A Call to Action to the Health & Fitness Industry to Reach the 80% - Exercise is Medicine® [Podcast Series]

• [:55] Dr. Bantham introduces her guest, Dr. Bob Sallis

  • Dr. Bob Sallis is a family medicine physician at Kaiser Permanente.  

  • He is also Past-President of the American College of Sports Medicine (ACSM) and current chair of Exercise is Medicine® Advisory Board. 

• [1:26] Exercise is Medicine® evolution

  • “And once I began attending the ACSM annual meeting each year, I really came to appreciate the depth and the breadth of the knowledge we had around the health benefits of physical activity, and I just became fascinated by the powerful effect that exercise has on our health. And as someone who comes to work every day trying to treat and prevent disease as a family medicine physician as well, it just occurred to me why were we not listening to all this data?”

• [3:01] Exercise is Medicine® mission

  • “So that was sort of the mission of Exercise is Medicine® since the beginning, was simply to just make physical activity assessment, you know, asking patients were they exercising and if they aren’t, to make a formal exercise prescription to them.  That's been the goal from the beginning.  And then along with that, the longer range goal was how do we merge the fitness industry with the healthcare industry? And that certainly is another frustration. Why can I refer my obese patients to a bariatric surgeon, and that gets covered, but I can't refer them to a fitness professional?  Again, something that just makes no sense to me and continues to this day, that I can refer them for all these expensive pills and procedures, but not something so basic and simple of just getting and moving.“

• [3:46] Engaging the health & fitness industry around reimbursement

  • “We have no problems getting reimbursement for that, but nobody knows how to do it in the fitness world. How do we get the fitness industry reimbursed? How do I as a family physician send a referral and have it covered by insurance? It just doesn't happen. And that's been the biggest battle that I encountered through this whole evolution of Exercise is Medicine®. And even quite beyond that the fitness industry, in my estimation, they've actually been the most difficult to engage. Just really a lack of interest from the fitness industry on sort of working with the healthcare industry on how to get these reimbursements to happen.”

• [5:10] COVID and physical activity

  • “And there was no discussion about that. How important was exercise to trying to prevent COVID and mitigate the harmful effects of it. Nobody seems to care and continues not to care. You never hear those coming out of the lips of Anthony Fauci that maybe we ought to go out and exercise every day. Try to be as fit and healthy as we can. It's no, just wait for the vaccine, hide in the house. Why is that?”

• [12:40] Physical activity vital sign

  • “And then at Kaiser Permanente, I knew that that we would be the perfect test place for this and that was one of my biggest battles was getting us to begin using a physical activity vital sign—we call it an exercise vital sign—where every patient at every visit gets asked about their exercise habits. And so right along with blood pressure, pulse, they weigh you and your height. So you have your BMI calculated, whether or not you smoke, we have two questions about your exercise habits. So we have exercise data on all of our patients that are asked it at each outpatient visit.”

• [14:43] Referring patients to strength training programs

  • “But clearly, I need more than just having my patients go walk. I'm missing out on the benefits of strength training, which is probably more important than cardiovascular training, if you're going to pick one.  And then flexibility as well, I'm not really leveraging those health benefits that are particularly important as we age. And so I need more help than just telling people to go walk. That's a fine starting point. But we need to figure out how to take it to the next level…”

• [18:06] Finding trusted fitness professionals

  • “But honestly, I struggle with how do we figure out who we can trust and who we can go to. And I also think sometimes there's maybe too much emphasis put on, being so restrictive.  Maybe you don't need a doctoral degree to work with my patients, you know, or even a bachelor's degree for that matter. I mean, I just need somebody that can be motivating. And obviously, I don't want them to hurt my patient, they got to make sure they know what they're doing in terms of what works for certain patients. But I'm not convinced they need such an in-depth medical knowledge.” 

• [20:25] Fitness professional standards

  • “But we have a standard that we sort of use, and it seems to me so easy to be able to apply the same sort of approach for fitness professionals.  Yet, we seem to make it so confusing and hard to follow that I think it's an easily solvable problem if there was some real motivation to do so.”

• [22:15] Patient exercise behavior change

  • “It's often tying into those kinds of things that the patients are afraid of, they're worried about, or they're in for symptoms that I know can be helped if they just get exercising. That's where you often see the behavior change, when I can tie it to those things they're worried about, or they're currently dealing with. And that's what I really look for opportunities to do, to explain to them how this is what you really, if you would just exercise if you would just walk every day, I guarantee you this will be it will go away or be much better, you'll be able to deal with it much easier.”

• [24:50] Reaching the 80%

  • “Yet the health club industry just continues to try to steal away that 18%. They have never seemed to be interested in growing it. And I just don't understand that. And as a physician, I can tell you that my patients who belong to a health club, I'm not worried about. They're going to be fine. They'll keep doing it, they'll find a way to do it. But it's the patients who have never belonged to a health club, that 82% of the population. That's the ones that cause all the problems. Those are the ones I'm worried about. Those are the ones costing us all the money. They're the ones filling up nursing homes at a young age, you know, that is who is getting disability and can't work at a young age. That's who is costing us. Health care costs are primarily driven by that group. Figuring out a way to get them into a health club is key.”

  • “I think that the fitness industry has got to fundamentally change how they try to service the public in the United States. What their mission is and what their role is has got to change if they're going to be relevant.”

• [27:41] Call to action

  • “And I just think we can't do it without the health and fitness industry.  Somebody in that industry has got to take a leadership role, to really step up and say, we're going to look beyond what we've been. Because that's needed, I need that expertise, I can't sit with a patient and put them on a proper resistance program, They need somebody to work with them. And it needs to be readily accessible. And but until you build it, no one's gonna come until there's interest on the part of the health club industry to make these clubs something more than they've been.”