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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.

    Comments

    • Yes. There is a growing population of individuals unable to participate in traditional land-based exercise who need to lose weight but have difficulty exercising because of bad joints. Our program uses aquatic therapy to address the exercise needs of this population and have seen marked improvement in community ambulation ability of this group as measured with the 10 meter walk test and with isokinetic testing of quad strength.

      Posted by Scott McGrew -> =LQ`DK on 3/7/2018 3:13 PM

    • The current medical model of the delivery of PT treatment does not keep our patients with complex medial needs and functional limitations well. Alternative models of physical therapy are needed- we can do so much more than provide a home exercise program or refer patients to community programs! With our education, expertise and experience, PT’s should be leading the way, transforming society, in the provision of wellness care for individuals with complex medical needs. GroupHab Physical Therapy and Wellness has pioneered an alternative model of PT care that begins with a PT assessment and the placement of a patient in a PT designed and supervised functionally based wellness class with aerobics, strengthening, balance and flexibility. Specialty classes such as arthritis management and back pain are also offered. We would love to see this model of PT care delivered all over the country – really making a profound impact, transforming society, and improving the health of our nation! Patrice Hazan, PT,DPT,GCS,MA www.GroupHab.com Patricehazan@grouphab.com 864-525-2654

      Posted by Patrice Hazan on 3/10/2018 3:31 PM

    • Functional Medicine can be very helpful in treating complex chronic conditions which contribute to difficulty exercising. Functional Medicine helps discover and address the underlying root cause(s) of these complex chronic medical conditions and helps the patient begin to lose weight. It may also help to improve the patient’s ability to exercise. Two year outcome data from the Cleveland Clinic showed patients receiving Functional Medicine had better PROMIS-10 Scores and lower patient costs than patients receiving primary care. These included very complex patients including those who had autoimmune, fatigue and mood disorders. I am a patient myself and had trouble exercising but am now, thanks to Functional Medicine doing much better and now able to exercise, more than I ever expected. It was difficult to be in that position and I am grateful for the help I received and am now a Functional Medicine Health Coach. Important considerations for all patients include adequate & restful sleep, regular exercise, nutritional status, health of the microbiome, levels of stress, environmental exposures, ability to eliminate daily cellular wastes and other toxins, and other factors. These all affect the patient’s health, ability to function and exercise as well as the ability to lose weight. Physical Therapists can learn to begin to address these areas of health by taking advantage of the APTA Learning Center webinars offered these topics. The Institute for Functional Medicine and the Functional Medicine Coaching Academy are also helpful resources. Donna DeSanto Ott PT, MS, FMCHC

      Posted by Donna DeSanto Ott -> =MYbC on 3/21/2018 7:09 AM

    • The prevalence of functional limitations is increasing as the large Baby Boomer population continues to age. Soon, more than 50% of the population will have at least one functional limitation. Fortunately, their are new tools to support those who want to continue living their active lives in spite of their limitations. My collection, based on my recent experience with mobility limitations, is on my blog at http://thielst.typepad.com/my_weblog/online-store.html My blog posts include highlights of thes and other supports as well. I continue to look for new items to share with others, so please send me your suggestions!

      Posted by Christina on 6/1/2018 11:35 AM

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