“A bear, however hard he tries, grows tubby without exercise.” -Winnie-the-Pooh, as channeled by A.A. Milne I was sitting in my office a few weeks ago when it was invaded by a group of energetic, young faces that wanted to bend my ear on the subject of exercise. I assumed they had sought me out for my highly (self) publicized skills as a senior hockey player, but no! They were the vanguard of an international movement who advocate for exercise as a therapy, not unlike a drug. Exercise is in their view something that can be prescribed during a medical encounter with confidence, based on evidence, that it will benefit patients. Exercise, can both prevent and treat many diseases, including cardiovascular diseases, lung diseases, cancer and musculoskeletal disease. The Department of Medicine was and is a receptive partner for their enthusiastic and optimistic effort. In her Feb 13th Medical GrandRounds, entitled “The Mobilization of Vulnerable Inpatients Project” Dr. Johanna Murphy (right), avid runner and member of the Division of General Internal Medicine, summarized a program that is active at KGH entitled MOVE ON (Mobilization of Vulnerable Elders in ONtario) This program sponsored by CAHO (Council of Academic Hospitals of Ontario) is lead by Terry Richmond, Hospital Elder Life Nurse Specialist. The program is one of Medicine’s Quality Improvement Programs, fondly referred to as tactics #7. This in-hospital version of an exercise program reflects the efforts of a talented team including, our esteemed program operational director, Richard Jewitt (left), a Physiotherapist, an ergonomist, charge nurses and Dr. Julie Gilmour (PGY3) as the resident representative. Dr. Murphy is the MD champion for this program, which went live last week. The MOVE ON program aims to shorten hospital stay times in vulnerable elderly inpatients by ensuring that they are mobilized early and often throughout their stay. An informal survey conducted during her Grand Rounds found that 75%+ of the faculty regularly exercise more than the minimum recommend dose of 150 minutes/week. As a first step to prescribing exercise for patients, I felt you should hear the voices of these passionate Kinesiology students as they present the case for Exercise as Medicine…and so I present to you this week’s guest blog.
Back row (l-r): Brendan Levac, John Clarke, Gifferd Ko, Ira Carson, Mitch Wilson Front row (l-r): Jasmin Ma, Marysa Smith, Andrea Brennan, Trish Scribbans, Sara Giovannetti
Exercise Is Medicine at Queen’s University
“What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? Would you prescribe it to your patients? Certainly.” –Dr. Bob Sallis, FACSM, founding Task Force Chair of the Exercise is Medicine® initiative, a joint partnership of the American College of Sports Medicine and the American Medical Association. For anyone who follows mainstream news coverage, it is no surprise to hear that our country is facing an epidemic of sorts, characterized by perpetually increasing rates of obesity and chronic disease associated with physical inactivity. Consequent to the growing rates of morbidity in the Canadian population is a health care system that is experiencing a great financial burden. According to the 2012 Drummond Report on the reform of Ontario’s public services, pharmaceuticals have been the fastest growing component of health care costs, and the cost of prescription drugs exceeded the overall growth for health care spending in every year from 1986 to 2007. In 2010, the Ontario Drug Plan accounted for 10% of Ontario’s health spending (or $4.5 Billion). What if there was a way to reduce the amount of spending on pharmaceuticals and attain an equal or greater health benefit? This concept directs us to the quote at the beginning of our post. The answer to the question - the ‘one prescription’ - is exercise. The “Exercise is Medicine” initiative was launched in 2007 by the American College of Sports Medicine in conjunction with the American Medical Association. Exercise is Medicine’s mission is to develop and encourage primary care physicians to include and assess physical activity as a routine treatment strategy for patients. Since its launch, the initiative has generated resources and guidelines including an online database of accredited fitness professionals as well as disease or illness specific activity guidelines/prescriptions. Recently, the Canadian Society of Exercise Physiology, in association with the Canadian College of Family Physicians and numerous other partners, has adopted this initiative in Canada. Queen’s has proposed to become the first Canadian university to head the “EIM Canada On Campus” initiative. The purpose of Exercise Is Medicine @ Queen’s is two-tiered: 1) We strive to promote physical activity as a means of treatment and prevention of illness and disease within the student population. 2) We set out to provide information and resources to involve health care providers in becoming advocates and supporters of exercise prescription as a means of treatment. Imagine this: You’re a primary care physician and you’ve been given the training and the resources to prescribe X minutes of exercise Y for Z days per week. Alternatively, as lack of time is often a barrier, you refer out to a centre that specializes in fitness assessments and exercise prescription. Your patient, John, with type II diabetes who has been on multiple medications for years, is now given the opportunity to supplement or perhaps even replace a portion of his list of medications as result of your ability to prescribe exercise. At this point, you may or may not be rolling your eyes, as the health promotion messages stressing the importance of increasing physical activity levels are widespread and certainly “déjà vu”. You may have already categorized us as another naïve group of optimistic students with the lofty goal of having every Canadian citizen meeting the physical activity recommendations. However, having this view would be a misinterpretation of the purpose of our group. If every student, faculty, or staff on campus and in the hospital were participating in regular physical activity, we might want to question the utility of our endeavor because why would we need to prescribe exercise if people are already doing it? The answer is that they aren’t. In fact, only 15% of Canadian adults are meeting the Canadian physical activity guidelines. Will prescribing exercise as you would prescribe medication lead to greater participation in physical activity, and be a realistic treatment for disease? We don’t have those answers at present; however, upon consideration of the low rates of physical activity and high rates of disease in our population it is clear that the current Canadian health care system can stand to make significant improvements through exercise prescription. We would like to point out that our goals are long-term. We recognize the challenges and limitations that are inherent in an initiative such as this. Let’s face it: if you are a primary care physician reading this post, you probably think we’re foolish for thinking that you could possibly add a physical activity assessment and treatment plan to your 15 minute patient consultations. Furthermore, we recognize that getting people to become active is no easy task. It is certainly much more difficult to get people to exercise than to take medication. We also do not assume we will be able to change or modify the current curriculum of the medical school here at Queen’s to be aligned with our proposition. From a financial perspective, the funding required to operate fitness assessment and physical activity centres would be massive. If we wish to progress towards long-term changes we must begin by making small steps. One of the strengths of our group and what we hope to expand upon is the notion of interdisciplinary participation. Within the School of Kinesiology and Health Studies alone, we are fortunate to have representation from a variety of disciplines, including Health Promotion, Exercise Physiology, Sport Sociology, and Sport Psychology. We also plan to involve other departments on campus, including but not limited to Medicine, Nursing, and Rehabilitation Sciences. Our thought is that by involving these disciplines, we will begin to create a culture in health care at Queen’s that makes it possible for routine assessment of fitness and prescription of exercise by designing and implementing the infrastructure that can make this goal possible. The following video, 23 ½ hours, by Dr. Mike Evans from the University of Toronto captures the importance and possibilities of exercise as a means of treating disease. (Click on the image to watch) At a time when health care in Canada is under reform, the Exercise is Medicine Canada initiative can play a role in integrating health care services and providing services on the complete continuum of care that a patient might need. This offers an exciting and valuable opportunity to re-examine our current practices, enhance our health care system, and develop a healthier population.