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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

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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

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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

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GUIDELINES
• WHAT DO WE MEAN BY EXERCISE?
• FOR HOW LONG AND HOW OFTEN?
• WHAT INTENSITY?
• STRENGTH or RESISTANCE TRAINING?
• WHAT ABOUT SEDENTARY BEHAVIOUR?
GUIDELINES
• What are the most common exercises?

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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
http://www.cdc.gov/physicalactivity/growingstronger/exercises/
• SEDENTARY GUIDELINES
– For Children and Adults – no more than 2 Hr of
recreational Screen time
– Limit extended sitting periods
http://www.csep.ca/english/view.asp?x=804

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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...

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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%

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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.

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ARE WE EFFECTIVE?
INVESTMENTS THAT WORK FOR PHYSICAL ACTIVITY
http://www.globalpa.org.uk/pdf/investments-work.pdf
• 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.

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WHAT CAN WE DO?
BELIEVE that EXERCISE IS MEDICINE (2007)
http://exerciseismedicine.org/charter/ (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

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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
– http://physicalactivityline.com/
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.

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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
http://www.gpscbc.ca/billing-fees/complete-guide