• Monday, June 01, 2015RSS Feed

    Jette Named PTJ Editor-in-Chief

    APTA has announced that Alan M. Jette, PT, PhD, FAPTA, was named editor-in-chief of Physical Therapy (PTJ), the association's monthly scientific journal. Jette will serve a 5-year term beginning January 1, 2016, succeeding Rebecca L. Craik, PT, PhD, FAPTA.

    Jette is professor of health policy and management at the Boston University School of Public Health, where he directs the Health and Disability Research Institute. He also serves as a professor in the Rehabilitation Sciences Program at the Massachusetts General Hospital Institute of Health Professions. For the past 14 years Jette has directed the Boston University Post-Doctoral Fellowship Program in Outcomes Research. He served as dean of Boston University’s Sargent College of Health and Rehabilitation Sciences from 1996 to 2004.

    In 2013 Jette was elected a member of the National Academies of Science’s Institute of Medicine (IOM), where from 2011-2014 he cochaired the IOM Forum on Aging, Disability, and Independence.

    Jette and his collaborators in the Department of Rehabilitation at the National Institutes of Health (NIH) Clinical Center are developing new measures to be applied within the Social Security Administration work disability determination process. In addition, Jette directs the Boston Rehabilitation Outcome Measurement Center, funded by the NIH National Center for Medical Rehabilitation Research (NCMRR); serves on the Executive Committee of the Boston Roybal Center for Active Lifestyle Interventions, funded by the NIH National Institute on Aging; and is director of the New England Regional Spinal Cord Injury Center, funded by the National Institute on Disability Rehabilitation Research.

    Jette received a BS in physical therapy from the State University of New York at Buffalo in 1973 and a MPH (1975) and PhD (1979) in Public Health from the University of Michigan.

    In an APTA news release, Jette said that he was "deeply honored" to be named to the position, and that he looks forward to serving PTJ "at a time of major changes in scholarly publishing" and in leading planning "that keeps PTJ and APTA in the vanguard."

    Founded in 1921, PTJ is the official publication of the American Physical Therapy Association and is an international scholarly peer-reviewed journal. PTJ is available for free to APTA members.

    Friday, May 29, 2015RSS Feed

    Study: Resistance as Effective as Eccentric Training for Achilles Tendinopathy

    The effectiveness of a loading regimen for treatment of Achilles tendinopathy is well-established, and when it comes to what kind of regimen to use—eccentric training (ECC) or heavy resistance training (HSR)—researchers were surprised to find that both work equally well.

    In a study published in the May 27 issue of The American Journal of Sports Medicine (abstract only available for free) researchers from Denmark compared ECC and HSR interventions among 58 patients with chronic Achilles tendinopathy and found that both approaches "yield positive, equally good, lasting clinical results." Authors had hypothesized that the HSR group would yield better outcomes, based on similar studies conducted on patients with patellar tendinopathy.

    For the Achilles study, patients were divided into 2 groups, with 30 receiving HSR and the remaining 28 receiving ECC. Evaluations were conducted at baseline, 12 weeks, and 52 weeks, and included the Victorian Institute of Sports Assessment for Achilles (VISA-A), pain level assessments, ultrasonography, color Doppler scans, and patient satisfaction ratings.

    The ECC group was assigned a regimen of 3 sets of 15 slow repetitions of eccentric unilateral loading while standing on the step of a staircase, 1 exercise performed with straight knees and 1 with bent knees twice a day, 7 days a week, for 12 consecutive weeks. The HSR regimen was performed 3 times a week using resistance equipment at a fitness center, and consisted of 3 2-legged exercises: heel rises with bended knee in a seated calf raise machine, heel rises with straight knee in the leg press machine, and heel rises with straight knee standing on a disc weight with the forefoot with barbells on shoulders. HSR participants completed "3 or 4" sets in each exercise, with reps decreasing and loads increasing over time. Physical therapists instructed both sets of patients on how to perform the exercises.

    "The main difference between the 2 exercises regimens is the total loading time 'seen' by the tendon and the calculated session," authors write. "The time of tendon loading was estimated to be approximately 63 min/wk for ECC and 41 min/wk for HSR."

    What researchers found was that both approaches resulted in "robust clinical and structural improvements" for patients, with average VISA-A improvements of 10 points or more (on a 100-point scale) and reductions of 30 points or more in pain while running. These improvements remained equal at the 12-week and 52-week marks.

    Researchers did identify a few minor differences between the groups: HSR participants reported higher patient satisfaction at 12 weeks (though that dropped off at 52 weeks), and compliance rates were lower for ECC (78%) compared with HSR (92%). Authors are unsure of the exact reason for the difference in compliance, but they speculate that the longer time commitments required by ECC could explain at least part of the differences—"one aspect that may be considered when loading regimens are offered to patients," they write.

    "Eccentric loading regimens for tendinopathy have been widely accepted as the treatment of choice," authors write. "Although the present study was not designed to answer the effect of [contraction regimens such as HSR] per se, it appears that HSR, which includes a concentric as well as eccentric component, produced similar results to the traditional ECC regimen."

    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.

    Thursday, May 28, 2015RSS Feed

    Study: Mobilization With Movement Can Make a Difference in Shoulder Impingement

    A new study that attempts to isolate the effectiveness of mobilization with movement (MWM) for unilateral shoulder impingement concludes that the intervention can result in significant reduction in pain compared with a sham intervention. Authors believe that the more realistic use of MWM—not in isolation but as part of a multimodal physical therapy plan—could point to even better results for patients with shoulder impingement syndrome (SIS).

    For the study, recently published in the Journal of Manipulative and Physiological Therapeutics (abstract only available for free), researchers analyzed pain and range of motion results for 42 patients with SIS, half of whom received 4 10-minute sessions of a specific MWM application, and half who received a sham MWM-like intervention. Joshua A. Cleland, PT, DPT, OCS, FAAOMPT, was among the authors of the study.

    The actual MWM was performed by a physical therapist (PT) "with more than 10 years of experience in manual therapy," according to authors, who described the MWM technique as a process whereby "one hand was placed over the scapula posteriorly while the thenar eminence of the other hand was placed over the anterior aspect of the head of the humera." The patient is then asked to move his or her shoulder in flexion while the PT maintains a posterior-lateral manual glide on the humeral head. In each session, 3 sets of 10 repetitions were attempted, but the application was stopped if patients experienced pain.

    The sham MWM involved the PT placing one hand over the belly of the pectoralis major muscle and the other over the scapula without applying pressure. The patient was then asked to move his or her shoulder in the same way as the real MWM.

    Researchers measured pain free and maximum (painful) range of motion (ROM) in shoulder flexion, and pain-free ROM in shoulder extension, abduction, external rotation, and medial rotation at the start of the interventions and after 2 weeks.

    Their findings: patients who received the MWM experienced greater ROM in flexion and external rotation, and achieved a reduction in pain intensity during flexion—"significantly better outcomes" than the sham group, according to authors.

    Authors of the study write that the reasons for the improvement through MWM are "speculative" but offer the possibility that the force applied by the PT "diminished the abnormal translation of the humerus, which has been identified in individuals with shoulder problems."

    Researchers cited the fact that the study focused on MWM as a sole intervention as a limitation to their work. "In typical physical therapy practice, a multimodal treatment approach is often used," they write. "It is possible that combining MWM with other commonly used interventions including exercise and taping may result in greater improvements."

    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.

    Thursday, May 21, 2015RSS Feed

    BMJ Study Links Regular Physical Activity to Longer Life in Elderly Men

    Older men have yet another incentive to be physically active—they can extend their lifespan. At least this was the case for elderly men in an observational study recently published in the British Medical Journal (BMJ) (free full-text download) that linked regular physical activity to a lower risk of death.

    Boosting physical activity levels in this age group seems to be as good for health as giving up smoking, the findings suggested.

    The 5,738 men under observation had taken part in the Oslo I study of 1972-1973, at which time they would have been aged 40-49, and again in Oslo II 28 years later. In Oslo II they were monitored for almost 12 years to see if physical activity level over time was associated with a lowered risk of death from cardiovascular disease, or from any cause.

    The men were surveyed on, among other things, their weekly leisure time physical activities. Activities were classified as sedentary (watching TV or reading); light (walking or cycling, including to and from work for at least 4 hours a week); moderate (formal exercise, sporting activities, or heavy gardening for at least 4 hours a week); and vigorous (hard training or competitive sports several times a week).

    The analysis indicated that more than an hour of light physical activity was linked to a 32% to 56% lower risk of death from any cause. Less than an hour of vigorous physical activity was linked to a reduction in risk of between 23% and 37% for cardiovascular disease and death from any cause. The more time spent doing vigorous exercise, the lower the risk seemed to be, falling by between 36% and 49%. Men who regularly engaged in moderate to vigorous physical activity during their leisure time lived 5 years longer, on average, than those who were classified as sedentary.

    Factoring in the rising risk with age of death from heart disease and stroke made only a slight difference to the results, researchers said. Overall, these showed that 30 minutes of physical activity—of light or vigorous intensity—6 days a week was associated with a 40% lower risk of death from any cause.

    Being an observational study, no definitive conclusions can be drawn about cause and effect, the researchers pointed out, adding that only the healthiest participants in the first wave of the study took part in the second wave, which may have lowered overall absolute risk. But the differences in risk of death between those who were inactive and active were striking, even at the age of 73, they suggest.

    More effort should go into encouraging elderly men to become more physically active, the researchers concluded, emphasizing the wide range of ill health that could be warded off as a result. PT in Motion News reported in 2014 on 2 other studies touting the benefits of physical activity for older adults: JAMA reported that a physical activity program can reduce the risk of losing the ability to walk without assistance; and the Journal of Physical Activity & Health reported that each hour of sedentary behavior increases the odds of disability in activities of daily living.

    APTA offers educational resources that address the role of the physical therapist in health and wellness in older adults and provide insight into older adults and exercise adherence. Additionally, APTA's consumer-focused MoveForwardPT.com website includes a webpage featuring videos addressing the importance of fitness across the lifespan. The association also offers a prevention and wellness webpage that includes videos, podcasts, and educational resources.

    Wednesday, May 20, 2015RSS Feed

    Patients With Colorectal Cancer Heed Physical Activity Advice – If They Get It

    The good news: a large-scale British study has found that individuals with colorectal cancer (CRC) who can recall a clinician giving them advice to stay as physically active as possible tend to do just that.

    The bad news: less than a third of CRC patients remember getting any such advice in the first place.

    In a study in the May issue of BMJ Open (.pdf), researchers presented findings based on a 2013 survey of 15,254 individuals in the United Kingdom who had received a CRC diagnosis in 2010-2011. The survey gathered demographic and other data—including rates of physical activity—and asked the question, "Did you receive any advice or information on physical activity or exercise?"

    Only 31% answered yes. And what makes this number particularly powerful is that receiving advice on physical activity (PA) seems to make a difference with patients.

    Researchers found that among the patients who recalled receiving PA advice, 51% were engaged in brisk physical activity for at least 30 minutes 1-4 days a week, with 25% participating in PA for at least 30 minutes 5-7 days a week. Those numbers dropped to 42% and 20%, respectively, among patients who didn't remember receiving PA advice.

    Authors write that while some clinicians may be waiting for the results of an ongoing clinical trial focused on the relationship of PA rates to CRC survival rates before considering giving PA advice, "in light of strong evidence for a number of other important outcomes, such as reductions in cancer-related fatigue and improved quality of life, it is important for clinicians to be advising their patients with CRC to be physically active."

    Other findings from the study:

    • Men (35%) were more likely than women (25%) to recall being given PA advice.
    • Patients 55 and younger recalled receiving advice more often than older patients (37% vs 20%).
    • Patients with higher socioeconomic status (SES) remembered getting advised on PA with more frequency than patients at lower SES levels (32% vs 28%).
    • Among patients in remission, 32% recalled receiving advice, compared with 27% of nonremission patients.

    Authors acknowledge that "giving PA advice may not always be easy for health care professionals" because of a "lack of appropriate support," uncertainty about what to recommend, or perceived time constraints.

    But these barriers must be overcome, they argue.

    "Our results strengthen the case for clinicians to recommend PA to their patients with cancer," authors write, citing the differences reported in the survey. "This difference is potential of real practical significance."

    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.

    Friday, May 15, 2015RSS Feed

    9 of 10 Parents of Overweight Children Don't See the Problem

    Nearly 95% of parents of overweight children in America don't perceive their child as overweight, according to a new study that underscores a phenomenon one editorial writer describes as "oblviobesity."

    The research, which appears in the June issue of Childhood Obesity (.pdf) analyzed data from National Health and Nutrition Examination Surveys (NHANES) administered between 1988 and 1994, and again between 2007 and 2012.

    Researchers compared an individual child's BMI with his or her parent's answer to the questions, "Do you consider [child's name] to be overweight, underweight, just about the right weight, or don't know?" (earlier survey) and "How do you consider [child's name] weight?—overweight, underweight, about the right weight, or don't know," (later survey). The comparison allowed authors of the study to gauge just how far parent perceptions veered from reality.

    They veered a lot. In the later survey 94.9% of parents of overweight children described their child's weight as "just about right," a slight decline from the 96.6% of parents who provided that response in the earlier survey.

    That perceived improvement, however, was offset by an increase in the number of parents who perceived their obese child's weight to be "just about right"—about 79% of parents of obese boys, and 68% of obese girls, numbers that increased from 69% and 59%, respectively. What that means, according to researchers, is that that probability of a parent appropriately perceiving his or her child as overweight or obese dropped by 30% between the surveys.

    Other findings:

    • Overall, the children sampled in the latest survey were "significantly heavier" than their counterparts in the earlier survey, with mean BMI increasing from .23 to .37.
    • The declining tendency to misperceive the weight of an obese or overweight child was most pronounced among black parents.
    • The apparent threshold for a parental perception of overweight shifted: in the earlier study, the majority of perceived overweight children were overweight; in the most recent study, the majority of children perceived as overweight were obese or severely obese.

    In an editorial that appeared in the same issue as the study, author David L. Katz, MD, described a number of earlier studies that produced similar results—both in terms of parental perceptions of a child's weight, and the perceptions of children themselves. He dubbed the phenomenon "oblivobesity."

    For their part, researchers point to several possible causes for the increasing misperceptions, including growing overall obesity rates that may prompt parents to look at peers for standards, poor communication between parents and the medical community, a belief that weight will be "outgrown," and an unwillingness "to label their child as overweight owing to societal pressures of maintaining a lower weight and/or the stigma often attached to obesity."

    Authors cite public health initiatives to decrease childhood obesity rates, but write that "the opportunity has not yet been fully realized and pediatricians' commitment may need revitalizing."

    In his editorial, Katz frames the problem in dire terms.

    "If parental inattention fosters a rising mean BMI among children globally, and a rising mean BMI fosters acclimation among parents to that ever-higher norm, then obesity in our children becomes the new normal," he writes.

    APTA offers extensive resources on the PT's role in prevention and wellness, as well as on behavior change in the patient and client.

    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.

    Monday, May 11, 2015RSS Feed

    Additional Day-Per-Week of Physical, Occupational Rehab Therapy Results in Cost-Savings

    What a difference a day makes.

    Researchers in Australia say that a study of inpatient rehabilitation there has revealed that adding Saturday physical and occupational therapy sessions to a weedays-only schedule can lower overall health care costs after 1 year while it increases functional independence.

    For the study, researchers tracked public and private health care costs of 996 patients admitted to 2 inpatient rehabilitation facilities. The patients were divided into 2 groups: 1 group of 500 that received 1 hour each of physical therapy and occupational therapy Monday through Friday, and a second group of 496 patients who received the therapy sessions on Saturdays, too. Authors of the study were interested in finding whether the cost of the additional day of rehab therapies was offset by patient gains that resulted in lower health care expenditures after 1 year.

    The answer: a definitive yes. Results were e-published ahead of print in the April 18 issue of BMC Health Services Research (.pdf).

    Researchers found that after 1 year of admission, the Monday-Friday group racked up, on average, $68,184 (Australian) in combined health care costs, inclusive of Australian Medicare costs, private insurance costs, and out-of-pocket expenditures. The plus-Saturdays group reported an average cost of $61,859—in US dollars, a savings of nearly $5,000.

    Authors believe that part of the savings was realized through shorter lengths-of-stay among the Saturday group, which averaged 10.3 days compared with the control group's 15.2-day average. The shortened stays more than made up for the average additional cost of $200 per patient for resources used to provide the additional day of rehabilitation therapies.

    Also significant, according to the researchers, were the differences between the groups when it came to functional independence after 6 months and 1 year: compared with the control group, the Saturday group was 19% more likely to achieve a minimal clinical important difference (MCID) in functional independence after 6 months, and 11% more likely to achieve an MCID after 12 months.

    Authors believe that the cost-effectiveness could be attributable to the idea that "participants who received the additional Saturday rehabilitation were discharged at a higher level of functional independence and therefore were equipped to live independently in the community with less dependence on community health services."

    "The provision of an additional Saturday inpatient rehabilitation service provided benefits that reduced short term costs to the health service and reduced the medium term costs across the health system, including a reduction in hospital readmissions that could potentially free up inpatient beds," authors write. "The implication is a win-win intervention for the health service, the health system, and the patient."

    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.

    Thursday, May 07, 2015RSS Feed

    Use of Mobility Devices Up By 50% Among Adults 65 and Older

    Americans 65 and over are using mobility devices such as canes and walkers more than ever—and increasingly, using more than 1 device, depending on the setting. And while that use doesn't necessarily mean that these adults are experiencing more—or fewer—falls than their counterparts who don't use mobility devices, the usage rates could challenge professionals who provide training to rethink their approaches, according to a new study.

    In an article published in the May 6 issue of the Journal of the American Geriatrics Society (.pdf), researchers shared data collected from National Health and Aging Trends (NHAT) surveys conducted in 2011 and 2012, and compared those data with earlier surveys. The 2011-2012 data included a nationally representative sample of 7,609 community-dwelling Medicare beneficiaries.

    What they found: in 2011-2012, nearly 1 in 4 adults over 65 (24%) reported using some kind of mobility device—a 50% increase since 2004. Of those users, 9.3% reported using more than 1 mobility device.

    Researchers offered several possible reasons for the rise in use, including greater disability rates, increased longevity, wider acceptance of the use of mobility devices, or "correction for unmet needs in previous decades."

    It's a topic worthy of further study, according to the authors, who write that "understanding the determinants of greater use will provide insight into the training needs of older adults (whether current mobility device training standards are sufficient for safety and mobility) and whether use tracks appropriately with current needs."

    When they shifted to an analysis of use data as it relates to self-reported falls incidence, authors found a mixture of the expected—for example, the highest incidence of falls was reported by participants with a history of device use and a history of falls—and the slightly surprising: there was no difference in falls incidence or recurrence of falls between the device and non-device groups, after adjusting for demographics, medical conditions, physical capacity, cognitive function, and falls history.

    On the other hand, use didn't lower incidence either.

    "Although mobility device use did not appear to lower the incidence of falling, this is not wholly unexpected, given that mobility device use is significantly associated with many of the risk factors for falls," authors write. "It is unknown how often comprehensive fall risk reduction efforts coincide with mobility device prescription."

    Authors believe the new finding that a significant number of Americans 65 and older use more than 1 mobility device could have an effect on the way training is approached.

    "This [finding] has implications for practitioners, especially those who prescribe and train older adults in the use of mobility devices," authors write. "In particular, a need for training and safety assessment on more than 1 device, when applicable, and continued follow-up to identify physical changes requiring additional devices or discontinuation of devices no longer needed for safety are indicated."

    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.

    Thursday, April 30, 2015RSS Feed

    If Supervised Exercise Is Better Than Unsupervised Exercise for Intermittent Claudication, Why Are Quality of Life Indicators Similar?

    A new study on intermittent claudication (IC) says that when it comes to improvements in walking distances and time before the onset of pain, supervised exercise (SE) is more effective than unsupervised exercise (UE). When it comes to quality of life and increased community-based walking, however, those differences aren't as clear—and teasing out exactly why isn't easy.

    Researchers conducted a meta-analysis of 27 studies (24 randomized controlled trials and 4 observational studies) of 2,074 patients that compared SE and UE approaches for participants with IC, a condition associated with peripheral artery disease that causes cramping and early fatigue after walking even short distances. What they found is likely not surprising to physical therapists (PTs) and physical therapist assistants (PTAs): SE resulted in a "moderate to large" improvement in maximal walking distance (MWD) and a "moderate" improvement in claudication onset time (COT) compared with unsupervised exercise.

    The findings are important, authors write, because even though SE is widely recognized as the preferred approach for treatment of IC, "given the lack of Medicare reimbursement, lack of physician and patient awareness of the role of [SE], and patient transportation and time barriers, [SE] is underused." The study was published in the American Heart Journal (abstract only available for free).

    Less definitive were differences in quality of life (QOL) and community-based walking as measured by the walking impairment questionnaire (WIQ). Here, researchers found little difference between the SE and UE groups—a result that seems to run counter to the assumption that if individuals with IC are able to walk longer with a slower onset of IC thanks to SE, they'll report improvements in life quality and more time spent walking at home.

    Authors argue that part of the reason for the similarities may have to do with the effects of treadmill walking versus overground walking on the 6-minute walk test used in some QOL assessments. "In contrast to treadmill walking, 6-minute walk tests have been shown to correlate better with physical activity in daily life," authors write. "In addition, the biomechanics of treadmill walking differ substantially from overground walking … providing for a potential physiologic basis for the discrepancy between treadmill gains and QOL."

    When it comes to similarities in community-based walking assessed through WIQ, authors urge caution about drawing conclusions due to the fact that only a small number of studies included this kind of analysis.

    The study's authors offer still another explanation for the QOL similarities: the lack of disease-specific QOL assessments used in some of the studies. More generic QOL assessments, they write, "typically do not address the emotional and psychosocial impact of disease-specific physical limitations and thus may not adequately assess therapy-related improvements in QOL."

    And while the authors found SE "superior" to UE for improvement in maximal treadmill walking and COT, they write that in the end, it could be this lack of solid disease-specific evidence on QOL improvements that will hold up any significant changes in utilization.

    "Given the current lack of evidence that [SE] improves QOL or community walking over [UE]," they write, "further evidence may be needed before reimbursement policies for supervised exercise will be reconsidered."

    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.

    Wednesday, April 29, 2015RSS Feed

    Survey of Individuals With PD Shows Strong Appreciation for Exercise, Role of PT

    A recently released survey of 1,500 individuals with Parkinson Disease (PD) reveals a high level of appreciation for the importance of exercise among this population, and a fairly strong understanding—both by people with PD and physicians—of the benefits of physical therapy in treatment.

    The survey was aimed at getting the patient's perspective on exercise (.pdf) by asking a series of questions that included not only how much and how often participants exercise, but their perceptions of the benefits, views on perceived barriers to exercise, and general life satisfaction. Results are presented in aggregate and by a variety of demographic factors, as well as according to the number of years since the individual was diagnosed with PD.

    The study was created and conducted by DBS4PD, an affiliate of the Parkinson Alliance that supports the use of deep-brain stimulation (DBS). No differences in exercise data were found between DBS and non-DBS groups.

    Among the findings:

    • Among all respondents, nearly 92% reported that they participated in some form of exercise, with 59% indicating they had engaged in exercise on a "fairly regular or regular basis" throughout their adulthood.
    • Eighty-four percent of participants reported that their physician had recommended exercise.
    • When it came to physical therapy, 66% of respondents indicated that their physician had recommended seeing a physical therapist, and 62% reported that they had participated in physical therapy for treatment.
    • Nearly 9 out of 10 (87%) of participants said that exercise was "quite a bit" to "extremely" important, with nearly that number (86%) believing that an individual with PD should exercise 3 times a week or more—although they were divided as to whether each exercise session should last for 30 minutes (46%) or 45 minutes or more (40%).
    • Walking was cited as the most common form of exercise (65%), followed by strength training (33%).
    • Approximately 90% of participants reported remaining sedentary for more than 2 hours a day, with 45% to 57% reporting being sedentary for more than 5 hours a day, depending on age and PD duration.
    • Barriers to exercise included feeling too tired (61%-74%), health problems related to PD (46%-67%), and health problems not related to PD (50%-60%). Specific to PD-related motor problems, respondents reported balance problems, walking difficulties, and stiffness as major barriers.

    In its summary of the findings, DBS4PD urges individuals with PD to consult with a physical therapist.

    "Asking the doctor for a referral to a physical therapist can help people with PD get started on an effective exercise program," survey authors write. "A physical therapist can help design or modify exercises to facilitate successful participation."

    APTA offers several resources on the role physical therapy can play in the treatment of PD, including a PT's Guide to Parkinson Disease and evidence-based practice research that can be accessed through PTNow. Looking for continuing education on the role of the PT in PD? Check out a 4-module series APTA produced in partnership with the Parkinson Disease Foundation (module 1, module 2, module 3, module 4).