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  • From PTJ: New Recommendations for PT Treatment of Childhood Obesity

    Primary care providers, rather than simply prescribing physical activity to young patients with obesity, should involve physical therapists (PTs) who can assess the child's risk factors and evaluate and monitor the child's increasing level of physical activity, say authors of a clinical recommendation in Physical Therapy (PTJ), APTA's science journal.

    While children with obesity need to increase their level of physical activity, they also are more likely to have comorbid conditions such as diabetes, asthma, or hypertension, and they also are at increased risk of injury from exercise. The authors, who represent the Belgian Physical Therapy Association (AXXON), present clinical recommendations for "first-line" PTs treating children and adolescents with obesity in a private practice or home care setting.

    Here are some of their recommendations:

    Don't rely on BMI.
    Interpreting body mass index (BMI) is complicated and can vary by geographic region and ethnicity. If possible, use BMI charts reflecting those demographics. The authors suggest using other tools for measuring whole-body fat mass, such as waist circumference or skin-fold thickness. Ideally, body composition should be analyzed by cross-sectional imaging before beginning treatment.

    Pay attention to medications.
    Some prescriptions can interfere with exercise. Insulin for type 2 diabetes can lead to hypoglycemia during exercise; this is not true for someone taking metformin for the same condition.

    Evaluate psychosocial barriers to success.
    Low self-esteem, anxiety, negative body image, and other psychological concerns can influence adherence to the plan of care. This also includes family and peer support.

    Use accelerometers to monitor physical activity.
    Out of 61 assessment tools the authors reviewed, none were reliable or valid. Pedometers have a high error rate, and heart monitors are expensive and sometimes impractical. Smart watches? No data yet.

    Measure exercise endurance capacity and muscle strength.
    The 20-meter shuttle run test is recommended for measuring endurance. For muscle strength, authors recommend using both the handgrip strength test and the standing broad jump test.

    Emphasize endurance in exercise prescription.
    Endurance exercise, whether through organized sports or daily activities, promotes weight loss more than simply increasing physical activity. Whole-body exercises are best. But even small changes, such as less sedentary time, are helpful if maintained long-term.

    Supervise strength training.
    Strength training is recommended if there is muscle weakness and to avoid injury, but only with a PT present to ensure "proper execution" of the exercises – and only for children over age 5.

    Be your patient's biggest fan.
    Helping build a child's sense of self-efficacy will motivate them to continue exercising. Give praise for achieving incremental goals, and educate parents about the importance of exercise and healthy lifestyles.

    The experts assert that "systematic involvement of physical therapists in the treatment of obesity in children and adolescents can result in a more comprehensive evaluation and improved care and treatment of obesity at the community level, especially in children and adolescents with increased health care needs."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • This article will certainly go a long way in helping me advocate for Physiotherapy in the primary health care setting.

      Posted by Jacqueline Rouse on 6/16/2016 8:24 AM

    • I am a mother of an obese (I hate that word) 6 year old boy. Our family lives a very healthy life style and my son is the only person with a weight problem. I started to see a nutricianist for him who recommended physical therapy & occupational therapy. For the first time in my son's life, his BMI is going down. It has been life changing, like this article says it has boosted his self esteem, made his core stronger do he is good at sports (so therefore likes playing sports) it's done so much for him and given him a healthier future. It needs to be available to ALL children with weight issues.

      Posted by Katie Ryan on 6/29/2017 5:35 PM

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