Model Programs to Address Obesity and Cardiometabolic Disease: Interventions for Suboptimal Nutrition and Sedentary Lifestyles.

Doctor measuring obese man waist body fat. Obesity and weight loss

Problems posed by obesity-related endocrine diseases embody a national health crisis. Caloric excess and sedentary lifestyle from which they develop also pose significant challenges for rehabilitation providers. Almost two thirds of the U.S. population are currently overweight or obese, a number that has increased by >10% within the last decade and is expected to grow. An overweight body habitus is strongly associated with clinical hazards, including cardiometabolic syndrome, diabetes hypertension, and coronary artery disease. The component health risks of the cardiometabolic syndrome include coalescing of risk factors that predict a health calamity unless effective interventions can be developed and widely adopted. Obesity by itself is now considered an American Diabetes Association-qualified disability, but it is also disturbingly prevalent in other physical disability groupings of adults and children. This monograph describes successes of the Diabetes Prevention Program (DPP), a National Institutes of Health multisite randomized controlled trial that reported significant weight reduction and a 58% decreased incidence of type-2 diabetes accompanying 1 year of structured lifestyle intervention. This treatment benefit (1) exceeded that of metformin pharmacotherapy, (2) was so powerful that the trial was closed before reaching endpoints, and (3) was judged cost-effective for the patient and society. The DPP roadmap incorporating physical activity, diet, and behavioral approaches has been widely adapted to specific community, faith, racial, ethnic, school, and national populations with excellent outcomes success. The lockstep physical activity approach, activity prescription, and long-term success of the program are described and compared with other programs to illustrate effective countermeasures for the pandemics of obesity and obesity-related cardioendocrine disease.

The authors will illustrate adaptation of the DPP for a cohort of persons with disability from spinal cord injury and the benefits observed.

Focused echocardiography: a systematic review of diagnostic and clinical decision-making in anaesthesia and critical care.

Flow color mode in echocardiogram in mitral valve regurgitation patient

Focused echocardiography is becoming a widely used tool to aid clinical assessment by anaesthetists and critical care physicians. At the present time, most physicians are not yet trained in focused echocardiography or believe that it may result in adverse outcomes by delaying, or otherwise interfering with, time-critical patient management. The authors performed a systematic review of electronic databases on the topic of focused echocardiography in anaesthesia and critical care.  18 full text articles were found, which consistently reported that focused echocardiography may be used to identify or exclude previously unrecognised or suspected cardiac abnormalities, resulting in frequent important changes to patient management. However, most of the articles were observational studies with inherent design flaws. Thirteen prospective studies, including two that measured patient outcome, were supportive of focused echocardiography, whereas five retrospective cohort studies, including three outcome studies, did not support focused echocardiography.

There is an urgent requirement for randomised controlled trials.

PNF for Lumbar Flexion in Quadruped: Restore Toe Touch and Lumbar Dissociation

Rehab has embraced the hip hinge. Yes, it’s important to teach hip dissociation from the lumbar spine when lumbar movement, particularly flexion is threatening and triggers output of pain. However, at some point, lumbar movement needs to be restored in a threat free manner. Toe touch and dissociation of lumbar spine flexion from the hips is often forgotten.

This is how I would educate the patient. “When hip hinges are practiced too much, you often lose the ability to actually flex at the lumbar spine. Every joint needs to move to remain healthy as long as it’s non threatening or done in excess to the point of injury.”

PNF for Lumbar Flexion and Toe Touch
Want to learn more ways to improve lumbar mobility plus Clinical Practice Patterns for Lower Quarter to cut down the amount of time you spend assessing? Check out Modern Manual Therapy Premium!

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic…

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Physical Activity Course Outcomes

Group of elementary school kids running in a school corridor. Children,  youth.

The Physiotherapy, Exercise and Physical Activity Course was a huge success. The course was designed to help healthcare professionals to get up, get moving and tackle physical activity and sedentary lifestyles around the world.

As part of the assessment participants of the course submitted a case study and some excellent contributions were provided and demonstrates what amazing work and ideas are out there. Why don’t you check out some of the content created?

Case Study A is all about how mental health can be positively effected by physical activity. More specifically how physical activity improves social, mood self-esteem and depression.

Case Study B investigates how a 10 week physical activity programme can improve ‘the silent killer’ hypertension. It is always good to recap the basics when it comes to the important physiological effects of exercise.

Motivational Interviewing is perhaps something you aren’t used to but it is a technique which all therapists should employ. Seriously, have a look and tell us if you don’t agree!

If videos are more your thing then check out this Elevator Pitch. Pre-school sitting activities are on the rise. This is worrying when low literacy ability is associated with a sedentary lifestyle. Watch the video to find out how workshops can make a difference.

Check back regularly for more content and don’t forget to discuss on social media!


Effect of dance therapy on blood pressure and exercise capacity of individuals with hypertension: A systematic review and meta-analysis.

Vector illustration of couple dancing modern dance, Partners dance bachata, Dancing style design concept set, traditional dance flat icon isolated vector illustration, Man and woman ballroom dancing.

Dance therapy is a less conventional modality of physical activity in cardiovascular rehabilitation. The authors performed a systematic review and meta-analysis to investigate the effects of dance therapy in hypertensive patients. Pubmed, Scopus, LILACS, IBECS, MEDLINE and SciELO via Virtual Health Library (Bireme) (from the earliest data available to February 2016) were searched for controlled trials that investigated the effects of dance therapy on exercise capacity, systolic (SBP) and diastolic (DBP) blood pressure in hypertensive patients. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I(2) test. Four studies met the eligibility criteria. Dance therapy resulted in a significant reduction in systolic blood pressure (WMD -12.01mmHg; 95% CI: -16.08, -7.94mmHg; P<0.0001) when compared with control subjects. Significant reduction in diastolic blood pressure were also found (WMD -3.38mmHg; 95% CI: -4.81, -1.94mmHg; P<0.0001), compared with control group. Exercise capacity showed a significant improvement (WMD 1.31; 95% CI: 0.16, 2.47; P<0.03). A moderate to high heterogeneity was observed in our analysis: I(2)=92% to SBP, I(2)=55% to DBP, and I(2)=82% to exercise capacity.

The meta-analysis showed a positive effect of dance therapy on exercise capacity and reduction of SBP and DBP in individuals with hypertension. However, the moderate to high heterogeneity found in our analysis limits a pragmatic recommendation of dance therapy in individuals with hypertension.

Teamwork enables high level of early mobilization in critically ill patients.

ICU room in a hospital with medical equipments and a patient

Early mobilization in critically ill patients has been shown to prevent bed-rest-associated morbidity. Reported reasons for not mobilizing patients, thereby excluding or delaying such intervention, are diverse and comprise safety considerations for high-risk critically ill patients with multiple organ support systems. This study sought to demonstrate that early mobilization performed within the first 24 h of ICU admission proves to be feasible and well tolerated in the vast majority of critically ill patients. General practice data were collected for 171 consecutive admissions to our ICU over a 2-month period according to a local, standardized, early mobilization protocol. The total period covered 731 patient-days, 22 (3 %) of which met our local exclusion criteria for mobilization. Of the remaining 709 patient-days, early mobilization was achieved on 86 % of them, bed-to-chair transfer on 74 %, and at least one physical therapy session on 59 %. Median time interval from ICU admission to the first early mobilization activity was 19 h (IQR = 15-23). In patients on mechanical ventilation (51 %), accounting for 46 % of patient-days, 35 % were administered vasopressors and 11 % continuous renal replacement therapy. Within this group, bed-to-chair transfer was achieved on 68 % of patient-days and at least one early mobilization activity on 80 %. Limiting factors to start early mobilization included restricted staffing capacities, diagnostic or surgical procedures, patients’ refusal, as well as severe hemodynamic instability. Hemodynamic parameters were rarely affected during mobilization, causing interruption in only 0.8 % of all activities, primarily due to reversible hypotension or arrhythmia. In general, all activities were well tolerated, while patients were able to self-regulate their active early mobilization. Patients’ subjective perception of physical therapy was reported to be enjoyable.

Mobilization within the first 24 h of ICU admission is achievable in the majority of critical ill patients, in spite of mechanical ventilation, vasopressor administration, or renal replacement therapy.

How should we teach lumbar manipulation? A consensus study.


Spinal manipulation is an effective intervention for low back pain, yet there is little consistency in how this skill is taught. The purpose of this study was to identify what educators and clinicians believe are important characteristics of the patient and operator position prior to side-lying lumbar manipulation and the patient position and operator motion during the manipulative thrust. Three rounds of questionnaires were sent to physical therapists, osteopaths and chiropractors. Consensus was established in Round 3 if at least 75% of respondents identified a characteristic as very important/extremely important on a 5-point Likert scale. 265 educators and clinicians completed the three rounds of questioning. There was consensus that localization to target segment, patient comfort, table height, and logrolling the patient towards the operator are important characteristics of patient position during the preparatory phase. During the manipulation phase, respondents agreed that it is important to maintain localization to the segment and rotate the patient’s pelvis and lumbar spine. For the operator characteristics, consensus was reached for the following items; moving up and over the patient, maintaining contact using forearms, and close contact between the operator and patient (preparatory phase); generating force through the body and legs, dropping the body downwards, maintaining localization, and providing a high-velocity and low-amplitude thrust (manipulation phase).

This Delphi study successfully identified key characteristics of patient position and operator position and motion for effective delivery of side-lying lumbar spine manipulations.