for physiotherapy works · physiotherapy works obesity is an evidence-based briefing from ... do...
TRANSCRIPT
Physiotherapy WorksPhysiotherapy is an ideally placed profession to provide the physical activity component of multidisciplinary weight management services.
forIntroductionObesity is a strong predictor of adult morbidity and mortality. Any loss of weight is beneficial in reducing many of the complications of obesity.(1)
Canadian guidelines for the management of obesity recommend that initial management comprises of a variety of interventions to modify diet and physical activity behaviours.(2)
Physical activity is important for maintaining long-term weight loss and managing co-morbidities.(3)(4)
Canadian guidelines also suggest that effective weight management interventions require multi-disciplinary teams.(2)
Weight managementPhysiotherapists have a role to play in the prevention and management of obesity.(5) Obesity leads to restrictions in movement, affecting engagement in physical activity.(6)
Exercise and movement is the keystone of the scope of physiotherapy practice.(7) Along with a holistic, patient-centred, and problem solving approach, physiotherapists have advanced knowledge and skills in:
• anatomical, physiological, and psychosocial mechanisms of health and disease
• assessment and diagnosis
• behaviour change
• biomechanics
• exercise prescription and therapeutic exercise
• management of long-term conditions
Physiotherapists are therefore ideally suited to address the physical and psychological complexities of obesity.(8) Physiotherapists provide valuable input and expertise in the multi-disciplinary management of obesity,(9) helping to optimise clinical outcomes and patient experience.
While the importance of being physically active is well recognized, in reality patients often experience difficulties in doing so. It is important to facilitate patients to increase physical activity at the right level, which can be achieved by referral to a physiotherapist. (10) An assessment and treatment plan from a physiotherapist will help overcome the barriers to execise. (8)(11)
Image courtesy of the Canadian Obesity Network
A treatment plan for an obese patient may comprise of:
• provision of personalized lifestyle advice, taking into account individual attitudes, beliefs,circumstances, cultural and social preferences, and readiness to change
• prescription, supervision, and progression of appropriate physical activity to increase muscle strength, flexibility, and endurance, and sustain energy output to enhance and maintain weight loss under safe and controlled conditions
• management of associated conditions such as arthritis, back pain, and other musculoskeletal and chronic conditions, such as heart disease
• co-ordination of comprehensive and sustainable programs of management in collaboration with service users, other health and social care professionals, and community services.
BariatricsThere is mounting evidence to demonstrate that physical activity can improve weight loss and other outcomes following bariatric surgery.(18-22)
It is consistently seen as the most important predictor of long-term weight loss maintenance.(23) Most preoperative patients are insufficiently active, and without support, fail to make substantial increases in their physical activity postoperatively.(19)
Wiklund et al(24) found that even one year post-surgery patients still experience social, physical and mental barriers preventing them from being physically active, often related to side effects from the surgery and a lack of support to increase physical activity. In particular, patients with balance, gait or other physical or sensory deficits should be referred to physiotherapy for support.(24) Patients with musculoskeletal conditions, which are especially common among bariatric patients(25) should also be referred.
Cost of ill health• Obesity is a risk factor for multiple health conditions and co-morbidities, including COPD, cardiovascular disease, type 2 diabetes, asthma, osteoarthritis, and certain cancers. (29)(30)
• Workers who are obese report decreased productivity, claim more days off and are more at risk for occupational injuries (31)(32)
• Children who are obese are at risk for obesity as adults (33)(34)
• Healthcare costs attributable to overweight or obesity was calculated as $6 billion in 2006, or 4.1% of the total healthcare budget (35)(36)
• Direct and indirect cost of illness associated with overweight and obesity in Alberta is over $1.27 billon (2005)(37)
$Prevalence of the problem• 62% of adults and 26% of children in Canada are overweight or obese. (26)
• In the 5-11 age group, obesity is three times more prevalent in boys than girls.(27)
• In 2012, 7 in 10 adults Albertans were overweight or obese.(28)
!
Physiotherapy managementRecommended evidence-based approach for the physiotherapy management of obesity.(5)
1. Assessment of the individual’s medical history
2. Evaluation of current physical activity level
3. Provision of an individualized physical activity program
4. Gradual progression of a physical activity program
5. Prescription of a cardiovascular training program
6. Prescription of resistance exercises
7. Prescription of moderate-intensity physical activity, 30 min/d, 3–5 d/wk
8. Calculation of body mass index
Note: Including education on strategies for adherence to an independent exercise program is also recommended whenever possible.
Children and young peopleChildren who are obese often present with a number of musculoskeletal signs and symptoms that may limit their time spent in physical activity.(12)
Being obese is detrimental to gross motor skill performance, for example in upper and lower limb coordination, balance, running speed and agility, and strength.(13) These differences become more pronounced as children get older, suggesting the need for early focus on motor skill development to encourage children who are overweight or obese to be physically active.(14)
Physiotherapy-led exercise classes and multi-disciplinary team interventions including physiotherapy input are effective in significantly improving motor skills, activity levels, BMI, and other anthropometry in children.(15 -17)
Physiotherapy Works for Obesity, p2
Obesity management in primary care The Canadian Obesity Network (CON-RCO) is the primary association for professionals, researchers policy makers, and other stakeholders to advance education, research, treatment, and the management of obesity. The website http://www.obesitynetwork.ca provides a number of resources that support this goal.
The 5As of Obesity Management is a tool developed by CON as a resource for the management of obesity in adults, pediatrics and pregnant women in primary care settings. It provides practitioners with strategies for obesity management that focus on improving health and wellbeing along with weight loss. The tools are available through the CON-RCO website.
Alberta Health Services’ Obesity Initiative
offers a comprehensive approach to weight
management that aims to reduce the impact
of obesity in Alberta. Its multidisciplinary
Provincial Bariatric Resource Team (PBRT) is
a key service within the initiative that supports
obesity care providers and zone-based programs
for both the adult and pediatric populations. The
team is composed of two clinical nurse specialists,
two psychologists, two dietitians, an occupational
therapist and a physiotherapist.
The PBRT physiotherapist provides clinically
relevant resources to support bariatric care
including education to apply research to clinical
practice, consultation, linking providers to
optimize care, and development of evidence-
informed practice resources such as Helping
Adults with Obesity (BMI > 30kg/m2) Who have
Functional Concern: Tips on Identifying When
Physiotherapy Can Help. Additional resources
and information are available at http://www.
albertahealthservices.ca/info/page7468.aspx
The Medicine Hat Bariatric Specialty Clinic offers a multidisciplinary team approach for adults living in Alberta’s south zone, and accepts referrals from within a 400 km radius of the clinic. Candidates are 64, or younger at time of referral, with a BMI ≥ 35 kg/m2, and an obesity-related co-morbidity, or a BMI ≥ 40 kg/m2 with or without a co-morbidity, and no active or untreated psychiatric condition, substance dependency or cognitive impairment. Following assessment at the initial visit, individuals who are accepted into the program are offered medical or surgical options for care. The medical option, to modify lifestyle, includes increasing their activity level, along with diet, stress reduction and mental health counseling as needed. These individuals, and those who have activity limitations and/or co-morbidities associated with obesity, are referred to the physiotherapist for assessment, treatment and exercise prescription, education and follow up. Individuals who undergo bariatric surgery are also seen by the physiotherapist and followed at three month intervals post-operatively.
The physiotherapy program supports the value of weight management and physical activity as an adjunct to other lifestyle changes to prevent further complications associated with obesity and inactivity. All clients work with the clinic team for one year, and are assisted in the transition back to their family physician and/or primary care team and the community.
SERVICE EXAMPLE
SERVICEEXAMPLE
ConclusionIndividuals who are obese often have complex bio-psychosocial barriers to physical activity participation. Physiotherapists are uniquely positioned to facilitate physical activity required for weight management in these patients due to their sound grounding in a range of relevant areas. They autonomously and effectively deliver high quality, personalized exercise and lifestyle interventions to prevent and address barriers to physical activity participation, promoting physical and mental health and wellbeing, and enabling obese people to move and function as well as possible.
Physiotherapy Works Obesity
is an evidence-based briefing from Physiotherapy Alberta – College + Association
www.physiotherapyalberta.ca 780-438-0338
Ackowledgement Adapted and used with permission of the Chartered Society of Physiotherapy.
1. National Institute for Health and Care Excellence. Obesity Clinical
Knowledge Summary. London: National Institute for Health and Care
Excellence; 2012. http://cks.nice.org.uk/obesity#!topicsummary
2. D.C.W. Lau et al, 2006 Canadian clinical practice guidelines on the
management and prevention of obesity in adults and children, CMAJ
2007; 176(8 suppl): online1-117 (www.cmaj.ca/cgi/content/full/176/8/S1/
DC1)
3. Foster J, Thompson K, Harkin J. Let’s Get Moving - Commissioning
Guidance. A new physical activity care pathway for the NHS. London:
Department of Health; 2012.https://www.gov.uk/government/
publications/let-s-get-moving-revised-comm...
4. Department of Health. Start Active, Stay Active: A report on physical
activity from the four home countries’ Chief Medical Officers. London:
Department of Health; 2011. http://www.paha.org.uk/Resource/start-
active-stay-active-a-report-on-phy...
5. Alexander E, Rosenthal S, Evans C. Achieving Consensus on
Recommendations for the Clinical Management of Overweight and Obese
Adults for Canadian Physiotherapy Practice. Physiotherapy Canada.
2012;64(1):42-52.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280708/
pdf/ptc-64-042.pdf
6. Wearing SC, Hennig EM, Byrne NM, et al. The biomechanics of
restricted movement in adult obesity. Obesity Reviews. 2006;7(1):13-24.
7. The Chartered Society of Physiotherapy. Scope of practice:
Introduction. London: The Chartered Society of Physiotherapy; 2014.
http://www.csp.org.uk/professional-union/professionalism/csps-
approach-professionalism/scope-practice-staff-only/introduct
8. Canadian Physiotherapy Association. Physiotherapists and the
management of obesity. Ontario: Canadian Physiotherapy Association;
2007. http://www.physiotherapy.ca/public
9. O’Connell J. Management of obesity: lessons learned from a multi-
disciplinary team. European Diabetes Nursing. 2012;9(1):26-9.
10. Wiklund M, Fagevik Olsén M, Willén C. Physical Activity as Viewed
by Adults with Severe Obesity, Awaiting Gastric Bypass Surgery.
Physiotherapy Research International. 2011;16(3):179-86.
11. Canadian Physiotherapy Association. Physiotherapy briefings for
physicians – Obesity. Toronto: Canadian Physiotherapy Association; 2008.
12. O’Malley G, Roche E, Hussey J. A profile of musculoskeletal problems
in children with obesity. 2nd Annual Conference of the Rehabilitation
and Therapy Research Society Dublin;2006.
13. Gentiera I, D’Hondta E, Shultzd S, et al. Fine and gross motor
skills differ between healthy-weight and obese children. Research in
Developmental Disabilities. 2013;34(11):4043–51.
14. D’Hondt E, Deforche B, Vaeyens R, et al. Gross motor coordination
in relation to weight status and age in 5- to 12-year-old boys and girls:
A cross-sectional study. International Journal of Pediatric Obesity.
2011;6(2):556-64.
15. Sheridan CB, Curley AE, Roche EF. Do physiotherapy-led exercise
classes change activity levels and weight parameters in children
attending a weight management clinic? 4th Annual Conference of
Rehabilitation and Therapy Research Society Royal College of Surgeons
in Ireland, Dublin; 2008.
16. Bocca G, Corpeleijn E, Stolk P, et al. Results of a Multi-disciplinary
Treatment Program in 3-Year-Old to 5-Year-Old Overweight or Obese
Children: A Randomized Controlled Clinical Trial. Archives of Pediatric and
Adolescent Medicine. 2012;166(12):1109-15.
17. Vignolo M, Rossi F, Bardazza G, et al. Five-year follow-up of a
cognitive-behavioural lifestyle multi-disciplinary programme for childhood
obesity outpatient treatment. European Journal of Clinical Nutrition.
2008;62(9):1047–57.http://www.nature.com/ejcn/journal/v62/n9/index.
html
18. Egberts K, Brown WA, Brennan L, et al. Does exercise improve weight
loss after bariatric surgery? A systematic review. Obes Surg. 2012;22:335-
41. 001169 P&D 01/15 2k
19. King WC, Bond DS. The Importance of Pre and Postoperative Physical
Activity Counseling in Bariatric Surgery. Exercise and Sports Science
Reviews. 2013;41(1):26–35.
20. Egberts K, Brown WA, O’Brien PE. SFR-111 Optimising lifestyle factors
to achieve weight loss in surgical patients. Surgery for Obesity and
Related Diseases. 2011;7(3):368.
21. Shah M, Snell PG, Rao S, et al. High-volume exercise program in
obese bariatric surgery patients: a randomized, controlled trial. Obesity.
2011;19(9):1826-34.http://onlinelibrary.wiley.com/doi/10.1038/oby.2011.172/
full
22. McCullough PA, Gallagher MJ, Dejong AT, et al. Cardiorespiratory
fitness and short-term complications after bariatric surgery. Chest.
2006;130(2):517–25.http://journal.publications.chestnet.org/article.
aspx?articleid=1084600
23. Donnelly JE, Blair SN, Jakicic JM, et al. American College of Sports
Medicine Position Stand, Appropriate physical activity intervention
strategies for weight loss and prevention of weight regain for adults.
Medicine and Science in Sports and Exercise. 2009;41(2):459-71.
24. Wiklund M, Fagevik Olsén M, Olbers T, et al. Experiences of Physical
Activity One Year after Bariatric Surgery. The Open Obesity Journal.
2014;6:25-30. http://benthamopen.com/toobesj/openaccess2.htm
25. King WC, Engel SGE, Elder KA, et al. Walking capacity of bariatric
surgery candidates. Surgery for Obesity and Related Diseases.
2012;8(1):48-59.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246050/
26. Statistics Canada, Body Composition of Adults, 2012- 2013 http://
www.statcan.gc.ca/pub/82-625-x/2014001/article/14104-eng.htm,
accessed July 21 2015
27. K.C. Roberts et al Overweight and obesity in children and adolescents,
Statistics Canada, Catalogue no. 82-003-XPE • Health Reports, Vol. 23,
no. 3, September 2012
28 Alberta Health Services, Diabetes, Obesity and Nutrition
Strategic Clinical Network Fact Sheet, May 2014 http://www.
albertahealthservices.ca/assets/about/scn/ahs-scn-don-obesity-facts.pdf
29. Janssen, I. The Public Health Burden of Obesity in Canada, Can J
Diabetes 37 (2013) 90- 96
30. Guh, D.P. et al, The incidence of co-morbidities related to obesity and
overweight: A systematic review and meta-analysis, BMC Public Health
2009, 9:88 doi:10.1186/1471-2458-9-88
31. Janssen et al Obesity and Its Relationship with Occupational Injury in
the Canadian Workforce, Journal of Obesity Volume 2011 (2011) Article ID
531403, 6 pages http://dx.doi.org/10.1155/2011/531403
32. Park, J Obesity on the Job, Perspectives February 2009, Statistics
Canada — Catalogue no. 75-001-X
33. Public Health Agency of Canada Curbing Childhood Obesity: A Federal,
Provincial and Territorial Framework for Action to Promote Healthy
Weights, http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/framework-cadre/
index-eng.php, accessed July 21 2015
34. Obesity in Canada: A Joint report Public Health Agency and Canadian
Institute for Health Information, 2011 Cat.: HP5-107/2011E-PDF, ISBN:
978-1-100-18133-2
35. Anis, .H. et al, Obesity and overweight in Canada: an updated cost-of-
illness study, Obesity Reviews, 2009, 11, pp. 31–40
36. The Canadian Obesity Network, About Obesity, http://www.
obesitynetwork.ca/, accessed July 22 2015
37. Health Quality Council of Alberta, Overweight and obesity in adult
Albertans: a case for primary healthcare. Calgary, Alberta, Canada: Health
Quality Council of Alberta; July 2015
References
Physiotherapy Works for Obesity, p4