Adaptation, Implementation, and Evaluation of Exercise is Medicine into a Student-Run Free Clinic

SUSAN M. GLOCKNER, MD; MPH candidate
University of California (UC) San Diego, Herbert Wertheim School of Public Health and Human Longevity Science

Although physical activity’s (PA) health benefits are well-documented, rates of meeting PA guidelines are low, particularly in marginalized populations. Primary care providers can promote PA with patients during routine visits but face barriers such as training, time, technology, and tools, which are amplified in under-resourced community-based clinical settings. Exercise Is Medicine (EIM) attempts to address these by leveraging technology-assisted decision support built into the electronic medical record (EMR) to help providers integrate PA assessment, discussions, and prescription into routine care. This implementation science study describes the systematic, multi-stakeholder process used to adapt EIM into the UC San Diego Student-Run Free Clinic Project (SRFCP) and evaluates it with the RE-AIM framework.

The SRFCP is led by medical students to serve an uninsured, primarily Spanish-speaking Latinx population residing in low-resourced communities.

The EIM workflow includes 5 core components: a physical activity vital sign (PAVS) score recorded in the EMR; a diagnosis of adequate or inadequate PA populated; the physician prompted with a banner to discuss PA and document this decision; a tailored PA prescription and link to a comprehensive PA manual generated; and free optional health coaching phone calls offered. EIM was adapted using Framework for Reporting of Adaptations and Modifications Extended (FRAME) to align with the SRFCP using a multi-stakeholder engaged process. Using the RE-AIM model for implementation planning and evaluation, patient- and provider-level data were obtained from the EMR, surveys administered to medical students and the implementation team, and questions added to the patient interviews.

Process and content adaptations facilitated the integration of tailored components into existing workflows and alignment with patients’ dominant Spanish language. Reach and adoption were high, with 62.4% and 89% of patient visits having documented PAVS scores and exercise discussions. Most patients (86%) recalled an exercise discussion with their provider, and 57% accepted health coaching. Among all patients who had more than one PAVS score recorded, the mean PAVS score significantly increased by 24.4% overall, including 32% among those who said yes to health coaching vs. 14% who did not. Surveys of medical students indicated improvements in confidence, comfort, frequency, and length of exercise discussions and fewer perceived barriers six months post-implementation. Surveys for the implementation team indicated high levels of acceptability, appropriateness, and feasibility.

Overall, adapting and implementing EIM was feasible, acceptable, and appropriate. Medical students felt confident about overcoming barriers to discussing exercise, while patients found EIM helpful. This preliminary evaluation shows promise in EIM’s effectiveness and sustainability.