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Exercise is medicine

Experts say exercise can keep us healthy, but too many Canadians wait until after they have had a heart attack or other health issue to become active

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Paul Cantafio pulls over to the side of the track and does a few stretches as he cools down after power walking.

The next item on his work-out list is a stretch and strength class, followed by time on a stationary bike. He monitors his heart rate as he pedals and drinks water, watching others in the huge open gymnasium at the Reh-Fit Centre on Taylor Avenue in Winnipeg.

"I'm determined to live my life well," says Cantafio, who used to play football at the University of Manitoba in his younger days. "I've lost weight, and exercise is now a big part of my life. I'm exercising every second day, doing my own thing: a little running, some biking to get my heart rate up."

Annette Albo breezes by on the track. She's been running since her late 30s and tries to take part in a half-marathon every year. "I'm a fair weather runner, which means I run indoors a lot in the winter and when it rains," she says between laps. Her workout this afternoon also includes time on the stationary bike and free weights.

Albo joined the Reh-Fit Centre five years ago, after taking a learn-to-run clinic and joining a running group. Cantafio is a more recent recruit.

Don't be fooled by the apparent picture of their health.

Both have had recent health scares that made them determined to overcome the perils of a sedentary life.

Cantafio suffered from congestive heart failure last fall. His recovery includes exercise, plenty of fluids, a regimen of pills and a healthy diet. He took part in a four-month long Cardiac Rehab program at Reh-Fit starting in December, where he learned more about dealing with his condition - a relatively rare case in which his heart problem was probably caused by a virus.

"I wasn't expecting any of this," he says of his heart problems. "I wasn't feeling well on the September long weekend. I went to see my doctor, who sent me to the hospital. There were lots of tests and I was on a heart monitor for eight days. I was really worried."

Told he needed to change his lifestyle, Cantafio headed to the Reh-Fit, where staff put him through a stress test. He failed that in under a minute. It was back home for more rest before he slowly began to feel well enough to begin exercising for real.

"I had to come in the mornings, at 9 a.m., because that's when there is a doctor on-site," he says. "I sure didn't like that. I'm used to doing my own thing. I love to cook and eat, and hang out with my friends." After the program was over, he continued to exercise.

Albo's story is different. She was diagnosed with breast cancer in January of 2012 after her doctor sent her for a mammogram. She underwent surgery last year, followed by radiation and chemotherapy.

"That part was just brutal," she says. "I felt fine before the surgery, like nothing was wrong. The chemo made me feel sick. It really knocked me out," adding that her doctor recommended she keep as active as possible to help recover from the cancer. "I did have to stop running, but kept on walking, at a slow saunter."

Cantafio and Albo both see exercise as their medicine. In both cases, their doctors believe that an active lifestyle can help them as they work to overcome their health challenges.

But health experts say the benefits of exercise aren't just for those who have experienced health issues. Research shows that exercise can help reduce the risk of developing health problems in the first place.

To punctuate the point, the Reh-Fit Centre celebrated Exercise is Medicine month in May as part of an effort to raise the profile of a new program it launched in Winnipeg last year. The initiative, based on an American program of the same name created by the American College of Sports Medicine, is designed to promote the notion that exercise is so powerful in maintaining and improving health that it should be prescribed, just as medications are.

Among other things, the Exercise is Medicine program aims to encourage health-care providers to record physical activity as a vital sign during patient visits, and provide those patients with exercise prescriptions for maintaining and improving their health.

"Our goal is to have family doctors ask their patients about their activity level, in the same way they would ask about their blood pressure or diet during every visit," says Sue Boreskie, Chief Executive Officer of the Reh-Fit Centre.

Reh-Fit has sent letters to physicians alerting them about the program and will continue to offer education sessions. In May, the centre offered programs for the public on how exercise improves overall health and helps to combat chronic diseases.

Dr. Neal Lerner is a medical advisor to the Reh-Fit Centre and an Intensive Care Unit doctor at Seven Oaks Hospital, where he serves as the cardiac rehab advisor to the Wellness Institute. He knows that exercise reduces the number of patients he'll be seeing "upstream." It can help cut the risk of heart disease by 40 per cent and stroke by 27 per cent. Type 2 diabetes can be reduced by almost 50 per cent and exercise reduces the mortality and risk of recurrent breast cancer by almost 50 per cent. The risk of colon cancer drops by more than 60 per cent. Exercise also helps reduce the risk of Alzheimer's disease by one-third, and can decrease depression as effectively as medication or behavioural therapy.

Lerner says everyone should be able to exercise to some level, other than those with critical aortic stenosis or uncontrolled angina.

So why don't more people exercise?

Lerner says many people have negative experiences with exercise, or face barriers to being active. Some don't know what exercises are safe or effective. Success increases with support, including guidance from a certified exercise professional and also a health-care professional, he says.

Joining a program or a peer group is another good idea. "We'd love it if people regularly talked to their doctor about exercise, to get it on their radar," says Lerner, who has been running and working out for approximately 10 years.

For many, that means starting with a stress test, which all cardiac rehabilitation patients are put through when they join the Reh-Fit Centre or Wellness Institute, says Lerner, along with new members as the need arises.

"If a person has high blood pressure, is overweight or has diabetes, they're a candidate for a stress test," he says. A stress test puts people on a treadmill and gradually increases the pace and elevation, while monitoring their heart rate and breathing.

We really are living in a sedentary society, and that's not good for our overall health. In fact, there are 40-plus health conditions that are caused or furthered by inactivity and overconsumption of food, according to Dr. Dean Kriellaars, an exercise physiologist at the University of Manitoba's School of Medical Rehabilitation, and a scientist with the Manitoba Institute of Child Health.

Kriellaars has been running exercise studies since 1987, looking at physical activity and physical literacy in obesity and the prevention of disease and injury.

"Everyone should know that 'input over output stays put,'" quips Kriellaars, while talking about the dysfunctional equation that ensures Canadians pack on the pounds and the effect that has on their health.

"Over-consumption of food - input - and lack of activity - output - means that 65 per cent of Canadians are overweight - stays put. This is contributing to an oncoming wave of health-care problems. It's like we're watching a train wreck, one that's been setting up for years," he says.

Mexico has just posted numbers that say that country is ahead of the United States in terms of the percentage of population that is overweight or obese. "And while Canada is the lowest in North America, we're catching up," says Kriellaars.

One major problem is that Canadians too often wait until they have a serious health issue before they decide to take the doctor's orders and become active, says Kriellaars. Canadian statistics show that the number of people meeting physical activity guidelines between the ages of 20 and 60 is roughly 3.5 to 7 per cent. This means 93 to 97 per cent of adults are not meeting the guidelines of at least 150 minutes of activity per week.

There has been a concerted effort for at least 45 years to get Canadians off the couch. Kriellaars remembers an advertisement from the 1960s on CBC Radio, which talked about people "committing armchair suicide." He says that if the ad were updated to 2013, almost nothing in it would have to change.

"The Chevy might become a Volkswagen. The man who is 37 pounds overweight might become a woman who is 47 pounds overweight. And instead of TV time, it's screen time now. We are still committing armchair suicide," he says.

All the messages put out by ParticipAction and other Canadian activity campaigns have failed because people are sitting when they hear them, he says. Sitting means you have a lap, where you can place high-calorie, low-nutrient food. "We all have lap disease. Sure, it's not a real term, just my fake term. But, let's just say no to laps!"

Unfortunately, most people don't change their lifestyle until they've had a health "event," says Kriellaars, and that event has to be verified and comprehensible.

"Tell someone they have high cholesterol, and they think, 'whatever that is,' and ignore the message. They're smoking, drinking, and not exercising, and they're told they're at risk for heart attack. People are diagnosed with hypertension or bad lipids in their blood, but again, it isn't a triggering event," he says. "But if they get a massive chest pain, and go to hospital and have it verified as a heart attack, then, 'ah-hah,' now the switch gets flicked."

And you can't blame electronics or even the couch for your inactivity, says Kriellaars. Instead, focus on not making excuses. No time? Take a five-minute break at work, and climb the stairs or stretch. No funds? Look for exercises that can be done with no equipment or a gym membership.

But if you really want to succeed, lay out the money. Anyone who has spent a thousand dollars on a flat screen TV could have spent that on hiring a personal trainer or certified exercise physiologist, says Kriellaars.

"We pay our taxes. The annual budget for health care in Manitoba is $5 billion dollars per million people. That's for health care, not personal health," he says.

"We need money for prevention of disease, and where do we get it? It wouldn't be that hard to raise the money. Add a 50 cent physical fitness levy to every drive-through purchase or drive-through bank transaction. No one rebelled when a two cent tax was added to recycling pop bottles, did they?

"People clearly want their health care when they are sick, but don't want their health. Health is a personal responsibility and they won't take the time to prevent these nasty diseases."

Paul Cantafio doesn't mind laying his money on the line when it comes to his future health. "It costs to have a membership here. But when my doctor started talking about my heart, and how bad it could get, I made sure to make exercise a part of my life, so that my life will go on. You know what I mean? I want to be around, to have many more years."

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