Addressing Chronic Disease as a Physical Therapist – Part 4

In Fitness and Physical Therapy, Physical Therapy Articles by Jeff Gilliam, PT, PhD, OCS1 Comment

Knowing that chronic disease is a major problem causing a financial drain on our economic healthcare system is the first step. Recognizing the underlying root causes of chronic disease is the second step. Implementing a program, addressing chronic disease within your physical therapy practice, with your patients is obligatory, if we are going to have any impact on preventing these diseases and helping our patients improve their function and quality of life.

A 48 year old patient who comes to us with osteoarthritis of the knee, who is also 80 pounds overweight, can do stationary cycling, straight leg raises, quad sets, and closed kinetic chain activities, however until they significantly decrease their body weight the adverse effects related to cumulative forces on the knee will continue.

Introducing your patients to the idea that their lack of appropriate exercise, their food choices and body weight are significant contributors to their problem will open the door for addressing the causes of their condition. Educate your patients on the benefits of a healthy lifestyle change, which includes increased exercise/activity and weight loss by providing your patients with the following information.

Inform your patients that just a 5-10% reduction in their current weight will significantly improve parameters of health including:

  • Reduction in blood pressure 5 mmHg
  • Increase in HDL 5 mg/dL
  • 40 mg/dL reduction in triglyceride
  • .5% reduction in HbA1C

Let your patient know that there is evidence that physical activity may be associated with a lower risk of several common forms of cancer, most notably colon and breast cancer.

Tell your patient that regular exercise decreases blood pressure in approximately 75% of hypertensive persons with an average decrease of 11 and 8 Hg mm for systolic and diastolic blood pressure respectively.

Inform your patient of the strong evidence from randomized controlled studies that moderate physical activity combined with weight loss and an improved diet can confer a 50-60% reduction in risk of developing diabetes among those already at high risk.

Also let your patients know that studies demonstrate an inverse association with fruit and vegetable intake and the risk of cardiovascular disease and all-cause mortality.

Finally, offer to help your patient set realistic weight loss goals, 5-10% of their initial weight has demonstrated improvements in parameters of health. Provide your patient with a wellness packet that helps them track their exercise and provides information on good food choices. Offer to help your patient track their weight loss and lifestyle changes involving exercise and food choices as they progress with their physical therapy program.

This type of intervention addresses the ‘whole’ person and has the potential to have both an immediate and future positive impact on your patient. As physical therapists, we truly become an instrument for healing our patients when we are addressing chronic disease.

The Impact of Chronic Disease – Part 1

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Jeff Gilliam PT PhD, OCS: is a weight loss specialist, who has studied extensively in the areas of health behavior, exercise physiology and nutritional biochemistry at the University of Florida. Jeff has taught a course at the University of Florida called ’Research Applications to Obesity and Weight Loss’. He has also taught courses for the DPT program at UF in Health Promotion and Wellness’ and ‘Evidence Based Practice III’. He has presented on a national level on topics related to diseases related to obesity and changing behavior to facilitate a healthy lifestyle. His PhD research was in the area of effective behavioral interventions for obesity and its associated diseases. He is founder of Physicians’ Choice for Weight Loss, a successful lifestyle/weight loss program, which can be found in over 50 clinics in the eastern US. He currently is clinical director of ReQuest Physical Therapy (Gainesville, Florida) and incorporates his lifestyle/weight loss program into his patients’ physical therapy to help them achieve their healthiest body weight. Jeff Gilliam is an Orthopedic Certified Specialist through the American Board of Physical Therapy Specialties


  1. Thank you Dr. Gilliam,
    I info that I learned on your posts has been very helpful and inspired me to change my ways. I am going to take a walk now.

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