1. Person-Centred, High-Quality, Safe and Sustainable Health and Wellness for Nova Scotians

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Proactive Health Care

surgical suite

Dr. Michael Schmidt (centre) in the operating room with former student Yaeesh Sardiwalla (left) and research coordinator Vera Lloyd (right).

Prescribing exercise to improve Nova Scotians’ health

By Melanie Jollymore

Health care providers in Nova Scotia may now prescribe daily exercise as part of health care, thanks to Exercise is Medicine Nova Scotia (EIM-NS), part of an international initiative to make exercise a go-to intervention for people with chronic disease.

“As much as 80 per cent of all disease in primary care is chronic, and preventable factors contribute to most chronic disease,” said project lead Dr. Jonathon Fowles, an NSHA-affiliated scientist and kinesiology professor at Acadia University in Wolfville.

“While many factors contribute to disease, physical activity is hugely important in prevention and management and with help, is something patients can do to take charge of their own health …. 30 minutes of moderate exercise a day reduces premature mortality by 30 to 40 per cent, while 75 minutes reduces it by 70 to 80 per cent.”

The result is added years of independent living for active Nova Scotians and could save at least $25 million annually for the province.

EIM-NS is a research and knowledge translation partnership involving NSHA and several universities, health professional associations and provincial disease care programs, endorsed by the Chief Medical Officer of Health. Its first step surveyed more than 600 health professionals in the province.

“Many health care providers reported moderate confidence in counselling patients on physical activity and low confidence in prescribing exercise programs,” said Dr. Fowles. “More than 80 per cent wanted more education.”

The EIM-NS partnership set out to teach providers how to appropriately counsel patients about physical activity and safely and effectively prescribe exercise, through a series of workshops, grand rounds, webinars and publications.

“Exercise in Medicine Nova Scotia is changing practice,” noted Dr. Fowles. “Providers’ attitudes and behaviours about prescribing exercise are changing and we have mobilized networks linking providers to fitness programs, professionals and facilities across Nova Scotia, to help patients follow through to become more active.”

Addressing cancer patients and survivors special needs

Research shows exercise reduces cancer recurrence risk and improves function, wellbeing and survival. However, cancer patients and survivors face such challenges as pain, muscle wasting and fatigue that make exercise difficult.

NSHA-affiliated scientist Dr. Melanie Keats and Cancer Care Nova Scotia have launched ACCESS* (Activating Cancer Communities through an Exercise Strategy for Survivors) to test the outcomes of an exercise program tailored to cancer patients’ needs.

“We’ll be comparing participants to a control group to see if the program reduces visits to the doctor’s office or emergency room, use of medications, or hospital stays,” said Dr. Keats. “If we can show that people are feeling and doing better, we will have a case for launching similar exercise programs for cancer patients and survivors across Nova Scotia.”

*ACCESS is funded by NSHA, the QEII Foundation, the Canadian Centre for Applied Research in Cancer Control and the Quebec Breast Cancer Foundation.

Protecting aging brains from anesthesia risk

Researchers at NHSA and Dalhousie University have teamed up to take a big-data approach to solving a common problem known as post-operative cognitive decline (POCD). This is a sudden drop in cognitive function that can occur in older patients after general anesthesia, particularly if they already have any issues with cognition—such as attention, working memory, processing or planning—or other vital brain functions.

“We are creating tools that will help us to assess people’s risk of POCD before surgery, and to investigate whether any post-operative cognitive changes are linked to the surgical/anesthesia variables routinely monitored during the surgery,” said project co-lead Dr. Gail Eskes, an NSHA-affiliated scientist and professor of psychiatry and psychology and neuroscience at Dalhousie.

“More information on risk and outcome can help patients make better-informed decisions and potentially identify ways that surgery and anesthesia protocols can be adjusted and monitored to minimize the risk.”

Dr. Eskes is working with anesthesiologist Dr. Michael Schmidt and other researchers in the Department of Anesthesia, as well as computer science professor Dr. Stan Matwin, to develop these tools. A grant from the NSHA Research Fund enabled the researchers to first demonstrate the feasibility and sensitivity of the Dalhousie Computerized Attention Battery (DalCAB, a series of tests Dr. Eskes’ team developed to measure various cognitive functions) to detect small changes after surgery.

Now the researchers are conducting a larger study with 50 more surgery patients. By comparing the cognitive performance of these patients to that of a large control group of people who are not undergoing surgery, they aim to confirm what cognitive changes are occurring and what factors about the patient, the type of surgery and the anesthesia are influencing these changes. This study is funded by the Centre for Aging and Brain Health Innovation, based in Toronto.

“Huge amounts of data are collected during surgery… our computer science collaborator, Dr. Matwin, is working on machine learning algorithms that will collapse this into meaningful information that will allow us to identify what factors play the biggest role in risk for POCD,” noted Dr. Eskes. “Our goal is to create tools that hospitals around the world could use to identify patients at risk and optimize assessment and intraoperative protocols to best protect people’s brains.”