Elsevier

Physiotherapy

Volume 101, Issue 3, September 2015, Pages 273-278
Physiotherapy

Does outpatient physical therapy with the aim of improving health-related physical fitness influence the level of physical activity in patients with long-term musculoskeletal conditions?

https://doi.org/10.1016/j.physio.2014.11.005Get rights and content

Abstract

Objective

To evaluate any change in self-reported level of physical activity in patients receiving a general physical exercise programme in addition to disease-specific physiotherapy treatment.

Design

Pre–post-intervention study.

Setting

Outpatient physiotherapy clinics.

Participants

One hundred and ninety patients with long-term musculoskeletal conditions attending outpatient physiotherapy were recruited from seven physiotherapy clinics.

Interventions

Physiotherapy including disease-specific modalities and a general individually tailored exercise programme. Patients were evaluated at baseline and at the end of the programme.

Main outcome measures

International Physical Activity Questionnaire short form (IPAQ-sf) and COOP WONCA functional assessment charts.

Results

Forty-two patients were excluded from the analysis because they did not complete the IPAQ-sf correctly or dropped out during the treatment period. There was a significant increase in the number of metabolic equivalent task (MET)-min/week for vigorous and moderate-intensity activities, walking and total physical activity. The number of exercise sessions per week increased from 1.8 [standard deviation (SD) 0.9] to 2.2 (SD 1.2) (P = 0.001). The proportion of patients with a low level of physical activity decreased by 12%, and the proportion of the participants who did not/could not exercise decreased from 26% to 8%. The COOP WONCA charts showed significant improvements in the physical fitness, feelings, daily activities and social activities items.

Conclusion

A significant increase was found in the number of MET-min/week for all activity levels. Therefore, a general physical exercise programme initiated by a physiotherapist led to a positive change in level of physical activity.

Introduction

Engaging in regular physical activity is crucial for the health of adults of all ages. Physical inactivity increases all-cause mortality and has resulted in increasing public health challenges over recent decades. Increased physical activity and exercise, however, has been shown to be effective for the prevention and treatment of chronic diseases, without any negative side-effects [1]. The greatest benefits from increased physical activity occur when individuals who are least fit start exercising, even at a low intensity [2], [3] and in modest amounts. Previous studies have shown that patients with chronic pain, in addition to their condition-specific problems, are prone to low physical activity and have significantly poorer physical fitness compared with population controls [4]. The consequences are increased risk of developing lifestyle diseases such as cardiovascular problems, cancer, type 2 diabetes and obesity.

In order to achieve important health benefits, the revised US physical activity guidelines recommend that both adults and older people should perform at least 150 minutes of moderate-intensity physical activity, or at least 75 minutes of vigorous physical activity, or an equivalent mix of moderate-intensity and vigorous physical activity per week [5]. The activity can be spread out over the week, and can be broken up into smaller amounts of time during the day for at least 10 minutes at a time. In addition, the recommendations include muscle strength activities that work all major muscle groups on at least 2 days/week. Fitting regular physical activity into their daily schedule on a permanent basis may seem difficult for many people [5], and may be even more difficult for patients with chronic health problems.

Primary healthcare providers such as physiotherapists routinely meet patients with chronic pain and reduced function. Physiotherapists are trained in exercise and physical activity prescription, with a particular focus on the correct type and dosage (intensity, frequency and duration) of activity adjusted to the patient's specific needs. As such, physiotherapists should be in an ideal position to promote physical activity and support patients to establish habits that are adjusted to their specific health condition. In a cross-sectional survey, Shirley et al. [6] determined the knowledge, confidence, role perception and barriers of physiotherapy students regarding promotion of general physical activity for better health. They concluded that physiotherapy practice appears to be an excellent avenue for promoting a physically active lifestyle, and could potentially play an important public health role [6].

The main purpose of this pre–post-intervention study was to examine if patients receiving a general physical exercise programme in addition to their disease-specific physiotherapy intervention reported an increase in their level of physical activity at the end of the treatment period. It was hypothesised that a general physical exercise programme would influence patients’ physical activity pattern, especially in patients who were less active before treatment.

Section snippets

Methods

Physiotherapists from ix clinics participated in the recruitment and treatment of patients. From January 2011 to April 2012, 190 patients with different long-term musculoskeletal conditions seeking outpatient treatment for pain and/or decreased function were asked to participate in the study. They were a subgroup of patients participating in a larger study evaluating the psychometric properties of field tests and questionnaires evaluating health-related physical fitness for use in outpatient

Results

Of the 190 patients included in the study, 42 did not complete the IPAQ-sf questionnaire correctly or dropped out during the treatment period and were excluded from the analysis. Anthropometric data are shown in Table 1. For most patients, the main complaint was located in the extremities (41% lower extremities and 21% upper extremities) or the back (9%), and the duration of symptoms before starting physiotherapy was 260 (IQR 52 to 520) weeks. The remaining 29% of patients had

Discussion

Following a general exercise programme that aimed to improve patients’ health-related physical fitness, there was an increase in the level of physical activity and a positive change in functional health status. The most important findings were: the proportion of patients with a low level of physical activity decreased by 12%; the proportion of patients who did not/could not exercise decreased from 7% to 1% (Fig. 1); and 47% of patients reported that their health had improved.

Verhagen and

Conclusion

There was a significant increase in the number of MET-min/week for vigorous and moderate-intensity activities, walking and total activity; however, the effect sizes were small (0.12 to 0.18). There was a significant increase in the number of exercise sessions performed per patient per week from baseline to the end of the treatment period. The proportion of patients with a low level of physical activity decreased by 12%, and the proportion of patients who did not/could not exercise decreased

Acknowledgements

The authors wish to thank the physiotherapists in the following physiotherapy clinics; Hans & Olaf Fysioterapi, Hillevåg Fysioterapi og Trening, Kongsberg Medisinske Treningssenter, Orkanger Fysioterapi og Osteopati, Tiller Fysioterapi og Manuellterapi, and Ullernklinikken Manuellterapi og Rehabilitering and the patients who participated in the study.

Ethical approval: Norwegian Regional Committees for Medical and Health Research Ethics (Ref No. 2010/1547).

Funding: Grant support was provided by

References (18)

There are more references available in the full text version of this article.

Cited by (10)

  • Accelerometry-based physical activity, disability and quality of life before and after lumbar decompression surgery from a physiotherapeutic perspective: An observational cohort study

    2021, North American Spine Society Journal
    Citation Excerpt :

    Physiotherapy (PT) is a key feature of patient rehabilitation after lumbar decompression surgery including patient training, information about postoperative behaviour and pain management and has been shown to lead to postoperative improvement [19,20]. Aerobic exercise positively affects health [21], and PT has the potential to change PA levels [22,23]. Thus, achieving an adequate amount of PA in postoperative interventions might positively affect surgical outcomes.

  • Physiotherapists use a small number of behaviour change techniques when promoting physical activity: A systematic review comparing experimental and observational studies

    2018, Journal of Science and Medicine in Sport
    Citation Excerpt :

    No observational studies reported the characteristics of non-responders. In the experimental studies, the duration of interventions ranged from 5 min24 to 2 years,26,30 with the number of physiotherapist contacts ranging from once only24 to twice weekly over several weeks.25,28 Five studies were RCTs26,29–32 and six studies used a usual care control.24,26,27,30–32

  • The role of physiotherapy in climate change mitigation

    2016, Physiotherapy (United Kingdom)
View all citing articles on Scopus
View full text