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A health-focused strategy proposes that the noninvasive interventions of physical therapy, in particular, health education and exercise, need to be maximally exploited in every individual through awareness and knowledge of the leading health care priorities and risk factors and of health behavior change. Health-focused practice is proposed that legitimizes health as a physical therapy priority in which the individual’s overall health and health risk factors are foci of practice. Health behavior reflects one’s lifestyle and mediating influences. Lifestyle modification is the single most powerful strategy a clinician can use to maximize health. Lifestyle practices including smoking, suboptimal nutrition, inactivity, stress, and poor sleep are largely behavioral and are best modified with an understanding of health behavior change psychology and environmental factors, including physical and psycho-social facilitators and barriers. As a basis for implementing health behavior change, leading theories and models of health behavior and health behavior change are reviewed. Self-management with underpinnings in the self-efficacy literature appears to be a powerful strategy for effecting positive behavior change and health outcomes. Health behavior change and the pro-motion of self-management are discussed in the context of culture, which largely defines one’s lifestyle and risk factors (Anand et al, 2000). Finally, the implications of a health-focused model of practice are presented with reference to clinical practice, professional education, and research. The exploitation of physical therapy practices including education and exercise to address our leading health priorities is justified on the basis of their established effectiveness, low risk, and low cost.
Health-focused practice: Rationale
Leading health reports, such as the Romanow Report (2002) and the Report of the Kirby Commission (2002) in Canada, call for greater responsiveness of health care delivery to societal need. In the 20th century, the profession of physical therapy demonstrated its responsive-to health priorities (e.g., the casualties of the world wars and polio epidemics). This trend was evidenced by the amount of journal and conference space and time dedicated to these topics at those times. Over the latter part of the 20th century and into the 21st century, there is an apparent lag in the degree to which vigor the physical therapy profession is prioritizing 21st-century health issues that it is preeminently well suited to address. Among the highest priorities are smoking cessation and reducing obesity, given the cascade of secondary pathologies associated with these (Mokdad, Marks, Stroup, and Gerberding, 2004; Zalesin et al, 2008) and their substantial social and economic burdens. Furthermore, physical therapists through exploitation of health education and exercise can reverse hypertension and diabetes or sub-stantially mitigate them and their dire con-sequences; see review (Dean, 2006)
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