Summer 2022 (Volume 32, Number 2)

CRA Great Debate 2022:
Be It Resolved That the Rheumatology Healthcare Provider is Responsible for Prescribing and Monitoring Physical Activity

By Volodko Bakowsky, MD, FRCPC, on behalf of
Arthur Bookman, MD, FRCPC;
Marie Clements-Baker, MD, FRCPC;
Claire LeBlanc, MD, FRCPC; and
Laura Passalent, PT, BScPT, MHSc, ACPAC

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There was great anticipation and enthusiasm that the CRA Great Debate would once again be held in front of a live audience. The debaters had all signed on with this expectation. We were vaccinating ourselves out of the pandemic and life was going to be getting better… except it didn’t really work out that way. A variant called Omicron disrupted the world and threw a wrench in our meeting plans. “Live” reverted once again to “virtual.”

The debaters all shared an interest in exercise and fitness. Unsurprisingly, each one of them wanted to debate in favour of the motion. However, after a combination of cajoling and thinly veiled threats from the debate chair, the general good nature of the debaters shone through and allowed for mutually satisfactory final teams. On the “for” side” were Laura Passalent and Dr. Claire LeBlanc, and on the “against” side were Drs. Art Bookman and Marie Clements-Baker. Pre-meeting, the Las Vegas bookies had the “for” side listed as 3:1 favourites.

Advanced Clinician Practitioner in Arthritis Care (ACPAC)-certified physiotherapist Laura Passalent started off the debate in favour of the motion. She outlined the 2018 European Alliance of Associations for Rheumatology (EULAR) recommendations for physical activity for people with arthritis and followed this up with several systematic reviews demonstrating the beneficial effect that physical activity has on many of the symptoms that our patients with rheumatic disease suffer from. Her final point was that most rheumatology practitioners are already assessing and recommending physical activity for their patients and emphasized that patients are more likely to adhere to recommendations when their rheumatology practitioners are involved in physical activity prescription and monitoring.

Next up was distinguished professor, Art Bookman. He painstakingly had tabulated the total amount of time in a rheumatology residency allocated to exercise rehabilitation education. The computational analysis came back with the result of ZILCH! He further pointed out that rheumatology “thought leaders” such as Philip “Darth Vader” Baer and Janet “Cat Woman” Pope possess many talents, but anything resembling credibility in the domain of exercise therapy is not among them. Although there are some rheumatology healthcare providers, such as ACPAC-certified therapists, who do indeed possess the necessary expertise, there are far too few of them to satisfy demand, which would result in a care gap that cannot be filled by rheumatologists.

The second speaker for the “for” side was Claire LeBlanc. She first went over the ways that exercise has been shown to be beneficial for the treatment of pediatric rheumatologic disorders. She then shredded the nihilism of the “negative nellies” with the message that barriers are not insurmountable, and “Behaviour change is more likely with our support!” She closed her thesis by wearing a hockey helmet and mouth guard, an image that I suspect cannot be unseen.

“New Granny” Marie Clements-Baker had the anchor leg of the debate. She pointed out that half of rheumatologists in a recent survey reported that they are burned out. Furthermore, the leading factor contributing to burnout was reported to be “too many bureaucratic tasks.” While she agreed that regional programs should support physical activity, no one should be asking rheumatologists to do it! With all the arguments in, it was time to go ahead with the vote. In a moment of great surprise to the debate chair, as well as the Las Vegas bookies, the motion was voted down “like a boss!” The good sport and collegiality of the debaters, however, was a dead draw.

Claire summed up the spirit of the debate best when she said, “These last two years have been so difficult for everyone, I just wanted so badly to make people laugh and give them a moment of joy.” I think in that regard, the “exercise” was a success!

Volodko Bakowsky, MD, FRCPC
Interim Division Head/Chief, Associate Professor,
Division of Rheumatology, Department of Medicine
Dalhousie University, Halifax, Nova Scotia


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