The Role of Physical Therapy and Exercise

Enhancing Your Health: The Role of Physical Therapy and Exercise

Course Summary:

This comprehensive course, "Enhancing Your Health: The Role of Physical Therapy and Exercise," explores the profound impact of physical therapy and exercise on overall health and well-being. It delves into the science behind exercise, its benefits across various health conditions, and practical guidelines for incorporating it into daily life.

The course features six interactive modules, each focusing on a specific aspect of physical therapy and exercise. Through engaging lectures by experienced physiotherapists, real-world examples, and practical tips, learners gain valuable insights into:

• The importance of physical activity and exercise: Understanding global health trends and the science behind exercise's multi-system benefits.
• Exercise and Cardiovascular Disease: Exploring the role of exercise in preventing and managing cardiovascular disease, understanding risk factors, and learning about tailored exercise programs for heart health.
• Exercise and Osteoporosis: Defining osteoporosis, understanding fracture risks, and learning how to design safe and effective exercise programs for individuals with this condition, including adaptation strategies for daily activities.
• Exercise and Cancer: Investigating the role of exercise in cancer prevention, management of treatment side-effects, and recovery. It addresses cancer-related fatigue and provides resources for cancer survivors.
• Exercise and Common Sport Injuries: Examining the causes of common sports injuries, prevention strategies, and management techniques, emphasizing the role of physiotherapists in rehabilitation.
• Exercise and Arthritis: Describing different types of arthritis, focusing on osteoarthritis. This module explores the benefits of exercise for managing arthritis symptoms, provides exercise recommendations from international organizations, and introduces the GLA:D program.

By the end of this course, learners will have a strong understanding of how physical therapy and exercise can be used to enhance their health and manage a variety of health conditions. The course equips individuals with the knowledge to make informed decisions about their health and to engage in safe and effective exercise practices.

Module Summaries:

# 01 Intro-To-The-Course-Module-1-Just-Keep-Moving-Why-Physical-Activity-And-Exercise

Introduction:

This module emphasizes the importance of physical activity and exercise for overall health and well-being. It highlights the global health trends indicating insufficient physical activity levels and emphasizes the role of physiotherapists in promoting exercise as medicine.

Main Content:

• The Importance of Physical Activity: The World Health Organization warns of alarmingly low physical activity levels globally.
• Factors Influencing Physical Activity: Cultural, economic (sedentary jobs), environmental (spectatorship over participation), physical ability/accessibility, political (recreational policies), and social factors significantly impact activity levels.
• The Forward Movement: An initiative promoting exercise and fitness for people of diverse abilities, challenging the passive view of disability.
• Global Health Trends & Physiotherapy:
  • Osteoarthritis: Increasing incidence globally. Physiotherapists raise awareness, educate about exercise benefits (especially weight-bearing), and address muscle imbalances.
  • Fall-related Injuries: Physiotherapists assess balance, implement fall prevention programs, and utilize neuromuscular training to improve joint mechanics and muscle strength.
  • Fragility Fractures: Increasing incidence, often indicating underlying conditions like osteoporosis. Weight-bearing exercise is crucial for bone health.
  • Non-life-threatening Spinal Cord Injuries: Physiotherapists help manage impairments, improve balance and strength, and design personalized exercise plans for long-term management.
• Benefits of Exercise as Medicine: Exercise provides multi-system benefits, improving cardiovascular health, bone density, cognitive function, and even impacting DNA.
• Exercise and Bone Health: Weight-bearing exercise promotes cartilage health, improves bone density, and strengthens muscles. It's safe to exercise with mild discomfort (0-3/10 on a pain scale).
• Physical Therapists and Exercise Prescription:
  • Injury Prevention: Identify risk factors, provide corrective exercises, and advise on safe return to activity.
  • Goal Setting: Collaborate with patients to set short-term, intermediate, and long-term exercise goals.
  • Rehabilitation: Develop customized plans for individuals recovering from injuries or post-traumatic stress, emphasizing a holistic approach.
• Evidence-Based Exercise Guidelines: Specific guidelines exist for various populations, including children, adolescents, adults, seniors, pregnant individuals, and those with spinal cord injuries.
• Being an Activity Advocate: Support recreational facilities and policies, promote urban exercise opportunities, and advocate for accessibility for all.

Key Takeaways:

• Regular physical activity is crucial for maintaining overall health and well-being.
• Physical therapists play a vital role in promoting exercise, preventing injuries, and rehabilitating individuals with various health conditions.
• Understanding and following evidence-based exercise guidelines is key to maximizing benefits and minimizing risks.
• It's crucial to be an advocate for accessible and inclusive exercise opportunities for all.

# 02 Managing-Your-Health-The-Role-Of-Physical-Therapy-And-Exercise-Module-2-Exercise

Introduction:

This module focuses on the relationship between exercise and cardiovascular disease, a leading cause of death worldwide. It highlights the role of exercise in preventing and managing this condition.

Main Content:

• Cardiovascular Disease Prevalence: CVD is the leading cause of death globally, claiming over 4,000 lives annually in Canada alone.
• Understanding Cardiovascular Disease: Ischemic heart disease arises from damaged or inefficient heart muscle due to reduced blood supply, often caused by atherosclerosis.
• Atherosclerosis: A process where plaque builds up inside arteries, narrowing them and restricting blood flow, potentially leading to angina, heart attack, or ischemic heart disease.
• The Heart's Blood Supply: Coronary arteries, branching from the aorta, supply oxygenated blood to the heart muscle. Blockages in these arteries can have serious consequences.
• Physiotherapists' Role in CVD Management:
  • Exercise Experts: Help patients regain mobility and function through tailored exercise programs.
  • Hospital & Home Care: Assist patients in regaining strength and endurance post-heart attack or surgery.
  • Cardiac Rehabilitation: Design and supervise safe and effective exercise programs, focusing on aerobic and strength training.
• Physical Inactivity: A significant risk factor for chronic diseases, including CVD, cancer, and diabetes.
• Exercise as a Lifesaver: Regular physical activity reduces CVD risk by almost 50% and helps manage major risk factors like blood pressure, cholesterol, obesity, and type 2 diabetes.
• Cardiovascular Risk Factors:
  • Non-modifiable: Family history, age, menopause, ethnicity.
  • Modifiable: Smoking, high cholesterol, hypertension, diabetes, sedentary lifestyle, overweight/obesity, stress, depression.
• Physical Activity Guidelines:
  • Aerobic Activity: 150 minutes of moderate-to-vigorous activity per week, spread across most days.
  • Resistance Training: 2-3 times per week, targeting major muscle groups.
• Benefits of Increased Cardiovascular Fitness: Weight loss, reduced waist circumference, lower blood pressure, improved cholesterol levels, better blood sugar control, improved mental health (reduced anxiety and depression).
• Sedentary Behaviour: Often termed "the new smoking" due to its detrimental health effects.

Key Takeaways:

• Cardiovascular disease is a major health concern, but many risk factors are modifiable through lifestyle changes.
• Exercise plays a vital role in preventing and managing CVD, improving cardiovascular fitness, and reducing the risk of heart attack and other complications.
• Physical therapists are integral in providing tailored exercise guidance and support to individuals with or at risk of cardiovascular disease.

# 03 Managing-Your-Health-The-Role-Of-Physical-Therapy-And-Exercise-Module-3-Exercise

Introduction:

This module delves into the connection between exercise and osteoporosis, a condition that weakens bones and increases fracture risk. It emphasizes the importance of targeted exercises and adaptations to daily activities for individuals with osteoporosis.

Main Content:

• Osteoporosis Explained: A condition characterized by decreased bone density and increased fracture risk due to bone loss. Fractures often occur from minor falls (fragility fractures).
• Common Osteoporosis Fracture Sites: Wrists, hips, and vertebrae (often silent, leading to postural changes and increased fall risk).
• Factors Influencing Fracture Risk: Family history, personal fracture history, lifestyle factors, and systemic conditions (cancer, malabsorption disorders, steroid use).
• Goals of Osteoporosis Exercise Management:
  • Fracture Prevention: Improving strength, balance, and mobility to reduce fall risk.
  • Minimizing Bone Loss: Maintaining or slowing down the rate of bone loss.
  • Safe Movement: Promoting safe movement patterns and adapting daily activities to protect bones.
• Too Fit to Fracture Guidelines: Recommendations for adults with and without vertebral fractures, emphasizing multi-component exercise programs that include resistance training, balance re-training, posture correction, and back extensor strengthening.
• Movement Guidelines: Shifting from restrictive advice ("don't bend, don't twist") to promoting mindful movement, encouraging individuals to:
  • Limit: Sustained or repetitive movements.
  • Avoid: Forceful movements, especially with external weight.
  • Control: Rapid movements, particularly at the end range of motion.
• Exercise Recommendations:
  • Strength Training: Twice weekly, targeting major muscle groups (examples: squats, lunges, heel raises, wall push-ups, diagonal raises with bands).
  • Balance Training: Daily, aiming for a total of 20 minutes to improve stability and reduce fall risk.
  • Aerobic Activity: Accumulate in short bouts (10 minutes or less), finding creative ways to combine with balance or strength training.
• Spinal Sparing Techniques:
  • Hip Hinge: Teaching proper bending technique to protect the spine during everyday movements.
  • Step-to-Turn: Modifying turning motions to avoid twisting the spine.
  • Ergonomic Training: Promoting awareness of body mechanics during work and activities to minimize strain on bones and joints.
• Individualized Approach: Adapting exercise and activity recommendations based on fracture risk, specific needs, and preferences.

Key Takeaways:

• Exercise is crucial for managing osteoporosis, reducing fracture risk, and maintaining functional independence.
• Exercise programs should be multi-component, incorporating strength, balance, and aerobic activity.
• It's important to shift from restrictive movement advice to promoting mindful movement and safe exercise techniques.
• Physical therapists play a vital role in assessing individual needs, designing personalized exercise programs, and teaching safe movement strategies for individuals with osteoporosis.

# 04 Managing-Your-Health-The-Role-Of-Physical-Therapy-And-Exercise-Module-4-Exercise

Introduction:

This module explores the multifaceted relationship between exercise and cancer, emphasizing its benefits in cancer prevention, management of treatment side effects, and long-term survivorship.

Main Content:

• Exercise as a Powerful Tool: Exercise offers a range of benefits throughout the cancer journey, from prevention to survivorship.
• Exercise and Cancer Prevention:
  • Hormonal Regulation: Exercise helps regulate hormones like insulin and glucose, which can stimulate tumor growth when present in excess.
  • Reduced Inflammation: Chronic inflammation is linked to cancer development, and exercise helps combat it.
  • Enhanced Immunity: Regular physical activity strengthens the body's immune response, potentially inhibiting cancer cell growth.
  • Weight Management: Maintaining a healthy weight is crucial, as obesity is linked to an increased risk of various cancers.
  • Healthy Bowel Function: Exercise promotes regular bowel movements, potentially reducing the risk of colon cancer.
• Exercise During Cancer Treatment:
  • Managing Chemotherapy Side Effects: Exercise helps combat fatigue, reduce pain, improve bone density, maintain flexibility, and support the immune system.
  • Managing Radiation Side Effects: Exercise can address fatigue, pain, loss of bone density, and range of motion limitations caused by radiation therapy.
  • Post-Surgery Recovery: Exercise is crucial for regaining strength, mobility, and range of motion after surgery, reducing the risk of complications like scar tissue formation.
• Exercise Recommendations from Cancer Care Ontario:
  • Aerobic Exercise: 150 minutes of moderate-intensity exercise per week, spread across at least 3 days.
  • Resistance Training: At least 2 days per week, ideally targeting major muscle groups 2-3 days per week.
  • Warm-Up & Cool-Down: Essential for preparing the body for and recovering from exercise.
• Types of Exercise:
  • Aerobic: Walking, swimming, stationary cycling, jogging.
  • Resistance: Weightlifting, bodyweight exercises (squats, lunges).
  • Mind-Body: Yoga (improves flexibility, breathing, and stress management).
• When to Modify or Avoid Exercise:
  • Bony Metastases (Bone Cancer): Choose low-impact, bodyweight exercises to avoid stressing fragile bones.
  • Weakened Immune System: Be mindful of exercising in public spaces to reduce infection risk.
  • Anemia (Low Red Blood Cell Count): Avoid high-intensity or resistance exercise that could increase bleeding risk.
  • Fatigue: Listen to your body, engage in shorter exercise sessions more frequently, and prioritize rest.
  • Altered Sensation (Neuropathy): Be cautious with weight-bearing activities if you experience numbness or tingling in your hands or feet.
  • Lines or Ports: Adjust exercises to avoid pressure or submersion of these medical devices.
• Understanding Cancer-Related Fatigue: This unique type of fatigue differs from everyday tiredness and is a common side effect of cancer and its treatments. It's characterized by:
  • Persistent Exhaustion: Doesn't improve with rest.
  • Lack of Motivation: Difficulty initiating and completing tasks.
  • Mental & Emotional Impact: Can lead to anxiety, depression, and difficulty concentrating.
• Theories Behind Cancer-Related Fatigue: Anemia (reduced oxygen-carrying capacity), increased energy expenditure at rest, and treatment side effects.
• Exercise for Cancer Survivors:
  • Work Hardening: Gradual and progressive exercise to regain strength and endurance for returning to work.
  • Psycho-social Benefits: Improved mood, reduced anxiety and depression, and a sense of normalcy.
  • Energy Restoration: Combat fatigue and rebuild energy reserves.
• Importance of Professional Guidance: Consult with a qualified healthcare provider, such as a physiotherapist, to develop a safe and effective exercise plan tailored to your specific needs and condition.

Key Takeaways:

• Exercise has a multifaceted and beneficial impact on the cancer journey, from prevention to survivorship.
• Physical activity can help manage treatment side effects, improve quality of life, and aid in recovery.
• Understanding cancer-related fatigue and its impact on daily functioning is essential.
• Working with a qualified healthcare professional is crucial for developing a personalized and safe exercise plan throughout the cancer journey.

# 05 Managing-Your-Health-The-Role-Of-Physical-Therapy-And-Exercise-Module-5-Common

Introduction:

This module focuses on common sports injuries, exploring their causes, prevention strategies, and management techniques, with a particular emphasis on the role of physiotherapists.

Main Content:

• Understanding Sports Injuries:
  • Intrinsic Risk Factors: Factors inherent to the individual (age, gender, body composition, injury history, fitness level, anatomy, skill level).
  • Extrinsic Risk Factors: External factors (type of sport, equipment, environment, opponent's actions).
  • Injury Mechanism: The force exerted on a tissue exceeds its tolerance, leading to either an acute (sudden) or chronic (overuse) injury.
• Common Sports Injury Terminology:
  • Sprain: Ligament injury (connects bone to bone).
  • Strain: Muscle or tendon injury (connects muscle to bone).
  • Fracture: Bone break.
  • Contusion: Bruise.
  • Effusion: Swelling within a joint.
• Common Knee Injuries:
  • ACL (Anterior Cruciate Ligament) Tear:
    • Often occurs during pivoting or sudden changes in direction.
    • Can be treated surgically (reconstruction) or non-surgically (bracing and physiotherapy).
    • Physiotherapy focuses on reducing inflammation, restoring range of motion, strengthening muscles, and improving balance.
  • Patellofemoral Pain Syndrome:
    • Pain around the kneecap, often due to muscle imbalances and overuse.
    • Common in athletes experiencing growth spurts or increased training loads.
    • Physiotherapy aims to correct muscle imbalances, address training errors, and alleviate pain.
• Common Shoulder Injuries:
  • Shoulder Impingement:
    • Pain caused by tendons being compressed in the shoulder joint, often due to muscle imbalances and overuse.
    • Common in overhead athletes (e.g., volleyball, swimming).
    • Physiotherapy focuses on correcting muscle imbalances, improving posture, and modifying activities to reduce impingement.
  • Shoulder Dislocation:
    • The ball of the shoulder joint (humerus) pops out of the socket.
    • Often requires medical attention to relocate the shoulder.
    • Physiotherapy involves regaining range of motion, strengthening rotator cuff muscles, and improving shoulder stability.
  • Shoulder Separation:
    • Injury to the ligaments connecting the collarbone (clavicle) to the shoulder blade (acromion).
    • Often caused by a direct blow to the shoulder.
    • Physiotherapy focuses on pain management, range of motion exercises, and strengthening to regain function.
• Common Elbow Injury:
  • Lateral Epicondylitis (Tennis Elbow):
    • Overuse injury affecting the tendons on the outside of the elbow.
    • Caused by repetitive wrist and hand movements.
    • Treatment includes pain management, stretching, strengthening, bracing, and activity modification.
• Common Ankle Injury:
  • Inversion Ankle Sprain:
    • Occurs when the ankle rolls inward, stretching or tearing ligaments.
    • Severity is graded based on the number of ligaments involved.
    • Physiotherapy involves reducing swelling, restoring range of motion, strengthening muscles, improving balance, and using proprioceptive exercises to regain stability.
• Sport-Related Concussions:
  • Caused by: Direct blows to the head or forces transmitted to the head from impacts elsewhere on the body.
  • Symptoms: Headaches, dizziness, nausea, visual disturbances, memory problems, difficulty concentrating.
  • Management: Rest, gradual return to activity under medical supervision, and cognitive rehabilitation as needed.
  • Assessment Tools: Concussion Recognition Tool (for parents and coaches) and Standardized Concussion Assessment Tool (SCAT5) for healthcare professionals.
• Principles of Sports Injury Treatment (RICE):
  • Compression: Applying pressure to reduce swelling (most important).
  • Relative Rest: Avoiding activities that aggravate the injury while staying active within pain-free limits.
  • Ice: Applying cold therapy to reduce pain and inflammation (most effective in the first 24-48 hours).
  • Elevation: Raising the injured area to reduce swelling.

Key Takeaways:

• Understanding the causes and mechanisms of common sports injuries is crucial for prevention and effective management.
• Early assessment and intervention by a physiotherapist are essential for optimal recovery and return to activity.
• Following the RICE principles can help minimize pain and swelling in the initial stages of an injury.
• It's crucial to gradually increase activity levels and follow a structured rehabilitation plan to prevent re-injury.

# 06 Managing-Your-Health-The-Role-Of-Physical-Therapy-And-Exercise-Module-6-Exercise

Introduction:

This module examines the impact of arthritis on physical activity and highlights the crucial role of exercise in managing this condition. It emphasizes the benefits of exercise, discusses international exercise guidelines, and introduces the GLA:D program.

Main Content:

• Types of Arthritis: Many forms exist, but osteoarthritis (OA) is the most prevalent.
• What is Osteoarthritis?: Characterized by joint damage, including cartilage breakdown, bone remodeling, osteophyte formation, inflammation, and functional limitations.
• Osteoarthritis Explained:
  • Osteo: Bone
  • Arth: Joint
  • -itis: Inflammation
• Joint Anatomy: Understanding the components of a joint (cartilage, joint capsule, synovial membrane, synovial fluid, ligaments) is crucial for comprehending osteoarthritis.
• Commonly Affected Joints: Knees, hips, thumbs, and fingers are frequently impacted by osteoarthritis.
• Osteoarthritis Diagnosis:
  • Physical Exam: Assessing for swelling, deformity, muscle atrophy, tenderness, range of motion limitations, and functional limitations.
  • Radiography (X-rays): Identifying characteristic features like joint space narrowing, sclerosis (bone hardening), bone cysts, and osteophytes (bone spurs).
• Osteoarthritis Symptoms: Pain (often worse with activity), stiffness, swelling, fatigue, and loss of function.
• Benefits of Exercise for Osteoarthritis: Reduces pain, decreases medication reliance, improves physical function, increases muscle strength and coordination, decreases fatigue, and improves stiffness.
• Physiotherapists' Role in Osteoarthritis Management: Provide musculoskeletal assessments, non-pharmacological pain management strategies, individualized exercise programs, education on joint protection, pacing activities, and adapting to work/leisure activities.
• Exercise as Medicine: Like medications, exercise prescriptions should consider type, dose (intensity, duration), and frequency.
• Types of Exercise for Osteoarthritis: Range of motion exercises, flexibility and stretching, strengthening, aquatic therapy (hydrotherapy), and adapted sports.
• Exercise Progression: Start with gravity-eliminated or non-weight-bearing exercises and gradually progress to weight-bearing and more challenging activities as tolerated.
• Factors Influencing Exercise Prescription: Stiffness, pain, inflammation, fatigue, soft tissue/joint involvement, other medical conditions, medications, work/leisure demands, fitness level, and access to facilities.
• International Exercise Recommendations:
  • OARSI (Osteoarthritis Research Society International): Land-based exercise, weight management, strength training, aquatic exercise, self-management education.
  • EULAR (European League Against Rheumatism): Combined strengthening, aerobic, range of motion, and stretching exercises.
  • NHS (National Health Service, UK): Encourages staying active despite pain, emphasizes that exercise won't worsen arthritis, and highlights the importance of a balanced diet.
  • Arthritis Society (Canada): Recommends a mix of flexibility, strengthening, and endurance exercises.
  • ACR (American College of Rheumatology): Provides specific guidelines for hand, knee, and hip osteoarthritis.
• GLA:D Program: A structured exercise program developed in Denmark and now implemented in Canada, focusing on:
  • Neuromuscular Exercise: Improving movement quality, joint control, and postural stability.
  • Evidence-Based Approach: Backed by scientific research demonstrating its effectiveness in managing osteoarthritis.

Key Takeaways:

• Exercise is a cornerstone of osteoarthritis management, offering numerous physical and mental health benefits.
• Exercise prescriptions should be tailored to individual needs, taking into account factors like pain levels, functional limitations, and overall health status.
• Physical therapists are essential for providing safe and effective exercise guidance, adapting activities, and educating individuals on how to best manage their arthritis.
• The GLA:D program is an example of an evidence-based exercise program that can significantly improve function and quality of life for individuals with osteoarthritis.