Dr. Blair Bigham:
I'm Blair Bigham.
Dr. Mojola Omole:
I'm Mojola Omole. This is the CMAJ podcast. Today, Blair, we are talking about exercise and depression…
Dr. Blair Bigham:
Specifically exercise as a treatment for depression.
Dr. Blair Bigham:
And from what I've been reading online, because I'm terminally online, there's actually some controversy with this concept that exercise can be used to treat depression, but it seems like it's not.
Dr. Blair Bigham:
Well, I am a little bit skeptical I mean,
Dr. Mojola Omole:
Why are you skeptical?
Dr. Blair Bigham:
Well, first of all, what is exercise? I want to ask specifically like I mean, if I go for a walk around the block, does that count or do I need to run a marathon? What would count as exercise? And then also just get into the nitty-gritty of how do you actually prescribe exercise? Are you sending somebody to a gym? Are you sending somebody to climb their own stairs three times a day? I don't know. I'm a little skeptical that you can just tell someone to up their activity and in the midst of their depression they'll just be like, "Sure, no problem. Let me go do that."
Dr. Mojola Omole:
And I also think that with people having concurrent health problems such as obesity, how would that be received by the person? If you're a person in a larger body and you're like, "I'm depressed, this is what's going on," and they're like, "Well, go exercise," could that be seen as fatphobic or dismissive of their symptoms?
Dr. Blair Bigham:
It sounds dismissive, like, "Oh, well you just need to lose weight. You just need to walk more,"
Dr. Mojola Omole:
Which is what we usually do as physicians.
Dr. Blair Bigham:
Yeah. So we're going to start off by speaking to one of the co-authors of the practice article, and then we're going to speak to an expert in motivating people with depression to up their movement.
Dr. Mojola Omole:
Movement is medicine.
Dr. Blair Bigham:
That's coming up on the CMAJ podcast.
Dr. Mojola Omole:
Dr. Nicholas Fabiano is the co-author of a practice article in the CMAJ entitled "Exercise as treatment for depression." He's a second-year psychiatry resident at the University of Ottawa. Nicholas, thanks so much for joining us today.
Dr. Nicholas Fabiano:
Yeah, thank you for having me.
Dr. Mojola Omole:
So the first question is, how effective is exercise at treating depression?
Dr. Nicholas Fabiano:
So there's been a lot of different studies that kind of look into this question. A lot of different individual studies, a lot of different meta-analyses, which is essentially where you put studies together, and what the evidence has shown is that exercise is similar to the effects of antidepressants and psychotherapy for depression. The caveat to that being is a lot of these populations are sometimes more focused on those that are attuned to doing exercise and stuff like that. So we have to be careful about overgeneralizing to everyone and especially with the severity of depression too, because you can imagine that if someone is severely depressed, getting them to exercise, whether that be run or lift weights, may not be as possible or feasible. Whereas with someone with mild or moderate depression, it might be easier and that's where you might see the sustained benefits. So again, just to reiterate, the studies have shown that it's similar, but again, it's in those specific circumstances. So it's important not to overgeneralize and apply it to all situations.
Dr. Blair Bigham:
How do you compare a drug, which has a dose, to exercise, which is sort of a more nebulous concept? Is there a set amount of exercise that seems to be effective or a type of exercise?
Dr. Nicholas Fabiano:
Yeah, so it's tricky. In the exercise literature, again, it's hard to do it as specifically as a medication like you said, when there's a drug dose or frequency. But you can have stuff similar in the exercise literature by breaking the exercise down into its constituent components as well too, as much as you can. So sometimes we like to do that using the FITT principle, so that's FITT: frequency, intensity, type, and time. And that essentially breaks the exercise down into similar dosing a drug and stuff like that, and it makes it easier for clinicians to speak to patients about it. So to go through that for frequency, you would look at that and say, how many times a week is it realistic for a patient to be engaging in this exercise? Oftentimes it's quoted that three to five times per week is what you aim for, but that's not always realistic for everyone. So we always say less or any exercise is better than none. So that's a starting point there. In terms of the intensity, that's similar to the dosage of a drug and how we separate that is usually into mild, moderate, and vigorous intensity for the exercise. That one, there's a lot of different ways to break that down in terms of how that's defined, but the easiest way to explain it to a patient would be something called the talk test. So essentially what you say is if you're able to do the exercise and have a full conversation, you can even sing or something, that's probably mild exercise. If you're getting a little bit more up there and you're having trouble, you can't maybe sing, you can still talk, but it's getting a little bit more difficult. That would be something that's more moderate. And then vigorous is when you're going so intensely that you couldn't even sustain a conversation, you need to just focus on what's in front of you. Then the other two parameters in the FITT model are the two last T's. So there's the timing. So how long are you exercising for? Again, we aim for 45 to 60-minute sessions, but we don't need to kind of attain that, and it's kind of working with the patient to see how long can they exercise, what can they tolerate, can they work up to it? And then the last thing is the type of exercise. So obviously there's a lot of different exercises that you can have, but to simplify it, we put them into different categories. So there's aerobic exercise such as running, there's resistance training, which would be more of your traditional kind of weightlifting at the gym. And then there's more of the mind-body, and that encompasses a large body of exercise such as yoga, tai chi, and stuff like that. And those are the big three main themes, and that's how research has divided stuff into as well too. Otherwise, like you said, exercise becomes too much of this big clump of this term "exercise," but what does it mean? So it's important to define it by that. So that number one, for the patient, they understand. And number two, for research, you can delineate different properties.
Dr. Mojola Omole:
What is the aim to get patients to? Maybe not where they start at, but what is the aim that we should be aiming them to get to?
Dr. Nicholas Fabiano:
So using that model, the general recommendations for antidepressant effects would be we'd aim for three to five sessions per week of 45 to 60 minutes of moderate to vigorous intensity, more for middle-aged adults. As you get older, the intensity level requirements for antidepressant effects actually go down a little bit. That's because of changes in how your body kind of works. And vigorous intensity exercise, as per some recent meta-analyses, actually shows that it isn't as effective as going down a step into more of the mild to moderate. So it's important to take that into consideration and we're not overarching and saying that we need to apply this to everyone, but it's specific to patient populations. So that's what we aim for. But the important part is sometimes it can be very overwhelming for a patient if they come into the office and you say, "I want you to do this three to five times per week at an hour a time," and someone's looking at their schedule, they're like, "Wow, I get off work at 9:00 PM I have one hour of free time." If we set that up too early, it might shut them down completely and they won't engage at all. So my thing that I like to emphasize is always just saying some exercise is better than none, and some things that you wouldn't even think are exercise can still count. So some more passive forms of exercise are just walking to different places rather than taking a car if it's close or something like that and incorporating it into your daily life. Because sometimes the notion is that I need to take an hour or two interval to go to the gym, get changed, have all this. It's a whole process and it's not realistic for a lot of people. So I think emphasizing that any starting point is great and working up there and not being too fixed on the goal. Yes, the literature shows a lot of that, but again, emphasizing that if we can get moving, that's the best goal and getting that patient motivated.
Dr. Mojola Omole:
And what do we tell patients in terms of the effectiveness of the exercise as a treatment compared to pharmacology or psychotherapy?
Dr. Nicholas Fabiano:
So in terms of the effectiveness, again in mild to moderate, it has similar effects. And the thing is it can even have more immediate effects than an antidepressant medication. As we speak to patients, sometimes the antidepressant medications, we tell them it takes four to six weeks even sometimes to start noticing some big changes in their mood, whereas exercise even immediately after you might feel transiently better and it gets the momentum going. It also helps with that social aspect of the depression where sometimes people that are depressed, they become more socially isolated, they stop involving themselves in activities. So exercise by proxy can also be good to get people back into things. So whether that be through group sports, whether that be through group fitness classes, and that in itself can help with that. But in the same breath, I would never want to withhold medication treatment or psychotherapy from a patient if that is what they are interested in as well too. The goal of exercise is just adding that as another treatment option for the patient because some people maybe are really interested in trying it, but it's important that they have a realistic expectation for that as well too, because sometimes exercise just like antidepressants or psychotherapy won't be all that's required to help with that depression. They may need some more help as well too.
Dr. Mojola Omole:
So as a psychiatry resident, how much instruction or how much teaching do you guys have regarding using exercise as a form of treatment compared to other therapies?
Dr. Nicholas Fabiano:
Yeah, so I think to even go a little bit further back with that question to going to medical school, even. For myself, there was no formal implementation of how to teach exercise or the benefits of exercise. We very superficially touch on it throughout medical school. Obviously, we all know the benefits of physical activity from a physical and mental health perspective, but rarely do we get into the details of how do I actually go about prescribing this as a physician or similar to what we spoke about before in terms of what dose should I prescribe, how often should I be prescribing this, who is the best fit for that? So I think where we fall short in both medical school and residency is we speak superficially about the benefits and how it could be a treatment option, but we're missing the link in terms of incorporating that into practice and having proper skills in terms of how to talk to a patient. Because in residency for psychiatry, we learn a lot of interview skills in terms of diagnostically figuring out what's going on. We do therapy training, psychotherapy, CBT, stuff like that. But we don't have formal, even a small session on exercise counseling to have maybe a standardized patient or someone to talk to because I think it's a very uncomfortable topic for some people to discuss. If it's not something that you are actively doing yourself, you are going to think that maybe the patient knows more than me and when they ask me a question, I'm not going to have an answer for them. So sometimes it's a topic that people avoid discussing at all, and there is research to show that physicians in general, particularly family physicians too, if they're engaging more in exercise and some of these activities, they're more likely to discuss this with their patient as well too, which shows it's important. And I don't think it's a fair expectation to expect all family physicians to exercise and stuff like that because maybe you're not interested. Maybe you have a physical condition that doesn't permit that. I think the onus is on the education going into it because we do know how beneficial exercise is, and again, to emphasize beyond just mental health, but also physical health. So being able to have those skills to talk to your patient openly about it is very crucial.
Dr. Mojola Omole:
Why can't we consider exercises first-line treatment for mild to moderate depression?
Dr. Blair Bigham:
Yeah, the evidence seems so good.
Dr. Nicholas Fabiano:
Yeah, so right now actually in the CANMAT guidelines for psychiatry, it is one of the first-line monotherapies for mild to moderate depression. And that's something that not a lot of people actually are aware of, even in the field.
Dr. Blair Bigham:
That's in a guideline?
Dr. Nicholas Fabiano:
Yeah, in the CANMAT guideline. Yeah, so not a lot of people are actually aware of that. Again, for mild to moderate, not for severe, but it's something that people I think are not as comfortable with because when you stray away from what is the norm, if all of your peers are prescribing antidepressants or psychotherapy as first-line, and you feel that your only options are the two, especially as a resident or during training, if you're to suggest something that seems out of the box because it's not necessarily standard of care or perceived to be standard of care, it's something that's just not explored. So despite it being in the guidelines, I think there's a disconnect. Again, going back to the teaching part, whereas I don't have a stat for this, but I imagine if you spoke to a lot of different residents or people in training or medical students, they wouldn't be aware of that guideline recommendation for exercise.
Dr. Mojola Omole:
What are some of the things physicians should consider before prescribing exercise?
Dr. Nicholas Fabiano:
So the biggest thing in terms of what you should consider before prescribing exercise for mental health is does the patient want to do this? Because if they're not open to it at all, maybe now is not the time to recommend it because ultimately the biggest predictor for exercise adherence is going to be that motivation of the patient themselves if they actually enjoy what they're doing because it gives them that sense of control. But other factors to consider as well too, from more of a safety perspective, would be, does this patient in front of me have any comorbid medical conditions that may preclude a safe prescription of exercise? So obviously the list is not exhaustive, but if your patient has different cardiac conditions or respiratory conditions that may predispose them to injuries or medical emergencies, then they need to be worked up properly, referred to appropriate specialists. And these are the patients that we would also heavily recommend are exercising in a supervised setting rather than unsupervised for many reasons from a safety perspective, but also to kind of allow them not to be demotivated if they're having issues because of that medical condition.
Dr. Blair Bigham:
What do you mean when you say a supervised setting? Like in a gymnasium or with a physical trainer? That's starting to sound expensive.
Dr. Nicholas Fabiano:
And that is a realistic thing as well too. So there's different levels of supervision. Like you said, going to the gym and having a personal trainer, it's not a cheap thing too. So if it's not accessible to a patient, unfortunately, that's something that hopefully we can work towards as physicians to lobby for and be able to make this something accessible. And also other things like having a kinesiologist or physical therapist be there to help them through exercise. Again, it's not something that's very cheap or accessible to all, but if it's something that is available, that's something that we would recommend. But we need to work on being able to make these things accessible to everyone. Otherwise, if we're making this recommendation of exercise, it becomes something that is unfairly offered or it's put on the table, but it can only be accepted by people that are able to. And it's beyond money too, because time is a big factor too.
Dr. Mojola Omole:
I guess I'm thinking that we have cardiac rehab that is something that is publicly funded. It's covered in your OHIP that you can go to cardiac rehab. Then if it's in the guidelines for the treatment of mild to moderate depression, then it should be covered by OHIP. It should be that there is some sort of government OHIP-covered, whether it's a kinesiologist, exercise physiologist, that you should see.
Dr. Nicholas Fabiano:
No, I completely agree.
Dr. Mojola Omole:
Outside of depression, are there other psychiatric or mental health conditions where exercise could play a bigger role?
Dr. Nicholas Fabiano:
Beyond the benefits of exercise for depression, I've done some work with my colleagues here at Ottawa in terms of the benefits of exercise for suicide as well too. So an important feature, because suicide is a component of depression, people have passive suicidal thoughts. Sometimes these progress to active suicidal thoughts and unfortunately lead to attempts and completed suicides. So we've done two reviews on the topic and interestingly found that exercise led to a decrease in suicide attempts. This was mostly for all people with mental and physical health together, but the large body of it was people that had depression. So we saw that it reduced suicide attempts, but interestingly, there wasn't a change in suicidal ideation. So those thoughts of suicide or the absolute deaths due to suicide. Now that might be due to kind of low sample sizes on either end, but the other interpretation of that is there's something called the ideation to action framework, and that says that there's different factors that go into someone developing suicidal ideation or going on to have a suicide attempt, and sometimes they can be individual to one another. And there's literature to show that exercise can reduce one's emotional impulsivity such that it may reduce these spontaneous suicide attempts where someone's feeling emotionally overwhelmed in response to a stimulus. However, it might not necessarily be protective against the more serious planned-out attempts that someone's set a date, they have a plan sort of thing. So it's an area of literature for exercise that's still growing. We still need more research, but I think it's very promising from a public health perspective when we see suicide rates that are increasing to have different preventative measures that can be on a large scale.
Dr. Mojola Omole:
That's great. Thank you so much.
Dr. Blair Bigham:
Thank you.
Dr. Nicholas Fabiano:
Alright, thank you.
Dr. Mojola Omole:
Dr. Nicholas Fabiano is a second-year psychiatry resident at the University of Ottawa Department of Psychiatry.
Dr. Blair Bigham:
Dr. Fabiano's article recommends physicians reference a practical guide for exercise for people who have depression. It was written by Dr. Michelle Fortier and colleagues. You'll find a link to it in our show notes, but we're going to save you a bit of time by speaking directly with Michelle. She joins us from the University of Ottawa where she's a physical activity psychologist and professor at the School of Human Kinetics. Michelle, thank you so much. Welcome to the show.
Dr. Michelle Fortier:
It's my pleasure.
Dr. Blair Bigham:
Let's pick up where we left off with Nicholas. A family physician has a patient who's depressed sitting there in the office. They've read Nicholas's article and they want to prescribe exercise. What's the first step?
Dr. Michelle Fortier:
The best thing the physician can do is ask the patient if they've done physical activity in the past, if there's something that they enjoy doing, and then encourage them to try and start doing that. Even just 10 minutes can make them feel better. So that's pretty much what the physician could do, but I really recommend referring to a kinesiologist because to get people to change their behavior, it's very difficult and they need a lot of help. Actually, everybody needs a lot of help to move. It's very difficult to do. And depressed people have added barriers, obviously energy and low mood. They really need somebody to accompany them, and I really recommend that they work with a kinesiologist.
Dr. Blair Bigham:
I got a bunch of questions here. Let's start with the first one. What if a physician is there trying to motivate someone and the person just goes, "I'm just not up for exercise." Are there any tips or tricks that could get that person into a more receptive zone?
Dr. Michelle Fortier:
So I teach motivational interviewing. I'm not sure if you're familiar with that, but motivational interviewing is an approach that physicians or kinesiologists or any healthcare practitioner can use, and it's a very kind of patient-centered approach where you're having a dialogue with the patient, you're not imposing stuff. So what I usually recommend is that physicians ask permission to talk about physical activity. So would it be okay if we talked a bit about physical activity today? I'd like to see what you've done or if that's something you're open to discuss or open to try for your depression. And then if the patient's not willing, I would say, we will talk about this at another time. If the patient is willing, then the doctor can get into a bit more like, what have you done in the past? What do you enjoy doing? What do you think you might be able to do in the next few weeks? Getting into realistic goals for the patient, but asking permission is a very good strategy for any healthcare provider because it creates a fertile ground for discussions, like productive discussions around behavior change.
Dr. Blair Bigham:
And then in terms of getting them set up with someone like a kinesiologist, what's the process for that? I assume it's not covered by provincial health plans, is it?
Dr. Michelle Fortier:
Well, actually, so I have different lines of research. One of them is looking at physical activity on mental health, including depression, which was the article that you were referring to. My other line of research is actually integrating kinesiologists into primary care. So in Ottawa, there are actually five primary care practices. Some of them are family health teams, some of them are community health centers that actually have kinesiologists on the primary care team. So that is the way to go because the people that really need help are often people that can't pay for a kinesiologist. It's people that have a lot of barriers. And so having the kinesiologist embedded in the medical practice is the way to go. And so this is starting, I actually did a trial where we integrated kinesiologists into primary care practices and we showed that the practices that have kinesiologists, actually the patients are more motivated and feel more confident to do physical activity, and they also move more.
Dr. Blair Bigham:
So they're almost acting as a coach.
Dr. Michelle Fortier:
I don't love the word coach just because kinesiologists are not coaches. They have a different kind of line of expertise. But one term that we do use and that's used in the literature is either a registered kinesiologist or also we'll often call them physical activity counselors because basically what they do is counsel the person about physical activity, and it's not telling them what to do at all because it's very much based on motivational interviewing. So they work together collaboratively to find solutions to barriers that the patients have. And so in Ottawa, we have clinics that actually have kinesiologists there, so the patients don't have to pay for the kinesiologist. The kinesiologist is part of the medical team.
Dr. Blair Bigham:
And this is a different role than, say, an occupational therapist or a physiotherapist?
Dr. Michelle Fortier:
Absolutely. So physiotherapists deal mostly with injury and rehabbing after injury. Occupational therapists have a much broader scope of practice. Kinesiologists are specialists in movement. They learn about how the body moves, and they're the specialists. And we have a college in Ontario, a College of Kinesiology, that the students write an exam and they get recognized by the College of Kinesiology similar to the College of Physicians, similar to the College of Physiotherapists. It's very similar.
Dr. Blair Bigham:
So it's a regulated health profession, at least in Ontario.
Dr. Michelle Fortier:
Absolutely. It's not a weekend course. They're trained.
Dr. Blair Bigham:
Moving back into that primary care practice, what sort of follow-up should a physician or nurse practitioner do with a patient after they've set them down this pathway?
Dr. Michelle Fortier:
So for instance, if they've just talked to them about physical activity or if they've referred them?
Dr. Blair Bigham:
Let's say they've referred them and they've set them up with, fortunately, they have access to a kinesiologist or they say, "Yes, I'm going to go in and take on this exercise." What type of follow-up comes next?
Dr. Michelle Fortier:
So I would think if there's no kinesiologist involved, the physician should follow up probably three, four weeks later to do a check-in with the patient to see what happened. How did it go? Because with behavior change, whether it be physical activity or smoking cessation, people, they have a lot of setbacks and that's completely normal. But the doctor needs to come back and say, "Okay, that's very normal that you weren't able to do it. Let's talk about your barriers." But again, it's a very involved process. So I'm not sure the doctors have time for that follow-up. If they refer the patient to the kinesiologist, well, the kinesiologist is the one that does the intensive physical activity counseling, checking in with the person, seeing them regularly early on, and then slowly tapering off how often they see the patient so that they can become independent and exercise on their own. But that can take a long time.
Dr. Blair Bigham:
What are some pitfalls that family doctors need to avoid when they're considering prescribing exercise to someone who has depression?
Dr. Michelle Fortier:
Telling them what to do. "I want you to start walking every day. I want you to walk briskly." Telling them what to do does not work. They need to have a collaborative conversation with the person. "What do you like to do? What are your hobbies?" Because there's so many different physical activities. Walking is obviously a good one, but not everybody loves that. People don't like to be told what to do. They need encouragement. So I think being very empathetic and saying, "I know you're struggling and it's very tough with your depression and you don't have a lot of energy." Another technique that they could use that I love and that works really well is what we call a "commit 10." So the doctor could say, "I know you're struggling a lot. I really think that physical activity could help you feel better. Do you think that you might be able, in the next two weeks, to find 10 minutes to go out on a sunny day and walk just for 10 minutes?" Patients will rarely say no to that, right? Because it’s 10 minutes over two weeks, it's not a hard thing to ask the patient. So that's step one. Step two is the doctor or the kinesiologist would say, "That's great. What I want you to do is when you go out and you go for your walk, once your timer rings and it's been 10 minutes, I want you to, if you're feeling as good as you were initially or better, you can continue if you want. If you're not, then I want you to stop and try another day." And the reason, the purpose of that is, with everybody but especially individuals with depression, we want them to have a positive association to physical activity. So many people have negative associations to physical activity because they weren't good in phys ed or they played a competitive sport and had a horrible coach. And so they have a negative bias towards physical activity. What we're trying to do with the "commit 10" is get people to realize that when they go out and they walk, even just for 10 minutes, they're going to feel better. They're going to have a hike in their mood, and you want them to have positive experiences as much as possible so that they become more motivated to do it. Because if they do it and they enjoy it, they will want to repeat it. There's tons of science showing that when people are intrinsically motivated to do an activity, then it's easier for them to go back and do another walk or another bike or another yoga class or something like that. So enjoyment is hugely important for everybody, but specifically for people that have depression because they have a lot of low mood and lack of enjoyment in their life. So enjoyment is really important. That would be, probably, my key thing.
Dr. Blair Bigham:
So it's not about cracking a whip.
Dr. Michelle Fortier:
Absolutely not. Absolutely not.
Dr. Blair Bigham:
Got it.
Dr. Michelle Fortier:
They do not have to do a triathlon or a marathon. They just have to move, even just 10 minutes. And I really feel that the best practitioner to help them is a kinesiologist and that they should be embedded in primary care practices, and I'm working on that.
Dr. Blair Bigham:
Wonderful. Well, Michelle, thank you so much for joining us today.
Dr. Michelle Fortier:
Awesome. Thanks so much.
Dr. Blair Bigham:
Dr. Michelle Fortier is a physical activity psychologist and professor in the School of Human Kinetics at the University of Ottawa.
Dr. Blair Bigham:
Alright, Jola, easier said than done maybe, but what do you think?
Dr. Mojola Omole:
I think for me, definitely, it makes sense. I am hesitating because I do think it's quite difficult to have these conversations with people with the current structure of how primary care practitioners, especially family physicians, are being paid. This is not conducive to that. What I do love though, is the concept of just movement is medicine. I share a story, and I think I shared it with you guys previously, about a patient of mine who was having some difficulties. And aside from what I saw her for, I was just like, "Well, what do you enjoy doing?" I'm like, "Do you love dancing?" And she's like, "Yes." And I'm like, "Well, what kind of music do you like?" She says she loved gospel music. So I was, "Well, why don't we commit to doing 10 minutes, 15 minutes every day of just worshiping and praising God and dancing." And she was able to actually stick to that and increase it up. And she's had quite a bit of changes that she needed to have metabolically. And so I do think that we have an important role in terms of talking to our patients whether it's about mental health, low to moderate depression, or other things, of viewing movement as medicine and not viewing it as, "Well, if you can't do it, then therefore it's your fault that you're this way."
Dr. Blair Bigham:
Yeah. Whenever I hear motivational interviewing, I sort of shudder because I think, "Oh my goodness, that's going to take forever." But your story demonstrates sometimes we can just in a very short period of time, get a little bit of motivation figured out. I think to my days in the ICU and how we try to learn more about people and their values and their families, particularly when things aren't going very well, and it's looking more and more likely like they might die. And yeah, we don't have a lot of time to have those conversations, but finding space and finding ways to have them, brief as they might be, can pay dividends for future conversations as you build that rapport and build that understanding of what makes people tick. But again, with the system collapsing and family doctors overworked like there's no tomorrow, how you even find those few moments to figure out what somebody might find joyful just seems so challenging.
Dr. Mojola Omole:
I think though that the answer is having more integrated healthcare like family medicine teams. It would help in managing mental health, but also just a host of other issues that come up where you need a pharmacist, you need a kinesiologist, you need the physiotherapist. And having a model of healthcare that is integrated would make such a huge difference in terms of just joy in practicing for family physicians to be able to focus on what family medicine is supposed to be focused on, but then also just improve patient care and improve mental health, cardiovascular disease, metabolic diseases, everything else, when you have an integrated model, because our current model isn't working.
Dr. Blair Bigham:
And movement really does touch on every organ system at the end of the day, it's not just depression.
Dr. Mojola Omole:
A hundred percent. So with that note, we probably should get out there and get some movement in. I need to go for my daily walk.
Dr. Blair Bigham:
Let's go. That's it for this episode of the CMAJ podcast. While Jola and I are out for a walk, we'd love if you could go ahead and give us a five-star rating wherever you get your podcasts. Share it with your networks, leave a comment, and help us get the word out. The CMAJ podcast is produced for CMAJ by PodCraft Productions. Thank you so much for listening. I'm Blair Bigham.
Dr. Mojola Omole:
I'm Mojola Omole. Until next time, let's keep moving.