PT in KC

WHAT CAN PT DO TO HELP YOU REACH YOUR WEIGHT LOSS GOALS

Obesity is a condition caused by the accumulation of excessive body fat. Nearly 100 million Americans are obese or overweight. Obesity is a worldwide epidemic.

A full 68% of the adult population in the United States currently is estimated to be overweight, and about 36% are obese. It is also estimated that 10% of children in the United States aged 2 to 5 years, 15% of children aged 6 to 11 years, and 16% of adolescents aged 12 to 19 years are overweight. Obesity increases the chance of early death; around 325,000 deaths in the United States each year are attributed to obesity, according to the CDC and NHANES.

Adults and children can be classified as normal, overweight, or obese by calculating their body mass index (BMI) based on their height and weight. For example, adults are considered overweight if their BMI is 25 to 29, and obese if their BMI is 30 or higher.

Obesity may be triggered by genetic, environmental, behavioral, social, physiological, and cultural factors. Sedentary lifestyles and surplus caloric intake are considered to be primarily responsible for the dramatic worldwide increase in obesity during the past 2 decades.

Obesity affects people of all ages, races, and socioeconomic levels. It contributes to many chronic diseases and can even cause early death. It can contribute to joint pain, due to increased stress that excess body weight puts on joints, muscles, and spinal discs. It can also cause a loss of "function"—the ability to perform simple daily activities like walking, climbing stairs, or doing household chores.

Numerous options for treating obesity are available today, including reduced-calorie diets, physical exercise, behavior modification, medication, and surgery. Physical therapists are experts in physical exercise, and can develop individualized physical activity plans for individuals who are overweight or obese to manage weight, prevent the development of obesity, or combat its effects.

What is Obesity?

Obesity is a condition involving the storage of excess body fat brought about by an imbalance between caloric intake (number of calories eaten) and energy expenditure (number of calories burned) occurring over an extended period of time. As little as 100 extra calories per day will lead to a 4.5 kg [10 lb] weight gain each year, which can lead to weight problems over time.

Obesity affects the body in many negative ways and can lead to other health problems, such as:

  • cardiovascular disease
  • stroke
  • diabetes
  • high blood pressure
  • cancer (breast, liver, endometrial, prostate, and colon)
  • osteoarthritis
  • lymphedema (swelling of arms and legs)
  • breathing problems, including asthma and sleep apnea
  • depression

Obese people have difficulty engaging in daily activities due to the increased body weight they carry, their loss of physical conditioning, and their movement limitations.

Modern society, especially in the past 20 years, enables and encourages overeating and acceptance of overeating because there is an abundance of inexpensive, high-calorie foods with poor nutritional value available (i.e., “fast food” and “junk food”). We are also encouraged to consume unreasonably large portions of food with “supersized” fast food options, and advertising of food and eating as a way to bond and celebrate special occasions (“holiday feasting”) may also contribute. The growth of sedentary lifestyles or inactivity also contributes greatly to obesity. We spend more time playing video games instead of playing sports outside, working at desk jobs instead of performing manual labor, and riding in cars instead of walking.

How Does it Feel?

A person who is obese may experience:

  • Fatigue when performing simple daily activities.
  • Joint pain, especially in the legs and back from increased stress that excess fat and weight put on the joints and muscles of the body.
  • Difficulty performing daily activities, such as walking, climbing stairs, or playing physically active games.
  • Frustration or depression about the condition and the inability to lose weight.

How Is It Diagnosed?

If you see your physical therapist first, your physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will also ask you detailed questions about your condition, such as:

  • Do you have any joint pain?
  • Do you have difficulty with any daily activities?
  • How much daily exercise do you get?
  • Do you have any other medical conditions or problems?
  • Do you take any medication for your obesity or any other condition?
  • Have you had any surgery related to your obesity?
  • Are you under the care of a physician?
  • What are your goals?

Your physical therapist will perform tests, such as motion, strength, coordination, and balance checks to help assess your overall physical ability. Your physical therapist may also perform specific obesity tests, such as calculating your BMI, or measuring your waist circumference, "skinfold" thickness, or percentage of body fat.

Your physical therapist may consult with your physician or other health care providers about your condition, who may order further tests to rule out other medical conditions that may affect the type of physical therapy you receive.

How Can a Physical Therapist Help?

Physical therapists can help people who are obese to be more physically active and fit by teaching them to exercise in pain free and fun ways. The right exercise is very important because it helps burn calories, get rid of fat, preserve muscle tissue, and protect your joints. When you start a fun exercise routine, it also helps you make better choices about your diet.

Your physical therapist will work with you to design a specific treatment program to address your needs, including exercises you can do at home. Aerobic exercise and strength training will likely be included in your program, as they both help in weight loss and weight control. Physical therapists are trained to create safe, effective physical activity programs for people of all ages and abilities, taking into account the Centers for Disease Control and Prevention physical activity recommendations for children and adults.

Physical therapists can also help individuals address any underlying reasons for their unhealthy behaviors; they are trained to identify any barriers to developing healthy habits, setting individual goals, and sticking to the program. Your physical therapist can help you:

Reduce pain. Your physical therapist will design a personalized exercise program to help you safely perform activities with the least amount of pain. Just getting up and getting moving can help relieve pain!

Improve cardiovascular fitness. Your physical therapist will design a "heart-healthy" aerobic exercise program for you, to elevate your body's metabolism and burn more calories. Physical therapists help people, including adults and children with disabilities find fun aerobic activities they can perform at their own comfortable level.

Improve strength. Your physical therapist will teach you exercises to address any muscle weakness you may have, or to improve your overall muscle strength. Building strength in muscles can help burn calories, make daily activities easier, and relieve joint pain. Gentle and low-impact forms of weight training performed with exercise bands can help avoid joint stress.

Improve movement. Your physical therapist will choose specific activities and treatments to help restore normal movement of stiff joints. These might begin with "passive" motions that the physical therapist performs for you, and progress to active exercises that you do yourself.

Improve flexibility and posture. Your physical therapist will determine if any of your major muscles are tight, and teach you how to gently stretch them. Your physical therapist will also assess your posture, and teach you exercises to improve your ability to maintain proper posture. Good posture can make difficult activities easier and less painful, and even improve your breathing.

Increase activity levels. Your physical therapist will discuss your activity goals with you, and design your exercise program to address your individual needs and goals. Your physical therapist will help you reach those goals in the safest, fastest, and most effective way possible.

If Surgery Is Necessary

Gastric bypass or bariatric surgery is sometimes chosen by patients and their doctors to treat severe obesity. Your physical therapist can help you prepare for and recover from surgery by designing and teaching you a preoperative and postoperative physical therapy program. Your physical therapist can guide you through each session, help you avoid injury to joints and muscles, and increase and adjust your program as needed. Preoperative programs often involve strength training and aerobic conditioning, while postoperative programs often start with deep breathing and lower-extremity (legs, ankles, feet) exercises, gently increasing to strength and aerobic training. Your physical therapist will help you minimize pain, regain motion and strength, and return to normal activities in the speediest manner possible after surgery.

Can this Injury or Condition be Prevented?

To help prevent obesity or prevent weight gain after weight loss, your physical therapist will likely advise you to:

  • Get moving! Include physical activities you enjoy into your daily routine so you can avoid returning to a sedentary lifestyle.
  • Avoid watching TV more than 2 hours per day.
  • Don’t use a computer longer than 1 hour without an exercise break. 
  • Use your body as much as you can to walk, climb stairs, garden, wash dishes by hand, and other daily activities that keep you moving.
  • Educate yourself about nutrition, and especially about portion sizes, to help you understand and control your calorie intake.
  • Exercise daily for at least 30 minutes (adults) or 1 hour (children). (This advice also applies to disabled individuals as well as those suffering from most medical conditions.) Always check with your physical therapist or a health care professional before beginning any exercise program.

Be sure to follow the special instructions your physical therapist gives you regarding your specific health conditions.

Your physical therapist will also prescribe a home-exercise program specific to your needs to prevent future problems or injuries. This program can include strength and flexibility exercises, posture retraining, and aerobic conditioning.

CHRONIC FATIGUE SYNDROME - WHAT IS IT??

Chronic fatigue syndrome (CFS) is a condition that affects approximately 1% of the population in the United States. Without treatment, CFS often leads to disability. With treatment, including physical therapy the condition can be managed well, leading to an improved quality of life.

 

What is Chronic Fatigue Syndrome?

Chronic fatigue syndrome is a condition categorized by generalized fatigue that persists for 6 months or longer, and is more intense than would be expected based on the effort a person regularly exerts. Although science has yet to yield a full understanding of the underlying cause(s) of CFS, many researchers suspect impairments of the aerobic energy, immune system, and gastrointestinal systems may be responsible for the functional impairment experienced in individuals with this condition.

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How Does it Feel?

The best known symptom of CFS is “postexertional malaise,” which causes a person to feel profoundly tired even with usual daily activities or minor overexertions. In addition, people with CFS may feel generalized body pains, headaches, difficulty thinking (ie, "brain fog"), and sleep disturbances. CFS has been described by some as feeling like a flu that has persisted for a very long period of time. These symptoms may fluctuate over time.

Full recovery is uncommon in adults with CFS, although it may be more common in children with CFS. Current clinical management relates to addressing symptoms and compensating for functional deficits in order to improve daily functioning.

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Signs and Symptoms

Research has identified several symptoms of CFS, including:

  • Fatigue. One of the primary symptoms of CFS is fatigue that lasts 6 months or more.
  • Generalized pain.There is a significant amount of overlap between diagnoses of CFS and fibromyalgia, and some studies have suggested that 50% to 80% of people diagnosed with CFS also qualify to have a diagnosis of fibromyalgia. In both conditions, widespread distributions of pain are often present.
  • Frequent headaches. Many people with CFS complain about frequent or recurring headaches, which can lead to avoiding physical activity.
  • Muscle weakness. Decreased physical activity can result in general muscle weakness.
  • Cloudy thoughts and confusion. CFS may make it difficult to concentrate or "stay on task."
  • Disturbed sleep. Despite generalized fatigue, those with CFS often have difficulty sleeping.
  • Flu-like symptoms. People with CFS report flu-like symptoms, including sore throats, muscle aches, and generalized fatigue.

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How Is It Diagnosed?

CFS is a diagnosis of exclusion, meaning that no other health problem may be responsible for the fatigue. Diagnosis of CFS is symptom-based; your physician or physical therapist will base the diagnosis on the symptoms you report. They may also conduct medical tests to rule out other medical conditions. Unfortunately, there are no diagnostic tests to confirm the presence of CFS.

Your physical therapist may be the first to recognize an onset of CFS because of its effects on your physical function. Your physical therapist may ask you:

  • When do you feel fatigued and how long have you been feeling fatigued?Do you experience any widespread pain or discomfort?
  • Have you noticed any significant changes in your ability to perform physical tasks?
  • Have you noticed any sleep disturbances?
  • Have you noticed any recent changes in your ability to think clearly?

Cardiopulmonary exercise testing, including 2 tests arranged 24 hours apart, may be used to characterize the severity of your functional impairment. In addition, your physical therapist may ask you to fill out a questionnaire in order to better understand your physical state, and to screen for the presence of other conditions.

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How Can a Physical Therapist Help?

Your physical therapist will work with you to develop a treatment plan to help ease your discomfort and improve your ability to perform daily activities.

Because fatigue, pain, and weakness are all associated with CFS, treatment will likely focus on improving short-term endurance and strength. Your physical therapist may also check for other conditions, such as depression and may refer you to other specialists for comanagement of your symptoms.

Physical therapy treatments may include:

Education. Your physical therapist will teach you strategies to help conserve energy while performing your daily activities.

Movement and Strengthening Exercises. Moving and exercising can improve your short-term endurance and strength and reduce your pain. Your physical therapist will help you identify specific movements that will help reduce your specific symptoms.

Manual Therapy. Manual (hands-on) therapy may be applied to manipulate or mobilize the skin, bones, and soft tissues to help reduce pain and improve movement.

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Can this Injury or Condition be Prevented?

Unfortunately, the actual mechanisms behind CFS are not completely understood. To date, there is no sure way to predict or prevent the onset of CFS. However, early detection of the signs and symptoms related to CFS may help in its management.

Upon diagnosis, your physical therapist will work with you to develop strategies to better understand and manage your signs or symptoms.

  • As with many conditions education is key. Understanding maintenance strategies, such as balancing periods of activity and rest, can help you live a functional life with CFS.
  • Moderate, short-duration exercises may be performed without making your symptoms worse after your symptoms are well controlled with a pacing self-management program.
  • Cognitive behavioral therapy and psychotherapy may also help in addressing possible associated disorders, such as anxiety and depression.

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Real Life Experiences

Angela is a small-animal veterinarian whose job requires her to be on her feet for 10 hours straight to perform surgeries during her workday.

Over the past few months, Angela has been feeling extremely tired, even on the days when her workload is light. Fearing that she could have multiple sclerosis like her sister, Angela makes an appointment with her primary care physician. He, after a thorough examination, refers her to a neurologist.

Angela's neurologist orders multiple tests, all of which comes back negative. At that point, she is given the diagnosis of CFS. Her neurologist refers her to physical therapy.

During her examination, Angela states that her fatigue tends to come and go, but she remains profoundly fatigued at all times. Angela has to stay in bed all weekend to recover from even a normal work week. She feels better earlier in the week than later in the week, but her symptoms are getting worse over time. Angela also says that she feels ill when she is fatigued, and that she also has difficulty concentrating. Angela reports that she has missed the past 3 weeks of work, due to her problems. She also reports that she feels anxious about the recent diagnosis, and that everything she has read about CFS sounds negative.

Her physical therapist identifies weakness, range of motion limitations, and muscle pain. The first cardiopulmonary exercise test reveals no abnormalities. However, the maximum volume of oxygen her body can consume is decreased on the second test, even though the test is rated as a maximal test. Her measurements suggest moderate to severe cardiovascular and pulmonary impairment on the second day, which explains her fluctuating functional deficits. Angela also experiences increased “brain fog” and body aches on the day of the second cardiopulmonary exercise test.

Following her exam, her physical therapist talks to her about her condition, and develops a strategy for physical therapy that he feels is best for her, consisting of activities and short exercises that will gently increase her strength and endurance, and help ease her pain.

Despite the complexity of her condition, Angela does well with a personalized course of physical therapy. Following several months of skilled services, she reports a 50% reduction in symptoms with her daily activities. With her physical therapist's help, Angela now feels confident that she can manage her symptoms as she performs her daily activities.

This story highlights an individualized experience of CFS. Your case may be different. Your physical therapist will tailor a treatment program to your specific needs.

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What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat CFS. However, when seeking a provider, you may want to consider:

  • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
  • A physical therapist who is well versed in the bio psychosocial model of care and understands the complexities of CFS.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

  • Get recommendations from family and friends or from other health care providers.
  • When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with CFS.
  • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible. Keeping a journal highlighting when you experience pain will help the physical therapist identify the best treatment approach.