Thursday, December 14, 2017

The Fourth Vital Sign- Physical Activity


by John Mersch, M.D.
December 2012
Physicians have traditionally considered three vital signs when assessing a broad overview of their patient’s health status. These three elements are temperature, heart and respiratory rate and blood pressure. However, with the epidemic of overweight and obese Americans (30% of children 2-18 years of age), many doctors are proposing that a fourth vital sign—physical activity—be included as an equally important measurement of well being. Standardizing physical activity (PA) is straightforward.

Physical Activity = # minutes/day in moderately intense physical activity x
# days/week such activity is done

For example, John is on the swim team that practices 60 minutes per session and has three sessions per week. PA = 60 min/session x 3 sessions/week = 180 min/week. National guidelines for adults recommend 150 minutes and 180 minutes per week for children.

Several important points should be noted. Fitness is more easily achieved than weight loss. The good news is that studies have repeatedly documented the linear relationship between physical activity and health status. It is better to be fat and fit than skinny and un-fit. In fact, a low level of fitness is a bigger risk factor for mortality (death) than mild to moderate obesity. In addition, the benefits of physical activity are the same regardless of a person’s weight. It is better to have daily activity of shorter duration than longer sessions limited only to the weekend. It is better to do something (anything!) on a daily basis than limit yourself to the “weekend warrior” pattern. Studies indicate that the daily activity duration may be broken into easily managed segments—e.g. parking your car a 10 minute walking distance from work will “use” 20 minutes of an adult’s 30 recommended minutes per day.

Many physicians are starting to write fitness prescriptions to their patients using the acronym “FITT”: “F” = frequency (5 or more days a week); “I” = intensity (mild difficulty carrying on a conversation or signing a song); “T” = type (use large muscle groups doing something enjoyable); “T” = time (30 minutes per day).
Many people have a litany of explanations at their disposal that act as barriers to physical activity. “Too many demands—work/kids/spouse”; “too tired”; “too boring”; “not enough time” all are at the ready. What is necessary is a mental shift in personal priorities and make exercise a habit not an option. While the weekly duration is 150/180 minutes (adults/children), this is a goal–not a starting point. Better to have 3 sessions of 10 minutes than nothing. After achieving the weekly duration goal it’s time to periodically increase the intensity of physical activity and consider setting a competitive goal—e.g. a local fun run. One of the best ways to encourage success in a physical activity program is to make it fun. Find an exercise partner. Treat yourself to a nice workout outfit and use shoes specific for your activity. Consider the “Every Body Walk!” app (available via the iTunes or Android App Stores.) This easy to use app can track and save your walking routes to share and compare with friends on Facebook.

For millennia people have sought ways to live happily longer. Studies have consistently demonstrated that there are four contributors to overall health status. These include: (1) genetics (20%), (2) environment (20%), (3) access to medical care (10%) and healthy behaviors (50%). Isn’t it amazing that if taking a pill daily would provide the benefits of daily physical activity, doctors would be considered negligent if they did not insist their patients take it. Health care systems (governmental and private) would make sure that every individual would have access to this drug. Physical activity is that pill—and there’s an unlimited supply available as soon as you go out your front door.

Acknowledgement: Robert Sallis, MD, FACSM, FAAFP

Conference Chairman—2012 Ironman Sports Medicine Conference

The contents of this web site are provided as an informational tool. This is not intended to replace medical advice or care administered by a healthcare professional. Common sense should always be used when referencing this site. If, at any time, you feel your child is experiencing a medical emergency, call 911 immediately.

Dr. Mersch has been with SOCPA since 1982.  He is currently providing care in our Ladera Ranch office.  Click here to learn more about Dr. Mersch.