Past the pills: Doctors turn to prescribing exercise for both recovery and prevention

After undergoing surgery to remove a tumour on her liver, Melanie Foubert knew she would need help to get back to full health.

The 36-year-old Winnipeg woman had been regularly physically active, working out up to five times a week, but after she was diagnosed with a hormonally caused hepatic adenoma in March 2017, she was forced to take a year-long break from the gym.

Prolonged inactivity and post-surgery weight gain from the high-calorie, high-protein diet needed to regrow her liver presented obstacles to getting back in shape.

"It was really [a question of] how to get back into exercise, but do it safely — knowing that I need a little more of a push, and some of that social aspect, and I guess accountability."

During a follow-up visit to her doctor, she saw a poster for a program called Exercise is Medicine at the Reh-Fit Centre and asked for a referral.

The eight-week program is an example of how health-care practitioners are recognizing the importance of not simply telling their patients to be more physically active, but prescribing ways of incorporating exercise into their daily lives — often to treat or prevent specific health ailments.

"Rather than relying on a passive modality, such as a pill or a blood-pressure medication or something like that, regular physical activity can help us reduce our dependence on that passive stuff, and help us take a more active, participatory role in our health," said Amandev Dhesi, head of the Exercise is Medicine program at the centre.

Personalized programs

Doctors, dietitians and nurse practitioners who want their patients to be more physically active can refer them to the program, which pairs them with a coach who helps prescribe the specific types of exercise to meet their goals.

Knowing that she couldn't do intense abdominal exercises due to her surgery, Foubert started with light weights and TRX suspension training, slowly building up her strength.

She says her weekly check-ins with her coach helped keep her motivated to show up.

"They want you to come three times a week at least, so I was like, 'OK, I've gotta minimally meet that,'" she said.

In addition to helping with her physical strength, getting back to the gym helped her overcome the mental hurdles she faced.

"It was a way to get rid of stress, and I just feel better that I accomplished something, even if it was 20 minutes of doing something that I wasn't doing before," she said.

New science

There's new science developing around how doctors can better support their patients to make healthy changes in their lifestyle, said Dr. Michael Routledge, a public health physician and a member of the Reh-Fit Centre's medical advisory committee.

"We have a long history of people go to their doctor and they get a prescription for a drug written down on a piece of paper, with very specific explanations about how to do it, how to take it. [We should] be more specific with exercise," he said.

The Wellness Institute attached to Seven Oaks Hospital offers members all the amenities of a normal gym, in an environment that makes it easier for non-exercisers to feel comfortable.

It's not uncommon to see someone walking on the track pulling an oxygen tank alongside a competitive runner, said executive director Casie Nishi.

"A lot of people who have not been exercisers, or they're not currently avid exercisers, they lack a lot of confidence, and so that's part of our role at the Wellness Institute," she said.

About one-third of the members at the institute are at risk of developing chronic diseases like diabetes or chronic obstructive pulmonary disease, Nishi said.

"Those are ones where we can intervene with an exercise and diet program, where we can actually change the course of their disease progression. We can reverse disease."

Members go through a standardized assessment to determine their readiness for change. Nishi says patients are most successful when they are given one specific behaviour to change.

The Wellness Institute receives some provincial funding for specific programs targeted at patients who have suffered heart attacks or strokes, but that funding only applies once patients are already sick, Nishi said.

In Alberta, the Prescription to Get Active program enables doctors to prescribe patients a 30-day gym membership.

Manitoba does not currently have any such programs, but Dhesi at the Reh-Fit Centre says he would support something similar here.

"I think the more we invest in prevention, the less cost we'll have towards reaction," he said.

The Exercise is Medicine program costs $100 for participants, but people with low incomes can qualify for financial help.

Although she's not yet back to full health, Foubert says the program sped up her recovery, and she wishes she had something like it when she went through similar surgery to remove benign cysts when she was 19 years old.

"Had I been able to come to a program that could help me get back into exercise, and know potentially what exercises to do that would work with my limitations, would have probably helped me in the long run."