METHODOLOGY

1
Exercise Promotion and Prescription in Primary
Care A Practical Approach
Neda Amani 1, Shirin Panahi 1, Fereshteh
Akhtari1, Shadi Nasseri 1, Shirin Adhami 1
Ashkan Golshani 2
1 Avicenna Health Centre, 77 Finch Ave West,
Toronto, ON Canada M2N 2H5 2 Department of
Biology, Carleton University, 1125 Colonel By Dr,
Ottawa, ON Canada K1S 5B6
SUMMARY Regular physical activity is known to
improve physical, social, and mental health in
people across all age groups. In clinical
trials, physical activity is shown to improve
blood pressure, insulin resistance, obesity,
blood lipid content and bone mineral density.
Family physicians have a unique opportunity to
positively influence the inactivity epidemic by
counseling their patients on diet and regular
physical activity. Here we present a model by
which family physicians may implement exercise
education and healthy diet promotion using the
current Ontario public funding structure.

• INTRODUCTION
• - Physical inactivity exists amongst two thirds
  of the Canadian
• population 1.
• Family physicians have a unique opportunity to
  impact the
• increasing obesity and inactivity epidemic by
  counseling their
• patients on diet and regular physical
  activity2.
• To date, efforts for physical activity promotion
  at the primary
• care level have remained through either verbal
  or written
• advice 3.
• Here we designed and examined the efficiency of
  a pilot project
• established in a community family medicine
  clinic in urban
• Toronto, emphasizing on educating patients to
  become more
• physically active to improve health, with the
  help of their family
• physician and allied health professionals.
• The goal of this pilot project was to provide a
  model for
• implementing community based, primary care
  driven, exercise
• prescription and healthy diet promotion,
  practically, using our
• current public funding structures.

• METHODOLOGY
• Our program was developed so that it would be
  both attractive
• and beneficial to patients, and practical and
  financially feasible
• for primary care physicians.
• Due to time and financial constraints, we
  enlisted the help of
• personal trainers and a dietician to provide
  the actual healthy
• lifestyle education
• Patients visited the office over a 3 month
  period, once per week
• for 20 minute sessions.
• Any patient visiting the office, in or outside
  of the family
• physicians practice, was welcome to enlist.
  The program was
• offered directly to overweight and obese
  patients, patients found
• to be physically inactive, and patients having
  any condition
• associated with obesity and inactivity.
• Patients were charged 40 (in the first 3 months
  of the program
• design) or 100 (the following 3 months of
  program
• development) for the 10 week intervention.
  This fee was
• waived for several patients who were on social
  assistance.
• -Exercise prescription was custom tailored to
  each patient

a With PT or RD and MD visits for 3-10 mins
(bill A1 or A7)For diet counseling provided by
MD for 20min KO13 b The personal trainer,
dietician, or MD make their own notes in this
space regarding what they were able to cover with
the patient, the patients progress, any
concerns or problems, benefits obtained
etc. C This space is for MD notes on the
patient d MDs signature To verify patient seen
directly and session goals reviewed etc.
PRELIMINARY OBSERVATION We have successfully
initiated a pilot study in a family practice
office. To date, the total number of
participants is 103, ages ranging from 7 to 86.
The number of patients completed the study thus
far is 36 number of patients thought to have
dropped out are 19. In post-program evaluation
with each patient conducted by the family
physician 90 reported enhanced energy level,
82 reported improved self esteem and/or mood,
100 dropped at least one dress size, and 90
reported full satisfaction with their obtained
results and an interest to continue their program
for maintenance. ALL participants responded
positively to the question Would you recommend
this program?. Although it is still too early
to make a decisive conclusion, it is clear to us
that most participants are gaining encouraging
health outcomes from this program.
PILOT PROGRAM DESIGN

• CONCLUDING REMARKS
• We have presented a novel, feasible program for
  family doctors to
• incorporate physical activity and healthy life
  style promotion into their
• primary care routine.
• Preliminary results obtained through a pilot
  trial are very promising
• supporting the importance and necessity for
  further study and
• development of such programs.
• To encourage family physicians to initiate this
  program, additional
• financial support from the health care system
  (and/or the patient
• directly), as well as exercise prescription
  training are necessary

References 1. Katsmarzyk et al (2000) CMAJ 163
1435-40. 2. Bull and Jamrozik (1998) Am J Prev
Med 15 85-94. 3. Boyd et al. (1998) APHA 88
288-91.