Why ‘fitness is something we should be measuring’ at the doctor’s office

Doctors should assess and estimate the cardiorespiratory fitness of adults during routine visits just as they measure blood pressure, according to the Canadian author who chaired a new scientific statement from the American Heart Association.

Cardiorespiratory fitness refers to the ability to do aerobic activities.  A growing body of medical research shows it’s potentially a stronger predictor of death risk than more established risk factors such as smoking, high cholesterol and hypertension.

That’s why the American Heart Association turned to Queen’s University kinesiology Prof. Robert Ross and his team of international experts to review the evidence.

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Their conclusions are published in the group’s journal, Circulation, titled “Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign.”

Ross said adding cardiorespiratory fitness as a vital sign accomplishes two objectives:

• It offers a simple way to improve a doctor’s ability to assess a patient’s risk of developing cardiovascular illness or death in the next 10 years.
• It provides a practical way to counsel patients and evaluate how well the “treatment”, prescribed exercise, is working.

“Fitness is something we should be measuring. It’s telling us something that no other measure that we have in clinical measure can give us, ” Ross said in an interview. “So why not take advantage of this?” 

Brisk walk prescribed

About 80 to 85 per cent of Canadians don’t meet physical activity guidelines of 150 minutes a week of moderate level intensity, and many are sedentary.

According to Ross, the good news is that small improvements in physical activity offer major payoffs in  reducing cardiovascular disease risk levels. “The greatest reductions that we have in cardiovascular disease is going from very low fitness to just doing something.”

What’s more, physical activity benefits can be achieved by brisk, purposeful walking — as if you’re late for a bus. No fancy equipment needed.

The 150 minutes is a target to build toward, Ross said. He acknowledged that’s a struggle for some, just as taking medication as prescribed can be.

Physician groups in British Columbia and Quebec offer customized fitness prescription pads to encourage exercise.

Dr. Ron Wilson of Denman Island, B.C., says the strategy works better with a wider public health response. 

“When we do give an exercise prescription to patients, they have somewhere in the community to go where they get the support they need,” Wilson said. 

In the past, it was thought that maybe physicians need sophisticated equipment, treadmills or exercise bicycles in their office to measure cardiorespiratory fitness. But now algorithms, websites and apps can provide an estimate of a person’s fitness level.

Since no special expertise is required, a nurse could use the algorithm while the patient is in the office waiting for the physician, Ross suggested, just as other vital signs such as blood pressure are measured. The physician could then interpret the results with the patient.