Five Questions with Dr. Nick Peirce: The Role of Physical Activity and Sport in Mental Health

Dr. Nick Peirce, lead on the FSEM team producing recent exercise and mental health position statement.

Reduce depression and cognitive decline by up to 30% with regular exercise?  Can this be so?

For those of us ‘in the know’ in this field of sport and exercise medicine, that statement may seem understood.  But medical research translating to broadly held knowledge which then may lead to meaningful change:  well, we ALL know how rare that situation can be.  The management of recent concussion events in the FIFA World Cup reminds us of the difficulty of knowledge translation: there were instances where it seemed as if we were ‘partying like it’s 1999’ so to speak.

Reviews of the current state of evidence-based knowledge about medically important findings continue to be of vital importance in ‘getting the word out’.  In that spirit, we couldn’t be happier to see the recent position statement released by one of our partner societies, the Faculty of Sport and Exercise Medicine (UK) : The Role of Physical Activity and Sport in Mental Health.

The lead on the team of authors which produced this FSEM UK Position Statement is Dr. Nick Peirce, Chief Medical Officer of the England and Wales Cricket Board.  We wanted to pick his brain to get a bit more of the background work which resulted in this statement.  The summer Cricket season has kept Dr. Peirce occupied above and beyond his usual level of busyness.  During a gap between competitions, CJSM caught up with him — the results of our interview can be found here.

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1. CJSM: We want to discuss the new FSEM statement on the role of physical activity and sport in mental health, but first can you tell us a bit about yourself: your background as a sports medicine clinician and your involvement with FSEM?

NP: I have been involved in Sports and Exercise medicine for over 20 years having worked across a large number of Olympic and Professional sports, including Leading Sports Medicine for English Institute of Sport (EIS) at the busiest site in the country at Loughborough University, the Davis Cup team and the football team Nottingham Forest. I am a Hospital Consultant in Sport and Exercise Medicine in the NHS and have been Chief Medical Officer for the England Cricket for the more than 10 years. I have been involved in many of the Sports Societies and for 3 years have sat on the Faculty (FSEM), although professional sport commitments make this challenging.

2. CJSM: How did you become involved with this particular FSEM project on mental health – was there a large team involved in the production of this project? Was FSEM the only organization involved in the drafting of this document? Read more of this post

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Five Questions with CASEM President Tatiana Jevremovic, M.D.

Tatiana Jevremovic, M.D. — current president of the Canadian Academy of Sport and Exercise Medicine (CASEM)

The Canadian Academey of Sport and Exercise Medicine (CASEM) hosts its annual symposium in Halifax, Nova Scotia, in just a couple of days:  from June 6 to 9 sports medicine clinicians from around Canada and the globe will be attending what looks to be another excellent conference which CASEM is hosting.

This past year Tatiana Jevremovic, M.D. has been serving as the CASEM president.  We thought it would be a good time to catch up with her before the clock runs out on her presidency at the end of this month.

In the midst of all her many, many commitments, she graciously found the time to do this interview.  We were delighted with the results, and we know you will be as well.

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1. CJSM: Where else to begin but by asking you about your year as President of the CASEM. You complete your term at the end of June, after the annual meeting which takes place in Halifax this year. What were your major challenges as president this year?  What were your high points?

TJ: There have been a few high points during my presidency year. We hired a communication advisor that has started elevating CASEM’s profile on social media through infographics and soon-to-be-completed new podcasts. We have met and introduced CASEM to the Public Health Agency of Canada as well as other organizations such as ParticipACTION, and are exploring future collaborations on projects of mutual interest such as concussion and health enhancing physical activity.. We continue to strengthen our professional relationships with friends and stakeholders such at Sport Information Resource Centre (SIRC), Canadian Medical Association (CMA), Royal College of Physicians and Surgeons of Canada (RCPSC), College of Family Physicians of Canada (CFPC), Canadian Concussion Collaborative affiliated organizations (CCC), and others.

It has been an extremely exciting year, and my biggest challenge has been accepting that this role is only for 1 year. I will miss it terribly, but am comforted in knowing that my successor, Dr. Paul Watson, will do a great job. I will also continue to promote the Academy and all of its success in my new role as past president.

2. CJSM: You currently work as an Associate Professor in the Dept. of Family Medicine at Western Ontario and at the Fowler Kennedy Sport Medicine Clinic in London, ON. Can you tell us a little about your background in sports medicine and what you do with your professional time when you are not attending to CASEM Presidential duties? Read more of this post

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

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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?  Read more of this post

Doctor, Doctor — Give Me the News!

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CJSM at CASEM 2014 with Pierre Fremont [L], former CASEM President & one of the authors in the new CASEM Position Statement

CJSM has always had a close relationship with the Canadian Academy of Sport and Exercise Medicine (CASEM).  CASEM is, after all, our mother — we were ‘born’ 25+ years ago as the “Canadian Journal of Sport Medicine.”   In the journal, on the podcasts and on these blog pages, CASEM shows up frequently.

Something else that shows up frequently in CJSM media:  research on the benefits of physical activity.  And so it’s not surprising to see in our current issue that CASEM is taking a hard look at the issue of “Exercise is Medicine” and is publishing with CJSM (and other journals) a position statement on the “Physical Activity Prescription:  A Critical Opportunity to Address a Modifiable Risk Factor for the Prevention and Management of Chronic Disease.”

The list of authors involved is a list of sports medicine heavyweights, including several MD/PhDs who have a presence on social media:  if you are not currently following folks like lead author Jane Thornton MD, PhD and former CASEM President Pierre Frémont MD, PhD and BJSM Editor-in-chief Karim Khan MD, PhD….you should.

These ‘doctor doctors,’ as I like to call my colleagues who have fought the good fight to earn an MD and a PhD, have produced a powerful statement that will have significant influence on how physicians can play a role in addressing the worldwide crisis of sedentary behavior.  The global problem of inactivity especially in children has been an ongoing concern of mine, and it has puzzled me that when I have spoken on this issue I frequently find that physicians feel as if they are on the sideline of this battle.  We collectively throw up our hands and say the problem is too big, or it’s not a clinical medicine problem it’s a public health issue.

But our patients are looking to us for guidance on this issue.  They really do ‘want the news.’ As the authors note in the position statement, “Over 80% of Canadians visit their doctors every year and prefer to get health information directly from their family physician. Unfortunately, most physicians do not regularly assess or prescribe physical activity as part of routine care,  and even when discussed, few provide specific recommendations.

They continue, “Physical activity prescription has the potential to be an important therapeutic agent for all ages in primary, secondary, and tertiary prevention of chronic disease.”  Indeed, Robert Palmer, the singer of “Bad Case of Loving You (Doctor, Doctor)” fame, could not have known how prescient he was when he penned the lyrics, “no pill’s gonna cure my ill…..”  He was talking about love, but he may as well have been talking about the chronic diseases associated with physical inactivity. Prescribing a pill won’t cure this ill: the physical activity prescription, delivered and acted upon, is required.

The beauty of this position statement is that it gives evidence-based tools that primary care physicians as well as sports and exercise medicine physicians can use in their practice to stem the tide of the inactivity epidemic.  I know this statement will be widely read and disseminated; it will be referenced frequently.  I am looking forward even more to seeing its principles put in action by me and my colleagues, around the world–both in our clinics and in the venues where we train future physicians.

Look it over now.  It’s free!  What’s stopping you?

 

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