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Physicians on Treadmills Diagnose with Accuracy, Says Mayo Doc

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   July 25, 2013

"All businesses with sedentary workers should allow employees to use" treadmill desks, says a former Mayo Clinic CEO and enthusiastic advocate for walking while working. Healthcare providers are no exception.

James Levine, MD

When Mayo Clinic endocrinologist James Levine, MD, was just a few years old, the neighborhood kids called him "Puffer."

"I was so chubby that wherever I ran, I puffed and bobbled along. My weight meant that I also was bullied at school, and my head was shoved down into a toilet."

Fast forward some five decades. Levine, who specializes in diabetes and obesity, no longer has these problems. Far from it. He's garnered a national reputation as an expert in treadmill desk efficacy for healthcare professionals and others who use them in their workplace.

He's even designed a dozen or so prototypes, sawing off treadmill arms to accommodate desks cobbled with steel and Formica. No matter where he works—at the Scottsdale or Rochester Mayo clinics, in his office, or at home, essentially anytime except while seeing patients—one can see him strolling along at 1 mph.  

He's also lost weight, so much that at one point his own doctor suggested—needlessly as it turned out—he undergo a work up for cancer.

And he's inspired his colleagues to follow, quite literally in his footsteps. Mayo's cardiologists have installed a treadmill desk for use during the eight to 12 hours they spend in the echo reading room, nicknamed "the bat cave." Medical transcriptionists there stroll along while they type physician notes.

Radiologists even interpret CT studies while punching in the miles. Research by Levine documents that their accuracy results are no worse than, and sometimes better than, when the images were read while sitting.

"I gave up my desk and chair to be in a study of treadmill desks," says Denise Dupras, MD, a Mayo general internist, "and now I'm walking or standing all the time."

Two years later, Dupras says, she continues to use the workstation for dictation, typing and phone calls in between seeing patients in the exam rooms nearby. And she's lost 35 pounds.

Even the former Mayo Clinic CEO Denis Cortese, MD, started using a Levine prototype a decade ago, "long before they were commercially available."

Now, as director of Healthcare Delivery and Policy Programs at Arizona State University, Cortese says, "I use it to do all computer work—e-mails, slides to read, and during phone calls. I can walk at 1.7 mph without having any problem typing," Above 1.8 or 1.9, he admits, there are typos.

"It's a great way to get steps in for your daily routine, it relieves stress and keeps phone calls short; you do not sit back and relax for the call," but get to the point. It's also helped his back. "All businesses with sedentary workers should allow employees to use them if they so chose," he says.

Levine notes that commercial applications are sprouting up, from high-end office furniture suppliers like Steelcase, whose units can run $4,000, and at discount stores like Target, where a walking desk setup costs $799.

"It's definitely taking off in the healthcare environment, and quite quickly, I'd say," says Levine. He's often asked to consult with organizations on all the pros and cons, and there are some of those, he acknowledges. It can take a bit longer to do some task while in motion.

The biggest question he's asked concerns corporate liability, which he quickly adds is a non-issue. Operation requires no more strenuous activity than slowly walking down a hallway in a straight line—these desks don't go more than 3 miles per hour—but if companies are concerned, those who want to use treadmill desks can sign the same waiver they would for the company gym.

"People who are overweight actually have more slips, trips and falls in the workplace anyway, forget about the treadmill," he says.

Levine says that he's asked by companies and government agencies across the country about liability concerns, and that's always been his response. "I've never heard back that [it] wasn't the right answer; and we at Mayo have never had a problem."

It's Levine's and his team's research on the use of treadmill desks in medical settings, however, that intrigued me enough to write this column.

Healthcare workers are not immune to the metabolic maladies sweeping the country, especially if their jobs —as radiologists or pathologists or administrative/clerical personnel require sitting and reading for long hours, Levine says.

Of course, a key question is whether providers can be as precise while moving as they are while seated. Studies by Levine and Mayo colleagues, and others, now conclude that accuracy rates are not compromised when work is done while walking. Not only that, he adds, the providers' cardiovascular systems are undoubtedly healthier.

Levine's line of research is not without its critics, some of whom have tried to trip up published findings by members of his team.

"I see that I can depend on this publication for comic relief," Robert Feld, MD, a radiologist at Saint Francis Hospital and Medical Center in Hartford, CT, wrote in a 2009 response to a paper by Mayo radiologist Jeff Fidler, MD, co-authored by Levine and others in the Journal of the American College of Radiology. Feld suggested that JACR editors ran the article "as a hoax."

Fidler and Levine's 2008 paper documented that reviewers who walked while reading cross-sectional CT scans had a 99% rate of detecting lesions with significant clinical importance, compared to 88.9% for reviewers who sat.

And Levine and co-authors point to a newer paper by residents of the University of Maryland Medical Center, who found that radiologists' had better accuracy finding lung nodules in CT scans while walking on a treadmill workstation than when standing or sitting.

"The routine use of a treadmill-based workstation for a portion of the day may provide substantial health benefits without a deleterious impact on image interpretation," and even conveys "a positive impact…on memory and concentration," the Maryland researchers wrote.

I'd have to agree. Prompted partly by an article in The New Yorker, this spring, yours truly built a treadmill desk for writing. It's a contraption made of plastic milk crates and Home Depot lumber, cut to suspend above the rails of an old Precor 9.33. I clock between 1 and 13 miles a day, usually between a 1 mph to 1.8 mph pace.

I'm walking as I type this column. A few minutes in, there's a rhythmic, almost hypnotic effect on my ability to focus. This set up is one of the four best things I've done for myself this year, and it only cost me about $100.

I read and respond to e-mail, study journal articles, listen to conference calls and transcribe recorded interviews while walking in place. Though phone conversations prove problematic because of the annoying motor noise, I'm told that higher-end, quieter machines would resolve that issue.

Best part: I no longer sit 10 hours a day, have lots more energy, and let's just say my legs have had a makeover.

Gabriel Koepp, Levine's colleague at the Mayo Endocrine Research Unit, says treadmill desks can be used by anyone who sits in an office, as long as there's a power supply and space. For healthcare settings, that means call centers, marketing departments, administrators, finance teams, or even clinicians who spend 15 minutes every hour typing into an electronic medical record.

For healthcare providers who worry they'll be even more exhausted at day's end, the opposite is true, Levine says.

"People said, 'Look, if I'm walking all day at work, I'm going to be exhausted when I get home and just want to go to bed.' But the opposite has happened. I come home and am energized." Levine describes a more nerdy concept in physics he calls "non-exercise activity thermogenesis, or NEAT. "NEAT begats more NEAT," he says.

Nerdiness aside, Levine urges healthcare providers to take a step back, no pun intended, and think. "This is about quality, the quality of our lives as health professionals too. That's so often overlooked. Even the American Medical Association has big concerns about the health and well-being of people in the medical profession."


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