Nadine Sinnen MSc Thesis Proposal

Title: “Qualified Exercise Professionals and the impact on aging health”

Supervisor: Dr. Michael Koehle (Kinesiology)
Committee Members: Dr. Darren Warburton (Kinesiology), Holly Kennedy-Symonds (Copeman Healthcare)

Background: Physical inactivity is a rising global concern as it relates to the risk of noncommunicable
diseases (NCD) and associated burden on health care costs (World Health
Organization, 2009). In 2008, the number of global deaths linked to inactivity equalled the
number of deaths linked to smoking at 5.15 million (Shavelle, et al., 2008). Failure to incorporate
150 minutes per week of physical activity (or 15-30 minutes per day) has been shown to increase
the risk of NCDs such as cancer, heart disease, stroke, and diabetes by 20-30%, and decreases
longevity by 3-5% (World Health Organization, 2009, Lee, et al.,2012, Tremblay, et al., 2011).
For those who are deconditioned, a small positive change in physical fitness may respond with
marked health outcomes status change. There is a dose – response relationship between physical
activity level and relative risk reduction for 25 chronic conditions, the value of physical activity
is undeniable and has been known for many decades. Why then are 51% of Canadians inactive,
and only 17.6% of Canadians meeting the current physical activity guidelines?
Aim: This study aims to support the positive influence of a collaborative health care model,
where an automatic referral is incorporated in a client care pathway (from physician lead to
qualified exercise professional – QEP) for fitness assessment and regular follow-up. We hope to
demonstrate that this model achieves greater clinical health outcomes and supports greater
cardiovascular risk reduction due to benefits in aerobic capacity (peak metabolic equivalent
level), and secondary metabolic health measures. We will use a one-year retrospective cohort
study design.
Methods: 460 patients both male and female of any age who signed up for the collaborative
health care model at a private health care centre in Vancouver, BC between 2010-2016, and
remained in the program for 3 or more consecutive years were assessed for eligibility.
204 patients were assessed with a baseline cardio-respiratory fitness level equal to or below 9.0
metabolic equivalents (METs), who repeated all metabolic health measures at year baseline and
year one with a physician lead and received either an initial assessment with QEP only or an
additional three or more fitness follow ups, will have charts retrospectively reviewed for changes
over 12-month program length.
A secondary prevention group of 66 patients who are at elevated risk for or coded with
cardiovascular disease who received either an initial QEP visit or an additional 3 or more visits
will have charts retrospectively reviewed for changes over 12-month program length.
Health outcomes to include cardio-respiratory fitness (CRF in METS) as well as secondary
physiological measures of waist circumference, cholesterol levels, blood pressure, and blood
glucose will be assessed.
Anticipated Results: It is anticipated that participants who attended three or more sessions with
their QEP over a 12-month program length as directed by their primary care physician, will have
statistically significant improvements in their primary and secondary health measures as
compared to the control group who received only one fitness assessment/consult with QEP.
It is anticipated that the secondary prevention group will have statistically significant
improvements in their health measures as compared to their matched controls.
Conclusions: With such a high relative economic burden in Canada, and an aging population, it
seems wise to focus on regular prevention strategies to mitigate the costs that contribute to
physical inactivity risks. How can we afford not to call to increase and rely on our network of
referral pathways in primary and secondary preventative care to include QEPs for assessment,
behavior change counseling, and exercise prescription regularly and/or automatically?