The Value of Eliminating Sedentary Lifestyles

OCTOBER 23, 2016
Ed Rabinowitz
Columns, Practice Management, Lifestyle, Sedentary, Sitting, Wellness, Exercise, Physical Activity

The Centers for Disease Control and Prevention (CDC) website indicates that approximately two-thirds of Americans are overweight. That factor increases their risk of developing heart disease and diabetes – and skyrockets their healthcare costs by 80%.

But what’s important to note is that it’s not just Americans’ weight that’s increasing their health risks, it’s their sedentary lifestyle. Or more simply put, inactivity.

According to a recent study, just over 11% of aggregate healthcare expenditures were associated with inadequate physical activity.

“That says a lot right there when you’re talking about the economics of it,” says Donald Hensrud, MD, MPH, associate professor of preventive medicine and nutrition at the College of Medicine, Mayo Clinic, Healthy Living Program. “There’s pretty consistent evidence that inactivity is associated with not only medical issues, but also healthcare costs.”

And ‘sitting’ is a huge factor.
 
Don’t just sit there
There’s fairly solid evidence that exercise is beneficial for good health in many respects. But exercise is only part of the equation. Hensrud references his colleague, James Levine, MD, PhD, and his work in the area of non-exercise activity thermogenesis, or NEAT. It stands for all the activities we do throughout the day separate from exercise.

“If you think about the time that we spend exercising, it’s not that much,” Hensrud says. “There’s a much greater opportunity to move throughout the day, albeit at a lower level. But the aggregate effect on burning calories and health can be quite large. People underestimate that.”

So just because someone exercises, or doctors recommend exercise as part of an overall healthy lifestyle, doesn’t mean people are immune to the effects of sitting. That has spawned some interesting trends, including the treadmill desk and standing desks.

“My secretary has a little pedal machine under her desk to keep moving even when she’s sitting,” Hensrud says. “Separate from exercise and the activities we do throughout the day is the independent effect of sitting.”
 
Limited recognition
Hensrud says there is increasing recognition on the part of physicians of the financial impact of patients’ sedentary lifestyles—especially as the industry moves to more value-based reimbursement. But he adds that the increasing recognition often depends on the physician’s specialty, individual characteristics, and interests.

“If a physician is practicing in an area related to conditions such as diabetes or heart disease, conditions related to physical activity, they’re probably aware,” Hensrud says. “And physicians who themselves are more active tend to counsel patients to be more active. But we’ve still got some work to do to influence the aggregate of medical care.”

And while it might seem that broaching the subject of lifestyle and inactivity with patients is a huge barrier to overcome, Hensrud says that’s not the case. Rather, it has more to do with time.

“Physicians have less time,” he says. “And counseling patients in lifestyle areas, such as physical activity, takes time. That’s a big one for physicians.”
 
Education support
It was about two years ago when the Mayo Clinic started its Healthy Living Program, and it goes well beyond spa-type programs where patients go on ‘healthy vacations’ to learn how to eat better and be more active.

“The challenge there is they go home and it’s hard to keep up these habits,” Hensrud says. “We’re also individualizing it. Our program isn’t one size fits all. Everybody has different health goals and different challenges to meet those goals. So we’re working with people individually. We have wellness coaches who work with people to help them develop their own wellness plan—what are you going to do, when are you going to do it, and when life gets in the way, then what are you going to do?”

But of particular interest is Mayo’s Healthy Living Program for Physicians. It’s a two-and-one-half day, continuing medical education (CME) program centered on wellness, healthy living, and physical activity. Through the program, physicians change their own health behavior, and learn about wellness and activities they can pass on to patients.

“Physicians have to get CME credits anyway,” Hensrud says. “They have to go to programs. So here’s an opportunity to improve their own health and the health of their patients.”

It’s a place to start, Hensrud explains, especially since physicians are not taught a great deal about wellness and health behavior change in medical school.

“We all grew up in a disease treatment model, but that’s starting to change a little bit,” he says. “Primary care physicians should be aware of this. We believe there’s value there.”


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