The Problems of Physiotherapy
Abstract
Keywords: exercise, nutrition, physiotherapy, obesity, diet.
This paper will look at the effects that a lack of adequate exercise and nutrition is having on our population from the point of view of a physiotherapist.
While physiotherapy is a normal part of many patients’ rehabilitation and recovery, the general lack of both exercise and healthy diet which has become a feature of many societies in developed countries has led to a situation where a stable loop is formed: people injure themselves due to a lack of exercise putting undue strain on their joints, physiotherapy is prescribed, and healing is not optimal due to the lack of attention to a healthy diet. And so the circle continues.
Introduction
Adequate exercise and nutrition are essential for a healthy body and mind throughout life. While we used to receive adequate exercise in the course of our day, the advent of systems of transport which were more effective than walking, and the changes which brought our society from an agricultural one to one which was more sedentary in its pursuits wrought changes. The developed countries of the world have reached a point where the changes which have been brought to society recently via the digitalisation of our world have also meant that people, in general, have less time to themselves.
The changes in society which have led to many (if not most) jobs becoming entirely sedentary in nature have also contributed to a situation where health in food has given way to convenience. The digital age may have been hailed as a time when we would be free of work to such a degree as to have more time to ourselves, but in fact the opposite has happened; we are now busier than ever, with even less time left over for healthy habits once we have tended to our own needs for rest and socialization. The net result is that we spend more time sitting or lying down, and rely on pre-prepared meals, which are not only loaded with salt and other ingredients which act as preservatives on the food, but quite often also contain ingredients which are detrimental to our own health. The reliance on these foods, coupled with the lack of exercise which is another feature of the modern day ‘rat-race’ we are compelled to participate in, both inevitably lead to weight gain and a general lack of health.
It is interesting to note that, while on the surface it is easy to dismiss the reliance of people on fast food as being entirely down to convenience, and the lack of adequate exercise on the societal norms of overwork, quite often people simply lack the skills and knowledge necessary to make healthy choices in these areas. Several generations have grown up and formed their own households since this societal change began to take place; cooking is, to some degree, a skill which is picked up via seeing a family member do it – if no one cooks, then there is very little encouragement or normalising of the activity within that family, and so the cycle continues to the next generation. While cooking has been experiencing something of a resurgence in recent years, at this point our society has had several generations of people for whom family cooking would not have been a regular thing. Because of this, basic knowledge about food and cookery has been lost – these families should not be held accountable for their lack of knowledge. The same can be held true of exercise: when the various forms of public and private transport were not so widely available, people had to rely on themselves more often, and so would likely have noticed the deleterious effects on their health that a lack of regular exercise would have had. Knowledge of the benefits of good nutrition and regular exercise has been lost in recent years, with consequences that should perhaps have been foreseen.
Briefly, this paper will discuss the effects that the lack of good exercise and nutrition has on our population at large, as viewed through the lens of physiotherapy. In the Method section, work on the lack of nutrition and exercise in our society will be examined in and of itself, to determine the effect that it has been having on our society as a whole, with work done by Bach (2013); the BBC news service (n.d.) and Booth et al (2012) brought in as means of anchoring the discussion, while the Results section will look at the effect that these lacks are having and (briefly) will have in the future. This section will use work by Love et al (2012); as a means of discussing the effects that nutrition has on physiotherapy and its changing role in medicine, with the article ‘Nutrition and Physiotherapy’ (2016) being used a counterpoint to the remarks, while Vincente-Rodriquez et al (2007) will be used as a discussion of the finer points of both exercise and nutrition when it comes to bone formation and care. The final section, Discussion, will take all conclusions which have so far been drawn from the research in the paper, and speculate on what this means for physiotherapy (with reference to work done by Campbell et al (2001)) and society as a whole as we move into the future.
Method
The rising percentages of people with obesity, as well as well as the rising number of people with certain chronic illnesses, can be linked to our societal lack of adequate nutrition and exercise (Bach, 2013; Booth, Roberts & Laye, 2012). Our lifestyles have not yet caught up with the changes which have been made to our working lives (the switch from physical to mental labour), with the result that we still eat for a life which contains a lot of movement, rather than the mainly sedentary life of the average worker.
The number of calories consumed per day did not change significantly. Nonetheless, diet remains a proven and important component of health, and participants may have been tempted to under-report how much they ate (Bach, 2013)
It is interesting to note that, at least when lifestyle alone is considered, it is not nutrition which is seen as the primary problem. While mention is made by Bach of the fact that just because caloric intake hasn’t changed, that doesn’t mean that the number or type of “calories consumed were optimal” (2013), it is very definitively the exercise that is the primary issue in her opinion and writing.
As well as leading to rising obesity levels – with all the problems that that entails (Bach, 2013) – a lack of exercise is being increasingly linked with the rise in chronic illnesses. Now referred to as “major killers in the modern era” (Booth, Roberts, & Laye, 2012), chronic illnesses in this context are used to describe conditions that range from insulin resistance to coronary heart disease, and many others along the way (Booth, Roberts & Laye, 2012).
Research suggests that physical activity is good for all parts of your body – joints, bones and muscles (‘The Risks of Not Taking Exercise’, n.d.). This correlates with the findings of Booth, Roberts and Laye which say that a lack of physical exercise can lead to any number of the chronic illnesses referred to above.
Inherited genes and their interaction with physical activity levels determine physical fitness. However, chronic physical activity levels themselves modulate fitness. Further, the levels of physical activity, themselves, modulate whether fitness improves. (Booth, Roberts, & Laye, 2012)
The integration of exercise into one’s lifestyle, while a difficult obstacle to surmount, is necessary if one wishes to live in reasonable health, to a reasonable age. A regular amount of physical activity is also necessary to stimulate the body’s own natural healing process (‘The Risks of Not Taking Exercise’, n.d.), which, combined with the knowledge that it wards off chronic diseases of all kinds, should render the practicality of undertaking exercise clear. The work done by Booth, Roberts and Laye (2012) also quite neatly underpins the work done by Bach (2013) as seen above, and possibly confirms the circular effect of the poor nutrition\exercise cycle: less exercise leads to a more sedentary lifestyle, which leads to more chronic diseases due to a net gain in weight because of people not having the knowledge necessary to make the requisite changes to allow their caloric intake to match their physical activity.
Results
Physiotherapy is a recognised part of many rehabilitation programmes, because it handles issues with all the major body parts, including bones, joints and muscles. Because of this, and because of the strain that many chronic illnesses can put on the body (Booth, Roberts & Laye, 2012), researchers are now paying attention to the effects that a lack of adequate nutrition (in whichever form that might take) might have on the patient’s progress in physiotherapy (‘Nutrition and Physiotherapy’, 2016).
The Chartered Society of Physiotherapy (CSP) recognises that the prevention and management of obesity requires an aggressive and comprehensive approach that addresses the complex and multifaceted issues. (Love, Whelan, Murray, et al, 2012)
As was highlighted in the work done by Bach (2013), caloric intake and nutrition affect each other and form a circular state which can, unfortunately, be very difficult to get out of. If we take Bach’s percentages for a moment, and take into consideration that caloric intake is inversely proportional to the amount of physical activity people do (2013), then the role that physiotherapy plays in counteracting these effects becomes clear. Linking again to the previous section, researchers such as Booth, Roberts and Laye (2012) have made it clear that chronic conditions such as obesity and coronary heart disease are on the rise due to a combination of inadequate nutrition, and a lack of physical activity. The strain that this will put on a human body will necessarily fall under the purview of physiotherapy to try and heal, with consequences which shall be discussed in the next section. At the current time, the rise in the levels of obesity and other chronic diseases, coupled with the natural effects that a population which is unused to physical exertion will mean that the services of physiotherapy will be needed on a scale that hasn’t been seen before, purely to try and stem the tide of complaints which come as a result of years of inactivity coupled with bad diet.
While there are immediate effects to be felt from the melding of bad diet and a lack of physical activity (Bach, 2013; Booth, Roberts & Laye, 2012), the melding of these two habits can have detrimental effects on more than just the present time. Bone and muscle growth are both stimulated by the perfect combination of nutrition and exercise (Vincente-Rodriguez, Ezquerra, Mesana et al, 2007), as many fitness aficionados will attest. Briefly, the proper nutrition, such as adequate calcium and vitamin D, is needed to form bones which are strong and supple enough to perform their intended tasks. Muscles not only require proper nutrition also – mainly in the form of protein and appropriate minerals to provide proper growth, but they need exercise in order to maintain their function. Exercising helps bones too, primarily because the exertion strengthens them by allowing them something to push against, but exercise is what truly helps muscles to form and grow beyond their original formation (Love, Whelan, Murray et al, 2012).
A complete and nutrient-dense diet is recommended, as many nutrients influence bone health as well as exercise participation because of its direct effect on bone development. (Love, Whelan, Murray et al, 2012)
This study was, as has been said, primarily concerned with the effect that calcium had on bones, but the results hold true for most nutrients. They are all needed for proper bone growth, and a lack of it is partially what is causing the contemporary need for increased physiotherapy interventions. If the proper attention is not paid to bone development, particularly during adolescence (Love, Whelan, Murray et al, 2012), then the bone will not be strong enough to perform its intended function, which will lead to problems, and, most likely to the need for intervention from physiotherapy. We can see, then, that problems which can be fixed in physiotherapy – mainly by formulating and then mandating a plan of physical exercise – can just as easily be fixed simply by paying the appropriate amount of attention to both exercise and nutrition during life in general.
Discussion
The rise in the need for physiotherapy and other medical interventions today can be explained by the perfect melding of a lack of adequate nutrition, and a lack of physical activity. Our society has been moving towards a more sedentary lifestyle for some time, starting with the advent of technologies which allowed us to switch from jobs which involved physical labour to jobs which involved ‘mental’ labour. Unfortunately, while this switch to a less physically taxing form of labour was touted as a way of decreasing the amount of time spent working and doing other tasks associated with employment, the opposite has in fact occurred. Even the advent of so-called ‘labour-saving devices’ have only seemed to serve to give us more time to devote to work.
The report emphasises the need for increased support for the field of bariatric physiotherapy and recommends that physiotherapists who specialise in this area be routinely included in weight management teams. (Love, Whelan, Murray et al, 2012)
An increase in the amount of time spent working has unfortunately led to less time spent on nutrition and exercise, two components of life which are highly important if people want to continue living with a certain degree of independence as they age (‘The Risks of Not Taking Exercise’, n.d.). As has been explored in the previous sections, a lack of nutrition and a lack of exercise both combine to create bone and muscle issues which have to be tackled by physiotherapists in the long run, rather than being addressed by eating properly and getting a good amount of physical activity in,
While our previous lifestyle was undoubtedly harder than the one we had today, it had two major advantages over the predicament we find ourselves in right now: there was no convenience food, which meant that people would have nutritionally valuable food to eat, in the main; and their physically active lifestyles would have ensured that they maintained a basic level of fitness. The work done by Love, Whelan, Murray et al (2012) has shown us that steps are already being taken to address the increased need for physiotherapy interventions in more medical cases, but it also takes into account that the future will likely bring an even greater need for them to be included in general clinical practice. The rising epidemics of obesity and other chronic diseases are unlikely to be stemmed unless society sees several large changes made to significant areas of life, so their intervention in future scenarios will likely be needed.
Non-compliance is traditionally defined as a failure by patients to follow advice. Attempts have been made to reduce the proportion of non-compliers, but with little apparent effect on levels of compliance. (Campbell, Evans, Tucker et al, 2001)
While the work undertaken by Campbell, Evans and Tucker et al is nominally concerned with patients in a very specific situation, his point can be extrapolated more widely. While patient non-compliance may simply seem like people simply feeling that they know best, or feeling like they do not need to comply with the mandates of the clinical team, the information which has been used in the course of this paper suggests that there may be another reason for it. The lack of knowledge which is a result of several generations feeling the results of a changed field of employment which allows less time for both cookery and physical activity. In essence, patient non-compliance in this case could be put down to people simply not understanding the very real consequences which could be incurred by them not following directions. In a broader sense, this could be used as a blanket excuse for the actions of our society as a whole: several generations of people who are not used to seeing cooking (and therefore have no tradition of cooking from scratch to lead them to do so themselves), and perhaps similarly don’t have a tradition of seeking out physical activity for its own sake, should perhaps not be expected to immediately understand what the problem is with their health and how to fix it. In the future, with physiotherapy becoming a more important part of the ongoing clinical scene, perhaps the medical community will find a way to begin to educate people on a grander scale about the need for adequate nutrition and exercise.
Conclusion
Our society does have a problem with getting adequate nutrition and exercise, and these lacks are causing problems which people are already turning to physiotherapy to solve. It is hoped that the future inclusion of physiotherapists in the main clinician team rather than purely as someone to be consulted in the final stages of treatment, when rehabilitation is being organised. Sadly, it does seem that the intervention of physiotherapy will be needed more in the future, rather than less, since society will need to change in several ways before it can fully address the problems which come with a lack of nutrition and exercise. Taking the reports of patient non-compliance into account, however, it does seem as though even that may be a long shot. Looking on the bright side, however, there do seem to be small changes occurring in society, and it is to be hoped that these changes will grow.
References
Bach, B. (2013). Lack of Exercise, Not Diet, Linked to Rise in Obesity, Stanford Research Shows. Stanford Medicine News Center. Retrieved from: https://med.stanford.edu/news/all-news/2014/07/lack-of-exercise--not-diet--linked-to-rise-in-obesity--stanford-.html
Booth, F. W., Roberts, C. K. & Laye, M. J. (2012). Lack of Exercise is a Major Cause of Chronic Diseases. Comprehensive Physiology 2(2). DOI: 10.1002/cphy.c110025
Campbell, R., Evans, M., Tucker, M., Quilty, B., Dieppe, P. & Donavon, J. L. (2001). Why Don't Patients Do Their Exercises? Understanding Non-Compliance with Physiotherapy in Patients with Osteoarthritis of the Knee. Journal of Epidemiology and Community Health 55. DOI: 10.1136/jech.55.2.132
Love, A., Whelan, R., Murray, J., Lowe, T. & Hafeez, A. (2012). The Emerging Role of the Physiotherapist in the Current Obesity Epidemic. Physiopedia. Retrieved from: http://www.physio-pedia.com/The_Emerging_Role_of_the_Physiotherapist_in_the_Current_Obesity_Epidemic
‘Nutrition and Physiotherapy’ (2016) Vancouver Physiotherapy and Sports Clinic. Retrieved from: http://physiovancouver.ca/view/post/nutrition-and-physiotherapy
‘The Risks of Not Taking Exercise’ (n.d.) BBC World Service. Retrieved from: http://www.bbc.co.uk/worldservice/sci_tech/features/health/healthyliving/exerciserisk.shtml
Vincente-Rodriguez, G., Ezquerra, J., Mesana, M. I., Fernandez-Alvira, J. M., Rey-Lopez, J. P., Casajus, J. A. & Moreno, L. A. (2007). Independent and Combined Effect of Nutrition and Exercise on Bone Mass Development. Journal of Bone and Mineral Metabolism 26. DOI 10.1007/s00774-007-0846-9
