Exercise Prescription Practices of a Group of Canadian Internal Medicine Physicians A Cross-sectional Survey Including Barriers and Facilitators to Exercise Prescription

Main Article Content

Alexi Kuhnow
Stephen Workman

exercise prescription, Internal Medicine, chronic disease management, survey, physical activity

Abstract


Background: Internal Medicine (IM) physicians are in a prime role to prescribe exercise for chronic disease management. Our main objectives were to investigate the exercise prescription (EP) practices of IM physicians, and identify barriers and facilitators to EP.
Methods: We emailed a confidential 16-item survey to 194 IM physicians practicing in the Central Zone of the Nova Scotia Health Authority (NSHA). The survey software Opinio was used for data collection and descriptive statistics.
Results: A total of 108 IM physicians completed the survey (response rate = 55.7%). Sixty-five participants reported regular EP (60.2%). The main barriers to EP were lack of resources, time, and training. Facilitators included having patient education materials and EP pads available.
Interpretation: Although most participants reported that exercise was important for chronic disease man-agement, about 40% did not report regularly prescribing it. Enabling facilitators and addressing barriers may improve EP practices for this group of IM physicians.


Résumé
Contexte : Les internistes jouent un rôle de premier plan en matière de prescription d’exercice dans la prise en charge des maladies chroniques. Nos principaux objectifs visaient à étudier les pratiques de prescription d’exercice (PE) chez les internistes et à cerner les facteurs qui entravent ou facilitent la PE.
Méthodologie : Nous avons fait parvenir par courriel à 194 internistes de la zone centrale de la Régie de la santé de la Nouvelle-Écosse un sondage confidentiel comportant 16 questions. Nous avons utilisé le logiciel de sondage Opinio pour la collecte des données et les statistiques descriptives.
Résultats : Au total, il y a eu 109 répondants (taux de réponse = 56,2 %) et 108 d’entre eux ont rempli le sondage. Soixante-cinq participants ont indiqué qu’ils prescrivaient régulièrement de l’exercice (60,19 %). Les principaux obstacles à la PE sont le manque de ressources, le manque de temps et le manque de formation. Les facteurs facilitants sont l’accès à du matériel pédagogique destiné aux patients et à des ordonnanciers conçus pour la PE.
Interprétation : Bien que la plupart des participants indiquent que l’exercice est important dans la prise en charge des maladies chroniques, environ 40 % d’entre eux ne le prescrivent pas régulièrement. Promouvoir les facteurs facilitants et s’attaquer aux obstacles pourraient améliorer les pratiques de PE chez ce groupe d’internistes.

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References

1. Hoffman TC, Maher CG, Briffa T, et al. Prescribing exercise interventions for patients with chronic conditions. CMAJ. 2016;188(7):510–18. http://dx.doi.org/10.1503/cmaj.150684
2. Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug interventions on mortality outcomes: Metaepidemiological study. Br J Sports Med. 2013;49(21):1414– 22. http://dx.doi.org/10.1136/bjsports-2015-f5577rep
3. Bullard T, Ji M, An R, et al. A systematic review and meta-analysis of adherence to physical activity interventions among three chronic conditions: Cancer, cardiovascular disease, and diabetes. BMC Public Health. 2019;19(1):636. http://dx.doi.org/10.1186/s12889-019-6877-z
4. Grandes G, Sanchez A, Sanchez-Pinilla RO, et al. Effectiveness of physical activity advice and prescription by physicians in routine primary care. Arch Intern Med. 2009;169(7):694–701. http://dx.doi.org/10.1001/archinternmed.2009.23
5. Petrella RJ, Koval JJ, Cunningham DA, et al. Can primary care doctors prescribe exercise to improve fitness? The Step Test EP (STEP) project. Am J Prev Med. 2003;24(4):316–22. http://dx.doi.org/10.1016/S0749-3797(03)00022-9
6. Thornton JS, Frémont P, Khan K, et al. Physical activity prescription: A critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: A position statement by the Canadian Academy of Sport and Exercise Medicine. Br J Sports Med. 2016;5:1109–14. http://dx.doi.org/10.1136/bjsports-2016-096291
7. Sallis RE. Exercise is medicine and physicians need to prescribe it! Br J Sports Med. 2009;43:3–4. http://dx.doi.org/10.1136/bjsm.2008.054825
8. Soegtrop R, Douglas-Vail M, Bechamp T, et al. Physical activity prescription by Canadian Emergency Medicine Physicians. Appl Physiol Nutr Metab. 2018;43:861–4. http://dx.doi.org/10.1139/apnm-2017-0616
9. Baillot A, Baillargeon JP, Paré A, et al. Physical activity assessment and counseling in Quebec family medicine groups. Can Fam Physician. 2018;64(5):e234–41. PMID: 29760272
10. Frank E, Segura C, Shen H, et al. Predictors of Canadian phy-sicians’ prevention counseling practices. Can J Public Health. 2010;101(5):390–5. http://dx.doi.org/10.1007/BF03404859
11. Taylor GW. Health status of Canadians 2016: A report of the Chief Public Health Officer. Ottawa: Public Health Agency of Canada (PHAC); 2016. p. 1–68.
12. Fowles JR, O’Brien MW, Solmundson K, et al. Exercise is Medicine Canada physical activity counselling and EP training improves counselling, prescription, and referral practices among physicians across Canada. Appl Physiol Nutr Metab. 2018;43:535–9. http://dx.doi.org/10.1139/apnm-2017-0763
13. O’Donnell DE, Hernandez P, Kaplan A, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease—2008 update—Highlights for primary care. Can Respir J. 2008;15(Suppl A):1A-8A. http://dx.doi.org/10.1155/2008/420268
14. Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020;75(6):1334–57. http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.15026
15. Wein T, Lindsay MP, Côté R, et al. Canadian stroke best practice recommendations: Secondary prevention of stroke, sixth edition practice guidelines, update 2017. Int J Stroke. 2017;13(4):420– 43. http://dx.doi.org/10.1177/1747493017743062
16. Mancini GB, Gosselin G, Chow B, et al. Canadian Cardiovascular Society Guidelines for the diagnosis and management of stable ischemic heart disease. Can J Cardiol. 2014;30:837–49. http://dx.doi.org/10.1016/j.cjca.2014.05.013
17. Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. Can Cancer J Clin. 2012;62:242–74. http://dx.doi.org/10.3322/caac.21142
18. Sigal RJ, Armstrong MJ, Bacon SL, et al. Physical activity and diabetes. Diabetes Canada Clinical Practice Guidelines Expert Committee. Can J Diabetes. 2018;42(Suppl 1):S54–63. http://dx.doi.org/10.1016/j.jcjd.2017.10.008
19. Groot C, Hooghiemstra AM, Raijmakers PG, et al. The effect of physical activity on cognitive function in patients with dementia: A meta-analysis of randomized control trials. Ageing Res Rev. 2015;25:13–23. http://dx.doi.org/10.1016/j.arr.2015.11.005
20. Abramson S, Stein J, Schaufele M, et al. Personal exercise habits and counseling practices of primary care physicians: A national survey. Clin J Sport Med. 2000;10:40–8. http://dx.doi.org/10.1097/00042752-200001000-00008
21. Sherman SE, Hershman WY. Exercise counseling: How do general internists do? J Gen Intern Med. 1993;8:243–8. http://dx.doi.org/10.1007/BF02600089
22. The Canadian Society of Internal Medicine. About CSIM [Internet]. Ottawa; 2020. Available from: www.csim.ca/about. Accessed on Dec 20, 2020.
23. Burns KE, Duffett M, Kho ME, et al. A guide for the design and conduct of self-administered surveys of clinicians. CMAJ. 2008;179(3):245–52. http://dx.doi.org/10.1503/cmaj.080372
24. Petrella RJ, Lattanzio CN, Overend TJ. Physical activity counseling and prescription among Canadian primary care physicians. Arch Intern Med. 2007;167(16):1774–81. http://dx.doi.org/10.1001/archinte.167.16.1774
25. O’Brien NW, Shields CA, Oh PI, et al. Health care provider confidence and EP practices of Exercise is Medicine Canada work-shop attendees. Appl Physiol Nutr Metab. 2017;42(4):384–90. http://dx.doi.org/10.1139/apnm-2016-0413
26. Petrella RJ, Wright D. An office-based instrument for exercise counseling and prescription in primary care. The Step Test EP (STEP). Arch Fam Med. 2000;9(4):339–44. http://dx.doi.org/10.1001/archfami.9.4.339
27. Malik SH, Blake H, Suggs LS. A systematic review of work-place health promotion interventions for increasing physical activity. Br J Health Psychol. 2014;19(1):149–90. http://dx.doi. org/10.1111/bjhp.12052
28. Bravata DM, Smith-Spangler C, Sundaram V, et al. Using pedometers to increase physical activity and improve health: A systematic review. JAMA. 2007;298(19):2296–304. http://dx.doi.org/10.1001/jama.298.19.2296
29. Holtz KA, Kokotilo KJ, Fitzgerald BE, et al. Exercise behaviour and attitudes among fourth-year medical students at the University of British Columbia. Can Fam Physician. 2013;59(1):e26–32. PMID: 23341676
30. McFadden T, Fortier M, Sweet SN, et al. Canadian medical students’ perceived motivation, confidence and frequency recommending physical activity. Prev Med Rep. 2019;15:100898. http://dx.doi.org/10.1016/j.pmedr.2019.100898
31. Owens B. Exercise prescription endorsed. CMAJ. 2014;186(13):
e478. http://dx.doi.org/10.1503/cmaj.109-4846
32. Carraça EV, Mackenback JD, Lakerveld J, et al. Lack of interest in physical activity—Individual and environmental attributes in adults across Europe: The SPOTLIGHT project. Prev Med. 2018;111:41–8. http://dx.doi.org/10.1016/j.ypmed.2018.02.021
33. Stonerock GL, Blumenthal JA. Role of counseling to promote adherence in healthy lifestyle medicine: Strategies to improve exercise adherence and enhance physical activity. Prog Cardiovasc Dis. 2016;59(5):455–62. http://dx.doi.org/10.1016/j.pcad.2016.09.003