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Dynamic Chiropractic Canada – December 1, 2013, Vol. 06, Issue 12
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Motivating Canadians to Embrace the Power of Exercise

Help your patients get active: support the "Exercise Is Medicine in Canada" initiative.

By Brenda Duran

Exercise has long been touted for its countless health benefits; now Canadian chiropractors are being encouraged to use it as a formal prescription to help patients achieve optimal health.

With the help of the Royal College of Chiropractic Sports Sciences (RCCSS), chiropractors nationwide have begun to take part in a new initiative called "Exercise Is Medicine Canada" (EIMC).

EIMC is a national initiative established a year and a half ago and guided by a task force made up of chiropractors, medical doctors, physiotherapists, exercise physiologists, and other allied health professionals who are working together for a common goal – the health of their patients.

"It is imperative for chiropractors to get behind EIMC because it fits with our paradigm of promoting wellness and healthy living with our patients," said Chris deGraauw DC, FRCCSS(C), president of RCCSS. "Part of being experts in spinal and musculoskeletal care includes understanding that physical activity level of our patients is a vital sign, that needs to be taken like a pulse. We need to know how to advise patients on strategies to get them adhering to the sedentary behavior guidelines and surpassing the Canadian physical activity guidelines."

Dr. DeGraauw has been working with other members of the task force on its multiple initiatives, including an exercise prescription tool, exercise prescription workshops and a joint position paper regarding EIMC. In addition, he has enlisted other fellows, residents and members of the RCCSS to begin learning more about EIMC to further promote and utilize "exercise as medicine."

The goal is to get chiropractors involved in acquiring a new tool to treat and care for their patients beyond the office visit.

"Chiropractors need to utilize community resources and exercise professionals to assist their patients in meeting their activity and exercise goals," said Dr. deGraauw.

Working Together

The idea to promote this new initiative began in April, when Dr. deGraauw attended the Canadian Academy of Sport and Exercise Medicine (CASEM) Conference in Whistler, B.C. DeGraauw said he sat in on EIMC meetings while Drs. Renata Franckovich (the CASEM president at the time) and Pierre Fremont (current CASEM president) led a workshop on exercise prescription.

"I was extremely impressed with their motivation and goals surrounding exercise prescription for patients. I immediately felt passionate about getting myself, the RCCSS and chiropractic involved in their initiative," Dr. deGraauw said.

After contacting Susan Yungblut, the national task force manager for EIMC, Dr. deGraauw was asked to represent chiropractic on the task force and join them for their next meetings in Ottawa this past May.

"I was pleased to see how strong the group's commitment is to their mission, and their emphasis on collaboration and interprofessional consideration and contribution," he said.

So far, the collaboration between the two groups has been successful.

Members of the EIMC task force such as well-known sports chiropractor Dr. Michelle Laframboise, provided multiple presentations on Canada's physical activity guidelines. Dr. Laframboise was asked recently to chair the RCCSS health promotion committee with the emphasis on supporting the EIMC initiatives. This includes the goals of conducting lectures, workshops and webinars for the chiropractic profession in Canada.

In addition, some faculty and students at the Canadian Memorial Chiropractic College have initiated meetings with the task force manager to bring EIMC on campus for the students to begin learning.

"Their energy and enthusiasm will help us connect with the next generation of chiropractors to ensure we are working in concert with our interprofessional partners," said Dr. deGraauw.

Patient Health Comes First

The concept of getting Canadians to start moving came into focus after numerous studies suggested the impact of sedentary behaviors on overall national health. One of those notable studies, "Aerobic Centre Longitudinal Study (ACLS)," authored by Dr. Steven Blair – considered a landmark study due to the surprising outcomes assessed over a period of 20 years – focused on the impact of low exercise level, smoking, diabetes and obesity on the risk of mortality from cardiovascular disease. Like the United States, cardiovascular disease is also the No. 1 cause of death in Canada.

This groundbreaking study, highlighted recently by Back Matters, showed that low fitness status was found to a bigger risk factor for CVD than smoking, diabetes and obesity combined. According to Dr. Blair, low cardiovascular respiratory fitness was also found to be the most important risk factor with respect to the development of cardiovascular disease.

The Canadian Health Measures Survey also recently showed that only 15 percent of Canadians currently meet the Canadian Physical Activity Guidelines, which state that adults need to be getting 150 minutes of aerobic activity per week. Therefore, to meet this target, chiropractic patients need to be doing about 30 minutes of moderate to vigorous activity five days per week.

To achieve health benefits and improve functional abilities, adults ages 65 years and older are also recommended at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes or more, according to the guidelines.

"The research is very strong [in showing] the benefit of using exercise for the prevention and treatment of chronic disease," said Yungblut. "Many Canadians remain unaware of the (guidelines) and more needs to be done to promote them. Promoting the guidelines through respected health care professionals is one of the key EIMC strategies."

Lucas Regier, clinical intern at CMCC (class of 2014), said he has been able to employ a few strategies when prescribing exercise that have proven to be effective.

"I use the term 'physical activity' instead and try to incorporate small, progressive increases into their normal daily activities. For example, let's say they have a dog that they walk for 5 minutes every day. I may suggest that they increase the duration of their walk to 10 minutes, then 20 minutes, and then maybe twice a day (and so on). Or I may try to get them involved with group activities like walking clubs in their area that can help keep them motivated," Regier said.

Regier added that he has been able to incorporate exercise prescription into patient visits by setting aside specific initial sessions for patients outside their normal treatment visits.

"I find that the patient is more receptive during these 'exercise prescription' visits because the focus is solely on them, and focused towards increasing their activity levels. With some patients I have also found it effective to create 'checklists' for them to take home," he said. "The feedback from my patients has been amazing. In general my patients have told me they have more energy and less pain. In turn they feel more in control of their health and thus more in control with their lives."

Yungblut noted that the most common chronic diseases, such as diabetes, hypertension and other cardiovascular conditions, depression and anxiety, many cancers, are all costly and time-consuming to manage in the absence of regular patient physical activity.

"If we can incorporate physical activity into standard health care treatment regimes, we will make great progress in stemming the tides of these challenging conditions," Yungblut said.

She added that later this year, the task force will be receiving results about how this new initiative has played out among patients of family physicians who have been using the EIMC exercise prescription and referral pad with their patients. The plan is to ask more physicians to pilot test the pad with their patients and share their findings via a follow-up survey.

Walking the Walk

For some chiropractors, the new initiative has given them a new way to go beyond the routine recommendations for mechanical neck and back exercises that normally follow an adjustment or consultation. Now, chiropractors will be able to further investigate the activity and exercise levels of their patients and set up healthy-lifestyle goals, since many of their patients are working in jobs that require them to be sedentary most of the day.

"It is incredible to think about a chiropractor's ability to impact their patients' musculoskeletal concerns and multiple chronic medical conditions with a single free intervention, 'exercise.' I think patients will be glad that we did review their health goals and going beyond their spinal complaints I believe will generate long-term doctor / patient relationships," said Dr. deGraauw.

For chiropractor Dr. Scott Howitt, first vice president of the RCCSS, prescribing exercise makes sense. He said chiropractors can ask every patient what types of exercise they have done since their last visit and how many minutes per week they spend on exercise, as well as what exercise goals they want to achieve.

In October, Dr. Howitt lectured at the Ontario Chiropractic Association's annual conference, explaining the value of incorporating exercise into patient care to improve overall wellness and address the difficult challenge of changing patient behaviors. Dr. Howitt said he recommends chiropractors begin to see themselves as role models when they begin to prescribe exercise to their patients and make sure they practice what they preach.

"Walk the talk, so to speak, or abide by the 'Healthy doctor equals healthy patient' saying," he said.

In a recent online poll posted on DC Canada, Canadian chiropractors were asked if they got at least a half hour of exercise at least five days a week. Approximately 63 percent answered yes and 38 percent answered no.

Dr. DeGraauw said he hopes this new initiative will not only help chiropractors, but also help patients become equal players in the process and have more motivation to follow through on a healthier lifestyle.

"I have seen firsthand how incorporating exercise into daily prescription for patients can improve their mood, give them more energy and decrease their pain. I'm not sure of any other modality that can do that. It makes sense to incorporate this into Canadian chiropractic practice. Working together with our partners in health care, we can improve the health of our communities and our country. After we have helped our patients get moving, we should prescribe that they keep moving," Dr. deGraauw said.

For more information on the nationwide exercise initiative, "Exercise Is Medicine Canada," visit

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