Workout prescriptions starting to gain traction among the next generation of Canadian health care workers.
By: Andrea Gordon Feature Writer, Toronto Star, Published on Fri Mar 07 2014
It had to be one of the catchiest headlines ever to grace the solemn pages of a medical journal. Even the punctuation was a wake-up call. “Exercise is medicine and physicians need to prescribe it!”
What followed in the British Journal of Sports Medicine was a two-page call to action written by Dr. Robert Sallis, a California physician who believed so strongly in his cause that he’d already launched a network called Exercise is Medicine to help make it happen.
Five years later, the first part of Sallis’ message is indisputable. Scientific research continues to pile up supporting his case that exercise is “the much needed vaccine to prevent chronic disease and premature death,” and citing inactivity as the biggest health problem of the 21st century. His second point, though, has been more of a challenge. Sure, regular aerobic activity wards off diabetes and cardiovascular disease, helps combat depression and lowers blood pressure. But that doesn’t mean doctors are rushing to prescribe brisk walks and free-weight repetitions the same way they dispense pills.
Lately, however, there are signs the idea is starting to gain traction among the next generation of Canadian health care workers. In the last six months, students at three Ontario universities have launched Exercise is Medicine On Campus programs. Their goals: promoting physical activity as a tool for students to fight illness and stress; developing tools such as prescription pads and referral systems that make it easier for physicians on and off campus to prescribe workout regimens; and putting the use of exercise as medicine high on the agenda for medical students. “It’s been snowballing, and I think you’ll see a lot more popping up,” says Jasmin Ma, 23, one of three Masters students in kinesiology who started the initiative at Queen’s University in Kingston.
She predicts a ground shift in how the next wave of health care workers and their young patients view the role of exercise in health. Similar groups are up and running at the University of Guelph and McMaster University in Hamilton, with half a dozen other schools expressing interest, says director Susan Yungblut, director of Exercise is Medicine Canada. The Canadian arm of Robert Sallis’ worldwide movement — which believes physical activity is as important a “vital sign” as blood pressure or pulse — has been building a network of physicians, exercise specialists and researchers. It’s not surprising that kinesiologists, who are trained in the science of human movement, have been a driving force.
In another key development, last year kinesiology became a regulated profession in Ontario. This opens the door for their services — such as designing personalized exercise programs and counselling patients — to be covered by extended health care plans. And it brings them a step closer to joining family health teams to assist physicians who believe in the healing and preventive powers of exercise, but want someone with more proficiency and time to work out the details. Research shows that telling patients to “lose a few pounds and get some exercise” doesn’t do the trick. A prescription needs to spell out doses and frequency, just as it would for any other medication. That’s where kinesiologists come in.
“Exercise is the magic pill,” says Michelle Fortier, a physical activity psychology scientist in the school of human kinetics at the University of Ottawa. Fortier has spent 10 years researching the benefits and costs of bringing kinesiologists onto primary health care teams. “But we need to think about how to we translate this, how do we get the doctors talking. The evidence is there, but we need leadership from different levels to move this forward.”
The two fields have long been collaborating in pockets around the province, particularly when it comes to treating heart patients.David Kidd, 61, of Toronto had heart surgery last September and for the past four months has been coming twice a week to work out at Toronto Western Hospital’s cardiac rehab unit. He exercises under the care of a team that includes two kinesiologists, who assess patients and prescribe routines aimed at gradually rebuilding strength and stamina. They circulate during the hour-long sessions with clipboards and stethoscopes. Patient vital signs are taken before and after. “It’s helpful to have a supervised buildup,” says Kidd as he pedals a stationary bike. “I feel confident because there are health professionals here.” Nearby, Howard Steinman, 76, marches on a treadmill as part of a regimen that helped him lose 80 pounds and avoid bypass surgery. He says being referred by a cardiologist to someone who can design and oversee an exercise plan made perfect sense. A physician’s opinion has clout, he says, but exercise specialists are masters of the details.“When you go to a dentist does he clean your teeth? No, a hygienist does. Same thing.”
About 400 patients are referred each year through the University Health Network’s cardiovascular prevention and rehabilitation program by cardiologists who know that exercise cuts the risk of a future heart problems or death in half. For kinesiologist Holly Wykes, the goal includes changing her patients’ habits for the long term.“We spend a lot of time talking about the kind of exercise they can do on their own. The whole idea is to promote independence, whether it’s walking regularly in your own neighbourhood or going to the Y.”
Motivational counselling is also a big part of kinesiologist Francois Cholette’s role with the Clarence-Rockland Family Health Team east of Ottawa. With only 15 per cent of Canadian adults meeting the recommended guideline of 150 minutes of exercise a week, “I should always be busy,” says Cholette, who sees patients for hour-long appointments. He is optimistic, but says it will take time for family physicians and patients to embrace the model of incorporating it into routine medical practice.The Ontario Kinesiology Association is trying to forge links with physicians and plans a public awareness campaign to educate the public about what kinesiologists do, says past president Sabrina Francescut of Thunder Bay. Harnessing exercise to prevent chronic disease could translate to cost savings for the health care system, she says. The field “is at a critical juncture, and once everything comes together it’s going to explode.”
Collaboration makes sense to Dr. Barry Bruce, a family physician and co-founder of the West Carleton Family Health Team in Carp.Since 2010, his team has included Jessica Nooyen, a “physical activity counsellor” with a degree in kinesiology and Masters in health intervention who designs tailored exercise programs and tries to keep patients motivated.“She has done marvellous things,” says Bruce. But she is one of only a handful hired by health teams in the province who believe in this approach. It’s still easier for time-crunched doctors to dole out pills, and more palatable for patients who aren’t prepared to commit to a consistent exercise routine.
For policy-makers and funders, a major barrier is the lack of data that gauges the impact of specific exercise intervention on patient health.It’s not easy to measure how many heart attacks and chronic diseases have been prevented, or to tally the number of lives saved. Bruce is hoping to gather evidence through a study that would compare patients’ levels of HDL cholesterol — associated with reduced risk of cardiovascular disease — before and after receiving exercise prescription.
Meanwhile, Exercise is Medicine Canada has attracted family doctors and physiotherapists to its advisory council and is negotiating with two potential corporate funding partners. A Public Health Agency of Canada grant program for chronic disease prevention would provide matching funds. Next month, a health team from Northern Ontario is hosting a one-day Exercise is Medicine workshop for those in the health field interested in using exercise prescription as a clinical tool. And a Muskoka forum on chronic disease prevention and management will include a similar session.
Exercise is Medicine has also launched a recognition program to connect doctors with certified professionals properly trained to assess, counsel and develop exercise programs for patients. “Our goal is to create a network that links up everybody who believes in the concept,” says Yungblut. And in turn, build strength in numbers.