Background:
The American College of Sports Medicine Exercise is Medicine initiative encourages clinicians and healthcare systems to incorporate exercise prescriptions into clinical care. Existing use cases involve prescribing exercise resources within the clinician’s own healthcare system. Given the growth of digital resources supporting exercise with chronic diseases in the commercial marketplace, there is a need to establish a referral pathway to these resources.
Purpose:
To report feasibility of soliciting exercise prescriptions from primary care providers (PCPs) as part of a clinical trial which included a commercially-marketed digital exercise coaching app for adults with type 1 diabetes or latent autoimmune diabetes of adulthood currently exercising below guidelines.
Methods:
As part of eligibility requirements for the clinical trial of participants recruited through healthcare system portal messages, clinicaltrials.gov, and snowball sampling on social media, we sent a letter to each participant’s PCP to request an exercise prescription on a 3-item form specifying (1) confirmation of readiness for home-based exercise, (2) limits regarding exercise intensity, and (3) special considerations.
Results:
An exercise prescription was mailed to PCPs of 26 eligible participants from 10 different US states: 77% female, mean age 47 (SD=11) years, 88% non-Hispanic white, 88% privately insured, and 46% had obesity and/or uncontrolled hypertension. A total of 23 (88%) PCPs returned the form confirming readiness for home-based exercise. PCP responses about intensity included: endorsing vigorous exercise (n=18), gradual buildup to vigorous exercise per tolerance (n=3), and moderate exercise only (n=2). Responses about special considerations included: none (n=13), guidance for blood sugar management around exercise (n=3), advised exercising “as tolerated” (n=2), monitoring for new-onset cardiac symptoms (n=2), monitoring for preexisting pain symptoms (n=2), and advised a specific type of exercise (n=1).
Conclusion:
It was highly feasible for the manager of a commercial digital exercise resource to elicit exercise prescriptions from PCPs for clinical trial participants with a disease that increases cardiac risk. This form of outreach to primary care providers should be included in the Exercise is Medicine initiative.