Rethinking the Annual Physical Exam - by Dr. Keith Barry

In years past, having patients come in for an "Annual Physical" was commonplace in any family medicine practice.  As evidence has evolved, we have realized that the time and cost of this practice can be better used elsewhere. The actual physical examination component of a yearly visit has never been shown to be of utility. What is more debatable, is the need for routine testing or screening. 

Screening is the practice of looking for disease in people without any symptoms. The idea is to find a disease or a modifiable risk factor for disease early on, where early intervention can prevent complications or offer an easier cure. Many screening tests are current recommended in Canada. Examples include but are not limited to: 

• pap smears
• mammograms
• FIT testing (fecal immunochemical test)
• bone density
• PSA (prostate-specific antigen)
• cholesterol testing
• diabetes screening

You may be surprised to learn that for even these commonly recommended tests, the evidence of benefit is often questionable and almost no one needs them yearly.  In this video, Dr. Mike Evans discusses some of these tests along with some others which are generally not recommended. The key with screening is making it individualized, based on your specific history, risk factors and values. This is why it is important to have a good relationship with your family doctor. 

Although an "Annual Physical" may not be necessary, you should touch base regularly with your family physician, who knows you and your health history, to discuss and decide which test's you may benefit from.  How often this discussion or "preventative health exam" should occur needs to be individualized. You can use the same opportunity to work on improving your lifestyle, which is usually much more beneficial to health than any test. 

I see a common practice still occurring in some physician offices, where a receptionist gives a patient a lab requisition as soon as they book for a physical. This is bad medicine. Which tests to do needs to be a discussion between you and your physician. A single list of tests for every patient is not appropriate. This is an unnecessary cost to the system; but more importantly will lead to unnecessary testing, false positives and harm. More information about various screening tests and their indications can be found at choosingwisely.ca. 

Below is information from Towards Optimized Practice about a change in the way we think about Cholesterol/Cardiovascular risk reduction.  No one needs their cholesterol checked every year! (click on image to download/enlarge.)

Consistancy in exercise is key - but how do we get there?

Motivation Monday! Today our Exercise Specialist provides pointers and tips on how to succeed with your healthy living and activity goals by building momentum. Consistency is key! Click the image below to check it out.

Subscribe to our YouTube Channel to receive Adrien's updates!

Overview of the 24-hour Movement Guidelines for people ages 18-64 from the Leduc Beaumont Devon PCN Exercise Specialist

 24-hour Movement Guidelines for people ages 18-64: An integration of physical activity, sedentary behaviour and sleep.

As an exercise physiologist who practices in the field of chronic disease management, I often have conversations with patients about increasing daily physical activity. Although beneficial overall, and depending on the individual, simply adding some physical activity to their day is not enough to truly produce the ideal level of heathy change for that person. These guidelines created by the Canadian Society of Exercise Physiology (CSEP) are now available to help provide specifics to answer that question for patients.

The guidelines themselves can be broken down to a few specific categories to ensure a “healthy 24 hours”. These include physical activity, sleep, and sedentary behaviours, or time spend inactive or sitting.

Physical Activity

Beginning with physical activity, the recommendations continue to include 150 minutes of moderate to vigorous aerobic physical activity added up throughout your week as well as muscle strengthening exercises for your major muscle groups two times per week. It is important to keep in mind these recommendations are for an individual that does not have any medical conditions or disabilities that would prevent their ability to reach these activities levels. If an individual is not able to reach these guidelines from a medical standpoint, they should consult with their health care team to determine appropriate levels of physical activity. This also includes several ours of light physical activity such as standing, which I will speak more on later.

Sleep

The 24-hour Movement Guidelines recommends 7-9 hours of sleep, which includes regular wake and sleep cycles. This continues to follow the current guidelines and remains the gold standard for sleep goals.

Sedentary Behaviour

This is the time spent being inactive such as sitting at a desk, watching TV or sitting in front of a screen. CSEP currently recommends limiting sedentary behaviour to 8 hours or less per day with goals of less than 3 hours of screen time a day, and breaking up long periods of sedentary positions as much as possible; I always tell my patients to try not to sit for more than an hour at a time.

It is important to discuss how people can implement these guidelines and why the recommendations are what they are. Sleep is self explanatory, but I believe these guidelines truly shine when reviewing the recommendations for physical activity and sedentary behaviour.

The get the biggest benefit from the guidelines, people should try and create a goal of turning more sedentary time into beneficial light activities such as standing, walking, moving, and progressing times you may be performing these light activities into more moderate of vigorous activities. Progressing these activities in your day increases the amount of time you spend moving each day, the calories that you burn, and helps your body adapt to being more physically active. When progressing sedentary time to light activity times such as standing, it helps increase what is called NEAT which stands for Non-Exercise Activity Thermogenesis, NEAT is defined as the energy spent for everything we do that is not sleeping, eating or sports-like exercise. It ranges from the energy spent walking to work, typing on a computer, performing yard work, doing yard work or gardening, and even fidgeting. The more you can move outside of planned times for physical activity, the higher your NEAT and the more calories you will burn and the greater, overall likelihood of positive health outcomes.

It is important to realize these are 24-hour movement guidelines and not physical activity guidelines. These new guidelines help to promote a greater range of activities per day, while emphasizing sleep and reducing sedentary behaviour and continuing to support the previous physical activity guidelines as provided by CSEP.

~ Adrien DeGroot BHK, CSEP-CEP, R.Kin, CSEP - High Performance Specialist, is an Exercise Specialist at the Leduc Beaumont Devon Primary Care Network. To access his services, please ask your PCN family doctor for a referral.

To view and participate in Adrien's at-home workouts, please check out our LBD PCN YouTube channel.

Barriers to physical activity

We know there are many barriers that keep people from being physically active and we have some helpful tips for breaking through those barriers:

Thanks to our PCN Exercise Specialist, Corinne Cutler, for this handout.

November is Diabetes Awareness Month - Exercise

Diabetes and the Effectiveness of Regular Physical Activity 

The short-term benefits of increasing physical activity for a person with diabetes:

• Lowers your blood glucose within one hour.
• Increases your energy and strength during the day
• Decreases stress, anxiety and fatigue
• Improves relaxation and sleep
• Improves overall well being  

The long-term benefits if activity is sustained:

• Improved blood glucose (sugar) control.
• Helps to maintain or lose weight.
• Lowered blood pressure.
• Stronger bones and muscles.
• Lower risk of diabetes complications such as eye, heart, and kidney disease.
• Improved quality of life.

One of the most effective aerobic activities with the lowest dropout rate is walking.  It can be as simple as going for a brisk walk in your neighborhood.  Click here for an example of a walking plan if you are just starting out. Feel free to print it for your own use or share it with others.  

Both aerobic and resistance exercises are important when it comes to decreasing the risk of developing or advancing Type 2 Diabetes as both help to improve the bodies insulin sensitivity.      

The following facts were taken from the Canadian Diabetes Association website:

• Low physical fitness is as strong a risk factor for mortality as smoking.
• Fitness level is one of the strongest predictors of all-cause mortality in people with diabetes.
• Physical activity can be as powerful as glucose-lowering medication… with fewer side effects.
• Regular physical activity, in conjunction with healthy eating and weight control, can reduce type 2 diabetes incidence by 60 per cent.

If you require help with getting started on an exercise or activity plan, ask your PCN family doctor for a referral to the Exercise Specialist on the SMILE team.      

Corinne Cutler is an Exercise Specialist at the Leduc Beaumont Devon Primary Care Network.                                                                                                                                                                                                                                                                                                                                                                

Exercise and Diabetes - Myths and Facts

Increased activity results in significant weight loss – myth or fact?

Myth - It takes a lot of energy to burn calories, a lot more than most people think.  If there are medical or chronic conditions (such as diabetes) that affect endurance, mobility and/or strength, it is not likely the activity will be done at a high intensity. 

There are 3500 calories in one pound of fat; in order to burn 3500 calories, it would take most people hours of activity at a high level of intensity to lose 1 pound. 

For the average person who is beginning a walking routine, changing your physical activity level without reducing or changing your caloric intake will not result in weight loss.  There will be health benefits gained through increased activity regardless of any weight loss. 

You have to do a significant amount of activity to achieve health benefits – myth or fact?

Myth - Achieving health benefits through increased activity can be done with as little as 150 minutes per week of moderate to vigorous intensity aerobic exercise. This can include anything from walking to cross country skiing to swimming.  That works out to 30 minutes a day, 5 days of the week.  These benefits can also be achieved with 10 minute bouts of activity, done three times throughout the day adding up to the 30 minutes.  We have many opportunities during the day to get that activity in! The next time you have coffee break at work, go for a quick 10 minute walk. 

Physical activity means participating in a structured exercise program at a fitness facility – myth or fact?

Myth - Being more active or increasing your physical activity does not mean having to go to a gym or doing a structured exercise routine.  It can be anything from walking to dancing in the living room to going for a bike ride. Even walking on the spot is activity and it all counts.

Walking is a great way to increase activity. It is free, easily accessible and most people can tolerate walking for even a short distance.  Of course if there are issues with the lower extremities that limit walking perhaps riding a stationary bike or water activities might be a better choice.  The trick is to find an activity that can be tolerated and is somewhat enjoyable to do. Many people find that a distraction while doing the activity is a good strategy to get through the activity. Try watching a favourite sitcom or listening to music while walking on the treadmill.  

Corinne Cutler is an Exercise Specialist at the Leduc Beaumont Devon Primary Care Network. 

For more information on diabetes, please see the Canadian Diabetes Association webpage.

How important is regular physical activity to your health?

So many of us associate regular and structured physical activity and/or exercise with weight loss.  Why is this?  For so long now society has placed images into our brains by way of media.  “Workout to lose weight!”, “Lose weight in 21 days with this workout!”, “In just 10 days you can have abs of steel through this workout!” We have heard it all. 

The truth is, the focus of exercise or increased physical activity should be on the health benefits and living longer, better quality lives.  Not only is there strong evidence that regular physical activity can help to manage most chronic conditions such as diabetes, hypertension, heart disease,  high cholesterol, high blood pressure  and some cancers,  but it can also help prevent them as well. 

“People who are active and fit, live longer, healthier lives”       ~ Dr. Robert Sallis 

The time has come to change the focus on the importance of increasing our daily physical activity.  Let’s start with changing the idea of “if I work out more or walk more often I will lose weight.”  Instead, think “if I walk regularly at a brisk pace for 30 minutes, gradually working up to 5 days per week, then my heart will work more efficiently, my energy level will improve and I will start to feel better overall.”

Of course starting off with what you are able to tolerate is important. If walking for 5 or 10 minutes is your limit now, start there and set monthly goals to increase gradually over time.

When it comes to health, activity level is vital.  Yes, it would be a bonus if some weight loss was to occur, but let’s remember that these health benefits, just to name a few, will happen overtime with regular and consistent activity, regardless of weight loss:

- Improved circulation
- Improved cardiovascular fitness
- Increased insulin sensitivity
- Increased HDL (good cholesterol)
- Increased energy level
- Improved quality of life
- Reduced stress and anxiety
- Reduced blood pressure
- Reduced risk of chronic conditions
- Decreased cognitive decline

Just like prescribed medicine, physical activity should be thought of as a prescription to take in order to be effective.

Corinne Cutler BPE, CSEP 

Certified Exercise Physiologist

Leduc Beaumont Devon Primary Care Network