5 Questions with Dr. Jane Thornton — what is the physical activity prescription?

Jane Thornton MD, PhD (2nd from left) — Canadian Olympian and Lead Author of CASEM Position Statement

We are having a sit down with Jane Thornton, MD PhD today as part of our recurring  blog offering, ‘5 Questions with CJSM.’  Among many other things, Dr. Thornton is the lead author of the new Canadian Academy of Sport and Exercise Medicine (CASEM) Position Statement on the ‘Physical Activity Prescription.’  This article, published in our July 2016 issue, has already drawn an immense amount of interest — it is currently free, so do not hesitate to check it out and print out/download the PDF to fully appreciate its contents.

Dr. Thornton is an extraordinarily accomplished individual who is finishing up her family medicine/sport medicine training at the University of Western Ontario.  Besides a medical degree, she has earned a Masters and PhD, doing her studies CJSM Associate Editor Connie Lebrun while at the Fowler Kennedy Sports Medicine Clinic.

With the Rio Olympics set to begin in a few days, it is perfect timing to conduct this interview with Dr. Thornton.  While doing all of that academic work noted previously, she was also training for the Canadian national rowing team. She rowed in the 2008 Olympics in Beijing with the Canadian women’s eight.  She knows a thing or two about physical activity, no doubt. In addition to her authorship of the CJSM manuscript, Dr. Thornton has co-created along with Dr. Mike Evans a website about how to #MakeYourDayHarder, advancing the notion that our every day activities offer abundant opportunity to get in meaningful levels of physical activity.

At CJSM, we have had an abiding interest in research on various aspects of physical activity (e.g. check out our recent post on #PEPA16 and Ann Gates, another mentor of Dr. Thornton’s), and so it is with great pleasure that we share with you our ‘chat’ with Jane Thornton.

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1) CJSM: How effective is an ‘exercise prescription’?  What is the evidence for this intervention?

JT: It may sound like common sense that physical activity is good for us, but it has taken us a long time to understand just how important it really is as a component of treatment. When we understand that it can lead to improved clinical outcomes in over 30 different chronic diseases, and can be as effective as medication in many instances (hypertension, stroke, and mild-to-moderate depression, to name a few), then we can’t ignore the fact that it should be something we talk about with our patients.

To best illustrate its effectiveness, though, let’s compare exercise prescription with smoking cessation counseling.  When we examine the number needed to treat (NNT), studies tell us that we need to counsel 50-120 patients to see one patient successfully quit smoking. When it comes to getting one patient to meet the globally agreed upon physical activity guidelines (150 minutes per week of moderate-to-vigorous physical activity), however, that number drops to 12 – meaning we have an incredible opportunity to help patients make a life-changing adjustment in their lives. No one, including me, would argue that smoking cessation counseling is not incredibly important. But given the recent findings that being inactive is almost as bad for you as smoking, we really should be expanding the conversation at each clinical encounter to include exercise.

2) CJSM: What are the barriers to its use?  Why aren’t more physicians actively engaged in giving their patients an exercise prescription?

JT: The most oft-cited barriers are time constraints, lack of education and training, complex comorbidities… and the most honest among us will also bring up the point that we just don’t think patients are motivated enough or willing to change. Interestingly, if we demonstrate a belief in patients, they will usually rise to the challenge. It may also come as no surprise that doctors who are active themselves are also more likely to counsel their patients to be active. A big obstacle in many countries is, of course, remuneration. It’s hard for some to justify time spent counseling on exercise if there is no billing code they can tack on. That one is a tougher nut to crack. Policy makers should take comfort in the fact that the practice of exercise prescription is also cost-effective.

3) CJSM: You are active on Twitter – if you could compose a 140 character Tweet for the CASEM position statement, what would it be? 

JT: Docs can play crucial role global fight against chronic disease – by prescribing exercise! Here’s how to do it right http://ow.ly/iN0k302NxAc

O Canada!

4) CJSM: You are an accomplished athlete – tell the readers about your own athletic career and achievements?  Are you still participating in your sport now that you are so busy with medicine? 

JT: I’m really fortunate that I found a sport that I love. I am one of those crazy people that wake up early in the morning and sit in a boat going backwards for hours. Rowing has been my sport of choice since I was a teen, although ‘choice’ is a generous word! I didn’t so much choose rowing as find a sport I could work at. I’m not at all athletically gifted and was one of those teenagers last picked for teams. In rowing, however, I gradually worked my way up. The pinnacle was winning a World Championship Gold medal in the women’s pair event in 2006, followed by an Olympic appearance in the women’s eight in 2008, where we narrowly missed the podium and came 4^th. I still row, even as a new mom, and currently train and race with some of our national team up-and-comers – it’s a great way to give back and also have the chance to stay active and get outdoors.

CJSM:  You are currently at the University of Western Ontario but just spent a year in Switzerland?  What were you doing there?  Were you stamping out some of the FIFA fires set by Sepp Blatter?

JT: Ha! Sorry to disappoint your readers but it was far less dramatic. I had a great year in Lausanne, Switzerland, learning preventive medicine at the Policlinique Médicale Universitaire as well as gaining insights from top sports medicine gurus such as Boris Gojanovic, Bengt Kayser, and Gerald Gremion. Racing overseas as a rower gave me a desire to see and learn from the world – I lived in Italy for a year prior to my time in Switzerland as well.  I have had the good fortune of learning from other sports medicine ‘giants’ in places such as South Africa, Luxembourg, and the UK, which has made me appreciate the global community we share and the impact we have when we join forces. Our position statement has been informed and endorsed by 10 sports medicine societies around the world and that, in my humble opinion, is the best part of this paper.

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Be sure to check out the CASEM position statement.  And while you’re on line, go over to Twitter and follow Jane to stay on top of the breaking research, policy and advocacy news about physical activity.