A Prescription for Prevention

Exercise prescription the solution for the prevention of chronic diseases, says family physician, sports medicine physician and exercise physiologist Dr. Stephane Lenoski

Written by Robin Summerfeld

Dr. Stephane LenoskiDr. Stephane Lenoski comes to the final slide of his presentation. He has been speaking to a room full of delegates, including experts from the United Nations, at the International Conference on Physical Literacy which was held at the Fort Garry Hotel in Winnipeg in early May. He pauses, choking up for a moment. The final slide is a photo of high school students in Winnipeg. They’re inside their school’s large fitness centre.

“I was asked to give a health literacy presentation to students at Fort Richmond Collegiate and as I walked into the school I was astonished to see almost 100 students working out with their teachers. Look at this program. The school has a gym, and offers free yoga, spinning, and TRX classes to all its students. These courses are all supervised by the school’s physical education teachers, two of which are former University Sport Athletes. It was beautiful to see. Kids of all shapes and sizes were all engaging in physical activity. It was inspiring,” says Dr. Lenoski.

“Because of this program, the 1,000 students who attend this high school are going to know how to be physically literate for life. Think of the impact that this will have. Every one of them will know how to avoid chronic diseases through exercise, “says Lenoski.

The conference crowd, made up of exercise, sports and active-living professionals, educators, academics and advocates from across Canada, the States, and farther afield, enthusiastically applaud his passion for the cause.

This high school program, which gets kids to be physically literate early on, so that they keep active and ultimately healthy for life, is a promising sign for the future. But Dr. Lenoski — who is a family doctor, sports medicine physician, and an exercise physiologist — wants more.

He wants more doctors to write exercise prescriptions for their patients with chronic diseases who haven’t been as fortunate to know what it is to be physically active. And  he wants more support for physicians to help refer these patients to exercise professionals.

In addition, he says that the number needed to treat (NNT) for one patient to meet the Canadian Exercise Guidelines through exercise counselling is 12, compared to 50 to 120 for smoking cessation.

“Unfortunately, most of the patients we see as physicians are on the other end of the health spectrum. They are plagued with chronic diseases, mental health conditions, are smokers, and cannot afford to get a gym membership
or to see an exercise professional, which is not covered by medical insurance,” says Lenoski, who is a preceptor at Legacy Sports Medicine and the vice-chair of the Doctors Manitoba Physician Health & Wellness Committee.

These patients, he explains, are in the pre-contemplative phase of lifestyle change.

The stages of lifestyle change are: pre-contemplative, contemplative, preparation and action.

“If physicians can help their patients progress through  the stages of  lifestyle change there is a chance that these patients will become physically active,” says Lenoski. This is a “massive opportunity” for physicians to influence these patients. However, the professional exercise community often has no access to these patients.

Moreover, Lenoski explains that exercise has benefits for the treatment and prevention of 42 chronic diseases, including: hypertension; diabetes, cardiovascular disease, osteoporosis, osteoarthritis, mental health and many cancers, to name a few. And exercise, he says, “is as effective as its pharmarcological counterpart in the treatment of hypertension and diabetes.”

“Type 2 diabetes has now reached epidemic proportions. This represents a failure of our health care system to provide an organized, structured lifestyle intervention program for patients who so desperately need it,” says Lenoski.

Dr. Stephane LenoskiAnd he’s in a good position to make people listen. Lenoski played 4 years in the Western Hockey League. He was a three-time, Canadian Inter-University Sport academic all Canadian in men’s hockey and represented Canada at the 2009 World University Games in men’s hockey in Harbin, China, earning a silver medal. These experiences taught him how to be physically active. Today, he stays active by biking, running, snowshoeing, walking his dog, weight lifting, and interval training.

Lenoski’s credentials as a physician and exercise physiologist put him in a unique position to help bridge the gap betweenmedicine and active-living literacy. He is believed to be the first fully practicing family physician/sports medicine physician/exercise physiologist in Canada.

He is also part of the National Exercise is Medicine Working Group. The group’s goal is to implement an exercise prescription curriculum  at all medical schools. He would like to see mandatory exercise prescription and exercise physiology curriculums in Canadian medical schools and residency programs, so that every physician will have the training to appropriately tailor an exercise program for their patient no matter their specialty.

Lenoski sees a simple solution to a complex problem: getting people to move more, get active, and stay active.