Canadians need to get fitter — before the next pandemic


The sprints and weight routines Conor McCann puts together for his family are no joke — but then, neither is their desire to get and stay in shape through the pandemic.

At a rugby field in Toronto where McCann, 27, used to train at rugby as a kid, the Toronto firefighter leads his mom, 57, adult siblings and their partners in an outdoor workout routine two to three times a week. The physically distanced interval sprints and weight routines are a way for them all to exercise safely, and together, during the pandemic.

“The evidence is becoming more and more overwhelming that it’s super important to be metabolically healthy right now,” McCann said. “With gyms closed, we were searching pretty hard for ways to stay fit.”

It’s the kind of activity doctors say is crucial to good health — including helping protect against the worst effects of COVID-19. But, for both individual and social reasons, regular exercise is one public health message Canadians haven’t been heeding enough during the pandemic.

McCann’s workout routines sprung from a stark reminder. Every day, people were getting sick, and dying from COVID-19. For his family, the situation brought their mortality into focus, he says, spurring them to get their bodies as strong as possible.

“(Health) has been pretty much a priority, I’m certainly not uber fit or uber conscious about what we eat, but I’ve always been conscious about feeding the kids good food and being active,” said McCann’s mother, Tracy Bain. It’s felt all the more important lately. “Those are kinds of things that have really come to the forefront with this pandemic.”

A recent study including about 50,000 Californians who got COVID-19, done out of the Kaiser Permanente Fontana Medical Center, found people who exercised regularly fared far better than those who did not.

It’s a reminder of the importance of exercise, which is already known to help prevent at least 30 chronic diseases. But to change all Canadians’ relationship with exercise may require a rethink of the message — and of what we include under the umbrella of “health care” in this country.

“I can only hope it’s a wake-up call,” says Dr. Deborah Young, one of the authors on the Kaiser study. “The reason I say that is we have so much evidence of the benefits of being regularly physically active, and yet most Americans are not.”

That applies to Canadians, too. A 2016 report by the chief public health officer found only one in 10 children and two in 10 adults were meeting Canada’s guidelines on physical activity. A 2012 study estimated the total (direct and indirect) cost of inactivity on Canada’s health-care system was $6.8 billion. Surveys suggest that during the pandemic, Canadians who were already exercising did so more, and Canadians who weren’t exercising did so even less than before.

Young hopes that, in the context of the pandemic, a message about the importance of exercise will carry new weight. It would be unacceptable, for example, for eight of every 10 people not to wash their hands or physically distance during the pandemic. But that’s what’s been happening, in effect, when it comes to physical activity.

The Kaiser study showed that, after age, a sedentary lifestyle was the top predictor of severe COVID-19. It wasn’t all linked to weight either — people who were active still did better than sedentary folks when the doctors compared people within similar body mass index categories.

In the study, people who exercised 10 minutes a week or less were hospitalized at twice the rate of people who were active more than 150 minutes per week, and were 20 per cent more likely to be hospitalized than people who got more than 10 minutes but less than 150.

Like many things, there’s an individual and social element to getting people moving. There are people who work multiple jobs and have limited outdoor space near their home to get exercise on their time off. There are also people who work from home and have spare time and ample space, but choose to watch Netflix.

A good public health strategy helps both groups move more, experts say.

Take the Canada exercise guidelines, which say adults should get 150 minutes per week of moderate to vigorous physical activity (like brisk walking or jogging) and kids need 60 minutes per day.

Eli Puterman, a Canada Research Chair in physical activity and health at the University of British Columbia, says those are good guidelines, based in evidence that meeting them improves health.

But Puterman said the fact so many Canadians are not meeting the guidelines may mean it would be beneficial to broaden our thinking about exercise, and how to make it more attainable.

“I think this concept of moderate to vigorous exercise is great and there are ways to get people to engage in more moderate to vigorous exercise,” he said. “But I do think there are other approaches to getting more people, on average, to move their bodies more.”

Puterman describes a more inclusive way to think about exercise that counts the daily movements built into the fabric of our lives. It means different things in different places. For an urban office worker, it could include walking to a nearby grocery store and taking the stairs instead of the elevator. For rural people, it could mean making a habit of social activities that involve movement — such as walking, biking and dancing.

In each of these examples, it’s possible to build communities and fund programming with these end-goals in mind.

On the individual level, Puterman said it would be useful to integrate fitness more into the practice of medicine — which are distinct in our society.

“I think expanding our insurance coverages to allow for more of these additive approaches to health with kinesiology, physiotherapy, mental health experts, expanding those options might be a good place to go so that (our health-care system) is not just a curative but also preventative,” he said.

There are some places in the world that do all of this exceptionally well. One of them is Nagano Prefecture in Japan, which holds the distinction of being the region with the longest-living people, in the country with the longest-living people on Earth. Women are expected to live to 87 and be healthy until 84. Men are expected to live to 81 and be healthy until 79.

This didn’t happen by accident.

Starting in the 1980s, local public health officials noted residents of the inland region were eating way too much salt, and started running healthy living programs like cooking classes and villagewide exercise programs. The key was that these things happened in people’s own communities, and doctors, too, knew to ask about and promote healthy lifestyles.

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Nagano’s programs, which are still in place, are an effective execution of a national priority — since Japan has an aging population, “extending the nation’s healthy life expectancy” is a policy goal of the national government.

There are organizations in Canada trying to promote a similar outlook — implementing designs, policies and programs that promote physical movement from the federal to the local levels.

Rita Koutsodimos of the B.C. Alliance for Healthy Living said that’s her organization’s “raison-d’etre.”

“When you are active, it’s considered primary prevention for over 30 conditions. It improves your immune function, it improves your physical wellness,” she said. “One thing that is misunderstood by the public is that it also improves mental health and social emotional well-being.”

There are versions of Healthy Living alliances in every province, which advocate and execute programs trying to get more people physically active every year.

Koutsodimos said the recent physical activity strategy in B.C. cost $7 million and included things such as training daycare providers on how to get young kids active, and providing recreation centres support to create programming for marginalized youth who don’t have the same access to sports as kids from affluent families.

She sees it as a low-cost way to save millions in the health-care system downstream, while making people feel better and healthier.

“We’d like to see the funds increased substantially,” she said, adding that money can go into programming as well as infrastructure — like the creation of trails and bike paths for more people to use. The federal government is investing $400 million on active transportation, to that end.

Adam van Koeverden during the 2016 Olympic Summer Games

Adam van Koeverden, the former gold-medal Olympic rower and current parliamentary secretary to the minister of finance for sport, said Canada must invest in sport and physical activity if it wants better health outcomes.

“We spend 20 times more addressing the consequences of inactivity than we do investing in physical activity,” he said. “That’s not progressive.”

With the 2021 budget released last week came an $80-million commitment to fund sports groups across the country, which Van Koeverden said is about investing in community programs across the country. That can be used to subsidize sport activities and to make them available more equitably across the country. Then, the last thing is convincing people to prioritize physical movements.

“Human beings as a species have a well developed proclivity to be lazy. I have four Olympic medals upstairs and I’m lazy,” he said, adding that the year of the pandemic has seen a decline in his own activity levels and healthy eating habits. “But we have to fight it. We can build better-built environments, educate people.

“I hope in the coming years it will continue to be a priority not only for our government but in the other levels, too,” he said.

That’s what Tracy Bain, the Toronto mom doing outdoor exercise with her family, has thought a lot about lately.

“We’re lucky enough to live right on the water in Toronto, so there’s a boardwalk we can walk,” she said. She knows it would be a lot harder to promote an active lifestyle for herself and her kids without these resources nearby.

“I think that’s something our governments really need to promote: Healthy eating, lifestyle and making sure there are places you can do that.”

For Bain and her adult kids, that will continue to be the rugby field nearby, and the gruelling workout routines by her son.

“Because I’m older it takes me a while to recover from some of these workouts,” she said. “It really has been a lifeline … for all of us.”





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