A Medicare-covered pathway for

Fitness Prescriptions in Lifestyle Medicine

Amy Pike, PT · Deb Halligan, BSN, RN · Katie Hill, MD · 2022

Increased Exercise, Balance, & Strength; Decreased Fall Risk in 12 Weeks

for patients with hypertension and atrial fibrillation

Background

Exercise is an essential component of healthy aging and lifestyle medicine (LM)

We propose using collaborative care, funded by Medicare, to deliver fitness treatment in LM

We report outcome measures for our fitness pathway delivered to a Medicare population treated in cardiology clinics after a phased, one-year implementation

Method

Patient type

Cardiologist prescribed Medicare patients with hypertension & atrial fibrillation

Care delivery

Participants were assessed by a fitness expert trained by a physical therapist (PT)

Care methods

  • Assessments were patient-reported activity levels and Five-Times-Sit-to-Stand-Test
  • Based on assessment results, patients were placed into categories of ability and started a 12-week program designed by the PT and tailored to ability level
  • Patients received follow-up by health coaches and assessments by fitness experts
  • Patients advanced through multiple levels upon meeting benchmarks

Results

N=18 (Exercise) · N=20 (Sit-to-stand)

Minutes of daily exercise

8.6min

30.2min

Avg. days per week with exercise

1.7days

4.6days

Avg. seconds 5x sit-to-stand test

14.2sec

10.2 sec

Fitness treatment caused increased exercise and improved strength and balance, leading to decreased fall risk and moving participants from sedentary to meeting USPSTF recommendations for older adults to decrease fall risk and prevent cardiovascular disease.

For patients treated in the fitness pathway, at least 8 weeks, average age was 76.7 years. Average length of program participation was 17 weeks.

Income from collaborative care covered the cost of fitness team experts.

Download PDF of this report

References

  1. Tiedemann A, Shimada H, Sherrington C, Murray S, Lord S. The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Age Ageing. 2008 Jul;37(4):430-5. doi: 10.1093/ageing/afn100. Epub 2008 May 16. PMID: 18487264.
  2. U.S. Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans, 2nd edition. Retrieved from https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf

*Conflict of interest: The authors are employees of Nudj Health and company stakeholders