EXERCISE IS MEDICINE
another exercise campaign – are we getting close to getting it right?
By Patrick Ling, MD, MPH
E
xercise is Medicine (EIM) is a global initiative to promote
physical activity for prevention and treatment of chronic
disease. Based on the evidence that physical activity and exercise can treat and prevent chronic diseases as well as improve overall health, EIM was launched in 2012 and has since
been endorsed by the College of Family Physicians of Canada
(CFPC), The Canadian Academy of Sport and Exercise Medicine, (CASEM), Canadian Society of Exercise Physiologists
(CSEP), Canadian Physiotherapy Association and Dietitians of
Canada. EIM was originally launched by the American Medical Association and the American College of Sports Medicine
in 2007.
Physical activity and exercise have numerous proven benefits
for the prevention and treatment of chronic disease. Exercise
is demonstrated to improve insulin sensitivity and glycemic
control, to decrease blood pressure and lower LDL and triglyceride level while increasing HDLs. Evidence supports the
fact that physical activity can decrease the risk of acquiring
breast, colon and endometrial cancer. Exercise is also proven
to alleviate symptoms of many chronic conditions such as
osteoarthritis, fibromyalgia, COPD, depression, anxiety and
irritable bowel disease, and to help patients manage these
conditions. It also reduces the burden of cardiovascular disease by treating obesity, hypertension, hyperlipidemia and
diabetes. Improved control of these cardiovascular risk factors translates into improved overall mortality.
Barriers to physical activity counselling
Some might argue that physicians do not need another exercise promotion campaign; physical activity promotion
seems to have reached a saturation point. Despite knowing
the overall health benefits of physical activity and exercise,
patients have reported that most physicians still do not offer
advice or promote physical activity. In fact only one-third of
patients report that their physician advised them to be physically active. The challenge facing physicians is to translate
knowledge into clinical practice.
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The barriers to incorporating exercise and physical activity
counselling with the physician encounter are well known.
Physicians state that there is:
• inadequate time to provide counselling service
• lack of training in physical activity counselling
• lack of prior success with patient behaviour change
• lack of financial incentive or reimbursement
• lack of resources
How is EIM Canada different?
EIM delivers the same message physicians have heard before however it differs from previous campaigns in a number of ways:
• Use of referral system i.e. exercise prescription and referral tool, rather than focusing on physician based activity counseling
• Encourages collaboration of exercise professionals with
healthcare professionals
• Incorporation of an Exercise Vital Sign (EVS) into your EMR
• Not directed specifically at physicians but all healthcare
providers
• Provides educational resources to patients regarding
the benefits of exercise
How can EIM Canada be applied in Saskatchewan?
1. Incorporating an Exercise Vital Sign into your EMR
Exercise can easily be measured in your EMR by including an
‘Exercise Vital Sign’ (EVS). The addition of this measurement
to your EMR can be done quickly through your EMR vendor.
The EVS takes less than one minute to administer and consists of tracking patient responses to the following two
questions:
Question 1: On average, how many days per week do you
engage in moderate to strenuous exercise (like a brisk walk)?