In 2012-13, less than 30% of women who were referred, participated in CRPs in our large Canadian city. The primary purpose of the STEP Project was to explore and describe the outcomes of a novel, gender-specific program, designed specifically for women who chose not to participate in a traditional CRP. However, numerous barriers were encountered in the recruitment process.

Interprofessional education (IPE) is a growing focus for educators in health professional academic programs. Recommendations to successfully implement IPE are emerging in the literature, but there remains a dearth of evidence informing the bigger challenges of sustainability and scalability. Transformation to interprofessional education for collaborative person-centred practice (IECPCP) is complex and requires "harmonization of motivations" within and between academia, governments, healthcare delivery sectors, and consumers. The main lesson learned at the University of Manitoba was the value of using a formal implementation framework to guide its work. This framework identifies key factors that must be addressed at the micro, meso, and macro levels and emphasizes that interventions occurring only at any single level will likely not lead to sustainable change. This paper describes lessons learned when using the framework and offers recommendations to support other institutions in their efforts to enable the roll out and integration of IECPCP.

Internationally, a growing number of interprofessional education (IPE) offices are being established within academic institutions. However, few are applying educational improvement methodologies to evaluate and improve the interprofessional (IP) learning opportunities offered. The University of Manitoba IPE Initiative was established in 2008 to facilitate the development of IP learning opportunities for pre-licensure learners. The research question for this secondary analysis was: what, if any, changes in the number and attributes of IP learning opportunities occurred in the academic year 2008–2009 compared to 2011–2012? The Points for Interprofessional Scoring (PIPES) tool was used to quantify the attributes of each IP learning opportunity. Most notably in 2012, eight (73%) of 11 IP learning opportunities achieved the highest PIPES score (> 55), compared to only four (36%) in 2009. The concept of the PIPES score is introduced as an educational improvement strategy and a potential predictor of achieving the desired educational outcome: collaborative competence.

Background: The chronic effects of high-intensity endurance training on metabolic health outcomes in overweight adolescents remains poorly understood. Objective: To test the hypothesis that high-intensity endurance training (ET) is superior to moderate-intensity ET for improving risk factors for type 2 diabetes in overweight adolescents. Design and methods: In this randomized trial, 106 overweight and obese adolescents (15.2 years; 76% female; 62% Caucasian) were randomly assigned to high-intensity ET (70–85% of heart rate reserve, n =38), moderate-intensity ET (40–55% heart rate reserve; n =32) or control for 6 months ( n =36). The primary and secondary outcome measures were insulin sensitivity assessed using a frequently sampled intravenous glucose tolerance test and hepatic triglyceride content with magnetic resonance spectroscopy. Exploratory outcomes were cardiorespiratory fitness, physical activity and MRI and dual x-ray absorptiometry-derived measures of adiposity. Results: The study had 96% retention and attendance was 61±21% and 55±24% in the high- and moderate-intensity ET arms. Intention-to-treat analyses revealed that, at follow-up, insulin sensitivity was not different between high-intensity (−1.0 mU kg −1 min −1 ; 95% confidence interval (CI): −1.6, +1.4 mU kg −1 min −1 ) and moderate-intensity (+0.26 mU kg −1 min −1 ; 95% CI: −1.3, +1.8 mU kg −1 min −1 ) ET arms compared with controls (interaction, P =0.97). Similarly, hepatic triglyceride at follow-up was not different in high-intensity (−1.7% fat/water (F/W); 95% CI: −7.0, +3.6% F/W) and moderate-intensity (−0.40% FW; 95% CI: −6.0, +5.3% F/W) ET compared with controls. Both high intensity (+4.4 ml per kg-FFM (fat-free mass) per minute; 95% CI: 1.7, 7.1 ml kg-FFM −1 min −1 ) and moderate intensity (+4.4 ml kg-FFM −1 min −1 ; 95% CI: 1.6, 7.3 ml kg-FFM −1 min −1 ) increased cardiorespiratory fitness, relative to controls (interaction P <0.001). Conclusions: ET improves cardiorespiratory fitness among obese adolescents; however, owing to lack of compliance, the influence of exercise intensity on insulin sensitivity and hepatic triglycerides remains unclear.

OBJECTIVE:To determine the feasibility of a cardiac prehabilitation (Prehab) program for patients waiting for elective coronary artery bypass graft (CABG).DESIGN:A two-group parallel randomized controlled trial.SETTING:Medical fitness facility.SUBJECTS:Seventeen preoperative elective CABG surgery patients were randomized to standard care (n = 9) or Prehab (n = 8).INTERVENTION:Standard care: three-hour preassessment appointment. Prehab: exercise and education classes for 60 minutes/day, twice weekly for at least four weeks.MAIN MEASURES:Data were collected at baseline, one week preoperatively, and three months postoperatively. The primary outcome measure was walking distance using a 6-minute walk test. Secondary outcome variables included 5-meter gait speed, and cardiac rehabilitation attendance three months postoperatively.RESULTS:Fifteen patients (standard care, n = 7; Prehab, n = 8) completed the study. No Prehab patients developed cardiac symptoms during study participation. Walking distance remained unchanged in the standard care group; whereas, the Prehab group increased their walking distance to mean ± SD 474 ±101 and 487 ±106 m at the preoperative and three month postoperative assessments (p < 0.05). Gait speed was unchanged in the standard care group, but improved in the Prehab group by 27% and 33% preoperatively and three months postoperatively, respectively (p < 0.05). Enrollment in cardiac rehabilitation three months postoperatively was higher for Prehab participants (100%) than standard care participants (43%; p < 0.05).CONCLUSION:These data provide evidence for the feasibility of a Prehab intervention to improve the health status of patients waiting for elective CABG surgery. A larger trial of 92 patients will be utilized to demonstrate the safety and efficacy of Prehab.

OBJECTIVE:Tobacco smoking, excess weight and physical inactivity contribute substantially to the preventable disease burden in Canada. The purpose of this paper is to apply a recently developed approach in addressing the issue of double counting in estimating the combined current economic burden of these risk factors (RFs) and to estimate the economic benefits of long-term RF reduction in Canada.METHODS:We used an approach based on population attributable fractions (PAF) to estimate the economic burden associated with the various RFs. Sex-specific relative risk and age-/sex-specific prevalence data were used in the modelling when available. Excess weight was modelled as a trichotomous exposure (normal weight, overweight, obese) while tobacco smoking was modelled as a tetrachotomous exposure (non-smoker, light, medium or heavy smoker). All costs are given in constant 2012 Canadian dollars.RESULTS:The annual economic burden of the RFs of tobacco smoking, excess weight and physical inactivity in Canada are estimated at $50.3 billion in 2012. Sensitivity analysis suggests a range for the economic burden of $41.6 to $58.7 billion. Of the $50.3 billion, $21.3 ($20.0 to $22.6) billion is attributable to tobacco smoking, $19.0 ($13.8 to $24.0) billion to excess weight and $10.0 ($7.8 to $12.0) billion to physical inactivity. A 1% relative annual reduction in each of the three RFs would result in an $8.5 billion annual reduction in economic burden by 2031.CONCLUSION:A modest annual 1% relative reduction in the RFs of tobacco smoking, excess weight and physical inactivity can have a substantial health and economic impact over time at the population level.

BACKGROUND:Walking is the main type of physical activity among community-dwelling older adults and it is associated with various health benefits. However, there is limited evidence about the relationship between functional fitness and walking performed under independent living conditions among older adults.PURPOSE:This study examined the relationship between functional fitness and steps walked per day among older adults, both assessed objectively, with performance-based measures accounting for the effect of age, gender, and chronic conditions.METHODS:In this cross-sectional study, 60 participants aged 65 years or older (mean = 76.9 ± 7.3 years, range 65-92 years) wore pedometers for 3 consecutive days. Functional fitness was measured using the Functional Fitness Test (lower and upper body strength, endurance, lower and upper body flexibility, agility/balance). The outcome measure was the mean number of steps walked for 3 days with participants classified into tertiles: low walkers (<3000 steps), medium walkers (≥3000 < 6500 steps), and high walkers (≥6500 steps).RESULTS:After controlling for age, gender, and the number of chronic conditions, none of the functional fitness parameters was significantly associated with steps taken per day when comparing medium walkers with low walkers. In contrast, all functional fitness parameters, except upper body flexibility, were significantly associated with steps taken per day when comparing high walkers with low walkers.CONCLUSION:In this sample of older adults, greater functional fitness was associated only with relatively high levels of walking involving 6500 steps per day or more. It was not related to medium walking levels. The findings point to the importance of interventions to maintain or enhance functional fitness among older adults.

INTRODUCTION:There are analytic challenges involved with estimating the aggregate burden of multiple risk factors (RFs) in a population. We describe a methodology to account for overlapping RFs in some sub-populations, a phenomenon that leads to "double-counting" the diseases and economic burden generated by those factors.METHODS:Our method uses an efficient approach to accurately analyze the aggregate economic burden of chronic disease across a multifactorial system. In addition, it involves considering the effect of body weight as a continuous or polytomous exposure that ranges from no excess weight through overweight to obesity. We then apply this method to smoking, physical inactivity and overweight/obesity in Manitoba, a province of Canada.RESULTS:The annual aggregate economic burden of the RFs in Manitoba in 2008 is about $1.6 billion ($557 million for smoking, $299 million for physical inactivity and $747 million for overweight/obesity). The total burden represents a 12.6% downward adjustment to account for the effect of multiple RFs in some individuals in the population.CONCLUSION:An improved estimate of the aggregate economic burden of multiple RFs in a given population can assist in prioritizing and gaining support for primary prevention initiatives.

We conducted a randomized controlled trial to test the hypothesis that compared to controls, vigorous-intensity physical activity (PA) would lead to a greater reduction in visceral adiposity than moderate-intensity PA despite similar caloric expenditure.

L'estimation du fardeau global que représentent les facteurs de risque multiples au sein d'une population présente certains défis d'ordre analytique. Nous décrivons une méthodologie permettant de tenir compte des facteurs de risque se chevauchant dans certaines sous-populations et entraînant un « double compte » des maladies et du fardeau économique qu'ils engendrent. Notre démarche permet d'analyser avec précision le fardeau économique global des maladies chroniques dans un cadre multifactoriel tout en tenant compte de l'incidence du poids en tant qu'exposition continue ou polytomique (allant de l'absence d'excédent de poids au surpoids et à l'obésité). Nous appliquons cette méthode au tabagisme, à l'inactivité physique et au surpoids et à l'obésité à la province du Manitoba (Canada). En 2008, le fardeau économique global annuel des facteurs de risque au Manitoba était d'environ 1,6 milliard de dollars (557 millions pour le tabagisme, 299 millions pour l'inactivité physique et 747 millions pour le surpoids et l'obésité). Le fardeau total représente un rajustement à la baisse de 12,6 % lorsqu'on tient compte de l'effet des facteurs de risque multiples chez certaines personnes. Une meilleure estimation du fardeau économique global des facteurs de risque multiples au sein d'une population peut faciliter l'établissement des priorités et améliorer le soutien aux initiatives de prévention primaire.

Introduction: There is limited evidence around the physical activity support delivered by different types of healthcare providers (HCPs) to patients with type 2 diabetes mellitus. The primary purpose of this study was to determine the type of physical activity support delivered by 3 HCP types, and to compare this support to that perceived by patients with type 2 diabetes. A secondary aim was to describe awareness, knowledge and use of the Canadian Diabetes Association (CDA) physical activity guidelines and Canada's Physical Activity Guide (CPAG).Method: The HCP and the Patient Physical Activity Support Questionnaire were answered by 48 HCPs and 26 patients from 8 interprofessional primary care clinics specializing in diabetes education.Results: There was no difference in the type of physical activity support between HCP types, however, there was a difference between overall HCP and patient report of physical activity support (5.29 vs. 2.04 unprompted; 9.90 vs. 6.07 prompted, p<0.001). Approximately half of HCPs used the CDA guidelines and the CPAG in practice.Conclusion: Physical activity support is similar between all HCP types in interprofessional primary care settings, but this support is perceived differently by patients. Strategies to increase certain types of physical activity support would allow for optimal counselling in primary care. (C) 2012 Canadian Diabetes Association

Introduction: Physical activity has a primary role in the prevention of chronic disease. However, primary care services in Canada do not provide the multi-level supports necessary for patients to adopt and sustain a physically active lifestyle. To better understand the limited delivery of physical activity as a health intervention, health care providers (HCP) were interviewed during the preliminary phase of a one-year intervention to integrate a kinesiologist into the primary care system of an urban health authority.

This study examined the associations between walking behavior and the perceived environment and personal factors among older adults. Sixty participants age 65 yr or older (mean 77 +/- 7.27, range 65-92) wore pedometers for 3 consecutive days. Perceived environment was assessed using the Neighborhood Environment Walkability Scale (abbreviated version). Physical function was measured using the timed chair-stands test. The mean number of steps per day was 5,289 steps (SD = 4,029). Regression analyses showed a significant association between personal factors, including physical function (relative rate = 1.05, p < .01) and income (RR = 1.43, p < .05) and the average daily number of steps taken. In terms of perceived environment, only access to services was significantly related to walking at the univariate level, an association that remained marginally significant when controlling for personal characteristics. These results suggest that among this sample of older adults, walking behavior was more related to personal and intrinsic physical capabilities than to the perceived environment.

This study compared the intensity and energy cost of playing 9 holes of golf with 40 min of lawn mowing in older men and determined whether both met the current recommendations for health benefits. Eighteen men (age 71.2 +/- 4.4 yr. BM I 27.3 +/- 2.3; M +/- SD) completed a graded treadmill test. During golfing and lawn-mowing field tests, oxygen consumption and walking velocity and distance were measured using a portable metabolic system and global positioning system receiver. The net energy costs of golfing and lawn mowing were 310 and 246 kcal, respectively. The average intensities in metabolic equivalents of golfing and lawn mowing were 2.8 +/- 0.5 and 5.5 +/- 0.9. respectively. Both lawn mowing and golfing met the original intensity and energy expenditure requirements for health benefits specified by the American College of Sports Medicine in 1998, but only lawn mowing met the 2007 intensity recommendations.

Canada's Physical Activity Guide to Healthy Active Living (CPAG) is the national reference for messaging on physical activity for health benefits, yet few studies have examined population activity levels in relation to its recommendations. As part of the province-wide in motion initiative, we obtained a baseline measurement of the physical activity levels of adult Manitobans. Physical activity levels were benchmarked against CPAG recommendations and were compared with criteria used in previous surveys. A stratified random sample of adults from the 9 Regional Health Authorities outside of Winnipeg, and from the 12 Community Areas within the Winnipeg Health Region, was surveyed by telephone. Respondents (n = 6,536) reported all light, moderate, and vigorous physical activity of 10 min or more in the previous week. Intensity levels were corrected to reflect standard MET equivalents, using the Ainsworth Compendium. A total of 69.5% of respondents met the minimum CPAG requirements; however, only 29.1% of those did so with vigorous activity. Relative to energy expenditure, 18.3% were classified as inactive (<1.50 kcal.kg-1.day-1 (KKD)), 16.4% as moderately active (1.50 to 2.99 KKD), and 65.3% as active (>or=3.00 KKD). When assessed against the CPAG recommendations, which promote integration of physical activity into one's daily routine, a higher proportion of Manitobans met recommended physical activity levels than that reported in previous surveys, which focused on leisure activity. Given the corresponding increase in levels of obesity and chronic disease, and equivocal nutrient intake data, we recommend that the CPAG recommendations be reviewed, especially with respect to the inclusion of routine baseline activities of daily living.

AIM:Maximizing the health benefits associated with reducing inactivity levels requires an understanding of the individual and environmental determinants of physical activity. Membership in a fitness facility promotes physical activity, yet little is known of its relationship to health. The purpose of this study was to compare physical activity levels, and health status, behaviours, and beliefs, in members of a fitness centre, and non-member community residents.METHODS:Using a cross-sectional design, fitness centre members (n=236) and non-members (n=302) were compared with respect to perceived health status, use of health care services, fitness status, physical activity level, perceived control over health, and the likelihood of engaging in health promoting behaviours, using The Health-Promoting Lifestyle Profile. Questionnaires were mailed to adult members of a fitness centre, and a stratified (age, sex) sample of non-members randomly selected from the local community.RESULTS:Fitness centre members were more likely than the comparison group to have visited a general physician, dentist, athletic therapist, optometrist, or nutritionist during the previous year (p<0.05), to exercise regularly, and to rate their physical fitness as very fit. They scored significantly higher on the overall health promoting lifestyle score (p=0.0353) as well as on health responsibility (p=0.0053), exercise (p=0.0001), and nutrition (p=0.0166) subscales, even after adjusting for differences in activity levels between groups.CONCLUSIONS:Fitness centre membership is associated with increased health responsibility and health promoting behaviours. This finding appears to be related to membership in the fitness centre, and not to increased participation in physical activity.

The purpose of this retrospective study was to compare the effects of a 2‐year, community‐based cardiac rehabilitation exercise program on cardiovascular fitness, body fatness, and blood lipids in middle‐aged (≤65 years, n=42) and elderly (>65 years, n=40) male cardiac patients. Estimated maximal metabolic equivalents increased in both groups; however, the increase was greater for middle‐aged patients (p = 0.003). High‐density lipoprotein cholesterol level increased significantly after 1 year in both groups, but the change was greater for the middle‐aged subjects by Year 2 (p= 0.02). The total cholesterol/high‐density lipoprotein cholesterol ratio and serum triglyceride levels decreased in both groups, whereas total cholesterol and low‐density lipoprotein cholesterol levels decreased only in the elderly group (p < 0.01). Body fatness did not change in either group. These findings reinforce the importance of referring elderly as well as middle‐aged patients to community‐based cardiac rehabilitation exercise programs.

This study investigated whether a behaviour change program, based on Canada's Physical Activity Guide and Handbook to Healthy Active Living for Older Adults (Health Canada, 1999a), would elicit greater benefits than adoption of the guide and handbook alone. Fifteen older adults received the guide and accompanying handbook and completed the 8-week behaviour change program (mean age 73.2 +/- 5.2 yrs), while 14 others received only the guide and handbook (mean age 76.8 +/- 10.0 yrs). Functional fitness (lower body strength/endurance, flexibility, agility/dynamic balance) (Rikli and Jones, 1999), and estimated energy expenditure (DiPietro et al., 1993) were measured at baseline and after 8 weeks. Lower body strength/endurance and agility/dynamic balance differed between groups at baseline, p < 0.05. All three functional fitness tests improved in both groups over time, p< 0.05. Estimated energy expended in physical activity increased in both groups over time, p < 0.05; however, there was a significantly greater increase in the behaviour-change group (Group x Time interaction, p < 0.05). Participant response to using the guide and handbook was positive. These results indicate that introduction to Canada's Physical Activity Guide and Handbook to Healthy Active Living for Older Adults leads to benefits, whether or not accompanied by program supports. The group receiving the behaviour change program had a greater increase in energy expenditure, which suggests that such an intervention may ultimately lead to greater health benefits.