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Exercise is Medicine Canada workshop training improves physical activity practices of physicians across Canada, independent of initial confidence level.

ABSTRACT: Background:Educational workshops help physicians (MDs) include physical activity and exercise (PAE) content in more patient appointments. It is unclear if MDs with varying degrees of confidence discussing PAE with their patients equally benefit from such training. We evaluated whether MDs' initial confidence affects the impact of an educational PAE workshop. Methods:MDs (n = 63) across Canada completed self-reflection questionnaires initially and 3-months following a PAE workshop. MDs were divided into low-confidence [confidence score (out of 100%): <40%; n = 21], medium-confidence (40-60%; n = 19) and high-confidence (>60%; n = 23). Results:PAE counselling confidence increased in all groups (relative increase: Low=~40%, Medium=~20%, High=~10%). Training increased the low-confidence group's knowledge, awareness of guidance/resources and perception of their patients' interest in lifestyle management (~30% change; all p < 0.001). Compared to baseline, a greater proportion (all p < 0.001) of MDs reported prescribing exercise at 3-month follow-up in each of the low-confidence (10% to 62%) medium-confidence (16% to 89%) and high-confidence (57% to 87%) groups. Conclusion:PAE training favorably improved MDs' confidence, perceived impact of many barriers and the proportion of MDs prescribing exercise, at each level of confidence. An educational workshop particularly assisted MDs with low-confidence (i.e., those who needed it the most) integrate PAE into their practice.

SUBMITTER: O'Brien MW

PROVIDER: S-EPMC7522882 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Exercise is Medicine Canada workshop training improves physical activity practices of physicians across Canada, independent of initial confidence level.

O'Brien Myles W MW Shields Chris A CA Solmundson Kara K Fowles Jonathon R JR

Canadian medical education journal 20200923 5

<h4>Background</h4>Educational workshops help physicians (MDs) include physical activity and exercise (PAE) content in more patient appointments. It is unclear if MDs with varying degrees of confidence discussing PAE with their patients equally benefit from such training. We evaluated whether MDs' initial confidence affects the impact of an educational PAE workshop.<h4>Methods</h4>MDs (<i>n =</i> 63) across Canada completed self-reflection questionnaires initially and 3-months following a PAE wo ...[more]

PMID: 33062086

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Project description:BackgroundSkilled physician communication is a key component of patient experience. Large-scale studies of exposure to communication skills training and its impact on patient satisfaction have not been conducted.ObjectiveWe aimed to examine the impact of experiential relationship-centered physician communication skills training on patient satisfaction and physician experience.DesignThis was an observational study.SettingThe study was conducted at a large, multispecialty academic medical center.ParticipantsParticipants included 1537 attending physicians who participated in, and 1951 physicians who did not participate in, communication skills training between 1 August 2013 and 30 April 2014.InterventionAn 8-h block of interactive didactics, live or video skill demonstrations, and small group and large group skills practice sessions using a relationship-centered model.Main measuresHospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), Jefferson Scale of Empathy (JSE), Maslach Burnout Inventory (MBI), self-efficacy, and post course satisfaction.Key resultsFollowing the course, adjusted overall CGCAHPS scores for physician communication were higher for intervention physicians than for controls (92.09 vs. 91.09, p < 0.03). No significant interactions were noted between physician specialty or baseline CGCAHPS and improvement following the course. Significant improvement in the post-course HCAHPS Respect domain adjusted mean was seen in intervention versus control groups (91.08 vs. 88.79, p = 0.02) and smaller, non-statistically significant improvements were also seen for adjusted HCAHPS communication scores (83.95 vs. 82.73, p = 0.22). Physicians reported high course satisfaction and showed significant improvement in empathy (116.4 ± 12.7 vs. 124 ± 11.9, p < 0.001) and burnout, including all measures of emotional exhaustion, depersonalization, and personal accomplishment. Less depersonalization and greater personal accomplishment were sustained for at least 3 months.ConclusionsSystem-wide relationship-centered communication skills training improved patient satisfaction scores, improved physician empathy, self-efficacy, and reduced physician burnout. Further research is necessary to examine longer-term sustainability of such interventions.

Project description:Key pointsObesity results in perilymphatic inflammation and lymphatic dysfunction. Lymphatic dysfunction in obesity is characterized by decreased lymphatic vessel density, decreased collecting lymphatic vessel pumping frequency, decreased lymphatic trafficking of immune cells, increased lymphatic vessel leakiness and changes in the gene expression patterns of lymphatic endothelial cells. Aerobic exercise, independent of weight loss, decreases perilymphatic inflammatory cell accumulation, improves lymphatic function and reverses pathological changes in gene expression in lymphatic endothelial cells.AbstractAlthough previous studies have shown that obesity markedly decreases lymphatic function, the cellular mechanisms that regulate this response remain unknown. In addition, it is unclear whether the pathological effects of obesity on the lymphatic system are reversible with behavioural modifications. The purpose of this study, therefore, was to analyse lymphatic vascular changes in obese mice and to determine whether these pathological effects are reversible with aerobic exercise. We randomized obese mice to either aerobic exercise (treadmill running for 30 min per day, 5 days a week, for 6 weeks) or a sedentary group that was not exercised and analysed lymphatic function using a variety of outcomes. We found that sedentary obese mice had markedly decreased collecting lymphatic vessel pumping capacity, decreased lymphatic vessel density, decreased lymphatic migration of immune cells, increased lymphatic vessel leakiness and decreased expression of lymphatic specific markers compared with lean mice (all P < 0.01). Aerobic exercise did not cause weight loss but markedly improved lymphatic function compared with sedentary obese mice. Exercise had a significant anti-inflammatory effect, resulting in decreased perilymphatic accumulation of inflammatory cells and inducible nitric oxide synthase expression. In addition, exercise normalized isolated lymphatic endothelial cell gene expression of lymphatic specific genes, including VEGFR-3 and Prox1. Taken together, our findings suggest that obesity impairs lymphatic function via multiple mechanisms and that these pathological changes can be reversed, in part, with aerobic exercise, independent of weight loss. In addition, our study shows that obesity-induced lymphatic endothelial cell gene expression changes are reversible with behavioural modifications.

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Exercise is Medicine Canada workshop training improves physical activity practices of physicians across Canada, independent of initial confidence level.

Publications

Exercise is Medicine Canada workshop training improves physical activity practices of physicians across Canada, independent of initial confidence level.

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