Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 38 - Evidence - June 17, 2015
OTTAWA, Wednesday, June 17, 2015
The Standing Senate Committee on Social Affairs, Science and Technology met this day, at 4:40 p.m., to continue its study on the increasing incidence of obesity in Canada: causes, consequences and the way forward.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I am Kelvin Ogilvie, chair of the committee, from Nova Scotia. I will ask my colleagues do introduce themselves, starting on my left.
Senator Eggleton: Art Eggleton, senator from Toronto and deputy chair of the committee.
Senator Raine: Nancy Greene Raine from B.C.
Senator Enverga: Tobias Enverga from Ontario.
Senator Stewart Olsen: Carolyn Stewart Olsen, New Brunswick.
Senator Seidman: Judith Seidman from Montreal, Quebec.
The Chair: Thank you, colleagues. I remind us that we are continuing our study to examine and report on the increasing incidence of obesity in Canada: causes, consequences and the way forward.
We have two witnesses before us today. Before I invite them to present, I want to remind us that regardless of our delayed start because of the vote in the Senate Chamber, this meeting will end no later than 6:15 p.m.
With that, I will get right into it. Since there wasn't any argument over who would go first, I will go according to the list on the agenda. In that case, I will invite Dr. Kirstin Lane, Core Faculty and Member of Special Projects Task Force for the Canadian Society for Exercise Physiology.
Ms. Lane, please go ahead.
Kirstin Lane, Core Faculty and Member of Special Projects Task Force, Canadian Society for Exercise Physiology: Thank you, Mr. Chair and committee, for asking the Canadian Society for Exercise Physiology here today. I applaud all of you for tackling a health issue that touches on the lives of too many Canadians.
You have had numerous experts and stakeholders from a range of health sectors speak you about the incidence and causes of obesity, with recommendations on the ways to move forward. Several of these presenters, Dr. Mark Tremblay, Dr. Ian Janssen and Dr. Jonathon Fowles, are also distinguished members of CSEP. I am someone who is in the trenches, preparing our next generation of exercise professionals.
Today I will speak to you about the role of physical activity in the treatment of obesity, and CSEP's leadership in research education and practice. In doing so, I do not want to minimize the importance of preventing obesity. This is crucial if we are to make a dent in obesity rates. In fact, as you may have heard, last Tuesday, ParticipACTION released the annual Report Card on Physical Activity for Children and Youth, and we received a D minus in overall physical activity and sedentary behaviours. This is a failing grade. We as parents, educators and society need to rethink physical activity opportunities in and out of the school system.
Aristotle said the whole is greater than the sum of its parts, and that could not be more evident in the treatment of obesity. Best practices in managing unhealthy weights echo Aristotle's wise words. The research tells us that a lifestyle intervention, including dietary advice, behaviour modification and physical activity support, is greater than the sum of its parts. More lasting and significant results occur when a person with an unhealthy weight has access to an interdisciplinary health care team.
The value of physical activity is that health benefits can be achieved even in those who are defined as overweight or obese. To borrow from the renowned exercise scientist Dr. Steven Blair, you can be fit and fat. Research tells us that even when people are classified as normal weight, overweight or obese, those with the longer life expectancy did more physical activity than those who were sedentary. Some physical activity is better than none; more physical activity is better than some.
Founded in 1967, CSEP is a not-for-profit organization composed of professionals interested and involved in the scientific study of exercise physiology, fitness and health. With over 5,000 members, our mission is to be the resource and voice for exercise physiology, health and fitness, providing leadership in research, education and practice to improve health outcomes for Canadians.
One of our key initiatives, which you've already heard about, is Exercise is Medicine Canada. The work they're doing is to have physical activity be an integral part of the prevention and treatment of chronic disease in the Canadian health care system.
The work of CSEP and its members contributes to the international voice for health and fitness issues; for example, CSEP released updated the Canadian Physical Activity Guidelines for children, youth, adults and older adults. And we're the first to ever produce guidelines for the early years.
At the same time, CSEP released Canadian Sedentary Behaviour Guidelines for early years, children and youth. Why is limiting sedentary behaviour important? We are learning now about the health consequences of being an "active couch-potato." This is the person who is classified as active because they do 150 minutes of physical activity per week as the guidelines recommend, but are pretty much sedentary the rest of the time. Research has shown a direct connection between increased sedentary time and decreased fitness, poor self-esteem, weak academic performance and obesity. Meeting the physical activity guidelines is good. Meeting the physical activity guidelines and reducing sedentary behaviour is better.
Recognizing that a more integrated and inclusive strategy may better address this health crisis, CSEP, along with partners, is developing the first-ever Canadian 24 Hour Movement Behaviour Guidelines for Children and Youth. This one guideline will recommend physical activity, sleep time and limits to sedentary time.
Now I would like to speak to the value of the qualified exercise professional in the Canadian health care system. Consider for a minute the patient that is becoming all too familiar in a physician's office. He or she has an unhealthy weight, is being treated for Type 2 diabetes and is at risk for heart disease. Sadly, we are seeing this now in young adults.
While physical activity is an over-the-counter prescription for many, this scenario demonstrates that some prescriptions can be complex. Complex health conditions require guidance from a professional with a post-secondary education in the exercise sciences to ensure a safe, evidence-based physical activity prescription — guidance from a professional who has taken course work in behaviour modification theories in order to lead clients through lifestyle changes that are meaningful and lasting.
CSEP certifications are the gold standard in the industry because we are the only ones directly affiliated with the scientists who are experts in the field, and we require that our applicants have post-secondary training and have passed a national board examination. Essentially, CSEP-certified members have the knowledge, skills and abilities to provide Canadians with evidence-based and client-tailored exercise programming advice for complex health conditions like obesity.
So how can CSEP assist in the fight against obesity?
CSEP can lead the development of the physical activity guidelines for the obese. The intent of the 2011 Physical Activity Guidelines was to reduce the risk of developing common chronic conditions and all-cause mortality. Obesity was not included at the time of the development of the guidelines because of the systemic review and the overwhelming evidence that were required. Safe, evidence-based, easy-to-understand physical activity guidance is needed for Canadians with unhealthy weights. Specific guidelines are also needed for other common chronic conditions like heart disease, diabetes and cancer.
CSEP can provide ongoing expertise in the development and revision of our current physical activity and sedentary behaviour guidelines. We recognize that sedentary behaviour guidelines for adults and older adults are needed. We also plan to do a revision of the guidelines in 2016 to reflect the growing evidence.
CSEP and partners like ParticipACTION can provide effective promotion. A national awareness campaign is needed so that all Canadians are aware of our guidelines. This is essential to successfully influence societal change and improve health outcomes.
Finally, CSEP prepares qualified exercise professionals and, with Exercise is Medicine Canada, can promote their value as part of the health care system. Our members are qualified to work with complex health conditions that are not nationally recognized within the health care system.
It is time to bridge the gap between the exercise professional and the medical community. Giving qualified exercise professionals recognition similar to how a registered dietitian physical therapist is perceived would positively impact the overall health of Canadians.
All of the above requires significant funding and a partnership approach in order to be successful. Making a dent in the obesity rates and increasing the health of Canadians would translate into major cost savings to the health care system. We believe that CSEP can make a significant contribution to obesity rates and the health of Canadians due to our unique mandate in providing leadership and physical activity research, education and practice.
Thank you for your consideration and your attention.
The Chair: Thank you. I will now turn to Elio Antunes, who is President and CEO of ParticipACTION.
Elio Antunes, President and CEO, ParticipACTION: Thank you for inviting ParticipACTION here this afternoon. For 45 years, ParticipACTION has been synonymous with physical activity in Canada. In 1971, our job, with the help of the 60-year-old Swede, was to let people know we had a problem. By the 1990s, we were known for providing easy tips to keep fit and have fun with Hal and Joanne. In 2001, however, ParticipACTION closed its doors after a drop in federal funding and remained dormant until it was reinstated with a funding commitment in 2006-07. Since 2007, the new ParticipACTION has led a complex debate about the physical inactivity crisis in this country.
We have been effective in changing minds about what it means to be active in this country, and moving forward, our intent is to focus on changing behaviour.
As Kirstin mentioned, only 9 per cent of children meet the recommended Canadian Physical Activity Guidelines, and only 15 per cent of adults meet their guidelines.
Canadians of all ages are not moving their bodies enough to get the benefits of regular exercise. Again, as Kristin mentioned, research now shows that sitting too much is also bad for you, even if you are active enough the rest of the time. Recent research from the Conference Board of Canada also showed that if we can just get 10 per cent of Canadian adults to sit less and move more, we would reduce Canada's health care costs by $2.6 billion and inject $7.5 billion into the Canadian economy in only 25 years. We developed a number of campaigns and programs to bring this issue to light. Our most recent Make Room for Play campaign is our public awareness campaign to encourage families to reduce screen time in favour of increasing outdoor active play. Through independent research, we know that as a result of seeing the ads, almost 70 per cent of moms have intentions to change habits related to increasing their children's physical activity or reducing their children's sedentary behaviour.
In just one year, from 2014 to 2015, awareness of the Canadian physical activity guidelines for children and youth tripled, from 8 per cent to 24 per cent, amongst the general population, through messaging and our campaigns. Ninety-two per cent of Canadians believe that ParticipACTION does an excellent job at raising awareness on the importance of physical activity.
We have a number of programs that we implement across the country, but one in particular is Sports Day in Canada, which is a national celebration of the power of sport to build community and get Canadians moving, with over 2,000 events hosted by organizations, municipalities, schools and leagues in over 550 communities. Again, through independent research, we know that 15 per cent of all Canadians participated in at least one way in Sports Day. More important, though, 58 per cent of participants said that the initiative increased their intentions to be healthy and active, up from 43 per cent in 2010. This is not just a one-day event. This event has a lasting impact in communities. Twenty-eight per cent of organizations who hosted events and participated in Sports Day indicated that registration and participation in their local programs of sport and physical activity have increased as a results of local Sports Day.
We also strive to provide leadership to the broader sector. Ninety-three per cent of organizations agree that ParticipACTION is positively contributing to the sector in an effort to increase physical activity. An example of that is the release of the 2015 ParticipACTION report card that you'll have copies of. For the first time, we actually included an evidence-informed position statement on outdoor active play that finds that play in nature and the outdoors, even with its risks, is essential for healthy child development. That position paper was done as a collaborative effort of 15 other organizations working together.
In 2010, ParticipACTION and its advisory groups developed a physical activity strategy for Canada. After much consultation across the entire country, the result was Active Canada 20/20, a clear vision for the successful steps required to increase physical activity and reduce sedentary behaviour.
We have just completed a strategic planning process for the organization, and moving forward, our vision remains a Canada where physical activity is a vital part of everyday life.
Our mandate, however, is evolving. As Canada's premier physical-activity brand, ParticipACTION will help Canadians sit less and move more through innovative engagement initiatives and thought leadership. Our main goal in the next five years is to contribute to 10 per cent of Canadians sitting less and moving more.
We will do that through, as I mentioned, engagement initiatives that are measurable, relevant and compelling. The use of public awareness campaigns in the future will be directed at driving participation and engagement initiatives, rather than promoting awareness of the broader physical inactivity issue. One such activity that we are working on right now is targeted at increasing walking in adults in the workplace, a robust program that borrows from behavioural economics and employs tracking, nudges, incentives and supportive environments to get parents, who are their kids most important role models, moving more.
We will also continue on thought leadership. We are an informed opinion leader and the go-to source in the Canadian field of physical activity and sport participation, and we will continue to look at bridging the gap between existing and emerging research and what is happening on the ground across Canada.
The need to help Canadians to become more physically active is greater now, given our aging population, our sedentary work lives and the intense lure of screen-based technologies for our children. An increased emphasis on physical activity will ensure a Canada that is healthy, prosperous and united.
Even small increases in physical activity can produce measurable health benefits, reducing the incidence of debilitating chronic diseases. A healthy Canada is a better Canada.
As I mentioned, just getting 10 per cent of Canadians to sit less and move more would reduce Canada's health care costs by $2.6 billion and inject $7.5 billion into the Canadian economy by the year 2040. A prosperous Canada is, indeed, a better Canada.
Physical activity, from playground to podium, unites our country in ways almost nothing but an overtime goal can, forges national spirit, strengthens community and instills pride in what it means to be Canadian. A united Canada is a better Canada, and, therefore, an active Canada is a better Canada.
ParticipACTION has three recommendations. First, the federal government should work more proactively with provincial and territorial governments and the physical activity sector in Canada to implement and fund a comprehensive national physical activity plan, based on Active Canada 20/20 and similar in nature and scope to the 2012 Canadian Sport Policy.
The complex challenge of increasing physical activity for all Canadians defies single-solution approaches. Partnerships and collaboration across all sectors of society are required. A national physical activity plan will help to outline how best to coordinate this massive effort, establish common objectives and ensure alignment.
We also need a mechanism to integrate sport, physical activity and wellness. Despite the fact that Canada has examples of programs, research, community interventions and education campaigns that are respected worldwide, our approach to increasing physical activity in this country has been fragmented. The mechanism could take the form of an interdepartmental council, a new ministry or a public-private, not-for-profit body. The point of this mechanism would be to integrate sport, physical activity and wellness across a number of departments, including education, transportation, human resources and infrastructure, as well as coordinated efforts between the private sector and other non-government stakeholders.
The third recommendation is priority investment in physical activity. An increased range of funding and investment is required to support active, healthy living, recreation and sport infrastructure, including physical activity promotion and entry-level sport participation. With a national physical activity plan and a new mechanism to integrate sport, physical activity and wellness, we would be better able to leverage resources, make more efficient use of existing funds, be more strategic in our planning, have greater impacts and be better able to identify gaps in funding. If we want to turn the tide on health, invest to save, and unite the country through physical activity and sport, we need increased investment across the broader sector, including multi-year financial commitments providing sustained funding to organizations and programs providing physical activity leadership.
Ultimately, ParticipACTION wants to see all Canadians sitting less and moving more, but, practically speaking, we cannot reach and support every person to do so. Behaviour change is complex. It is impossible to attribute population-level change to one or even several factors. We know absolutely that ParticipACTION will be part of the solution, but we will never be the only solution. It will take many facets of society working together to shift the behaviour of a nation. Ultimately, if we all — parents, schools, policy-makers, the private sector, physicians, urban planners, governments, workplaces and even the Senate — do our jobs right, we will see major change over time. ParticipACTION is the number one physical-activity brand in Canada, and Canadians recognize us for providing resources and easy ways for Canadians to be active and helping to overcome barriers to physical activity. It is essential to cultivate and preserve the equity in this Canadian asset, the ParticipACTION brand, so that it can continue to be used by government, partners, NGOs and corporations to fuel Canada's physical activity movement.
Moving our nation won't be easy, but it is essential. ParticipACTION is here to help. In order to make physical activity a desirable, accessible and vital part of everyday life in Canada, we need not only to give people the opportunities to sit less and move more but also to support them to do so. Eventually, being active will just be part of what it means to be Canadian. Thank you.
The Chair: Thank you both. I'm going to open it up to my colleagues on the committee.
Senator Eggleton: I feel as if I should stand up and walk around the table and then ask you questions.
Mr. Antunes: We should.
Senator Eggleton: We sit so much as senators. Maybe we should be considering some different kind of format for our meetings. I remember the 60-year-old Swede, and that seemed like a good model at the time, but at my current age, that's too young.
I'm glad to see ParticipACTION is back, because I got the impression that it disappeared for a number of years. Is it the same organization? I remember the organization back in the 1980s, the 1970s even. It was quite high-profile. I understood it's messaging. Is the messaging much the same now? Is it a different organization?
Mr. Antunes: The organization went dormant for six years. It laid off its staff. The board maintained its legal status, but the organization, for all intents and purposes, ceased to exist for six full years. We came back in the later part of 2007 with a renewed funding commitment. The organization since then has really built upon its legacy to be a social marketing organization. We have been very focused on communicating messages to mothers of school-aged children, and our messages have been around the need to ensure that kids have the opportunity to be more physically active in school, at home and in the broader community.
The times have changed since the 1980s. The whole media landscape has changed. It's much more challenging in this thousand-channel universe as opposed to in the 1980s when we had maybe six channels. Social media is something we have been very active and involved with, as well as other leadership activities.
Moving forward, we recognize that creating public awareness campaigns is not a business model that's necessarily sustainable. Our intent moving forward is actually to help and support Canadians to sit less and move more. We will be implementing engagement initiatives where we will be touching people with their behaviour. We will work in partnership with our various colleagues. We have about 5,000 organizations as part of the ParticipACTION network, and we will be mobilizing those organizations to help Canadians sit less and move more. Public awareness campaigns in the future may exist, but there will be a very specific call to action related to changing behaviour as opposed to creating general awareness.
Senator Eggleton: How are you going to communicate? It's kind of ironic that the communication tools you are using are the things you are trying to get kids away from — the screen — and get them out and more active. Do you have any other means of doing this, getting into the school systems, for example?
Mr. Antunes: In our most recent campaign, Make Room for Play, the last tag line said, "Don't visit our website." We recognize that we are using this medium that we want people to be moving away from. The issue for us is that the technology is here to stay. We can't fight against technology. Technology is not necessarily the issue. It's the unbalance in our lifestyles, and we put too much emphasis on technology and not enough emphasis on active play.
What we have suggested to parents is to find that balance within their family. In particular, as parents, we need to put down our own screens and be role models to our kids. We need to change this level of imbalance. Technology has taken us over. It's here to stay, but we need to regroup and find that balance.
We have our campaign. We have a number of initiatives, and then we have communication pieces like the report card. That's generated a significant amount of discussion with parents right now. It's about letting your kids be kids and sending them outside to play and addressing parents' fears of safety and injury. Again, we have gone to the other extreme, to the point where we are trying to keep our kids indoors to keep them safe, when in fact we're creating more harm for them than if we let them go to the park to play with their friends.
Senator Eggleton: Good for you for doing that.
Ms. Lane, the membership of your organization, the people you particularly certify, what occupational groups are they?
Ms. Lane: We have two branches of our certified membership class. A certified personal trainer has two years of post-secondary education, and then a certified exercise physiologist has as a minimum a bachelor's degree in exercise sciences. Depending on which certification, you might see them in your recreation centres or fitness studios, assisting Canadians who are already motivated to go into those facilities and access programs.
A certified exercise physiologist we are seeing now much more in the health care team. A specific example in Victoria is at the cancer agency. I do a little bit of work there, looking at exercise during cancer. The Prostate Centre has now hired a certified exercise physiologist to lead exercise group sessions for men with prostate cancer and their partners, if they want to join. I think you see a variety of roles from your health authorities, to rec centres, to cardiac rehabilitation programs where you need someone with some good educational background to lead people who have just had a heart incident.
Senator Eggleton: You said in your presentation that you, along with partners, are developing a 24-hour integrated movement behaviour guideline for children and youth. This one guide will recommend the physical activity, sleep times and limits to sedentary time. Could you talk about that a little more?
Ms. Lane: Yes. That's under the leadership of Dr. Tremblay, who has spoken to this committee. It is recognizing the fact that when we look at the 24-hour clock, we obviously sleep, and that's really important. We have about 40 per cent of our time in sleep, 40 per cent of our time doing sedentary behaviour and about 15 per cent of the time doing light physical activity. Only 5 per cent of our day in people who are active and doing what they should be doing is spent doing moderate intensity, so the sort of intensity that you can feel your breathing rate increase. That's what the guidelines speak to is 5 per cent of our day.
What CSEP under the direction of Mark Tremblay is trying to do, and their group, is to say rather than just pick apart each of these separate movement behaviours, put them together, because when we look at the food guide, we don't just talk about protein. We talk about all of our food groups together under one guide. The 24-hour integrated movement behaviour is getting people thinking about the importance of all three and making small changes in all. You can have someone, say a child, doing the 60 minutes of moderate to vigorous intensity activity a day, like they should, but they're getting poor sleep and they're sedentary either because they are being driven to school, they sit in their school day, or it's a rainy day so you don't go outside and you play games inside, so you're doing one part of movement where there are other parts of movement that make a difference as well.
Their group has engaged with pediatricians to ask how they would value separate guidelines versus one guideline. I believe the pediatricians have said they would prefer to have one sheet with one message that has integrated thought into sleep, physical activity and to decreasing sedentary behaviour.
Senator Seidman: Thank you very much for your presentations. If I might, Ms. Lane, I would like to ask you about the guidelines. It's on Table 1 in your submission, Canadian physical activity and sedentary behaviour guidelines recommendations specific for each age group.
Ms. Lane: Yes.
Senator Seidman: What I'd like to know is, are these guidelines evidence-based?
Ms. Lane: Yes. Great question. The physical activity and sedentary behaviour guidelines are evidence-based guidelines. They went through about a four-and-a-half year process that went through systematic reviews. It followed the AGREE process, and AGREE is an acronym that stands for something and I don't remember all the specifics. Basically, the AGREE process is used when developing clinical practice guidelines. It's a very thorough and systematic way of judging the evidence. It basically grades the evidence. If you have lots of research that has used a randomized control trial, that's better than studies that don't have a control group that's not getting the interventions. It looks at the data in a very objective way. Both sets of guidelines have gone through that process. It's costly and takes a lot time. The 24-hour integrated movement behaviour is also going through that process and nearing completion. They are evidence-based.
Senator Seidman: Is it a kind of meta-analysis of all the studies out there which, as you say, are ranked according to the credibility of the design of the study?
Ms. Lane: That's exactly what I'm saying. They look at design and the control group. In some studies, you can be blind or not blind to the intervention. They can use a wait-list control — there are different ways — so they have a grading system to look at the quality of each one.
Senator Seidman: These are guidelines that have been put together in the last two or three years, I think.
Ms. Lane: The physical activity guidelines were published or released in 2011, and the sedentary behaviour guidelines, and then the early years, which was zero to four years of age, were released in 2012.
Senator Seidman: Do you have regular intervals where you would update them?
Ms. Lane: The idea is to have that happen, and 2016 is when they are set to be revised, assuming the funding is there to do that.
Senator Seidman: Mr. Antunes, I want to ask you a question about the success of ParticipACTION programs, similar to Ms. Lane. Do you measure the success of your programs?
Mr. Antunes: Actually, I had a board of directors meeting this morning, and they said we measure too much, so yes. We measure everything, and we have a research advisory group that's a standing committee of the organization. They advise us on all of our evaluations, and, in fact, they have used much of the data that we've collected through our campaigns and programs, and they have published research articles on the impacts of our work.
We do measure. We have two full-time knowledge managers, one dedicated solely to evaluation, and we use third-party evaluation firms on certain big initiatives to have an impartial and objective perspective on our evaluation. Yes, we evaluate everything, and subsequent programs or campaigns are developed based on the information and data we collect from our previous experiences.
Senator Seidman: Would you be able to share with us the programs that represent the best opportunities for Canadians or the most successful types of programs?
Mr. Antunes: In general, or with respect to ParticipACTION?
Senator Seidman: With respect to ParticipACTION's programs.
Mr. Antunes: We have a number of ways that we've tried to address this issue. As I mentioned in my presentation, I think sometimes we expect that one intervention is the magic intervention that changes the issue. It's not so. We've contributed to the addressing of this issue. ParticipACTION alone and our programs and initiatives alone can't change physical activity levels in this country. We need things like guidelines and organizations in our communities that deliver programs. The public awareness campaigns we have been doing for the last seven years have been evaluated very effectively, and usually around 70 per cent of moms, who they have been targeted to, have said that they've changed their intentions to change their family's behaviour around physical activity and sedentary behaviour.
We obviously haven't been able to track the same mom over seven years, so it's difficult for us to say our campaigns have changed behaviour, but we know unequivocally that our campaigns have influenced their intentions to change their family's behaviour.
Then we have things like Sports Day, as I mentioned, where on the surface it seems like a one-day celebration, but it's much more than that. It's an opportunity for communities to collaborate and to come together around sport and to really focus around sport. We use the one-day celebration as a platform to enable a lot of good work happening in communities.
As I mentioned, the participants' intentions to be more active and healthy as a result of being exposed to that message has increased, but more importantly, organizations and communities have said, "My registrations in my program, whether a sport organization or the YMCA, have actually increased as a result of Sports Day."
We're engaging more Canadians, and in particular more kids, in more programs as a result of our Sports Day initiative.
Senator Seidman: I want to be clear. When I first started out by asking you if you measure the success of your programs, you said that, in fact, ParticipACTION measures too much. I'm not doubting the value at all of physical activity and physical activity programs, but I'm seriously trying to understand what programs are the most successful. If you measure the success of your programs, then I would hope that I could hear which programs present the most successful opportunities for Canadians.
Mr. Antunes: As I mentioned, I don't think there is any one particular program that can address it all. I can tell you that our public awareness campaigns have been successful in raising the consciousness of parents and mothers in particular around their families' behaviours. They have replied to us saying their intentions have changed.
Our campaigns have been successful. That's what they were designed to do. Have they actually changed physical activity levels? It's difficult to say because we would have to track the same person over a long period of time to determine that. We know our campaigns have been effective in changing the mindset of moms. If you're asking me what works, campaigns work in creating a level of awareness and consciousness about the family's environment.
Then as far as on-the-ground programs go, as a national organization, we don't deliver programs, but we create platforms to enable local organizations to deliver programs. I would say that model is very effective. Local organizations are telling us they don't have the resources or necessarily the profile that the ParticipACTION brand has to be able to promote their programs to their local residents. We know that what works well is having a national program or national platform that raises awareness and provides opportunities for communities to engage collectively in delivering programs.
I can provide you with research reports from a number of other initiatives, but as I mentioned, I don't think it's one particular program. It's a combination of interventions that have the impact that we desire.
Senator Seidman: Absolutely, I understand that completely. Again, I'm just trying to get at the individual programs that you have researched and have success on. I think you have done that. I think you have helped us, so thank you.
Senator Raine: It's wonderful to have you both here.
Ms. Lane, in your certification process, I appreciate that there are two different kinds of certifications and two different areas of work for those different people. I'm very supportive of an exercise physiologist being part of the health delivery system. It's a little frustrating to understand that at this point it isn't.
I want to talk to you a little bit about the other certification in terms of the personal trainers. Right now, there are a lot of different personal trainers out there, dealing mostly with adults who are well-motivated with good intention to do something. Has there been a problem with poorly trained personal trainers causing damage? Is that something that you're trying to overcome?
Ms. Lane: That's a great question. It is challenging because it's not a regulated industry. You can have a certified personal trainer that requires education, and there are others that require you to do an online course that may or may not have exit criteria. Anyone can call themselves what they want in regard to personal training in a broad sense. That creates confusion amongst Canadians, making them wonder whether it matters and what they are getting.
What we emphasize, even with our lower certified personal trainer, is to know what you don't know. One of the things we value is pre-participation screening. That means knowing, before the person even starts their physical activity program, a little bit about whether there is a risk. Is there a risk for something to happen? In most cases, the benefits of physical activity clearly outweigh the risks; sitting is a greater risk than being active. But in some cases, and within my example, there is more complexity to the exercise prescription. If they go through pre-participation screening, which we do in a standardized way, if that's identified, then the certified personal trainer who has a limited scope of practice would then refer to an exercise physiologist, who is a person who has a degree in exercise sciences and is able to work with more complex health conditions.
Looking at litigation, what creates lawsuits is when pre-participation screening doesn't happen. We ensure that always happens; that's tied to their scope of practice. It happens because of an inappropriate exercise prescription. That can be tied to inappropriate exercise being given to someone who may have said, "I have some chest pain," which is ignored, and they are then given vigorous exercise. The few times where there is a risk if the person who has chest pain — vigorous exercise might not be a good idea if they haven't been seen by their doctor.
We really ensure that if there is anything that would be a slight elevation of risk, they would be referred. Then, if there are no indicators of risk, we make sure our certified personal trainer understands an emergency action plan, so that if something bad does happen — the thing that usually happens is the person drops the weight accidentally, fractures or bruises their toe, and you need to get some help, ice and things. It's knowing what to you do and where is your first aid kit, and that is another part of our professionalism that we mandate.
Senator Raine: Do your trainers work in the school system at all?
Ms. Lane: The lower one, no. We had just gone through a renewal with a certified personal trainer and changed their scope of practice. All the physical literacy research had just been entered into our program called Physical Activity Training for Health, or PATH. At the time, we weren't ready to roll out a bigger change to the scope of practice of the certified personal trainer.
Often, kids are doing things in the schools, through PE classes or sports teams and coaches. We're now seeing a shift where they're wanting to have some physical literacy and run, jump and throw programs and things. So there are other certifications and programs, and we're moving quickly to have that age range of — Canadians being able to access.
Senator Raine: I understand that physical education at the university level is a faculty where enrolment is decreasing because there haven't been the jobs.
Ms. Lane: Right.
Senator Raine: Because they've cut out physical education and put in computers, et cetera. If we're going to ramp up to address the physical literacy skills, we will need more trained people in the schools. Do you see that as a role for CSEP?
Ms. Lane: Yes, I think so. In terms of the school system, too, being able to access our certified exercise physiologist — but making sure that when they maybe hire within the school system, they think about hiring a phys. ed. teacher who is a specialist teacher in physical education. I don't know school boards and how they work — I know locally what happens — and if there is an opportunity to have a physical education specialist within the school, there are shifts, and things happens in that regard.
Senator Merchant: You are both very enthusiastic presenters. I'm going to pull this back a little bit, not because I disagree with anything you have said regarding the benefits of physical activity, but because we are studying obesity as well. I have read and I have been told and people in conversation say that sometimes the exercise myth prevents or hurts the development of policy regarding obesity and how we can attack this phenomenon, which is getting worse and worse. We have had ParticipACTION — now you said there was a time when you were no longer operational — but things are getting worse; they are not getting better.
Do you agree with that? Obesity is related to calories. The other day I heard that you can walk for three hours and you burn 70 calories. If I'm a person who wants to lose weight, that's a very depressing thought. It's not because I don't want to walk, but I also like to eat something.
Do you think there is some validity to the fact that sometimes we put so much emphasis? Exercise is good for the reasons that it is good, but how does it work for obesity?
Ms. Lane: If we just looked at exercise all by itself, and had that being the intervention, it's not as powerful as a dietary change. But what happens with a dietary change is you cut calories and then you tend not to feel so happy and cheery; your energy levels go down, and you might then start to decrease your physical activity because you're not feeling energetic. It can affect sleep and a whole host of things.
In the short term, in the studies that get talked about that get the cover of Time Magazine and things, on its own, dietary change is crucial. Exercise helps to make the dietary change and the decrease in weight lasting, and it gives you all these other added health benefits.
If we're just about changing weight, I can't imagine physical activity not being part of the equation because there is research to show that we do better regulating our energy input, which is the food we take in, and the exercise and the energy we expend — through our resting metabolic rate, our physical activity, just by digesting food — all of that is better balanced when we are physically active. There is some evolutionary role to that. We do a good job balancing those two when there is physical activity, and that's not just exercise — it's movement.
Where we do poorly at regulating that balance is we go into a low physical activity state. Then what happens is you have to decrease your caloric intake to make a dent. It's not livable, and as I said, it affects your energy expenditure, so your body weight goes down in the short term and starts to come back up. Then the only way our body can increase energy expenditure is to gain weight, because, per pound, you're expending more energy to sustain that.
I understand where you're coming from when I hear that, but I just think it's a puzzle, and the whole equation is dietary change, physical activity and getting support for behavioural change, because you're not going to make a change if you're not ready to do that. What CSEP certified members do is take course work in behaviour modification theory to help a person become more intrinsically or extrinsically motivated so that they are more likely to do something that's livable and lasting.
Senator Merchant: Are there some countries that we hold as the ideal? You, or maybe it was Senator Eggleton, talked about one of Scandinavian countries. Do we hold them as the ideal? Is that still the case?
Mr. Antunes: I know your mandate is to address obesity, and we have an obesity crisis. I would also say we have a physical inactivity crisis. Although they're related, they are also somewhat independent of one another. Our organization is focused on the physical activity side of things.
The physical inactivity crisis is a global problem; it's not limited to Canada. The report card last year did an international comparison of other countries. We found that Canada is doing quite well in organized sport and physical activity opportunities; I think we ranked about a B minus. Where we ranked very low is with things like active transportation. Many other countries have very high active transportation rates, which leads to higher physical activity rates.
So we do certain things really well; we do other things compared to other countries not as well.
That's where need to focus: Get kids outside, let them play and use active transportation to school or to distances of less than one kilometre. If we had every child take an active mode of transportation — walking or wheeling — distances of one kilometre, we would have a significant achievement with physical activity guidelines.
So those are the areas I would say Canada is currently lacking right now.
Senator Merchant: Do you think at schools instead of having desks we should have something where students stand a little bit more — different kinds of desks? Somebody was telling me — and I have heard this before — that, even for us, if we're talking on the phone, we should stand up and maybe walk around a little bit.
There are some simple things. I don't know if those help, but those are the kinds of things you can integrate into your day. Sometimes it's more difficult to find the time to participate in a class, and maybe it's a little expensive to get a personal trainer.
Mr. Antunes: Kirstin will jump in here, because this is her line of work, but I would say, yes, everything counts. Often we've been promoting to Canadians that you have to achieve the physical activity guidelines as a measure of success. Well, if you are inactive, achieving the guidelines is a significant goal, which is sometimes overwhelming.
I think what we need to do as professionals is simply say, "Get started." Our mandate moving forward is to help people just get started. Once you get started, you find you can move up the continuum to achieve the guidelines eventually. But the biggest health gains we have is to get inactive people to start being slightly active. The first start is just standing.
In our offices, we have standing desks for every employee. I don't sit at my desk anymore, and I found a huge difference both in lower back pain and energy levels. I'm not actually physically active, but I'm non-sedentary. Now, I need to work on my physical activity like everyone else in Canada. The start is to do small things, achieve some success and really implement a cultural shift in what we value as Canadians.
Also, I will take an opportunity to respond to something around schools and leaders and physical activity specialists. I have worked in health promotion and physical activity promotion for almost 30 years. We have to stop seeing it as a school problem or a home problem or a community problem. We need to look at ways to engage the broader community where a child is, at school, at home and in the community, and leverage the assets and the expertise that we have available to us. We have a lot to offer; we just don't coordinate our efforts very well. We have school facilities that remain empty in the evenings. We have community facilities that are empty during the day, with qualified people. How are we not mobilizing the community assets to be able to develop a more comprehensive program offering for kids? It is not that hard. Sometimes I think that we think it is harder than it actually is.
Senator Merchant: A last question: We need somebody to coordinate all of these things. Who should be the person? Somebody has to be in charge of all of these things because you are doing a bit. You are doing a bit. The school is doing a bit, but I don't know who should really be in charge.
Mr. Antunes: I agree with you; I think we need some leadership. Of the three recommendations that I've presented, one is developing a national physical activity plan or a blueprint that understands what has to be done and who is going to do it. We need a mechanism to coordinate it at all levels, including federal and then, eventually, provincial and even local. Then, we need the resources behind it to make it work. Again, these are very simplistic recommendations, but we do not have a national physical activity strategy in this country. When we say we are uncoordinated, it is because we are all trying to do our best, but we are not all working toward the same vision.
Senator Merchant: Thank you.
Senator Enverga: Thank you for the presentation. I really value the activities that you have been doing to help our kids.
I know that you want to promote physical activity and deliver the message that action is better than sitting. Mr. Antunes, you mentioned earlier that one of the things you are worried about is the technology imbalance. Something is wrong with the technology.
Have you looked into the fact that maybe we can use technology to send the message to make kids or people more active?
My kids have a Wii. It is making them walk or run or jump. Have you ever thought about promoting this kind of game, especially during winter? That is what kids want, especially in wintertime, when you cannot be outdoors all of the time. Have you thought about promoting all of these types of technology that are available? At the same time, we have this useful item that's called a pedometer that counts how many times you walk, how many times you jump. You can even put it on our BlackBerry or iPod, which is good. Have you thought about using those as a way of creating activity in the general population as a whole?
Mr. Antunes: I will start. Yes. Technology is not our enemy. We have to embrace technology, but we have to use it in ways that will help us as opposed to hinder us.
We are developing a program right now that is targeted at adults, the parents of kids, that uses technology to be able to track physical activity. We are also integrating behavioural economics and nudge theory so that we can nudge people to take some action. If you are sitting at your desk too long, you will get some sort of prompt that says, "Maybe you should stand up for a while," or maybe we can send them a message at lunch and say, "If you walk two extra blocks, we are going to give you an incentive. We are going to give you a half-price sandwich if you walk those two extra blocks as opposed to going to the downstairs cafeteria." We are developing that program right now that will use technology to be able to engage with Canadians around their behaviours, to prompt them to get up and move more. We are starting with adults in workplaces because we know that having a supportive environment is essential to supporting behaviour change — so colleagues, a workplace that values it. If you have standing meetings or walking meetings, that they are valued. Taking the stairs versus the elevator. We will be piloting this program in the province of British Columbia this fall, in the hopes of rolling it out nationally.
Yes, we have to look at ways of using technology to enable behaviour change around physical activity, but I would suggest that, currently, a lot of the recreational use of technology is taking the place of what kids used to do outside being physically active. Even if we are using technology to support behaviour change, we still have to understand that technology is not a substitute for real, active play. I know that Kirstin is going expand on that.
Ms. Lane: I thought I would give an example. There is a program in the U.S. called America On the Move. It was an initiative where they're just trying to make small change steps, small behaviour changes. It was adding 2,000 steps and decreasing 100 kilocalories per day from one's diet, so really small, achievable recommendations, based on wherever the person is now. Not based on us all having to do 10,000 steps. Wherever you are at, trying to do 2,000 more. Pedometers were used. Sometimes those tools are great because it's objective, and, for some people, that helps with their motivation. They see on their pedometer, Fitbit or whichever device. "Okay, I did this. I'm just going to try to add a few more steps every day." In America On the Move, the recommendation was 2,000 steps. That program was targeted toward prevention of obesity, so trying to stop the gain of weight from happening. They had some really good success. The awareness of and engagement in physical activity increased. People felt it was achievable. In their groups that were participating, there was less weight gain that occurred than the control groups had.
With the video games, I live in a part of Canada where we don't have horrible weather very often.
Senator Enverga: Lucky you.
Ms. Lane: So I speak a bit of not being there, knowing what it is like to have really cold temperatures and snow all the time. With video games, it gets people moving, but there is something about being outdoors. That was the position that came in the report card, the value of breathing outdoor air even if it is cold. Again, I do not know what it is like to be really cold, but, whenever possible, there is some value to outdoor play.
Senator Enverga: I understand. By the way, I used to work for a school board, and I think you should be promoting more of all of these activities through the school board because it would really help the students.
My other question is related to new technologies. If you agree that these new technologies could help certain individuals to move along, be more active, do you think it is advisable for the government, like us, to give more tax credits or subsidies to this kind of application or paraphernalia so that we can promote more activity?
Ms. Lane: I am not very good with the financial side of things, but if there are GST and extra taxes on anything that can help to increase physical activity, pedometers and things — I don't know if there is — it helps when it is less costly, as does anything that cuts down the price.
We get the physical activity credit with our kids and participation. That helps me, but I know I have the money to be able to pay out the gymnastics fees and everything else that my kids do and wait to get my tax credit. I am not sure if that always works for all Canadians, but I am not at all an expert in knowing policy in terms of that.
Mr. Antunes: I think providing incentives to help behaviour change is an area of study that we are exploring, using behavioural economic theory in changing behaviour. Incentives do have a place in helping to change behaviour. I think they have to be the right type of incentives and accessible to all. To provide an incentive that is only accessible to those who are already active, for instance, if you provide a tax break for recreational programs for adults playing hockey, if you are inactive, you're not going to be enrolled in those programs. We need to think about incentives and how they are applied to ensure they are targeted to all Canadians and not those who are already active.
Senator Cordy: I really like the report card. I haven't seen Make Room for Play, but I will make sure that I watch it because I am seeing in the media that there are more discussions about helicopter parents and the ramifications of helicopter parents, so maybe that is a good start.
One of the things you said, Mr. Antunes, is that Canada is very good in organized sport, and I believe that, but is organized sport synonymous with being physically healthy and physically fit?
Mr. Antunes: No. In fact, the report card suggests that, because we scored a B minus in organized sport and physical activity, yet our overall physical activity levels are D minus. That in itself is not enough. I am not suggesting that organized sport programs are not good. They need to be maintained and in fact grown, because providing opportunities for kids to play sport provides benefits even beyond physical activity levels. If you're looking strictly from a physical activity level perspective, organized sports two or three times a week, first, it's not every day, and second, if you look at a typical soccer or hockey practice, the amount of time they are actually physically active is not as high as if you'd sent them outside to play. There is instruction and skill development — all important things. It is a complement to a child's physical activity experience, but it shouldn't be seen as the only thing. That's unfortunately what parents have done because we are so busy. We enroll our child in a program, check, I have done that. The report card is suggesting that those things are important, but what we are lacking is just old-fashioned play. If you sent kids outside to play, they would get a lot more physical activity.
Senator Cordy: And then you drive them to their soccer practice, right?
I want to go back to Senator Seidman's comments about what works and what doesn't work. You have certainly given us an indication of the kinds of things that work for ParticipACTION. Health promotion was one of the things that you commented on. From the numbers you have given us, people are certainly aware of what is happening.
What works? I will look at this from a federal government perspective. We have done tax incentives, not removing GST on sports equipment or anything, but tax incentives for, as you rightfully said, people who would probably sign their kids up for hockey without the tax incentive. I am wondering also about the building of sports facilities. There is nothing greater when you are in politics than cutting the ribbon to a sports facility. I believe in hockey rinks, soccer fields and all of these things, but how do we find out what incentives really do change behaviour and what incentives really work? Do we have any outcomes for programs that are working and are really making a difference? I understand what you said, Mr. Antunes, that there is no silver bullet and it has to be a combination of things, but are there things that work? You spoke about health promotion. That seems to work. Are there things that we are doing that are not working and that we are spending money on that could be better used somewhere else?
Mr. Antunes: It is such a big question. That is why I struggle to answer that. I don't know, Kirstin, if you have any thoughts, but I think health promotion and public awareness do work. It is part of the puzzle; it is not the only thing.
I think programs that are accessible to all and that are facilitated through collaborative approaches where you have collaboration in the delivery of those programs are more effective than if they are just delivered by one institution. I don't know.
Ms. Lane: I was thinking back to what you said, Elio, with ParticipACTION's integrated physical activity approach that's national. We're all trying to do things and increase. We are doing the guidelines and trying to prepare the qualified exercise professional. Exercise is Medicine Canada is trying to link the health care professionals with the knowledge. An integrated approach definitely helps. Having that would be a good starting point.
Mr. Antunes: We have sport, recreation, physical activity and health promotion. We have all these disciplines. We are all independently trying to do what we can, and I think they need to be integrated. The dots need to be connected. If we have a sports strategy, how does that improve physical activity levels in addition to generating high performance levels? If we have a recreation strategy, how does that connect to improving physical activity levels? I think what we are missing is an integrated strategy in this country that looks at connecting all these dots. There are many players in this space working to help and support Canadians to be more physically activity from a number of different perspectives. We don't always coordinate, and there isn't always a mechanism to be able to coordinate. Again, I would say that we need a national physical activity strategy that makes all of these links, identifies specific priorities, identifies the outcomes that we desire to achieve and by when, and identifies who is responsible and what resources are required to implement it.
Senator Cordy: Thank you. That was a good answer for someone who was struggling to answer.
I am wondering also about exercise physiologists. Are health care communities becoming more in tuned to using exercise physiologists?
Ms. Lane: I think so. I think the tide is changing. Maybe the health care community might not always know what it is they are asking for, but they know that they don't have time. Going back to the cancer example, it is not part of what we are talking about today, but the oncologist said to me, "I have about 10 minutes that get booked with someone who has been diagnosed with cancer. I know physical activity is important and I want to talk about it, but I just don't have time, and I don't want to take on the prescription." So Exercise is Medicine Canada is trying to take on that role where they are doing primary care workshops, just letting the physician know about basic exercise prescription and motivational interviewing, trying to increase the knowledge and awareness to be able to say, "Here is our database of people who are qualified." If you want to refer your client because they do have some concerns and need exercise advice and maybe they are even wanting exercise advice and have asked for that from the doctor, we are trying to make it easier so that people can access the right qualified exercise professional.
The Chair: Before we go to the second round, had it been known at the time I was young that it existed, I would have been given Ritalin and tied to chairs and otherwise tried to be contained. In other words, I have been very active all my life and run dog teams and done just about everything.
Listening to you makes me a bit tired. Even though I know some of the specific things you are talking about because I am involved in areas where specific programs with specific groups in the right facility really do work, I deliberately live in rural Canada. That is an area where people used to be very healthy because they lived rugged, outdoor lives. As a result, there were roads in the forests and there was this and that. There was access to off-highway capability. It was also in a pre-litigious society. School facilities were available. There were also family structures. If a kid vandalized the school and was caught, it was probably more dangerous for them to go home and be disciplined at home. Today that has all changed. Many of the facilities that exist underutilized in all of our communities are not available because of the human infrastructure and legal definitions that are required in order to make them available. Yet we know there is a kind of latent desire to get in and use those facilities in off hours, even in some cases parks, especially if they have any equipment in them. Goodness knows, somebody might actually hurt themselves on it in those areas. In the rural area where I live, one of the things that everyone recommends is walking. The default activity is walking. It is something that, as long as you are mobile, in principle, everyone should be able to do, but in actual fact, if you live in rural areas today, your only walking access is on the road. There is not even a shoulder on most rural roads, let alone a sidewalk. It may be that in certain fine locations, organized in a way — and these are wonderful things — there are deliberate hiking trails. However, those aren't where people live, in general.
I know you folks are working hard to try to find these things, and I know that the modern version of phys. ed., which is kinesiology, in general — that is what most universities have switched to because they now study physical motor activity and the benefits and so on — is far advanced from when I was young. But those then translate into organized programs, in general, requiring some sort of facility.
I have been listening to the questions and struggling to hear something said that gives me encouragement about your organized approach to things. I get the bit about encouraging people through carefully developed advertising to get them motivated to do something, but they still have to be able to find a way to go out to do something, that is, an area where they can go out and do something. Again, if you are in rural Canada, you have to drive a long way to an organized structure in many cases. We complain about busing our kids everywhere, but you have to bus yourself to get to an organized facility.
We are studying obesity, and from all we have heard, we know that exercise is not the sole answer. It is a piece of life's equation. We have heard that if you can get people moving and active, they look slightly differently at their behaviour. I know from observing people, from a long life, that people who will do an activity for a certain minimum amount of time will get to the point where they are addicted and will want to keep doing something active. Activity is the part of the total program.
I am more interested in hearing something that says to the average Canadian, "These are the things that could be part of your life that, in addition to all the other things we have heard about, will contribute to your having a healthier, better, less likely obese lifestyle."
Ms. Lane: Sedentary behaviour research is where I think we will see a shift in how we speak to that. There are big studies. Peter Katzmarzyk looked at over 12,000 Canadians in one study — and he probably has numerous other ones — where even if obese people reduce their sitting by a quarter to half, the impact on mortality from all causes and cardiovascular disease is significant. They could reduce their risk in half if they don't sit so much.
For someone who struggles with weight, it is daunting to do exercise. That is a daunting change to make, but I think if we start getting the message out about just start moving more and let that movement not necessarily be exercise but standing up in the middle of a meeting and taking a break, changing the culture. Maybe it is through things coming through the Conference Board of Canada and ParticipACTION, but getting the message that moving matters. It is not just exercise movement but reducing our sitting, just trying to stand up, move around and change the culture of how we typically do things.
Mr. Antunes: I would agree. I, too, am tired. I have been at this for a long, long time. If I didn't think we could make some headway, I would be off in another career.
I do think it is an enormous task that we have collectively in front of us. We must change the cultural norm and value toward what it means to be physically active in this country. If we can't change the cultural norm, we won't be successful. That means that if a child gets hit in the head with a ball in recess we don't automatically now prevent all ball playing at recess.
The Chair: Right.
Mr. Antunes: That is what we are doing as a society. We jump to the quick solutions because of other issues because we don't value, down to our core, the value of an active, healthy lifestyle. If we did, then schools, parents, community organizations and government officials would all be partners in all of this. Currently, we do not value active healthy lifestyles. We'll value our iPad or other means because that is the society that we are in. It is a culture of convenience and instant gratification.
It is an enormous task, but that is what we need to do. We need to change our Canadian culture.
The Chair: I will urge you, as part of ParticipACTION, to insist that every school put X number of balls loose in the environment per how many students because, in fact, they have taken them all out of the play system. ParticipACTION, get out there and fill the school yard with balls and just let the kids go with it.
Senator Nancy Ruth: Good idea.
Mr. Antunes: My son, when he was in Grade 1, was constantly getting detentions to the point where we got a phone call from the principal saying, "Your son is going to be suspended with one more detention." We went to the school and said, "What is going on?" "Well, he is playing tag at recess with his friends. We have a no-body-contact rule, and he keeps playing tag with his friends."
That is where we are at.
The Chair: I would say that is it. There is another one. If ParticipACTION would identify those things specifically, and, using the power that you have — because every Canadian relates to the term ParticipACTION from its past time — get out there and urge every school to put balls in place and allow the kids to play tag.
Mr. Antunes: Yes. The challenge is the resources that are required to be able to do those things, but absolutely that is what ParticipACTION is here to do.
The Chair: Virtually no expense for tag.
Senator Nancy Ruth: I am speaking as a senior now. I am interested that neither of you talk about muscle development or strength. For me at my age, that is the biggest incentive to do two and a half hours a week. I wondered about that. When you talk about walking, you don't talk about osteoporosis or any exercise where you are upright.
Ms. Lane: I apologize; I didn't include that. That was an error on my part. What we are learning in exercise physiology is the important role resistance training and muscle and bone strengthening plays, not just for the aging population but also to try to preserve our body mass before we get to the point where it starts to decrease.
As for interpretation of the guidelines, I say sometimes to a person who is older and wants to make change that sometimes strength changes can be a good starting point because you see success and can do things you couldn't do before because you have increased strength. I think of a woman who said to me, "I had trouble getting out of the bathtub because I didn't have the strength to lift myself." Strength plays a huge role. Not only does it help to preserve muscle mass and slow the decline in bone density that happens normally with aging, but we are also seeing that with an increase in resistance training and strength, people can have better glucose control and less risk of falls. We know if a person has a fall and fracture, within one year they have a higher risk of death. There is an important role for resistance training. It doesn't have to be in the gym pushing weights. There are lots of forms of resistance we can use to move our muscles against.
Thank you for asking that. As an exercise physiologist, I feel that is something that should have been highlighted right from the start.
Senator Eggleton: Both of you can comment on this if you wish. You mentioned a national physical activity plan and the integration of sports in physical activity and all of these things here. You also mentioned something called Active Canada 20/20. That appears to be something that feeds into that. Maybe it is an effort to create this kind of strategy. I would like to know where that stands. A witness a month ago suggested that it might have lost momentum. Has it, or is it still very much in play? What is it?
Mr. Antunes: It was an attempt by the sector, collectively, to say, "We don't have a national physical activity strategy, and the government has no immediate plans to develop one. We think it's important, so let's do it."
ParticipACTION facilitated a process back in 2010 and it was supposed to be a 10-year plan for physical activity. We developed Active Canada 20/20, based on consultation across the country. It was our best effort to determine what our physical activity strategy should and could be. It has lost momentum, unfortunately, largely due to resources. At the same time, ParticipACTION got a $2.5 million cut in our funding. So our ability to continue to provide that kind of leadership was impacted, and we don't have resources to continue the momentum.
We have had some positive suggestions with the federal government recently around using Active Canada 20/20 as the basis on which to develop a federally sponsored physical activity strategy. A lot of the good work has already been done. It's not like we will have to start from scratch, but certainly we have lost momentum with that whole strategy, yes.
Senator Eggleton: Were you funding the whole thing?
Mr. Antunes: Yes, we were.
Senator Eggleton: The other organizations weren't able to?
Mr. Antunes: Other organizations contributed a significant amount of in kind, but ParticipACTION was committing our non-governmental resources to developing that strategy, yes.
Ms. Lane: I think that CSEP has taken on the role of secretariat for Active Canada 20/20. We have a fairly lean budget and our manager is trying to keep a little momentum with it right now, but we've taken that on. Our main funds come from membership, workshops, some partnerships, and what have you. We're trying to keep it going.
Senator Seidman: I think the chair kind of pushed this a bit, and I'm going back to it, if I might, and that is the kind of programming that is successful. I know it's a complex picture, and I know that we've heard that over time in this study, and the obesity study, namely that it is very multi-factorial, very complex picture of how to deal with this.
For example, I think one of the most successful public health campaigns we ever had in this country — and we talked about it during this study, and otherwise — has been the whole multi-pronged public health program to stop smoking. That was complicated. It went on for decades, but it has been successful by all measures.
Perhaps we could talk about tackling obesity in the same way — that is, complex, multi-pronged, long term. ParticipACTION has a huge brand. Its focus is being the national voice of physical activity and sport participation in Canada. It seeks to improve the physical activity level of all Canadians through communications, capacity building and knowledge exchange. It's critical in public education and moving this forward.
Help me here a bit as to how we can think about this as federal legislators. How do we move this forward?
Mr. Antunes: Again, my expertise is not in obesity, it's in physical activity, but I think the smoking reduction campaign is a good example. It was very comprehensive. We had a national plan of action strategy, and it included significant policy and legislation. It included quality interventions that were based on good evidence and a significant amount of public awareness and education, and it had a significant amount of investment.
In the approach to address obesity, the challenge is we have not had all of those elements at one time. We might have had good interventions but not as much public awareness or education. Certainly the level of investment toward physical activity promotion is nowhere near what it has been in other health areas.
I keep coming back to the point that a fully integrated approach with a strong strategy in place makes a lot of sense.
Ms. Lane: If you think back to the smoking cessation and the number of years of life lost because of long-term smoking, it's about 10 years or so — perhaps a bit less. If you look at someone who is obese, inactive and sedentary, it's approaching about seven and a half years. We are on an equal playing field. We made a decision a while ago to tackle tobacco. We started programs; we kind of expect that as a policy. I think going back to having that integrated policy can help.
In terms of treatment of obesity, the Canadian who is sitting right now, who has an unhealthy weight and has complications as a result — that is, they don't feel good to move because it hurts and are at risk of diabetes or have diabetes, et cetera — needs to have his doctor ask about physical activity as the fifth vital sign. The doctor will ask about your blood pressure. The risk of years of life lost with inactivity is greater than blood pressure. It is close in men with high blood pressure, but physical inactivity or low cardiovascular fitness has a greater risk. When doctors speak, it's a trusted voice. When people are asked, "How much activity are you doing and for how long," it starts a thought process. If we then have ParticipACTION and other groups trying to have other programming to engage Canadians, I think that would help.
The last thing is billing. I don't know a lot about it, but in B.C. we have the physical activity Prescription for Health. If you as a patient go to see your doctor and you are a smoker, obese, inactive or have unhealthy eating habits, the doctor can do an assessment — basically, it's a bit of a goal-setting exercise — and refer you to the Physical Activity Line. They can bill for that because if they can't bill, that makes it hard for them. My doctor values it; she always mentions it. However, not all doctors do. They're not taught about exercise in med school, but that's changing. I think some programs like that can help in terms of front-line treatment.
Mr. Antunes: One of the things that the smoking cessation strategy has done is made it culturally unacceptable to smoke now, especially in public places and within families. It took a while, but if you smoke now, you're in the minority. I think we need to get to a place where if you are inactive you are a minority, and collectively we value a healthy lifestyle. That is, it's part of the norm as opposed to the exception.
Senator Raine: You've given us a lot to think about and good insight into what the needs are. I can see that the Active Canada 20/20 strategy exists, but what you're really saying is that it's not being implemented and it doesn't have the resourcing to implement it.
Mr. Antunes, your funding was reduced in 2014 from $4.5 million to $2 million. What is your funding for 2015-16? Are you having any indication that some resources will be made available? As you say, a small increase in the amount of activity will result in a big savings in the health care system.
Mr. Antunes: Coming back to Active Canada 20/20, part of its limitation is that it has not been developed with government at the table for many reasons — not because we didn't want government, but it was not part of the government priority of the day. We purposely did this anyway, independent of government, because we valued it. For it to resonate and to have meaning and impact, we need to have government as a partner at the table and it needs to be a collective government and non-government approach. Even with money, it will always be a limitation if we don't have government at the table as a partner. More than money, we need to be making connections around that at a policy level, and the government needs to be at the table to be able to do that.
With respect to our funding, we get $2 million from Sport Canada. Sport Canada has been a valuable partner of ours from day one. We are in the process of renewing that funding. I anticipate and hope that it will be remain at about just under $2 million. We have been successful in approaching the Public Health Agency of Canada for a project grant. They matched Royal Bank of Canada on a program called Learn to Play, and we received $3.1 million over three years, so about $1 million a year. That's directly connected to a particular program.
Other than that, at the federal level currently there is no other indication of additional funding. We have funding relationships with the B.C. Ministry of Health, a valuable partner of ours. This past year we had relationships with governments of Newfoundland, Nova Scotia and New Brunswick as well. On top of that we have corporate partnerships that we rely on.
Senator Raine: I would like to take this opportunity to publicly thank ParticipACTION for the help you've given us, John Weston and me, on the National Health and Fitness Day promotion and getting the bill passed, which makes the first Saturday in June National Health and Fitness Day. Your support and help was very valuable to us, and we look forward to working with you as that goes forward.
Mr. Antunes: Absolutely. I said this in my presentation and I will say it again: Many of you have recognized the value of the ParticipACTION brand, and I think our strategy moving forward is to identify ways to leverage that brand to move this issue along.
The brand doesn't belong to me or to our board of directors; it belongs really to Canadians, and we have to figure out a way to leverage the power in that brand to get Canadians to move more. We look forward to continuing to work with you and others.
The Chair: Thank you both very much. This has been really interesting, and I think, Mr. Antunes, your budget is one that I think we're going to get you to get balls in every school. We're going to have to find a way to include that in Health Canada's realization of ways to reduce the costs in that area. I noted the great carefulness with which you addressed the budget issue, but it is impressive what you are able to do with the funding you have available.
Ms. Lane, we very much appreciate the role that your organization plays and, quite apart from my earlier comments, I am hoping that you are able to grow as an important part of the total equation dealing with both the health of Canadians and indeed with regard to the body mass index.
With that, I declare the meeting adjourned.
(The committee adjourned.)