World Physical Therapy Day 2014 - Resources on Why PT Matters

8/11/2019 World Physical Therapy Day 2014 - Resources on Why PT Matters

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World Physical Therapy Day

2014

Resources on why physical therapy matters


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World Confederation for Physical Therapy | 1

Contents

Introduction ............................................................................................................................... 2

About physical therapy ............................................................................................................... 3

Facts and figures about physical therapists .................................................................................. 4

Article by WCPT President ............................................................................................................. 5About physical therapy, independence and participation ...........................................................6

About physical activity and child obesity .................................................................................... 8

About physical activity and cardiovascular disease ...................................................................... 11

About physical activity and diabetes ......................................................................................... 13

About physical activity and active ageing .................................................................................... 15

About physical activity and cancer ............................................................................................ 18

Journal articles about physical therapy ...................................................................................... 20

Notes about this booklet

The terms physical therapy and physiotherapy

refer to the same profession some countries

use one term, some the other. When the words

physical therapy and physical therapist are used

in this document, they also refer to physiotherapy

and physiotherapist.

The information in this booklet may be

reproduced without charge. It is designed as a

resource, and does not necessarily represent an

official WCPT view or policy.


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2 | World Confederation for Physical Therapy

Introduction

This booklet provides facts, research findings, statistics and articles to help you demonstrate the contribution of

physical therapists, as part of your World Physical Therapy Day events and campaigns.

World Physical Therapy Day falls on 8th September every year. It is an opportunity for physical therapists (known

in some countries as physiotherapists) all over the world to raise awareness about the crucial role their profession

plays in making and keeping people well, mobile and independent. The day was established in 1996, by the WorldConfederation for Physical Therapy the professions global body representing over 350,000 physical therapists in

106 countries.

WCPT has compiled this information for you to use freely. If youre not sure what to organise for World Physical

Therapy Day yet, there are plenty of suggestions in the complementary booklet World Physical Therapy Day: what

to do, how to do it, how to get noticed.


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Here is some basic information about physical therapy

for you to copy and use in any material you produce to

educate the public. If you refer to physiotherapists rather

than physical therapists in your country, do change the

text appropriately.

Physical therapists are experts in developing and

maintaining peoples ability to move and function

throughout their lives. With an advanced understanding

of how the body moves and what keeps it from

moving well, they promote wellness, mobility and

independence. They treat and prevent many problems

caused by pain, illness, impairments and disease, sport

and work related injuries, ageing and long periods of

inactivity.

Physical therapists work with people affected by a wide

range of conditions and symptoms, for example:

painful conditions such as arthritis, repetitive strain

injury, neck and back pain

cancer

strokes, Parkinsons disease and spinal cord injury

heart problems

lung disease

trauma, such as road traffic accidents and landmines

incontinence

They work in a variety of settings, including hospitals,

health centres, sports facilities, education and research

centres, hospices and nursing homes, rural and

community settings.

Here are some examples of how physical therapists

make a difference. They:

use their skills to treat the underlying causes of pain

About physical therapy

and limitations in movement and function

use many treatment approaches to help individuals

regain their mobility and maximise their potential

promote healthy lifestyles and exercise

treat each patient/client as an individual and

thoroughly assess them to identify their needs

treat sports injuries

promote safe and healthy activities

work with children with coordination, balance and

other movement problems to improve and maximise

their independence.

To achieve all this, physical therapists are educated

over several years, giving them a full knowledge of thebodys systems and the skills to treat a wide range of

problems. This education is usually university-based

and at a level that provides full professional recognition

and allows them to practise independently. Continuing

education ensures that they keep up to date with the

latest advances in research and practice. Many physical

therapists are engaged in research themselves.


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Facts and figures about

physical therapistsPhysical therapists work with people of all ages to bring

about improvements in their health and independence.

Physical therapists provide exercise prescriptions to

help people keep fit and achieve/maintain a healthy

weight.

Around 500 million people are obese worldwide.

Physical activity is one of the best means of countering

obesity.

Children and young people under the age of 18 need 60

minutes of moderate to vigorous physical activity each

day to promote and maintain health.

Adults need 30 minutes of moderate physical activity

five days a week, or 20 minutes of vigorous physical

activity three days a week to maintain health. Plus theyneed to do muscle strengthening exercises at least

twice a week.

Research has shown that physical therapy exercise

prescriptions help women who experience

incontinence, osteoporosis or breast cancer surgery.

Studies have indicated that physical therapy treatments

have a major impact on conditions such as back and

neck pain.

Physical activity provided under the guidance andsupervision of a physical therapist reduces the risk of

heart attack, stroke, type 2 diabetes, colon cancer and

breast cancer.

Despite limited numbers of physical therapists in some

countries around the world, they have proved their

effectiveness at getting and keeping people healthy.

Physical therapists provide exercise programmes for

conditions that affect the bones and muscles, such

as arthritis, back and neck pain, osteoporosis, joint

replacements, and urinary incontinence.

More detailed information about what physical

therapists do can be found in WCPTs Description

of Physical Therapy at www.wcpt.org/policy/ps-

descriptionPT.
http://www.wcpt.org/policy/ps-descriptionPThttp://www.wcpt.org/policy/ps-descriptionPThttp://www.wcpt.org/policy/ps-descriptionPThttp://www.wcpt.org/policy/ps-descriptionPT


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Article by WCPT President

This article by WCPTs President, Marilyn Moffat, can be

published in newsletters, magazines and journals, or

passed to other publications as background information.

If you are making any changes they should be checked

with the WCPT Secretariat [email protected].

People with disabilities and long-term illnesses have the

right to lead full and fulfilled lives as part of society. But

many do not, because they have not received the right

kind of support. This waste of human potential has a

huge cost beyond personal hardship.

Several studies indicate that lack of participation by

people with disabilities costs some countries 7% of their

gross domestic product reflecting both the loss of somany people not contributing economically and the

cost of supporting them.

On top of mobility and independence problems, low

incomes, higher living costs and restricted employment

combine to limit the life chances of people with

disabilities. This denies a large proportion of the worlds

population their fundamental freedoms.

It neednt be like that. This year, to mark World Physical

Therapy Day, WCPT is highlighting the role of physical

therapists in supporting people with long-term illness

and disability to participate fully in society. Their role

is to help people fulfil their potential by maximising

movement and functional ability.

Physical therapists specialise in human movement

and physical activity. They identify physical and other

factors that prevent people from being as active and

independent as they can be, and then find ways of

overcoming them through rehabilitation, science-based

exercise prescription, and promotion of physical activity.

Every year on 8th September,

physical therapists around

the world use World Physical

Therapy Day to draw attention

to the contribution the

profession can make to the

health and well-being of

individuals and nations. The

message is Movement for

Health. This year were promoting the message that

people with chronic illness and disability have a basic

human right to be able to participate in society and that

physical therapists can play a key part in helping them

be Fit to take part.

The United Nations Convention on the Rights of Personswith Disabilities says ...the importance of accessibility to

the physical, social, economic and cultural environment,

to health and education and to information and

communication, in enabling persons with disabilities

to fully enjoy all human rights and fundamental

freedoms...

Physical therapists can help make that happen and

the message has to go out to politicians and other

policy makers that they are worth the investment.

The World Health Organization and the World Bankhave said in a joint report: Rehabilitation is a good

investment because it builds human capacity. It should

be incorporated into general legislation on health,

employment, education, and social services and into

specific legislation for people with disabilities.

I can only echo those words. Physical therapy, including

the rehabilitation services we provide, is a good

investment because its builds human capacity. More

than that, it allows people to fulfil their true potential.

Marilyn Moffat, WCPT President


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About physical therapy,

independence and participationThe facts

People with disabilities are more likely to be

unemployed. An Organization for Economic Co-

operation and Development study of working age

people with disabilities in 27 countries found that

their rate of employment (44%) was almost half that of

people without disabilities (75%).Source: Sickness, disability and work: breaking the barriers. A synthesis

of findings across OECD countries. Paris, OECD, 2010 http://ec.europa.

eu/health/mental_health/eu_compass/reports_studies/disability_

synthesis_2010_en.pdf

Low incomes, higher living costs and restricted

employment opportunities often combine to limit

the life chances of disabled people far beyond the

restrictions of the disability itself.

Source: Masse, B. (1994). The Commission on Social Justice: Disabled

People and Social Justice. London: Institute for Public Policy

Research p.13 www.nhsemployers.org/Aboutus/Publications/Pages/

RapidAccesstoTreatmentandRehabilitationforNHSstaff.aspx

Physical therapy brings participation

A United Kingdom Hospital introduced early access

to physiotherapy services for NHS staff who were off

sick with musculoskeletal problems, or reporting MSK

problems. This resulted in more staff remaining in work,

absent staff returning quicker, and a saving to thehospital of 586,000 over six months as a result of not

having to bring in temporary staff.Source: NHS Employers, Rapid access to treatment and rehabilitation

for NHS staff. London 2012

Research shows that rehabilitation at home after

a stroke is cost-effective and reduces long-term

dependency. The total economic cost of stroke to the

UK in 2006/07 was 4.5 billion.Sources: Saka O, Serra V, Samyshkin Y, McGuire A, Wolfe CC. Cost-

effectiveness of stroke unit care followed by early supported

discharge. Stroke. 2009 Jan;40(1):24-9http://stroke.ahajournals.org/

content/40/1/24.abstract

Scarborough P, peto V, Bhatnagar P, Kaur A, Leal J, Luengo-Fernandez

R, et al. Stroke statistics. Oxford: University of Oxford 2009www.bhf.

org.uk/publications/view-publication.aspx?ps=1001548

Multidisciplinary interventions involving physical

components such as physical therapy alongside

psychological and vocational components have beenshown to lead to higher return to work rates.Source: de Boer A, Taskila T, Tamminga S, Frings-dresen M, Feurstein M,

Verbeek J (2011), Interventions to enhance return-to-work for cancer

patient, Cochrane Database of Systematic Reviews, Feb (2)CD007569

www.thecochranelibrary.com/details/file/1018207/CD007569.html

Participation benefits economies

According to the World Health Organisation and the

World Bank, the economic cost of disability comes

mainly from loss of productivity from insufficientinvestment in educating disabled children, and exits

from work or reduced work related to the onset of

disability, and the loss of taxes related to the loss of

productivity.Source: World Report on Disability 2011www.who.int/disabilities/

world_report/2011/en/

A Canadian analysis estimated that the national

economic cost caused by the loss of productivity due

to short and long-term disability was 6.7% of gross

domestic product.Source: The Economic Burden of Illness in Canada,1998. Ottawa,HealthCanada, 2002 http://publications.gc.ca/collections/Collection/

H21-136-1998E.pdf

An Australian study has concluded that increasing

participation by disabled people and reducing their

unemployment by one third over a decade would result

in a cumulative increase in Australias GDP of AUD 43

billion.Source: The Economic Benefits of Increasing Employment

for People with Disability, by Deloitte Access Economics

for Australian Network on Disability, 2011 www.deloitte.com/view/en_AU/au/industries/Lifesciencesandhealth/

b147a016d0b47310VgnVCM2000001b56f00aRCRD.htm
http://ec.europa.eu/health/mental_health/eu_compass/reports_studies/disability_synthesis_2010_en.pdfhttp://ec.europa.eu/health/mental_health/eu_compass/reports_studies/disability_synthesis_2010_en.pdfhttp://ec.europa.eu/health/mental_health/eu_compass/reports_studies/disability_synthesis_2010_en.pdfhttp://www.nhsemployers.org/Aboutus/Publications/Pages/RapidAccesstoTreatmentandRehabilitationforNHSstaff.aspxhttp://www.nhsemployers.org/Aboutus/Publications/Pages/RapidAccesstoTreatmentandRehabilitationforNHSstaff.aspxhttp://stroke.ahajournals.org/content/40/1/24.abstracthttp://stroke.ahajournals.org/content/40/1/24.abstracthttp://stroke.ahajournals.org/content/40/1/24.abstracthttp://stroke.ahajournals.org/content/40/1/24.abstracthttp://www.bhf.org.uk/publications/view-publication.aspx?ps=1001548http://www.bhf.org.uk/publications/view-publication.aspx?ps=1001548http://www.bhf.org.uk/publications/view-publication.aspx?ps=1001548http://www.thecochranelibrary.com/details/file/1018207/CD007569.htmlhttp://www.who.int/disabilities/world_report/2011/en/http://www.who.int/disabilities/world_report/2011/en/http://www.who.int/disabilities/world_report/2011/en/http://publications.gc.ca/collections/Collection/H21-136-1998E.pdfhttp://publications.gc.ca/collections/Collection/H21-136-1998E.pdfhttp://www.deloitte.com/view/en_AU/au/industries/Lifesciencesandhealth/b147a016d0b47310VgnVCM2000001b56f00aRCRD.htmhttp://www.deloitte.com/view/en_AU/au/industries/Lifesciencesandhealth/b147a016d0b47310VgnVCM2000001b56f00aRCRD.htmhttp://www.deloitte.com/view/en_AU/au/industries/Lifesciencesandhealth/b147a016d0b47310VgnVCM2000001b56f00aRCRD.htmhttp://www.deloitte.com/view/en_AU/au/industries/Lifesciencesandhealth/b147a016d0b47310VgnVCM2000001b56f00aRCRD.htmhttp://www.deloitte.com/view/en_AU/au/industries/Lifesciencesandhealth/b147a016d0b47310VgnVCM2000001b56f00aRCRD.htmhttp://www.deloitte.com/view/en_AU/au/industries/Lifesciencesandhealth/b147a016d0b47310VgnVCM2000001b56f00aRCRD.htmhttp://publications.gc.ca/collections/Collection/H21-136-1998E.pdfhttp://publications.gc.ca/collections/Collection/H21-136-1998E.pdfhttp://www.who.int/disabilities/world_report/2011/en/http://www.who.int/disabilities/world_report/2011/en/http://www.thecochranelibrary.com/details/file/1018207/CD007569.htmlhttp://www.bhf.org.uk/publications/view-publication.aspx?ps=1001548http://www.bhf.org.uk/publications/view-publication.aspx?ps=1001548http://stroke.ahajournals.org/content/40/1/24.abstracthttp://stroke.ahajournals.org/content/40/1/24.abstracthttp://www.nhsemployers.org/Aboutus/Publications/Pages/RapidAccesstoTreatmentandRehabilitationforNHSstaff.aspxhttp://www.nhsemployers.org/Aboutus/Publications/Pages/RapidAccesstoTreatmentandRehabilitationforNHSstaff.aspxhttp://ec.europa.eu/health/mental_health/eu_compass/reports_studies/disability_synthesis_2010_en.pdfhttp://ec.europa.eu/health/mental_health/eu_compass/reports_studies/disability_synthesis_2010_en.pdfhttp://ec.europa.eu/health/mental_health/eu_compass/reports_studies/disability_synthesis_2010_en.pdf


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The economic cost of disability in Africa is between 3%

of GDP in Malawi, and 7% of GDP in South Africa. In Asia,

the costs lie between 3% of GDP in Vietnam and 4.6% of

GDP in Thailand.

Source: The Price of Exclusion, International Labour Office, Geneva

2009 www.ilo.org/wcmsp5/groups/public/@ed_emp/@ifp_skills/

documents/publication/wcms_119305.pdf

A UK study has shown that if just half of breast cancer

survivors who initially return to work but then leave

were helped to stay in work the economy could save

30 million every year.Source: Making it Work, Macmillan Cancer Support, London 2010

www.macmillan.org.uk/Documents/GetInvolved/Campaigns/

Campaigns/Working_through_cancer/WorkingThroughCancer2010/

MakingitWork.pdf

What the World Health Organization and the

World Bank say

In their World Report on Disability (2011) The World

Bank and the World Health Organization support

rehabilitation as an effective means to help people

participate and fulfil their potential.

They say:

Rehabilitation is a good investment because it builds

human capacity. It should be incorporated into generallegislation on health, employment, education, and

social services and into specific legislation for people

with disabilities.

Providing assistive technology the responsibility of

rehabilitation professionals such as physical therapists

increases independence, improves participation, and

may reduce care and support costs.

Convincing evidence shows that some therapy

measures improve rehabilitation outcomes. Forexample, exercise therapy in a broad range of health

conditions including cystic fibrosis, frailness in elderly

people, Parkinsons disease, stroke, osteoarthritis in the

knee and hip, heart disease, and low back pain...

Unmet rehabilitation needs can delay discharge, limit

activities, restrict participation, cause deterioration in

health, increase dependency on others for assistance,

and decrease quality of life. These negative outcomes

can have broad social and financial implications for

individuals, families, and communities.

Many countries particularly low-income and middle-

income countries struggle to finance rehabilitation,

but rehabilitation is a good investment because it

builds human capital. Financing strategies can improve

the provision, access, and coverage of rehabilitation

services, particularly in low-income and middle-income

countries.

Source:www.who.int/disabilities/world_report/2011/en/

What the United Nations Convention on the

Rights of Persons with Disabilities says

...the full enjoyment by persons with disabilities of

their human rights and fundamental freedoms and

of full participation by persons with disabilities will

result in their enhanced sense of belonging and in

significant advances in the human, social and economicdevelopment of society and the eradication of poverty...

...the importance of accessibility to the physical, social,

economic and cultural environment, to health and

education and to information and communication,

in enabling persons with disabilities to fully enjoy all

human rights and fundamental freedoms...

One of the eight general principles of the convention is

Full and effective participation and inclusion in society.

Source:www.un.org/disabilities/convention/conventionfull.shtml
http://www.ilo.org/wcmsp5/groups/public/@ed_emp/@ifp_skills/documents/publication/wcms_119305.pdfhttp://www.ilo.org/wcmsp5/groups/public/@ed_emp/@ifp_skills/documents/publication/wcms_119305.pdfhttp://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Campaigns/Working_through_cancer/WorkingThroughCancer2010/MakingitWork.pdfhttp://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Campaigns/Working_through_cancer/WorkingThroughCancer2010/MakingitWork.pdfhttp://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Campaigns/Working_through_cancer/WorkingThroughCancer2010/MakingitWork.pdfhttp://www.who.int/disabilities/world_report/2011/en/http://www.who.int/disabilities/world_report/2011/en/http://www.un.org/disabilities/convention/conventionfull.shtmlhttp://www.un.org/disabilities/convention/conventionfull.shtmlhttp://www.un.org/disabilities/convention/conventionfull.shtmlhttp://www.un.org/disabilities/convention/conventionfull.shtmlhttp://www.who.int/disabilities/world_report/2011/en/http://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Campaigns/Working_through_cancer/WorkingThroughCancer2010/MakingitWork.pdfhttp://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Campaigns/Working_through_cancer/WorkingThroughCancer2010/MakingitWork.pdfhttp://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Campaigns/Working_through_cancer/WorkingThroughCancer2010/MakingitWork.pdfhttp://www.ilo.org/wcmsp5/groups/public/@ed_emp/@ifp_skills/documents/publication/wcms_119305.pdfhttp://www.ilo.org/wcmsp5/groups/public/@ed_emp/@ifp_skills/documents/publication/wcms_119305.pdf


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According to the World Health Organization, childhood

obesity is one of the most serious public health

challenges of the 21st centurySource:www.who.int/dietphysicalactivity/en/

Obesity in childhood is linked with asthma,

musculoskeletal problems, hypertension, early signs of

cardiovascular disease, low self-esteem and depression.

In the long-term, it can increase the likelihood of being

an obese adult, and having a greater risk of cancer, type

2 diabetes and cardiovascular disease. Encouraging

children and their families to reach recommended levels

of physical activity is a cornerstone of obesity treatment

and prevention.

Participation in physical activity helps prevent many

chronic diseases. All physical therapists are expertsin movement and exercise, and the ways in which

it promotes health. Some physical therapists, called

paediatric physical therapists, specialise in working with

children. A physical therapy assessment is particularly

important for children who are obese. The assessment

can screen for musculoskeletal impairments and guide

therapeutic exercise and physical activity prescription.

Childhood obesity facts

Globally, over 40 million preschool children were

overweight in 2008. More than 75% of overweight and

obese children live in low-and middle-income countries.Source: WHO www.who.int/features/factfiles/obesity/en/

Childhood obesity affects people regardless of their

income. The problem is global and is steadily affecting

many low-and middle-income countries, particularly in

urban settings.Source: WHO www.who.int/mediacentre/factsheets/fs311/en/

Childrens choices, diet and physical activity habits are

influenced by their surrounding environment.Source: WHOwww.who.int/features/factfiles/obesity/en/

Children who are obese have a high incidence of

musculoskeletal impairments.

Source:http://onlinelibrary.wiley.com/doi/10.1111/j.1440-

1754.2011.02102.x/abstract

Rising levels of childhood obesity are being caused

mainly by a shift towards energy-dense foods high in fat

and sugars, and decreasing levels of physical activity.Source: WHOwww.who.int/dietphysicalactivity/childhood/en/

Defining child obesity

The World Health Organization defines childhood

obesity as having a body mass index (BMI) standardised

deviation score (SDS) above 2.0. Childhood growth and

BMI should be plotted on WHO age and gender specific

charts in tandem with national growth reference

charts. Measures of body composition such as waist

circumference should be used to describe obesity.Source: WHOwww.who.int/growthref/who2007_bmi_for_age/en/

index.html

Child obesity and physical activity

The World Health Organization recommends 60 minutes

of moderate to vigorous intensity physical activity

every day for children aged 5-18. Moderate activity

includes activities that raise the heart rate and cause

some breathlessness. Vigorous activity is exercise

that makes people huff and puff and could include

dancing, household chores and sports like running

and football. Activities for children should be fun and

age-appropriate. In addition, families should be active

together because parents are the most important

agents of lifestyle change.Source: WHO www.who.int/dietphysicalactivity/childhood_what_can_

be_done/en/index.html

About physical activity and

child obesity
http://www.who.int/dietphysicalactivity/en/http://www.who.int/dietphysicalactivity/en/http://www.who.int/features/factfiles/obesity/en/http://www.who.int/mediacentre/factsheets/fs311/en/http://www.who.int/features/factfiles/obesity/en/http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1754.2011.02102.x/abstracthttp://onlinelibrary.wiley.com/doi/10.1111/j.1440-1754.2011.02102.x/abstracthttp://onlinelibrary.wiley.com/doi/10.1111/j.1440-1754.2011.02102.x/abstracthttp://www.who.int/dietphysicalactivity/childhood/en/http://www.who.int/dietphysicalactivity/childhood/en/http://www.who.int/growthref/who2007_bmi_for_age/en/index.htmlhttp://www.who.int/growthref/who2007_bmi_for_age/en/index.htmlhttp://www.who.int/growthref/who2007_bmi_for_age/en/index.htmlhttp://www.who.int/dietphysicalactivity/childhood_what_can_be_done/en/index.htmlhttp://www.who.int/dietphysicalactivity/childhood_what_can_be_done/en/index.htmlhttp://www.who.int/dietphysicalactivity/childhood_what_can_be_done/en/index.htmlhttp://www.who.int/dietphysicalactivity/childhood_what_can_be_done/en/index.htmlhttp://www.who.int/growthref/who2007_bmi_for_age/en/index.htmlhttp://www.who.int/growthref/who2007_bmi_for_age/en/index.htmlhttp://www.who.int/dietphysicalactivity/childhood/en/http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1754.2011.02102.x/abstracthttp://onlinelibrary.wiley.com/doi/10.1111/j.1440-1754.2011.02102.x/abstracthttp://www.who.int/features/factfiles/obesity/en/http://www.who.int/mediacentre/factsheets/fs311/en/http://www.who.int/features/factfiles/obesity/en/http://www.who.int/dietphysicalactivity/en/


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Physical activity recommendations

Children from birth to age five should engage in daily

physical activity that promotes skill in movement and

lays the foundations of health-related fitness.Source: National Association for Sport and Physical Education

guidelines on physical activity for children www.shapeamerica.org/

standards/guidelines/pa-children-5-12.cfm

Infants should interact with caregivers in daily physical

activities that are dedicated to exploring movement and

the environment and that promote skill development in

movement.Source: National Association for Sport and Physical Education



Toddlers should engage in a total of at least 30 minutes

of structured physical activity and at least 60 minutes

per day of unstructured physical activity and should not

be sedentary for more than 60 minutes at a time, except

when sleeping.Source:www.shapeamerica.org/standards/guidelines/pa-

children-5-12.cfm

Children under five should be physically active daily for

at least 180 minutes spread throughout the day.Source: WHO recommendations 2010 in WCPT Active and Healthy.

The role of the physiotherapist in physical activity. General Meeting of

European Region of the WCPT 2012. Pages 13-14.

Children should accumulate at least 60 minutes, and

up to several hours, of age-appropriate physical activity

on all or most days of the week. This should include

moderate and vigorous physical activity with most

of the time being spent on activities where exercise

is intermittent. Children should participate in several

bouts of physical activity lasting 15 minutes or more

each day. Periods of inactivity of two or more hours are

discouraged for children, especially during the daytime

hours.

Source: National Association for Sport and Physical Education



The role of the physical therapist

In cases of childhood obesity, a physical therapyassessment covers: 1) parental beliefs around

healthy childhood growth and development; 2)

cardiorespiratory (exercise testing); 3) musculoskeletal

(including assessment of range of movement; strength;

flexibility; balance; coordination; posture; gait and bony

alignment); 4) sedentarism (eg screen-time); 5) sleep;

6) physical activity levels and perceived barriers to

reaching recommended levels.

Treatment includes: 1) general health literacy education

for child and parent 2) management of any associated

conditions (eg painful flat fee, knee pain, weak core)

identified in physical assessment; 3) age-appropriate

and fun exercise training to increase physical fitness;

4) assisting parent/s to make changes at home to

prevent obesity developing or progressing; 5) providing

education and practical strategies to improve sleep and

energy balance; 6) liaison and onward referral within the

interdisciplinary team.

Positive communication between the therapist andfamily is essential. Many parents may not be aware

that their childs weight is a problem. Ensuring that a

holistic assessment is used to identify areas where the

child may have functional difficulties (eg balance or low

cardiorespiratory fitness) may help the therapist discuss

the childs health without solely focusing on shape or

size. In order to facilitate a childs lifestyle change, it is

recommended that the full family works towards this.Sources: Jlusson PB, et al., Overweight and obesity in Norwegian

children: prevalence and socio-demographic risk factors.
http://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfmhttp://www.shapeamerica.org/standards/guidelines/pa-children-5-12.cfm


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Acta Paediatr. 2010 Jun;99(6):900-5. www.ncbi.nlm.nih.gov/

pubmed/20175763

OMalley et al., A Pilot study to profiles the lower limb musculoskeletal

health in obese children. Pediatric Physical Therapy (in press).www.

therapydia.com/articles/12586-a-pilot-study-to-profile-the-lower-

limb-musculoskeletal-health-in-children-with-obesity

A review of evidence on the effect of physical activity

on the development of pre-school children concluded

that the availability of outside playing areas, and the

encouragement and involvement of adults, were

important in encouraging exercise.Source: Timmons BW et al. Physical activity for preschool children -

how much and how? Can J Public Health. 2007; 98 Suppl 2:S122-34.

www.ncbi.nlm.nih.gov/pubmed/18213943

Children with illness or disabilities are more restricted in

exercise participation, and have higher levels of obesity

than their peers. Finding structures that support them

to participate brings psychological and social, as well

as physical, advantages. Professionals such as physical

therapists are well placed to ensure that activities are

appropriate.Source: Murphy NA et al. Promoting the participation of children with

disabilities in sports, recreation, and physical activities. Pediatrics.

2008; 121(5):1057-61http://pediatrics.aappublications.org/

content/121/5/1057.full

This information was produced with the kind assistance

of the International Organisation of Physical Therapists in

Paediatrics.
http://www.ncbi.nlm.nih.gov/pubmed/20175763http://www.ncbi.nlm.nih.gov/pubmed/20175763http://www.therapydia.com/articles/12586-a-pilot-study-to-profile-the-lower-limb-musculoskeletal-health-in-children-with-obesityhttp://www.therapydia.com/articles/12586-a-pilot-study-to-profile-the-lower-limb-musculoskeletal-health-in-children-with-obesityhttp://www.therapydia.com/articles/12586-a-pilot-study-to-profile-the-lower-limb-musculoskeletal-health-in-children-with-obesityhttp://www.therapydia.com/articles/12586-a-pilot-study-to-profile-the-lower-limb-musculoskeletal-health-in-children-with-obesityhttp://www.ncbi.nlm.nih.gov/pubmed/18213943http://pediatrics.aappublications.org/content/121/5/1057.fullhttp://pediatrics.aappublications.org/content/121/5/1057.fullhttp://pediatrics.aappublications.org/content/121/5/1057.fullhttp://pediatrics.aappublications.org/content/121/5/1057.fullhttp://pediatrics.aappublications.org/content/121/5/1057.fullhttp://www.ncbi.nlm.nih.gov/pubmed/18213943http://www.therapydia.com/articles/12586-a-pilot-study-to-profile-the-lower-limb-musculoskeletal-health-in-children-with-obesityhttp://www.therapydia.com/articles/12586-a-pilot-study-to-profile-the-lower-limb-musculoskeletal-health-in-children-with-obesityhttp://www.therapydia.com/articles/12586-a-pilot-study-to-profile-the-lower-limb-musculoskeletal-health-in-children-with-obesityhttp://www.ncbi.nlm.nih.gov/pubmed/20175763http://www.ncbi.nlm.nih.gov/pubmed/20175763


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Cardiovascular disease is the term used to describe

diseases affecting the heart and circulatory system, and

includes heart disease, stroke and raised blood pressure

(hypertension).

Exercise, particularly aerobic conditioning and strength

training, is one of the key interventions that can prevent

death and disability from cardiovascular disease.

Physical therapists are experts in prescribing these as

part of a structured, safe and effective programme.

For those already affected by cardiovascular disease, the

expert advice provided by physical therapists can help

bring a return to usual roles. Physical therapists help

people achieve a return to work, education, community

participation and fulfilled lives.

Cardiovascular general

Cardiovascular disease is now the leading cause of

deaths worldwide. Globally, 17.3 million people died

from cardiovascular disease in 2008, 30% of all deaths.

7.3 million were due to coronary heart disease and

6.2 million due to stroke. It is estimated that by 2030,

almost 23.6 million people will die from cardiovascular

diseases, mainly heart disease and stroke.Source: World Health Organization www.who.int/mediacentre/

factsheets/fs317/en/

The death and disability rates caused by heart diseaseand stroke for every country are available at: http://

whqlibdoc.who.int/publications/2011/9789241564373_

eng.pdf

It has been estimated that if everyone walked briskly at

4.8-6.4 kph (3-4 mph) on most days of the week, about

30% of deaths from cardiovascular disease would be

prevented each year.Sources: Pate R et al. Physical activity and public health. JAMA.

1995;273(5):402-407. www.ncbi.nlm.nih.gov/pubmed/7823386

Wei M, Kampert et al. Relationship between low cardiorespiratory

fitness and mortality in normal-weight, overweight, and obese

men. JAMA. 1999;282(16):1547-1553. www.ncbi.nlm.nih.gov/

pubmed/10546694

Manson JE et al. A prospective study of walking as compared with

vigorous exercise in the prevention of coronary heart disease in

women. NEJM. 1999;341(9):650-658. content.nejm.org/cgi/content/

abstract/347/10/716

Tully M et al. Brisk walking, fitness, and cardiovascular risk: a

randomized controlled trial in primary care. Prevent Med. 2005;41:622-

628. www.ncbi.nlm.nih.gov/pubmed/15917061

Research involving people at risk of cardiovascular

disease has indicated that exercise supervised by

physical therapists, along with counselling from a

dietician, brings significant improvements in blood

pressure, weight, quality of life and other health

indicators after one year.Source: Eriksson KM, Westborg CJ, Eliasson MC. A randomized trial

of lifestyle intervention in primary healthcare for the modification of

cardiovascular risk factors. Scand J Public Health. 2006;34(5):453-61.


Raised blood pressure

Raised blood pressure, which is a risk factor for heart

attack and stroke, can be controlled by exercise. One

study has indicated that endurance exercise brings an

average reduction of 10mm Hg for both systolic and

diastolic blood pressure readings.Source: American College of Sports Medicines Guidelines for Exercise

Testing and Prescription. 6th Ed. Baltimore MD: Lippincott Williams &

Wilkins 2000.www.exrx.net/Store/Other/ACSMGuidelinesExTestingRx.

html

The type of strength training prescribed by physical

therapists can effectively reduce blood pressure in older

men and women.Source: Martel GF et al. Strength training normalizes resting blood

pressure in 65- to 73-year- old men and women with high normal

blood pressure. J Am Geriatr Soc. 1999 Oct;47(10):1215-21. www.ncbi.

nlm.nih.gov/pubmed/10522955

Major analyses of available research have indicated that

exercise can reduce resting blood pressure by 3mm Hg

for resting systolic blood pressure.

Sources: Cornelissen VA, Fagard RH. Effects of endurance trainingon blood pressure, blood pressure-regulating mechanisms, and


cardiovascular disease
http://www.who.int/mediacentre/factsheets/fs317/en/http://www.who.int/mediacentre/factsheets/fs317/en/http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdfhttp://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdfhttp://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/7823386http://www.ncbi.nlm.nih.gov/pubmed/10546694http://www.ncbi.nlm.nih.gov/pubmed/10546694http://www.ncbi.nlm.nih.gov/pubmed/15917061http://www.ncbi.nlm.nih.gov/pubmed/16990155http://www.exrx.net/Store/Other/ACSMGuidelinesExTestingRx.htmlhttp://www.exrx.net/Store/Other/ACSMGuidelinesExTestingRx.htmlhttp://www.exrx.net/Store/Other/ACSMGuidelinesExTestingRx.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/10522955http://www.ncbi.nlm.nih.gov/pubmed/10522955http://www.ncbi.nlm.nih.gov/pubmed/10522955http://www.ncbi.nlm.nih.gov/pubmed/10522955http://www.exrx.net/Store/Other/ACSMGuidelinesExTestingRx.htmlhttp://www.exrx.net/Store/Other/ACSMGuidelinesExTestingRx.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/16990155http://www.ncbi.nlm.nih.gov/pubmed/15917061http://www.ncbi.nlm.nih.gov/pubmed/10546694http://www.ncbi.nlm.nih.gov/pubmed/10546694http://www.ncbi.nlm.nih.gov/pubmed/7823386http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_29_world_data_table.pdfhttp://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdfhttp://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdfhttp://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdfhttp://www.who.int/mediacentre/factsheets/fs317/en/http://www.who.int/mediacentre/factsheets/fs317/en/


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Heart disease

Systematic reviews of evidence have shown that

therapeutic exercise provided by physical therapists is

beneficial to people with coronary heart disease, heart

failure and chronic obstructive pulmonary disease.

Source: Taylor, NF et al. Therapeutic exercise in physiotherapy practice

is beneficial: a summary of systematic reviews 20022005. Australian

Journal of Physiotherapy. 2007, Vol 53(1): 7-15. www.ncbi.nlm.nih.gov/

pubmed/17326734

Reviews of evidence have shown that exercise-based

cardiac rehabilitation for patients with coronary heart

disease significantly improves health outcomes and

mortality rates.Sources: Clark et al. Meta-analysis: secondary prevention programs for

patients with coronary artery disease. Ann Intern Med. 2005; 143:659-

672. www.annals.org/cgi/content/abstract/143/9/659

Taylor RS et al. Exercise-based rehabilitation for patients with coronaryheart disease: systematic review and meta-analysis of randomized

controlled trials. Am J Med. 2004; 116:682 692. www.ncbi.nlm.nih.

gov/pubmed/15121495

A review of evidence has indicated that exercise

training in people who have had heart failure is safe and

effective.Source: Smart N, Marwick TH. Exercise training for heart failure

patients: a systematic review of factors that improve patient mortality

and morbidity. Am J Med. 2004; 116: 693-706 www.ncbi.nlm.nih.gov/

pubmed/15121496

Telehealth interventions can help reduce cardiovasculardisease risk and help increase uptake of a prevention

programmes by those who do not access cardiac

rehabilitation.Source: Neubeck L et al. Telehealth interventions for the secondary

prevention of coronary heart disease: a systematic review. European

Journal of Cardiovascular Prevention and Rehabilitation. 2009; Vol

16(3): 281-9 www.ncbi.nlm.nih.gov/pubmed/19407659

This information was produced with the kind assistance of

Julie Redfern.

cardiovascular risk factors. Hypertension 2005 Oct; 46(4):667-75. www.

ncbi.nlm.nih.gov/pubmed/16157788

Kelley GA, Kelley KS. Progressive resistance exercise and resting

blood pressure: a meta- analysis of randomized controlled trials.

Hypertension. 2000 Mar; 35(3):838-43.www.ncbi.nlm.nih.gov/

pubmed/10720604

This type of blood pressure reduction has been

associated with a 5-9% reduction in heart morbidity,

and a 8% to 14% reduction in the risk of stroke.Source: Whelton et al. Primary prevention of hypertension: clinical

and public health advisory from The National High Blood Pressure

Education Program. JAMA. 2002 Oct 16;288(15):1882- 8.www.ncbi.


Stroke

Exercise reduces the risk of stroke. Walking at 4.8 kph

(3 mph) for 5 hrs/wk brings a 46% lower risk of stroke,compared with non-exercisers.Sources: Hu F et al. Physical activity and risk of stroke in women. JAMA.

2000; 283(22):2961- 2967. www.ncbi.nlm.nih.gov/pubmed/10865274

Lee I et al. Exercise and risk of stroke in male physicians. Stroke.


Structured exercise also brings improvement in all

measures of impairment and disability in people who

have had a stroke.Source: Teixeira-Salmela et al. Muscle strengthening and physical

conditioning to reduce impairment and disability in chronic stroke

survivors. Arch Phys Med Rehabil. 1999 Oct; 80(10):1211-8. www.ncbi.


In one study, patients who had had a stroke performed

strengthening and functional tasks three times a week

for four weeks, and gained significant improvements

in strength, walking speed, standing/sitting and

endurance.Source: Dean CM et al. Task-related circuit training improves

performance of locomotor tasks in chronic stroke: a randomized,

controlled pilot trial. Arch Phys Med Rehabil. 2000 Apr;81(4):409-17.

http://www.ncbi.nlm.nih.gov/pubmed/17326734http://www.ncbi.nlm.nih.gov/pubmed/17326734http://www.annals.org/cgi/content/abstract/143/9/659http://www.annals.org/cgi/content/abstract/143/9/659http://www.ncbi.nlm.nih.gov/pubmed/15121495http://www.ncbi.nlm.nih.gov/pubmed/15121495http://www.ncbi.nlm.nih.gov/pubmed/15121496http://www.ncbi.nlm.nih.gov/pubmed/15121496http://www.ncbi.nlm.nih.gov/pubmed/19407659http://www.ncbi.nlm.nih.gov/pubmed/16157788http://www.ncbi.nlm.nih.gov/pubmed/16157788http://www.ncbi.nlm.nih.gov/pubmed/10720604http://www.ncbi.nlm.nih.gov/pubmed/10720604http://www.ncbi.nlm.nih.gov/pubmed/10720604http://www.ncbi.nlm.nih.gov/pubmed/12377087http://www.ncbi.nlm.nih.gov/pubmed/12377087http://www.ncbi.nlm.nih.gov/pubmed/12377087http://www.ncbi.nlm.nih.gov/pubmed/10865274http://www.ncbi.nlm.nih.gov/pubmed/9880379http://www.ncbi.nlm.nih.gov/pubmed/10527076http://www.ncbi.nlm.nih.gov/pubmed/10527076http://www.ncbi.nlm.nih.gov/pubmed/10768528http://www.ncbi.nlm.nih.gov/pubmed/10768528http://www.ncbi.nlm.nih.gov/pubmed/10527076http://www.ncbi.nlm.nih.gov/pubmed/10527076http://www.ncbi.nlm.nih.gov/pubmed/9880379http://www.ncbi.nlm.nih.gov/pubmed/10865274http://www.ncbi.nlm.nih.gov/pubmed/12377087http://www.ncbi.nlm.nih.gov/pubmed/12377087http://www.ncbi.nlm.nih.gov/pubmed/10720604http://www.ncbi.nlm.nih.gov/pubmed/10720604http://www.ncbi.nlm.nih.gov/pubmed/16157788http://www.ncbi.nlm.nih.gov/pubmed/16157788http://www.ncbi.nlm.nih.gov/pubmed/19407659http://www.ncbi.nlm.nih.gov/pubmed/15121496http://www.ncbi.nlm.nih.gov/pubmed/15121496http://www.ncbi.nlm.nih.gov/pubmed/15121495http://www.ncbi.nlm.nih.gov/pubmed/15121495http://www.annals.org/cgi/content/abstract/143/9/659http://www.ncbi.nlm.nih.gov/pubmed/17326734http://www.ncbi.nlm.nih.gov/pubmed/17326734


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About physical activity

and diabetesDiabetes mellitus is a condition where the amount of

glucose in the blood is too high, causing tissue damage.

There are two types. Type 1 diabetes occurs when the

body is unable to produce any insulin. It cannot be

prevented. Type 2 diabetes develops when the body

isnt producing enough insulin, or becomes resistantto insulin. This type of diabetes can be prevented. Most

cases of type 2 diabetes are associated with being

overweight.

Exercise is one of the best ways to control or reduce

weight, and reduce risk of type 2 diabetes. Physical

therapists are experts in prescribing structured, safe and

effective exercise programmes.

Their advice can also help people who have health

complications as a result of diabetes. For example, they

can help those who have lost limbs through diabetes-related amputations recover their mobility and adapt

their environment so that they have independence.

Physical therapists help people achieve a return to work,

education, community participation and fulfilled lives.

Diabetes facts

The World Health Organization (WHO) estimates that

347 million people worldwide have diabetes. This

number is expected to double by 2030.

Source: World Health Organization factsheet www.who.int/mediacentre/factsheets/fs312/en/

Diabetes was traditionally more common in developed

countries, but modernisation and lifestyle changes

have meant it is increasingly prevalent in developing

countries. According to WHO, almost 80% of diabetes

deaths occur in low and middle-income countries.Source: World Health Organization factsheet www.who.int/

mediacentre/factsheets/fs312/en/

Diabetes and its complications have a significant

economic impact on individuals, families, health

systems and countries. For example, WHO estimates

that in the period 2006-2015, China will lose $558 billion

in national income due to heart disease, stroke and

diabetes alone.Source: World Health Organization factsheet www.who.int/

mediacentre/factsheets/fs312/en/

The death and disability rates caused by diabetes for

every country are available at: www.who.int/entity/

cardiovascular_diseases/en/cvd_atlas_29_world_data_

table.pdf

Exercise and diabetes

Exercise has a role in preventing and controlling

diabetes. According to the World Health Organization,30 minutes of moderate intensity physical activity on

most days, along with a healthy diet, can help reduce

the risk of developing type 2 diabetes. Source: World Health

Organization www.who.int/mediacentre/factsheets/fs312/en/

Both resistance exercise and aerobic exercise are

effective at reducing glucose intolerance and reducing

the risk of diabetes.Sources: Fenicchia LM et al. Influence of resistance exercise training

on glucose control in women with type 2 diabetes Metabolism. 2004

Mar;53(3):284-9. www.ncbi.nlm.nih.gov/pubmed/15015138

Castaneda C et al. A randomized controlled trial of resistance exercisetraining to improve glycemic control in older adults with type 2

diabetes. Diabetes Care. 2002 Dec; 25(12):2335-41. www.ncbi.nlm.nih.

gov/pubmed/12453982

High-intensity progressive resistance training, in

combination with moderate weight loss, is effective in

controlling blood glucose levels in older patients with

type 2 diabetes.

Source: Dunstan DW et al. High-intensity resistance training improvesglycemic control in older patients with type 2 diabetes. Diabetes Care.

2002 Oct;25(10):1729-36. www.ncbi.nlm.nih.gov/pubmed/12351469
http://www.who.int/mediacentre/factsheets/fs312/en/http://www.who.int/mediacentre/factsheets/fs312/en/http://www.who.int/mediacentre/factsheets/fs312/en/http://www.who.int/mediacentre/factsheets/fs312/en/http://www.who.int/mediacentre/factsheets/fs312/en/http://www.who.int/mediacentre/factsheets/fs312/en/http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_29_world_data_table.pdfhttp://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_29_world_data_table.pdfhttp://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_29_world_data_table.pdfhttp://www.who.int/mediacentre/factsheets/fs312/en/http://www.ncbi.nlm.nih.gov/pubmed/15015138http://www.ncbi.nlm.nih.gov/pubmed/12453982http://www.ncbi.nlm.nih.gov/pubmed/12453982http://www.ncbi.nlm.nih.gov/pubmed/12351469http://www.ncbi.nlm.nih.gov/pubmed/12351469http://www.ncbi.nlm.nih.gov/pubmed/12453982http://www.ncbi.nlm.nih.gov/pubmed/12453982http://www.ncbi.nlm.nih.gov/pubmed/15015138http://www.who.int/mediacentre/factsheets/fs312/en/http://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_29_world_data_table.pdfhttp://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_29_world_data_table.pdfhttp://www.who.int/entity/cardiovascular_diseases/en/cvd_atlas_29_world_data_table.pdfhttp://www.who.int/mediacentre/factsheets/fs312/en/http://www.who.int/mediacentre/factsheets/fs312/en/http://www.who.int/mediacentre/factsheets/fs312/en/http://www.who.int/mediacentre/factsheets/fs312/en/http://www.who.int/mediacentre/factsheets/fs312/en/http://www.who.int/mediacentre/factsheets/fs312/en/


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Moderate aerobic exercise alone or with resistance

training improves glycemic control, waist circumference,

and protects heart in individuals with type 2 diabetes.Source: Chudyk A, Petrella RJ. Effects of exercise on cardiovascular

risk factors in type 2 diabetes: a meta-analysis. Diabetes Care. 2011

May;34(5):1228-37. www.ncbi.nlm.nih.gov/pubmed/21525503

Regular, moderate exercise lowers risk of developing

diabetes in those who are overweight and with pre-

diabetes.Sources: Evans WJ. Effects of exercise on body composition and

functional capacity of the elderly. J Gerontol A Biol Sci Med Sci.

1995;50 Spec No:147-50. www.ncbi.nlm.nih.gov/pubmed/7493209

Christakos CN, Fields KB. Exercise in diabetes: minimize the risks and

gain the benefits. J Musculoskeletal Med. 1995;12:1625.

Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in

the incidence of type 2 diabetes with lifestyle intervention or

metformin. NEJM. 2002;346(6):393403. www.ncbi.nlm.nih.gov/

pubmed/11832527

A 16 week high-intensity exercise programme results in

decreased diabetic medication regimes, lowered systolicblood pressure, decreased abdominal adipose tissue,

and increases in strength, physical activity, and lean

muscle mass.Source: Castaneda C, Layne JE, Munoz-Orians L, et al. A randomized

controlled trial of resistance exercise training to improve glycemic

control in older adults with type 2 diabetes. Diabetes Care.


Prevalence of diabetes by WHO Region

2000 2030 (predicted)

Africa 7,020,000 18,234,000

Eastern Mediterranean 15,188,000 42,600,000

The Americas 33,016,000 66,812,000

Europe 33,332,000 47,973,000

South-East Asia 46,903,000 119,541,000
http://www.ncbi.nlm.nih.gov/pubmed/21525503http://www.ncbi.nlm.nih.gov/pubmed/7493209http://www.ncbi.nlm.nih.gov/pubmed/7493209http://www.ncbi.nlm.nih.gov/pubmed/11832527http://www.ncbi.nlm.nih.gov/pubmed/11832527http://www.ncbi.nlm.nih.gov/pubmed/12453982http://www.ncbi.nlm.nih.gov/pubmed/12453982http://www.ncbi.nlm.nih.gov/pubmed/11832527http://www.ncbi.nlm.nih.gov/pubmed/11832527http://www.ncbi.nlm.nih.gov/pubmed/7493209http://www.ncbi.nlm.nih.gov/pubmed/21525503


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Physical therapists are exercise experts, providing

services to optimise physical ability in a wide range of

people. They prescribe exercise as part of a structured,

safe, and effective programme.

An important part of their role is to help people remain

active as they age. More than any other profession,

physical therapists prevent and treat chronic disease

and disability in aging adults through prescribed

activity and movement.

The World Health Organization encourages regular

physical activity for older adults, because it has been

shown to improve their independence and quality

of life (www.who.int/dietphysicalactivity/factsheet_

olderadults/en/). It says that older adults should engage

in at least 30 minutes of moderate-intensity physical

activity five days a week, if appropriate (www.who.int/ageing/active_ageing/en/index.html).

Here is some information demonstrating the

contribution of physical therapists in keeping people

active as they age particularly their role in maintaining

general health, preventing and treating cardiovascular

disease, and countering joint problems.

Improving functional ability

Older adults engaged in regular physical activity

demonstrate improved balance, strength, coordination,

motor control, flexibility and endurance. As a result,

physical activity can reduce the risk of falls a major

cause of disability among older people.Source: World Health Organization, Physical activity and older adults

www.who.int/dietphysicalactivity/factsheet_olderadults/en/

Participation in regular exercise programmes leads to

older adults having higher levels of function, greater

independence, and improved quality of life.Source: Ellingson T, Conn VS. Exercise and quality of life in elderly

individuals. J Gerontol Nurs. 2000 Mar;26(3):17-25. www.ncbi.nlm.nih.

gov/pubmed/11111627


active ageingExercise programmes can slow down functional

decline. Elderly adults can, with an appropriate exercise

programme, be helped to achieve levels of activity

that will bring health benefits, and slow the decline in

function that might normally be expected with age.

Source: Landin RJ, Linnemeier TJ, et al. Exercise testing and trainingof the elderly patient. Cardiovasc Clin. 1985; 15(2): 201-18.www.ncbi.


Even for those in their 80s and 90s, exercise

programmes can increase functional ability, postpone

disability and maintain independent living.Sources: Spirduso WW Cronin DL. Exercise dose-response effects

on quality of life and independent living in older adults. Med Sci

Sports Exerc. 2001;33(6 Suppl):S598-608.www.ncbi.nlm.nih.gov/

pubmed/11427784

Hruda KV, Hicks AL, et al. Training for muscle power in older adults:

effects on functional abilities. Can J Appl Physiol. 2003;28(2):178-89.


Physical activity and exercise are inversely associated

with mortality and age-related morbidity.Sources: Kushi LH, Fee RM, et al. Physical activity and mortality in

postmenopausal women. JAMA. 1997 Apr 23-30; 277(16): 1287-92.


Nied RJ, Franklin B. Promoting and prescribing exercise for the elderly.

Am Fam Physician. 2002 Feb 1;65(3):419-26. www.ncbi.nlm.nih.gov/

pubmed/11858624

Gregg EW, Cauley JA, et al. Relationship of changes in physical activity

and mortality among older women. JAMA. 2003 May 14; 289(18):2379-

86. www.ncbi.nlm.nih.gov/pubmed/12746361

Promoting cardiovascular health

Regular exercise in older adults has many positive

effects on cardiovascular health, including increasing

cardiac output, maximum heart rate, endurance, and

arterial blood flow, and decreasing heart rate, blood

pressure, and risk of heart disease.Source: Vincent KR, Braith RW et al. Resistance exercise and physical

performance in adults aged 60 to 83. J Am Geriatr Soc. 2002 Jun;

50(6):1100-7. www.ncbi.nlm.nih.gov/pubmed/12110072
http://www.who.int/dietphysicalactivity/factsheet_olderadults/en/http://www.who.int/dietphysicalactivity/factsheet_olderadults/en/http://www.who.int/ageing/active_ageing/en/index.htmlhttp://www.who.int/ageing/active_ageing/en/index.htmlhttp://www.who.int/dietphysicalactivity/factsheet_olderadults/en/http://www.ncbi.nlm.nih.gov/pubmed/11111627http://www.ncbi.nlm.nih.gov/pubmed/11111627http://www.ncbi.nlm.nih.gov/pubmed/3912049http://www.ncbi.nlm.nih.gov/pubmed/3912049http://www.ncbi.nlm.nih.gov/pubmed/3912049http://www.ncbi.nlm.nih.gov/pubmed/11427784http://www.ncbi.nlm.nih.gov/pubmed/11427784http://www.ncbi.nlm.nih.gov/pubmed/11427784http://www.ncbi.nlm.nih.gov/pubmed/11427784http://www.ncbi.nlm.nih.gov/pubmed/12825328http://www.ncbi.nlm.nih.gov/pubmed/9109466http://www.ncbi.nlm.nih.gov/pubmed/11858624http://www.ncbi.nlm.nih.gov/pubmed/11858624http://www.ncbi.nlm.nih.gov/pubmed/11858624http://www.ncbi.nlm.nih.gov/pubmed/12746361http://www.ncbi.nlm.nih.gov/pubmed/12110072http://www.ncbi.nlm.nih.gov/pubmed/12110072http://www.ncbi.nlm.nih.gov/pubmed/12746361http://www.ncbi.nlm.nih.gov/pubmed/11858624http://www.ncbi.nlm.nih.gov/pubmed/11858624http://www.ncbi.nlm.nih.gov/pubmed/9109466http://www.ncbi.nlm.nih.gov/pubmed/12825328http://www.ncbi.nlm.nih.gov/pubmed/11427784http://www.ncbi.nlm.nih.gov/pubmed/11427784http://www.ncbi.nlm.nih.gov/pubmed/3912049http://www.ncbi.nlm.nih.gov/pubmed/3912049http://www.ncbi.nlm.nih.gov/pubmed/11111627http://www.ncbi.nlm.nih.gov/pubmed/11111627http://www.who.int/dietphysicalactivity/factsheet_olderadults/en/http://www.who.int/ageing/active_ageing/en/index.htmlhttp://www.who.int/ageing/active_ageing/en/index.htmlhttp://www.who.int/dietphysicalactivity/factsheet_olderadults/en/http://www.who.int/dietphysicalactivity/factsheet_olderadults/en/


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One study found that after eight months of regular

training, a group of 85-year-olds had increased walking

speed and increased maximal oxygen uptake and

decreased blood pressure. This resulted in reduced

health risk and improved independence.

Source: Puggaard L, Larsen JB, et al. Maximal oxygen uptake, musclestrength and walking speed in 85-year-old women: effects of

increased physical activity. Aging (Milano). 2000 Jun;12(3):180-9. www.


Walking 10,000 steps is effective in lowering blood

pressure and increasing exercise capacity in individuals

with hypertension.Source: Iwane M, Arita M, Tomimoto S, et al. Walking 10,000 steps/

day or more reduces blood pressure and sympathetic activity in mild

essential hypertension. Hyperten Res. 2000;23:573-580. www.ncbi.


Improving joint health

Tai Chi exercise brings improved balanced and physical

functioning to people with osteoarthritis.Source: Song R, Lee EO et al. Effects of tai chi exercise on pain, balance,

muscle strength, and perceived difficulties in physical functioning

in older women with osteoarthritis: a randomized clinical trial.

J Rheumatol. 2003 Sep; 30 (9): 2039-44. www.ncbi.nlm.nih.gov/

pubmed/12966613

Research indicates that exercise decreases pain,

increases function, increases balance, and increases

ability to exercise in people with osteoarthritis andrheumatoid arthritis.Sources: Minor MA, Hewett JE et al. Efficacy of physical conditioning

exercise in patients with rheumatoid arthritis and osteoarthritis.

Arthritis Rheum. 1989 Nov; 32(11): 1396-405. www.ncbi.nlm.nih.gov/

pubmed/2818656

OReilly SC, Muir KR et al. Effectiveness of home exercise on pain and

disability from osteoarthritis of the knee: a randomised controlled

trial. Ann Rheum Dis. 1999 Jan; 58(1): 15-9. www.ncbi.nlm.nih.gov/

pmc/articles/PMC1752761/

Exercise decreases depression and anxiety in people

with osteoarthritis.Source: Minor MA, Hewett JE et al. Efficacy of physical conditioning

exercise in patients with rheumatoid arthritis and osteoarthritis.

Arthritis Rheum. 1989 Nov; 32(11):1396-405.www.ncbi.nlm.nih.gov/

pubmed/2818656.

Land-based therapeutic exercise programmes have

been shown to reduce pain and improve physical

function in people with osteoarthritis of the knee.Source: Fransen M, McConnell S. Therapeutic exercise for people with

osteoarthritis of the hip or knee. A systematic review. J Rheumatol.

2002 Aug; 29(8):1737-45. www.ncbi.nlm.nih.gov/pubmed/12180738

For people with osteoarthritis of the knee, both high

intensity and low intensity aerobic exercise (stationary

cycling) are equally effective at improving functional

status, gait, pain, and aerobic capacity.Source: Brosseau L, MacLeay L, et al. Intensity of exercise for the

treatment of osteoarthritis. Cochrane Database Syst Rev. 2003;(2):

CD004259. www.ncbi.nlm.nih.gov/pubmed/12804510

Research indicates that regular exercise by people

with arthritis decreases the likelihood of developing

disability by 10% and protects against functional

decline.Source: Feinglass J, Thompson JA et al. Effect of physical activity

on functional status among older middle-age adults with arthritis.

Arthritis Rheum. 2005 Dec 15; 53(6): 879-85. www.ncbi.nlm.nih.gov/

pubmed/16342096

Research provides strong evidence that for individuals

with rheumatoid arthritis exercise from low to high

intensity is effective in improving disease-related

characteristics, reducing cardiovascular disease, and

increasing functional abilitySource: Metsios GS, Stavropoulos-Kalinoglou A, et al. Association of

physical inactivity with increased cardiovascular risk in patients with

rheumatoid arthritis. Eur J Cardiovasc Prev Rehabil. 2009;16:18894.

http://www.ncbi.nlm.nih.gov/pubmed/10965376http://www.ncbi.nlm.nih.gov/pubmed/10965376http://www.ncbi.nlm.nih.gov/pubmed/11131268http://www.ncbi.nlm.nih.gov/pubmed/11131268http://www.ncbi.nlm.nih.gov/pubmed/12966613http://www.ncbi.nlm.nih.gov/pubmed/12966613http://www.ncbi.nlm.nih.gov/pubmed/2818656http://www.ncbi.nlm.nih.gov/pubmed/2818656http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1752761/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1752761/http://www.ncbi.nlm.nih.gov/pubmed/2818656http://www.ncbi.nlm.nih.gov/pubmed/2818656http://www.ncbi.nlm.nih.gov/pubmed/2818656http://www.ncbi.nlm.nih.gov/pubmed/12180738http://www.ncbi.nlm.nih.gov/pubmed/12804510http://www.ncbi.nlm.nih.gov/pubmed/16342096http://www.ncbi.nlm.nih.gov/pubmed/16342096http://www.ncbi.nlm.nih.gov/pubmed/19238083http://www.ncbi.nlm.nih.gov/pubmed/19238083http://www.ncbi.nlm.nih.gov/pubmed/16342096http://www.ncbi.nlm.nih.gov/pubmed/16342096http://www.ncbi.nlm.nih.gov/pubmed/12804510http://www.ncbi.nlm.nih.gov/pubmed/12180738http://www.ncbi.nlm.nih.gov/pubmed/2818656http://www.ncbi.nlm.nih.gov/pubmed/2818656http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1752761/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1752761/http://www.ncbi.nlm.nih.gov/pubmed/2818656http://www.ncbi.nlm.nih.gov/pubmed/2818656http://www.ncbi.nlm.nih.gov/pubmed/12966613http://www.ncbi.nlm.nih.gov/pubmed/12966613http://www.ncbi.nlm.nih.gov/pubmed/11131268http://www.ncbi.nlm.nih.gov/pubmed/11131268http://www.ncbi.nlm.nih.gov/pubmed/10965376http://www.ncbi.nlm.nih.gov/pubmed/10965376


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Improving mental health

Cardiovascular fitness is associated with increases in

brain volume, in both gray and white matter and thus

sparing of brain tissue in aging humans.Source: Colcombe SJ, Erickson KI, Scalf PE, et al. Aerobic exercise

training increases brain volume in aging humans. J Gerontol ABiolSci Med Sci. 2006;61(11):1166-1170. www.ncbi.nlm.nih.gov/

pubmed/17167157

Physical activity has been shown to improve mental

health and cognitive function in older adults and

contributes to the management of disorders, such as

depression and anxiety. Active lifestyles often provide

older persons with regular occasions to make new

friendships, maintain social networks, and interact with

other people of all ages.Source: World Health Organisation, Physical activity and older adults

www.who.int/dietphysicalactivity/factsheet_olderadults/en/

Research has indicated that increased levels of physical

activity reduces the risk of Alzheimers disease. Exercise,

along with cognitively stimulating activities, can reduce

some of the symptoms of the disease.Sources: Penrose FK. Can exercise affect cognitive functioning in

Alzheimers disease? A review of the literature. Activities, Adaptation

& Aging 2005:29(4): 15-40. www.tandfonline.com/doi/abs/10.1300/

J016v29n04_02

Christofoletti G, Oliani MM et al. A controlled clinical trial on the effects

of motor intervention on balance and cognition in institutionalized

elderly patients with dementia. Clin Rehabil. 2008 Jul:22(7):618-26.http://cre.sagepub.com/content/22/7/618.abstract

Aerobic exercises significantly reduced depressive

symptoms in people over 60.Source: Penninx BW, Rejeski WJ et al. Exercise and depressive

symptoms: a comparison of aerobic and resistance exercise effects on

emotional and physical function in older persons with high and low

depressive symptomatology. J Gerontol B Psychol Sci Soc Sci. 2002

Mar;57(2):P124-32. www.ncbi.nlm.nih.gov/pubmed/11867660

A regular programme of aerobic exercise can slow

or reverse functional deterioration, reducing the

individuals biological age by 10 or more years, and

potentially prolonging independence.Source: Shephard RJ. Maximal oxygen intake and independence in old

age. Br J Sports Med. 2009 May;43(5):342-6. Epub 2008 Apr 10. http://

bjsm.bmj.com/content/early/2008/04/10/bjsm.2007.044800.short


Marilyn Moffat, Professor of Physical Therapy at New York

University and President of WCPT.
http://www.ncbi.nlm.nih.gov/pubmed/17167157http://www.ncbi.nlm.nih.gov/pubmed/17167157http://www.who.int/dietphysicalactivity/factsheet_olderadults/en/http://www.tandfonline.com/doi/abs/10.1300/J016v29n04_02http://www.tandfonline.com/doi/abs/10.1300/J016v29n04_02http://cre.sagepub.com/content/22/7/618.abstracthttp://www.ncbi.nlm.nih.gov/pubmed/11867660http://bjsm.bmj.com/content/early/2008/04/10/bjsm.2007.044800.shorthttp://bjsm.bmj.com/content/early/2008/04/10/bjsm.2007.044800.shorthttp://bjsm.bmj.com/content/early/2008/04/10/bjsm.2007.044800.shorthttp://bjsm.bmj.com/content/early/2008/04/10/bjsm.2007.044800.shorthttp://bjsm.bmj.com/content/early/2008/04/10/bjsm.2007.044800.shorthttp://www.ncbi.nlm.nih.gov/pubmed/11867660http://cre.sagepub.com/content/22/7/618.abstracthttp://www.tandfonline.com/doi/abs/10.1300/J016v29n04_02http://www.tandfonline.com/doi/abs/10.1300/J016v29n04_02http://www.who.int/dietphysicalactivity/factsheet_olderadults/en/http://www.ncbi.nlm.nih.gov/pubmed/17167157http://www.ncbi.nlm.nih.gov/pubmed/17167157


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Cancer is an umbrella term used to describe more than

100 different diseases with the common characteristic

of uncontrolled malignant cell growth. It is a leading

and growing cause of death worldwide, with the total

number of cases globally increasing, as the world

population grows and ages.

The growing global population with cancer faces

unique challenges from their disease and from the

treatments they receive. Physical therapists can help

them achieve health and quality of life. The prescribed

exercises and lifestyle advice that physical therapists

provide can also help people reduce their risk of getting

cancer.

Cancer facts

Cancer is a leading cause of death worldwide andaccounted for 7.6 million deaths (around 13% of all

deaths) in 2008.Source: International Agency for Research on Cancer www.iarc.fr

Deaths from cancer worldwide are projected to

continue to rise to over 11 million in 2030. More than

30% of cancer can be prevented by modifying or

avoiding key risk factors, including:

being overweight or obese

physical inactivity.

Other risk factors include:

tobacco use

low fruit and vegetable intake

alcohol use

HPV-infection

urban air pollution

indoor smoke from household use of solid fuels.

Source:World Health Organizationwww.who.int/mediacentre/factsheets/fs297/en/

About physical activity

and cancerThe link between physical activity and cancer

Getting adequate physical activity, maintaining a

healthy weight and eating a healthy diet can reduce the

chance of recurrence of many cancers and increase the

likelihood of disease-free survival after a diagnosis, say

new guidelines from the American Cancer Society.Source: American Cancer Society http://onlinelibrary.wiley.com/

doi/10.3322/caac.21142/full

Large population studies have identified a strong

association between lower levels of physical activity and

higher cancer mortality. Walking or cycling an average

of 30 minutes per day has been associated with a 34%

lower rate of cancer death and a 33% improved cancer

survival.Source: Orsini N, Mantzoros C S et al. Association of physical activity

with cancer incidence, mortality, and survival: a population based

study of men. British Journal of Cancer. 2008 98: 1864-1869. www.


Increasing numbers of studies are indicating that

physical activity can reduce the incidence of cancer.

World Health Organization recommendations say that

undertaking 150 minutes of moderate intensity aerobic

physical activity a week can reduce the risk of breast

and colon cancers. The same amount of exercise can

also reduce the risk of diabetes and heart disease.Source: Global Recommendations on Physical Activity for Health,

released by the World Health Organization in 2011 www.who.int/dietphysicalactivity/factsheet_recommendations/en/index.html

According to the International Agency for Research

on Cancer: Physical activity is one risk factor for

non-communicable diseases which is modifiable and

therefore of great potential public health significance.

Changing the level of physical activity raises challenges

for the individual but also at societal level. www.un.org/

apps/news/story.asp?NewsID=37467&Cr=cancer&Cr1
http://www.iarc.fr/http://www.who.int/mediacentre/factsheets/fs297/en/http://www.who.int/mediacentre/factsheets/fs297/en/http://onlinelibrary.wiley.com/doi/10.3322/caac.21142/fullhttp://onlinelibrary.wiley.com/doi/10.3322/caac.21142/fullhttp://www.ncbi.nlm.nih.gov/pubmed/18506190http://www.ncbi.nlm.nih.gov/pubmed/18506190http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/index.htmlhttp://www.who.int/dietphysicalactivity/factsheet_recommendations/en/index.htmlhttp://www.un.org/apps/news/story.asp?NewsID=37467&Cr=cancer&Cr1http://www.un.org/apps/news/story.asp?NewsID=37467&Cr=cancer&Cr1http://www.un.org/apps/news/story.asp?NewsID=37467&Cr=cancer&Cr1http://www.un.org/apps/news/story.asp?NewsID=37467&Cr=cancer&Cr1http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/index.htmlhttp://www.who.int/dietphysicalactivity/factsheet_recommendations/en/index.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/18506190http://www.ncbi.nlm.nih.gov/pubmed/18506190http://onlinelibrary.wiley.com/doi/10.3322/caac.21142/fullhttp://onlinelibrary.wiley.com/doi/10.3322/caac.21142/fullhttp://www.who.int/mediacentre/factsheets/fs297/en/http://www.who.int/mediacentre/factsheets/fs297/en/http://www.iarc.fr/


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Physical activity helps people with the effects of

treatment for cancer

A systematic review of controlled trials of physical

activity interventions in cancer survivors, during and

after treatment, showed that physical activity had a

significant effect. A large effect was shown on upper

and lower body strength, and a moderate effects on

fatigue and breast- cancer-specific concerns. Exercise

was generally well-tolerated during and after treatment,

with minimal adverse events. The study abstracted data

from over 82 studies.Source: Speck RM, Courneya KS et al. An update of controlled physical

activity trials in cancer survivors: a systematic review and meta-

analysis. J. Cancer Surviv. 2010 Jun;4(2):87-100.www.ncbi.nlm.nih.

gov/pubmed/20052559

A panel of experts convened by the American College

of Sports Medicine concluded that exercise training is

safe during and after cancer treatments and results in

improvements in physical functioning, quality of life and

cancer-related fatigue in several cancer survivor groups.Source: Schmitz KH, Courneya KS et al. American College of Sports

Medicine roundtable on exercise guidelines for cancer survivors.

Med Sci Sports Exerc. 2010 Jul;42(7):1409-26. www.ncbi.nlm.nih.gov/

pubmed/20559064

Physical activity helps improve outcomes for

people with cancer

Studies have indicated a relationship between higher

physical activity levels and lower mortality in cancer

survivors. A recent meta-analysis reported that, post-

diagnosis, physical activity reduced breast cancer

deaths by 34%, all causes mortality by 41% and disease

recurrence by 24%.Source: Ibrahim EM, Al-Homaidh A. Physical activity and survival after

breast cancer diagnosis: meta-analysis of published studies. Med

Oncol. 2010 Apr 22. www.ncbi.nlm.nih.gov/pubmed/20411366

Studies also indicate the volume of exercise necessary

to bring benefits. The Nurses Health Study reported

50% fewer cancer recurrences in women who exercised

more than three hours per week. Among people who

have had colo-rectal cancer, a study found a 50% lower

rate of recurrence and related death in those who

exercised more than six hours per week.Sources: Holmes, MD, Chen WY et al. Physical activity and survival after

breast cancer diagnosis. JAMA 2005 293: 2479-2486. www.ncbi.nlm.

nih.gov/pubmed/15914748

Meyerhardt J A, Giovannucci E L et al. Physical Activity and Survival

After Colorectal Cancer Diagnosis. Journal of Clinical Oncology

2006 Vol 24, No 22 (August 1): 3527-3534. http://jco.ascopubs.org/

content/24/22/3527.abstract

Current lack of physical activity among people

with cancer

Generally, cancer survivors display low levels of physical

activity. A study has reported that in Canada less than

22% of cancer survivors are physically active.Source: Courneya KS, Katzmarzyk PT et al. Physical activity and

obesity in Canadian cancer survivors: population-based estimates

from the 2005 Canadian Community Health Survey. Cancer 2008

Jun;112(11):2475-82. www.ncbi.nlm.nih.gov/pubmed/18428195


Julie Walsh-Broderick, HRB Research Fellow, Department of

Physiotherapy, Trinity Centre for Health Science, St Jamess

Hospital, Dublin
http://www.ncbi.nlm.nih.gov/pubmed/20052559http://www.ncbi.nlm.nih.gov/pubmed/20052559http://www.ncbi.nlm.nih.gov/pubmed/20052559http://www.ncbi.nlm.nih.gov/pubmed/20559064http://www.ncbi.nlm.nih.gov/pubmed/20559064http://www.ncbi.nlm.nih.gov/pubmed/20411366http://www.ncbi.nlm.nih.gov/pubmed/15914748http://www.ncbi.nlm.nih.gov/pubmed/15914748http://jco.ascopubs.org/content/24/22/3527.abstracthttp://jco.ascopubs.org/content/24/22/3527.abstracthttp://www.ncbi.nlm.nih.gov/pubmed/18428195http://www.ncbi.nlm.nih.gov/pubmed/18428195http://jco.ascopubs.org/content/24/22/3527.abstracthttp://jco.ascopubs.org/content/24/22/3527.abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15914748http://www.ncbi.nlm.nih.gov/pubmed/15914748http://www.ncbi.nlm.nih.gov/pubmed/20411366http://www.ncbi.nlm.nih.gov/pubmed/20559064http://www.ncbi.nlm.nih.gov/pubmed/20559064http://www.ncbi.nlm.nih.gov/pubmed/20052559http://www.ncbi.nlm.nih.gov/pubmed/20052559


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Here are some useful references for articles that show the

benefit of physical therapy in:

hypertension

cardiovascular disease

stroke

diabetes

obesity

chronic obstructive pulmonary disease.

Hypertension

ACSMs Guidelines for Exercise Testing and Prescription.

9th Ed. Baltimore MD: Lippincott Williams & Wilkins; 2013.

Blumenthal JA, Sherwood A, et al. Exercise and weight

loss reduce blood pressure in men and women with

mild hypertension: effects on cardiovascular, metabolic,

and hemodynamic functioning. Arch Intern Med.

2000;160(13): 1947-58.

Miller ER, Erlinger TP, Young DR, et al. Results of the diet,

exercise, and weight loss intervention trial. Hypertension.

2002;40(5):612-618.

Tanaka H, Bassett DR, Howley ET, Thompson DL, Ashraf M,

Rawson FL. Swimming training lowers the resting blood

pressure in individuals with hypertension. J Hypertens.

1997;15:651-7.

Cardiovascular disease

Ades P. Cardiac Rehabilitation and Secondary Prevention

of Coronary Heart Disease. N Eng J Med. 2001; 345, 12.

Balady G et al. Cardiac rehabilitation programs. A

statement for healthcare professionals from the

American Heart Association. Circ. 1994;90:1602-10.

Brown A, Taylor R, Noorani H, Stone J, Skidmore

B. Exercise-based cardiac rehabilitation programs

Useful references about

physical therapyfor coronary artery disease: a systematic clinical

and economic review. Ottawa, Canada; Canadian

Coordinating Office For Health Technology Assessment

(CCOHTA), 2003.

Brubaker PH, Kaminsky LK, Whaley MH. Coronary Artery

Disease: Essentials of Prevention and Rehabilitation

Programs. Champaign IL Human Kinetics, 2002.

Brubabaker PH, Warner JG, Rejeski DG, et al. Comparison

of standard and extended length participation in cardiac

rehabilitation on body composition, functional capacity,

and blood lipids. Am J Cardiol 1996;78:769-773.

Davies EJ, Moxham T, Rees K, Singh S, Coats AJS, Ebrahim

S, Lough F, Taylor RS. Exercise based rehabilitation for

heart failure. Cochrane Database of Systematic Reviews

2014, Issue 4. Art. No.: CD003331. DOI: 10.1002/14651858.

CD003331.pub3.

Frownfelter D, Dean E. Cardiovascular and Pulmonary

Physical Therapy. Evidence to Practice. 5th Edition. St

Louis. Mosby. 2012.

Heran BS, Chen JMH, Ebrahim S, Moxham T, Oldridge N,

Rees K, Thompson DR, Taylor RS. Exercise-based cardiac

rehabilitation for coronary heart disease. Cochrane

Database of Systematic Reviews 2011, Issue 7. Art. No.:

CD001800. DOI: 10.1002/14651858.CD001800.pub2.

www.ncbi.nlm.nih.gov/pubmed/21735386National Institute for Health and Clinical Excellence.

Chronic heart failure: management of chronic heart

failure in adults in primary and secondary care. CG108.

London, UK: National Institute for Health and Clinical

Excellence; 2010.

National Institute for Health and Clinical Excellence.

Prevention of cardiovascular disease at population level.

London, UK: National Institute for Health and Clinical

Excellence; 2010.

Pollock M et al. Resistance Exercise in Individuals With

and Without Cardiovascular Disease: An Advisory
http://www.ncbi.nlm.nih.gov/pubmed/21735386http://www.ncbi.nlm.nih.gov/pubmed/21735386


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From the Committee on Exercise, Rehabilitation, and

Prevention, Council on Clinical Cardiology, American

Heart Association. Circ. 2000; 101: 828.

Seki E et al. Effects of Phase III Cardiac Rehabilitation

Programs on Health-related Quality of Life in Elderly

Patients with Coronary Artery Disease. Circ J. 2003; 67:

73-77.

Taylor RS, Brown A, Ebrahim S, et al. Exercise-based

rehabilitation for patients with coronary heart disease:

systematic review and meta-analysis of randomized

controlled trials. Am J Med. 2004 May 15;116(10):682-92.

Vincent K, Vincent H. Resistance Training for Individuals

With Cardiovascular Disease. J Cardiopulm Rehab. 2006;

26: 207-16.

Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentiallymodifiable risk factors associated with myocardial

infarction in 52 countries (the INTERHEART study): case-

control study. Lancet. 2004 Sep 11-17;364(9438):937-52.

Stroke

Dean CM, Richards CL, Malouin F. Task-related circuit

training improves performance of locomotor tasks in

chronic stroke: a randomized, controlled pilot trial. Arch

Phys Med Rehabil. 2000;81(4):409-17.

Endres M, Gertz K, et al. Mechanisms of stroke protectionby physical activity. Ann Neurol. 2003;54(5):582-90.