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Sat 1420-prescribing-exercise- -arbutus


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Sat 1420-prescribing-exercise- -arbutus

  1. 1. 5/23/2014 1 PRESCRIBING EXERCISE • BENEFITS OF EXERCISE • GUIDELINES OF EXERCISE • HOW ACTIVE ARE WE • ARE WE EFFECTIVE IN PRESCRIBING EXERCISE? • WHAT CAN WE DO? Faculty/Presenter Disclosure • Faculty: Ron Wilson MD • Relationships with commercial interests: – Grants/Research Support: – Speakers Bureau/Honoraria – Consulting Fees: – Other: CFPC CoI Templates: Slide 1
  2. 2. 5/23/2014 2 Disclosure of Commercial Support • This program has received financial support NO ONE • This program has received in-kind support from NO ONE • Potential for conflict(s) of interest: NONE Mitigating Potential Bias CFPC CoI Templates: Slide 2 BENEFITS OF EXERCISE • As good as or Better than most pills that we regularly prescribe • Cuts across a wide group of conditions, not just for one specific condition • Prevents 14-33% of deaths for CHD/CVA/HBP, Colon and Breast Cancer, DMT2, Osteoporosis • Reduces risk of developing Chronic Disease • Equal results to meds in depression
  3. 3. 5/23/2014 3 BENEFITS • Lower CV risk • Less DM/Met syndrome • Better Bone/Muscle strength • Less Cancer (colon/breast) • Less falls/fractures • Live longer BENEFITS • Feel better • Have more energy • Fewer aches and pains • Better quality of life for longer • Be able to do more things • Be more relaxed • Be less stressed
  5. 5. 5/23/2014 5 GUIDELINES • HOW LONG? – ADULTS: 150 MIN/WK In 10 min. Aliquots – CHILDREN: 60 MIN/DAY • INTENSITY? – Moderate – Faster breathing and sweating a little but not out of breath (50-70% Max HR (220-age)) – Vigorous – Deep rapid breathing, sweating a lot and can’t carry on a conversation (70-85% MHR) GUIDELINES • STRENGTH OR RESISTANCE TRAINING – Adults 2 days/wk – Children and youth 3 days/wk • SEDENTARY GUIDELINES – For Children and Adults – no more than 2 Hr of recreational Screen time – Limit extended sitting periods
  6. 6. 5/23/2014 6 Katzmarzyk et al. Arch Intern Med 2004;164: 1092-7. CVD Mortality Among 19,223 Men from the Aerobics Center Longitudinal Study: 10 Years of Follow-up Metabolic Syndrome, Fitness, and Mortality HOW ACTIVE ARE WE? CANADIAN COMMUNITY HEALTH SURVEY (Self report) For Population over 12 PA during leisure time 2008 2012 Inactive Canada 50.6 53.9 46.1 BC 58.7 61.3 38.7 HOWEVER...
  7. 7. 5/23/2014 7 HOW ACTIVE ARE WE? CANADIAN HEALTH MEASURES SURVEY (accelerometer data) Who meets the guidelines? Adults (150 min/wk) - 15% meet the GL. (M-17%, F-13%) - 18-39 yr old -19%, - 40-59 – 13%. - 60-79 – 11% Sedentary time – 69 % of waking time (9.5 hr) HOW ACTIVE ARE WE? YOUTH (60 min/day) - OVERALL only 6% meet GL - M – 8%, F – 4% BY AGE - M 6-11 11% - 12-17 5% - F 6-11 5% - 12-17 2%
  8. 8. 5/23/2014 8 HOW ACIVE ARE WE? YOUTH BY WEIGHT M – Normal wt – 10% - Overweight – 6% - Obese – 5% F - No statistical difference by weight - already pretty low SEDENTARY TIME – 9 Hr or 64% of their waking hrs. ARE WE EFFECTIVE? USPSTF – In 2002-03 stated that there was insufficient evidence to recommend either for or against behavioural counselling in primary care settings to promote Physical Activity. - in 2013 they stated that current evidence suggest small increases in participants PA levels (see an increase in 40 min/wk of PA for up to 12 months.
  9. 9. 5/23/2014 9 ARE WE EFFECTIVE? INVESTMENTS THAT WORK FOR PHYSICAL ACTIVITY • There is no one single solution to increasing physical activity, an effective comprehensive approach will require multiple concurrent strategies to be implemented. • Physical activity integrated into primary health care settings is one of the seven best investments which is supported by good evidence of effectiveness and that will have worldwide applicability. ARE WE EFFECTIVE? Doctors and health care professionals are important influencers of patient behaviour and key initiators of NCD prevention actions within the heath care system and can influence large proportions of the population. Health care systems should include physical activity as an explicit element of regular behavioural risk factor screening for NCD prevention, patient education and referral. Positive messages about physical activity are important for primary and secondary prevention. Opportunities for NCD prevention should be integrated with communicable disease management systems, tailored to the context and resources available. The focus should be on practical brief advice and links to community-based supports for behaviour change. Most countries will require additional training of health professionals to build competencies in NCD prevention through behavioural risk factor modification and physical activity.
  10. 10. 5/23/2014 10 WHAT CAN WE DO? BELIEVE that EXERCISE IS MEDICINE (2007) (2010) The Charter: Calls on all health care providers to assess and review every patient’s physical activity program at every visit. Utilize the physical activity vital sign. WHAT CAN WE DO? PHYSICAL ACTIVITY VITAL SIGN On average, how many days per week do you engage in Moderate or vigorous exercise and for how many minutes per day? 0-2 days = Sedentary 3-4 days = Somewhat active 5-7 days = Meets the guidelines for health benefits
  11. 11. 5/23/2014 11 WHAT CAN WE DO? Start at current level and recommend an increase of 10-20% per week or even per month. Tie this in to their current diagnoses (i.e. HBP, Diabetes, risk of CHD, CVA, Cancer, Osteoporosis) or better yet to feeling better, less depression, more energy, being able to do more and have fewer aches and pains. Remind about some strength training and less sitting time. WHAT CAN WE DO? ENLIST SOME HELP • PAL – PHYSICAL ACTIVITY LINE – Toll Free Number: 1-877-725-1149 – Lower Mainland: 604-241-2266 – The Physical Activity Line (PAL) is British Columbia's primary physical activity counselling service & your FREE resource for practical & trusted physical activity & healthy living information.
  12. 12. 5/23/2014 12 FINAL POINTS • Doctors who are active themselves are more likely to promote physical activity AND • WE CAN GET PAID FOR DOING THIS – Prevention Fee for Personal Health Risk Assessment – Rx for Health – Bill G14066 ICD 9 code 785 – Up to 100 times a year, no age limit