This post has been in the making for a long time – often, I find the topics I’m most passionate about are the hardest to put pen to paper on. Where to begin? Well, as you know, I’m a qualified doctor, in my third year of training, working in Dublin, Ireland. My passion in medicine surrounds the area of preventive medicine, also known as ‘lifestyle medicine’ in some circles – i.e. how we can optimise the health of the population as a whole by addressing diet, exercise, and other aspects of our daily lives, like sleep hygiene, stress management, and social interaction. Levels of non-communicable diseases (or NCDs as they’re known for shorthand) such as obesity, ischaemic heart disease, chronic obstructive lung disease, cancer, and diabetes mellitus have reached heights we haven’t seen before. I truly believe we can prevent so much of that disease burden through lifestyle change. I also believe there is often a tendency towards over-complicating messages delivered and promoted to the public on how to ‘live healthier’ and as a result, many people feel they have to go to extremes of lifestyle change to see and feel a difference.
But you know what? That’s not true. Extremes are not where should be sending people. Fad diets, crazy unrealistic fitness regimes, work environments that encourage ‘busyness’ and ‘rise and grind’ mentality – no. I didn’t name my blog The Irish Balance on a whim – balanced lifestyles are what I believe in to achieve better, sustainable health. As a doctor, a health professional in a privileged position to help others individually and on a national (maybe international someday?) level, I want to be able to advise my patients and the public on how to make those lifestyle changes – and any advice I give WILL be evidence-based, and from an educated perspective.
But unfortunately, as doctors, lessons on the area of ‘preventive medicine’ aren’t really a big or small part of our medical school training. Don’t get me wrong, I loved my college years, I’m forever grateful for the instructive learning I received throughout, and I use it every single day. As doctors, we are constantly learning even when qualified. And so, I think that a core part of our training at both under-graduate AND post-graduate level SHOULD focus on lifestyle medicine. I should be able to give a patient a decent answer when they ask me advice on their activity levels and their diet, and I should be aware of other health professionals who I can work with to help these patients (e.g. physiotherapy or clinical nutrition).
And so, that led myself and my friend (and fellow doctor) Aisling Farrell to attend the Irish Faculty of Sports Medicine Autumn Conference in Dublin this year. We listened to fascinating presentations address the role of exercise in multiple common NCDs as listed above, interventional programmes both in Ireland and elsewhere, and eye-opening science on obesity. One of the very clear messages from the conference was that as doctors, we are ill-equipped to adequately advise our patients on their exercise regimes and even activity levels in general. And more than that, it showed us that it wasn’t just myself and Aisling with an interest in learning about the concept of exercise prescribing – many junior doctors were willing to engage when surveyed, and hadn’t considered the power of their role with their patients to address it.
We were inspired, to say the least – so much so that we followed up the conference with a meeting with two of the lead senior physiotherapists at our hospital (one of whom had been at the conference). We met with a clear purpose – to brainstorm about whether we could organise an introductory, basic teaching session for our junior doctors colleagues on ‘Exercise Prescribing in Chronic Disease.’ We first surveyed 20 of our colleagues to assess their interest in receiving this education, their experience and current levels of confidence in exercise prescribing, and finally their ideas of the most relevant chronic illnesses to tackle. The response was overwhelmingly positive, and so on a very proud Monday a couple of weeks ago, we held the first education session on ‘Exercise Prescribing’, kindly delivered by an eminent senior physiotherapist with huge experience in this area. It was fascinating, and SO FRICKIN’ EXCITING. It went so well that I’m currently organising a follow-up ‘workshop’ style session for January/February, where we will (with our physiotherapy colleagues) do theory case based discussions to identify challenges and pathways to prescription of exercise in practice.
So…What did we learn?
Many of you have asked me to chat about some of the principles of exercise prescribing addressed, and I’m more than happy to do that IN BRIEF here, bearing in mind that I’m learning this all as new information too, and as you know, I don’t share anything blindly! I’m planning a follow-up blog post for you on how our workshop goes in early 2018, because I know a LOT of you are keen to hear, and some of you are working on implementing similar sessions in your hospitals or communities, which is AMAZING. I’ve included some of the introductory educational slides from the Powerpoint presentation we received, courtesy of Professor Juliette Hussey (Professor of Physiotherapy, Vice President of Global Relations, Trinity College Dublin) and Dr Emer Guinan (BSc, PhD, Assistant Professor in Interprofessional Learning, Faculty of Health Sciences, Trinity College Dublin), who I am so delighted to be working with on these exercise prescribing sessions. Professor Hussey and Dr. Guinan kindly allowed me to share some of these slides with you, and they are my reference for them!
Let’s start with some definition on how we define activity and exercise:
Many of us in the healthcare profession are vaguely aware of the American College of Sports Medicine Guidelines for weekly exercise – that was the extent of my basic knowledge! Here’s a reminder:
That at least gives us a starting point to address with patients, but of course, we are all unique, and each patient will have different medical, psychological and social issues to be mindful of – which is why tailored advice is essential for both safety and optimised compliance too!
Here are some of the brilliant points shared with us to consider when prescribing an exercise programme:
So now I hear you ask – what is FITT? The FITT principle is a brilliant concept I learnt about in our session. In a nutshell, here’s an explanation:
We also learnt some really valuable additional principles to consider when prescribing exercise, and these in particular I found interesting:
Finally, two super important areas to address with a patient before you consider prescribing an exercise programme:
- Is the patient ready in terms of their mental and physical health to undertake an exercise programme, or at least engage with exercise advice?
There are some questionnaires in use to assess a patient’s ‘readiness to engage’ so to speak, in a physical activity programme, and additionally questionnaires exist for prescribers to use as a health screen for their patients before prescribing exercise.
- How can you assess a patient’s cardiorespiratory fitness before starting a programme?
This area is a bit specialised and to be honest, I won’t go into detail here because I don’t know enough about it yet! But suffice it to say for now that there are some tests that can be done in a laboratory setting (some of you may have heard of cardio-pulmonary exercise testing), as well as simpler exercise tolerance tests some of you may have heard of such as the six minute walk test.
PHEW! What knowledge bombs right! I want to say a massive thank you to Professor Hussey and Dr. Guinan for being so enthusiastic and generous with their time and knowledge in this mission of mine. Aisling and I are really passionate that exercise prescribing is a concept that we as doctors NEED education on, and the earlier the better. I can’t wait to share the outcomes of our 2018 workshop with you – stay tuned for that! As always, I would LOVE any feedback you all have on this post, or the idea of ‘Exercise is Medicine’ in general – leave a comment here or on my social channels (Instagram mainly, also Twitter, Facebook), email me, or message me on Instagram! I can’t even tell you how excited I am that we’ve got the ball rolling on this – it’s a 2018 MISSION for me!
Ciara 🙂 x