Take Two Runs and Call Me in the Morning

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.”