Download in Adobe PDF.
Alexandria, VA, July 12, 2016 — Guidelines to help physical therapists (PTs) provide safe and effective exercise interventions for children with obesity were published in the June issue of Physical Therapy (PTJ), the scientific journal of the American Physical Therapy Association (APTA).
Children and adolescents with obesity are more likely to have conditions such as diabetes, asthma, and exercise hypertension that put them at increased risk of injury from exercise. A clinical evaluation conducted by a PT prior to participation can assess patients’ risk factors, detect potential limitations or difficulties in exercise participation, and evaluate and monitor increasing levels of physical activity.
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."
The recommendations, provided by the Belgian Physical Therapy Association (AXXON), are intended for PTs who provide care for children and adolescents in private practice or home care settings. These settings, researchers explain, do not always provide adequate access to clinical practice guidelines, complex assessment tools, and treatment resources for dealing with the pediatric obesity epidemic. Experts suggest that physical therapists, who provide a conservative and cost-effective approach to patient care, obtain access to important health information by working closely with health care professionals and institutions offering more complex evaluation methods.
Clinical recommendations for physical therapists include:
- During follow-up, physical therapists are advised to measure waist circumference for observing changes in fat mass and assess and report changes in percentile scores and absolute values. PTs should screen medication prescriptions. Insulin for type 2 diabetes, for instance, can lead to hypoglycemia during exercise. Cardiovascular, respiratory, and orthopedic systems should also be examined.
- Psychosocial barriers to success such as low self-esteem, anxiety, and negative body image should be examined as they can influence adherence to a plan of care.
- Accelerometers are recommended to monitor physical activity, as they are easy to wear, are not too costly, and provide additional information such as caloric expenditure and exercise intensity. Validity of this information should be interpreted with care.
- To measure endurance exercise capacity, the 20-meter shuttle run test is preferred for assessing peak oxygen uptake.
- To measure muscle strength, authors recommend using both the handgrip strength test and the standing broad jump test.
- Endurance exercise, whether through organized sports or daily activities, should be promoted to increase physical activity and fitness in children and adolescents with obesity. Whole-body exercises are best, but even small changes, such as less sedentary time, can be highly beneficial over the long term. PTs are encouraged to stay in contact with children and adolescents and their parents to further promote physical activity and provide feedback or assistance when necessary.
- 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. Strength training should not be done in children under 5 years of age.
- Along with prescribing exercise, physical therapists should try to enhance self-efficacy in children and adolescents with obesity. PTs should explain why the exercise is beneficial and, along with the parent or guardian, participate in the prescribed exercises.
The American Physical Therapy Association represents more than 93,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Learn more about the types of conditions physical therapists can treat, and find a physical therapist in your area, by visiting www.MoveForwardPT.com. Follow Move Forward PT on Twitter and Facebook.