable population that is often less active than their partnered peers or single-male caregivers. OBJECTIVE: The primary objective of this cross-sectional investigation was to identify the prevalence of physical inactivity in single-family, female-led households and determine differences in personal factors and social characteristics between physically active and not physically active single-female caregivers. A secondary objective was to examine associations among the social characteristic variables and physical inactivity in single-female caregiver households. Finally, we examined the odds single-female caregivers who are physically inactive reported chronic health conditions. DESIGN: Cross-sectional survey design. METHODS: We used the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data. Participants were selected based on pre-determined criteria for inclusion. RESULTS: There was a 39.3% prevalence of physical inactivity among single-female caregivers in the sample. Single-female caregivers who were physically inactive had greater odds of having a history of multiple chronic health conditions. CONCLUSION: Healthcare providers and other community stakeholders should explore existing physical activity promotion strategies to increase physical activity in single-female caregivers. Future research should employ more rigorous, prospective research designs to determine if these chronic conditions and various social characteristics are caused by physical inactivity.

Health Status and Healthcare Utilization Patterns of Emergency Department Patients Who Prefer a Language Other Than English.

Immigrants, nearly half of whom prefer a language other than English (LOE), face structural barriers to healthcare. This subgroup is believed to be at increased risk for reduced access to quality healthcare, yet few studies have examined the health needs and utilization patterns of LOE-preferring patients who seek care in the Emergency Department (ED). Given that the ED is often an entry point to the health system, we sought to characterize the health patterns of this population in an urban ED setting. We conducted a retrospective chart review of the electronic medical records of 1,566 patients who utilized interpreter services in the ED or Urgent Care) at an urban safety net hospital. We found that LOE-preferring patients had high levels of chronic disease. We also found that the majority of these patients had not seen a primary care provider (PCP) within the study period. PCP visits were positively associated with ED utilization suggesting that those without a PCP are less likely to receive ED care. These findings point to a need for greater policy and community health solutions addressing the high burden of chronic disease and underutilization of healthcare for those with LOE preferences.

Association of complete blood count parameters with the risk of incident pulmonary heart disease in pneumoconiosis: a retrospective cohort study.

BACKGROUND: Pneumoconiosis mostly combines pulmonary and cardiovascular diseases, among which pulmonary heart disease (PHD) is of major concern due to its significant impact on the survival of pneumoconiosis patients. White cell count (WCC), red cell distribution width (RDW) and platelet parameters are thought to affect inflammatory responses and may be predictors of various cardiovascular diseases. However, very few studies have focused on PHD. OBJECTIVES: To examine the relationship between baseline complete blood count parameters (WCC, RDW, platelet parameters) and the risk of incident PHD in pneumoconiosis patients. DESIGN: A retrospective cohort study. SETTING: This was a single-centre, retrospective cohort study that used data from an Occupational Disease Hospital, Chengdu, Sichuan. PARTICIPANTS: A total of 946 pneumoconiosis patients from January 2012 to November 2021 were included in the study. Female patients and patients who had PHD, coronary heart disease, hypertensive heart disease, cardiomyopathy, heart failure, oncological disease, multiple organ dysfunction, AIDS at baseline and follow-up time of less than 6 months were also excluded. OUTCOME MEASURES: We identified PHD according to the patient's discharge diagnosis. We constructed Cox proportional hazard regression models to assess the HR of incident PHD in pneumoconiosis, as well as 95% CIs. RESULTS: In the multiple Cox proportional hazard regression analysis, platelet count (PLT) and plateletcrit (PCT) above the median at baseline were associated with an increased risk of PHD in pneumoconiosis with adjusted HR of 1.52 (95% CI 1.09 to 2.12) and 1.42 (95% CI 1.02 to 1.99), respectively. CONCLUSION: Higher baseline PLT and PCT are associated with a higher risk of PHD in pneumoconiosis.

Bioactivity and Bioavailability of Carotenoids Applied in Human Health: Technological Advances and Innovation.

This article presents a groundbreaking perspective on carotenoids, focusing on their innovative applications and transformative potential in human health and medicine. Research jointly delves deeper into the bioactivity and bioavailability of carotenoids, revealing therapeutic uses and technological advances that have the potential to revolutionize medical treatments. We explore pioneering therapeutic applications in which carotenoids are used to treat chronic diseases such as cancer, cardiovascular disease, and age-related macular degeneration, offering novel protective mechanisms and innovative therapeutic benefits. Our study also shows cutting-edge technological innovations in carotenoid extraction and bioavailability, including the development of supramolecular carriers and advanced nanotechnology, which dramatically improve the absorption and efficacy of these compounds. These technological advances not only ensure consistent quality but also tailor carotenoid therapies to each patient's health needs, paving the way for personalized medicine. By integrating the latest scientific discoveries and innovative techniques, this research provides a prospective perspective on the clinical applications of carotenoids, establishing a new benchmark for future studies in this field. Our findings underscore the importance of optimizing carotenoid extraction, administration, bioactivity, and bioavailability methods to develop more effective, targeted, and personalized treatments, thus offering visionary insight into their potential in modern medical practices.

Effect of community-based public health service on health-related quality of life among middle-aged and older adults with chronic diseases in China.

BACKGROUND: The growing prevalence of non-communicable chronic diseases poses a significant public health challenge globally, particularly impacting the well-being of aging populations. This study aims to assess the impact of community-based public health service (PHS) on the health-related quality of life (HRQoL) among middle-aged and older adults with chronic diseases in China. METHODS: Utilizing data from the China Health and Retirement Longitudinal Study, we constructed a novel scale based on the 36-Item Short Form Health Survey (SF-36) to measure the HRQoL of middle-aged and older patients with hypertension and/or type-2 diabetes. Multivariate linear regression models with Instrument Variables and Propensity Score Matching techniques were applied to examine the effect of PHS on the HRQoL of identified chronic disease patients. RESULTS: Among 8,403 hypertensive and/or diabetic patients, only 10.98% had received PHS. After adjusting for covariates, PHS exhibited a significant association with an elevated overall SF-36 score (ß = 3.539, p < 0.001). Similar effects were observed in the physical and mental component summary scores, with increases of 1.982 (p < 0.001) and 5.095 (p < 0.001), respectively. Sensitive analysis affirmed the robustness of these findings. Heterogeneity analysis revealed significant HRQoL improvements among males, females, those aged 70 and older, patients with comorbidities, and urban residents, while the effect was less pronounced in the middle-aged, those without comorbidities, or rural dwellers. CONCLUSION: Community-based PHS has exerted a positive impact on both the physiological and psychological aspects of HRQoL among middle-aged and older chronic disease patients, with effects varying among individuals with different characteristics. Our findings advocate for enhancing the delivery and utilization of government-funded PHS, increasing health literacy, and promoting early prevention strategies for chronic diseases. Furthermore, targeted health management initiatives for patients with comorbidities and enhancements in the quality of community healthcare services, particularly in rural areas, are deemed necessary.

A comparison of self-reported chronic disease, health awareness and behaviours in social housing residents: cross-sectional study of communities in Ontario and Quebec.

OBJECTIVE: Social housing programs are integral to making housing more affordable to Canadian seniors living in poverty. Although the programs are similar across Canada, there may be inter-provincial differences among the health of residents that could guide the development of interventions. This study explores the health of low-income seniors living in social housing in Quebec and compares it with previously reported data from Ontario. RESULTS: 80 responses were obtained in Quebec to compare with the previously reported Ontario data (n = 599) for a total of 679 responses. More Ontario residents had access to a family doctor (p < 0.001). Quebec residents experienced less problems with self-care (p = 0.017) and less mobility issues (p = 0.052). The visual analog scale for overall health state was similar in both provinces (mean = 67.36 in Ontario and 69.23 in Quebec). Residents in Quebec smoked more cigarettes per day (p = 0.009). More residents in Ontario participated in moderate physical activity (p = 0.09), however, they also spent more time per day on the computer (p = 0.006).

Assessing the Impact of Behavioral Sciences Interventions on Chronic Disease Prevention and Management: A Systematic Review of Randomized Controlled Trials.

Studies have highlighted the importance of applying Behavioral Sciences interventions to develop equity in the prevention of chronic diseases in the public health domain. Our study aims to assess the evidence of this influence. We undertook a systematic review study using the electronic databases PubMed, Web of Science, Scopus and Cochrane, searching for work published between 2013 and 2023. The research analyzed the influence of Behavioral Sciences intervention studies on public health. This review was registered and published in PROSPERO, registration number CRD42023412377. The systematic search identified 2951 articles. The review analyzed 26 studies. The quality assessment of the articles showed an overall average of 74%, with the majority of studies being of high quality. The interventions with the best evidence for chronic diseases used framing messages, nudges and vouchers. Messages with incentives also showed satisfactory evidence. The most prevalent outcomes were related to screening tests and patient adherence to treatment. The current state of decision-making remains mainly at the patient level, with potential for further exploration of the roles of healthcare professionals and decision-makers in future research efforts. Limitations relate to the heterogeneity of the study sample, which hinders a more precise analysis of specific interventions and outcomes in chronic diseases.

Transitioning to Working from Home Due to the COVID-19 Pandemic Significantly Increased Sedentary Behavior and Decreased Physical Activity: A Meta-Analysis.

At the start of the COVID-19 pandemic, many workplaces transitioned to remote work, which altered lifestyle behaviors. We conducted a meta-analysis to understand if the transition to working from home due to the pandemic affected workers' physical activity and sedentary behavior worldwide. We reviewed articles published between November 2019 and May 2022. Of an initial 3485 articles, a total of 17 were included, 15 of 17 were included for their physical activity (PA) comparisons (n = 36,650), and 12 of 17 (n = 57,254) were included for their sedentary behavior (SB) comparisons (10 studies have data for both PA and SB). This work is registered through PROSPERO (CRD42022356000). Working from home resulted in a significant decrease in PA (Hedge's g = -0.29, 95% CI [-0.41, -0.18]) and an increase in SB (Hedge's g = +0.36, 95% CI [0.20, 0.52]). Working from home impaired preventative activity behaviors, and these results are relevant to worker health as the future of work evolves beyond the pandemic.

A Randomized Controlled Trial Testing the Effects of a Social Needs Navigation Intervention on Health Outcomes and Healthcare Utilization among Medicaid Members with Type 2 Diabetes.

Health systems are increasingly assessing and addressing social needs with referrals to community resources. The objective of this randomized controlled trial was to randomize adult Medicaid members with type 2 diabetes to receive usual care (n = 239) or social needs navigation (n = 234) for 6 months and compare HbA1c (primary outcome), quality of life (secondary outcome), and other exploratory outcomes with t-tests and mixed-effects regression. Eligible participants had an HbA1c test in claims in the past 120 days and reported 1+ social needs. Data were collected from November 2019 to July 2023. Surveys were completed at baseline and at 3-, 6-, and 12-month follow-up. Health plan data included care management records and medical and pharmacy claims. The sample was from Louisiana, USA, M = 51.6 (SD = 9.5) years old, 76.1% female, 66.5% Black, 29.4% White, and 3.0% Hispanic. By design, more navigation (91.5%) vs. usual care (6.7%) participants had a care plan. Social needs persisted for both groups. No group differences in HbA1c tests and values were observed, though the large amount of missing HbA1c lab values reduced statistical power. No group differences were observed for other outcomes. Proactively eliciting and attempting to provide referrals and resources for social needs did not demonstrate significant health benefits or decrease healthcare utilization in this sample.

Endotyping Chronic Respiratory Diseases: T2 Inflammation in the United Airways Model.

Over the past 15 years, the paradigm of viewing the upper and lower airways as a unified system has progressively shifted the approach to chronic respiratory diseases (CRDs). As the global prevalence of CRDs continues to increase, it becomes evident that acknowledging the presence of airway pathology as an integrated entity could profoundly impact healthcare resource allocation and guide the implementation of pharmacological and rehabilitation strategies. In the era of precision medicine, endotyping has emerged as another novel approach to CRDs, whereby pathologies are categorized into distinct subtypes based on specific molecular mechanisms. This has contributed to the growing acknowledgment of a group of conditions that, in both the upper and lower airways, share a common type 2 (T2) inflammatory signature. These diverse pathologies, ranging from allergic rhinitis to severe asthma, frequently coexist and share diagnostic and prognostic biomarkers, as well as therapeutic strategies targeting common molecular pathways. Thus, T2 inflammation may serve as a unifying endotypic trait for the upper and lower airways, reinforcing the practical significance of the united airways model. This review aims to summarize the literature on the role of T2 inflammation in major CRDs, emphasizing the value of common biomarkers and integrated treatment strategies targeting shared molecular mechanisms.

Effect of a self-care promoting program on engagement in self-care behaviors and health-related outcomes among persons with type 2 diabetes and diabetic retinopathy: A single-blind randomized controlled trial.

Background: Diabetic retinopathy (DR) is the most common microvascular complication of diabetes, leading to visual impairment and eventual blindness. Promoting self-care behaviors is crucial in controlling DR progression and preventing blindness. Objective: This study aimed to investigate the effects of a Self-Care Promoting Program (SCPP) on engagement in self-care behaviors, HbA1c levels, visual acuity (VA), severity of DR, and vision-related quality of life (VRQoL) among individuals with type 2 diabetes and DR. Methods: This study employed a single-blind randomized controlled trial design to compare SCPP with conventional diabetic care interventions (standard care). The SCPP was based on the Self-Care of Chronic Illness Theory, Self-efficacy theory, and the Association of Diabetic Care and Education Specialist (ADCES) guidelines incorporating health education, self-care maintenance, monitoring, and management skills training over 12 weeks. Ninety-eight participants were randomly allocated to the experimental or control group (n = 49 per group). While the experimental group received SCPP alongside standard care, the control group received standard care alone. Data collection occurred between May 2022 and March 2023 and included demographic information, the Self-Care of Diabetes Index questionnaire (SCODI), the self-care for diabetes eye care questionnaire (SCFDE), the impact of visual impairment questionnaire (IVI-Thai version), and retinal images for DR severity grading. Data analysis utilized descriptive statistics, Chi-Square tests, t-tests, and MANOVA. Results: Following 8 and 16 weeks of SCPP, the experimental group had significantly higher mean scores in engagement with self-care and eye-care behaviors compared to the control group (p <0.001). The highest scores were observed in self-care and eye-care confidence behaviors, followed by maintenance, monitoring, and management. Furthermore, HbA1c levels and VRQoL significantly decreased and were lower than those of the control group at week 16 (p <0.001 and p <0.05, respectively). However, there were no significant differences in VA, and DR severity increased in both groups by week 16. Conclusion: SCPP benefits individuals with DR, enhancing their confidence and ability to perform, monitor, and manage self-care behaviors. These strategies contribute to improved diabetes management, enhanced quality of life, and reduced DR-related blindness. Integrating SCPP into routine DR management is recommended, with nurses playing a pivotal role in overseeing and driving this integration, highlighting the critical role of nurses in managing this widespread global disease. Trial Registry Number: Thai Clinical Trials Registration (TCTR20230302002).

Factors of presenteeism and its association with detrimental effects among employees in Switzerland working in different sectors - a cross-sectional study using a multi-item instrument.

PURPOSE: Presenteeism, the phenomenon of employees working despite illness, is a significant issue globally, impacting individual well-being and organizational efficiency. This study examines presenteeism among Swiss employees, exploring its occurrence, primary factors, reasons, and impact on employees' health. METHODS: This study used cross-sectional data from 1,521 employees in different sectors in Switzerland. Descriptive statistics and multiple linear models for influencing factors and detrimental effects, such as burnout symptoms, job satisfaction, general health, and quality of life, were calculated for data analysis. Presenteeism was measured using the Hägerbäumer multi-item scale, ranging from 1 = "Never in case of illness" - 5 = "Very often in case of illness." RESULTS: The employees reported that in case of illness, they rarely worked in the last 12 months M = 2.04 (SD = 1.00). A positive approach to presenteeism in the team was associated with less presenteeism (ß = -0.07) and problematic leadership culture in dealing with presenteeism with increased presenteeism (ß = 0.10). In addition to well-known factors, presenteeism was significant for burnout symptoms (ß = 1.49), general health status (ß = -1.5), and quality of life (ß = -0.01). CONCLUSION: The study offers insights into the phenomenon of presenteeism among Swiss employees in various sectors by applying a multi-item scale for presenteeism. The findings indicate that a positive team dynamic and organizational culture may significantly reduce presenteeism. Presenteeism behavior is a significant factor of adverse outcomes. This highlights the importance of acknowledging presenteeism in the context of occupational health.

Randomised pilot study comparing a coach to SMARTPhone reminders to aid the management of heart failure (HF) patients: humans or machines.

Ambulatory management of congestive heart failure (HF) continues to be a challenging clinical problem. Recent studies have focused on the role of HF clinics, nurse practitioners and disease management programmes to reduce HF readmissions. This pilot study is a pragmatic factorial study comparing a coach intervention, a SMARTPHONE REMINDER system intervention and BOTH interventions combined to Treatment as USUAL (TAU). We determined that both modalities were acceptable to patients prior to randomisation. Fifty-four patients were randomised to the four groups. The COACH group had no readmissions for HF 6 months after enrolment compared with 18% for the SMARTPHONE REMINDER Group, 8% for the BOTH intervention group and 13% for TAU. Medium-to-high medication adherence was maintained in all four groups although sodium consumption was lower at 3 months for the COACH and combined (BOTH) groups. This pilot study suggests a beneficial effect on rehospitalisation with the use of support measures including coaches and telephone reminders that needs confirmation in a larger trial.

Intensity and associated factors of home health care service needs among elderly patients with chronic diseases in the community: A cross-sectional survey.

AIM AND OBJECTIVES: This study aimed to investigate the intensity of needs for home health care services (HHCs) among elderly patients with chronic diseases and to identify the associated factors. DESIGN: A cross-sectional survey was conducted in Wuhou District, Chengdu, Sichuan Province, China, from April to November 2021. METHODS: Convenient sampling was used to screen elderly patients with chronic diseases managed by Yulin Community Health Service Center. The questionnaires included general information and the Chinese version of the Community Healthy Intensity Rating Scale were completed according to patients' conditions. The data were analyzed using descriptive statistics and binary logistic regression. RESULTS: A total of 371 patients (10.40%) completed the survey. The mean age of the elderly patients was 84.04 years (SD = 7.07); these patients suffered from 1 to 7 kinds of chronic diseases, and the most common were hypertension (78.98%) and diabetes (40.97%). The need intensity of patients for HHCs was moderate (41.51%) or severe (58.49%). For each additional chronic disease that patients suffered from, the need intensity increases by 1.289 times (OR = 1.289; 95% CI: 1.055-1.575, p = .013); in additional, those aged more than 90 years, with a personal monthly income less than 2500 yuan ($387.00), with a poor health current status, and with only basic medical insurance presented greater need intensity (p < .05). CONCLUSION: Our data analysis revealed that economic status, insurance condition, poor health status, and multiple comorbidities may be the most common factors associated with the need intensity for HHCs. These characteristics may help medical staff to identify and help those with urgent health problems.

Construction and application of medication reminder system: intelligent generation of universal medication schedule.

BACKGROUND: Patients with chronic conditions need multiple medications daily to manage their condition. However, most patients have poor compliance, which affects the effectiveness of treatment. To address these challenges, we establish a medication reminder system for the intelligent generation of universal medication schedule (UMS) to remind patients with chronic diseases to take medication accurately and to improve safety of home medication. METHODS: To design medication time constraint with one drug (MTCOD) for each drug and medication time constraint with multi-drug (MTCMD) for each two drugs in order to better regulate the interval and time of patients' medication. Establishment of a medication reminder system consisting of a cloud database of drug information, an operator terminal for medical staff and a patient terminal. RESULTS: The cloud database has a total of 153,916 pharmaceutical products, 496,708 drug interaction data, and 153,390 pharmaceutical product-ingredient pairs. The MTCOD data was 153,916, and the MTCMD data was 8,552,712. An intelligent UMS medication reminder system was constructed. The system can read the prescription information of patients and provide personalized medication guidance with medication timeline for chronic patients. At the same time, patients can query medication information and get remote pharmacy guidance in real time. CONCLUSIONS: Overall, the medication reminder system provides intelligent medication reminders, automatic drug interaction identification, and monitoring system, which is helpful to monitor the entire process of treatment in patients with chronic diseases.

Compassionate Curiosity: Mitigating the Effects of Bias Through Motivational Interviewing.

There is strong evidence that the implicit biases of health care professionals affect the treatment of patients, and that minority and other marginalized patients are disproportionately harmed. Assumptions made about patient knowledge or lack thereof function as judgments that are prone to bias, which then affect the education and advice imposed upon patients. We review how the motivational interviewing (MI) approach to patient engagement includes components of evidence-based bias-mitigating strategies, such as understanding circumstances from the patient's point of view, and therefore we propose that the MI approach can reduce the impact of bias in patient care.

Validating the Ontario Child Health Study Emotional Behavioural Scales-Brief Version (OCHS-EBS-B) in children with chronic physical illness.

BACKGROUND: A substantial proportion of children have a physical illness; these children commonly experience physical-mental comorbidity. To assess child mental health, brief scales that can be used in clinical and research settings are needed. This study assessed the validity and reliability of parent-reported Ontario Child Health Study Emotional Behavioural Scale-Brief Version (OCHS-EBS-B) scores. METHODS: Data come from a longitudinal study of children aged 2-16 years with a physical illness recruited from outpatient clinics at a pediatric hospital. Confirmatory factor analysis and McDonald's coefficient assessed the factor structure and internal consistency reliability of the OCHS-EBS-B, respectively. Point biserial correlations assessed agreement between the OCHS-EBS-B and Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), a structured diagnostic interview. The Wilcoxon rank sum test compared OCHS-EBS-B scores between children with versus without physical-mental comorbidity (known-group validity). RESULTS: The three-factor structure of the OCHS-EBS-B was replicated in this sample of children with physical illness (χ2 = 196.23(272), p < 0.001; CFI = 0.98; TLI = 0.98; SRMR = 0.06; RMSEA [90% CI] = 0.034 [0.027, 0.044]). It had excellent internal consistency reliability (ω = 0.86-0.92) and was moderately correlated with the MINI-KID (baseline: rpb = 0.43-0.51; 6 months: rpb = 0.55-0.65). OCHS-EBS-B scores were significantly higher among children with versus without physical-mental comorbidity. CONCLUSIONS: Findings confirm psychometric evidence that the OCHS-EBS-B is a valid and reliable measure of mental health in children with chronic physical illness. Its brevity and robust psychometric properties make the OCHS-EBS-B a strong candidate for routine use in integrated pediatric physical and mental health services.

Exercise Is a Vital Sign.

Description In this review, we argue that exercise (physical activity) be monitored as a vital sign since no other basic sign or symptom provides as much information about a patient's health status. The influence of regular exercise on patient health is indisputable, with strong evidence to show the power of exercise to mitigate chronic disease and improve overall health. Several simple tools, such as Physical Activity as a Vital Sign and Exercise as a Vital Sign are available to assess patient physical activity. When properly applied, there is evidence to support the efficacy of these tools, but there are barriers that prevent broad inclusion in primary care, among which are time and provider knowledge. In our review, we also discussed the value of physician-led lifestyle discussions with patients and found they view these discussions favorably. There is also evidence that physicians who exercise are more likely to have these lifestyle discussions with their patients, but the proportion of physicians who exercise regularly is fairly low. We believe physicians' awareness of their patients' sedentary lifestyles should prompt a prescription to increase physical activity, but additional in-clinic support and community resources need to be in place for patients to get a regular dose.