There’s a low- to no-cost medicine that drastically improves the fortunes of patients. It’s widely available without a prescription, but to many it’s an unfamiliar pill. Some who try it find it bitter, and it has been known to trigger confusion and frustration. As commonly prescribed, it’s hard to dose, and from a medication-compliance perspective, providers have a hard time tracking and monitoring it.
We’re talking about exercise. Maybe you’ve heard it before: exercise is medicine. Whether it’s a muscle-ripping CrossFit routine or a walk around the park, exercise reduces risks across the health spectrum: heart disease, diabetes, injury, depression and much more. But while the health care establishment has long employed scientific, structured approaches to understanding the benefits of exercise, it’s lacked a good way of employing similar science and structure to help the vast numbers of patients who need the medicine of exercise. Thanks to a new method called Method, that’s about to change for primary care patients at UCHealth and beyond.
Method is a codified, computerized, app-enabled system that injects science and structure into exercise programming and planning by finding someone’s unique metabolic fingerprint. It’s the brainchild of Nicholas Edwards, MS, director of Exercise-Medicine Integration at the University of Colorado. Frank deGruy, MD, who chairs CU’s Department of Family Medicine, described Method as “the best thing I’ve ever seen for implementing exercise into primary care.” Family Medicine liked Edwards’ method so much they helped launch Method and owns a stake in it – with a big assist from CU Innovations.
The Center for Dependency, Addiction, and Rehabilitation (CeDAR) at UCHealth University of Colorado Hospital is already an adherent. Edwards rolled out Method there in November 2014, focusing on college and pro athletes in CeDAR’s Ascent Program. It’s since expanded to every CeDAR residential treatment program patient – and far beyond. Edwards says Method is also in place at physical therapy, sports medicine, orthopedics and athletic training facilities in several states, with a half dozen additional facilities embracing the approach this month alone. All told, thousands of athletes and patients are using the system, he adds.
Into the cells
Edwards, 32, knows a bit about exercise, both firsthand and as a student of it. He studied exercise science and dietetics at North Dakota State, where he played cornerback and also pole vaulted, clearing 16’2”. His pugilist nose is a keepsake from his eight years as an amateur and professional mixed martial arts pro.
Edwards has worked on the University of Colorado Anschutz Medical Campus for years. As the Anschutz Health & Wellness Center’s exercise testing coordinator, he devised the wellness assessment given to all incoming members. But Edwards also spent time working with professional and college athletes and sports teams and establishing fitness programs as well as entire sports medicine facilities. It was through a combination of that work and his CU experience that Method came about.
The approach tailors exercise and strength programs to individuals based on what’s happening in their bodies at the cellular level. It involves blood-based biomarker tests during exercise at increasing intensities. For an elite athlete, that may involve repeated sprints or doing deadlifts. For a couch potato, it might be standing up and sitting back down a few times from a chair.
By pegging escalating heart rate to changes in blood markers, Method’s approach establishes when someone transitions from aerobic to anaerobic (which happens when cells go from burning stored energy to burning what you just ate as fast-twitch muscles increasingly engage – and you breathe a lot harder) and then from anaerobic to catabolic (which happens when you max out and is ultimately counterproductive).
With the relationship between heart rate and muscle-cell status in hand, a Method user can know exactly how the body’s responding to exercise based on heart rate. The end result is faster return to play, healthier choices during exercise and lifestyle change, Edwards said.
The elite first
That’s a big step up from the old 220-minus-your-age approach of determining one’s maximum heart rate and then estimating anaerobic and aerobic training zones based on standard formulas. Think about it, Edwards said: the exercise transition points of a 55-year-old former Olympic swimmer who’s stayed in shape will look nothing like those of a sedentary obese diabetic of the same vintage. Their training programs should vastly different, too.
Metabolic testing is not new – elite endurance athletes have been doing it for years. But metabolic testing has been absent from the gym, the rehab facility and the weight room, where the anaerobic exercise that builds strength as well as endurance reigns. It has left us to our own devices, which so often leads to ineffective workouts or injury. Method addresses this not only through the metabolic testing, but also via automated exercise programs and individual workouts that can adjust in real-time based on that metabolic testing.
Adherents include two NFL and two NHL teams, including the Colorado Avalanche, for whom Edwards does sports science. Once a week during the season and more often during the preseason, Edwards is at practice or in the gym with the team, monitoring heart rates, oxygen, exercise readiness and intensities – and by extension, real-time work rates to make adjustments – of some of the world’s top team sport athletes. If a player’s not pushing quite hard enough for maximum gain, the coaches know; conversely, if someone’s overdoing it, Edwards and coaches can ask the player to ease up.
If CeDAR’s experience with Method is any measure, it will be a hit in primary care. Method is now ingrained in CeDAR as a pillar of every residential patient’s recovery program. Once medically cleared, they hit the gym for an hour a day, six mornings a week. Their Method smartphone apps carry tailored programs chosen from hundreds of exercises preloaded into Method or custom-added by Edwards or CeDAR exercise physiologist and nutrition consultant Casey Shivers. Many exercises have accompanying videos demonstrating proper technique. Shivers or Edwards are there to monitor groups of up to 20, answer questions, and offer guidance.
Afterwards they can look at statistical reports Method creates. That data is later made anonymous and collected in a central database. Over time, Edwards and Family Medicine colleagues can use it to spot trends, such as what sorts of programs work best for certain types of patients, Edwards said.
“I truly believe this will change best practices over time, and right now, all the medical specialties using it are finding huge changes in people’s lives,” he said.
Method works across the full spectrum of athleticism and fitness levels, Shivers said. Plus it gives patients a psychological boost. Progress in addiction recovery can be hard to measure when it comes to strengthening personal relationships or coping skills, she said, “but I can show somebody that they’re different on a cellular level in 30 days.”
Patients can keep using Method at their own gyms after they leave CeDAR, she added, and when they do follow-on metabolic testing at 30 days, 60 days or even farther out, “the difference we see is kind of bananas.”
Beyond the body
Method brings other benefits, said LaTisha Bader, PhD, the CeDAR psychologist who leads the Ascent Program. It provides daily structure that addiction-recovery patients often lack. It also helps ensure that patients don’t shift their addictive focus from substances to exercise, work out too hard and get hurt. It speeds up healing because clients feel stronger physically and are better positioned to do the spiritual and emotional heavy lifting so critical to their recovery.
“It helps patients reconnect with this body that you’ve numbed out and that you have used toxins to shut down,” Bader said.
deGruy and the CU Department of Family Medicine are betting that the same will hold for Family Medicine. He brought Edwards in as faculty in 2013 to address the general failure of U.S. primary care in prescribing exercise as medicine.
“We have these cheesy, weak programs for exercise and they don’t work. They’re not very structured and they don’t deal with the psychology or with health behavior change,” deGruy said. “I’m a little bit embarrassed about how ineffective we are in prescribing exercise, and this goes right to the heart of that.”
deGruy and David Clute, MBA, the department’s director of finance and administration, steered Edwards to CU’s Anschutz Medical Campus technology transfer team, now known as CU Innovations. Kimberly Muller, CU Innovations’ director, said it’s not the first time deGruy’s organization knocked on the door.
“The Department of Family Medicine takes a very proactive approach to innovation in trying to really help their faculty members take what they’re doing and translate that for impact,” Muller said.
CU Innovations brought in Method’s CEO, Craig Domeracki, helped establish trademarking and intellectual property protection, and set up the licensing and ownership structure for the company, Muller said.
Now Edwards and the Department of Family Medicine are moving Method into primary care, the aim being to “integrate exercise deep into the fabric of somebody’s personal care plan,” Edwards said.
“The goal is to get every patient involved – not only here, but to be a beacon for this across primary care and sports medicine around the U.S.,” he added.
UCHealth’s A.F. Williams Family Medicine Clinic – Stapleton, which is well familiar with pioneering change in primary care, is next up. deGruy is hoping to establish a partnership with CU’s Physical Therapy program, which has space in the same Stapleton neighborhood building.
“We’ve got to be really careful about changing the workflow,” he said. “Those clinics run really tight.”
When used in a clinical setting, Method is covered by health insurers. That’s important, deGruy said.
“We’re doing this because it’s good patient care. But we can only do it if we don’t lose too much money,” he said.
If Method is the right prescription for the medicine of exercise in primary care, others will follow, deGruy is convinced. At national family medicine gatherings, “they’re going to want me in the front of the room talking about this.”