JamesLHollyMD.com

	James L. Holly, M.D.

About SETMA Joint Commission Contact Information History Mission Statement Medical Home Scope of Services I-CARE Initiative Infusion Center The SETMA Way - What is it? SETMA's Model of Care Patient-Centered Medical Home The SETMA Approach to Patient Care	In The News Letters Vital Signs - Examiner Publication SETMA's Providers as of January, 2015 SETMA Knows - Abraham Lincoln and Healthcare Analytics SETMA – 1999 – Four Seminal Events PC-PCC Award January, 2015 Vital Signs Spring 2015 Vital Signs Q&A for PC-PCC Award Links to SETMA 2012 eHealth Innovator Award for LESS initiative Handout for Attendees eHealth Conference January 12, 2012 eHealth Initiative 2012 Award Program Application The eHealth Initiative's 2012 Award Letter 2012 National Quality Forum National Healthcare Improvement Award Effective prioritization of performance improvement goals Dashboard to Measure and Manage Whole System Performance Commitment to transparency Date-driven improvement of NQS priorities Demonstration of readiness to assume responsibilities of an ACO Demonstrated results on publicly reported performance measures Public Reporting Quality Metrics for 2009, 2010, 2011 Internally Tracked Reporting Quality Metrics for 2009, 2010, 2011 Complete Application in PDF Format SETMA's Medical Home Pilgrimage 2009 Medical Home Series I 2010 Medical Home Series II 2011 Medical Home Series Two 2009, 2010, 2011 Medical Home Miscellaneous Articles The Dr. and Mrs. James L. Holly Distinguished Professorship Universal American Letter of Transmittal for Support Dr. Holly's Acceptance Address for the 2012 Distinguished Alumnus Award CMS Medical Home Feedback Report Qualify & Cost SETMA questions Influenza Data SETMA I - October 2011 SETMA II - October 2011 Mark A. Wilson Clinic SETMA West - October 2011 SETMA and Fox 4 News - Healthy Living Videos SETMA Advertisements - Display and Video SETMA Announcements Featured Content Archive	Syllabus PC-MH Externship SETMA's MS4 Patient-Center Medical Home Selective Syllabus Introduction to SETMA's Senior Externship and Syllabus An Introduction to the Origins and Beginnings of Southeast Texas Medical Associates, LLP Patient-Centered Communication PC-MH Health Affairs August 15, 2013 Policy Brief -- Health Gap SETMA 8.20.13 Provider Training -- Health Affairs 2.14.13 -- Patient Engagement SETMA Provider Training 8.20.13 during First Senior Medical Student PC-MH Externship Medical Home Coordination Review Tutorial 2011 Medical Home Series Two Teaching Tool for PC-MH Course - Patient Care Activation, Engagement, Shared-Decision Making	Patient Information What Does Patient-Centered Medical Home Mean to You? What Does Patient-Centered Medical Home Mean to You? Health information exchange Patient Rights and Responsibilities Patient Directions Contact SETMA – Secure Texting What is HIPAA? Authorization To Release or Obtain Medical Records Complete Privacy Policy Website Privacy Policy	Presentations Invited Presentations SETMA Provider Training
Governance Board Governance Board Responsibilities Governance Board Leadership Training The SETMA Team and The SETMA Culture SETMA's Mission, Vision and Goals: Patient Safety and Quality Care Harassment, Neglect, Abuse, Exploitation - Role of HCAHPS & CAHPS Healthcare Provider Standards Providers Responsibility Medication Refills, Reconciliation and Maintenance Provider and Leadership Use of Data and Analytics Commitment To All Patients -- Ethnic Disparities Kaizen - Board Creates Culture of Safety and Quality SETMA's Policy and Practice for Advanced Directives SETMA's Policy on Completion of Medical Records Care Guidelines : Improve processes to evaluate and treat Integrated patient safety program (Sentinel Events) Effectively Manages all programs, services or sites Provides Patients with information about Primary-care Medical Home Organization-wide Planning to Maintain Focus on safety and quality Organization-wide Planning to Maintain Focus on safety and quality SETMA's Performance Quality & Safety Judged by CMS SETMA's Performance Quality & Safety Judged by CMS SETMA Awarded by HIMSS for Quality and Safety 2011 John M. Eisenberg Patient Safety and Quality Awards Application Healthcare Quality Award 2012 Principles of Quality and Metrics Principles Contacting SETMA & Secure Texting PC-MH Mission, Vision, Goal, Access, End-of-Life Communications and Public Reporting Change Existing Processes to Improve Performance Team Members Focused on Safety and Quality	Your Life Your Health View Articles by Subject Aging Well Behavioral Health Cardiovascular Disease Risk Care Coordination Care Transitions Children's Health COGNOS Project Diabetes Exercise Healthcare Reform:Public Policy HIPAA & Security Labor Day Less Initiative Medical Home Medical Records Men's Health Mental Health Nutraceuticals Nutrition Smoking Cessation Thanksgiving Weight Management Women's Health All Articles	Public Reporting Public Reports by Year (2009-2017) Public Reports by Type Fall Risk, Pain, Functional, Wellness, Stress Assessment Fall Risk, Pain, Functional, Wellness, Stress Assessment for 2011 AND 2012 Core Measures: SETMA & Baptist Hospital Core Measures for January to December 2011 PQRS Diabetes Measures - Blood Pressure Diabetes Measures - Glyco and LDL Diabetes Measures - Nephropathy Screening, Foot Exam, and Eye Exam Preventive Measures - Screening (BMI, Colorectal Cancer, Mammography, Osteoporosis) Preventive Measures - Influenza, Pneumococcal, Urinary Incontinence Preventive Measures - Tobacco Use NQF Care for Older Adults Comprehensive CHF Care Diabetes Measures Diabetes Measures - Blood Pressure Control Diabetes Measures - Glyco and LDL Diabetes Measures - Smoking Cessation Female Measures General Health Measures Medication Measures Persistent Medications Medication Measures Pediatric Measures HEDIS (NCQA) Effectiveness of Acute Care Effectiveness of Chronic Care - Clinic/Hospital Effectiveness of Chronic Care - Clinic Only Effectiveness of Chronic Care - Diabetes (Smoking Cessation) Effectiveness of Chronic Care - Diabetes (Glyco and LDL) Effectiveness of Chronic Care - Diabetes (Blood Pressure Control) Effectiveness of Preventive Care Effectiveness of Preventive Care - Older Adults Effectiveness of Chronic Care - Diabetes Measures Effectiveness of Chronic Care - Persistent Medications (MPM) NCQA Diabetes Recognition Program Audit LESS Initiative PCPI PCPI Hypertension PCPI Diabetes PCPI Chronic Stable Angina PCPI Care Transitions PCPI CHF PCPI Weight Management PCPI CKD Stages IV V SETMA Lipid Audit Lipids Treatment Audit Tutorial Lipids Tutorial AQA COGNOS Project SETMA Audit for CKD Stages I III Patient Satisfaction Survey	Accreditations/Awards Achievements which have Advanced SETMA: The Time-line, Philosophy and Principles which Underlie that Advancement Awards	Diabetes Center of Excellence Education Diabetes Order Referral Form Seven Stations 2011 Advances in Diabetes Diabetes Tutorial Diabetes Prevention
EPM Tools Association of Medication and Diagnosis Automated Team Function Behavioral Health Adult Weight Management Tutorial Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Behavioral Health in SETMA's Patient-Centered Medical Home Model of Care Depression Tutorial Fall Risk Tutorial Health Insurance Portability and Accountability Act (HIPAA) Privacy Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive LESS Initiative Tutorial Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Pain Management Tutorial Reduction of Antipsychotic Medications Toolkit Smoking Cessation Tutorial Stratifying End-of-Life Risk for Hospice Services Tutorial Chronic Conditions Tutorial Chronic Renal Disease Management Tool Tutorial Calculating the Stages of Renal Disease Proteinuria Disease Management Tools Acute Coronary Syndrome Tutorial Adult Weight Management Tutorial Angina Tutorial Cardiometabolic Risk Syndrome Tutorial Chronic Renal Disease Tutorial Congestive Heart Failure Tutorial Diabetes Tutorial Hypertension Tutorial Lipids Tutorial Lipid Quality Audit Tutorial Primary Pulmonary Hypertension Tutorial Framingham Cardiovascular Risk Cardiometabolic Risk Assessment Framingham Heart Study Risk Calculators Tutorial Frederickson Classification of Dyslipidemia LDL Level Lipid Disease Management Risk Assessment General principles about ICD-9 Codes and HCC/RxHCC Codes Charge Posting Tutorial Coding to Ensure Accurate Health Risk Scoring E & M Codes Tutorial HCC & RxHCC Risk HCC/RxHCC Risk Tutorial ICD-9 Code Training Manual Hepatitis Screening Hospital Based Tools Hospital Care Summary and Post Hospital Plan of Care and Treatment Plan Tutorial Admission Orders Tutorial Daily Progress Notes Tutorial Care Transition Data Set from PCPI Tutorial Using The Clinic and Hospital Follow-up Call Templates Respiratory Failure Tutorial Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS): Tutorial for SETMA's Internal HCAHPS Survey Master GP Suite of Templates Master GP Suite of Templates Tutorial Medical Home Support Materials Department of Care Coordination, Director of Care Coordination and Care Coordination Referral Template Electronic Tickler File Electronic Tickler File Tutorial Follow-up Calls Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Services Medical Home Coordination Review Tutorial Medical Home Plan of Care and Treatment Plan Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Patient-Centered Medical Home Annual Questionnaires Patient-Centered Medical Home: SETMA's Medical Home Coordination Review (MHCR) Tutorial Patient Document for Coordination of Care Transitions of Care Management Coding (TCM Code) Tutorial Merit-Based Incentive Payment System (MIPS) Quality Metric Tool Tutorial Nursing Home Depression Tutorial Fall Risk Tutorial Hydration Assessment Tutorial Nursing Home Guidelines for Care Tutorial Nursing Home Principal Suite of Templates Nutrition Assessment Tutorial Reduction of Antipsychotic Medications Toolkit Skin Care Tutorial Outpatient Infusion Center for Intravenous Antibiotic Therapy and Other Meds Preventive Health Tools Adult Weight Management Tutorial CHF Exercise Tutorial Diabetic Exercise Tutorial Diabetes Prevention Tutorial Exercise Prescription Tutorial Hypertension Prevention Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Initial Preventive Physical Exam & Annual Wellness Visit Tutorial LESS Initiative Tutorial Progression to Type 2 Diabetes Smoking Cessation Tutorial Progression to Type 2 Diabetes Quality Metrics ACO and Medicare Advantage Stars HEDIS: NCQA, History, Quality, Safety, STARS, ACO ACO Quality Measures Performance Tool ACO Quality Measures Performance Tool Tutorial STARs - A Tutorial for Utilizing SETMA's Deployment of the STARS MA Program Specialized Tools Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Association of Medication & Diagnosis Chronic Conditions Tutorial Chronic Care Management Code (CCM) Tutorial Depression Tutorial Drug Interactions Tutorial Electronic Tickler File Tutorial Evaluation Lower Urinary Tract Symptoms in the Male Fall Risk Tutorial Future Labs Tutorial Hydration Assessment Tutorial HCC Risk Training Tool Hypertension: Fulfilling Quality Metrics for the PCPI Program Laboratory Results - Signing Off: Why and How Medication Module Tutorial Medication Reconciliation Tutorial Nutrition Tutorial Pain Management Tutorial Problem List Reconciliation Tutorial Progression to Type 2 Diabetes Referral Skin Care Tutorial SOAAP Opioid Risk Assessment Stratifying End-of-Life Risk for Hospice Services Tutorial Texas State Reportable Infectious Diseases Tutorial Transitions of Care Management Coding (TCM Code) Tutorial	Transforming Your Practice Library Introduction to SETMA's TCPI Library Transforming Your Practice (TCPI) Summary Document of TCPI CMS Quality 12.2015 TCPI Leadership and Governance Care Coordination HIPPA and Security Data Analytics Care Transitions LESS Initiative Medical Records Clinical Decision Support Hospital Care Tools Disease Management Tools Preventive Health Tools Behavioral Health Transformation Tools New Transformation Tools Patient-Centric Care Nursing Home Medical Home Display and Explanation of SETMA's Patient-Centered Medical Home Tools	Medical Home The Story and the Ideals Introduction to Preventive Health Tools PC-MH Patient Engagement & Alternative Payment Models Preventive Care: The Best Way to Treat Illness is Don’t Get it Coordination of Care Patient-Centric Care Population Health Transition of Care - One form of Care Coordination HCAHPS - Hospital Consumer Assessment Of Healthcare Providers and Systems CAHPS - Consumer Assessment of Health Care Provider and Systems Teaching Tool for PC-MH Course – Patient Care Activation, Engagement, Shared-Decision Making Display & Explanation of PC-MH Tools SETMA's Medical Home Pilgrimage Concierge Medicine not Medical Home Medical Neighborhood Security & HIPPA Referrals Patient Web Portal Health Information Exchange Medication Reconciliation The Automated Team Coordination of Care Medical Home Description & Standards AAAHC Joint Commission NCQA Planetree URAC NCQA Interview February 14, 2014	Facebook	Letters

Your Life Your Health - Moderate Exercise: The Health Benefits Part II

James L. Holly,M.D.

May 25, 2006

Your Life Your Health - The Examiner

(Author's Note: The content of this two part series on exercise was suggested by an article published on WebMD Medscape which is an educational service for healthcare providers. It was originally posted on 3/28/06 and was authored by Harvey Simon, MD. For more information about "cardiometabolic exercise" see Harvey B. Simon's, MD, FACP, The No Sweat Exercise Plan. Lose Weight, Get Healthy, and Live Longer, published by McGraw-Hill in 2006)

There is no question that moderate exercise has enormous health benefits. The following summary of twenty two studies shows that "getting moving," is the foundation of good health.

Recent Studies of Moderate Daily Activities

Population Group	Type and Amount of Activities	Observed Benefit
10,269 Harvard alumni	Walking at least 9 miles a week	22% lower death rate
	Climbing at least 55 flights of stairs a week	33% lower death rate[9]
836 residents of King County, Washington	Gardening at least 1 hour/week	66% lower risk for sudden cardiac death
	Walking at least 1 hour/week	73% lower risk for sudden cardiac death[10]
1453 middle-aged Finnish men	At least 2.2 hours of leisure time activity a week	69% lower risk for heart attack
4484 Icelandic men aged 45-80	Spending at least 43 minutes a day on leisure time physical activity after age 40	16% lower risk for stroke[11]
73,743 American women aged 50-79	Walking for at least 2.5 hours per week	30% lower risk for cardiovascular events[12]
44,452 American male health professionals	Walking at least 30 minutes/day	18% lower risk for coronary artery disease
39,372 American female health professionals	Walking at least 1 hour/week	51% lower risk for coronary artery disease[13]
72,488 American female nurses	Walking at least 3 hours/week	35% lower risk for heart attack and cardiac death
		34% lower risk for stroke[14]
30,640 Danish men and women aged 20-93	Spending 2-4 hours/week on light leisure time activity	32% lower mortality rate[15]
4311 British men aged 40-59	Performing light-to-moderate physical activity	35% to 39% lower mortality rate[16]
1404 female residents of Framingham, Massachusetts	Performing moderate physical activity	37% lower mortality rate[17]
802 Dutch men, aged 64-84	Walking or biking at least 1 hour/week	29% lower mortality rate[18]
707 retired Hawaiian men, aged 61-81	Walking at least 2 miles/day	50% lower mortality rate[19]
9518 older American women	Walking up to 10 miles/week	29% lower mortality rate[20]
229 postmenopausal American women	Walking 1 mile/day or more (a 10-year randomized clinical trial)	82% lower risk for heart disease[21]
7951 pairs of Finnish twins	Exercising at least 30 minutes on at least 6 days/month	43% lower mortality rate[22]
6017 Japanese men, aged 35-60	Walking (to work) for 21 minutes or more on work days	29% lower risk of developing hypertension[23]
1645 Americans aged 65 and older	Walking more than 4 hours/week	27% lower mortality rate
		31% lower risk for hospitalization for heart disease[24]
3206 Swedish men and women aged 65 and older	Performing physical activity at least once a week	40% lower mortality rate[25]
3316 Finnish men and women with type 2 diabetes	Performing moderate leisure time physical activity	18% lower mortality rate[26]
1204 Swedish men and 550 women aged 45-70	Walking or performing demanding household work	54% (men) and 84% (women), lowers risk for heart attacks[27]
2229 European men and women aged 70-90	Performing moderate physical activity	37% lower mortality rate

Source: Simon HB. The No Sweat Exercise Plan. Lose Weight, Get Healthy, and Live Longer. New York: McGraw-Hill; 2006.

The clear health benefits of exercise have been demonstrated in animal models. Randomized clinical trials in humans prove that regular exercise can produce a broad range of physiologic changes and improvements in risk factors (cholesterol, blood sugar, body fat, blood pressure, etc) that can be expected to improve health and reduce the risk for many diseases.

We don't have the advantage of randomized clinical trials that evaluate the effects of exercise on cardiac events and mortality in healthy people. However, 48 such trials have been conducted in patients with proven coronary artery disease. According to these studies, about half of the 8940 patients were randomly assigned to receive the best medical and surgical care available, whereas the others got the same standard of care plus enrollment in cardiac rehabilitation programs that were based on moderate exercise. The exercisers came out on top; in all, they enjoyed a 26% reduction in the risk for death from heart disease and a 20% reduction in the overall death rate. It's powerful evidence that exercise protects the heart -- and what's good for ailing hearts should be at least as beneficial for healthy ones.

If cardiovascular risk reduction was the only benefit of moderate exercise, it would still be vitally important for every physically able individual. But there are many other benefits. Exercise is an essential partner with diet for people who need to lose weight. And many studies also suggest that "no-sweat" exercise can help reduce the risk for stroke (by 21% to 34%), diabetes (16% to 50%), dementia (15% to 50%), fractures (40%), breast cancer (20% to 30%), and colon cancer (30% to 40%).

If that's not enough to get Americans moving, consider that exercise is also the only known way to slow the physiologic changes associated with the aging process in humans. While most people want to take a pill, a vitamin or a shot to find the "fountain of youth," it is right in their feet - get moving. You will longer, better and "weller." None of the benefits of exercise require aerobic intensity; in science, as in the fable, the tortoise will do very nicely indeed.

A 2005 analysis of data from the famed Framingham Heart Study reports that people who exercise regularly enjoy 3.7 years of additional life expectancy as compared with sedentary individuals. An intensity equivalent to walking at a pace of 17 minutes per mile was sufficient. And another 2005 study showed that moderate exercise (walking 8.6 miles a week at 40% to 55% of maximum heart rate) will even increase the VO2 max (although not to the same degree as aerobic training).

Cardiometabolic Exercise

One of the barriers to getting our patients moving is the academic distinction between exercise (defined as formal structured activity designed to promote fitness) and physical activity (defined as everything else). In our busy world, most people do not believe that they are able to set aside time for formal exercise, especially intense workouts. In fact, the distinction is both arbitrary and misleading. Any physically active undertaking will contribute to health if it is part of an active lifestyle. Raking the lawn and cross-country skiing are at opposite poles of a single spectrum of benefit. For maximum protection, activities at the low end of the spectrum require more time than those at the high end, but they also are safer and less likely to produce injuries -- and the health benefits are remarkably similar.

What should we call the broad spectrum of activities that contribute to health? The familiar terms (aerobic, anaerobic, endurance, isometric, and isotonic) are not quite right. Dr. Simon proposed the term cardiometabolic exercise (CME) to emphasize the health benefits of everything from moderate activity to aerobic training, from washing the car to hitting the elliptical. And the term is meant to emphasize that even at the low end of the spectrum, exercise has major benefits for the cardiovascular system (coronary artery disease, hypertension, stroke, arrhythmias, peripheral artery disease, etc) and metabolism (body fat, glucose homeostasis and insulin levels, lipids, etc).

The CME system should help people set realistic individual goals instead of wondering what to make of "guidelines" that call for 30-90 minutes of exercise a day. For general health and gradual weight loss, aim for 150 points a day or about 1000 points a week. For faster weight loss, reduce dietary calories more sharply and/or aim for 300 CME points a day.

The system encourages people to view physically active tasks as opportunities, not punishments. Climbing stairs instead of riding the elevator is but one example of a healthful choice that incorporates exercise into the fabric of daily life. We should encourage our patients to choose whatever activities work for them as long as they get enough exercise to maintain good health. As people experience the subjective benefits of moderate exercise, some will go on to aerobic training or sports participation.

CME Points for Selected Activities

Activity	Pace	Duration	CME Points
Daily Activities
Carpentry	Moderate	30 minutes	100
Cleaning	Heavy	30 minutes	150
Digging in yard	Moderate	30 minutes	190
Dusting	Moderate	30 minutes	75
Mowing lawn	Pushing hand mower	30 minutes	200
	Pushing power mower	30 minutes	145
Raking lawn	Moderate	30 minutes	130
Stair climbing	Moderate, upstairs	10 minutes	100
	Moderate, downstairs	10 minutes	30
Washing car by hand	Moderate	30 minutes	100
Recreational Activities
Aerobic dance	Moderate	30 minutes	200
Biking	Moderate	30 minutes	250
Calisthenics	Moderate	30 minutes	130
Golfing	Pulling clubs	30 minutes	145
Jogging	12 minutes/mile	30 minutes	200
Rope jumping	Moderate	15 minutes	200
Skiing	Downhill or water	30 minutes	200
	Cross-country	30 minutes	315
Swimming	Moderate	30 minutes	230
Tennis	Doubles	30 minutes	160
	Singles	30 minutes	200
Walking	Moderate	30 minutes	125
Yoga (Hatha)	Moderate	30 minutes	130

CME = cardiometabolic exercise

In 460 BC, Hippocrates said: "If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health." In 2466 years, this has not changed. Remember, it is your life and it is your health.

Other Articles in the Moderate Exercise: The Health Benefits Series

	Moderate Exercise: The Health Benefits Part I

About SETMA	In The News	Syllabus PC-MH Externship	Patient Information	Presentations
Governance Board	Your Life Your Health	Public Reporting	Accreditations/Awards	Diabetes Center of Excellence
EPM Tools	Transforming Your Practice Library	Medical Home	I-CARE Initiative	NextMD