
“As the 18th United States Surgeon General (2009-2013), I encouraged physical activity, especially walking, as a central part of moving us to a more healthy and fit nation. The health benefits of physical activity profoundly impact individuals of every stage of life. Developing clinical standards for physical activity is key to giving our healthcare system the tools needed to prevent or manage many chronic diseases.”
Dr. Regina Benjamin, 18th US Surgeon General

The major components of our policy and systems change work are:
- Standardizing Measures:
- Standardizing measures for physical activity assessment, prescription and referral that can be integrated into electronic health records and prompt conversations and follow-through between clinicians and patients is a critical first step. Accordingly, we worked with Health Level Seven International (HL7), a non-profit organization that develops standards for health information exchange and integration, and a technical consultant to develop the first ever HL7 FHIR Physical Activity Implementation Guide with accompanying patient and provider apps that can be integrated into health systems’ electronic health records (EHRs). We are continuing to test and refine these resources for integration with health systems, EHRs, digital health technology companies, qualified exercise professionals and others.
- Standardizing measures for physical activity assessment, prescription and referral that can be integrated into electronic health records and prompt conversations and follow-through between clinicians and patients is a critical first step. Accordingly, we worked with Health Level Seven International (HL7), a non-profit organization that develops standards for health information exchange and integration, and a technical consultant to develop the first ever HL7 FHIR Physical Activity Implementation Guide with accompanying patient and provider apps that can be integrated into health systems’ electronic health records (EHRs). We are continuing to test and refine these resources for integration with health systems, EHRs, digital health technology companies, qualified exercise professionals and others.
- Connecting Care to Community – Interoperability between Health Systems and Community-Based Organizations
- We want to connect patients to community-based resources that offer supervised exercise programs. We were successful in applying to have physical activity assessment included in the US Core Data for Interoperability, (USCDI) the minimum core data set required of all electronic health records in the US. We are hoping the latest version of USCDI will be included in final federal regulation on interoperability to allow for seamless referrals.
- We want to connect patients to community-based resources that offer supervised exercise programs. We were successful in applying to have physical activity assessment included in the US Core Data for Interoperability, (USCDI) the minimum core data set required of all electronic health records in the US. We are hoping the latest version of USCDI will be included in final federal regulation on interoperability to allow for seamless referrals.
- Making Movement Available and Affordable
- We are also working on getting coverage and reimbursement for evidence-based supervised exercise programs with private payers and with the Centers for Medicare and Medicaid Services. We are also scoping a pilot project in North Carolina with health systems, EPIC, and community-based organizations to demonstrate continuum of care. If successful, this effort could be scaled nationally.
- Building the Economic Case
- We have contributed to and led studies that helped frame the economic argument about why supervised exercise is so important. This is especially important for conversations with public and private payers.
- We collaborated with the Centers for Disease Control and Prevention and researchers at the University of Georgia on Inadequate Aerobic Physical Activity and Healthcare Expenditures in the United States: An Updated Cost Estimate, which found inadequate leisure-time aerobic physical activity accounts for $192 billion in annual health care costs among U.S. adults—12.6% of total national health care spending.
- We led A Review of the Cost-Effectiveness of Supervised Exercise Therapy for Adults with Chronic Conditions in the United States that systematically evaluated the cost-effectiveness of supervised exercise programs for US adults with chronic conditions. We found a consistent, positive return on investment of $1.15-1.70 for every dollar spent.
- Driving Change by Aligning Financial Incentives
- We will be exploring opportunities to develop quality measures for physical activity assessment and referral. If adopted and used effectively, these measures can financially incentivize integration of physical activity assessment, prescription, and referral into care delivery.
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