Take Two Runs and Call Me in the Morn­ing

Canadian Running - - EDITORIAL - By Tara Camp­bell

TARA CAMP­BELL is a Cana­dian writer and run­ner liv­ing in Omaha, Neb. She is a for­mer daily news jour­nal­ist and col­le­giate hockey player who’s jour­ney­ing back into com­pet­i­tive sport as a run­ner.

Walk­ing out of the doc­tor’s of­fice with a pre­scrip­tion for run­ning may soon be the norm in Canada. In fact, as the ur­gency grows to get Cana­di­ans mov­ing more, pre­scrip­tions for ex­er­cise are al­ready be­ing writ­ten across the coun­try.

It is well doc­u­mented that a lack of phys­i­cal ac­tiv­ity con­trib­utes to a va­ri­ety of chronic dis­eases and health com­pli­ca­tions, in­clud­ing heart dis­ease, Type 2 di­a­betes, obe­sity, hy­per­ten­sion, can­cer, os­teo­poro­sis, arthri­tis, de­pres­sion, anx­i­ety and at­ten­tion deficit hy­per­ac­tiv­ity dis­or­der ( adhd).

Health-care pro­fes­sion­als and re­searchers have long touted the ben­e­fits of ex­er­cise and the need to get Cana­di­ans liv­ing more ac­tive life­styles. The chal­lenge, how­ever, lies in mak­ing that hap­pen, which is where pre­scrip­tions come into play.

“Pre­scrip­tions are an im­por­tant tool, be­cause peo­ple highly value the health ad­vice of their pri­mary care providers,” says Dr. Jonathon Fowles, Ex­er­cise Is Medicine Canada chair and pro­fes­sor at the School of Ki­ne­si­ol­ogy at Aca­dia Univer­sity.

“The key as­pect of the writ­ten pre­scrip­tion is that we know that gen­eral rec­om­men­da­tions are not ef­fec­tive. Things that are ‘ smart’ ori­ented – spe­cific, mea­sur­able, at­tain­able, rel­e­vant, time-ori­ented – are most ef­fec­tive,” ex­plains Dr. Fowles. “So, t he pre­scrip­tion – when done in brief coun­sel­ing with a health-care pro­fes­sional – meets a lot of those re­quire­ments.”

Ev­i­dence of t he ef­fect ive­ness of pre­scrib­ing ex­er­cise con­tin­ues to grow as stud­ies emerge and plans are put into ac­tion. The Pre­scrip­tion To Get Ac­tive pro­gram in Al­berta found that 73 per cent of peo­ple who re­ceive a pre­scrip­tion for ex­er­cise in­crease their level of phys­i­cal ac­tiv­ity.

This for­ward-think­ing pro­gram takes a proac­tive ap­proach by of­fer­ing an on­line plat­form to guide peo­ple through the pre­scrip­tion process.

Once a pre­scrip­tion is in hand, pa­tients re­ceive free ac­cess for a month to one of more than 40 fit­ness fa­cil­i­ties in Al­berta. For those who do not live near a par­tic­i­pat­ing fa­cil­ity, there are re­sources on­line to help them nav­i­gate through an ex­er­cise pro­gram. With its ro­bust on­line pres­ence, the pro­gram is able to reach be­yond the bor­ders of Al­berta to help peo­ple across the coun­try get more ac­tive.

The need to get peo­ple mov­ing more isn’t solely a Cana­dian prob­lem. Stud­ies on the ef­fec­tive­ness of ex­er­cise pre­scrip­tions are be­ing con­ducted world­wide as many coun­tries grap­ple with how to get their pop­u­la­tions more phys­i­cally ac­tive. Dr. Matti Lei­jon’s re­search out of Swe­den shows 50 per cent of pa­tients who are pre­scribed ex­er­cise re­main ac­tive 12 months af­ter be­ing given the pre­scrip­tion, which is con­sid­ered a high ad­her­ence rate.

Dr. Fowles, who works closely with the Cana­dian Di­a­betes As­so­ci­a­tion, also points to the re­search.

“Stud­ies show that a writ­ten pre­scrip­tion for ex­er­cise in­creases phys­i­cal ac­tiv­ity lev­els by pa­tients by 10 to 20 per cent at one year af­ter­ward. [This] has sign­f­i­cant ef­fects on clin­i­cal out­comes, like re­duced weight, blood pres­sure, blood glu­cose and re­duced in­sulin re­sis­tance,” says Dr. Fowles.

“This 10 to 20 per cent num­ber is also im­por­tant be­cause this level of im­prove­ment in phys­i­cal ac­tiv­ity by the Cana­dian pop­u­la­tion would re­duce eco­nomic bur­den by $2.1 bil­lion per year in Canada by the year 2030,” says Dr. Fowles, ref­er­enc­ing a 2014 study led by Dr. Hans Krueger out of Bri­tish Co­lum­bia.

While the health ben­e­fits alone merit a push to get peo­ple more phys­i­cally ac­tive, there is an­other crit­i­cal fac­tor at play: the fi­nan­cial sus­tain­abil­ity of Canada’s health­care sys­tem.

In a 2012 study, Dr. Ian Janssen, a pop­u­la­tion health re­searcher in phys­i­cal ac­tiv­ity and obe­sity at Queen’s Univer­sity, found the to­tal es­ti­mated health-care cost of phys­i­cal in­ac­tiv­ity re­lated to seven pri­mary chronic dis­eases is $6.8 bil­lion per year.

“A key driver of i ncreased health-care spend­ing in Canada is the ag­ing pop­u­la­tion. We have more older adults now than ever be­fore. Older adults are more likely to have a chronic dis­ease, such as heart dis­ease or can­cer, and it costs a lot of money to treat these dis­eases,” says Dr. Janssen.

“Reg­u­lar par­tic­i­pa­tion in phys­i­cal ac­tiv­ity helps re­duce the risk of de­vel­op­ing sev­eral chronic dis­eases. There­fore, over time, the health-care costs tend to be much lower in peo­ple who ex­er­cise than in peo­ple who don’t ex­er­cise.” How­ever, as Dr. Janssen ex­plains, de­spite the sig­nif­i­cant dol­lar fig­ures, it’s re­mark­ably dif­fi­cult to get peo­ple to be as phys­i­cally ac­tive as they need to be. “Un­for­tu­nately, that is far eas­ier said than done,” says Dr. Janssen. “In fact, de­spite in­creased ef­forts to get more Cana­di­ans ac­tive i n re­cent years, phys­i­cal ac­tivit y lev­els in the pop­u­la­tion have not im­proved. There­fore, as the pop­u­la­tion con­tin­ues to get older and as the to­tal cost of health care in the coun­try con­tin­ues to in­crease, the health­care costs at­trib­ut­able to a lack of ex­er­cise will un­doubt­edly in­crease as well.” So, are pre­scrip­tions for ex­er­cise go­ing to save the Cana­dian health-care sys­tem? That’s likely a stretch, ac­cord­ing to Dr. Fowles, but he be­lieves pre­scrip­tions will play an im­por­tant role in sus­tain­ing the sys­tem. “I think that the pre­scrip­tion for ex­er­cise will be­come more and more of a le­git­i­mate and valid ther­a­peu­tic treat­ment rec­og­nized within health care for the preven­tion and man­age­ment of chronic dis­eases,” says Dr. Fowles. “The over­whelm­ing ev­i­dence for this has reached the con­scious­ness of health-care providers who em­body ev­i­dence-based medicine, and there­fore, there are more and more that rec­og­nize that they need to in­clude this in their health­care for pa­tients.” Be­yond phys­i­cal healt h, pre­script ions for ex­er­cise in t he treat­ment of men­tal health con­di­tions are just as likely to be­come the norm in Canada. Ex­ten­sive re­search into the con­nec­tion be­tween the brain and ex­er­cise, and how this con­nec­tion be used in the

“Stud­ies show that a writ­ten pre­scrip­tion for ex­er­cise in­creases phys­i­cal ac­tiv­ity lev­els by pa­tients by 10 to 20 per cent at one year af­ter­ward.”

treat­ment of nu­mer­ous men­tal health con­di­tions, is draw­ing the at­ten­tion of health-care pro­fes­sion­als and the gen­eral pub­lic.

In his ground­break­ing book, Spark: The Rev­o­lu­tion­ary New Sci­ence of Ex­er­cise and the Brain, Dr. John Ratey, an as­so­ciate clin­i­cal pro­fes­sor of psy­chi­a­try at Har­vard Med­i­cal School and one of world’s lead­ing ex­perts in neu­ropsy­chi­a­try, con­cludes that fre­quent, mod­er­ate- to high-in­ten­sity ex­er­cise is ef­fec­tive in the treat­ment and preven­tion of anx­i­ety, de­pres­sion, adhd, Alzheimer’s, ad­dic­tion and more. “The ev­i­dence is al­ready there. It’s as good as a pill, but pa­tients have to do it,” says Dr. Ratey. “I think there are now some re­ally good long-term stud­ies and ad­vice on how to get peo­ple to stick with it.”

Dr. Ratey points to the im­por­tance of get­ting rel­e­vant in­for­ma­tion out to pa­tients, so they can fully un­der­stand the pos­i­tive im­pact ex­er­cise will have on their men­tal health. For ex­am­ple, Dr. Ratey points to stud­ies go­ing back decades.

“There were blood pres­sure stud­ies out of Duke Univer­sity Med­i­cal School in the late ’90s and again in 2008 show­ing that ex­er­cise was as a good as an an­tide­pres­sant for treat­ing mild to mod­er­ate de­pres­sion,” ex­plains Dr. Ratey.

While in­form­ing pa­tients is one of the keys to get­ting peo­ple to stay with an ex­er­cise rou­tine, Dr. Ratey says the pa­tient’s aware­ness about how ex­er­cise makes them feel is of ut­most im­por­tance.

“The big move is to fo­cus on how you feel to­day af­ter you’ve worked out. You’re more aroused, awake, alert and ready to take on the day on. This is what we need to have peo­ple rec­og­nize in them­selves: not just that it’s go­ing to tire them out, but that it’s go­ing to make them feel bet­ter and feel more en­ergy,” ex­plains Dr. Ratey.

The ev idence of t he posit ive i mpact ex­er­cise has on men­tal healt h ex­tends into t he most crit ical of men­tal healt h con­dit ions, in­clud­ing peo­ple suf fer ing f rom se­vere de­pres­sion.

“If you can get them mov­ing on a tread­mill for 10 min­utes even, they be­gin to no­tice a change in their mood. Some­body may need to be there with them to en­cour­age them for the first few times, but once they be­gin to no­tice their mood has changed it’s go­ing to lead to a very nice out­come.”

Dr. Ratey is not sur­prised to see pre­scrip­tions com­ing into play as a way of get­ting pa­tients to start ex­er­cis­ing. He says it has come “full cir­cle,” not­ing that in 300 BC Socrates’ pre­scrip­tion for peo­ple with men­tal health prob­lems was to go for a long walk.

“If they were de­pressed when they came back, he’d send them out again, so it’s been in the lit­er­a­ture, but it’s only since the mid -’90s peo­ple have re­ally started to pay at­ten­tion to it for men­tal health again be­cause we’ve had some great data and some good stud­ies,” says Dr. Ratey.

“We’re start­ing to see peo­ple wake up to the fact that this is a non-med­i­ca­tion in­ter­ven­tion that can make a big dif­fer­ence in ev­ery psy­chi­atric di­ag­no­sis,” says Dr. Ratey. “As with most phys­i­cal diagnoses ex­er­cise is a great com­po­nent be­cause of its ef­fect on the im­mune sys­tem and the ef­fect on stress and well­be­ing in gen­eral, which is al­ways a boost for any phys­i­cal prob­lem, as well as men­tal health prob­lems.” Tara Camp­bell is a Candian writer in Omaha Neb.

“As with most phys­i­cal diagnoses ex­er­cise is a great com­po­nent be­cause of its ef­fect on the im­mune sys­tem and the ef­fect on stress and well­be­ing in gen­eral.”

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