Evidence Based Rehab

I read an eye opening article by Frank Furedi, a sociologist from the University of Kent. He orates on the evolution of our society, especially western society, of illness being an infrequent negative state to a normal accepted state. In his article, Furedi laments that "wellness" is a social responsibility and possibly a state we can never acheive.

Wellness has become something you have to work on, something to aspire to and achieve. This reinforces the presupposition that not being well - or being ill - is the normal state. That is what our culture says to us now: you are not okay, you are not fine; you are potentially ill. The message seems to be that if you do not subscribe to this project of keeping well, you will revert to being ill.

The more we obsese with "wellness" the more it seems we are forever in a state of "illness". My opinion is that we should continue to counsel "wellness" but to take every opportunity to reinforce our patient's (and each others) successes. Embrace to good and accept that we can really never reach the nirvana of "wellness" that has been placed in front of us.

Labels: education, health, physical therapy

CNN posted an article today focusing on new research that shows as little as 10 minutes a day of exercise is beneficial for obese women. I think this reaffirms many of our beliefs that increasing activity in any way is helpful to the sedantary adult. The thought of a rigid 60 minute exercise session a day turns the majority of us away from becoming more active. This article can be a tool to help get more effort out of the reluctant patient.

An experience I had last year can help illustrate how PT's and research like this can help the general public. I was co-treating in a pro bono clinic with a physician. We evaluated a women with a history of IDDM and a 2 month old foot fracture. At the end of the eval the physician turned to the patient and said "you need to loose 100lbs in order to improve your health. Follow up in 3 months to check your progress". I'm sure that motivated her to go out and join a health club!

When the physician left, it was my turn to discuss with the patient some changes she could make to slowly increase her activity levels. These included simple tasks such as walking 3 laps around her home during commercials, parking 1 row further out from the store, and taking 1 flight of stairs to work and then the elevator to the last 3 flights.

I believe simple semantic change away from pushing an "exercise program" on the sedentary and obese and instead championing "increased activity" (which, down the road, should include specific cardiovascular exercise) will lead to better outcomes.

As I tell all my patients, "Doing something is better than doing nothing".

Labels: exercise, health, physical therapy