Project Update: Follow-up Project Physicians Implement Exercise as Medicine (PIE=M)

PIE=M stands for Physicians Implement Exercise as Medicine. This project ran from September 2018 until the end of 2020.

The PIE=M project focused on the potential to provide patients with exercise advice to promote a healthier lifestyle, prevent and treat chronic diseases, facilitate recovery, and promote healthy aging. The PIE=M research was conducted by UMC Groningen and Amsterdam UMC. It was a research project subsidized by ZonMW and carried out at the departments of Rehabilitation Medicine (UMCG and Amsterdam UMC), Orthopedics (UMCG), and Oncology (Amsterdam UMC). The PIE=M project resulted in an implementation plan for prescribing Exercise as Medicine in the hospital setting, known as the "Beweegstappenplan" (see www.beweegstappenplan.nl). Research publications related to this project are still ongoing, as evidenced by these three publications:

The team of this project received financial resources from the Take-Off Call to conduct a feasibility study for optimizing the Beweegstappenplan and exploring its broader application in hospital care. With these resources, the team continued this worked on valorization of the research outcomes.

In October 2022, we interviewed Adrie Bouma, a sports scientist and senior researcher at UMCG.

Valorization

UMCG and Amsterdam UMC (VUmc department) remain closely involved in this follow-up project. In 2021, the foundation Special Heroes Nederland took over the Beweegstappenplan. The foundation advocates for people with disabilities and illnesses by promoting a healthy and active lifestyle and creating a wide range of opportunities in sports, culture, work, and health. "They have essentially become stewards of the Beweegstappenplan, and they are well-equipped to work with us to ensure further development and make it available to other healthcare institutions in practice. They are also assessing what else is needed in hospitals to enable the prescription of exercise advice and referrals."

Another partner was the Dutch Center for Exercise is Medicine, a national network that supports the concept of Exercise is Medicine.

This valorization project took place in the first half of 2022. In this research, the prescription of Exercise as Medicine using the Beweegstappenplan was evaluated in two hospitals (Nij Smellinghe Hospital in Drachten and Gelderse Vallei Hospital in Ede).

Results

The follow-up research revealed that the Beweegstappenplan has significant potential but needs further development. The main reason for this is the recognition that there is a strong demand for comprehensive lifestyle support. "We had a comprehensive plan for exercise, but they needed more. So, there was a need for attention to other lifestyle elements, such as the BRAVO factors. BRAVO factors represent the different elements related to your lifestyle. B stands for Exercise (Dutch: beweging), R for Smoking (roken), A for Alcohol, V for Nutrition (voeding), and O for Relaxation (ontspanning)."

Additionally, there was a desire for more support than the written information provided. "Even though the Beweegstappenplan was quite extensive with tools, lessons learned, etc., it was suggested that users would have preferred a kind of coach who could have guided them through and with whom they could brainstorm regularly. It was mainly a lot of information, but it didn't really come to life. This was valuable feedback."

The availability of knowledge, expertise, and time was also not always sufficient for this healthcare innovation. "People were deeply involved in the healthcare process themselves, and there wasn't always enough attention for project development and implementation. We also had the misfortune of a personnel change in one of the hospitals, which unfortunately resulted in a loss of a lot of knowledge."

In addition to the need for extra support, it became apparent that organizing the prerequisites required a lot of attention. "Despite enthusiastic leaders, we found that commitment from multiple layers of the organization is necessary to prioritize the development of a lifestyle care desk, from ICT to lifestyle coaches and physiotherapists who can also invest time."

LOFIT and National Network

"As a follow-up to the PIE=M study, a lifestyle care desk called LOFIT was established in UMCG Groningen." LOFIT is a four-year research project funded by ZonMw. In LOFIT, a lifestyle care desk is set up in the hospital environment to make lifestyle an integral part of the treatment for patients with chronic diseases.

LOFIT is coordinated by Amsterdam UMC (VUmc department). In Amsterdam UMC (VUmc and AMC locations), UMC Groningen, and Ommelander Ziekenhuis Groningen (OZG), lifestyle care desks will be established. This project involves collaboration with universities, colleges, health insurers, and partners connected to local "healthy lifestyle initiatives" in the region. "With LOFIT, based on the evaluation, we are not only focusing on exercise but also on other lifestyle factors. We are also looking at the patient's vulnerability; some may need more guidance than others."

In the meantime, UMC Groningen is pioneering lifestyle care in six other departments through the GLIM project (Groningen Lifestyle Intervention Model). "We received a grant to establish lifestyle care with a regional network. Mapping such a network is a lot of work; if it's not well mapped, it becomes a significant barrier to easily referring patients. We are also examining who needs to be supported within the hospital and have hired lifestyle coaches ourselves. The great thing is that this also aligns with government plans to allocate more financial resources for prevention, including lifestyle care desks."

Government and Health Insurers on Board

"When we started PIE=M in 2018, we wanted to explore the barriers healthcare providers face in discussing lifestyle and what is needed to provide lifestyle advice and refer people for lifestyle interventions. We now have a clear understanding of this. There are already significant efforts to map the network (for referral options) and to incorporate it into the Electronic Patient Record (EPD) to make it as efficient as possible for healthcare providers. We didn't dare to dream that the government would now also recognize the need for more attention to prevention, even in hospitals. The next step is to get health insurers on board, and there is certainly progress in that direction. A breakthrough in this area would further accelerate the process toward healthier and fitter Dutch citizens."