Here's a simple message for physicians struggling to find a fitness program that helps patients lead a healthier lifestyle: AIM-HI works.
Preliminary results from the AAFP's Americans In Motion-Healthy Interventions, or AIM-HI, research project, which was conducted by the Academy's National Research Network, or NRN, indicate that the program can help patients increase physical activity, make healthier choices, lose weight and maintain those lifestyle changes.
AIM-HI is not a weight-loss program but, rather, a lifestyle program with a holistic view of fitness. The initiative promotes a fitness philosophy that includes healthy eating, physical activity and emotional well-being for the prevention and treatment of chronic conditions.
In a study involving nearly two dozen primary care practices, preliminary results show
- a 10 percent increase in the number of patients who reported physical activity at least 20 minutes a day, three times a week, from baseline to four months and a 10.1 percent increase in the number of patients reporting the same amount of physical activity from baseline to 10 months;
- a nearly 42 percent increase in the number of patients who ate at least a half serving more of healthy foods each week from baseline to 10 months, and a nearly 45 percent increase in the number of patients who ate at least half a serving less of unhealthy foods each week from baseline to 10 months; and
- nearly 12 percent of patients lost 10 pounds or more from baseline to four months, and nearly 18 percent lost 10 pounds or more from baseline to 10 months.
"Most diet programs tend to peak around six to nine months, and you start to see weight gain back again around 10-12 months," said Wilson Pace, M.D., director of the AAFP's NRN and a professor in the family medicine department at the University of Colorado-Denver. "To see an increasing percentage of people continue to have good outcomes is very hopeful that this really is a lifestyle-changing activity versus a short-term diet."
The first step in implementing the AIM-HI approach is fostering a healthy office, which means that physicians raise awareness among fellow clinicians and office staff members about their own fitness and encourage them to make changes to improve their health.
Vance Blackburn, M.D., of Birmingham, Ala., said he works out at a gym three times a week and was in good shape before starting the AIM-HI study. However, he said, the program helped him make important changes in his lifestyle.
"It's not just for people who are overweight," said Blackburn. "It's for everybody. Everybody has ways that they can become healthier. It helped me realize that I need to make changes in the way I eat."
According to Blackburn, following a healthy lifestyle gives him credibility when counseling patients about fitness. Several of his patients work out at his gym.
"I had one gentleman who commented that I had been an inspiration to him," said Blackburn. "Inspiration is a pretty strong word. I'm not sure I would take it to that extent, but he knew I took care of myself, and that made him want to try to take care of himself."
Andrew Pasternak, M.D., of Reno, Nev., said AIM-HI helped members of his staff make healthy changes in their lives, which, in turn, helped patients.
"We try to do counseling with our patients as physicians, but a lot of times it's the staff doing counseling," he said. "It's good for our patients to see that anybody can do it. No matter what age you are or where you're coming from, building some physical activity into your day is possible."
Thomas Marshall, M.D., lives near a lake and forest trails in Lincoln, Mich., and many of his patients know he enjoys outdoor activities, such as cycling, running and canoeing. Marshall said that although it's good to be a positive role model, physicians should emphasize to patients who are just starting a fitness regimen that expectations should be realistic.
"You have to be sure you talk about baby steps as far as getting started with exercise," he said. "You don't have to go on a 100-mile bike trip like I do. You just need to get out the front door, walk 15 minutes and then turn around and come back. We try to give them a graded progression. If you can get them going, they usually start to buy into it, and they feel better."
Talking with patients about sensitive issues, such as overweight and obesity, can be difficult in a 15-minute office visit, especially if the patient is there to be treated for another issue. But AIM-HI offers physicians three helpful tools:
- a fitness inventory, which gauges a patient's confidence about their fitness and their readiness to change;
- a fitness prescription, through which the patient and the physician establish mutually agreed-upon goals that are assessed periodically; and
- a food and activity journal, which helps patients track nutrition and exercise goals.
Blackburn said many of his previous efforts to help patients lose weight were ineffective, but AIM-HI provides a framework to quickly address how a patient's excess weight affects his or her health and then provides a plan to make improvements.
"It's helped me develop an easier way to talk to patients about it," he said. "We're busy trying to deal with so many issues that sometimes obesity, which affects so many medical problems, gets pushed aside and doesn't get addressed.
"The tools AIM-HI has put together are an effective way to work on the problem bit by bit."
Marshall said writing a fitness prescription puts an exclamation point on what was discussed during an office visit.
"If I get a feeling like they're blowing it off and are just worried about getting new prescriptions for their medications, then to give them the idea that fitness is just as important as their medicines, I will actually write it down on a prescription pad and give it to them," he said.
Blackburn said the prescription gives the patient "something tangible to hold instead of just telling them to go out and try to eat better and exercise more." He said a prescribed goal might be something as simple as eating less fried food.
"Studies have shown that patients are more likely to lose weight when the doctor addresses that condition," he said. "They're also more likely to lose weight when they have a plan."
According to Blackburn, the fitness inventory helps patients take stock of where they're starting and gives us them ideas for areas they can focus on and try to change.
Gabriella Miotto, M.D., of Long Beach, Calif., said she stays fit with yoga, tai chi and a weekly belly-dancing class. Although common activities, such as walking, are fine, she said she encourages patients to find hobbies that will hold their interest.
"It needs to be something that's personally motivating," said Miotto. "Sometimes I'll ask them what they really enjoyed as a child. Can they imagine bringing some of that back into their daily life? A lot of people say they're too busy, so we break it down to the fact that there are 24 hours in the day. Take half an hour to do something that's creatively fulfilling."
Miotto said physicians also can help patients by investigating a community-based referral system for services such as depression and nutrition counseling, as well as being aware of sites where patients can exercise, such as a local YMCA.
Following the AIM-HI method can improve patient satisfaction and lead to better outcomes, she said.
"If someone feels a personal investment -- that you are looking at them as a whole person and not just as their physician -- that allows for the healing relationship to be deeper between the person and their health care provider," said Miotto.