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REP 19: ARE THE CANADIAN PHYSICAL ACTIVITY GUIDELINES PERTINENT TO PHYSIOTHERAPISTS?

Sunita Mathur

 

It is well known that low physical activity is a major risk factor for cardiovascular disease, type 2 diabetes, obesity, and certain forms of cancer – some of the leading causes of death in Canada. Yet, 85% of adults and 93% of children and youth are not meeting Canadian Physical Activity Guidelines. Do physiotherapists have a role to play in addressing this public health concern?

Let’s discuss how we as physiotherapists can use the Canadian Physical Activity Guidelines in daily practice.

The big idea

Simply stated, the Canadian Physical Activity Guidelines published by the Canadian Society for Exercise Physiology (CSEP) indicate that every adult should be participating in a minimum of150 minutes per week of “moderate to vigorous” intensity aerobic activity, and muscle building activities on at least 2 days per week. Ideally, aerobic exercise should be accumulated in 30 minutes sessions on 5 days per week. Each session should include a warm-up and cool-down (5 to 10 minutes each), PLUS 30 minutes of moderate to vigorous aerobic exercise. Muscle building activities can include weight lifting, or other forms of resistance training such as yoga or Pilates.

My take on things…

The guidelines are a credible resource. They were developed from a series of systematic reviews of the literature and have a strong evidence base. CSEP has also made an effort to develop guidelines that apply to a wide spectrum of Canadians. There are specific guidelines foradults (18-64 years), older adults (65 years and older), children (5 to 11 years), youth (12 – 17 years) and also early years (0 to 4 years). They have also released guidelines for special populations (spinal cord injury, multiple sclerosis and Parkinson’s Disease). There are also several resources available to make the guidelines easier to use, including an online interactive handbook, and fillable log-sheets.

With the science behind these guidelines, we can feel confident counseling our patients on engaging in a physically active lifestyle to benefit their health. As physiotherapists, our scope of practice IS exercise and we have an important role in empowering our patients to achieve a healthy lifestyle through exercise.

As primary care practitioners, we must start to see our role in preventative health, as well as rehabilitation.

In settings such as cardiac or pulmonary rehabilitation, our role in exercise counseling is very clear. We can use these guidelines as part of discharge planning and in helping people achieve an active lifestyle after they leave the supervised exercise program. However, when we see clients for a specific orthopedic injury or neurological condition, the role of counseling on lifestyle physical activity becomes secondary. We are often very focused and proficient on treating the “primary problem”, rather than exploring overall health. As primary care practitioners, we must start to see our role in preventative health, as well as rehabilitation. Even when we work with a client for a specific condition such as neck pain, we must also ask questions about their exercise habits, and counsel them on engaging in an active lifestyle.

Exercise has beneficial effects on every body system, so it can be part of every evidence-based treatment plan! Let’s be part of the physical activity strategy for Canadians.

How can we use the guidelines in our practice?

In your own practice, do you typically ask your clients about their level of physical activity? This can be as a simple as asking them a series of questions during your subjective exam, or as part of an intake questionnaire. If you’re not already, three simple questions you might ask are:

“In the last month did you…

  • participate in a regular exercise program? What types of exercise?
  • play sports or engage in an active hobby?
  • walk or ride a bike to work/school, or to do your errands?”

Or you might ask them about their sedentary activities, such as “On a typical day, how many leisure hours (time outside of work/school) did you spend watching TV, using a computer, etc.?”

Regardless of your approach, getting this information from the client is important and will give you an idea of their general activity level and sedentary behavior.

In settings such as cardiac or pulmonary rehabilitation, our role in exercise counseling is very clear. We can use these guidelines as part of discharge planning and in helping people achieve an active lifestyle after they leave the supervised exercise program. However, when we see clients for a specific orthopedic injury or neurological condition, the role of counseling on lifestyle physical activity becomes secondary. We are often very focused and proficient on treating the “primary problem”, rather than exploring overall health. As primary care practitioners, we must start to see our role in preventative health, as well as rehabilitation. Even when we work with a client for a specific condition such as neck pain, we must also ask questions about their exercise habits, and counsel them on engaging in an active lifestyle.

In children and youth, it has been recommended that “screen time” be limited to less than 2 hours per day; and even less in infants and toddlers.

What is the best way to apply these guidelines?

After asking clients about physical activity and sedentary behavior, it is time to put on your heath promotion hat!

Many people quote time as a barrier to engaging in exercise, so discuss options for exercise and physical activity that would fit in their current routine. These people can start with small ‘bits’ of exercise throughout the day. Research suggests that 10 minutes of physical activity (such as a 10 minute walk), done 3 times throughout the day for 30 minutes total, is a great way to get started on an aerobic program. These short bouts of physical activity, sometimes called ‘fractional exercise’, typically do not include a warm up and cool down in ‘healthy’ people.

Similarly, if your client has a chronic condition (or multiple conditions), is recovering from an injury/surgery, or is being discharged from the hospital, then the guidelines need to be tailored accordingly. Using 10 minute bouts of a low intensity aerobic exercise, separated by adequate rest will be more manageable for these clients than trying to finish 30 minutes of moderate to vigorous intensity training all at once. If the exercise is performed in intermittent bouts of 10 minutes, a warm-up prior to the first bout and a cool down after the last bout is highly recommended.

Resistance training exercises can be adapted to reduce energy demands and minimize risk of injury. For example, exercises can be done in sitting with the body supported. Training single muscle groups one at a time, and using body weight, an elastic band, or light weights are great ways to engage your clients in resistance exercises to strengthen muscle and bones. In people with mobility issues, balance exercises are key to their overall health and to reducing their risk of falls.

Every exercise can be adapted to ensure that it is both safe and effective for an individual. It is our role to help people realize what they can do to be more active each day.

Discuss

Are there barriers to implementing the Guidelines with your clientele? Are you willing to take on the challenge and make a difference in helping Canadians become more active? How can you address physical activity in your daily clinical practice?

About Sunita Mathur

Sunita Mathur is an Assistant Professor in the Dept of Physical Therapy at the University of Toronto. She previously worked as a physiotherapist in Halifax and Vancouver in the areas of cardiac and pulmonary rehabilitation. Her current research program focuses on exercise to improve skeletal muscle health in people with chronic disease. 

 

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