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Whenever a patient enters the clinic, physical therapists (PTs) are quick to start the examination process, eager to find out what is causing the patient's pain or disability. While there may be variations on style, the majority of examinations tend to focus on the history of the incident, the cause of the injury, its duration, etc. But what if I told you that PTs are routinely missing one of the most important components of the entire examination? A component that plays a part in over forty chronic conditions that plague the United States health care system-conditions such as diabetes, heart disease, depression, anxiety, hypertension, obesity, arthritis and osteoporosis. What is this mystery component? Exercise!
It seems that we hear the daunting statistics on a daily basis, but sometimes they need repeating. According to the World Health Organization's most recent global health risks data (2004), physical inactivity accounts for the fourth largest cause of death globally, accounting for 3.3 million deaths per year.1 More than half of adults (56%) do not meet the recommendations for physical activity, while 36% of adults participated in no leisure-time physical activity at all.1 A 2008 study shows that physical inactivity costs on average $330 per person per year in the United States, or over $102 billion dollars annually.1 Despite such dismal data, it's difficult to find the time in today's higher-volume treatment environment to counsel patients on their exercise habits. What's needed is a quick and simple screening process that can be included into the examination for each patient. Thankfully, much of that hard work has been done for us.
The Beginning
In November 2007, the American College of Sports Medicine (ACSM) and the American Medical Association (AMA) teamed up in an effort to get physical activity into the lives of the patients seen in doctors' offices each and every day. This collaborative effort resulted in a program called Exercise is Medicine. Exercise is Medicine (EIM) is a program that calls on doctors to "prescribe" exercise to their patients, even going so far as to consider exercise a regular vital sign that should be screened at every visit. And apparently, this is something that patients want from their physicians. In a survey that the ACSM conducted in 2007, 65% of respondents reported that they would be more interested in exercising to stay healthy if they were advised by their doctor and given additional resources.2 The same survey reported that 41% of physicians talk to their patients about regular exercise, but don't always offer suggestions on the best ways to be physically active.2
The EIM initiative is a great opportunity for physical therapists to help in the effort to monitor patients exercise habits and encourage more activity in day-to-day tasks. The procedures for the patient-therapist interaction are fairly simple. The EIM website has a toolkit available for therapists to use, making the assessment quick and easy. An action guide leads you through the process of screening the patients, and a physical activity readiness questionnaire (PAR-Q) form may be quickly filled out by the patient, cluing the therapist in to any potential cardiac issues that may require a referral to a physician. There are even example brochures that may be printed and handed to the patient in the clinic, with a list of referral sources of qualified fitness experts that could be utilized to make sure the patient is exercising safely.
Why Should PTs Get Involved?
As movement experts, PTs are in a prime position to consult with patients on exercise and wellness-a sentiment that has been growing in recent years. In her PT 2011 Mary McMillan lecture, Dr. Gail Jensen touched on the potential need for physical therapists to engage their patients in this area. Dr. Jensen encouraged therapists to become more involved in the possible reform of our educational curricula to better meet the needs of society, stating, "Do we have a commitment to improving the health of the country?"3 Dr. Jensen also spoke of the need for physical therapists to more fully engage with other health professions in demonstrating that "good health is a public good."3 The American Physical Therapy Association (APTA) has long advocated for PTs to promote physical activity and wellness, and states on their consumer-based website, Move Forward that PTs "can also help you prevent loss of mobility and motion by developing a fitness and wellness-oriented program tailored to your specific needs."4
The APTA is a network member of EIM, and starting in 2012, EIM will be making a concerted effort to reach out to the allied health professions, including physical therapists. According to Ellen Burton, EIM Program Officer, physical therapists will be a key component to the program success. Ms. Burton states, "We are in the process of reaching out to the APTA to send a joint message to their members about the program, the importance of physical activity as part of health care and the resources available on our website to help promote physical activity."6
A Global Issue
Of course, much of the interest in exercise and health promotion is not just an issue for American PTs. At the recent World Confederation for Physical Therapy (WCPT) conference in Amsterdam, several of the speakers spoke of the need for physical therapists worldwide to become more involved in exercise and behavioral counseling. Eva Kaltenbacher, from the Hanze University of Applied Science in Groningen, Holland, completed a systematic review of the literature and concluded that "...the contribution of physical therapy is essential" and "our research says that physical therapists can be effective counselors, at least in the short term, and especially on exercise and weight loss."5
Elizabeth Dean, faculty member in the Department of Physical Therapy at the University of British Columbia, Canada, also spoke at the WCPT Conference of the need for further research into health promotion. "Given the need for health promotion, I believe that physical therapy research priorities need to reflect practice informed by epidemiological priorities," Ms. Dean stated at one of the Conference discussion panels. She continued, "These priorities relate to lifestyle-related risk factors and conditions such as smoking-related conditions, heart disease, hypertension, stroke, type-2 diabetes and cancers."5
Let's Get Started!
With the increased burden placed on the health care system from chronic diseases, not to mention the stated obligation of the role therapists play in health promotion, it is critical that PTs begin to monitor their patients exercise status. But patients need specific guidance beyond being told to "start exercising." With programs such as Exercise Is Medicine, the process can be easily streamlined into already existing examination procedures, and clear instructions can be given to the patient. As the movement professionals of first choice, PTs are uniquely qualified to assist in this initiative and make an impact far beyond the clinic. Here's to good health!
References
1. Exercise Is Medicine Fact Sheet accessed June 15, 2011 available at: http://exerciseismedicine.org/documents/EIMFactSheet_all.pdf
2. Exercise Is Medicine website accessed June 10, 2011 available at: http://exerciseismedicine.org/images/PressReleaseNov07.pdf
3. PT 2011 Daily News update accessed June 11, 2011. Available at: http://www.apta.org/uploadedFiles/APTAorg/National_Conferences/Annual_Conference/News/PT2011DailyNews_061111.pdf
4. Move Forward website accessed June 10, 2011. Available at: http://www.moveforwardpt.com/WhyTherapy/AboutPTs/
5. WCPT Congress News, Issue 2 accessed June 23, 2011. Available at: http://issuu.com/wcpt/docs/congressnews-issue2midres?viewMode=magazine&mode=embed
6. E. Burton (personal communication, July 11, 2011)
Nathaniel Mosher, PT, DPT, CSCS is a clinical supervisor for a multi-site outpatient orthopedic practice in the Albany, NY area.
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