Rourk, Zachary2018-08-142018-08-142018-05https://hdl.handle.net/11299/199023University of Minnesota Ph.D. dissertation. May 2018. Major: Kinesiology. Advisors: Dr. Eric Snyder, Dr. Michael Wade. 1 computer file (PDF); v, 169 pages.It is well established that physical activity is an important factor related to health and well-being. Currently, the leading health institutions and associations, including the US Department of Health and Human Services (USDHHS), the American Heart Association (AHA), the American College of Sports Medicine (ACSM), the American Diabetes Association (ADA) and the American Cancer Society (ACS), recommend 150 minutes of moderate intensity, or 75 minutes of high intensity, physical activity per week (Colberg et al., 2010, 2016; Kushi et al., 2012). The current physical activity recommendations are based on a thorough body of evidence that demonstrates the positive effect of physical activity on a wide variety of health outcomes, including all-cause mortality, cardiovascular disease, stroke, type II diabetes mellitus, Alzheimer’s disease, depression and breast and colon cancer (Aune, Norat, Leitzmann, Tonstad, & Vatten, 2015; Hamer & Chida, 2009; Johnson et al., 2013; Kyu et al., 2016; Lear et al., 2017; Sattelmair et al., 2011; Silveira et al., 2013; Wu, Zhang, & Kang, 2013). With this understanding in mind, it is surprising to find out that a majority of Americans fail to meet the recommendations for weekly physical activity (Troiano et al., 2008; Tucker, Welk, & Beyler, 2011; US Department of Health and Human Services, 2014). The Exercise is Medicine® (EIM®) initiative, was developed in an effort to increase population physical activity through primary care practitioner action, in 2007. However, there is little evidence to suggest that it has been successful thus far. The general research question that this dissertation aims to address is, “how can the clinical Exercise is Medicine® model be integrated more effectively into the current medical system? To answer this question, three studies were performed. First an updated economic analysis of the effects of physical inactivity on the US healthcare system was carried out in order to answer the question, “is it worth it to implement a physical activity intervention such as the EIM®?” It was hypothesized that the annual direct medical costs of physical inactivity would rival those of tobacco, and that the accomplishment of the Healthy People 2020 objective of increasing population physical activity levels by 10% would result in meaningful reductions in terms of caseload and direct medical costs. Second, a survey Assessment of Providers’ Knowledge and Understanding of the American College of Sports Medicine Exercise is Medicine® Initiative, was distributed to over 10,000 primary care practitioners in order to gain a better understanding of the current state of the EIM® strategy from the perspective of the primary care practitioner. It was hypothesized that primary care practitioners are not aware of the EIM® initiative, are not regularly implementing all of the steps of the EIM® process with their patient populations, do think that the steps of the EIM® process fall within their scope of practice and do believe that implementation of the EIM® initiative will increase population physical activity levels. Third, A Critical Evaluation of the Exercise is Medicine® Initiative with Proposed Amendments assesses each individual step of the EIM® process and the evidence on which it is based. From this assessment strengths and weaknesses of the process are highlighted and recommendations for improvement are made.enexercise is medicineprimary care practitionerThesis or Dissertation