Running Head: CONTINUED MOVEMENT AFTER PHYSICAL THERAPY !

Continued Movement After Physical Therapy

Jenna M. George

Baker College of Muskegon

Continued Movement After Physical Therapy !2

Abstract

Since physical therapy is a movement-based profession, the effect of movement or the lack

thereof is explored surrounding the release of rehabilitation from the clinic. Topics such as falls,

quality of life, and longevity of outcomes will be discussed in relation to a physically active

lifestyle. From reviewing multiple sources and studies, exercise is proven to be effective in

maintaining benefits relating to function of movement. Further research needs to be developed to

determine to what extent and specifically which forms of exercise are the most instrumental in

keeping patients healthy and active. A meta-analysis would need to be done to determine if there

is a link between variables of exercise and preventative measures of physical therapy (ie

prehabilitation).
Continued Movement After Physical Therapy !3

Movement is the natural state of design of the human body. Joints, muscles, and the

cardiorespiratory system are all crafted to function comprehensively in pushing, pulling,

bending, and gait. To take a system inherently made to exist in motion and put it in continual

inactivity will result in eventual pathology. That’s where physical therapists come into the

picture. They restore the body’s ability to move the way that it was designated to, and release

patients back to function. Upon completion of the plan of care, with renewed ability, a patient

will see improvement in daily activities. However, problems arise when a patient who is

rehabilitated returns to a state of physical stagnancy. The human system which was created to be

active is suppressed back to staleness. Physical activity is truly significant to maintain both

function and quality of life in patients after release from physical therapy.

Physical exercise has been shown to have incredible health benefits. Weight control,

reduction of heart disease, blood sugar and insulin level management, and prevention of cancer

are several physiological outcomes linked with consistent movement on the human system.

Better sleep and reduction in falls later on in life are also noted with physical activity (US

National Library of Medicine). Quality of life can be affected by exercise’s studied impact on

improving mental health and mood. With age, working out has the ability to keep “thinking,

learning, and judgment skills sharp” (US National Library of Medicine). Cost-free increases in

multiple realms of health are available to every person, simply by moving the limbs around that

were crafted to move.

Surprisingly, even with so many benefits of movement on a movement-designed system,

many people remain in inactivity. The US Department of Health and Human Services reports that
Continued Movement After Physical Therapy !4

only “one in three adults receive the recommended amount of physical activity each week.”

Additionally, “More than 80% of adults do not meet the guidelines for both aerobic and muscle-

strengthening activities.” The older adult population greatly represents physical stagnancy, with

only “28-34% of adults ages 65-74 physically active.” From this lack of fitness come the

problems that follow it. An even greater need arises for a movement-minded medical approach in

the midst of a statistically sedentary society.

Physical therapists come to the rescue of this immobile society and radically re-pattern

the way that a person functions. Due to direct access and the way that third party payer

regulations have changed, more people are using physical therapy as a means to reduce pain and

restore movement quality in their lives. One study showed that when employees received five PT

visits for every one copay, physical therapy became “the first-line treatment for back

pain” (Maeng). This “Geisinger Health Plan” led to an “associated 29%–35% short-term

reduction in emergency department visits and 12%–20% reduction in primary care visits after six

months” (Maeng). Having the ability of movement practitioners to get their hands on movement-

related pathologies has truly been revolutionary in patient care. Along with increased physical

therapy visits, the medical field is realizing that “home health care is the most cost effective

treatment setting in the medical model” (Lehmann). This prospectively changes the way that

physical therapy will deliver interventions as well. Home exercise programs that can be provided

where the patient lives instead of at the clinic, will cut costs and enable more functionality in the

environment where a patient ambulates. This incentivizes care towards inexpensive home

exercise programs and movement focused therapies to progress a patient back to function. What

is healed with movement; however, cannot become immobile post physical therapy and be
Continued Movement After Physical Therapy !5

expected to maintain the same level of soundness. That is where exercise that is continued post

physical therapy could benefit the changing medical model of care as the physical therapist

becomes the go-to practitioner for pain and function.

A huge annual cost on the health care system is the prevalence of falls and the injuries

resulting from them. Studied prevention of these falls is greatly linked with exercise programs.

In one study performed by Hewitt et al, falls were reduced by 55% in a group that performed

both resistance and balance training for 50 hours over a span of 25 weeks, followed by a six

month maintenance period. Slight increases in physical performance were also noted. To be able

to hypothetically cut fall incidences in half would astronomically lessen rehabilitation and

temporary nursing facility costs for older adults and the health care system. Promoting the

consistency of activity into a lifestyle could substantially keep the functioning of the geriatrics

population higher. In another similar study, an exercise group met twice per week to perform

nine lower-limb resistance band exercises. Participants were tested 6 and 12 weeks into the study

for strength, balance, and coordination differentiations. Almost every test had a notable

improvement in balance, strength, and coordination factors (between 3.25-22.6% measured

increases). In summation, Motalebi noted that the “findings support the feasibility and efficacy of

a simple and inexpensive resistance training program to improve lower-limb muscle strength and

dynamic balance among institutionalized older adults.” Postmenopausal women with

osteoporosis—a population to whom falls are detrimental—were found to have similarly

benefitted from exercise programs. It was found that “the improvement of muscle strength and

balance are essential to prevent falls, and consequently to reduce the incidence of fractures in this
Continued Movement After Physical Therapy !6

population” (Caputo). By implementing an exercise program into one’s life upon release from

physical therapy, patients will enjoy better long term function and longevity of movement.

Aiding in the substantiation of the outcomes of rehabilitation is exercise’s speculative

effect on increasing quality of life. When a person experiences greater mental health benefits in

their return back to daily activities, they will be more apt to stay involved in the groups and

things that matter to them. Injury and immobility often leads to isolation, and a decrease in

quality of life. Exercise promotes the continual mobility of the person, and aids in the mental

benefits to keep a person up and running. One systematic review of randomized control trials

concluded that “exercise programs in older people are effective in improving depressive

symptoms, quality of life and self-esteem” (Park). Limitations caused by an injury can also effect

the patient’s quality of life going forward when they are released from physical therapy back to

activities of daily living but left un-progressed. One study noted that an intentional four week

home-based circuit training program on individuals with traumatic brain injuries was beneficial

for improving “self-perception of occupational performance,” beyond measured physical

increases in gait speed, strength, and balance (Tiwari). This study speaks to the propensity of

adolescents to be “often discharged from physical therapy (PT) services without transitioning

into exertional conditioning programs” (Tiwari). Progression into further activity and sports

training allowed adolescents in this example to “achieve a sense of accomplishment and

acceptance” (Tiwari). Keeping movement as a necessity for the prevalence of function will

empower patients to higher quality of life, beyond just the physical implications of their

progression.
Continued Movement After Physical Therapy !7

Exercise programs established after completion of the plan of care result in further

progressions and continuance of function out of the clinic. In the case of cardiac rehab, Borges

noted that “self-regulated exercising following CR discharge seems to be effective to maintain

gains in exercise capacity acquired during supervised center-based programs.” A patient can only

be progressed to a certain extent while within the building of the physical therapist. After

attainment of certain outcomes, it is the patient’s responsibility to go forth and make activity a

priority. Although it is reported that a supervised PT program can be more effective than a HEP

(specifically in older adults) (Gutiérrez-Espinoza), the physical therapist cannot follow patients

around throughout their lifetime. What comes into consideration then, is which activities will

help spur the patient to continued greater health. Group exercise therapy has found to be more

effective in improving body composition, glycemic control, and lipid profile in diabetic women

when compared to home exercise programs (Dagostar). Psychosocial factors of having support in

exercise could contribute to increased exercise adherence and long-term effectiveness. In short

periods of training, one meta-analysis discovered that “explosive training and heavy strength

training are effective resistance training methods aiming to improve both muscle strength and

rate of force development” (Guizelini). Looking specifically at the geriatrics population,

Guizelini declared this style of weight training on this group as truly effective. Improved strength

and muscle control is key in the success of daily activities, and long term physical function.

Patient education and encouragement towards continued physical movement will allow the

outcomes of rehabilitation to be “lasting,” and for the patient to enjoy the effects of restored

movement.
Continued Movement After Physical Therapy !8

Exercise and continued activity is truly impactful in function and quality of life upon

discharge from a physical therapy program. Substantial decreases in falls, improved quality of

life, and strength increases are noted when exercise programs are put into place. Without

movement, therapy is only a temporary band-aid that might completely restore one piece of the

body; but with a life of stagnancy, another piece is likely to present injury at another time.

Physical therapists can promote movement and lifestyles of activity, but it remains in the hands

of the patients to put to work the things that are suggested to them. Gearing up an inactive

society for greater mobility will change health care as a whole and allow patients to achieve a

body that is functioning in the way that it was designed to.

 References !9

Borges, J. P., Mediano, M. F., Farinatti, P., Coelho, M. P., Nascimento, P. M., Lopes, G. O., . . .

Tibiriçá, E. (2016, November). The Effects of Unsupervised Home-based Exercise Upon

Functional Capacity After 6 Months of Discharge From Cardiac Rehabilitation: A

Retrospective Observational Study. Retrieved February 16, 2018, from https://

www.ncbi.nlm.nih.gov/pubmed/27333938

Caputo, E. L., & Costa, M. Z. (2014, September 28). Influence of physical activity on quality of

life in postmenopausal women with osteoporosis. Retrieved February 16, 2018, from

https://www.ncbi.nlm.nih.gov/pubmed/25458028

Dadgostar, H., Firouzinezhad, S., Ansari, M., Younespour, S., Mahmoudpour, A., & Khamseh,

M. E. (2016). Original Article: Supervised group-exercise therapy versus home-based

exercise therapy: Their effects on Quality of Life and cardiovascular risk factors in

women with type 2 diabetes. Diabetes & Metabolic Syndrome: Clinical Research &

Reviews, 10(Supplement 1), S30-S36. doi:10.1016/j.dsx.2016.01.016

Elliot, C. A., & Hamlin, M. J. (n.d.). Combined diet and physical activity is better than diet or

physical activity alone at improving health outcomes for patients in New Zealand's

primary care intervention. Retrieved February 16, 2018, from https://

www.ncbi.nlm.nih.gov/pubmed/29422040

Hewitt, J., Goodall, S., Clemson, L., Henwood, T., & Refshauge, K. (n.d.). Progressive

Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged

Care: A Cluster Randomized Trial of the Sunbeam Program. Retrieved February 16,

2018, from https://www.ncbi.nlm.nih.gov/pubmed/29402651

Lehmann, C. (2018). The Payment Squeeze in Postacute Care. PT In Motion, 10(1), 38-45.
 References !10

Motalebi, S. A., Cheong, L. S., Iranagh, J. A., & Mohammadi, F. (n.d.). Effect of low-cost

resistance training on lower-limb strength and balance in institutionalized seniors.

Retrieved February 16, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/29336735

Park, S. H., Han, K. S., & Kang, C. B. (2014, November). Effects of exercise programs on

depressive symptoms, quality of life, and self-esteem in older people: a systematic review

of randomized controlled trials. Retrieved February 16, 2018, from https://

www.ncbi.nlm.nih.gov/pubmed/24602398

Secretary, H. O., & President’s Council on Fitness, Sports & Nutrition. (2017, January 26). Facts

& Statistics. Retrieved February 21, 2018, from https://www.hhs.gov/fitness/resource-

center/facts-and-statistics/index.html

Tiwari, D., Daly, C., & Alsalaheen, B. (2017, September 6). Home-based circuit training

program for an adolescent female with severe traumatic brain injury: A case report.

Retrieved February 16, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/28876156

US National Library of Medicine. (2018, January 5). Benefits of Exercise: MedlinePlus.

Retrieved February 21, 2018, from https://medlineplus.gov/benefitsofexercise.html

Pedrode Camargo Guizelini, Rafael Alves de Aguiar, Benedito Sérgio Denadai, Fabrizio Caputo,

Camila Coelho Greco. Effect of resistance training on muscle strength and rate of force

development in healthy older adults: A systematic review and meta-analysis,

Experimental Gerontology, Volume 102, 2018, Pages 51-58, ISSN 0531-5565