Addressing the Sum of the Parts
Our goal as physical therapists is to fulfill rehabilitation needs optimizing function, and promote wellness in our patients. In order to achieve this end goal we must address the whole person in terms of maximizing strength along with increasing stamina and endurance. In order to achieve this we must address the “whole” person.
APTA holds as ethically binding the principle that PTs “shall endeavor to address the health needs of society.”
When addressing a primary diagnosis such as degenerative joint disease of the knee, not only should quadricep and hamstring strengthening be targeted, but core strengthening can and should be addressed. Core strengthening as it relates to DJD of the knee serves to provide further strength development through the entire kinetic chain improving the patient’s overall function. Inform your patients of the relationships with overweight/obesity and associated diseases, particularly those diagnoses that you may be addressing. Osteoarthritis of knees, hips, has an incidence 3-10.5 times greater in those who are obese. Low back pain has a relative risk of 2 in obese persons.
Educate your patients on the benefits of a healthy lifestyle change, which includes increased exercise/activity and weight loss. Inform your patients on the results received from a small amount of weight loss. Let them know that weight loss of 10-12 pounds decreased parameters of knee pain by 30% and improved function by 24% in 316 overweight people in one study. In another study a weight reduction of 10% improved function by 28% in 80 patients with osteoarthritis.
Inform your patients that just a 5-10% reduction in their current weight will significantly improve parameters of health including: a reduction in blood pressure 10-20 mmHg, a drop in total cholesterol by 10% and LDL by 15% and a reduction in risk of developing diabetes greater than 50%.
Educate Your Patients on the Benefits of Exercise
In a study of 21,925 men age 30-83 years of age, unfit men regardless of leanness had a greater risk of cardiovascular disease mortality than those who were fit. Let your patients know that physical activity is associated with a lower risk of several common forms of cancer, most notably colon and breast cancer.
Inform Your Patients on the Benefits of Making Good Food Choices
In the NHANES I study, 9,608 adults 25-74 years of age demonstrated and inverse association with fruit and vegetable intake and the risk of Cardiovascular disease and all-cause mortality.Additionally according to a 7 year study, people who do not smoke, have a body mass index lower than 30, exercise for 3.5 hours of week, and eat many fruits and vegetables and whole grains, can reduce the risk of chronic illness like diabetes, heart attack, stroke and cancer by an average of 80 percent.
Inform Your Patient that You Can Assess Their Body Mass Index (BMI) and Risk of Disease if They Would Like to Know
Research indicates that just a 5-10% reduction in body weight improves parameters of health. Set realistic short and medium range weight loss goals for your patient of 5-10% of their current body weight. Weight loss should be at the rate of between 1-2 pounds per week. Example: 220 pound person. Short term goal of 5%: would be an 11 pound weight loss, medium range goal of 10%: would be a 22-pound weight loss.
After discharge of your patients, encourage them to continue with an ongoing exercise program integrating their rehabilitation exercises into a general fitness program. Provide patients with exercise sheets with suggested ways to add activity to their routines, along with checklists for keeping track of their progress. Provide a list of recreational facilities for your patient. Provide patients with information on healthy food choices and helpful hints on making behavioral changes regarding eating patterns.
Those who think they have no time for bodily exercise will sooner or later have to find time for illness. ~ Stanley Edwards
Andersen RE. et. Al. Relationship between body weight gain and significant knee, hip, and back pain in older Americans. Obese Res. 2003;11:1159-1162.
Bazzano, LA, et. Al. Fruit and vegetable intake and risk of cardiovascular disease in US adults: the first National Health and Nutrition Examination Survey Epidemiologic follow-up study. Am J Clin. Nutr. 2002:76:93-99.
Chong Do Lee, Blair SN, Jackson, AS. Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. Am. J. Clin Nutr. 199:69;373-380.
Christensen R., Astrup A., Bliddal H. Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis Cartilage. 2005;13:20-27
Ford, ES, et al. Healthy living is the best revenge. Arch Intern Med. 2009;169(15):1355- 1362
McTiernan A, et al. Women’s Health Initiative Cohort Study. Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women’s Health Initiative Cohort Study. JAMA. 2003 Sep 10;290(10):1331-6.
Messier SP. Et. Al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum. 2004;50:1501-1510.
Oliveria SA. Et. Al. body weight, body mass index, and incident of symptomatic osteoarthritis of the hand, hip and knee. Epidemiology. 1999. 10(2): 161-166.
Latest posts by Jeff Gilliam, PT, PhD, OCS (see all)
- The White Elephant in the Clinic - July 26, 2018
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- Encouraging Your Patient to make a Healthy Lifestyle Change - December 16, 2016
- How to Address Obesity in the Patient with Osteoarthritis of the Weight Bearing Joints - October 15, 2016
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