The Clinic is a Trojan Horse for Exercise

“In the 21st century, health care is increasingly about long-term condition management and thus about health behavior change” [1]

Inactivity is a major worldwide problem. The World Health Organization (WHO) lists “physical inactivity” as the fourth leading risk factor for mortality [2]. Unfortunately, the rates of exercise participation are shockingly low. In the U.S. it is estimated that less than 30% of adults meet current exercise recommendations [3].

We, as physical therapists, are uniquely suited to combat this problem. The PT clinic is the perfect Trojan Horse to get clients exercising regularly.

Why PT’s Should Promote Exercise

Promoting exercise doesn’t just improve general health-there are musculoskeletal benefits that may prevent the need for PT in the first place.* Exercise, specifically resistance training, has preventative musculoskeletal health benefits including: preserving cartilage, preserving/increasing bone mineral density, improving tendon stiffness (a good thing for tendon function), and reducing frailty (which relates closely to fall risk) [4].

However, beyond the preventative benefits of exercise, many of the conditions we treat require long term management. Physical therapists no longer just treat acute injuries. For the chronic conditions we are increasingly working with, patients need tools like exercise, to manage pain and improve function.

The Unique Advantages of PT’s to Promote Exercise

PT is one of the few healthcare professions that spends massive amounts of time with patients. A PT might see a patient for several weeks for 30-60 minutes per session. On the other hand, a physician might only see a patient for an annual checkup for 10-20 minutes.

With so much time spent with patients we are able to:

-Understand and change beliefs about exercise like “lifting weights is dangerous” or “just swim because it’s low impact”. We not only have the time to discuss these beliefs, but the context of the clinic can help patients feel “safe” while exercising. Patients can gradually build up confidence exercising in the clinic in order to exercise independently upon discharge from PT.

Design exercise programs that fit a patient’s life. We get to know our patients well. We deeply understand their exercise preferences and the constraints of their life. So we can create exercise programs that a patient will actually stick to.

For example, I would love all patients to have gym access. However, this is not always possible. For some patients a bodyweight exercise program would have to suffice. Sometimes, the “optimal program” is the program that patient will stick to long term.  

-Help patients build support to exercise. Having support from loved ones and social groups helps many patients stick with exercise. As PT’s we often meet patients’ loved ones and can talk directly with them about how to exercise long term. For example, we often need the buy-in of loved ones to help a patient get exercise equipment, make time to exercise, and to motivate them.

However, even if we don’t meet a patient’s loved ones, we can still help them build support for exercise. We can help them involve their loved ones in exercise. Or we can even help them connect to groups to make exercise social.

But won’t this take away from “treatment” time?

We shouldn’t see exercises for fitness as distinct from exercises for “treatment”.  Many rehab exercises are quite similar to general strength and conditioning exercises. For example, with rotator cuff tendinopathy, we often use isolated strengthening exercises and then progress towards compound movements like pushups and rows. With the right dosage of load and volume, the same exercises that were once rehab exercises become general strengthening exercises.

The clinic need not be only a place for PT “treatment”. The clinic can be the Trojan Horse to empower patients to transform their health through exercise.  

*We cannot truly “prevent” injury or pain, but we can reduce the risk of injury. I use the word “prevent” since “reduce risk of injury” is too verbose.

References:

1. Rollnick S, Miller WR, Butler CC (2008). Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, NY: The Guilford Press.

2. GLOBAL HEALTH RISKS GLOBAL HEALTH RISKS WHO Mortality and burden of disease attributable to selected major risks. (2009). Retrieved November 19, 2020, from https://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf

3. Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., George, S. M., & Olson, R. D. (2018). The Physical Activity Guidelines for Americans. JAMA320(19), 2020–2028. https://doi.org/10.1001/jama.2018.14854

4. Maestroni, L., Read, P., Bishop, C., Papadopoulos, K., Suchomel, T. J., Comfort, P., & Turner, A. (2020). The Benefits of Strength Training on Musculoskeletal System Health: Practical Applications for Interdisciplinary Care. Sports medicine (Auckland, N.Z.)50(8), 1431–1450. https://doi.org/10.1007/s40279-020-01309-5

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