World Physical Therapy Day

Resources on physical activity and non-communicable diseases

Contents
Introduction ............................................................................................................................... 2 About physical therapy ............................................................................................................... 3 Facts and figures about physical therapists .................................................................................. 4 About physical therapy and non-communicable diseases .......................................................... 5 About physical activity and child obesity .................................................................................... 6 About physical activity and cardiovascular disease ....................................................................... 9 About physical activity and diabetes ......................................................................................... 11 About physical activity and active ageing .................................................................................... 13 About physical activity and cancer ............................................................................................ 16 Journal articles about physical therapy ...................................................................................... 18

Notes about this booklet

The terms physical therapy and physiotherapy refer to the same profession some countries use one term, some the other. When the words physical therapy and physical therapist are used in this document, they also refer to physiotherapy and physiotherapist. The information in this booklet may be reproduced without charge. It is designed as a resource, and does not necessarily represent an official WCPT view or policy.

World Confederation for Physical Therapy | 1

Introduction
This booklet provides facts, research findings, statistics and articles to help you demonstrate the contribution of physical therapists, as part of your World Physical Therapy Day events and campaigns. World Physical Therapy Day falls on 8th September every year. It is an opportunity for physical therapists (known in some countries as physiotherapists) all over the world to raise awareness about the crucial role their profession plays in making and keeping people well, mobile and independent. The day was established in 1996, by the World Confederation for Physical Therapy the professions global body representing over 350,000 physical therapists in 106 countries. WCPT has compiled this information for you to use freely. If youre not sure what to organise for World Physical Therapy Day yet, there are plenty of suggestions in the complementary booklet World Physical Therapy Day: what to do, how to do it, how to get noticed.

2 | World Confederation for Physical Therapy

About physical therapy

Here is some basic information about physical therapy for you to copy and use in any material you produce to educate the public. If you refer to physiotherapists rather than physical therapists in your country, do change the text appropriately. and limitations in movement and function use many treatment approaches to help individuals regain their mobility and maximise their potential promote healthy lifestyles and exercise treat each patient/client as an individual and thoroughly assess them to identify their needs treat sports injuries promote safe and healthy activities work with children with coordination, balance and other movement problems to improve and maximise their independence. To achieve all this, physical therapists are educated over several years, giving them a full knowledge of the bodys systems and the skills to treat a wide range of problems. This education is usually university-based and at a level that provides full professional recognition and allows them to practise independently. Continuing education ensures that they keep up to date with the latest advances in research and practice. Many physical therapists are engaged in research themselves.

Physical therapists are experts in developing and maintaining peoples ability to move and function throughout their lives. With an advanced understanding of how the body moves and what keeps it from moving well, they promote wellness, mobility and independence. They treat and prevent many problems caused by pain, illness, impairments and disease, sport and work related injuries, ageing and long periods of inactivity. Physical therapists work with people affected by a wide range of conditions and symptoms, for example: painful conditions such as arthritis, repetitive strain injury, neck and back pain cancer strokes, Parkinsons disease and spinal cord injury heart problems lung disease trauma, such as road traffic accidents and landmines incontinence They work in a variety of settings, including hospitals, health centres, sports facilities, education and research centres, hospices and nursing homes, rural and community settings. Here are some examples of how physical therapists make a difference. They: use their skills to treat the underlying causes of pain

World Confederation for Physical Therapy | 3

Facts and figures about physical therapists

Physical therapists work with people of all ages to bring about improvements in their health and independence. Physical therapists provide exercise prescriptions to help people keep fit and achieve/maintain a healthy weight. Around 350 million people are obese worldwide. Physical activity is one of the best means of countering obesity. Children and young people under the age of 18 need 60 minutes of moderate to vigorous physical activity each day to promote and maintain health. Adults need 30 minutes of moderate physical activity five days a week, or 20 minutes of vigorous physical activity three days a week to maintain health. Plus they need to do muscle strengthening exercises at least twice a week. Research has shown that physical therapy exercise prescriptions help women who experience incontinence, osteoporosis or breast cancer surgery. Studies have indicated that physical therapy treatments have a major impact on conditions such as back and neck pain. Physical activity provided under the guidance and supervision of a physical therapist reduces the risk of heart attack, stroke, type 2 diabetes, colon cancer and breast cancer. Despite limited numbers of physical therapists in some countries around the world, they have proved their effectiveness at getting and keeping people healthy. Physical therapists provide exercise programmes for conditions that affect the bones and muscles, such as arthritis, back and neck pain, osteoporosis, joint replacements, and urinary incontinence. More detailed information about what physical therapists do can be found in WCPTs Description of Physical Therapy at www.wcpt.org/policy/psdescriptionPT.

4 | World Confederation for Physical Therapy

About physical therapy and non-communicable diseases

This is an article by WCPTs President, Marilyn Moffat, explaining how physical therapists are at the heart of the global battle against non-communicable diseases like stroke, heart disease, chronic respiratory disease, diabetes and cancer. It can be published in newsletters, magazines and journals, or passed to other publications as background information. If you are making any changes they should be checked with the WCPT Secretariat info@wcpt.org. that physical inactivity is one of the leading risk factors for global mortality, causing 3.2 million deaths annually, and that physical activity can reduce noncommunicable diseases, it is clear that the profession has a major part to play. Many people do not recognise the contribution physical therapists make in keeping people healthy and independent. On World Physical Therapy Day on 8th September, physical therapists have the opportunity to draw attention to their all important roles. I conduct workshops around the world, demonstrating how adults with chronic health problems can improve their health by learning how to exercise safely under the guidance and instruction of physical therapists. Activity has to be introduced carefully if a person is overweight, unfit, older, or has a chronic disease. Physical therapists do this by examining the person, recommending exercises that are safe and appropriate for them, and educating them about how to look for signs of trouble. Physical therapy doesnt just mean more healthy people, but more productive people who can contribute to countries economies. Physical therapists services are provided in an atmosphere of trust and respect for human dignity and underpinned by sound clinical reasoning and scientific evidence. These are important messages that physical therapists want to convey to the world every day, but especially on World Physical Therapy Day. The message is clear: physical therapists are movement, physical activity, and exercise experts and a resource in the battle against non-communicable disease that should never be overlooked.

In 2011 a high level meeting of world leaders at the United Nations recognised that non-communicable diseases (cardiovascular diseases, chronic respiratory diseases, diabetes and cancer) are an increasing global health challenge. They claim 35 million lives a year around 60 per cent of deaths. For physical therapists, the official recognition that a global strategy is required to reduce this burden of disability and deaths is significant. Physical therapists help millions of people every year prevent these conditions and their risk factors most importantly obesity. They also manage their effects, along with the effects of aging, illness, accidents, and the stresses and strains of life. Physical therapists specialise in human movement and physical activity, promoting health, fitness, and wellness. They identify physical impairments, activity limitations, and disabilities that prevent people from being as active and independent as they might be, and then they find ways of overcoming them. They maximise peoples movement potential. So when the World Health Organization points out

Marilyn Moffat, WCPT President

World Confederation for Physical Therapy | 5

About physical activity and child obesity

According to the World Health Organization, childhood obesity is one of the most serious public health challenges of the 21st century
Source: www.who.int/dietphysicalactivity/en/

influenced by their surrounding environment.

Source: WHO www.who.int/features/factfiles/obesity/en/

Children who are obese have a high incidence of musculoskeletal impairments.

Source: http://onlinelibrary.wiley.com/doi/10.1111/j.14401754.2011.02102.x/abstract

Obesity in childhood is linked with asthma, musculoskeletal problems, hypertension, early signs of cardiovascular disease, low self-esteem and depression. In the long-term, it can increase the likelihood of being an obese adult, and having a greater risk of cancer, type 2 diabetes and cardiovascular disease. Encouraging children and their families to reach recommended levels of physical activity is a cornerstone of obesity treatment and prevention. Participation in physical activity helps prevent many chronic diseases. All physical therapists are experts in movement and exercise, and the ways in which it promotes health. Some physical therapists, called paediatric physical therapists, specialise in working with children. A physical therapy assessment is particularly important for children who are obese. The assessment can screen for musculoskeletal impairments and guide therapeutic exercise and physical activity prescription. Childhood obesity facts Globally, over 40 million preschool children were overweight in 2008. More than 75% of overweight and obese children live in low-and middle-income countries.
Source: WHO www.who.int/features/factfiles/obesity/en/

Rising levels of childhood obesity are being caused mainly by a shift towards energy-dense foods high in fat and sugars, and decreasing levels of physical activity.
Source: WHO www.who.int/dietphysicalactivity/childhood/en/

Defining child obesity The World Health Organization defines childhood obesity as having a body mass index (BMI) standardised deviation score (SDS) above 2.0. Childhood growth and BMI should be plotted on WHO age and gender specific charts in tandem with national growth reference charts. Measures of body composition such as waist circumference should be used to describe obesity.
Source: WHO www.who.int/growthref/who2007_bmi_for_age/en/ index.html

Child obesity and physical activity The World Health Organization recommends 60 minutes of moderate to vigorous intensity physical activity every day for children aged 5-18. Moderate activity includes activities that raise the heart rate and cause some breathlessness. Vigorous activity is exercise that makes people huff and puff and could include dancing, household chores and sports like running and football. Activities for children should be fun and age-appropriate. In addition, families should be active together because parents are the most important agents of lifestyle change.
Source: WHO www.who.int/dietphysicalactivity/childhood_what_can_ be_done/en/index.html

Childhood obesity affects people regardless of their income. The problem is global and is steadily affecting many low-and middle-income countries, particularly in urban settings.
Source: WHO www.who.int/mediacentre/factsheets/fs311/en/

Childrens choices, diet and physical activity habits are

6 | World Confederation for Physical Therapy

Physical activity recommendations Children from birth to age five should engage in daily physical activity that promotes skill in movement and lays the foundations of health-related fitness.
Source: National Association for Sport and Physical Education guidelines on physical activity for children www.aahperd.org/naspe/ standards/nationalGuidelines/ActiveStart.cfm

hours.
Source: National Association for Sport and Physical Education guidelines on physical activity for children www.aahperd.org/naspe/ standards/nationalGuidelines/PA-Children-5-12.cfm

The role of the physical therapist In cases of childhood obesity, a physical therapy assessment covers: 1) parental beliefs around healthy childhood growth and development; 2) cardiorespiratory (exercise testing); 3) musculoskeletal (including assessment of range of movement; strength; flexibility; balance; coordination; posture; gait and bony alignment); 4) sedentarism (eg screen-time); 5) sleep; 6) physical activity levels and perceived barriers to reaching recommended levels. Treatment includes: 1) general health literacy education for child and parent 2) management of any associated conditions (eg painful flat fee, knee pain, weak core) identified in physical assessment; 3) age-appropriate and fun exercise training to increase physical fitness; 4) assisting parent/s to make changes at home to prevent obesity developing or progressing; 5) providing education and practical strategies to improve sleep and energy balance; 6) liaison and onward referral within the interdisciplinary team. Positive communication between the therapist and family is essential. Many parents may not be aware that their childs weight is a problem. Ensuring that a holistic assessment is used to identify areas where the child may have functional difficulties (eg balance or low cardiorespiratory fitness) may help the therapist discuss the childs health without solely focusing on shape or size. In order to facilitate a childs lifestyle change, it is recommended that the full family works towards this.
Source: Jlusson PB, et al., Overweight and obesity in Norwegian

Infants should interact with caregivers in daily physical activities that are dedicated to exploring movement and the environment and that promote skill development in movement.
Source: National Association for Sport and Physical Education guidelines on physical activity for children www.aahperd.org/naspe/ standards/nationalGuidelines/ActiveStart.cfm

Toddlers should engage in a total of at least 30 minutes of structured physical activity and at least 60 minutes per day of unstructured physical activity and should not be sedentary for more than 60 minutes at a time, except when sleeping.
Source: www.aahperd.org/naspe/standards/nationalGuidelines/ ActiveStart.cfm

Children under five should be physically active daily for at least 180 minutes spread throughout the day.
Source: WHO recommendations 2010 in WCPT Active and Healthy. The role of the physiotherapist in physical activity. General Meeting of European Region of the WCPT 2012. Pages 13-14.

Children should accumulate at least 60 minutes, and up to several hours, of age-appropriate physical activity on all or most days of the week. This should include moderate and vigorous physical activity with most of the time being spent on activities where exercise is intermittent. Children should participate in several bouts of physical activity lasting 15 minutes or more each day. Periods of inactivity of two or more hours are discouraged for children, especially during the daytime

World Confederation for Physical Therapy | 7

children: prevalence and socio-demographic risk factors. Acta Paediatr. 2010 Jun;99(6):900-5. www.ncbi.nlm.nih.gov/ pubmed/20175763 OMalley et al., A Pilot study to profiles the lower limb musculoskeletal health in obese children. Pediatric Physical Therapy (in press). www. mendeley.com/research/tracking-overweight-early-childhoodadolescence-cohorts-born-1988-1994-overweight-high-birth-weightpopulation

A review of evidence on the effect of physical activity on the development of pre-school children concluded that the availability of outside playing areas, and the encouragement and involvement of adults, were important in encouraging exercise.
Source: Timmons BW et al. Physical activity for preschool children how much and how? Can J Public Health. 2007; 98 Suppl 2:S122-34. www.ncbi.nlm.nih.gov/pubmed/18213943

Children with illness or disabilities are more restricted in exercise participation, and have higher levels of obesity than their peers. Finding structures that support them to participate brings psychological and social, as well as physical, advantages. Professionals such as physical therapists are well placed to ensure that activities are appropriate.
Source: Murphy NA et al. Promoting the participation of children with disabilities in sports, recreation, and physical activities. Pediatrics. 2008; 121(5):1057-61 http://aappolicy.aappublications.org/cgi/ content/full/pediatrics;121/5/1057

This information was produced with the kind assistance of the International Organisation of Physical Therapists in Paediatrics.

8 | World Confederation for Physical Therapy

About physical activity and cardiovascular disease

Cardiovascular disease is the term used to describe diseases affecting the heart and circulatory system, and includes heart disease, stroke and raised blood pressure (hypertension). Exercise, particularly aerobic conditioning and strength training, is one of the key interventions that can prevent death and disability from cardiovascular disease. Physical therapists are experts in prescribing these as part of a structured, safe and effective programme. For those already affected by cardiovascular disease, the expert advice provided by physical therapists can help bring a return to usual roles. Physical therapists help people achieve a return to work, education, community participation and fulfilled lives. Cardiovascular general Cardiovascular disease is now the leading cause of deaths worldwide. Globally, 17.3 million people died from cardiovascular disease in 2008, 30% of all deaths. 7.3 million were due to coronary heart disease and 6.2 million due to stroke. It is estimated that by 2030, almost 23.6 million people will die from cardiovascular diseases, mainly heart disease and stroke.
Source: World Health Organization www.who.int/mediacentre/ factsheets/fs317/en/ Manson JE et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. NEJM. 1999;341(9):650-658. content.nejm.org/cgi/content/ abstract/347/10/716 Tully M et al. Brisk walking, fitness, and cardiovascular risk: a randomized controlled trial in primary care. Prevent Med. 2005;41:622628. www.ncbi.nlm.nih.gov/pubmed/15917061

Research involving people at risk of cardiovascular disease has indicated that exercise supervised by physical therapists, along with counselling from a dietician, brings significant improvements in blood pressure, weight, quality of life and other health indicators after one year.
Source: Eriksson KM, Westborg CJ, Eliasson MC. A randomized trial of lifestyle intervention in primary healthcare for the modification of cardiovascular risk factors. Scand J Public Health. 2006;34(5):453-61. www.ncbi.nlm.nih.gov/pubmed/16990155

Raised blood pressure Raised blood pressure, which is a risk factor for heart attack and stroke, can be controlled by exercise. One study has indicated that endurance exercise brings an average reduction of 10mm Hg for both systolic and diastolic blood pressure readings.
Source: American College of Sports Medicines Guidelines for Exercise Testing and Prescription. 6th Ed. Baltimore MD: Lippincott Williams & Wilkins 2000. www.exrx.net/Store/Other/ACSMGuidelinesExTestingRx. html

The death and disability rates caused by heart disease and stroke for every country are available at: http:// whqlibdoc.who.int/publications/2011/9789241564373_ eng.pdf It has been estimated that if everyone walked briskly at 4.8-6.4 kph (3-4 mph) on most days of the week, about 30% of deaths from cardiovascular disease would be prevented each year.
Sources: Pate R et al. Physical activity and public health. JAMA. 1995;273(5):402-407. www.ncbi.nlm.nih.gov/pubmed/7823386 Wei M, Kampert et al. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA. 1999;282(16):1547-1553. www.ncbi.nlm.nih.gov/ pubmed/10546694

The type of strength training prescribed by physical therapists can effectively reduce blood pressure in older men and women.
Source: Martel GF et al. Strength training normalizes resting blood pressure in 65- to 73-year- old men and women with high normal blood pressure. J Am Geriatr Soc. 1999 Oct;47(10):1215-21. www.ncbi. nlm.nih.gov/pubmed/10522955

Major analyses of available research have indicated that exercise can reduce resting blood pressure by 3mm Hg for resting systolic blood pressure.
Sources: Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension 2005 Oct; 46(4):667-75. www. ncbi.nlm.nih.gov/pubmed/16157788 World Confederation for Physical Therapy | 9

Kelley GA, Kelley KS. Progressive resistance exercise and resting blood pressure: a meta- analysis of randomized controlled trials. Hypertension. 2000 Mar; 35(3):838-43. www.ncbi.nlm.nih.gov/ pubmed/10720604

failure and chronic obstructive pulmonary disease.

Source: Taylor, NF et al. Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 20022005. Australian Journal of Physiotherapy. 2007, Vol 53(1): 7-15. www.ncbi.nlm.nih.gov/ pubmed/17326734

This type of blood pressure reduction has been associated with a 5-9% reduction in heart morbidity, and a 8% to 14% reduction in the risk of stroke.
Source: Whelton et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. 2002 Oct 16;288(15):1882- 8. www.ncbi. nlm.nih.gov/pubmed/12377087

Reviews of evidence have shown that exercise-based cardiac rehabilitation for patients with coronary heart disease significantly improves health outcomes and mortality rates.
Sources: Clark et al. Meta-analysis: secondary prevention programs for patients with coronary artery disease. Ann Intern Med. 2005; 143:659672. www.annals.org/cgi/content/abstract/143/9/659 Taylor RS et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004; 116:682 692. www.ncbi.nlm.nih. gov/pubmed/15121495

Stroke Exercise reduces the risk of stroke. Walking at 4.8 kph (3 mph) for 5 hrs/wk brings a 46% lower risk of stroke, compared with non-exercisers.
Sources: Hu F et al. Physical activity and risk of stroke in women. JAMA. 2000; 283(22):2961- 2967. www.ncbi.nlm.nih.gov/pubmed/10865274 Lee I et al. Exercise and risk of stroke in male physicians. Stroke. 1999;30(1):1-6. www.ncbi.nlm.nih.gov/pubmed/9880379

A review of evidence has indicated that exercise training in people who have had heart failure is safe and effective.
Source: Smart N, Marwick TH. Exercise training for heart failure patients: a systematic review of factors that improve patient mortality and morbidity. Am J Med. 2004; 116: 693-706 www.ncbi.nlm.nih.gov/ pubmed/15121496

Structured exercise also brings improvement in all measures of impairment and disability in people who have had a stroke.
Source: Teixeira-Salmela et al. Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. Arch Phys Med Rehabil. 1999 Oct; 80(10):1211-8. www.ncbi. nlm.nih.gov/pubmed/10527076

In one study, patients who had had a stroke performed strengthening and functional tasks three times a week for four weeks, and gained significant improvements in strength, walking speed, standing/sitting and endurance.
Source: Dean CM et al. Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Arch Phys Med Rehabil. 2000 Apr;81(4):409-17. www.ncbi.nlm.nih.gov/pubmed/10768528

Telehealth interventions can help reduce cardiovascular disease risk and help increase uptake of a prevention programmes by those who do not access cardiac rehabilitation.
Source: Neubeck L et al. Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review. European Journal of Cardiovascular Prevention and Rehabilitation. 2009; Vol 16(3): 281-9 www.ncbi.nlm.nih.gov/pubmed/19407659

This information was produced with the kind assistance of Julie Redfern.

Heart disease Systematic reviews of evidence have shown that therapeutic exercise provided by physical therapists is beneficial to people with coronary heart disease, heart
10 | World Confederation for Physical Therapy

About physical activity and diabetes

Diabetes mellitus is a condition where the amount of glucose in the blood is too high, causing tissue damage. There are two types. Type 1 diabetes occurs when the body is unable to produce any insulin. It cannot be prevented. Type 2 diabetes develops when the body isnt producing enough insulin, or becomes resistant to insulin. This type of diabetes can be prevented. Most cases of type 2 diabetes are associated with being overweight. Exercise is one of the best ways to control or reduce weight, and reduce risk of type 2 diabetes. Physical therapists are experts in prescribing structured, safe and effective exercise programmes. Their advice can also help people who have health complications as a result of diabetes. For example, they can help those who have lost limbs through diabetesrelated amputations recover their mobility and adapt their environment so that they have independence. Physical therapists help people achieve a return to work, education, community participation and fulfilled lives. Diabetes facts The World Health Organization (WHO) estimates that 346 million people worldwide have diabetes. This number is expected to double by 2030.
Source: World Health Organization factsheet www.who.int/ mediacentre/factsheets/fs312/en/

Diabetes and its complications have a significant economic impact on individuals, families, health systems and countries. For example, WHO estimates that in the period 2006-2015, China will lose $558 billion in national income due to heart disease, stroke and diabetes alone.
Source: World Health Organization factsheet www.who.int/ mediacentre/factsheets/fs312/en/

The death and disability rates caused by diabetes for every country are available at: www.who.int/entity/ cardiovascular_diseases/en/cvd_atlas_29_world_data_ table.pdf Exercise and diabetes Exercise has a role in preventing and controlling diabetes. According to the World Health Organization, 30 minutes of moderate intensity physical activity on most days, along with a healthy diet, can help reduce the risk of developing type 2 diabetes. Source: World Health
Organization www.who.int/mediacentre/factsheets/fs312/en/

Both resistance exercise and aerobic exercise are effective at reducing glucose intolerance and reducing the risk of diabetes.
Sources: Fenicchia LM et al. Influence of resistance exercise training on glucose control in women with type 2 diabetes Metabolism. 2004 Mar;53(3):284-9. www.ncbi.nlm.nih.gov/pubmed/15015138 Castaneda C et al. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care. 2002 Dec; 25(12):2335-41. www.ncbi.nlm.nih. gov/pubmed/12453982

Diabetes was traditionally more common in developed countries, but modernisation and lifestyle changes have meant it is increasingly prevalent in developing countries. According to WHO, almost 80% of diabetes deaths occur in low and middle-income countries.
Source: World Health Organization factsheet www.who.int/ mediacentre/factsheets/fs312/en/

High-intensity progressive resistance training, in combination with moderate weight loss, is effective in controlling blood glucose levels in older patients with type 2 diabetes. Source: Dunstan DW et al. High-intensity resistance training improves
glycemic control in older patients with type 2 diabetes. Diabetes Care. 2002 Oct;25(10):1729-36. www.ncbi.nlm.nih.gov/pubmed/12351469

World Confederation for Physical Therapy | 11

Moderate aerobic exercise alone or with resistance training improves glycemic control, waist circumference, and protects heart in individuals with type 2 diabetes.
Source: Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis. Diabetes Care. 2011 May;34(5):1228-37. www.ncbi.nlm.nih.gov/pubmed/21525503

Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. NEJM. 2002;346(6):393403. www.ncbi.nlm.nih.gov/ pubmed/11832527

Regular, moderate exercise lowers risk of developing diabetes in those who are overweight and with prediabetes.
Sources: Evans WJ. Effects of exercise on body composition and functional capacity of the elderly. J Gerontol A Biol Sci Med Sci. 1995;50 Spec No:147-50. www.ncbi.nlm.nih.gov/pubmed/7493209 Christakos CN, Fields KB. Exercise in diabetes: minimize the risks and gain the benefits. J Musculoskeletal Med. 1995;12:1625.

A 16 week high-intensity exercise programme results in decreased diabetic medication regimes, lowered systolic blood pressure, decreased abdominal adipose tissue, and increases in strength, physical activity, and lean muscle mass.
Source: Castaneda C, Layne JE, Munoz-Orians L, et al. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care. 2002;25(12):2335-41. www.ncbi.nlm.nih.gov/pubmed/12453982

Prevalence of diabetes by WHO Region 2000 Africa Eastern Mediterranean The Americas Europe South-East Asia 7,020,000 15,188,000 33,016,000 33,332,000 46,903,000 2030 (predicted) 18,234,000 42,600,000 66,812,000 47,973,000 119,541,000

12 | World Confederation for Physical Therapy

About physical activity and active ageing

Physical therapists are exercise experts, providing services to optimise physical ability in a wide range of people. They prescribe exercise as part of a structured, safe, and effective programme. An important part of their role is to help people remain active as they age. More than any other profession, physical therapists prevent and treat chronic disease and disability in aging adults through prescribed activity and movement. The World Health Organization encourages regular physical activity for older adults, because it has been shown to improve their independence and quality of life (www.who.int/dietphysicalactivity/factsheet_ olderadults/en/). It says that older adults should engage in at least 30 minutes of moderate-intensity physical activity five days a week, if appropriate (www.who.int/ ageing/active_ageing/en/index.html). Here is some information demonstrating the contribution of physical therapists in keeping people active as they age particularly their role in maintaining general health, preventing and treating cardiovascular disease, and countering joint problems. Improving functional ability Older adults engaged in regular physical activity demonstrate improved balance, strength, coordination, motor control, flexibility and endurance. As a result, physical activity can reduce the risk of falls a major cause of disability among older people.
Source: World Health Organization, Physical activity and older adults www.who.int/dietphysicalactivity/factsheet_olderadults/en/

Exercise programmes can slow down functional decline. Elderly adults can, with an appropriate exercise programme, be helped to achieve levels of activity that will bring health benefits, and slow the decline in function that might normally be expected with age.
Source: Landin RJ, Linnemeier TJ, et al. Exercise testing and training of the elderly patient. Cardiovasc Clin. 1985; 15(2): 201-18. www.ncbi. nlm.nih.gov/pubmed/3912049

Even for those in their 80s and 90s, exercise programmes can increase functional ability, postpone disability and maintain independent living.
Sources: Spirduso WW Cronin DL. Exercise dose-response effects on quality of life and independent living in older adults. Med Sci Sports Exerc. 2001;33(6 Suppl):S598-608. www.ncbi.nlm.nih.gov/ pubmed/11427784 Hruda KV, Hicks AL, et al. Training for muscle power in older adults: effects on functional abilities. Can J Appl Physiol. 2003;28(2):178-89. www.ncbi.nlm.nih.gov/pubmed/12825328

Physical activity and exercise are inversely associated with mortality and age-related morbidity.
Sources: Kushi LH, Fee RM, et al. Physical activity and mortality in postmenopausal women. JAMA. 1997 Apr 23-30; 277(16): 1287-92. www.ncbi.nlm.nih.gov/pubmed/9109466 Nied RJ, Franklin B. Promoting and prescribing exercise for the elderly. Am Fam Physician. 2002 Feb 1;65(3):419-26. www.ncbi.nlm.nih.gov/ pubmed/11858624 Gregg EW, Cauley JA, et al. Relationship of changes in physical activity and mortality among older women. JAMA. 2003 May 14; 289(18):237986. www.ncbi.nlm.nih.gov/pubmed/12746361

Promoting cardiovascular health Regular exercise in older adults has many positive effects on cardiovascular health, including increasing cardiac output, maximum heart rate, endurance, and arterial blood flow, and decreasing heart rate, blood pressure, and risk of heart disease.
Source: Vincent KR, Braith RW et al. Resistance exercise and physical performance in adults aged 60 to 83. J Am Geriatr Soc. 2002 Jun; 50(6):1100-7. www.ncbi.nlm.nih.gov/pubmed/12110072

Participation in regular exercise programmes leads to older adults having higher levels of function, greater independence, and improved quality of life.
Source: Ellingson T, Conn VS. Exercise and quality of life in elderly individuals. J Gerontol Nurs. 2000 Mar;26(3):17-25. www.ncbi.nlm.nih. gov/pubmed/11111627

World Confederation for Physical Therapy | 13

One study found that after eight months of regular training, a group of 85-year-olds had increased walking speed and increased maximal oxygen uptake and decreased blood pressure. This resulted in reduced health risk and improved independence.
Source: Puggaard L, Larsen JB, et al. Maximal oxygen uptake, muscle strength and walking speed in 85-year-old women: effects of increased physical activity. Aging (Milano). 2000 Jun;12(3):180-9. www. ncbi.nlm.nih.gov/pubmed/10965376

Exercise decreases depression and anxiety in people with osteoarthritis.

Source: Minor MA, Hewett JE et al. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum. 1989 Nov; 32(11):1396-405. www.ncbi.nlm.nih.gov/ pubmed/2818656.

Land-based therapeutic exercise programmes have been shown to reduce pain and improve physical function in people with osteoarthritis of the knee.
Source: Fransen M, McConnell S. Therapeutic exercise for people with osteoarthritis of the hip or knee. A systematic review. J Rheumatol. 2002 Aug; 29(8):1737-45. www.ncbi.nlm.nih.gov/pubmed/12180738

Walking 10,000 steps is effective in lowering blood pressure and increasing exercise capacity in individuals with hypertension.
Source: Iwane M, Arita M, Tomimoto S, et al. Walking 10,000 steps/ day or more reduces blood pressure and sympathetic activity in mild essential hypertension. Hyperten Res. 2000;23:573-580. www.ncbi. nlm.nih.gov/pubmed/11131268

Improving joint health Tai Chi exercise brings improved balanced and physical functioning to people with osteoarthritis.
Source: Song R, Lee EO et al. Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. J Rheumatol. 2003 Sep; 30 (9): 2039-44. www.ncbi.nlm.nih.gov/ pubmed/12966613

For people with osteoarthritis of the knee, both high intensity and low intensity aerobic exercise (stationary cycling) are equally effective at improving functional status, gait, pain, and aerobic capacity.
Source: Brosseau L, MacLeay L, et al. Intensity of exercise for the treatment of osteoarthritis. Cochrane Database Syst Rev. 2003;(2): CD004259. www.ncbi.nlm.nih.gov/pubmed/12804510

Research indicates that regular exercise by people with arthritis decreases the likelihood of developing disability by 10% and protects against functional decline.
Source: Feinglass J, Thompson JA et al. Effect of physical activity on functional status among older middle-age adults with arthritis. Arthritis Rheum. 2005 Dec 15; 53(6): 879-85. www.ncbi.nlm.nih.gov/ pubmed/16342096

Research indicates that exercise decreases pain, increases function, increases balance, and increases ability to exercise in people with osteoarthritis and rheumatoid arthritis.
Sources: Minor MA, Hewett JE et al. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum. 1989 Nov; 32(11): 1396-405. www.ncbi.nlm.nih.gov/ pubmed/2818656 OReilly SC, Muir KR et al. Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial. Ann Rheum Dis. 1999 Jan; 58(1): 15-9. www.ncbi.nlm.nih.gov/ pmc/articles/PMC1752761/

Research provides strong evidence that for individuals with rheumatoid arthritis exercise from low to high intensity is effective in improving disease-related characteristics, reducing cardiovascular disease, and increasing functional ability
Source: Metsios GS, Stavropoulos-Kalinoglou A, et al. Association of physical inactivity with increased cardiovascular risk in patients with rheumatoid arthritis. Eur J Cardiovasc Prev Rehabil. 2009;16:18894. www.ncbi.nlm.nih.gov/pubmed/19238083

14 | World Confederation for Physical Therapy

Improving mental health Cardiovascular fitness is associated with increases in brain volume, in both gray and white matter and thus sparing of brain tissue in aging humans.
Source: Colcombe SJ, Erickson KI, Scalf PE, et al. Aerobic exercise training increases brain volume in aging humans. J Gerontol A BiolSci Med Sci. 2006;61(11):1166-1170. www.ncbi.nlm.nih.gov/ pubmed/17167157

A regular programme of aerobic exercise can slow or reverse functional deterioration, reducing the individuals biological age by 10 or more years, and potentially prolonging independence.
Source: Shephard RJ. Maximal oxygen intake and independence in old age. Br J Sports Med. 2009 May;43(5):342-6. Epub 2008 Apr 10. http:// bjsm.bmj.com/content/early/2008/04/10/bjsm.2007.044800.short

Physical activity has been shown to improve mental health and cognitive function in older adults and contributes to the management of disorders, such as depression and anxiety. Active lifestyles often provide older persons with regular occasions to make new friendships, maintain social networks, and interact with other people of all ages.
Source: World Health Organisation, Physical activity and older adults www.who.int/dietphysicalactivity/factsheet_olderadults/en/

This information was produced with the kind assistance of Marilyn Moffat, Professor of Physical Therapy at New York University and President of WCPT.

Research has indicated that increased levels of physical activity reduces the risk of Alzheimers disease. Exercise, along with cognitively stimulating activities, can reduce some of the symptoms of the disease.
Sources: Penrose FK. Can exercise affect cognitive functioning in Alzheimers disease? A review of the literature. Activities, Adaptation & Aging 2005:29(4): 15-40. www.tandfonline.com/doi/abs/10.1300/ J016v29n04_02 Christofoletti G, Oliani MM et al. A controlled clinical trial on the effects of motor intervention on balance and cognition in institutionalized elderly patients with dementia. Clin Rehabil. 2008 Jul:22(7):618-26. http://cre.sagepub.com/content/22/7/618.abstract

Aerobic exercises significantly reduced depressive symptoms in people over 60.

Source: Penninx BW, Rejeski WJ et al. Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. J Gerontol B Psychol Sci Soc Sci. 2002 Mar;57(2):P124-32. www.ncbi.nlm.nih.gov/pubmed/11867660

World Confederation for Physical Therapy | 15

About physical activity and cancer

Cancer is an umbrella term used to describe more than 100 different diseases with the common characteristic of uncontrolled malignant cell growth. It is a leading and growing cause of death worldwide, with the total number of cases globally increasing, as the world population grows and ages. The growing global population with cancer faces unique challenges from their disease and from the treatments they receive. Physical therapists can help them achieve health and quality of life. The prescribed exercises and lifestyle advice that physical therapists provide can also help people reduce their risk of getting cancer. Cancer facts Cancer is a leading cause of death worldwide and accounted for 7.6 million deaths (around 13% of all deaths) in 2008.
Source: International Agency for Research on Cancer http://globocan. iarc.fr/factsheets/populations/factsheet.asp?uno=900

The link between physical activity and cancer Getting adequate physical activity, maintaining a healthy weight and eating a healthy diet can reduce the chance of recurrence of many cancers and increase the likelihood of disease-free survival after a diagnosis, say new guidelines from the American Cancer Society.
Source: American Cancer Society http://onlinelibrary.wiley.com/ doi/10.3322/caac.21142/full

Large population studies have identified a strong association between lower levels of physical activity and higher cancer mortality. Walking or cycling an average of 30 minutes per day has been associated with a 34% lower rate of cancer death and a 33% improved cancer survival.
Source: Orsini N, Mantzoros C S et al. Association of physical activity with cancer incidence, mortality, and survival: a population based study of men. British Journal of Cancer. 2008 98: 1864-1869. www. ncbi.nlm.nih.gov/pubmed/18506190

Deaths from cancer worldwide are projected to continue to rise to over 11 million in 2030. More than 30% of cancer can be prevented by modifying or avoiding key risk factors, including:

being overweight or obese physical inactivity.

Other risk factors include:

Increasing numbers of studies are indicating that physical activity can reduce the incidence of cancer. World Health Organization recommendations say that undertaking 150 minutes of moderate intensity aerobic physical activity a week can reduce the risk of breast and colon cancers. The same amount of exercise can also reduce the risk of diabetes and heart disease.
Source: Global Recommendations on Physical Activity for Health, released by the World Health Organization in 2011 www.who.int/ dietphysicalactivity/factsheet_recommendations/en/index.html

tobacco use low fruit and vegetable intake alcohol use HPV-infection urban air pollution indoor smoke from household use of solid fuels.
Source: World Health Organization www.who.int/mediacentre/ factsheets/fs297/en/

According to the International Agency for Research on Cancer: Physical activity is one risk factor for non-communicable diseases which is modifiable and therefore of great potential public health significance. Changing the level of physical activity raises challenges for the individual but also at societal level. www.un.org/ apps/news/story.asp?NewsID=37467&Cr=cancer&Cr1

16 | World Confederation for Physical Therapy

Physical activity helps people with the effects of treatment for cancer A systematic review of controlled trials of physical activity interventions in cancer survivors, during and after treatment, showed that physical activity had a significant effect. A large effect was shown on upper and lower body strength, and a moderate effects on fatigue and breast- cancer-specific concerns. Exercise was generally well-tolerated during and after treatment, with minimal adverse events. The study abstracted data from over 82 studies.
Source: Speck RM, Courneya KS et al. An update of controlled physical activity trials in cancer survivors: a systematic review and metaanalysis. J. Cancer Surviv. 2010 Jun;4(2):87-100. www.ncbi.nlm.nih. gov/pubmed/20052559

more than three hours per week. Among people who have had colo-rectal cancer, a study found a 50% lower rate of recurrence and related death in those who exercised more than six hours per week.
Sources: Holmes, MD, Chen WY et al. Physical activity and survival after breast cancer diagnosis. JAMA 2005 293: 2479-2486. www.ncbi.nlm. nih.gov/pubmed/15914748 Meyerhardt J A, Giovannucci E L et al. Physical Activity and Survival After Colorectal Cancer Diagnosis. Journal of Clinical Oncology 2006 Vol 24, No 22 (August 1): 3527-3534. http://jco.ascopubs.org/ content/24/22/3527.abstract

Current lack of physical activity among people with cancer Generally, cancer survivors display low levels of physical activity. A study has reported that in Canada less than 22% of cancer survivors are physically active.
Source: Courneya KS, Katzmarzyk PT et al. Physical activity and obesity in Canadian cancer survivors: population-based estimates from the 2005 Canadian Community Health Survey. Cancer 2008 Jun;112(11):2475-82. www.ncbi.nlm.nih.gov/pubmed/18428195

A panel of experts convened by the American College of Sports Medicine concluded that exercise training is safe during and after cancer treatments and results in improvements in physical functioning, quality of life and cancer-related fatigue in several cancer survivor groups.
Source: Schmitz KH, Courneya KS et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010 Jul;42(7):1409-26. www.ncbi.nlm.nih.gov/ pubmed/20559064

Physical activity helps improve outcomes for people with cancer Studies have indicated a relationship between higher physical activity levels and lower mortality in cancer survivors. A recent meta-analysis reported that, postdiagnosis, physical activity reduced breast cancer deaths by 34%, all causes mortality by 41% and disease recurrence by 24%.
Source: Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 2010 Apr 22. www.ncbi.nlm.nih.gov/pubmed/20411366

This information was produced with the kind assistance of Julie Walsh-Broderick, HRB Research Fellow, Department of Physiotherapy, Trinity Centre for Health Science, St Jamess Hospital, Dublin

Studies also indicate the volume of exercise necessary to bring benefits. The Nurses Health Study reported 50% fewer cancer recurrences in women who exercised

World Confederation for Physical Therapy | 17

Journal articles about physical therapy

Here are some useful references for articles that show the benefit of physical therapy in: hypertension cardiovascular disease stroke diabetes obesity chronic obstructive pulmonary disease.
for coronary artery disease: a systematic clinical and economic review. Ottawa, Canada; Canadian Coordinating Office For Health Technology Assessment (CCOHTA), 2003. Brubaker PH, Kaminsky LK, Whaley MH. Coronary Artery Disease: Essentials of Prevention and Rehabilitation Programs. Champaign IL Human Kinetics, 2002. Brubabaker PH, Warner JG, Rejeski DG, et al. Comparison of standard and extended length participation in cardiac rehabilitation on body composition, functional capacity, and blood lipids. Am J Cardiol 1996;78:769-773. Davies EJ, Moxham T, Rees K, Singh S, Coats AJS, Ebrahim S, Lough F, Taylor RS. Exercise based rehabilitation for heart failure. Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD003331. DOI: 10.1002/14651858. CD003331.pub3. Frownfelter D, Dean E. Cardiovascular and Pulmonary Physical Therapy. 4th Edition. St. Louis. Mosby Elsevier. 2006. Heran BS, Chen JMH, Ebrahim S, Moxham T, Oldridge N, Rees K, Thompson DR, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001800. DOI: 10.1002/14651858.CD001800.pub2. www.ncbi.nlm.nih.gov/pubmed/21735386 National Institute for Health and Clinical Excellence. Chronic heart failure: management of chronic heart failure in adults in primary and secondary care. CG108. London, UK: National Institute for Health and Clinical Excellence; 2010. National Institute for Health and Clinical Excellence. Prevention of cardiovascular disease at population level. London, UK: National Institute for Health and Clinical Excellence; 2010. Pollock M et al. Resistance Exercise in Individuals With and Without Cardiovascular Disease: An Advisory

Hypertension ACSMs Guidelines for Exercise Testing and Prescription. 6th Ed. Baltimore MD: Lippincott Williams & Wilkins 2000 Blumenthal JA, Sherwood A, et al. Exercise and weight loss reduce blood pressure in men and women with mild hypertension: effects on cardiovascular, metabolic, and hemodynamic functioning. Arch Intern Med. 2000;160(13): 1947-58. Miller ER, Erlinger TP, Young DR, et al. Results of the diet, exercise, and weight loss intervention trial. Hypertension. 2002;40(5):612-618. Tanaka H, Bassett DR, Howley ET, Thompson DL, Ashraf M, Rawson FL. Swimming training lowers the resting blood pressure in individuals with hypertension. J Hypertens. 1997;15:651-7. Cardiovascular disease Ades P. Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease. N Eng J Med. 2001; 345, 12. Balady G et al. Cardiac rehabilitation programs. A statement for healthcare professionals from the American Heart Association. Circ. 1994;90:1602-10. Brown A, Taylor R, Noorani H, Stone J, Skidmore B. Exercise-based cardiac rehabilitation programs

18 | World Confederation for Physical Therapy

From the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association. Circ. 2000; 101: 828. Seki E et al. Effects of Phase III Cardiac Rehabilitation Programs on Health-related Quality of Life in Elderly Patients with Coronary Artery Disease. Circ J. 2003; 67: 73-77. Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004 May 15;116(10):682-92. Vincent K, Vincent H. Resistance Training for Individuals With Cardiovascular Disease. J Cardiopulm Rehab. 2006; 26: 207-16. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): casecontrol study. Lancet. 2004 Sep 11-17;364(9438):937-52. Stroke Dean CM, Richards CL, Malouin F. Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Arch Phys Med Rehabil. 2000;81(4):409-17. Endres M, Gertz K, et al. Mechanisms of stroke protection by physical activity. Ann Neurol. 2003;54(5):582-90. English C, Hillier SL. Circuit class therapy for improving mobility after stroke. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD007513. DOI: 10.1002/14651858.CD007513.pub2. Ouellette MM, LeBrasseur NK, et al. High-intensity resistance training improves muscle strength, selfreported function, and disability in long-term stroke survivors. Stroke. 2004;35(6):1404-9. Outpatient Service Trialists. Therapy-based rehabilitation services for stroke patients at home. Cochrane Database

of Systematic Reviews 2003, Issue 1. Art. No.: CD002925. DOI: 10.1002/14651858.CD002925. Pollock A, Baer G, Pomeroy VM, Langhorne P. Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD001920. DOI: 10.1002/14651858. CD001920.pub2. Royal College of Physicians Intercollegiate Stroke Working Party. National Clinical Guidelines for Stroke. 3rd ed. London, UK: Royal College of Physicians 2008 Saka O, Serra V, Samyshkin Y, McGuire A, Wolfe CCDA. Cost-effectiveness of stroke unit care followed by early supported discharge. Stroke 2009; 40(1): 24-29. Stroke Unit Trialists Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000197. DOI: 10.1002/14651858.CD000197.pub2. Teixeira-Salmela LF, Olney SJ, et al. Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. Arch Phys Med Rehabil. 1999;80(10):1211-8. Diabetes Castaneda C, Layne JE, Munoz-Orians L, et al. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care. 2002;25(12):2335-41. Dunstan DW, Daly RM, Owen N, Jolley D, De Courten M, Shaw J, Zimmet P. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care. 2002 Oct;25(10):1729-36. Evans WJ. Effects of exercise on body composition and functional capacity of the elderly. J Gerontol A Biol Sci Med Sci. 1995;50 Spec No:147-50. Fenicchia LM, Kanaley JA, Azevedo JL Jr, et al. Influence of
World Confederation for Physical Therapy | 19

resistance exercise training on glucose control in women with type 2 diabetes. Metabolism. 2004;53:284289. Greaves CJ, Sheppard KE, Abraham C, Hardeman W, Roden M, Evans PH, Schwarz P, Image Study Group. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health 2011 Feb 18;11(119):Epub Orozco LJ, Buchleitner AM, Gimenez-Perez G, Roqu i Figuls M, Richter B, Mauricio D. Exercise or exercise and diet for preventing type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD003054. DOI: 10.1002/14651858.CD003054.pub3. Umpierre D, Ribeiro PAB, Kramer CK, Leitao CB, Zucatti ATN, Azevedo MJ, Gross JL, Ribeiro JP, Schaan BD. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 2011 May 4;305(17):1790-1799 Obesity Dunstan DW, Daly RM, Owen N, Jolley D, De Courten M, Shaw J, Zimmet P. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care. 2002 Oct;25(10):1729-36. Hagberg JM, Graves JE, Limacher M, et al. Cardiovascular responses of 70- to 79-yr-old men and women to exercise training. J Appl Physiol. 1989;66(6):2589-94. Shaw KA, Gennat HC, ORourke P, Del Mar C. Exercise for overweight or obesity. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003817. DOI: 10.1002/14651858.CD003817.pub3. Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD001871. DOI: 10.1002/14651858.CD001871.
20 | World Confederation for Physical Therapy

pub3. Chronic Obstructive Pulmonary Disease American College of Chest Physicians, American Association of Cardiovascular and Pulmonary Rehabilitation [American College of Chest Physicians (ACCP) and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)]. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based guidelines [with systematic review]. Chest 1997 Nov;112(5):1363-1396 American College of Sports Medicine. Guidelines for Exercise Testing and Prescription. 7th ed. Champaign IL: Human Kinetics, 2006. Casaburi R, Patessio A, Ioli F, et al. Reduction in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am Rev Respir Dis. 1991;143:9-18. Casaburi R, Porszasz J, Burns MR, Carithers ER, et al. Physiologic benefits of exercise training in rehabilitation of severe COPD patients. Am J Respir Crit Care Med. 1997;155:15411551. Casaburi R. Mechanisms of the reduced ventilatory requirement as a result of exercise training. Eur Respir Rev. 1995;5:25, 4246. Clark CJ, Cochrane LM, et al. Skeletal muscle strength and endurance in patients with mild COPD and the effects of weight training. Eur Respir J. 2000;15(1):92-97. Coppoolse R, Schols A, Baarends EM et al. Interval versus continuous training in patients with severe COPD: a randomized clinical trial. Eur Respir J. 1999;14:258-263. Gosselink R, Langer D, Burtin C, Probst V, Hendriks HJM, van der Schans CP, Paterson WJ, Verhoef-de Wijk MCE, Straver RVM, Klaassen M, Troosters T, Decramer M, Ninane V, Delguste P, Muris J [Koninklijk Nederlands Genootschap voor Fysiotherapie (KNGF) [Royal Dutch

Society for Physiotherapy]]. KNGF guidelines: Chronic obstructive pulmonary disease clinical practice guidelines [with systematic review]. Nederlands Tijdschrift voor Fysiotherapie [Dutch Journal of Physical Therapy] 2008;118(4 Suppl):1-60 Gosselink R, Troosters T, Decramer M. Effects of exercise training in COPD patients: interval versus endurance training. Eur Respir J. 1998;12:2S. Gosselink R, Troosters T, Decramer M. Exercise training in COPD patients: the basic questions. Eur Respir J. 1997;10:28842891. Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomized controlled trial. Lancet. 2000;355:362-368. Hernandez MTE, Rubio TM, Ruiz FO, et al. Results of a home-based training program for patients with COPD. Chest. 2000;118:106-114. Hirata K, Okamoto T, Shiraishi S. The efficacy and practice of exercise training in patients with chronic obstructive pulmonary disease (COPD). Nippon Rinsho. 1999;57(9):2041-5. Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003793. DOI: 10.1002/14651858. CD003793.pub2. http://onlinelibrary.wiley.com/ doi/10.1002/14651858.CD003793.pub2/abstract Maltais F, LeBlanc P, Jobin J, et al. Intensity of training and physiologic adaptation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1997;155:555561. National Institute for Health and Clinical Excellence. Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care. Update guideline. London: National Institute for Health and Clinical Excellence 2010.

http://publications.nice.org.uk/chronic-obstructivepulmonary-disease-cg101 Ng LWC, Mackney J, Jenkins S, Hill K. Does exercise training change physical activity in people with COPD? A systematic review and meta-analysis. Chronic Respiratory Disease February 2012; 9(1):17-26 Normandin EA, McCusker C, Connors ML, et al. An evaluation of two approaches to exercise conditioning in pulmonary rehabilitation. Chest. 2002;121:1085-1091. Puhan MA, Gimeno-Santos E, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD005305. DOI: 10.1002/14651858.CD005305. pub3. Ries AL, ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based guidelines. Chest. 1997;112:1363-1396. Seymour JM, Moore L, Jolley CJ, Ward K, Creasey J, Steier JS et al. Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax 2010; 65(5):423-428 Troosters TR, Casaburi R, Gosselilnk R, Decramer M. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;172(3):19-38. Vogiatzis I, Nanas S, Roussos C. Interval training as an alternative modality to continuous exercise in patients with COPD. Eur Respir J. 2002;20:1219. ZuWallack R. The nonpharmacologic treatment of chronic obstructive pulmonary disease: advances in our understanding of pulmonary rehabilitation. Proc Am Thorac Soc. 2007 Oct 1;4(7):549-53. Review.

World Confederation for Physical Therapy | 21

Visit www.wcpt.org/wptday for more information about World Physical Therapy Day and the resources available

This booklet has been produced by: World Confederation for Physical Therapy Victoria Charity Centre 11 Belgrave Road London SW1V 1RB United Kingdom World Confederation for Physical Therapy 2012