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Start Exercising Already! A Physician's Step-by-step Guide to Prescribing Exercise for All Patients

Teaser: 

Dr. Aly Abdulla, MD, CCFP, FCFP, DipSportMed CASEM, CTH, CCPE, McPL,1
Neelam Charania, BSc, MSc (OT),2

1 is a family doctor with specialties in sports medicine, palliative care, and cosmetic medicine. He can be found on Twitter, LinkedIn and https://ihopeyoufindthishumerusblog.wordpress.com/
2 has a Masters in Occupational Therapy from Boston University.

CLINICAL TOOLS

Abstract: Sedentarianism raises multiple health concerns. In an effort to provide safe options this article will include a short primer on types of exercises along with a step-by-step approach to exercise prescription in the adult population.
Key Words: exercise, sedentarianism, exercise prescription.
1. Exercise has been shown to improve both physical and mental well-being through the following mechanisms: improved body physique, reduced disability associated with arthritis, mproved balance and a reduction in falls, and improved psychological health.
2. Most physicians are aware of the two most common types of exercise training; aerobic/cardiovascular endurance training and muscular strength/resistance training. Other types of exercise are performed to improve flexibility, balance and coordination.
3. The exercise programme's duration should begin at about 10 minutes and progress to 20-30 minutes (it is possible to divide this into tenminute aliquots).
4. The latest research confirms that only one set per exercise or strength training is required to have the same benefit as multiple sets
5. The most important caveat is not to progress if pain, discomfort, or interposing illness is encountered. Sometimes a holding pattern or regression is required
1. The Canadian Society for Exercise Physiology (CSEP)* through Health Canada has developed the Physical Activity Readiness Questionnaire (PAR-Q) which can easily identify adults for whom physical activity might be inappropriate or those who should have a more thorough medical work-up prior to starting an exercise programme.
2. Every attempt should be commended, and any indiscretion should not be belaboured. The patient should be veered back to his goals without guilt.
3. I ask each patient to record their heart rate upon waking and their post-exercise heart rate. This is the beginning of their exercise log, which will include the type of exercise, duration, intensity, and frequency. Patients should be be encouraged to bring it to each appointment. This serves two purposes— ONE, it helps familiarize the patient with his or her level of exertion and progress, and TWO, it helps, within the actual exercise regimen, to target appropriate intensity levels.
4. The simplified calculation for determining MHR is MHR = (220-age). Intially target 40-60% MHR over 1-2 months, then improve to 70-75% MHR over 6months, then maintain.
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Related Terms: Sports Medicine, exercise, sedentarianism, exercise prescription
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JCCC 2018 Issue 5

Table of Contents

The Impact of Depressive Symptoms: Considerations for Clinicians Treating Patients with Low Back Pain

Teaser: 

Jessica Wong, DC, MPH,1
Linda Carroll, PhD, 2
Pierre Côté, DC, PhD, 3

1 Research Associate, UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC).
2Professor Emeritus, School of Public Health, University of Alberta.
3 Professor and Canada Research Chair in Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT); Director, UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC).

CLINICAL TOOLS

Abstract: A considerable proportion of patients with low back pain (LBP) experience depressive symptoms. A clinical case is used to highlight potential steps that clinicians can take to help manage depressive symptoms in these patients: 1) Assess for depressive symptoms using a valid and reliable questionnaire; 2) Provide education, reassurance, and self-management strategies to initiate the program of care; 3) Adjust care plans if patients also present with depressive symptoms (e.g., ongoing support and education); and 4) Provide ongoing assessment of depressive symptoms, and consider referrals to a specialist or other health care providers (e.g., counselors, clinical psychologists, or psychiatrists) for further evaluation if symptoms are worsening.
Key Words: Low back pain, depressive symptoms, depression, depressive disorder.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

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A considerable proportion of patients with low back pain present with depressive symptoms
Depressive symptomatology includes depression that has not been formally diagnosed and symptoms that do not meet the criteria for depression
The presence of depression may indicate poorer recovery from low back pain
Patients experiencing low back pain and concomitant depressive symptoms may benefit from ongoing assessments, education, reassurance, and self-management strategies
Assess for depressive symptoms in patients with LBP using a valid and reliable questionnaire (e.g., Patient Health Questionnaire-9)
Provide education, reassurance, and self-management strategies to all patients with LBP to initiate the program of care
Adjust the care plan accordingly if patients also present with depressive symptoms, including additional support and education (e.g., addressing misconceptions, encouraging activity) on an ongoing basis
Provide ongoing assessment of depressive symptoms, and consider referrals for further evaluation if symptoms are worsening
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, low back pain, depressive symptoms, depression, depressive disorders
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Importance of Screening Children with Adenotonsillar Hypertrophy for Obstructive Sleep Apnea

Teaser: 

Madison O.L. Rays, Sharon Chung, PhD, Maya Capua, MD, Colin M. Shapiro, MBBCh, PhD, FRCPC,

Youthdale Child and Adolescent Sleep Centre and Youthdale Treatment Centres, Toronto, ON.

CLINICAL TOOLS

Abstract: Obstructive sleep apnea (OSA) is a disorder in which patients stop breathing repeatedly during sleep, and it is linked to a number of serious medical consequences. However, most patients with OSA remain undiagnosed. The consequences of OSA are particularly severe in children. Adenotonsillar hypertrophy (AT) is a major factor in the etiology of Obstructive Sleep Apnea (OSA) in children. Physicians should consider snoring, pauses in breathing while asleep, restless sleep, bizarre sleeping positions, paradoxical chest movements, cyanosis, bedwetting, hyperactivity, and disruptive behaviour in school as possible indications of untreated OSA in children. The presentation of OSA in children differs substantially from that in adults. For example, hyperactivity is often a primary symptom in children but is not a symptom typically found in adults.
Key Words: obstructive sleep apnea (OSA), children, adenotonsillar hypertrophy (AT), medical consequences.
The presentation of OSA in children is significantly different than that in adults; hyperactivity can be a primary symptom in children but is not typically found in adults.
Adenotonsillar hypertrophy is an indicator of undiagnosed OSA in children and merits a sleep study.
Untreated OSA in children can lead to medical and psychiatric issues.
Adenotonsillectomy, a common treatment for OSA in children with large tonsils, not only reduces or eliminates the OSA, but in most cases improves the associated behavioral problems.
Evidence-based medicine supports the need for children with adenotonsillar hypertrophy to be referred to a sleep specialist to be screened for OSA regardless of the degree of tonsillar enlargement.
The I'm Sleepy questionnaire allows doctors to quickly and easily identify children with a high risk of having OSA.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Men’s Health, Women’s Health, obstructive sleep apnea, children, adenotonsillar hypertrophy, medical consequences
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JCCC 2018 Issue 4

Table of Contents