Staying Resilient in a Time of Crisis
By Stephanie DeShano Wakeman, PT, DPT
The physical therapy profession always has focused on the health and wellness of our patients and clients, but we as health care providers must practice what we preach in these stressful times. Around the world, across our country, throughout our communities, but also within our profession, life as we know it has come to a screeching halt. Most of the world's children are not in school. The global economy is faltering. In the United States, physical therapists and physical therapist assistants are among the 13% of unemployed workers — the highest since the Great Depression.
Many PTs who are employed are facing a variety of difficult challenges: Acute care specialists are struggling to provide care in the absence of strong leadership or direction and are overburdened with constant policy changes. Some PTs working in a skilled nursing facility are expected to continue providing services, in patients' rooms, without adequate personal protective equipment. More often, physical therapists are not being used in some way at the frontline of COVID-19. These experiences have left members of our profession and the health system at large with many questions.
The COVID-19 pandemic is a disruptor that is forcing many of us to consider and innovate alternative models of delivering care, such as telehealth. How will we continue to operate and sustain these new delivery models, and how will we measure success and outcomes of said models? What is the landscape going to look like on the other side? These tough questions will need to be tackled not only by our leaders, but through actions by each one of us. So now is the time to listen to each other, help one another, and support all PTs and PTAs in all settings through empathy, advocacy, and action.
APTA's House of Delegates has long recognized the importance of health and wellness in "transforming society" and our role in this space, and the Board of Directors established the Council on Prevention, Health Promotion, and Wellness to promote positive change in society. But to competently deliver this message, we must be able to practice it. During this crisis we can study and apply the principles of wellness into our own daily lives.
Let's first break down the basic building blocks of health prevention and wellness:
Exercise. We are movement experts. This is the perfect time to assess your own fitness level and improve upon it. Test yourself with a simple YMCA step test or Rockport 1-mile walking test. Cardiorespiratory fitness is an indicator of cardiovascular disease and all-cause mortality from noncommunicable diseases. Exercise has been shown to mitigate these risks and have positive effects on anxiety and regulation of stress. The Centers for Disease Control and Prevention guidelines for physical activity for adults is a minimum of 150 minutes of moderate-intensity exercise or 75 minutes of high-intensity exercise per week. Get your sweat on, try some new exercises, and go outside to experience the calming effects of nature.
Sleep. Adults need 7-8 hours of uninterrupted sleep each night to maintain healthy cognition, decrease stress response, maintain healthy metabolism, decrease risk for mood disorders, and decrease central pain sensitization mechanisms. Sleep is behaviorally regulated, so setting a consistent bedtime and turning off electronics 30 minutes beforehand helps to set a rhythm for our bodies to wind down. Avoid caffeine at least 4 hours before bedtime and limit alcohol intake. Caffeine is a stimulant and keeps us awake by blocking the adenosine receptor, and alcohol interferes with the REM stage of sleep.
Connection. We are social creatures. We are in this together and we need each other, now more than ever. In times of crisis, some barriers come down because we may feel more united. Reach out to a colleague, friend, or family member. Think of physical distancing with social connecting. Apps like FaceTime, Google Hangouts, and Zoom allow you to have virtual meetups to connect with others. You could also try some old-fashioned techniques like email or letter writing!
Nutrition. Eating more fruits and vegetables and less sugar and processed foods is simple in theory, but difficult in reality. We tend to snack more when we spend more time at home and during times of stress. We have more time to make and eat comfort food and indulge in celebrating seasonal holidays with more food and fewer family members to share it with. Try to limit the processed stuff and meat consumption, and stock your kitchen with healthy snacks such as nuts and ready-to-eat fruits and veggies.
Resiliency. We must learn to manage stress in a way that helps us become stronger in the end. We have the opportunity to build emotional strength during trying times, especially when all the other elements presented above are put in place. Here is a good resource on five strategies to build resiliency. Reflection, breathwork, and meditation all can help to reduce the sympathetic load that can affect our physical and mental health.
During this time, we can do a lot to advance ourselves personally through self-education and self-awareness by establishing our own healthy habits. We can reach out to others, practice our listening skills, and allow for some stillness to consider how to move forward as a more united, stronger profession.
[Editor's note: For more on this topic, tune in to an APTA Facebook Live event, The Impact of COVID-19 on the Mental Health of the Patient and Clinician, at noon on Thursday, April 16. Experts from physical therapy, psychology, and the Pan American Health Organization will discuss the impact of COVID-19 on mental health and how physical therapists play an important role in the recovery of patients' mental and physical health.]
Stephanie DeShano Wakeman is a longtime member of APTA and is delegate for the New Jersey Chapter. She has over 20 years of experience in multiple settings, but she is focused on orthopedics, wellness and health promotion, and digital physical therapy and telehealth.
Have an interest in prevention and wellness? The Council on Prevention, Health Promotion, and Wellness in Physical Therapy is a community for physical therapists, physical therapist assistants, and students who are interested in incorporating prevention, health promotion, and wellness as an integral aspect of physical therapist practice, as well as in promoting and advocating for healthy lifestyles to reduce the burden of disease and disability on individuals and society.