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Lifestyle modification interventions based on education, including advice and recommendations for smoking cessation, basic optimal nutrition, weight control, regular physical activity and exercise, stress management, and sleep hygiene may be common to a number of conditions for which the patient is at risk. The effect size of the change required for general health benefit or risk factor reduction, however, varies for different conditions. The lower the risk category achieved, the better.
Most clients or patients are likely to benefit from a general health program; the specific parameters being based on the assessments of health, health behaviors, risk factors, and any manifestations of lifestyle conditions. The physical therapist has expertise in viewing the individual’s health holistically in addition to addressing individual impairments. Based on sound clinical reasoning, the physical therapist can prioritize the individual’s concerns to help reduce the most serious of the risks in a sequential or concurrent manner, depending on the person’s individual presentation and needs, or reverse or mitigate manifestations of lifestyle conditions. In addition, the client or patient may have come to the physical therapist with a problem not directly related to one of the primary lifestyle conditions (e.g., low back pain). Thus, risk factor modification and reduction needs to be instituted concurrently with management for the presenting problem, in this case an orthopedic complaint. Risk of lifestyle conditions related to obesity, for example, necessitates a nutritional plan coupled with increased regular physical activity and structured exercise program. Although the physical therapist may prescribe treatment directed at symptomatic relief of the low back pain, this problem may be influenced or eliminated by weight reduction (Bener, Alwash, Gaber, and Lovasz, 2003; Deyo, 1991; Liuke et al, 2005).
Furthermore, the problem may be remediated long term if the causes or contributing factors (e.g., obesity and sedentary lifestyle) are addressed before irreversible injury, refractory to management, ensues or surgery is indicated. Similarly, two thirds of patients requiring knee and joint replacements are overweight. Reducing obesity may avert the need for joint replacement, reduce complications, improve postsurgical outcome, and reduce need of repeat surgery.
The patient or client is actively involved with reviewing the results of the health assessment with the physical therapist and establishing a health plan for the short and long term that the person actively supports and to which he or she is committed. Health behavior change is a complex activity involving multiple factors including psychosocial and economic ones. These factors need to be identified and addressed to maximize the outcome of a health behavior change program. In cases in which multiple risk factors are present and multiple health behavior change indicated, decisions need to be made about what interventions are needed and whether these are staged, concurrent, or sequential. Health behavior change theory and strategies are described in detail with special reference to sustained physical activity and exercise in the article by Rhodes and Fiala in this issue.
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