A medical clinic in the park: The MOVE program

A medical clinic in the park: The MOVE program

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By Doug Klein, MD, Edmonton Oliver Primary Care Network and Associate Professor, Department of Family Medicine, University of Alberta

Summary

Primary care is an optimal setting for most prevention and screening services in the healthcare system.

This issue highlights MOVE, a physician-led, interdisciplinary exercise program that encourages physical activity among patients while in the great outdoors.

Family physicians (FPs) provide care throughout patients’ lifetimes.1 They are typically the first and continuing point of contact for access to health services, support, and care, and they often deliver preventive care based on the effects of lifestyle choices on the health of their patients.1

Suboptimal diet and physical inactivity are common lifestyle choices among the Canadian population.2,3 Current physical activity guidelines for adults ages 18-64 recommend at least 150 minutes of moderate to vigorous aerobic exercise weekly, completed in intervals of at least 10 minutes, along with at least two days per week of resistance training.4 However, 85% of Canadians fall short of the current physical activity recommendations.5 In relation to healthy eating, 60% of Canadians report eating less than five daily servings of fruit and vegetables.6 In contrast, on any given day, 25% of Canadians will eat from a fast food outlet.7

A recent Canadian study, exploring cancer incidence due to obesity and physical inactivity, concluded that interventions to reduce these risk factors could prevent thousands of cancers annually.8 These findings are consistent with an international study which estimated that 3.6% of all new cancer cases in adults were attributable to obesity worldwide.9 Modifiable lifestyle risk factors including maintaining a healthy weight, eating a healthy diet, and being more physically active could significantly reduce the incidence of cancer in Alberta.10

Primary and Team-based Care

Primary care is the optimal setting for most prevention and screening services in the healthcare system. Despite evidence showing that lifestyle interventions could substantially reduce the costs and complications of these medical conditions,11-14 the application of these results in primary care has been minimal.15 In a recent national survey in primary care, less than half of FPs reported discussing obesity and physical activity with their patients during periodic health examinations.15 Reasons for the poor implementation of lifestyle interventions in primary care include lack of time, lack of resources, and limited training.16-19

Through primary care reform, team-based care has become more common, with FPs working alongside dietitians, kinesiologists, and other providers to support patient care.20 In Alberta, some individual primary care physician offices have joined together in primary care networks (PCNs) to access funding to share the expertise of additional health professionals and dedicated PCN office space. These health professionals may include nurses, nurse practitioners, social workers, pharmacists, mental health workers, exercise specialists, or registered dietitians. Every PCN is locally developed by primary care physicians, in cooperation with the local health region and other health professionals. These networks include both rural and urban settings and are diverse in size and available resources. Such team-based care creates the opportunity for programs like MOVE.

An Unconventional Idea

FPs and PCN staff are continually looking for methods that can support their patients in achieving the recommended 150 minutes of moderate to vigorous physical activity per week. Being a Family Physician, I started to think that perhaps there could be an effective way to engage with patients outside the clinic to encourage them to exercise. Because FPs are indeed a trusted source of health advice, could FPs not only tell patients to get physically active but also show patients how to get physically active by meeting them in their communities to walk alongside them?

This idea, that the powerful influence of a family doctor on patients’ behaviour could be infused into a primary care program encouraging activity among patients, was the catalyst for development of the MOVE program. Utilizing the interdisciplinary team, the Edmonton Oliver PCN helped create and implement MOVE (www.moveyeg.ca), an innovative physician-led, interdisciplinary team–based exercise program.

MOVE began in 2013 with a group of five patients. It is a free, weekly exercise program that provides the opportunity for patients to be physically active alongside an FP and a kinesiologist. In the natural surroundings of a local community park, the exercise program combines walking, strength training, and other physical activities and evidence-based exercises, such as high-intensity interval training. This community-based program takes advantage of trails, hills, stairs, picnic tables, and park benches to teach people how to exercise.

Who Can Join?

MOVE is available to all age groups and anyone is welcome to attend. The program targets beginner and intermediate fitness levels. The patient just needs running shoes, a water bottle, and weather-appropriate clothing.

Why MOVE Works

There are many benefits to this clinic-in-the-park idea. Patients spend less time sitting and achieve daily exercise goals. Patients who are unsure about starting to exercise, or those with medical conditions that invoke fear of going to a gym, feel comfortable participating in MOVE. The family physician and kinesiologist are able to deliver the program to maximize the effects and patient satisfaction. Parking is free and easily accessible. Participants are encouraged to be active outside, without needing to go to a gym or buy any exercise equipment. In addition, there is evidence that time in nature (e.g., sounds of a creek or river) are good for your health.21,22 Most importantly, the distinguishing feature of MOVE that sets it apart from traditional exercise programs is physician involvement. The presence of a family physician enables patients to exercise in a safe environment with readily available access to a health professional to address any concerns and provide personalized exercise advice.

I have come to love going to MOVE each week for many reasons! Not only are we moving our body and physically becoming stronger, but there’s an entire social aspect to it as well!… I love being surrounded by the incredible beauty of the Edmonton River Valley, as we take new paths each week. Then ending with our stretching and strength segment of the program. I highly recommend the MOVE program to absolutely anyone who is looking to start or already has an active lifestyle and for those who want to meet new people and get to know them as you walk yourself to better health!

— MOVE Participant

There is currently no literature on other Canadian fitness programs based in primary care that offer both physician and kinesiologist expertise. The preliminary evaluation of the MOVE program has demonstrated program feasibility, participant satisfaction, and initial improvement in physical abilities.

The MOVE program, along with the PCN walking groups and other initiatives, can promote and protect the health of the population by decreasing the risk and recurrence of cancer and many other medical conditions. It is important to empower people to make healthy choices and reduce barriers to being physically active because promoting a healthier lifestyle is always good medicine.

Visit the MOVE website at www.moveyeg.ca for more information or to join.


About the Author

Doug Klein, MD, is an Associate Professor with the Department of Family Medicine at the University of Alberta. He is also the Director of CHANGE Alberta Research Group. His research focuses on healthy eating and physical activity both in the clinical setting and the community. He has strong connections to primary care physicians through his work with Primary Care Networks in Alberta.

Doug is also the co-founder of the MOVE Program and Founder of the CHANGE Adventure Camp, a program designed to build skills for children and families.


References

  1. McIsaac WJ, Fuller-Thomson E, Talbot Y. Does having regular care by a family physician improve preventive care? Can Fam Physician. 2001;47:70-76.
  2. Ohinmaa A, Schopflocher D, Jacobs P, et al. A population-based analysis of health behaviours, chronic diseases and associated costs. Chronic Dis Can. 2006;27(1):17-24.
  3. Klein-Geltink JE, Choi BC, Fry RN. Multiple exposures to smoking, alcohol, physical inactivity and overweight: Prevalences according to the Canadian Community Health Survey Cycle 1.1. Chronic Dis Can. 2006;27(1):25-33.
  4. Canadian Society for Exercise Physiology. Canadian Physical Activity Guidelines and Canadian Sedentary Behaviour Guidelines 2015. http://www.csep.ca/english/view.asp?x=949. 2015.
  5. Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2011;22(1):7-14.
  6. Dehghan M, Akhtar-Danesh N, Merchant AT. Factors associated with fruit and vegetable consumption among adults. J Hum Nutr Diet. 2011;24(2):128-134.
  7. Garriguet D. Nutrition: Findings from the Canadian Community Health Survey—Overview of Canadians’ Eating Habits. Statistics Canada; 2006.
  8. Brenner DR. Cancer incidence due to excess body weight and leisure-time physical inactivity in Canada: implications for prevention. Prev Med. 2014;66:131-139.
  9. Arnold M, Pandeya N, Byrnes G, et al. Global burden of cancer attributable to high body-mass index in 2012: a population-based study. Lancet Oncol. 2015;16(1):36-46.
  10. Stein CJ, Colditz GA. The epidemic of obesity. J Clin Endocrinol Metab. 2004;89(6):2522-2525.
  11. Gouveri ET, Tzavara C, Drakopanagiotakis F, et al. Mediterranean diet and metabolic syndrome in an urban population: the Athens Study. Nutr Clin Pract. 2011;26(5):598-606.
  12. Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol. 2011;57(11):1299-1313.
  13. Engstrom G, Hedblad B, Janzon L. Hypertensive men who exercise regularly have lower rate of cardiovascular mortality. J Hypertens. 1999;17(6):737-742.
  14. Rubenfire M, Mollo L, Krishnan S, et al. The metabolic fitness program: lifestyle modification for the metabolic syndrome using the resources of cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2011;31(5):282-289.
  15. Katz A, Lambert-Lanning A, Miller A, Kaminsky B, Enns J. Delivery of preventive care: the national Canadian family physician cancer and chronic disease prevention survey. Can Fam Physician. 2012;58(1):e62-69.
  16. Australian Primary Care Research Institute. Centre for Obesity Management and Prevention Research Excellence in Primary Health Care. http://compare-phc.unsw.edu.au/. 2012.
  17. Lau DC, Douketis JD, Morrison KM, et al. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. CMAJ. 2007;176(8):S1-13.
  18. Petrella RJ, Lattanzio CN, Overend TJ. Physical activity counseling and prescription among Canadian primary care physicians. Arch Intern Med. 2007;167(16):1774-1781.
  19. Petrella RJ, Koval JJ, Cunningham DA, Paterson DH. Can primary care doctors prescribe exercise to improve fitness? The Step Test Exercise Prescription (STEP) project. Am J Prev Med. 2003;24(4):316-322.
  20. Alberta Medical Association Primary Care Alliance Board. PCN Evolution. Vision and framework. 2013.
  21. Lee AC, Maheswaran R. The health benefits of urban green spaces: a review of the evidence. J Public Health (Oxf). 2011;33(2):212-222.
  22. Mowen A, Orsega-Smith E, Payne L, Ainsworth B, Godbey G. The role of park proximity and social support in shaping park visitation, physical activity, and perceived health among older adults. J Phys Act Health. 2007;4(2):167-179.
  23. Klein D, Kallio M, Humphries S, Mueen M. Collaborative team-based health promotion in a primary care setting: The MOVE program. Can Fam Physician. 2017;63(2):e123-e127.

April 2018, Volume 29, No. 04


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