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Exercise is Medicine

As a leading cause of morbidity and mortality in Canada and worldwide, physical inactivity needs to be addressed by family physicians with their patients. This month, the Canadian Academy for Sport and Exercise Medicine (CASEM) released a position statement on physical activity prescription1, providing guidance on the use of exercise as a therapeutic intervention for the prevention and management of many chronic diseases. Prescribing exercise effectively has been proven to increase physical activity (PA) and lead to positive outcomes in hypertension, diabetes, mental health, and cognitive function in older adults, so we owe it to our patients to acquire this skill.

To initiate a brief intervention in clinic, asking two questions can inform further counseling: (1) ‘On average, how many days/week do you engage in moderate or greater physical activity (like a brisk walk)?’ and (2) ‘On those days, how many minutes do you engage in activity at this level?’ Using these two pieces of information can provide the exercise vital sign: the amount of minutes of moderate-vigorous activity per week. The goal is 150 minutes of exercise per week with of moderate intensity exercise (causes increased breathing or sweating but allows the patient to still be able to maintain a conversation2). Moving forward, incorporating a written prescription, PA measurement and tracking (e.g. with a smart phone or pedometer), and clinical follow-up are key components to induce behaviour change (see Resources below).

Before starting an exercise program, individuals can self-screen with the Physical Activity Readiness Questionnaire (PAR-Q+) tool3 which will direct them to a physician for further evaluation if there are concerns. Patients who should receive medical clearance include: 1) those with signs or symptoms of cardiovascular (CV), metabolic, or renal disease; 2) inactive patients with said diseases; and 3) stable CV, metabolic, or renal patients wishing to progress from moderate to vigorous intensity exercise4. These patients should be referred to a qualified exercise professional for consideration of a thorough physical exam and exercise test. Otherwise, healthy individuals can gradually begin a light-moderate exercise regimen at home and progress as tolerated. Patients in the Champlain LHIN can make use of the Heart Wise Exercise program to find locations in the community that provide exercise classes suitable for individuals with or at risk of developing a cardiovascular or chronic health issue.

Key messages for patients during the discussion of the health benefits of physical activity1:

–        Exercise is more effective than medication for the treatment of stroke and as effective for the secondary prevention of coronary heart disease and diabetes.

–        A 150 min of moderate-to-vigorous physical activity (MVPA) accumulated per week can reduce the risk of most major chronic diseases by 25–50%.

–        A 15 min of MVPA per day (or 75 min/week) is associated with a ∼15% relative mortality risk reduction, and benefits increase with the dose.

Physical Activity Recommendations as per CSEP Guidelines5

Frequency ≥5d/wk of moderate exercise, or ≥3d/wk of vigorous exercise
Intensity Moderate (brisk walk, water aerobics) and/or vigorous
Time 30-60min/d of moderate or 20-60min/d of vigorous exercise (≥10min per session)
Type Regular, purposeful exercise that involves major muscle groups and is continuous
Progression Increase 5-10min per session every 1-2wk

 

References

  1. Thornton JS, Fremont PF et al. Physical Activity Prescription: A Critical Opportunity to Address a Modifiable Risk Factor for the Prevention and Management of Chronic Disease: A Position Statement by the Canadian Academy of Sport and Exercise Medicine. Clin J Sport Med. 2016;26(4):259-65
  2. Reed JL, Pipe AL. The talk test: a useful tool for prescribing and monitoring exercise intensity.Curr Opin Cardiol. 2014;29(5):475–80
  3. Warburton DE, Jamnik VK, Bredin SSD, et al. The 2015 Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and electronic Physical Activity Readiness Medical Examination (ePARmed-X+). Health Fitness J 2015;8:53–6.
  4. Riebe D, Franklin BA, Thompson PD, et al. Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening. Med Sci Sports Exerc 2015; 47: 2473–9
  5. Canadian Society for Exercise Physiology. Canadian Physical Activity Guidelines. Ottawa, Canada: Canadian Society for Exercise Physiology, 2011. http://www.csep. ca/guidelines (accessed 31 Jul 2016).

Resources:

Heart Wise Exercise Program: http://www.champlainhealthline.ca/displayservice.aspx?id=23256 or http://heartwise.ottawaheart.ca/

Exercise prescription pad: http://www.exerciseismedicine.org/canada/assets/page_documents/EIMC_Pad_ENnewlogo_v3.0_1_copy.pdf

Pedometers: https://www.stepscount.com/

 

Advisor: Dr. Taryn Taylor, BKIN, MSc, MD, CCFP (SEM), Dip Sport Med

Ryan Shields, MD, MSc, CCFP

PGY-3 Sport and Exercise Medicine

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