A number of chronic and debilitating conditions such as cardiovascular disease, stroke, hypertension, anxiety, depression, pain, osteoporosis, and falls are known to be delayed, improved, or prevented by increasing physical activity (PA) levels. The numbers of those affected form a substantial portion of the US population. As of 2011, for example, 26 million adults in the U.S. were diagnosed with diabetes mellitus (DM) alone. Another 79 million people had elevated blood glucose measurements putting them at risk for DM. Despite knowledge of the connection with chronic disease, PA levels are not consistently and quantitatively assessed during primary care office visits. Healthcare providers often believe lifestyle change intervention with sedentary adults is futile and encounter barriers to regular PA for many low-income, inner-city clients.
Barriers are potentially reduced through partnership with the YMCA (Y), which cooperates with local churches and community organizations to open sites that offer nutrition and exercise classes at no cost to participants. Healthcare providers at the Grand Valley State University Family Health Center (FHC) did not previously refer sedentary clients to the Y. Referral to the Y became an innovative part of an evidencebased intervention set.
Quality enhancements were put in place at the FHC, guided by a logic model to improve PA assessment and intervention. A policy was written that specifies the process to be used to evaluate and document clients\u27 PA levels and application of interventions for those clients who were assessed and found to have suboptimal habitual PA levels. Assessment uses the International Physical Activity Questionnaire self-report, short-form because it yields numeric and categorical results that allow tracking of progress and determination of the need for PA intervention. A low to moderate PA level result now triggers implementation of an evidence-based intervention set consisting of counseling, printed educational materials, and an offer of referral to Y community outreach programs. The electronic health record-embedded educational material was written to facilitate teaching and client self-review
