Physical inactivity is the fourth leading risk factor for death. With most adolescents and one-quarter of adults not meeting the World Health Organization’s recommended levels of physical activity, and big disparities across income, age, sex, education and race/ethnicity, it’s more important than ever to re-energize a movement for increasing physical activity (PA) to improve health.
The question is: How?
The science behind the benefits of PA is convincing: benefits that accrue across the lifespan include better brain health, less chronic disease, weight management, stronger bones, lower odds of dying prematurely, and better quality of life. Although numerous guidelines and the U.S. National Physical Activity Plan (published by the organization one of us [L.W.] works for) promote the importance of assessing, prescribing, and referring activity in routine clinical care, under 10% of clinicians discuss physical activity with their most at-risk patients and refer them to physical activity counseling.
Food as medicine has recently gained a lot of momentum as an important strategy to improve health and well-being. It’s time to elevate physical activity as medicine to the same status.
Addressing population-wide physical inactivity calls for creative solutions and interventions to support people on their healthy living journeys. Digitally measuring physical activity will be key to accelerating efforts to improve it.
Wearable devices, including smart watches, smart rings, and smart phones tracking activity, are now used by more than one-third of U.S. adults, allowing for an unprecedented shift towards empowerment, accountability, and leveraging data for better informed discussions with care providers.
Digital measurement offers clinicians more objective data on activity in their patients’ daily lives than asking them to recall past activities. It also empowers patients to actually carry out a prescription for physical activity. Together, patients and their doctors can better track and refine activity recommendations to improve health outcomes.
Guidance and resources now exist for care providers, digital health technology developers, and clinical researchers on adopting digital measures of PA into clinical care. Doing that can help clinicians maximize the benefit of physical activity for their patients.
Consider 51-year-old Mr. R, who is overweight and has high blood pressure. He is motivated to make lifestyle changes and is already tracking his health using a smart watch. Though Mr. R is at a higher-than-average risk for developing heart disease and type 2 diabetes, intervening early can prevent them. Mr. R’s care team can potentially leverage digital measures from his wearable to track his progress more effectively and collaborate on achieving his physical activity goals. But the wealth of data being collected is often left unnoticed by care teams and not optimized to support their patient’s care.
The evidence behind digital measurement of physical activity
Many clinicians are motivated by evidence. Extensive evidence that implementing digital measurement of PA into care workflows improves their patients’ health could be the spark that many need to begin doing this.
There is compelling evidence of the relationship between physical activity measured with digital devices and reduced incidence of chronic disease and all-cause mortality. There is also overwhelming evidence that using activity trackers significantly increases an individual’s activity levels.
Clinicians are beginning to incorporate data from smart watches and smart phones as part of physical examinations. They also are increasingly prescribing wearables to promote activity among their patients.
Efforts to promote standardization and interoperability
Recognizing the need to improve the use of physical activity as medicine, a collaboration composed of patient organizations, digital health technology companies, non-profit organizations, drug development companies, and academia (including the three organizations we represent) recently paved the way for digital measurement of activity in routine clinical practice.
One of the biggest barriers to adoption has historically been a lack of common measures and methods, because of siloed development of measures by individual companies. The Physical Activity Alliance and Digital Health Measurement Collaborative Community are coordinating efforts with key players and industry partners, such as Google FitBit, to collaborate on standardized digital measures and define common technical definitions. This collaboration will not only benefit a single organization, but also provides value for the entire field by putting forth actionable resources to guide integrating digital measures of physical activity into clinical care, clinical research, and product development.
To support measure standardization and interoperability, the Physical Activity Alliance leads the “It’s Time to Move” initiative, a multi-year effort made up of multiple organizations, government agencies, and key players working to integrate assessing physical activity, prescribing it, and referring to additional physical activity services (such as trainers, behavior change apps, and the like) into health care delivery.
In August 2023, the Physical Activity Alliance released the Physical Activity Implementation Guide for HL7, providing health systems with the coding needed to integrate physical activity assessment, prescription, and referral into their patient and clinical workflows. It is important for systems to include this as a priority into their patient care, as it will integrate the infrastructure and common language needed to practically implement digital measures of physical activity. The alliance also worked with the Office of the National Coordinator for Health Information Technology to have physical activity assessment included in the U.S. Core Data for Interoperability v.4 (standardized health elements used by health IT systems to exchange electronic data) and incorporated in electronic health records by 2028.
Conclusion
Health care professionals can be at the center of maximizing the value of digital measurement to improve their patients’ health. While work to integrate digital measures into clinical workflows will continue to be done, there is enough to get us across a threshold to where digital measurement of physical activity is a common part of patient care plans. To kick the can down the road and delay leveraging digital measures of physical activity in practice is a disservice to patients and the care they deserve.
Laurie Whitsel is the national vice president of policy research for the American Heart Association and a senior advisor to the Physical Activity Alliance. John Hernandez is the clinical director and head of health impact for Google. Candice Taguibao is the program lead for the Digital Health Measurement Collaborative Community (DATAcc) of the Digital Medicine Society.
