Canada ranks as one of the most inactive nations on the planet. Four out of every five Canadians are not sufficiently active.
Sedentary lifestyles have led to skyrocketing chronic disease rates, leading the World Health Organization to rank physical inactivity as one of its top four risk factors for early mortality.
Our health care system has become reactive instead of proactive, putting our doctors on the defensive line of a team with an ineffective offensive strategy. What would it take to turn this around? We need to treat chronic disease with a dose of exercise.
We all know the old adage that an ounce of prevention is worth a pound of cure. Physical activity is often seen as just this: something that healthy people can do to stay healthy. In reality, however, it is far more than a simple preventive measure. Exercise should be considered as treatment, too.
Even minor increases in activity levels can boost the effects of treatment or even replace medication for over 25 different chronic diseases. This is true for anxiety and depression, as well as arthritis, diabetes, and several types of cancer. Engaging in physical activity is also a winning strategy for seniors to prevent falls, reduce loneliness and increase independence.
And yet, we don’t focus on it within our current health care system. As the recent Senate committee report on obesity in Canada points out, improved training for physicians on exercise “prescription” is needed. Just as dose and frequency is written down on a script for medication, writing a prescription for a “dose” of activity (frequency, intensity, time and type) is one way to help patients reach their treatment goals.
Exercise prescriptions are not yet prioritized at most Canadian medical schools nor in training in later years, although students rate it as highly relevant. After all, studies show that it is fitness, more than “fatness”, which has the greatest effect on quality of life and life expectancy.
Doctors face many challenges when attempting exercise counselling, such as time constraints, dealing with multiple comorbidities, and the usual difficulties with sustained behaviour change. But these arguments don’t prevent doctors from engaging in smoking cessation, which is done regularly, as it should be. When we compare physician counselling on physical activity to that of smoking cessation, studies show exercise counselling could be at least effective as smoking cessation counselling – meaning we have an incredible opportunity to help patients make a life-changing adjustment in their lives.
The year 2016 marks an important anniversary: 50 years of universal health care. Most of us agree that medicare is showing its age. Yet among all the concerns being raised about its sustainability due to rising costs of chronic disease, we’re at risk of missing the point. One key solution is a simple, and sustainable one. Prevention and treatment can be facilitated through the simple and cost-effective act of writing an exercise plan down on a prescription pad.
In fact, “only through the practice of preventive medicine,” cautioned Tommy Douglas, “will we keep the costs from becoming so excessive that the public will decide that medicare is not in the best interests of the people of the country.”
Exercise prescription can’t fix everything – nationwide change outside clinic walls will be critical, including urban planning that supports walking and cycling, funded exercise programs and more. But it can go a long way to improve the health of Canadians and our health care system. Creative strategies will be required, and patient voices will play an important role.
Advocates can encourage exercise counselling in health settings by raising awareness of what was accomplished by the clinical adoption of smoking cessation advice. Medical experts and patients can work together on resources for the general public about the benefits of physical activity, not only for prevention, but also for treatment – catered to those diagnosed with specific chronic diseases.
As a delegate of the Canadian Academy of Sport and Exercise Medicine at the annual Canadian Medical Association General Council meeting last month, I wrote a motion to support physical activity counselling training among medical students nationwide. I am pleased to report doctors took the important first step of passing the motion.
It is not too late for Canadians with chronic disease, and it’s not too late for our health care system either. The march of medical progress in the last hundred years has been truly amazing, and the advances in understanding and practice of each generation has given new life and hope to the next. But we’re not yet applying what we know about physical activity to the practice of medicine in a meaningful way. As poet Maya Angelou said, “Do the best you can until you know better. Then when you know better, do better.” It’s time we heed this advice.
This is Canada’s challenge. We can improve one of our best assets and lead the world in preventive care and innovation.