There's a powerful medicine gaining favour these days that can't be found in a tablet or on pharmacy shelves.
This potent remedy, which can reduce blood pressure, cholesterol and the risk of heart attack, is good old-fashioned exercise.
A movement is emerging among physicians, researchers and public-health experts who want the medical system to harness its healing and preventive powers — through exercise prescriptions.
At a time when Canadians are fatter, more inactive and facing higher rates of chronic disease than ever before, they say it's time doctors started prescribing brisk walks and strength training the same way they dole out pills for diabetes or hypertension.
The notion that cardiovascular disease and other conditions can be prevented and treated with regular aerobic activity is not new.
"The difference we're trying to focus on is to get the authority — the physician — to tell patients 'you need to do this for your health,' " says Brian MacIntosh, kinesiology professor at the University of Calgary and board member of the Canadian Society for Exercise Physiology, which sets national guidelines for physical activity and sedentary time.
Next month, MacIntosh will chair the first meeting of a new group called Exercise is Medicine Canada in Victoria, B.C. Like its U.S. parent, the Canadian chapter wants to make physical activity another "vital sign" that's assessed at every doctor's appointment along with blood pressure and pulse. It is also pushing for physical activity to be at the centre of policy discussions on disease prevention and health.
Other health advocates are also embracing this philosophy. The Canadian Diabetes Association launched its downloadable exercise prescription pad ( http://www.diabetes.ca/documents/for-professionals/Patient_Provider_Prescription_Tool_4.pdf) late last year. It provides doctors with five prescription options, depending on a patient's fitness level and gradually increases in intensity and duration as the patient makes exercise part of their daily routine.
"Just telling someone to be physically active isn't enough," says Jonathon Fowles, kinesiology professor at Acadia University in Wolfville, N.S., and designer of the new pad.
Research has shown that written prescriptions motivate patients to pay attention, retain the information and return for follow-up visits, he says.
Fifty physicians from the Leduc Beaumont Devon Primary Care Network south of Edmonton may be the first in Canada to adopt the practice en masse.
They have handed out 850 exercise prescriptions since launching their initiative in November, and each comes with a free one-month pass to a local recreation facility.
They know doctors' orders have clout. But those orders need to be explicit and in writing, especially for patients who aren't in the habit of exercising.
Take Robert Bradley, 68, of Toronto. After three decades of living with Type 2 diabetes, he takes his prescriptions seriously, carefully following instructions about dosage, frequency and potential side effects.
But general advice to "get more exercise" never had much impact. When his family physician suggested regular walks to make up for sedentary hours at a desk, Bradley would try for a few months. Then he'd gradually slip back to his inactive ways.
"I turned into a couch potato, to be honest, and I wasn't very motivated."
What he needed was an approach that treated exercise as seriously as a bottle of pills.
He finally got one at the Toronto Rehabilitation Institute, which provides assessments, fitness plans and monitoring for people living with chronic health conditions. The program, which treats 1,800 patients a year, is covered by OHIP but requires a physician's referral.
Bradley signed up for a 26-week session last fall, after high blood sugars left him facing the prospect of going on insulin. His first exercise prescription was to walk four laps (800 metres) around the track at the institute's Leaside facility five days a week.
Six months later, he's up to 5.6 kilometres almost every morning on his own treadmill while watching Canada AM (it takes him 64 minutes). He also does resistance training exercises twice a week.
Bradley is 20 pounds lighter, has lost five inches from his waistline and seen his blood sugar levels fall to the normal range. His doctor is delighted.
"Now I look forward to it," says Bradley. "I've had very positive results so I feel a lot better about myself."
His experience underscores the biggest challenges for physicians: making sure patients are consistent; and providing advice tailored to the individual.
"No drug works unless you actually take it, and you have to take it every day and the right dose and at the right time," says Dr. Paul Oh, internist and medical director at Toronto Rehab.
"The analogy to medicine is we would never say 'take some aspirin and good luck.' We would say 'take 81 milligrams each morning, make sure you take it, if you miss a dose, here's what you do. If your stomach is upset, take an antacid or take it with food. If you have bleeding, please call me.' "
Oh has been prescribing exercise for 20 years to improve the outlook for patients with chronic conditions that put them at risk of heart attack and stroke, and to treat those recovering. But he says physicians should make exercise a priority for all patients.
Walking at a brisk pace for half an hour five days a week accompanied by twice-weekly resistance exercises using light weights or elastic can have a huge impact on health. Studies have shown it can improve an array of conditions from osteoporosis to joint pain to anxiety — as long as patients follow through.
"It's as powerful as any medication therapy we might offer," says Oh, also a pharmacologist. "The unfortunate thing is it's vastly underutilized by physicians and patients."
To change the culture, they need to understand exercise isn't just a matter of cosmetics or lifestyle but that "the person over there walking around (the track) actually has a 50 per cent lower chance of dying."
For the past five years, everyone from the World Health Organization to Health Canada and local public health authorities have warned that sedentary behaviour is making society sick.
Exercise guidelines make newscasts, public awareness campaigns blare the "get moving" message on screens and billboards.
But according to Statistics Canada studies that tracked Canadians' activity levels, only 15 per cent of adults get the recommended minimum of 150 minutes a week of moderate to vigorous exercise, while a dismal 7 per cent of kids meet the minimum one hour a day.
Physicians on the front lines are in a unique position to prime the pump, says Dr. Robert Petrella, assistant director at the Lawson Health Research Institute in London, Ont., and a University of Western Ontario professor who holds research chairs in aging and health.
While many believe in physical activity for optimum health, the challenge is translating it into practical advice.
His 2007 survey of more than 13,000 family physicians found 85 per cent raised the issue of exercise with patients during routine examinations. While 70 per cent provided verbal counselling, only 16 per cent provided written instructions.
It's that piece of paper that can have the biggest impact among patients accustomed to leaving the office with something in hand. That's where the prescription pad comes in.
There are barriers to getting physicians to make exercise a priority. There is often a lot of ground to cover in limited time during appointments. Many feel they lack the expertise to prescribe exercise.
One solution is expanding health-care teams to include an exercise physiologist trained to design programs for both healthy patients and those with chronic conditions.
Discussing a range of exercise options is also key, says Petrella, whether it's mall-walking, cycling or joining a pickup soccer league. Sending everyone to a fitness centre isn't going to work.
Whatever the exercise of choice, physicians need to be on top of the options in their own communities, including hiking trails, pools and recreation centres, says Petrella.
"And they need to incorporate those into what they're telling patients."
