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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