Active lifestyle significantly lowers risk of 19 chronic diseases, study finds

University of Iowa researchers are recommending all patients be surveyed about their physical activity levels, after a new study underscores the link between physical activity and chronic disease.

The study, led by Lucas Carr, associate professor in the Department of Health and Human Physiology, examined responses from more than 7,000 patients at University of Iowa Health Care Medical Center who noted their level of physical activity in a questionnaire.

The study, “Screening Patients for Physical Inactivity Helps Identify Patients at Risk for Cardiometabolic and Chronic Diseases,” was published online in Preventing Chronic Disease.

From patients’ answers to the questionnaire, the researchers found that those who reported the highest level of physical activity—meaning they exercised moderately to vigorously at least 150 minutes per week—were at a statistically significant lower risk of having 19 chronic conditions, including cardiovascular disease, cancer, respiratory disease, and diabetes.

The findings further suggest patients who are least active—meaning they reported little to no exercise in a given week—are at increased risk to develop a chronic disease.

Based on those results, the Iowa researchers also recommend health care systems provide information on health and wellness services for physically inactive patients who are at most risk.

“In our health care environment, there’s no easy pathway for a doctor to be reimbursed for helping patients become more physically active,” says Carr, the study’s corresponding author. “And so, for these patients, many of whom report insufficient activity, we need options to easily connect them with supportive services like exercise prescriptions and/or community health specialists.”

Most hospitals in the United States do not ask patients about their physical activity, and no hospital system in the Midwest has done so, according to the researchers.

In this study, Carr partnered with Britt Marcussen, a family medicine physician at UI Health Care, to offer the questionnaire to patients visiting for annual wellness exam appointments. The study period was from November 2017 to December 2022.

The Exercise Vital Sign survey, as the questionnaire is called, asked patients two questions that they answered on a tablet:

• “On average, how many days per week do you engage in moderate to vigorous exercise (like a brisk walk)?” (0-7 days)
• “On average, how many minutes do you engage in exercise at this level?”

Carr and his team propose making the survey available to all patients.

“This two-question survey typically takes fewer than 30 seconds for a patient to complete, so it doesn’t interfere with their visit. But it can tell us a whole lot about that patient’s overall health,” Carr says.

The researchers also compared results from patients who completed the surveys with more than 33,000 patients who weren’t offered the survey in other areas of the hospital. The researchers found patients who took the survey were younger and in better health than the patient population who weren’t given the questionnaire, based on analyzing all patients’ electronic medical records.

While the link between physical activity and reduced risk of chronic disease has been known, the researchers say the study underscores the value of surveying patients about their physical activity levels.

“We believe this finding is a result of those patients who take the time to come in for annual wellness exams also are taking more time to engage in healthy behaviors, such as being physically active,” Carr says.

In a related study, published in the Journal of Physical Activity and Health, Carr’s team found that when health care providers billed for providing exercise counseling to patients, those invoices were reimbursed by insurance providers nearly 95% of the time.

“Our findings suggest the recommended physical activity billing codes are reimbursed at a high rate when providers submit them for reimbursement, which reinforces the idea to make physical activity surveys and counseling services available,” Carr says.

Cole Chapman, assistant professor in the College of Pharmacy, is the first author of the study. Chapman, who joined the Pharmacy faculty in 2019 after earning bachelor’s and doctoral degrees at Iowa, collected and analyzed the data from the patients’ electronic medical records.

Marcussen and Mary Schroeder, associate professor in the Department of Pharmacy Practice and Science in the College of Pharmacy, are study co-authors.