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

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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?

 

May Day

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CJSM: bringing you clinical sports and exercise medicine research, from around the globe

Whether you are celebrating today as International Workers’ Day, running around a May pole, or watching Leicester City try to complete the 5000:1 shot of winning the Premiership, we are sure that today, May 1, can only be a good day:  our third issue of the year has just published.  And this May Day CJSM is full of offerings we’re sure will be of  interest to you.

Two of the articles have a special focus on physical activity as an intervention for medical conditions — one is a meta-analysis from Chinese colleagues finding a protective effect for physical activity against lung cancer, and the other is a prospective, single-blinded, randomized clinical trial looking at rock climbing as an intervention in the treatment of low back pain. This study is from Austria, and had positive findings for dependent measures of disability (the Oswestry Disability Index), a physical examination maneuver, and even the extent of disc protrusion on MRI.  We’re proud to publish these high quality studies from across the globe.

We are also proud to contribute to the growing body of literature on the effectiveness of “Exercise is Medicine.” Read more of this post

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