A Review of Current Literature on Vital Sign Assessment of Physical Activity in Primary Care

To conduct an integrated review of the performance and implementation of two physical activity (PA) assessment tools, the exercise vital sign (EVS) and the physical activity vital sign (PAVS), in U.S. primary care practice.

An integrative review following Whittemore and Knafl's methodology.

Medline and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched. Search terms were "exercise vital sign" OR "physical activity vital sign" AND "primary care". Additional inclusion criteria were studies conducted in the United States, published in English, in primary care, between 2010 and 2016.

Nine studies met inclusion criteria. Five studies reported validity data of the EVS tool, while four studies reported data from the PAVS tool. Compared with the accelerometer, the EVS tool overestimated moderate-vigorous PA, while the PAVS tool demonstrated moderate agreement in identifying those not meeting national PA guidelines. The EVS tool was successfully implemented in large, integrated practices utilizing electronic health record systems. PA documentation increased compared to non-EVS practices. The predictive ability of the PAVS tool for clinical outcomes was shown. Studies of PA assessment tool use in children were not found.

Preliminary evidence on the validity of both the EVS and PAVS tools support cautious use of each as a screening tool in primary care. There were no data on reliability, with limited data on tool use in diverse populations or settings. Data in children, older adults, and diverse population subgroups were lacking.

Two brief exercise vital signs tools have each shown some initial validity for use by primary care clinicians as measures to identify patients not meeting PA guidelines.