By empowering our patient’s with holistic lifestyle choices, we are investing in positive change for our respective communities.
Physical therapists (PT) and other healthcare providers already provide patient on a variety of topics. For example, physical therapists provide patient education on joint protection guidelines, proper lifting mechanics, energy conservation guidelines, pre- and post-surgical guidelines, caregiver training, and assistive device use. These are only a few areas PT’s provide education. However, in the next decade and beyond, physical therapists will continue to play a leading role in lifestyle education and the wellness needs of the patient. The purpose of the article is to provide an overview of areas PT’s need to continue emphasizing in their clinical care of patients.
INTEGRATIVE LIFESTYLE MEDICINE
Integrative medicine is about including advice and recommendations from your doctor and healthcare provider into a patient’s health and wellness program. However, it is also about incorporating lifestyle changes such as managing stress, getting adequate sleep, eating nourishing foods, meditating, and performing fun and meaningful exercises.
What does “integrative, alternative, and complementary medicine” mean? The National Center for Complementary and Integrative Health (https://nccih.nih.gov) defines the terms as follows:
- “If a non-mainstream practice is used together with conventional medicine, it’s considered ‘complementary.’”
- “If a non-mainstream practice is used in place of conventional medicine, it’s considered ‘alternative.’”
- Integrative health care involves “bringing conventional and complementary approaches together in a coordinated way.” The integrative approach typically involves pain management, relief of symptoms, and promoting healthy behaviors.
What is mind-body medicine? The mind-body medicine model includes self-care and self-awareness as a key component of care, treats the person in a holistic manner, aims to get at the root cause of an illness or disease, and encourages adopting a healthy lifestyle, which includes wholesome nutrition, meaningful exercise, restorative sleep, stress management strategies, meditation, mindfulness, balance between work and rest, and finally, involvement in healthy relationships. Some of the basic foundations of mind-body medicine are that the program accounts for differences in each individual (not everyone gets the same program), the program is sustainable (the program is not a one-month- and-done routine), and the program is meaningful to the person. Some of the clinical uses of mind-body medicine (or integrative healing) include treatment and care for anxiety, attention-deficit/hyperactivity disorder (ADHD), central sensitization (or heightened sensitivity to pain), depression, fibromyalgia, headache or migraines, pain, pain catastrophizing, post-traumatic stress disorder, sleep disorders, and chronic stress.1
SLEEP FOR HEALTH
Chronic sleep problems can increase your risk of heart attack, stroke, high blood pressure, diabetes, depression, and other medical problems. A person could lose sleep because he or she is experiencing pain, taking certain medications, or undergoing hormonal changes (such as menopause). Quality of sleep is considered good when a person can fall asleep relatively quickly (within 5 to 15 minutes), wake up easily, stay asleep almost continuously, and sleep long enough to feel refreshed the next day.2
The following are some of the results of sleep deprivation:3,4,5
- Daytime fatigue, low energy, physical and mental tiredness, and weariness
- Mood disturbances
- Impaired cognitive functioning
- Impaired memory and concentration
- Difficulty sustaining attention with tasks
- Slowed response times (good reaction times are critical for safe driving, safety at work, and preventing falls)
- Increased incidence of colds and viruses, and a weakened immune system
- Increased pain perception
- Increased risk of falls
- Decreased job performance
- Reduced quality of life and inability to enjoy social relationships
- A possible role in the current obesity epidemic
- Decreased safety on the road, leading to car crashes
The American Academy of Sleep Medicine (AASM) recommends that “Adults should sleep 7 or more hours per night on a regular basis to promote optimal health.” The consensus statement from the AASM also indicates that “Sleeping less than 7 hours per night on a regular basis is associated with adverse health outcomes, including weight gain and obesity, diabetes, hypertension, heart disease and stroke, depression, and increased risk of death. Sleeping less than 7 hours per night is also associated with impaired immune function, increased pain, impaired performance, increased errors, and greater risk of accidents.”6
The American Academy of Sleep Medicine recommends the following sleep guidelines for specific age groups in a 24-hour period to promote optimal health:7
- Infants one to twelve months of age should sleep 12 to 16 hours (including naps)
- Children one to two years of age should sleep 11 to 14 hours (including naps)
- Children three to five years of age should sleep 10 to 13 hours (including naps)
- Children six to twelve years of age should sleep 9 to 12 hours
- Teenagers thirteen to eighteen years of age should sleep 8 to 10 hours
From a direct physical therapy perspective, the following are key reasons for sleep:
- Al-Sharman et al. (2013)8 indicate that “sleep facilitates learning clinically relevant functional motor tasks.”
- Siengsukon et al. (2009)9 indicate that despite certain unanswered questions in sleep research, “therapists should consider encouraging sleep following therapy sessions as well as promoting healthy sleep in their patients with chronic stroke to promote offline motor learning of the skills practiced during rehabilitation.”
Table 1 outline 10 practical sleep improvement tips physical therapists may use with their patients.10
STRESS MANAGEMENT FOR HEALTH
Some causes of stress include chronic overstimulation of the senses (excessive noise or overcrowding), lack of sleep, poor diet, overtraining with exercise, information overload (due in large part to cellular phones and the Internet), and constant barrage of news via various media outlets, financial concerns, relationship problems, or job issues. Finding the root causes of their stress and try to find strategies to correct or manage their triggers. A trigger for one person may not even register as stress in another person. For example, some individuals consider standing in long lines or being stuck in freeway traffic as a high level of stress. Other individuals may look at these situations as a way to slow down their hectic life or listen to soothing music. Our bodies cannot be in a constant state of “fight or flight” (sympathetic nervous system) where the stress hormones are dominant. We need to have a balance where we are in a state of “rest and digest” (parasympathetic nervous system) to allow for digestion, healing, and recovery.
Table 2 outline 10 practical stress improvement tips physical therapists may use with their patients.1
SUTAINABLE EXERCISE FOR HEALTH
Sustainable exercise is not about promising miracle cures or quick-fix solutions, trying to sell a specific product, or finding a one-size-fits-all exercise routine. Every person has the freedom of choice to pursue whatever lifestyle, activity, sport, or exercise he or she wishes. For this reason, physical therapists need to help the patient explore different types of movement patterns or exercises to find the one(s) which resonate with them. One patient may like hiking, dancing, yoga, tai chi, qigong, Pilates, or labyrinth walking, while another patient may enjoy weight training, walking, biking, swimming, or sports like soccer or tennis. Table 5 outlines some types of mind-body movements which may be introduced in physical therapy to help improve home program compliance:1
NUTRITION FOR HEALTH
Good nutrition is not only about calories and consuming adequate protein, carbohydrates, fats, vitamins, and mineral, but using food as medicine to heal and restore the body. In physical therapy, nutrition can be a very tool to help control inflammation and pain.
The nutrition book Nutrition and Diagnosis-Related Care23 outlines the basic principles of the Mediterranean or an anti-inflammatory diet:
- Focus on a plant-based diet
- Focus on foods rich in antioxidants and phytochemicals
- Eat fresh and minimize processed foods
- Eat “super-foods” such as salmon, blueberries, bananas, broccoli, avocado, or dark chocolate (at least 70% cocoa)
- Drink green or oolong tea
- Use spices and herbs such as oregano, cinnamon, dill, turmeric, curcumin, ginger, or garlic
The nutrition book Krause’s Food & the Nutrition Care Process24 states that after athletes are injured, the inflammatory stage of healing is affected by foods. The authors indicate that a “diet high in trans fats, saturated fats, and some omega-6 vegetable oils has been shown to promote inflammation, whereas a diet high in monosaturated fat [such as olive and avocado] and essential omega-3 fats have been shown to be anti-inflammatory. The authors also state that “It is believed that nightshade plants aggravate the inflammation that causes pain, swelling, and stiffness in the joints of some patients with arthritis.” Finally, the authors outline the following principles of the anti-inflammatory diet:
- Consume colorful vegetables and fruits, and also include anti-inflammatory spices and herbs such as turmeric, garlic, ginger, rosemary, oregano, cocoa, ginger, clove, coriander, cinnamon, nutmeg, black pepper, parsley, sage, dill, and basil.
- Eat a low glycemic diet.
- Eat nuts and seeds.
- Adjust the quality and quantity of fats to include olive oil, coconut oil, and avocados and decrease excess animal protein and omega-6 fatty acids (such as soybean, corn, safflower, and sunflower oils). Also, avoid hydrogenated fats and trans fats.
- Get adequate sources of probiotics from sources such as fermented and cultured foods.
- Be aware of any food allergies and food sensitivities and minimize or avoid these foods. Common food allergens include eggs, milk, fish, shellfish, wheat, tree nuts, peanuts, and soybeans.
- Avoid chemical and pesticides which can irritate your immune system.
- Drink alcohol in moderation.
- Get enough sleep.
- Keep stress levels under control.
There are studies which in general discuss inflammation and diets25,26,27 and may be useful for clinicians wishing to learn more. There is also the free Dietary Inflammation Index (DII Screener) app at the Apple Store and additional information about the app at Connecting Health Innovations (http://chi-llc.net). Finally, see Table 6 for nutrients having anti-inflammatory effects.
In conclusion, physical therapists are in a leadership position to empower patients and clients with healthy lifestyle habits which will not only be beneficial during therapy and rehabilitation but also reducing risk factors and preventing many diseases. As PT’s if we empower our patients with holistic lifestyle choices, we are all, in turn, investing in positive change our respective communities.
- Altug Z. Integrative Healing: Developing Wellness in the Mind and Body. Springville, UT: Plain Sight Publishing; 2018.
- Akerstedt T, Hume K, Minors D, et al. Good sleep—its timing and physiological sleep characteristics. Journal of Sleep Research 1997; 6 (4): 221–229.
- Ancoli-Israel S, Cooke JR. Prevalence and comorbidity of insomnia and effect on functioning in elderly populations. Journal of the American Geriatrics Society 2005; 53 (Supplement 7): S264–71.
- Kundermann B, Krieg JC, Schreiber W, et al. The effect of sleep deprivation on pain. Pain Research & Management 2004; 9 (1): 25–32.
- Walker MP. The role of sleep in cognition and emotion. Annals of the New York Academy of Sciences 2009; 1156: 168–197.
- Watson NF, Badr MS, Belenky G, et al. Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. 2015; Journal of Clinical Sleep Medicine 11 (6): 591–592.
- Paruthi S, Brooks LJ, D’Ambrosio C, et al. Recommended amount of sleep for pediatric populations: A consensus statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine 2016; 12 (6): 785–786.
- Al-Sharman A, and Siengsukon CF. Sleep enhances learning of a functional motor task in young adults. Physical Therapy 2013; 93 (12): 1625–1635.
- Siengsukon CF, Boyd LA. Does sleep promote motor learning? Implications for physical rehabilitation. Physical Therapy 2009; 89 (4): 370–383.
- Siengsukon CF, Al-Dughmi M, Stevens S. Sleep health promotion: Practical information for physical therapists. Physical Therapy 2017; 97 (8): 826–836.
- National Sleep Foundation. Sleeping smart. National Sleep Foundation. www.sleepfoundation.org. Accessed August 8, 2018
- Kryger MH, Roth T, Dement WC. Principles and Practice of Sleep Medicine, 6th ed. Philadelphia, PA: Elsevier; 2016.
- Reid KJ, Baron KG, Lu B, et al. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Medicine 2010; 11 (9): 934–940.
- Zee PC, Goldstein CA. Treatment of shift work disorder and jet lag. Current Treatment Options in Neurology 2010; 12 (5): 396–411.
- Morita E, Miyazaki S, Okawa M. Pilot study on the effects of a 1-day sleep education program: Influence on sleep of stopping alcohol intake at bedtime. Nagoya Journal of Medical Science 2012; 74 (3–4): 359–365.
- Attarian HP. Sleep Disorders in Women: A Guide to Practical Management. Totowa, New Jersey: Humana Press; 2010.
- Ancoli-Israel S. All I Want Is a Good Night’s Sleep. St. Louis, MO: Mosby-Yearbook; 1996.
- Hess U, Blairy S. Facial mimicry and emotional contagion to dynamic emotional facial expressions and their influence on decoding accuracy. International Journal of Psychophysiology 2001; 40 (2): 129–141.
- Birnbaum MH. Nearpoint visual stress: A physiological model. Journal of the American Optometric Association 1984; 55 (11): 825–835.
- Birnbaum MH. Nearpoint visual stress: Clinical implications. Journal of the American Optometric Association 1985; 56 (6): 480–490.
- Haff GG, Triplett NT. (Eds.). Essentials of Strength Training and Conditioning, 4th ed. Champaign IL: Human Kinetics; 2016.
- Jacobson E. You Must Relax, 5th ed. New York, NY: McGraw-Hill Book Company, Inc; 1976.
- Escott-Stump S. Nutrition and Diagnosis-Related Care, 8th ed. Philadelphia, PA: Wolters Kluwer; 2015.
- Mahan LK, Raymond JL. Krause’s Food & the Nutrition Care Process, 14th ed. St. Louis, MO: Elsevier; 2017.
- Cavicchia PP, Steck SE, Hurley TG, et al. A new dietary inflammatory index predicts interval changes in serum high-sensitivity C-reactive protein. The Journal of Nutrition 2009; 139 (12): 2365–2372.
- Minihane AM, Vinoy S, Russell WR, et al. Low-grade inflammation, diet composition and health: Current research evidence and its translation. The British Journal of Nutrition 2015; 114 (7): 999–1012.
- Olendzki BC, Silverstein TD, Persuitte GM, et al. An anti-inflammatory diet as treatment for inflammatory bowel disease: A case series report. Nutrition Journal 2014; 13:5.
- Shivappa N, Steck SE, Hurley TG, et al. Designing and developing a literature-derived, population-based Dietary Inflammatory Index. Public Health Nutrition 2014; 17 (8): 1689–1696.