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?

 

Catching my breath

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Part of the large contingent coming to #ACSM16 from South Africa. Photo courtesy of Phatho Zondi, current SASMA president.

I am just coming up for air after three days here in Boston, where I (and thousands of other sports medicine professionals) are attending the 2016 annual conference of the American College of Sports Medicine (ACSM).

Every year at this time I will make the pilgrimage to San Diego or Orlando or other spots in these big United States to attend this big, big conference.  Each year I leave with my brain chock full of new ideas and my bag chock full of business cards; as I step back to gain some perspective on the experience I am overwhelmed by the size and scope of the conference.  I am not complaining when I declare that it is simply not possible to attend every session one would want.  I am, rather, merely making a statement of fact!

So, like the proverbial dog trying to drink out of a gushing fire hydrant, I am doing targeted nipping at the flow of information rushing before me, and I want to share, in a most definitely non-comprehensive way, a few of the impressions I am left with as the conference heads into its penultimate day.

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Slide photo courtesy of Martin Schwellnus

First, it’s been great to catch up with a host of South African colleagues, ranging from Martin Schwellnus, Wayne Derman and Jon Patricios, to current South African Sports Medicine Association (SASMA) president Phatho Zondi, Pierre Viviers and Christa Janse vanRensburg.  It’s tremendous to see these folks and realize the great distance they have come to contribute to the ACSM proceedings.  In terms of contribution, they most definitely ‘punch about their weight’:  one of the sessions I attended was Dr. Schwellnus’ lecture on Exercise Associated Muscle Cramping (EAMC), a subject about which we publish quite frequently at CJSM.  I learned a tremendous amount from that talk, and I am sharing one of the slides from his talk for which he gave permission to be photographed.

There are many other international attendees at ACSM.  I have seen my friend and fellow CJSM editor Hamish Osborne, who arrived from Dunedin, New Zealand (bringing to my mind the very real possibility that ACSM should start betting operation taking propositions on who will win the “Conference attendee who has travelled the furthest” award).  I have heard Chinese, Italian and French spoken. Read more of this post

The power of exercise + the power of the internet = #PEPA16

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Ann Gates a.k.a. @exerciseworks

I have a lot to share this morning, but I am writing an intro to a guest blog post…and so I shall be brief.

I’ve got ‘exercise on the brain’ of late.  We’re only three weeks away from the beginning of the American College of Sports Medicine (ACSM) Annual Meeting and the coincident 7th World Congress on Exercise is Medicine taking place in Boston, which I’ll be attending.  Here at CJSM, we just released our May issue which features a couple of highly discussed research studies:  a meta-analysis on physical activity and the risk of lung cancer and an RCT on the effect of rock climbing on low back pain.

And to top it off, I’ve ‘met’ Ann Gates, founder and CEO of Exercise Works, aka @exerciseworks for those of you, like me, who have followed that Twitter handle for years. Last week I noticed on that feed an announcement that Exercise Works would hold a MOOC this summer — ‘Physiotherapy, Exercise and Physical Activity’ #PEPA16. And it starts July 4 2016.

What is a MOOC you say? What exactly will go on in #PEPA16?

Let’s hear from Ann.

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#PEPA16? It sounds like a rock group… but it’s a mission.

It’s a passion. It’s an opportunity to support health care professionals interested in exercise medicine and disease: from Africa to Afghanistan, doctors to community outreach workers, and to embed physical activity into making every contact count, every consult.

So what’s a MOOC, and what’s happening this summer? A MOOC is a massive, open online, course run by expert educational organizations (in this case Physiopedia). It’s also a unique opportunity to learn, participate, contribute, engage, and share on a global scale! The excitement of it all is that the course has been designed and evaluated to deliver high quality learning outcomes on the role of physical activity in health. It provides a global, level playing field, to gain knowledge on the health benefits of exercise and chronic disease prevention and treatment. It’s also the final part (phew!) of my three year project to change the way we educate health care professionals in prevention medicine (in this case using exercise as a medicine).

I set out in 2014, to disrupt the way in which physical activity medical education is delivered. I wanted most of all to open up the opportunities to all, and to deliver learning and implementation science of physical activity opportunities, into everyday patient care. We’ve achieved this for doctors and health care professionals in the UK- but I wanted to take this global, and provide educational support for all, in any country, for any health care professional interested in learning more about the benefits of physical activity in health.

So, #PEPA16 is the result. A global, online, “rocking”, opportunity to care and share the knowledge, that indeed, exercise is best medicine! Join us, this summer, and please register here.

What’s in the #PEPA16 MOOC Resources? Read more of this post

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