研究背景：

健康中国建设紧紧围绕健康的决定因素组织多部门协同发力，是一项目标导向的系统工程。从“规划纲要”、“行动”到“十四五规划”，体育越来越多的被赋予医疗保健和主动健康的使命，体育部门和医疗部门的协同成为健康中国建设的重要一环。

研究目的：

从健康中国建设视角，深度调研体医协同实践案例，分析现存问题和制约发展的因素，为实现我国体育和医学跨领域高效协同、推动卫生健康体系从以疾病为中心向以健康为中心的整合型服务体系转变提出建议。

研究内容：

1.我国体医协同在社区和医院场景的实践进展和现实困境；

2.医务人员是体医协同的关键力量，深入探究本研究调研案例中，北京市H医院医务人员身体活动水平和参与健身服务计划的情况，以及临床医务人员是否认同在临床诊疗中需要向患者提出适度运动的建议。

研究方法：

本研究综合运用了文献研究法、深度访谈法、问卷调查法和数理统计法。通过文献研究法梳理我国体医协同的萌芽历程、理论研究和实践进展；采用线下和线上相结合的方式，对体医协同案例的关键知情人开展半结构化访谈，深入调查体医协同实际项目的开展情况与所遇现实困境；对北京市H医院医务人员进行问卷调查。

研究结果：

1.半结构化访谈结果：本研究调研的一处基层社区开展体医协同案例和四例医院开展的体医协同案例均表明，体育和医学两个领域已开展了积极的协同合作，在社区层面尝试搭建了“三甲医院-社区医院-社会体育指导员-运动积极分子”的体医协同模式，在医院层面形成了处方细化模式、联合门诊模式、专病试点模式和身体力行模式。

2.问卷调查结果：

（1）医务人员对健身服务计划的知晓率为92.7%，实际参与率为69.5%。在参与健身服务计划的医务人员中，高频健身者（即每月健身16天及以上）的比例达到13.0%，相较之下，未参与者的比例为2.8%。

（2）对于过去一年中未参与健身服务计划的医务人员而言，他们在过去7天内，身体活动的强度主要为中低强度，占比高达75%。在过去一年中，男性医务人员、临床科室人员以及高强度身体活动者，参与健身服务计划的频次相对较高。

（3）本次调查共涵盖125位临床科室的医务人员。其中，有103位医务人员（占比82.4%）认同在对患者进行健康教育时，适量运动是重要内容之一。这一数据表明，在健康教育实践中，绝大多数医务人员能够充分认识到适量运动对于患者健康的重要性，并积极将其纳入临床诊疗的健康教育内容中，以期提高患者的健康意识和生活质量。同时，不同职称的临床医务人员在“是否认同临床诊疗中要建议患者适度运动”这一议题上具有显著差异，这也反映了职称对于医务人员是否认同将“适量运动”纳入临床诊疗中是具有影响的。

研究结论与建议：

1.目前，我国虽然局部地区开展了体医协同各种形式的尝试，但并未开展符合医学和运动原理、规模化、常态化的行动。建议在临床层面建立体医协同的研究机制，在实践层面搭建体医协同的行动网络。

2.体医协同的广泛开展取决于民众健身知识和意识水平的提高，这离不开医疗工作者、体育指导者和患者三方的参与。建议大力加强医务人员和社会体育指导员的医学和体育知识培训及现场实习，并对居民开展广泛的健身知识宣传与教育。

3.医务人员对于推进体医协同的建设至关重要。临床科室的医务人员参与科学的、有组织的身体活动对其临床上建议患者进行适量运动有重要的作用，职称对于医务人员是否认同将“适量运动”纳入临床诊疗中是具有影响，体会过符合医学原理的运动指导，才能认可并在临床中积极开展对患者参与运动的建议。建议通过与体育类大学合作、住派专业人员进行活动组织与运动指导、广泛建设医务人员职工健身房，推动提高医务人员自身的身体活动水平。

Background:

The construction of Healthy China is a goal-oriented systematic project, focusing on the determinants of health and organizing multi-departments to work together. From the "planning outline", "action" to the "14th Five-Year Plan", more and more sports have been given the mission of medical care and active health, and the collaboration between sports and medical departments has become an important part of the construction of Healthy China.

Objective:

From the perspective of the construction of a healthy China, the paper deeply investigated the practice cases of physical medicine collaboration, analyzed the existing problems and factors restricting the development, and put forward suggestions for realizing efficient cross-field collaboration between sports and medicine in China and promoting the transformation of the health system from a disease-centered to a health-centered integrated service system.

Content:

1. The practice progress and realistic dilemma of physical medicine collaboration in community and hospital scenes in China;

2. Medical staff is a key force in the coordination of physical and medical services. In the cases investigated in this study, the physical activity level and participation in fitness service plan of medical staff in Beijing H Hospital were deeply explored, and whether clinical medical staff agreed that it was necessary to suggest moderate exercise to patients in clinical diagnosis and treatment.

Methods:

This study uses literature research, in-depth interview, questionnaire survey and mathematical statistics. Through literature research, we reviewed the budding process, theoretical research and practical progress of body-medicine collaboration in China. By combining offline and online methods, semi-structured interviews were conducted with key insiders of physical medicine collaboration cases to investigate the development of physical medicine collaboration projects and the realistic difficulties encountered. A questionnaire survey was conducted among the medical staff of H Hospital in Beijing by means of convenient sampling.

Results:

1. Semi-structured interview results: A case study of physical medicine collaboration in a grass-roots community and four cases of physical medicine collaboration in a hospital show that active collaborative cooperation has been carried out in the two fields of sports and medicine, and an attempt has been made to build a physical medicine collaboration model of "Top three hospitals - community hospitals - social sports instructors - sports activists" at the community level. At the hospital level, prescription refinement mode, joint outpatient mode, special disease pilot mode and physical practice mode have been formed.

2. Results of questionnaire survey:

(1) The awareness rate of medical staff to the fitness service plan was 92.7%, and the actual participation rate was 69.5%. The proportion of high frequency exercisers (i.e., 16 or more days of exercise per month) who participated in fitness service programs reached 13.0%, compared with 2.8% of non-participants.

(2) For medical staff who did not participate in the fitness service plan in the past year, the intensity of their physical activities in the past 7 days was mainly low to medium intensity, accounting for 75%. In the past year, male medical staff, clinical staff and people with high intensity physical activity participated in fitness service programs relatively frequently.

(3) The survey covered a total of 125 medical staff in clinical departments. Among them, 103 medical staff (82.4%) agreed that moderate exercise was one of the important contents in health education for patients. This data shows that in the practice of health education, the vast majority of medical personnel can fully realize the importance of appropriate exercise for the health of patients, and actively incorporate it into the health education content of clinical diagnosis and treatment, in order to improve the health awareness and quality of life of patients. At the same time, clinical medical staff with different professional titles have significant differences in the issue of "whether they agree that patients should be advised to exercise moderately in clinical diagnosis and treatment", which also reflects that professional titles have an impact on whether medical staff agree to include "appropriate exercise" in clinical diagnosis and treatment.

Conclusions:

1. At present, although various forms of physical and medical collaboration have been tried in some parts of China, no large-scale and regular actions have been carried out in line with medical and sports principles. It is suggested to establish a research mechanism of physician-medical collaboration at the clinical level and an action network of physician-medical collaboration at the practical level.

2. The extensive development of physical and medical collaboration depends on the improvement of people's fitness knowledge and awareness, which is inseparable from the participation of medical workers, sports instructors and patients. It is suggested to strengthen the medical and sports knowledge training and field practice of medical staff and social sports instructors, and carry out extensive publicity and education of fitness knowledge for residents.

3. Medical personnel are crucial to promoting the construction of physical and medical collaboration. The participation of medical staff in clinical departments in scientific and organized physical activities plays an important role in advising patients to take appropriate exercise in clinical practice. Professional titles have an impact on whether medical staff agree to incorporate "appropriate exercise" into clinical diagnosis and treatment. Only after experiencing exercise guidance in line with medical principles can they recognize and actively carry out suggestions for patients to participate in exercise in clinical practice. It is suggested to improve the physical activity level of medical personnel through cooperation with sports universities, sending professional personnel to organize activities and exercise guidance, and extensively building fitness centers for medical personnel.