Adaptation, Implementation, and Evaluation of Exercise is Medicine into a Student-Run Free Clinic

Introduction: Exercise Is Medicine (EIM) addresses barriers to primary care-based physical activity (PA) promotion by leveraging technology-assisted decision support built into the electronic medical record to help providers integrate PA assessment, discussions, and prescription into routine care. This implementation science study describes the multi-stakeholder process used to adapt EIM for the UC San Diego Student-Run Free Clinic Project (SRFCP), led by medical students to serve an uninsured, primarily Spanish-speaking Latinx population), and evaluate it with the RE-AIM framework. Methods/Intervention: Adaptations to the EIM workflow to align with the SRFCP were made using a multi-stakeholder engaged process and tracked with the Framework for Reporting of Adaptations and Modifications Extended (FRAME-IS). The program was evaluated with the RE-AIM framework. Results: Process and content adaptations facilitated the integration of tailored components into existing workflows and alignment with patients’ dominant Spanish language. Reach and adoption were high, with 62.4% and 89% of patient visits having EMR-documented physical activity vital sign (PAVS: minutes/week) and PA discussions, and 57% agreeing to health coaching. Among all who had more than one PAVS recorded, the mean significantly increased by 18 minutes/week during the third month of the intervention. Patients (86%) interviewed recalled exercise discussions. Medical student questionnaires indicated improvements in confidence of exercise discussions, and decreasing perceived barriers, while implementation team surveys indicated promising acceptability, appropriateness, and feasibility. Conclusion: Adapting and implementing EIM in an under-resourced community-based clinic demonstrated promising effectiveness and sustainability. Medical students felt confident about overcoming barriers to discussing exercise, while patients found EIM helpful