Implementing individually tailored prescription of physical activity in routine clinical care: protocol of the Physicians Implement Exercise = Medicine (PIE=M) development and implementation project

ABSTRACT:

Background: 
The prescription of physical activity (PA) in clinical care has been advocated worldwide. This ‘exercise is medicine’ (E=M) can be used to prevent, manage and cure various lifestyle-related chronic diseases. Due to several challenges, E=M is not yet routinely implemented in clinical care. 
Objective: 
This paper describes the rationale and design of the Physicians Implement Exercise = Medicine (PIE=M) study, which aims to facilitate the implementation of E=M in hospital care. 
Methods: 
PIE=M consists of three inter-related work packages. First, levels and determinants of PA in different patient and healthy populations will be investigated using existing cohort data. The current implementation status, facilitators and barriers of E=M will also be investigated using a mixed-methods approach among clinicians of participating departments from two diverse university medical centers (both located in a city, but one serving an urban population, and one serving a more rural population). Implementation strategies will be connected to these barriers and facilitators using a systematic implementation mapping approach. Second, a generic E=M-tool will be developed which will provide a tailored PA prescription and referral. Requirements for this tool will be investigated among clinicians and department managers. The tool will be developed using an iterative designing process in which all stakeholders reflect on the design of the E=M-tool. Third, we will pilot-implement the set of implementation strategies, including the E=M-tool, to test its feasibility in routine care of clinicians in these two university medical centers. An extensive learning process evaluation will be performed among clinicians, department managers, lifestyle coaches and patients, using a mixed-methods design based on the RE-AIM framework. 
Results: 
This project was approved and funded by a Dutch grant provider ZonMW in April 2018. The project started in September 2018 and continues until December 2020 (depending on the course of the COVID-19 crisis). All data from the first work package has been collected, analyzed and is expected to be published in the summer of 2020. Results of the second work package are described. The manuscript is expected to be published in the summer of 2020. The third work package is currently being conducted in clinical practice in four departments of two university medical hospitals among clinicians, lifestyle coaches, hospital managers and patients. Results are expected to be published in 2021. 
Conclusions: 
The PIE=M project addresses the potential of providing patients with PA advice to prevent and manage of chronic disease, improve recovery and healthy ageing by developing E=M implementation strategies including an E=M-tool in routine clinical care. The PIE=M project will result in a blueprint of implementation strategies, including an E=M screening and referral tool, which aims to improve E=M referral by clinicians to improve patients’ health, while minimizing the burden on clinicians.