Exercise as a Vital Sign in Spine Care

North American Spine Society 34th Annual Meeting Highlight

Physical inactivity is “an urgent public health priority,” Stanley A. Herring, MD, told attendees at the North American Spine Society 34th Annual Meeting in Chicago, IL. Dr. Herring discussed the implications of physical inactivity on outcomes of spinal surgery and the need for a paradigm change to promote physical activity earlier in life as preventative medicine.
group of people walking, close up on walking shoesApproximately 80% of people in the United States do not meet physical activity guidelines for aerobic or strength exercise and physical inactivity is an urgent health priority. Photo Source: iStock.com.“Taking someone who is already in a disabled state with comorbidities and trying to fix their spine is usually an unsuccessful recipe, but we still keep trying,” Dr. Herring said. “I think we are making a huge mistake if we don’t promote wellness from birth…. It really is our job, as spine care providers, to make sure that there is lifelong fitness.”

“Approximately 80% of people in the United States do not meet physical activity guidelines for aerobic or strength exercise; that is a big number,” said Dr. Herring, who is Clinical Professor in the Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery at the University of Washington.1 “Physical inactivity, as a standalone risk factor, is the number four cause of death in the world independent of obesity or other comorbidities.”2

Physical inactivity, not surprisingly, is linked to the rising obesity rates as well as the more than 53 million Americans who are disabled in the United States, explained Dr. Herring, who also is Cofounder and Senior Medical Advisor of The Sports Institute at UW Medicine.3

“There are a lot of reasons that people aren’t healthy, but 50% is accounted for by health behaviors,” Dr. Herring said. “You can address exercise, smoking, and diet and make a big difference on patient outcomes, including people with back pain.”

Impact of Physical Inactivity on Diseases

“The impact of physical inactivity is fairly impressive,” Dr. Herring said. “Six percent of the burden of coronary heart disease and 10% of the burden of all breast and colon cancers worldwide are directly related to physical inactivity.4 If the world exercised, the entire population would live almost a year longer simply from being physically active.”4

In fact, high levels of physical activity are associated with lower risks of 13 types of cancer independent of body mass or smoking habits.5 In addition, research suggests that a structured exercise program is equally good, if not better, at reducing mortality than almost every medication prescribed for cardiovascular conditions, with the exception of diuretics in the treatment of heart failure.6

In addition to cancer and cardiovascular disease, the recommended 150+ minutes per week of moderate-aerobic intensity is linked to reduced risk for the following conditions:7

  • Dementia
  • Depression and anxiety
  • Fall and fall-related injuries in older adults
  • Hypertension
  • Osteoarthritis
  • Type 2 diabetes
  • Weight gain

“While I think we all know these benefits, whether we act on it or not is a different conversation,” Dr. Herring said. “I think if we do act on it, we probably act on it too late.”

“A lot of the spine interventions that we perform to treat adults with complex comorbidities (eg, deconditioning, disability, mental health, psychological diseases) in isolation is a bit like moving furniture into a burning house,” Dr. Herring noted. “We use a lot of resources, but I’m not sure the outcome is really very satisfactory.”

Benefits of Exercise in Children and Adolescents

“In children, there is no question that physical activity improves muscular strength, motor coordination, bone, mood, and brain structure and function,” Dr. Herring said. Physical activity also prevents inactivity-related diseases that occur in childhood including type 2 diabetes, asthma, hypertension, atherosclerosis, fatty liver disease, sleep apnea, and depression.

“Importantly, if you’re active as a kid, you have a much greater chance of being active as an adult,” Dr. Herring noted. “Teaching adults, who have never been physically active. to be regular exercisers is challenging and often unsuccessful.”

“Unfortunately, on average, kids spend approximately 7 hours and 12 minutes a day sedentary,” Dr. Herring explained (see Table).
table lists inactivity rates and obesity in US children, adolescentsInactivity Rates and Obesity in Children and Adolescents in the United States.“Only approximately one-quarter of children in the United States meet recommended exercise activities for their age group, and less than half of children have adequate cardiovascular fitness,” Dr. Herring said. “There is no question that inactivity–both directly and indirectly–leads to lifelong serious issues.”

Exercise is Medicine Initiative

The American College of Sports Medicine started the Exercise is Medicine initiative with the goal of making physical activity assessment and promotion standard in clinical care. The program involves the following:

  • Routine physical activity assessment and screening
  • Brief advice/counseling
  • Physical activity prescription, depending on patient health, fitness, and preference
  • Referral to physical activity resources

“If you ask about exercise as part of a regular visit, counsel your patients about the value of exercise, find out what they like to do, and write them a prescription with a resource—which takes about 4 or 5 minutes per visit—it clearly changes behavior,” Dr. Herring told NASS attendees. “Just asking about exercise changes behavior.”

In Dr. Herring’s institute, clinicians monitor exercise as a vital sign in the electronic health record along with blood pressure, pulse, and weight. Patients are asked how many minutes a day they exercise and how many days a week? All patients are given an exercise prescription after discussing what physical activities they like.

“And then we’ve developed Exercise RX which lists no-cost or low-cost centers that provide evidence-based exercise in each community [Seattle, WA areas],” as well as free online exercise videos and apps, Dr. Herring said. “We now have 50,000 people enrolled.”

In addition, Dr. Herring’s institute is a co-supporter of The Daily Mile campaign in which elementary school children and their teachers walk or run for 15 minutes each day, with no training or equipment required.

“We are measuring to see what The Daily Mile does for academic performance,” he explained. “We hope it is gateway to fitness.”

“I think we are making a huge mistake if we don’t promote wellness from birth,” Dr. Herring concluded. “If we don’t do that, we’re coming in too late in the game to affect disability.”

Dr. Herring has no relevant disclosures.

Updated on: 12/20/19
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