Prioritize physical activity assessment in all patient visits, AHA recommends

Clinicians should prioritize physical activity assessment during every office visit, especially when the focus of the visit is providing preventive care or evaluating and managing cardiovascular disease, the American Heart Association (AHA) recently recommended.

Physical activity has a substantial role (in many cases comparable to or greater than the role of medications) in preventing and managing more than 40 diseases besides cardiovascular disease, such as obesity, diabetes, cancer, depression, Alzheimer disease, arthritis, and osteoporosis, according to the AHA.

In a scientific statement, the group reviewed evidence supporting the feasibility and effectiveness of routinely assessing and promoting physical activity in health care settings and offered suggestions for doing so. The recommendations were published online on April 4 by Circulation.

The AHA recommended using a simple, standardized tool, such as the Physical Activity Vital Sign (PAVS), to assess physical activity in practice. The PAVS consists of two questions: “On average, how many days per week do you engage in moderate or greater intensity physical activity (like a brisk walk)?” and “On average, how many minutes do you engage in this physical activity on those days?”

If physical activity time is less than the guideline-recommended 150 minutes per week, clinicians should advise patients of the associated health benefits and encourage them to gradually increase either their frequency or duration of activity. If an inactive patient perceives the guideline-recommended amounts as unobtainable, clinicians should explain that even 60 to 100 minutes per week of activity (ideally in 10-minute bouts of moderate or higher intensity) greatly contributes to cardiovascular disease reduction, as well as physical and mental health, according to the AHA.

As part of their physical activity assessments, clinicians should also ask how many days per week patients perform muscle-strengthening exercises (e.g., body weight exercises, resistance training), the AHA recommended. U.S. physical activity guidelines recommend training major muscle groups at least twice a week.

Smartphones and wearable activity-monitoring devices are feasible tools to objectively assess activity levels, the statement said. While self-tracking can help some patients increase their activity levels in the short term, a more robust plan for behavior change is needed to maintain progress, according to the AHA.

Physicians can use the transtheoretical model of health behavior change to help tailor their physical activity counseling and gauge patients' readiness to change their behaviors, according to the statement. To make their advice more credible and motivating, “Physicians should ensure that they ‘walk the talk’ themselves,” the AHA recommended.