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  • Easier Said than Done: A Third of Patients Told to Lose Weight Have Functional Limitations That Could Make Exercise Difficult or Unsafe

    Physicians increasingly may be prescribing exercise for patients who need to lose weight, but nearly a third of those patients have functional limitations that could interfere with their ability to safely follow those recommendations, according to new study. Researchers see physical therapists (PTs) as providers who are uniquely positioned to help fix that disconnect.

    The study's findings, published in Physiotherapy Theory and Practice (abstract only available for free) are based on data from 5,480 participants in 2 rounds of National Health and Nutrition Examination Surveys (NHANES) who answered yes to 1 or more of 3 questions about whether a doctor or health professional had recommended physical activity or weight loss in the past 12 months. Researchers looked at how this group answered other questions about functional limitations—activities such as walking for a quarter mile, walking up 10 steps without resting, preparing meals, dressing, standing up from an armless chair, and pushing or pulling large objects—as well as questions about past attempts at weight loss. Here's what they found:

    • Among respondents (56.5% female, 43.5% male ranging in age from 40 to 65) who were told to lose weight, nearly 1 in 3 (31%) reported 1 or more functional limitations.
    • More than 20% reported difficulties with instrumental and basic activities of daily living (IADL and BADL) and with lifting, pushing, or pulling objects.
    • More than 90% of respondents who reported difficulties with IADL and BADL also had a history of obesity, prediabetes, diabetes, hypertension, heart failure, angina, or a myocardial infarction, either alone or in combination.
    • Among the functional limitation group, 57.6% reported intentionally attempting weight loss, with 40.7% using exercise as a weight-loss method.
    • Only 9.9% of respondents who were told to lose weight reported seeking professional advice for weight loss: 48% of that group sought advice from a nutritionist or dietitian, 26% sought out a personal trainer, 23.5% met with a "doctor," and 2% reported "other." Physical therapists were not listed as a separate option.

    Authors of the study acknowledge that while the relationship between functional limitations and lower levels of physical activity (PA) may be a 2-way street, with low levels of PA leading to functional limitations and vice-versa, this relationship only underscores the need for carefully planned and monitored prescriptions for exercise in this population. That's where they believe PTs can play an important role.

    "Physical therapists are well-suited to manage the PA and exercise programs of individuals with functional limitations given [their] education, expertise, and documented self-efficacy in primary, secondary, and tertiary prevention with exercise testing, prescription, and implementation," authors write. "This perspective is strengthened by the documented low self-efficacy of physicians with PA counseling."

    Authors acknowledge that their study may have limitations, including the "bidirectional" relationship between low PA and functional limitations and the NHANES loose use of provider terminology—specifically its reliance on the generic term "doctor." Additionally, they write, more research is needed to assess the impact of functional limitations on the ability to exercise, as well as to explore why PTs don't seem to be a regular part of prescribed weight-loss efforts.

    Nevertheless, they argue, the data in the study point to the need for a more thoughtful approach to weight-loss recommendations.

    "Individuals with these limitations should be identified at the time of health professional recommendation to increase exercise or lose weight and referred to an appropriate health professional for exercise testing, prescription, and program implementation," authors write. "Physical therapists have an opportunity to assist with these efforts."

    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.

    Editor's note: APTA offers resources on encouraging healthy, active lifestyles at APTA's Prevention, Wellness, and Disease Management webpage as well as its webpage on arthritis management through community programs. The association has also launched a new knowledge-sharing opportunity: The Council on Prevention, Health Promotion, and Wellness in Physical Therapy.

    From PT in Motion: PT 'Boomers' Offer Advice on Life in the Clinic and Beyond

    With so much focus on the aging patient population, it's easy to forget that the physical therapist (PT) population is aging as well, with the percentage of PTs ages 55 and older rising from 11.1% in 2000 to 24.7% in 2013, according to an APTA survey. And while PTs in the clinic can remain passionate about their profession as they age, keeping up with the physical demands of the job may be another matter. Fortunately, there are a variety of ways older PTs can adapt to their changing capacities.

    This month's PT in Motion magazine includes “Career Transitioning Advice for Aging PTs,” an exploration of how long-time clinicians are adjusting their routines or transitioning to new career paths, and the life circumstances that led them in that direction.

    One example from the article: Damien Howell, PT, DPT, who was in his mid-60s when he was diagnosed with rheumatoid arthritis (RA). Although clinical practice became more difficult, he decided it wasn't yet time to retire. "I loved my job and loved working with my patients. I wasn't about to give all of that up," he told PT in Motion. "So, instead, I focused on making improvements where I could—on trying to adjust my practice so I could continue to work." For example, Howell began to teach patients more self-mobilization techniques, and he has moved toward telehealth services.

    Other PTs featured in the article found a new direction with less demanding hours. Randy Roesch, PT, DPT, MBA, FAPTA, transitioned from clinical practice to business consulting when she acknowledged that her "workaholic" tendencies were pushing her toward 80-hour work weeks. Physical therapy, Roesch notes, "is hard physically, mentally, and emotionally, mainly because we get so involved."

    "Career Transitioning Advice for Aging PTs,” is featured in the March issue of PT in Motion magazine. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.