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Evaluating the Heart Wise Exercise program: a model for safe community exercise programming

Jennifer L. Reed, Jennifer M. Harris, Liz Midence, Elizabeth B. Yee, Sherry L. Grace.

BMC Public Health, Volume16, February 2016.

Promoting physical activity in the primary care setting remains a significant challenge. The Canadian Guidelines for Physical Activity recommend that adults should get at least 150 minutes of moderate to vigorous physical activity per week, in bouts of 10 minutes or more. Despite the overwhelming evidence that regular aerobic exercise is one of the most beneficial things one can do for their health, many barriers stand in the way for patients who may seek to make positive behavioural change.

Increasingly, our patients are living with many chronic diseases including heart disease, diabetes, and chronic obstructive pulmonary disease. Often times, patients with these ailments do not understand how physical activity can be a regular part of their lives, and will often cite their poor overall health as a reason not to be active.

The Heart Wise Exercise Program was started at the University of Ottawa Heart Institute as a way to combat this issue. The program seeks to work with community physical activity providers to designate facilities, programs, and classes where participants can exercise regularly to prevent or limit the negative effects of living with a chronic health condition. Heart Wise Exercise was launched in 2007 in partnership with several local organizations and support from the Ontario Ministry of Health Promotion.

A program or class that displays the Heart Wise Exercise logo satisfies 6 criteria. In 2015, Reed et al. utilized a piloted checklist and audited 45 Heart Wise Exercise programs for the 6 criteria, in addition to administering a survey to a convenience sample of 147 participants:

  • Encourages regular, daily aerobic exercise – 71% of exercise leaders encouraged daily aerobic exercise. Participants reported engaging in an average of 149 minutes of aerobic exercise per week.
  • Encourages and incorporates warm up, cool down, and self-monitoring with all exercise sections – 100% of programs incorporated a warm-up and cool down, and 84% encouraged self-monitoring in class.
  • Allows participants to exercise at a safe level and offers options to modify intensity – 98% of programs offered different options for participants exercise at appropriate intensity levels.
  • Includes participants with chronic health conditions – participants reported living with a variety of chronic health conditions including arthritis, osteoporosis, diabetes, heart disease, and chronic obstructive pulmonary disease.
  • Offers health screening for all participants – 93% of instructors offered health screening for patients.
  • Has a documented emergency plan that is known to all exercise leaders, including the requirement of current CPR certification, phone access to local paramedic services and presence of a defibrillator – 100% of the exercise sites had automated external defibrillators, and 90% of instructors were aware of the documented emergency plan.
  • Furthermore, participants reported being, on average, “somewhat happy” to “very happy” with their Heart Wise Exercise locations, program dates and times, leaders’ knowledge of disease and exercise, cost, and the social aspect of being part of a group.

In all, Heart Wise Exercise Programs are safe and appropriate for your patients with various chronic health conditions. Current participants are highly satisfied with their programs. For more information, please visit:


Sean Mindra MD, CCFP

PGY3 – Sport and Exercise Medicine, University of Ottawa

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

The Noisy Knee

Song, S. J., Park, C. H., Liang, H., & Kim, S. J. (2018). Noise around the Knee. Clinics in orthopedic surgery, 10(1), 1-8.

A common MSK question patients ask is “is it normal that my knee makes this sound?” While this review focuses on the knee, the approach can be generalized to any shoulder. Noise in the knee is common, and often patients are worried the noise is pathological.

Noise around the knee can be separated into physiologic and pathologic causes. This is defined by whether the sound is associated with pain, swelling, and abnormal range of motion. There are also many different types of sounds which are more likely to describe one cause than another. Crepitus is a vague descriptor used to represent a sound during a joint’s range of movement. Popping is a sudden explosive and well perceived sound, usually associated with injury such as meniscal, cruciate, or collateral ligament tears. Clunking is a loud singular noise due to release against resistance, often suggestive of something that was subluxed and now relocated. Clicking is a tiny, singular noise that occurs during one cycle of knee extension and flexion, this can be associated with various causes. Grinding and grating are used to describe continuous scratching sounds and are more associated with degenerative OA and patellofemoral pain syndrome.

Physiologic Sounds:

Not associated with any history of trauma, swelling, or pain.

Tend to be sporadic in nature

No aggravation of sounds and combined symptoms

Causes include:

  • build up or bursting of tiny bubbles in the synovial fluid
  • snapping of ligaments
  • catching of the synovium or physiological plica
  • hypermobile or discoid meniscus.

One way to distinguish between these causes is whether the joint sound occurs repeated during range of motion. If it happens repeatedly, it is usually due to anatomic structures rubbing against each other, such as ligaments/tendons or plica over a bony prominence. One common is the bicep femoris tendon at the lateral aspect of the knee. If the crack has a refractory period, it is likely due to air build up in the joint, and subsequent changes in joint pressure during range of motion cause cavity formation which creates a popping sound.

Management of physiologic noise involves reassurance and stretching and strengthening of affected musculotendinous structures.

Pathologic Sounds:

Can have history of trauma or injury

Tend to be higher pitch/frequency

observed consistently, has gradual aggravation


  • Degenerative changes
    • Structural cause such as bony spurs and cysts, meniscal tears…etc
  • Pathologic plica
    • If a plica gets irritated, it can cause synovitis and pain
  • Patellofemoral instability
    • Due to hypermobility of patella or subluxation of patella
  • Post-surgical
  • Pathologic snapping knee syndrome
    • Any extra or intra-articular structure that causes painful sounds, which can include ganglion cysts, lipoma, synovial nodules, fabella, osteochondromas, osteophytes

Management of these pathologic noises depends on the underlying cause.

Overall, noise around the knee is a common phenomenon, with one study suggesting 38.1% of women and 17.1% of men over 40. With this approach, careful evaluation of the noise can help prevent unnecessary diagnostic interventions and provide appropriate guidance for healthy patients experiencing physiologic noise.


Jim Niu MD, CCFP

Sport and Exercise Medicine Fellow, University of Ottawa

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

Chronic Exertional Compartment Syndrome – An Introduction

We have all heard of compartment syndrome. This is a medical emergency where increased pressures within a compartment can lead to rapid ischemia, muscle damage, and even potential amputation after a trauma or injury.

How many of us have heard of chronic exertional compartment syndrome (CECS)?

CECS is a cause of chronic exertional leg pain. Most often seen in young runners and elite athletes, it is a relatively unknown and underdiagnosed condition. Its incidence and pathophysiology are not well understood. One theory suggests a noncompliant fascia that cannot accommodate the expansion of muscle volume during exercise, causing increased intracompartmental pressures.

Suspect CECS with athletes who present with chronic anterior/lateral leg pain that worsens with prolonged use and resolves shortly upon cessation of activity. Most cases will occur in the anterior or lateral compartments. Classically, these athletes will be able to tell you that a specific time, distance, or intensity will bring on the symptoms, characterized as burning, aching, cramping, or pressure. It usually resolves fairly shortly if they stop the activity unless they continue to push through the symptoms for longer durations. It is fairly common to be bilateral. They may have some numbness/tingling in the dermatomal distribution of the nerve that runs through the compartment and weakness of those muscle groups.

Physical exam is often normal at rest. Some people will have visible painless fascial herniations. On physical exam immediately after exercise, there may be pain on palpation of the muscles involved, pain with passive stretching of the muscles, and the compartments may be quite firm. No imaging is necessary but will commonly be done to rule out other diagnoses such as a stress fracture. The diagnosis of CECS can be made clinically but given its non-specific nature, it can be confirmed using immediate post-exercise intracompartmental pressure testing. If confirmed, a surgeon may be consulted for an ELECTIVE fasciotomy.

The differential diagnosis includes medial tibial stress syndrome (shin splints), stress fractures, fascial defects, nerve entrapment syndromes, popliteal artery entrapment syndrome, and vascular or neurogenic claudication.

It is important to note that shin splints present with pain on the medial border of the tibia. Shin splints are NEVER lateral! A high level of suspicion is required for the diagnosis of ant/lat CECS as all imaging will be reported as normal.

While uncomfortable, there is no evidence to suggest that the pain from CECS indicates any muscle damage or has long-lasting implications. Modified activity is a reasonable treatment option. People may choose to avoid continuous running and opt to bike, swim, skate or play shorter shifts. Hopefully, this brief introduction sheds some light on the subject.

Jim Niu MD, CCFP

Sport and Exercise Medicine Fellow, University of Ottawa

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

HPV Related Diseases and HPV Vaccination

Author: Michael Fung-Kee-Fung, Gynecologist Oncologist, Chief Strategy Officer, The Society of Gynecology Oncology of Canada

A new edition of the reference guide on prevention of HPV and the care of patients with HPV has just been published online by the Society of Gynecologic Oncology of Canada (GOC).

Take a look to find answers to more than 50 questions.

Who should be vaccinated against HPV? Are 2 doses of HPV vaccine adequate? How do we treat persistent HPV disease? What is HPVthe best test for cure of cervical dysplasia.

Learn the answers and more at

Nominate a Caregiver for a Heroes in the Home Award

Heroes in the Home logoAs a primary care practitioner, you may come across some truly exceptional caregivers in your community — family members, friends, and volunteers whose kindness and commitment allow loved ones to live better lives despite the limitations of age, illness or disability.

The Champlain Community Care Access Centre (CCAC) is currently accepting nominations for the 2015 Heroes in the Home Caregiver Recognition Awards.

How to nominate a caregiver

Recognize a caregiver you know by nominating them for a Heroes in the Home award – it’s easy and makes a difference! The deadline for nominations is February 27th, 2015.

  1. Submit your nomination online or
  2. Print the form and send it back to Champlain CCAC by e-mail, fax or mail

About Heroes in the Home

Watch a video of Dr. Steve Radke, Chief of Staff at Renfrew Victoria Hospital, as he speaks about the impact that caregivers make for their families, physicians and the community.

The Heroes in the Home Caregiver Recognition Awards are a small gesture to celebrate people who might otherwise go unnoticed. All nominees will be honoured at a series of award ceremonies in May 2015.

Learn more and see photos from last year’s ceremony at

Register now: AMO 8th Annual Clinical Day is February 20th

The Academy of Medicine Ottawa’s 8th Annual Clinical Day will take place on Friday, February 20th, 2015 at the Ottawa Conference & Event Centre (200 Coventry Rd, Ottawa). Register now and save! Early bird registration is available until November 30th.

To support your clinical practice and promote better health for your patients

The AMO Clinical Day is designed for physicians, nurses and allied health professionals, to support clinical best practice and promote health for patients. We offer the highest quality accredited continuing medical education with an interdisciplinary program, to build awareness of options, strategies and resources.

Topics and speakers

  1. Slaying the zombies of smoking cessation – Andrew Pipe, CM, MD, LLD(Hon), DSc(Hon)
  2. Autism spectrum disorder – Susan Farrell, PhD
  3. Mindfulness starts here – Lynette Monteiro, PhD
  4. Helping our patients keep their marbles – Tony Hakim, OC, MD, PhD, FRCPC
  5. Choosing Wisely: prevention of unnecessary tests, treatments and procedures – Chris Simpson, MD, FRCPC, FACC, FHRS
  6. Sport concussion – Taryn Taylor, BKIN, MSc, MD, CCFP, DipSportMed
  7. Suicide prevention – Simon Hatcher, MD, MRCPsych, FRANZCP, FRCPC
  8. Lyme disease, MERS-CoV and other scarey bugs – Carolyn Pim, MD, FRCPC

CME credits

This program has been accredited by the College of Family Physicians of Canada and the Ontario Chapter for up to 6 Mainpro-M1 credits. This event is an accredited group learning activity (section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, approved by the Canadian Psychiatric Association (CPA). The specific opinions and content of this event are not necessarily those of the CPA, and are the responsibility of the organizer(s) alone.

Register now and save!

Early bird registration until November 30. Registration includes continental breakfast, nutritional morning snack and lunch. Parking is free.

ABI System Navigator Recognized for Work Excellence

Suzanne McKenna poses after receiving an awardLast June the Champlain region’s Acquired Brain Injury (ABI) System Navigator was recognized for her work by the Ontario Association of Community Care Access Centres. In her role, Suzanne McKenna guides ABI survivors and caregivers who are unsure about where to start looking for care during this difficult time in their lives.

Since McKenna began her work in October of 2011, she has helped to connect more than 120 individuals in need of specialized services and supports.

“A brain injury doesn’t just change the life of the individual; it changes the lives of everyone around them. Creating a better life for those who suffer a brain injury, along with their families and caregivers, is my ultimate goal,” says McKenna.

ABI Resources for Primary Care

An ABI Primary Health Care Resource Guide is available to be used as a quick reference tool for ABI support services available in the Champlain region (e.g. day programs, transportation, continuing education, support groups, recreational opportunities).

Visit the Ontario Neurotrauma Foundation’s website to read the latest: