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In a nutshell
- Physical inactivity is linked to increased risk of 19 different chronic conditions, according to a University of Iowa study analyzing over 40,000 patient records. The research provides the most comprehensive evidence yet of how sedentary lifestyles impact health.
- A simple two-question survey about exercise habits, taking just 30 seconds to complete during regular check-ups, helped researchers identify patients at higher risk for conditions like depression, obesity, and hypertension. Inactive patients had nearly twice as many chronic conditions as active patients.
- While insurance companies reimburse exercise counseling claims 95% of the time, most hospitals don’t screen for physical activity levels. The researchers recommend making activity screening as routine as checking blood pressure to help prevent chronic disease development.
IOWA CITY, Iowa — In an era where many of us spend our days hunched over computers or scrolling through phones, mounting evidence suggests our sedentary lifestyles may be quietly damaging our health. A new study from the University of Iowa reveals that physically inactive individuals face significantly higher risks for up to 19 different chronic health conditions, ranging from obesity and diabetes to depression and heart problems.
Medical researchers have long known that regular physical activity helps prevent disease and promotes longevity. However, this comprehensive study, which analyzed electronic medical records from over 40,000 patients at a major Midwestern hospital system, provides some of the most detailed evidence yet about just how extensively physical inactivity can impact overall health.
Leading the study, now published in the journal Preventing Chronic Disease, was a team of researchers from various departments at the University of Iowa, including pharmacy practice, family medicine, and human physiology. Their mission was to examine whether screening patients for physical inactivity during routine medical visits could help identify those at higher risk for developing chronic diseases.
The simple 30-second exercise survey
When patients at the University of Iowa Health Care Medical Center arrived for their annual wellness visits, they received a tablet during the standard check-in process. Researchers implemented the Exercise Vital Sign (EVS), which asks two straightforward questions: how many days per week they engaged in moderate to vigorous exercise (like a brisk walk) and for how many minutes per session. Based on their responses, patients were categorized into three groups: inactive (0 minutes per week), insufficiently active (1-149 minutes per week), or active (150+ minutes per week).
“This two-question survey typically takes fewer than 30 seconds for a patient to complete, so it doesn’t interfere with their visit. But it can tell us a whole lot about that patient’s overall health,” says Lucas Carr, associate professor in the Department of Health and Human Physiology and the study’s corresponding author, in a statement.
Study authors discovered clear patterns when they analyzed responses from 7,261 screened patients. About 60% met the recommended guidelines by exercising moderately for 150 or more minutes per week. However, 36% fell short of these guidelines, exercising less than 150 minutes weekly, and 4% reported no physical activity whatsoever. When the team examined the health records of these groups, they found remarkable differences in health outcomes.
Consequences of a sedentary lifestyle
The data painted a compelling picture of how physical activity influences overall health. Active patients showed significantly lower rates of depression (15% compared to 26% in inactive patients), obesity (12% versus 21%), and hypertension (20% versus 35%). Their cardiovascular health markers were also notably better, including lower resting pulse rates and more favorable cholesterol profiles.
Perhaps most revealing was the relationship between activity levels and chronic disease burden. Patients reporting no physical activity carried a median of 2.16 chronic conditions. This number dropped to 1.49 conditions among insufficiently active patients and fell further to just 1.17 conditions among those meeting exercise guidelines. This clear progression suggests that even small increases in physical activity might help reduce disease risk.
To provide context for their findings, the researchers compared the screened group against 33,445 unscreened patients from other areas of the hospital. This comparison revealed an important pattern: patients who completed the survey tended to be younger and healthier than the general patient population. As Carr notes, “We believe this finding is a result of those patients who take the time to come in for annual wellness exams also are taking more time to engage in healthy behaviors, such as being physically active.”
Need for better exercise counseling
The findings highlight a crucial gap in healthcare delivery that needs addressing. “In our healthcare environment, there’s no easy pathway for a doctor to be reimbursed for helping patients become more physically active,” Carr explains. “And so, for these patients, many of whom report insufficient activity, we need options to easily connect them with supportive services like exercise prescriptions and/or community health specialists.”
However, there’s encouraging news about the financial feasibility of exercise counseling. A related study by Carr’s team found that when healthcare providers billed for exercise counseling services, insurance companies reimbursed these claims nearly 95% of the time. This suggests that expanding physical activity screening and counseling services could be both beneficial for patients and financially viable for healthcare providers.
These findings add substantial weight to recommendations from the American College of Sports Medicine’s Exercise is Medicine initiative, which has advocated for treating physical activity as a vital sign since 2007. The research demonstrates that implementing routine physical activity screening could help identify at-risk patients earlier and potentially prevent the development of chronic conditions through targeted interventions.
Paper Summary
Methodology
The researchers utilized a two-pronged approach to understanding physical activity’s relationship with health outcomes. First, they collected Exercise Vital Sign (EVS) data from patients during annual wellness visits at the University of Iowa Health Care Medical Center. The survey was administered via tablet during the routine rooming process, ensuring minimal disruption to normal appointment flow.
The research team then compared this data against comprehensive electronic medical records, examining everything from basic demographics to detailed health markers like blood pressure, cholesterol levels, and documented diagnoses. To ensure thorough analysis, they looked at patient data from both 365 days before and after each patient’s initial EVS screening, creating a 730-day window of health information for each participant.
To provide context for their findings, the researchers also analyzed records from over 33,000 patients who weren’t offered the EVS survey. This comparison helped them understand whether the screened population was representative of the broader patient community.
Results
The study’s findings revealed several clear patterns in how physical activity levels correlate with health outcomes. Active patients (those exercising 150+ minutes per week) showed notably better health markers across multiple measures:
The difference in chronic disease burden was particularly striking – active patients averaged 1.17 chronic conditions, compared to 2.16 conditions among inactive patients. Active patients also showed better cardiovascular health indicators, including lower diastolic blood pressure, better cholesterol profiles (particularly HDL cholesterol), and improved blood sugar control.
The researchers discovered that screened patients generally had lower rates of several chronic conditions compared to unscreened patients, including obesity (15% vs 18%), depression (17% vs 19%), and hypertension (22% vs 28%). This finding suggested that patients who attend annual wellness visits may be more health-conscious overall.
Limitations
The researchers identified several important constraints in their study design. First, the EVS screening relied on self-reported data, which can be subject to social desirability bias – patients might overestimate their activity levels to appear healthier. Additionally, the screenings captured only a single point in time rather than tracking activity patterns over extended periods.
The study population also skewed younger and healthier than the general patient population, potentially limiting the broader applicability of the findings. Finally, the research was conducted at a single Midwestern university hospital system, which might not perfectly represent other healthcare settings or geographic regions.
Discussion and Takeaways
The research offers several significant implications for healthcare delivery. First, it demonstrates that a brief, two-question screening tool can effectively identify patients at higher risk for chronic conditions. This efficiency is crucial for real-world implementation, as it doesn’t significantly impact appointment times or workflow.
The findings strongly support expanding physical activity screening beyond annual wellness visits, particularly in specialty clinics treating conditions like cardiovascular disease, obesity, diabetes, and cancer. Early identification of inactive patients could enable timely interventions before chronic conditions develop or worsen.
The related finding about insurance reimbursement (95% coverage for exercise counseling) suggests that implementing broader screening and counseling programs could be financially viable for healthcare systems while benefiting patient health.
Funding and Disclosures
The research was funded by the UI Health Care Stead Family Children’s Hospital. The study authors, including Cole Chapman, Mary Schroeder, Britt Marcussen, and Lucas Carr, declared no professional or financial conflicts of interest.
Publication Information
The study, titled “Screening Patients for Physical Inactivity Helps Identify Patients at Risk for Cardiometabolic and Chronic Diseases,” was published in Preventing Chronic Disease, a journal of the U.S. Centers for Disease Control and Prevention. The research represents a collaboration between the University of Iowa’s Departments of Pharmacy Practice and Science, Family Medicine, and Health and Human Physiology.
