wptd clinical resources

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World Physical Therapy DayResources on physical activity and

non-communicable diseases


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World Conederation or Physical Therapy | 1

Contents

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

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

Facts and fgures about physical therapists .................................................................................. 4

About physical therapy and non-communicable diseases .......................................................... 5About physical activity and child obesity .................................................................................... 6

About physical activity and cardiovascular disease ....................................................................... 9

About physical activity and diabetes ......................................................................................... 11

About physical activity and active ageing .................................................................................... 13

About physical activity and cancer ............................................................................................ 16

Journal articles about physical therapy ...................................................................................... 18

Notes about this booklet

The terms physical therapy and physiotherapy

reer to the same proession some countriesuse one term, some the other. When the words

physical therapy and physical therapist are used

in this document, they also reer to physiotherapy

and physiotherapist.

The inormation in this booklet may be

reproduced without charge. It is designed as a

resource, and does not necessarily represent an

ocial WCPT view or policy.


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2 | World Conederation or Physical Therapy

Introduction

This booklet provides acts, research ndings, statistics and articles to help you demonstrate the contribution o

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

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

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

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

106 countries.

WCPT has compiled this inormation or you to use reely. I youre not sure what to organise or World Physical

Therapy Day yet, there are plenty o 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 inormation about physical therapy

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

educate the public. I you reer 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 unction

throughout their lives. With an advanced understanding

o how the body moves and what keeps it rom

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 o

inactivity.

Physical therapists work with people aected by a wide

range o conditions and symptoms, or example:

painul 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 trac accidents and landmines

incontinence

They work in a variety o settings, including hospitals,

health centres, sports acilities, education and research

centres, hospices and nursing homes, rural and

community settings.

Here are some examples o how physical therapists

make a dierence. They:

use their skills to treat the underlying causes o pain

About physical therapy

and limitations in movement and unction

use many treatment approaches to help individuals

regain their mobility and maximise their potential

promote healthy liestyles and exercise

treat each patient/client as an individual and

thoroughly assess them to identiy their needs

treat sports injuries

promote sae 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 ull knowledge o thebodys systems and the skills to treat a wide range o

problems. This education is usually university-based

and at a level that provides ull proessional 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 fgures about

physical therapistsPhysical therapists work with people o all ages to bring

about improvements in their health and independence.

Physical therapists provide exercise prescriptions to

help people keep t and achieve/maintain a healthy

weight.

Around 350 million people are obese worldwide.

Physical activity is one o the best means o countering

obesity.

Children and young people under the age o 18 need 60

minutes o moderate to vigorous physical activity each

day to promote and maintain health.

Adults need 30 minutes o moderate physical activity

ve days a week, or 20 minutes o 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 o a physical therapist reduces the risk o

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

breast cancer.

Despite limited numbers o physical therapists in some

countries around the world, they have proved their

eectiveness at getting and keeping people healthy.

Physical therapists provide exercise programmes or

conditions that aect the bones and muscles, such

as arthritis, back and neck pain, osteoporosis, joint

replacements, and urinary incontinence.

More detailed inormation about what physical

therapists do can be ound in WCPTs Description

o 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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About physical therapy and

non-communicable diseasesThis is an article by WCPTs President, Marilyn Moat,

explaining how physical therapists are at the heart o the

global battle against non-communicable diseases like

stroke, heart disease, chronic respiratory disease, diabetes

and cancer.

It can be published in newsletters, magazines and

journals, or passed to other publications as background

inormation. I you are making any changes they should be

checked with the WCPT Secretariat [email protected].

In 2011 a high level meeting o world leaders at the

United Nations recognised that non-communicable

diseases (cardiovascular diseases, chronic respiratory

diseases, diabetes and cancer) are an increasing global

health challenge. They claim 35 million lives a year

around 60 per cent o deaths.

For physical therapists, the ocial recognition that a

global strategy is required to reduce this burden o

disability and deaths is signicant. Physical therapists

help millions o people every year prevent these

conditions and their risk actors most importantly

obesity. They also manage their eects, along with the

eects o aging, illness, accidents, and the stresses and

strains o lie.

Physical therapists specialise in human movement

and physical activity, promoting health, tness, and

wellness. They identiy physical impairments, activity

limitations, and disabilities that prevent people rom

being as active and independent as they might be,

and then they nd ways o overcoming them. They

maximise peoples movement potential.

So when the World Health Organization points out

that physical inactivity is one o the leading risk

actors or global mortality, causing 3.2 million deaths

annually, and that physical activity can reduce non-

communicable diseases, it is clear that the proession

has a major part to play.

Many people do not recognise the contribution

physical therapists make in keeping people healthy and

independent. On World Physical Therapy Day on 8th

September, physical therapists have the opportunity

to draw attention to their all important roles. I conduct

workshops around the world, demonstrating how

adults with chronic health problems can improve their

health by learning how to exercise saely under the

guidance and instruction o physical therapists.

Activity has to be introduced careully i a personis overweight, unt, older, or has a chronic disease.

Physical therapists do this by examining the person,

recommending exercises that are sae and appropriate

or them, and educating them about how to look or

signs o trouble.

Physical therapy doesnt just mean more healthy

people, but more productive people who can

contribute to countries economies. Physical therapists

services are provided in an atmosphere o trust and

respect or human dignity and underpinned by sound

clinical reasoning and scientic evidence.

These are important messages that physical therapists

want to convey to the world every day, but especially

on World Physical Therapy Day. The message is clear:

physical therapists are movement, physical activity, and

exercise experts and a resource in the battle against

non-communicable disease that should never be

overlooked.

Marilyn Moat, WCPT President


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According to the World Health Organization, childhood

obesity is one o the most serious public health

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

Obesity in childhood is linked with asthma,

musculoskeletal problems, hypertension, early signs o

cardiovascular disease, low sel-esteem and depression.

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

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

2 diabetes and cardiovascular disease. Encouraging

children and their amilies to reach recommended levels

o physical activity is a cornerstone o 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 or children who are obese. The assessment

can screen or musculoskeletal impairments and guide

therapeutic exercise and physical activity prescription.

Childhood obesity acts

Globally, over 40 million preschool children wereoverweight in 2008. More than 75% o overweight and

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

Childhood obesity aects people regardless o their

income. The problem is global and is steadily aecting

many low-and middle-income countries, particularly in

urban settings.Source: WHO www.who.int/mediacentre/actsheets/s311/en/

Childrens choices, diet and physical activity habits are

infuenced by their surrounding environment.Source: WHO www.who.int/eatures/actles/obesity/en/

Children who are obese have a high incidence o

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

1754.2011.02102.x/abstract

Rising levels o childhood obesity are being caused

mainly by a shit towards energy-dense oods high in at

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

Defning child obesity

The World Health Organization denes 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 speciccharts in tandem with national growth reerence

charts. Measures o body composition such as waist

circumerence should be used to describe obesity.Source: WHOwww.who.int/growthre/who2007_bmi_or_age/en/

index.html

Child obesity and physical activity

The World Health Organization recommends 60 minutes

o moderate to vigorous intensity physical activity

every day or children aged 5-18. Moderate activity

includes activities that raise the heart rate and cause

some breathlessness. Vigorous activity is exercise

that makes people hu and pu and could include

dancing, household chores and sports like running

and ootball. Activities or children should be un and

age-appropriate. In addition, amilies should be active

together because parents are the most important

agents o liestyle 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 rom birth to age ve should engage in daily

physical activity that promotes skill in movement and

lays the oundations o health-related tness.Source: National Association or Sport and Physical Education

guidelines on physical activity or children www.aahperd.org/naspe/

standards/nationalGuidelines/ActiveStart.cm

Inants 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 or Sport and Physical Education


standards/nationalGuidelines/ActiveStart.cm

Toddlers should engage in a total o at least 30 minutes

o structured physical activity and at least 60 minutes

per day o unstructured physical activity and should not

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

when sleeping.Source:www.aahperd.org/naspe/standards/nationalGuidelines/

ActiveStart.cm

Children under ve should be physically active daily or

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

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

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

Children should accumulate at least 60 minutes, and

up to several hours, o age-appropriate physical activity

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

moderate and vigorous physical activity with most

o the time being spent on activities where exercise

is intermittent. Children should participate in several

bouts o physical activity lasting 15 minutes or more

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

discouraged or children, especially during the daytime

hours.Source: National Association or Sport and Physical Education


standards/nationalGuidelines/PA-Children-5-12.cm

The role o the physical therapist

In cases o childhood obesity, a physical therapy

assessment covers: 1) parental belies around

healthy childhood growth and development; 2)

cardiorespiratory (exercise testing); 3) musculoskeletal

(including assessment o range o movement; strength;

fexibility; 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 educationor child and parent 2) management o any associated

conditions (eg painul fat ee, knee pain, weak core)

identied in physical assessment; 3) age-appropriate

and un exercise training to increase physical tness;

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 reerral within the

interdisciplinary team.

Positive communication between the therapist and

amily is essential. Many parents may not be aware

that their childs weight is a problem. Ensuring that a

holistic assessment is used to identiy areas where the

child may have unctional diculties (eg balance or low

cardiorespiratory tness) may help the therapist discuss

the childs health without solely ocusing on shape or

size. In order to acilitate a childs liestyle change, it is

recommended that the ull amily works towards this.Source: Jlusson PB, et al., Overweight and obesity in Norwegian
http://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/PA-Children-5-12.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/PA-Children-5-12.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/PA-Children-5-12.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/PA-Children-5-12.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfmhttp://www.aahperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfm


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children: prevalence and socio-demographic risk actors.

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

pubmed/20175763

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

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

mendeley.com/research/tracking-overweight-early-childhood-

adolescence-cohorts-born-1988-1994-overweight-high-birth-weight-population

A review o evidence on the eect o physical activity

on the development o pre-school children concluded

that the availability o outside playing areas, and the

encouragement and involvement o adults, were

important in encouraging exercise.Source: Timmons BW et al. Physical activity or 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 inexercise participation, and have higher levels o obesity

than their peers. Finding structures that support them

to participate brings psychological and social, as well

as physical, advantages. Proessionals such as physical

therapists are well placed to ensure that activities are

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

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

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

content/ull/pediatrics;121/5/1057

This inormation was produced with the kind assistance

o the International Organisation o Physical Therapists in

Paediatrics.
http://www.ncbi.nlm.nih.gov/pubmed/20175763http://www.ncbi.nlm.nih.gov/pubmed/20175763http://www.mendeley.com/research/tracking-overweight-early-childhood-adolescence-cohorts-born-1988-1994-overweight-high-birth-weight-populationhttp://www.mendeley.com/research/tracking-overweight-early-childhood-adolescence-cohorts-born-1988-1994-overweight-high-birth-weight-populationhttp://www.mendeley.com/research/tracking-overweight-early-childhood-adolescence-cohorts-born-1988-1994-overweight-high-birth-weight-populationhttp://www.mendeley.com/research/tracking-overweight-early-childhood-adolescence-cohorts-born-1988-1994-overweight-high-birth-weight-populationhttp://www.mendeley.com/research/tracking-overweight-early-childhood-adolescence-cohorts-born-1988-1994-overweight-high-birth-weight-populationhttp://www.ncbi.nlm.nih.gov/pubmed/18213943http://aappolicy.aappublications.org/cgi/content/full/pediatrics;121/5/1057http://aappolicy.aappublications.org/cgi/content/full/pediatrics;121/5/1057http://aappolicy.aappublications.org/cgi/content/full/pediatrics;121/5/1057http://aappolicy.aappublications.org/cgi/content/full/pediatrics;121/5/1057http://aappolicy.aappublications.org/cgi/content/full/pediatrics;121/5/1057http://www.ncbi.nlm.nih.gov/pubmed/18213943http://www.mendeley.com/research/tracking-overweight-early-childhood-adolescence-cohorts-born-1988-1994-overweight-high-birth-weight-populationhttp://www.mendeley.com/research/tracking-overweight-early-childhood-adolescence-cohorts-born-1988-1994-overweight-high-birth-weight-populationhttp://www.mendeley.com/research/tracking-overweight-early-childhood-adolescence-cohorts-born-1988-1994-overweight-high-birth-weight-populationhttp://www.mendeley.com/research/tracking-overweight-early-childhood-adolescence-cohorts-born-1988-1994-overweight-high-birth-weight-populationhttp://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 aecting the heart and circulatory system, and

includes heart disease, stroke and raised blood pressure

(hypertension).

Exercise, particularly aerobic conditioning and strength

training, is one o the key interventions that can prevent

death and disability rom cardiovascular disease.

Physical therapists are experts in prescribing these as

part o a structured, sae and eective programme.

For those already aected 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 ullled lives.

Cardiovascular general

Cardiovascular disease is now the leading cause o

deaths worldwide. Globally, 17.3 million people died

rom cardiovascular disease in 2008, 30% o 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 rom cardiovascular

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

actsheets/s317/en/

The death and disability rates caused by heart disease

and stroke or every country are available at: http://

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

eng.pd

It has been estimated that i everyone walked briskly at

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

30% o deaths rom 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

tness 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 o walking as compared with

vigorous exercise in the prevention o 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, tness, 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 o cardiovascular

disease has indicated that exercise supervised by

physical therapists, along with counselling rom a

dietician, brings signicant improvements in blood

pressure, weight, quality o lie and other health

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

o liestyle intervention in primary healthcare or the modication o

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


Raised blood pressure

Raised blood pressure, which is a risk actor or heart

attack and stroke, can be controlled by exercise. One

study has indicated that endurance exercise brings an

average reduction o 10mm Hg or both systolic and

diastolic blood pressure readings.Source: American College o Sports Medicines Guidelines or Exercise

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

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

html

The type o strength training prescribed by physicaltherapists can eectively 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 o available research have indicated that

exercise can reduce resting blood pressure by 3mm Hg

or resting systolic blood pressure.Sources: Cornelissen VA, Fagard RH. Eects o endurance training

on blood pressure, blood pressure-regulating mechanisms, andcardiovascular risk actors. Hypertension 2005 Oct; 46(4):667-75. www.

ncbi.nlm.nih.gov/pubmed/16157788


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/16157788http://www.ncbi.nlm.nih.gov/pubmed/16157788http://www.ncbi.nlm.nih.gov/pubmed/16157788http://www.ncbi.nlm.nih.gov/pubmed/16157788http://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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ailure and chronic obstructive pulmonary disease.Source: Taylor, NF et al. Therapeutic exercise in physiotherapy practice

is benecial: a summary o systematic reviews 20022005. Australian

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

pubmed/17326734

Reviews o evidence have shown that exercise-basedcardiac rehabilitation or patients with coronary heart

disease signicantly improves health outcomes and

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

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 or patients with coronary

heart disease: systematic review and meta-analysis o randomized

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

gov/pubmed/15121495

A review o evidence has indicated that exercise

training in people who have had heart ailure is sae and

eective.Source: Smart N, Marwick TH. Exercise training or heart ailure

patients: a systematic review o actors 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 cardiovascular

disease risk and help increase uptake o a prevention

programmes by those who do not access cardiac

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

prevention o coronary heart disease: a systematic review. European

Journal o Cardiovascular Prevention and Rehabilitation. 2009; Vol

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

This inormation was produced with the kind assistance o

Julie Redern.

Kelley GA, Kelley KS. Progressive resistance exercise and resting

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

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

pubmed/10720604

This type o blood pressure reduction has been

associated with a 5-9% reduction in heart morbidity,and a 8% to 14% reduction in the risk o stroke.Source: Whelton et al. Primary prevention o hypertension: clinical

and public health advisory rom The National High Blood Pressure

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


Stroke

Exercise reduces the risk o stroke. Walking at 4.8 kph

(3 mph) or 5 hrs/wk brings a 46% lower risk o stroke,

compared with non-exercisers.Sources: Hu F et al. Physical activity and risk o stroke in women. JAMA.

2000; 283(22):2961- 2967. www.ncbi.nlm.nih.gov/pubmed/10865274Lee I et al. Exercise and risk o stroke in male physicians. Stroke.


Structured exercise also brings improvement in all

measures o 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 perormed

strengthening and unctional tasks three times a week

or our weeks, and gained signicant improvements

in strength, walking speed, standing/sitting and

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

perormance o locomotor tasks in chronic stroke: a randomized,

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


Heart disease

Systematic reviews o evidence have shown that

therapeutic exercise provided by physical therapists isbenecial to people with coronary heart disease, heart
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/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/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 o

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 o diabetes can be prevented. Most

cases o type 2 diabetes are associated with being

overweight.

Exercise is one o the best ways to control or reduce

weight, and reduce risk o type 2 diabetes. Physical

therapists are experts in prescribing structured, sae and

eective exercise programmes.

Their advice can also help people who have health

complications as a result o 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 ullled lives.

Diabetes acts

The World Health Organization (WHO) estimates that

346 million people worldwide have diabetes. This

number is expected to double by 2030.Source: World Health Organization actsheet www.who.int/

mediacentre/actsheets/s312/en/

Diabetes was traditionally more common in developed

countries, but modernisation and liestyle changes

have meant it is increasingly prevalent in developing

countries. According to WHO, almost 80% o diabetes

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


Diabetes and its complications have a signicant

economic impact on individuals, amilies, 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 actsheet www.who.int/


The death and disability rates caused by diabetes or

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

cardiovascular_diseases/en/cvd_atlas_29_world_data_

table.pd

Exercise and diabetes

Exercise has a role in preventing and controlling

diabetes. According to the World Health Organization,

30 minutes o moderate intensity physical activity onmost days, along with a healthy diet, can help reduce

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

Organization www.who.int/mediacentre/actsheets/s312/en/

Both resistance exercise and aerobic exercise are

eective at reducing glucose intolerance and reducing

the risk o diabetes.Sources: Fenicchia LM et al. Infuence o 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 o resistance exercise

training 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 eective 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 circumerence,

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

risk actors 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 o developing

diabetes in those who are overweight and with pre-

diabetes.Sources: Evans WJ. Eects o exercise on body composition and

unctional capacity o 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 benets. J Musculoskeletal Med. 1995;12:1625.

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

the incidence o type 2 diabetes with liestyle intervention or

metormin. 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 o resistance exercise training to improve glycemic

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


Prevalence o diabetes by WHO Region

2000 2030 (predicted)

Arica 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 o

people. They prescribe exercise as part o a structured,

sae, and eective programme.

An important part o their role is to help people remain

active as they age. More than any other proession,

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 or older adults, because it has been

shown to improve their independence and quality

o lie (www.who.int/dietphysicalactivity/actsheet_

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

in at least 30 minutes o moderate-intensity physical

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

Here is some inormation demonstrating the

contribution o 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 unctional ability

Older adults engaged in regular physical activity

demonstrate improved balance, strength, coordination,

motor control, fexibility and endurance. As a result,

physical activity can reduce the risk o alls a major

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

www.who.int/dietphysicalactivity/actsheet_olderadults/en/

Participation in regular exercise programmes leads to

older adults having higher levels o unction, greater

independence, and improved quality o lie.Source: Ellingson T, Conn VS. Exercise and quality o lie 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 unctional

decline. Elderly adults can, with an appropriate exercise

programme, be helped to achieve levels o activity

that will bring health benets, and slow the decline in

unction that might normally be expected with age.

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


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

programmes can increase unctional ability, postpone

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

on quality o lie 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 or muscle power in older adults:

eects on unctional 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 or 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 o 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

eects on cardiovascular health, including increasing

cardiac output, maximum heart rate, endurance, and

arterial blood fow, and decreasing heart rate, blood

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

perormance 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 ound that ater eight months o regular

training, a group o 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: eects o

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


Walking 10,000 steps is eective 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

unctioning to people with osteoarthritis.Source: Song R, Lee EO et al. Eects o tai chi exercise on pain, balance,

muscle strength, and perceived diculties in physical unctioning

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 unction, increases balance, and increases

ability to exercise in people with osteoarthritis and

rheumatoid arthritis.Sources: Minor MA, Hewett JE et al. Ecacy o 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. Eectiveness o home exercise on pain and

disability rom osteoarthritis o 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. Ecacy o 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

unction in people with osteoarthritis o the knee.Source: Fransen M, McConnell S. Therapeutic exercise or people with

osteoarthritis o 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 o the knee, both high

intensity and low intensity aerobic exercise (stationary

cycling) are equally eective at improving unctional

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

treatment o 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 o developing

disability by 10% and protects against unctional

decline.Source: Feinglass J, Thompson JA et al. Eect o physical activity

on unctional 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 or individuals

with rheumatoid arthritis exercise rom low to high

intensity is eective in improving disease-related

characteristics, reducing cardiovascular disease, and

increasing unctional abilitySource: Metsios GS, Stavropoulos-Kalinoglou A, et al. Association o

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 tness is associated with increases in

brain volume, in both gray and white matter and thus

sparing o brain tissue in aging humans.Source: Colcombe SJ, Erickson KI, Scal 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 unction in older adults and

contributes to the management o disorders, such as

depression and anxiety. Active liestyles oten provide

older persons with regular occasions to make new

riendships, maintain social networks, and interact with

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

www.who.int/dietphysicalactivity/actsheet_olderadults/en/

Research has indicated that increased levels o physical

activity reduces the risk o Alzheimers disease. Exercise,

along with cognitively stimulating activities, can reduce

some o the symptoms o the disease.Sources: Penrose FK. Can exercise aect cognitive unctioning in

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

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

J016v29n04_02

Christooletti G, Oliani MM et al. A controlled clinical trial on the eects

o 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 signicantly reduced depressive

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

symptoms: a comparison o aerobic and resistance exercise eects on

emotional and physical unction 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 o aerobic exercise can slow

or reverse unctional 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 Moat, Proessor o Physical Therapy at New York

University and President o 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 dierent diseases with the common characteristic

o uncontrolled malignant cell growth. It is a leading

and growing cause o death worldwide, with the total

number o cases globally increasing, as the world

population grows and ages.

The growing global population with cancer aces

unique challenges rom their disease and rom the

treatments they receive. Physical therapists can help

them achieve health and quality o lie. The prescribed

exercises and liestyle advice that physical therapists

provide can also help people reduce their risk o getting

cancer.

Cancer acts

Cancer is a leading cause o death worldwide and

accounted or 7.6 million deaths (around 13% o all

deaths) in 2008.Source: International Agency or Research on Cancer http://globocan.

iarc.r/actsheets/populations/actsheet.asp?uno=900

Deaths rom cancer worldwide are projected to

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

30% o cancer can be prevented by modiying or

avoiding key risk actors, including:

being overweight or obese

physical inactivity.Other risk actors include:

tobacco use

low ruit and vegetable intake

alcohol use

HPV-inection

urban air pollution

indoor smoke rom household use o solid uels.

Source:World Health Organizationwww.who.int/mediacentre/

actsheets/s297/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 o recurrence o many cancers and increase the

likelihood o disease-ree survival ater a diagnosis, say

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

doi/10.3322/caac.21142/ull

Large population studies have identied a strong

association between lower levels o physical activity and

higher cancer mortality. Walking or cycling an average

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

lower rate o cancer death and a 33% improved cancer

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

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

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


Increasing numbers o studies are indicating that

physical activity can reduce the incidence o cancer.

World Health Organization recommendations say that

undertaking 150 minutes o moderate intensity aerobic

physical activity a week can reduce the risk o breast

and colon cancers. The same amount o exercise can

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

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

According to the International Agency or Research

on Cancer: Physical activity is one risk actor or

non-communicable diseases which is modiable and

thereore o great potential public health signicance.

Changing the level o physical activity raises challenges

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

apps/news/story.asp?NewsID=37467&Cr=cancer&Cr1
http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=900http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=900http://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://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=900http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=900


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Physical activity helps people with the eects o

treatment or cancer

A systematic review o controlled trials o physical

activity interventions in cancer survivors, during and

ater treatment, showed that physical activity had a

signicant eect. A large eect was shown on upper

and lower body strength, and a moderate eects on

atigue and breast- cancer-specic concerns. Exercise

was generally well-tolerated during and ater treatment,

with minimal adverse events. The study abstracted data

rom over 82 studies.Source: Speck RM, Courneya KS et al. An update o 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 o experts convened by the American College

o Sports Medicine concluded that exercise training is

sae during and ater cancer treatments and results in

improvements in physical unctioning, quality o lie and

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

Medicine roundtable on exercise guidelines or cancer survivors.

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

pubmed/20559064

Physical activity helps improve outcomes or people

with cancer

Studies have indicated a relationship between higherphysical 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 ater

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

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

Studies also indicate the volume o exercise necessary

to bring benets. The Nurses Health Study reported

50% ewer cancer recurrences in women who exercised

more than three hours per week. Among people who

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

rate o 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 ater

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

Ater Colorectal Cancer Diagnosis. Journal o Clinical Oncology

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

content/24/22/3527.abstract

Current lack o physical activity among people with

cancer

Generally, cancer survivors display low levels o physical

activity. A study has reported that in Canada less than

22% o cancer survivors are physically active.

Source: Courneya KS, Katzmarzyk PT et al. Physical activity andobesity in Canadian cancer survivors: population-based estimates

rom 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 o

Physiotherapy, Trinity Centre or 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 useul reerences or articles that show the

beneft o physical therapy in:

hypertension

cardiovasculardisease

stroke

diabetes

obesity

chronicobstructivepulmonarydisease.

Hypertension

ACSMs Guidelines or Exercise Testing and Prescription.

6th Ed. Baltimore MD: Lippincott Williams & Wilkins 2000

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

loss reduce blood pressure in men and women with

mild hypertension: eects on cardiovascular, metabolic,

and hemodynamic unctioning. Arch Intern Med.

2000;160(13): 1947-58.

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

exercise, and weight loss intervention trial. Hypertension.

2002;40(5):612-618.

Tanaka H, Bassett DR, Howley ET, Thompson DL, Ashra 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

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

Balady G et al. Cardiac rehabilitation programs. A

statement or healthcare proessionals rom the

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

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

B. Exercise-based cardiac rehabilitation programs

Journal articles about

physical therapyor coronary artery disease: a systematic clinical

and economic review. Ottawa, Canada; Canadian

Coordinating Oce For Health Technology Assessment

(CCOHTA), 2003.

Brubaker PH, Kaminsky LK, Whaley MH. Coronary Artery

Disease: Essentials o Prevention and Rehabilitation

Programs. Champaign IL Human Kinetics, 2002.

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

o standard and extended length participation in cardiac

rehabilitation on body composition, unctional 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 or

heart ailure. Cochrane Database o Systematic Reviews

2010, Issue 4. Art. No.: CD003331. DOI: 10.1002/14651858.

CD003331.pub3.

Frownelter D, Dean E. Cardiovascular and Pulmonary

Physical Therapy. 4th Edition. St. Louis. Mosby Elsevier.

2006.

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

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

rehabilitation or coronary heart disease. Cochrane

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

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

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

Chronic heart ailure: management o chronic heart

ailure in adults in primary and secondary care. CG108.

London, UK: National Institute or Health and Clinical

Excellence; 2010.

National Institute or Health and Clinical Excellence.

Prevention o cardiovascular disease at population level.

London, UK: National Institute or 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. Eects o Phase III Cardiac Rehabilitation

Programs on Health-related Quality o Lie in Elderly

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

73-77.

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

rehabilitation or patients with coronary heart disease:

systematic review and meta-analysis o randomized

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

Vincent K, Vincent H. Resistance Training or Individuals

With Cardiovascular Disease. J Cardiopulm Rehab. 2006;

26: 207-16.

Yusu S, Hawken S, Ounpuu S, et al. Eect o potentiallymodiable risk actors associated with myocardial

inarction 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 perormance o 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 o stroke protection

by physical activity. Ann Neurol. 2003;54(5):582-90.

English C, Hillier SL. Circuit class therapy or improving

mobility ater stroke. Cochrane Database o Systematic

Reviews 2010, Issue 7. Art. No.: CD007513. DOI:

10.1002/14651858.CD007513.pub2.

Ouellette MM, LeBrasseur NK, et al. High-intensity

resistance training improves muscle strength, sel-

reported unction, and disability in long-term stroke

survivors. Stroke. 2004;35(6):1404-9.

Outpatient Service Trialists. Therapy-based rehabilitationservices or stroke patients at home. Cochrane Database

o Systematic Reviews 2003, Issue 1. Art. No.: CD002925.

DOI: 10.1002/14651858.CD002925.

Pollock A, Baer G, Pomeroy VM, Langhorne P.

Physiotherapy treatment approaches or the recovery

o postural control and lower limb unction ollowing

stroke. Cochrane Database o Systematic Reviews 2007,

Issue 1. Art. No.: CD001920. DOI: 10.1002/14651858.

CD001920.pub2.

Royal College o Physicians Intercollegiate Stroke

Working Party. National Clinical Guidelines or Stroke. 3rd

ed. London, UK: Royal College o Physicians 2008

Saka O, Serra V, Samyshkin Y, McGuire A, Wole CCDA.

Cost-eectiveness o stroke unit care ollowed by early

supported discharge. Stroke 2009; 40(1): 24-29.

Stroke Unit Trialists Collaboration. Organised inpatient(stroke unit) care or stroke. Cochrane Database o

Systematic Reviews 2007, Issue 4. Art. No.: CD000197.

DOI: 10.1002/14651858.CD000197.pub2.

Teixeira-Salmela LF, Olney SJ, et al. Muscle strengthening

and physical conditioning to reduce impairment and

disability in chronic stroke survivors. Arch Phys Med

Rehabil. 1999;80(10):1211-8.

Diabetes

Castaneda C, Layne JE, Munoz-Orians L, et al. A

randomized controlled trial o resistance exercise training

to improve glycemic control in older adults with type 2

diabetes. Diabetes Care. 2002;25(12):2335-41.

Dunstan DW, Daly RM, Owen N, Jolley D, De Courten

M, Shaw J, Zimmet P. High-intensity resistance training

improves glycemic control in older patients with type 2

diabetes. Diabetes Care. 2002 Oct;25(10):1729-36.

Evans WJ. Eects o exercise on body composition and

unctional capacity o the elderly. J Gerontol A Biol Sci

Med Sci. 1995;50 Spec No:147-50.Fenicchia LM, Kanaley JA, Azevedo JL Jr, et al. Infuence o


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resistance exercise training on glucose control in women

with type 2 diabetes. Metabolism. 2004;53:284289.

Greaves CJ, Sheppard KE, Abraham C, Hardeman W,

Roden M, Evans PH, Schwarz P, Image Study Group.

Systematic review o reviews o intervention components

associated with increased eectiveness in dietary and

physical activity interventions. BMC Public Health 2011

Feb 18;11(119):Epub

Orozco LJ, Buchleitner AM, Gimenez-Perez G, Roqu i

Figuls M, Richter B, Mauricio D. Exercise or exercise and

diet or preventing type 2 diabetes mellitus. Cochrane

Database o Systematic Reviews 2008, Issue 3. Art. No.:

CD003054. DOI: 10.1002/14651858.CD003054.pub3.

Umpierre D, Ribeiro PAB, Kramer CK, Leitao CB, Zucatti

ATN, Azevedo MJ, Gross JL, Ribeiro JP, Schaan BD. Physical

activity advice only or structured exercise training and

association with HbA1c levels in type 2 diabetes: a

systematic review and meta-analysis. JAMA 2011 May

4;305(17):1790-1799

Obesity

Dunstan DW, Daly RM, Owen N, Jolley D, De Courten

M, Shaw J, Zimmet P. High-intensity resistance training

improves glycemic control in older patients with type 2

diabetes. Diabetes Care. 2002 Oct;25(10):1729-36.

Hagberg JM, Graves JE, Limacher M, et al. Cardiovascularresponses o 70- to 79-yr-old men and women to

exercise training. J Appl Physiol. 1989;66(6):2589-94.

Shaw KA, Gennat HC, ORourke P, Del Mar C. Exercise or

overweight or obesity. Cochrane Database o Systematic

Reviews 2006, Issue 4. Art. No.: CD003817. DOI:

10.1002/14651858.CD003817.pub3.

Waters E, de Silva-Sanigorski A, Hall BJ, Brown T,

Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell

CD. Interventions or preventing obesity in children.

Cochrane Database o Systematic Reviews 2011, Issue 12.Art. No.: CD001871. DOI: 10.1002/14651858.CD001871.

pub3.

Chronic Obstructive Pulmonary Disease

American College o Chest Physicians, American

Association o Cardiovascular and Pulmonary

Rehabilitation [American College o Chest Physicians(ACCP) and the American Association o Cardiovascular

and Pulmonary Rehabilitation (AACVPR)]. Pulmonary

rehabilitation: joint ACCP/AACVPR evidence-based

guidelines [with systematic review]. Chest 1997

Nov;112(5):1363-1396

American College o Sports Medicine. Guidelines or

Exercise Testing and Prescription. 7th ed. Champaign IL:

Human Kinetics, 2006.

Casaburi R, Patessio A, Ioli F, et al. Reduction in exercise

lactic acidosis and ventilation as a result o exercisetraining in patients with obstructive lung disease. Am Rev

Respir Dis. 1991;143:9-18.

Casaburi R, Porszasz J, Burns MR, Carithers ER, et al.

Physiologic benets o exercise training in rehabilitation

o severe COPD patients. Am J Respir Crit Care Med.

1997;155:15411551.

Casaburi R. Mechanisms o the reduced ventilatory

requirement as a result o exercise training. Eur Respir

Rev. 1995;5:25, 4246.

Clark CJ, Cochrane LM, et al. Skeletal muscle strength and

endurance in patients with mild COPD and the eects o

weight training. Eur Respir J. 2000;15(1):92-97.

Coppoolse R, Schols A, Baarends EM et al. Interval versus

continuous training in patients with severe COPD: a

randomized clinical trial. Eur Respir J. 1999;14:258-263.

Gosselink R, Langer D, Burtin C, Probst V, Hendriks

HJM, van der Schans CP, Paterson WJ, Verhoe-de Wijk

MCE, Straver RVM, Klaassen M, Troosters T, Decramer

M, Ninane V, Delguste P, Muris J [Koninklijk Nederlands

Genootschap voor Fysiotherapie (KNGF) [Royal Dutch


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Society or Physiotherapy]]. KNGF guidelines: Chronic

obstructive pulmonary disease clinical practice

guidelines [with systematic review]. Nederlands

Tijdschrit voor Fysiotherapie [Dutch Journal o Physical

Therapy] 2008;118(4 Suppl):1-60

Gosselink R, Troosters T, Decramer M. Eects o exercise

training in COPD patients: interval versus endurance

training. Eur Respir J. 1998;12:2S.

Gosselink R, Troosters T, Decramer M. Exercise training

in COPD patients: the basic questions. Eur Respir J.

1997;10:28842891.

Griths TL, Burr ML, Campbell IA, et al. Results at 1 year

o outpatient multidisciplinary pulmonary rehabilitation:

a randomized controlled trial. Lancet. 2000;355:362-368.

Hernandez MTE, Rubio TM, Ruiz FO, et al. Results o ahome-based training program or patients with COPD.

Chest. 2000;118:106-114.

Hirata K, Okamoto T, Shiraishi S. The ecacy and

practice o exercise training in patients with chronic

obstructive pulmonary disease (COPD). Nippon Rinsho.

1999;57(9):2041-5.

Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary

rehabilitation or chronic obstructive pulmonary

disease. Cochrane Database o Systematic Reviews 2006,

Issue 4. Art. No.: CD003793. DOI: 10.1002/14651858.CD003793.pub2. http://onlinelibrary.wiley.com/

doi/10.1002/14651858.CD003793.pub2/abstract

Maltais F, LeBlanc P, Jobin J, et al. Intensity o training

and physiologic adaptation in patients with chronic

obstructive pulmonary disease. Am J Respir Crit Care

Med. 1997;155:555561.

National Institute or Health and Clinical Excellence.

Chronic obstructive pulmonary disease: management

o chronic obstructive pulmonary disease in adults in

primary and secondary care. Update guideline. London:

National Institute or Health and Clinical Excellence 2010.

http://publications.nice.org.uk/chronic-obstructive-

pulmonary-disease-cg101

Ng LWC, Mackney J, Jenkins S, Hill K. Does exercise

training change physical activity in people with COPD? A

systematic review and meta-analysis. Chronic Respiratory

Disease February 2012; 9(1):17-26

Normandin EA, McCusker C, Connors ML, et al. An

evaluation o two approaches to exercise conditioning in

pulmonary rehabilitation. Chest. 2002;121:1085-1091.

Puhan MA, Gimeno-Santos E, Scharplatz M, Troosters T,

Walters EH, Steurer J. Pulmonary rehabilitation ollowing

exacerbations o chronic obstructive pulmonary disease.

Cochrane Database o Systematic Reviews 2011, Issue 10.

Art. No.: CD005305. DOI: 10.1002/14651858.CD005305.

pub3.

Ries AL, ACCP/AACVPR Pulmonary Rehabilitation

Guidelines Panel. Pulmonary rehabilitation: joint

ACCP/AACVPR evidence-based guidelines. Chest.

1997;112:1363-1396.

Seymour JM, Moore L, Jolley CJ, Ward K, Creasey J, Steier

JS et al. Outpatient pulmonary rehabilitation ollowing

acute exacerbations o COPD. Thorax 2010; 65(5):423-428

Troosters TR, Casaburi R, Gosselilnk R, Decramer

M. Pulmonary rehabilitation in chronic obstructive

pulmonary disease. Am J Respir Crit Care Med.2005;172(3):19-38.

Vogiatzis I, Nanas S, Roussos C. Interval training as an

alternative modality to continuous exercise in patients

with COPD. Eur Respir J. 2002;20:1219.

ZuWallack R. The nonpharmacologic treatment o

chronic obstructive pulmonary disease: advances in our

understanding o pulmonary rehabilitation. Proc Am

Thorac Soc. 2007 Oct 1;4(7):549-53. Review.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003793.pub2/abstracthttp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003793.pub2/abstracthttp://publications.nice.org.uk/chronic-obstructive-pulmonary-disease-cg101http://publications.nice.org.uk/chronic-obstructive-pulmonary-disease-cg101http://publications.nice.org.uk/chronic-obstructive-pulmonary-disease-cg101http://publications.nice.org.uk/chronic-obstructive-pulmonary-disease-cg101http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003793.pub2/abstracthttp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003793.pub2/abstract


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Visit www.wcpt.org/wptday or more inormation about

World Physical Therapy Day and the resources available

This booklet has been produced by:

World Conederation or Physical Therapy

Victoria Charity Centre

11 Belgrave Road

London

SW1V 1RB

United Kingdom

World Conederation or Physical Therapy 2012

wptd clinical resources

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