Exercise isn’t just prevention, but treatment too

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  • Terry Nixon says:

    Dr. Thornton,

    Thank you for the advice and links. I am a senior who has changed diet and exercise. I have had the reversal of several conditions. My knees used to be too sore to climb stairs, I had acid reflux, a large patch on my hand that would break open and bleed, phlegm. All have at least decreased 95%. I have been trying to get the younger family members to join me, with limited success. I like my new life.

    Do you have any links to overcome the resistance of the younger gen.


  • Maureen Peniuk says:

    I have been preaching this for years, but I don’t have enough of a voice to reach a large enough population. Many excellent points in here – and so glad you have a voice that is being heard and influencing decisions.

  • Professor Craig Williams says:

    So pleased you are influencing the medical professions. We have been engaging with clinicians in the U.K., especially related to physical activity prescription and promotion for young patients with congential heart disease and cystic fibrosis. But it is not as easy as this, we and others have shown that doctor’s own physical activity habits correlate to their willingness to discuss and advocate for physical activity for their patients. Hence, the greater the proportion of students adopting and maintaining regular PA habits might therefore increase the rates and quality of future PA counselling delivered by doctors. A collaborative effort with exercise scientists will go a considerable way to inform and educate medical practitioners and those professions allied to medicine/health.

  • Nathan says:

    I am an undergraduate student studying sport development at Worcester University and found this article extremely inspiring. The points made are clear and the statistics support the overgrowing problem in Canada.

    Thank you,
    Nathan Caesar

  • Connie Lebrun says:

    Great article Jane – keep up the good work – you are inspiring a new generation (and an older generation) of physicians – to walk the walk and counsel their patients about the health benefits of regular physical activity.

  • Sarah Harrison says:

    Hi Jane,
    THANK YOU! Thank you for recognizing this and being vocal about the need we are facing in this country. As a Recreation Therapist I have been actively working with clients to increase activity level to maintain/improve and prevent health concerns. We have always struggled as a profession to have our voices heard on the importance of activity related to health. You are a breath of fresh air. Keep up the great work and hoping our paths cross in the campaign for healthier Canadians!
    Your old Rowing Friends,
    Sarah and Barry Harrison

    • Jane Thornton says:

      Hi Sarah,

      Fantastic! Thanks for your comments and great to see rowing friends here as well.

      Thanks as well for all the great work you are doing.


  • Dr. Beverly Goodwin says:

    Thanks for this article, Dr. Thornton. As individuals and as a society we do need to prioritize healthy living (eating, exercise, overall lifestyle) as a core component of health and wellness, not only to prevent and help manage many chronic illnesses but simply for our general well-being. This can be supported by physicians, but there are limits to our influence on others’ behaviour, particularly when people are dealing with specific sorts of challenges.

    I am a psychiatrist serving a largely rural / small-town population, with a focus on moderate to severe mental illness. Smoking, obesity, inactivity and other health risk factors are a particular concern for people with serious mental illnesses such as schizophrenia, bipolar disorder and severe depression, and can be more challenging to address in that context. The medications used to help treat these conditions can have metabolic side effects, and the illnesses themselves can affect appetite, eating behaviours, sleep patterns (which can influence weight & health), and levels of physical energy and stamina. Additionally, some illnesses can reduce a person’s motivation, drive, interest and ability to take pleasure in activities. Socioeconomic determinants of health can take a further toll, as poverty and lack of transportation can reduce access to healthy foods (not always found at food banks!) and to a variety of exercise options (gym, yoga, swimming, sports) which might otherwise increase the repertoire of opportunities for activity. When a person has difficulty just finding the motivation and energy to get out of bed in the morning, a prescription for exercise is not an easy one to fill. This does not tend to be addressed at workshops on ‘lifestyle medicine’. I wonder if the Canadian Academy of Sport and Exercise Medicine has access to research or helpful strategies which are specific to this population?

  • Jessica Otte says:

    Pleased to meet you at CMA GC Jane; this is a great piece!

    The Tommy Douglas quote is an important one and I’m so glad to see that “preventative medicine” equates to promoting healthy behaviours, not more screening tests and statins. Too often we/patients assume that some medical test or pill can replace the harder work of healthy living, but I think there’s no debate that exercise is best as prevention and treatment for most chronic conditions (back pain, HTN, migraine, fibromyalgia, diabetes, etc).

    A ‘health in all policies’ approach is an extension of your call for fitness-supporting urban planning, but of course we need to do something direct and we need to do it now. I like the idea of exercise prescribing. However, as you mentioned it is hard to get over the drawbacks and the main one that I’ve seen myself and other MDs struggle with: uncertainty that prescribing/counselling is effective. I know the literature supports a few things as effective to helping patients maintain long-term active lifestyles, like decreasing barriers to exercise, decreasing social isolation, and using prompts to remind/encourage people. I’ve looked at Cochrane and PubMed and can’t find anything that talks specifically about prescribing exercise as a tool that helps with long-term adherence, in fact some (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2968119/) suggest we need to shift from prescribing it to supporting people with teams to do this.

    It seems that to succeed, we may need the multifaceted approach as we have had with smoking cessation: effective labeling, creating barriers to unhealthy behaviour, (good) peer pressure and role modelling, media campaigns, 1:1 doctor-patient counselling and prescribing, supportive group learning, healthy city design, employer programs, educating kids in school, etc.

    I hope we can look back in 10 years and say wow, we turned a corner, and see rates of sedentary lifestyle and chronic disease all on a steady downward slide. I hope your call to action is a big part of that change – keep it up!

    • Jane Thornton says:

      Hi Jessica,

      Thanks for your comments – and great meeting you as well! I’m a big fan of your work.

      Your point about uncertainty is well taken. We need more studies that look at efficacy and not just effectiveness – i.e. does it actually work in the “real world”? There are a few studies that do show good long-term outcomes (one example: http://www.ncbi.nlm.nih.gov/pubmed/22451477) and a doctor who exudes confidence in his/her patients can help nudge those outcomes too. The study you cited deals with physical activity and obesity, which I would tend to agree may need more of a multidisciplinary (team-based) approach.

      There’s a Canadian position statement we authored that deals with some of the nuances with referrals (http://www.ncbi.nlm.nih.gov/pubmed/27335208). Supporting people with teams can be good in many cases, but unfortunately the hardest hit are those in the lowest socioeconomic bracket – and referrals can mean one more roadblock. It is then when the burden of treatment can start to outweigh the perceived burden of disease. I’m a big fan of equipping doctors to do the relatively simple task of counselling and follow-up where possible – at least understanding the benefits themselves and starting the conversation.

      Agreed completely about following the successful work done with smoking cessation models too – great suggestions. Lastly, thanks for your encouragement. Your contributions to improving our health care landscape are inspiring to all of us!

  • Melanie says:

    Excellent article and exactly what prescription to get active is trying to achieve in Alberta and beyond.
    Melanie- BPE, CSEP CEP

  • Ediriweera Desapriya says:

    Exercise is medicine-http://jama.jamanetwork.com/article.aspx?articleID=2468899

  • Susan Yungblut says:

    Thank you very much Dr. Thornton, for your leadership on this important issue! Exercise is Medicine Canada (EIMC) provides national leadership in promoting physical activity as a chronic disease prevention and management strategy to improve the health of Canadians. Our vision is that: Physical Activity is an integral part of prevention and treatment of chronic disease in the Canadian Health Care System, so that more Canadians meet the Canadian Physical Activity and Sedentary Behaviour Guidelines. Please view our website: http://www.exerciseismedicine.ca for information on our accredited workshops for health professionals, and clinical tools including our EIMC Exercise Prescription and Referral Tool and EIMC Guide to Prescribing Exercise. We also facilitate an exciting EIMC on Campus leadership program for college and university students of all disciplines to promote physical activity on their campuses and in their communities: our goal is for the next generation of health and exercise professionals to well prepared to help their patients be physically active.

  • Diane Richmond says:

    what a great read, I can relate to what you are talking about I believe that physical activity is so important for us elders and I certainly keep trying to keep active in spite of many issues that I have both knee replacement.

  • Lori Teeple says:

    So well done, Dr Thornton!!

    • Jane Thornton says:

      Thanks, Dr. Teeple! I am learning from inspiring physicians such as yourself who are already “walking the walk” and have done so for years.

  • Kevin brady says:

    Love it! You are right on the money with everything you say. I will help drive this movement.

    Sincerely grateful for you taking a stand.

    Kevin Brady, Kevinbradyhealth.com

  • Anna says:

    Great piece! There are many factors at play and the issue is very complex. As a PT, of course one big problem that quickly comes to mind is the fact that many patients want the easy fix. Exercise requires ongoing effort on the part of the patient. There is no magic exercise to lose weight. One cannot expect to exercise once a week and see a change. One cannot expect that simply completing a 6 week rehab program is enough to maintain health over the remainder of their lifespan. It’s an ongoing, daily investment and the patient needs to be motivated and compliant. Another big issue is the fact that “medical treatment” in the westernized sense has been overtaken by big pharma and only now are people recognizing the importance of nutrition and exercise in health maintenance and disease prevention. Pharma money funds studies which support pharmaceutical intervention as the only treatment, despite many more recent studies showing some big name drugs (e.g. antidepressants) as no better than placebo. However, with pharma invested so heavily in medicine and medical school curricula, there’s no surprise that many doctors out there do not think beyond published clinical trials and do not provide a holistic regimen which involves diet, exercise, other lifestyle factors. Of course there is a role for drugs in the treatment of many critical illnesses, but healthcare programs need to invest more time in teaching nutrition, exercise physiology, and prevention.

    There are many researchers out there who have been actively showing the benefits of exercise on disease prevention over the last decade, have they not been receiving adequate attention in the medical community because they are not conducting large trials funded by big pharma?

    One great program to look into:
    Mandatory reading for all healthcare professionals and researchers:

    • Jane Thornton says:

      Hi Anna,

      Thanks for your comments. I think it’s fair to say that “humans” want the easy fix, vs. patients alone. We all want the best information to make good decisions. The strength of evidence on physical activity and health is growing, but it hasn’t always been there – it has been difficult to show long-term results with some of these interventions. Medical school curricula in Canada is fortunately not funded by pharmaceutical companies or other commercial interests, and I do believe positive changes are coming in terms of teaching on prevention.

    • Jeffrey Price says:

      I loved Bad Science by Ben Goldacre and think it is a must read for every physician. That being said, I will say as a resident that “Big Pharma” had no input into my training. I will say that it was actually the opposite, disclosures had to be mentioned for every talk and we were shielded from any pharmaceutical rep visit.

      There are many opportunities to develop your knowledge base more into exercise with physical medicine and rehabilitation or sports medicine rotations during residency.

      Great article Jane – keep up the good fight!

  • Peter says:

    Excellent article. When I worked as a psychologist I would suggest cardiovascular exercise as part of the treament for depression and anxiety.

  • Drew Laskoski R.Kin, Athletic Therapist, CAT(C) says:

    Mandatory physical education in grade 9-12 that includes walk/running and weight training mandatory would make more sense and take a portion of the burden away from our beleaguered Family Physicians!

  • John says:

    Best advice our new graduates could get, especially the Tommy Douglas quote. Our system cannot afford to continue increases in health care spending, and as you said, prevention is better than the cure. In Med School (1969) we had a class called Soc & Pre ( social and preventive medicine) that was the most boring class we took, but has now turned out to be the most relevant. Keep it up.


Jane Thornton


Dr. Jane Thornton is a medical resident with a PhD in sport and exercise medicine, and a 2016 Action Canada Fellow.

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