Implementing and evaluating the comprehensive integration of physical activity into a major health system: study design and protocol

Stoutenberg, Mark; Estabrooks, Paul A; Brooks, John M; Jindal, Meenu; Wichman, Christopher; Rosemeyer, James; Schumacher, Leah M; McNulty, Lia K; Ewing, Alex; Eskuri, Stephanie; Bennett, Frankie; Trilk, Jennifer L

Abstract

Introduction:
The healthcare sector has great potential for promoting physical activity (PA) for chronic disease prevention, treatment and management; however, multiple adoption and implementation barriers exist, ranging from practice integration to information flow. In 2016, Exercise is Medicine Greenville (EIMG), a comprehensive clinic-to-community approach that involves PA assessment, recommendation and/or prescription and provider-based referral of patients to community-based PA programmes, was launched by Prisma Health in Greenville, South Carolina, USA. Since inception, variability has emerged in adoption and implementation, impacting patient reach, referral rates and engagement in the community-based PA programmes, highlighting the need for closer evaluation and refinement of strategies to maximise programme impact.

Methods and analysis:
This pragmatic study will examine the adoption, implementation and reach of EIMG. 20 Prisma Health primary care clinics will be invited to adopt EIMG. In Phase I, adopting clinics will receive a standardised EIMG instructional video followed by EIMG activation, allowing providers to refer eligible patients to a 12-week evidence-informed PA programme offered at local community facilities. In Phase II, adopting clinics will receive a more in-depth EIMG onboard training. At adopting clinics, referral rates of eligible patients will be tracked over both phases (each lasting 4 months). A mixed-methods approach will explore factors related to EIMG adoption, achieving optimal implementation and reach, and patient enrolment in the PA programmes. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will inform the assessment of implementation outcomes, while the integrated Promoting Action on Research Implementation in Health Services framework will be used to explore contextual factors influencing patient-level and clinic-level outcomes.

Ethics and dissemination:
We received ethical approval to conduct this study from the Prisma Health IRB Committee A (#1963762). The results of this study have the potential to significantly enhance clinical practice and improve health outcomes related to integrating a clinic-to-community PA model in health systems to connect patients with community-based PA resources. Information gained from this study will lead to the refinement of a generalisable approach to inform future implementation strategies on optimising and scaling up the integration of comprehensive PA models in US health systems and be disseminated through conference presentations, publication in peer-reviewed journals and direct work with health systems. Trial registration number: NCT06073041.

Citation

Stoutenberg, M., Estabrooks, P. A., Brooks, J. M., Jindal, M., Wichman, C., Rosemeyer, J., Schumacher, L. M., McNulty, L. K., Ewing, A., Eskuri, S., Bennett, F., & Trilk, J. L. (2025). Implementing and evaluating the comprehensive integration of physical activity into a major health system: study design and protocol. BMJ Open, 15(1), Article e091556. https://doi.org/10.1136/bmjopen-2024-091556

• Journal Article Type: Other
• Acceptance Date: Dec 10, 2024
• Online Publication Date: Jan 6, 2025
• Publication Date: Jan 6, 2025
• Deposit Date: Jan 17, 2025
• Publicly Available Date: Jan 17, 2025
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Issue: 1
• Article Number: e091556
• DOI: https://doi.org/10.1136/bmjopen-2024-091556
• Keywords: Exercise, Primary Health Care, Implementation Science
• Public URL: https://durham-repository.worktribe.com/output/3332313