Implementing Exercise = Medicine in routine clinical care; needs for an online tool and key decisions for implementation of Exercise = Medicine within two Dutch academic hospitals

Abstract

Background There is much evidence to implement physical activity interventions for medical reasons in healthcare settings. However, the prescription of physical activity as a treatment, referring to as ‘Exercise is Medicine’ (E = M) is currently mostly absent in routine hospital care in The Netherlands. To support E = M prescription by clinicians in hospitals, this study aimed: (1) to develop an E = M-tool for physical activity advice and referrals to facilitate the E = M prescription in hospital settings; and (2) to provide an E = M decision guide on key decisions for implementation to prepare for E = M prescription in hospital care. Methods A mixed method design was used employing a questionnaire and face-to-face interviews with clinicians, lifestyle coaches and hospital managers, a patient panel and stakeholders to assess the needs regarding an E = M-tool and key decisions for implementation of E = M. Based on the needs assessment, a digital E = M-tool was developed. The key decisions informed the development of an E = M decision guide. Results An online supportive tool for E = M was developed for two academic hospitals. Based on the needs assessment, linked to the different patients’ electronic medical records and tailored to the two local settings (University Medical Center Groningen, Amsterdam University Medical Centers). The E = M-tool existed of a tool algorithm, including patient characteristics assessed with a digital questionnaire (age, gender, PA, BMI, medical diagnosis, motivation to change physical activity and preference to discuss physical activity with their doctor) set against norm values. The digital E = M-tool provided an individual E = M-prescription for patients and referral options to local PA interventions in- and outside the hospital. An E = M decision guide was developed to support the implementation of E = M prescription in hospital care. Conclusions This study provided insight into E = M-tool development and the E = M decision-making to support E = M prescription and facilitate tailoring towards local E = M treatment options, using strong stakeholder participation. Outcomes may serve as an example for other decision support guides and interventions aimed at E = M implementation.

Mixed Methods-Ansätze zur Implementierung von Bewegung in der Tertiärprävention

“…Neben dem allgemeinen Wissen über Verordnung von Bewegung in der Tertiärprävention ist im Vergleich zur Primärprävention oft spezifischeres Wissen erforderlich, wie Kontraindikationen oder Anpassungen der Bewegungstherapie an vorliegende Erkrankungen (bspw. fortgeschrittene Herzinsuffizienz oder Knochenmetastasen) [13][14][15]. Bekannte Faktoren wie Zeitmangel werden durch die erforderliche umfangreichere Kommunikation, zusätzlich zur Besprechung der Grunderkrankung, durch die Möglichkeit einer Verordnung von Bewegungstherapie noch verschärft [16].…”

Global Alliance for the Promotion of Physical Activity: the Hamburg Declaration

“…An individualised prescription, including NCD-specific PA and exercise recommendations, could be more beneficial than standard PA prescriptions 4 17 19. However, standard PA prescriptions achieve equal or even better therapeutic outcomes than traditional medical treatments 17 19 75…”

“… 3 4 9 10 20 This could increase patients’ PA, improve staff communication skills and build collaboration with local sports clubs, sports and fitness specialists, other community services and self-help organisations. The ‘Exercise is Medicine’ initiative, 41 ‘Moving Medicine’, 74 the Swedish ‘PAP (Physical Activity on Prescription)’ model 20 or the Dutch ‘Exercise=Medicine’ model 75 are excellent examples of PA prescription initiatives.…”