Population and Community-Based Promotion of Physical Activity: A Priority for Physical Therapy

Many advocate an interprofessional practice paradigm that focuses on prevention through population and community-based promotion of health and prevention of lifestyle-related noncommunicable diseases, both in the United States and around the globe. Dean et al1 stated clearly the role of physical therapy in prevention of lifestyle-related noncommunicable diseases. The changing health care landscape in the United States invites and even demands new levels of commitment to public health delivery and policy advocacy by all health care disciplines. Bezner,2 as well as Dean et al,1 have captured the importance of participating in prevention and public health initiatives and of making community-based health a priority in professional education and physical therapist practice. Here, we advocate focused action within the academic and clinical communities especially to promote physical activity (PA) at the individual, societal, and policy levels. Physical inactivity is a key risk factor for the development of most noncommunicable diseases and many other conditions across the life span, including obesity, cardiovascular disease, chronic low back pain, and type 2 diabetes.3 Survivorship from many conditions that were life-threatening a century ago has resulted in more than 89 million Americans of all ages living with a lifestyle-related noncommunicable disease and has caused one of the most daunting public health challenges of this country's history. Obesity alone has become a particularly challenging issue for public health and service delivery in the United States because of its prevalence and its linkage to behavioral and environmental factors that can be difficult to address without widespread adoption of community, as well as individual, change.4 Estimates place 31% of the world population, or a little more than 2 billion people, as physically inactive5 and thus at risk for both life-threatening and disabling conditions. In the United States, more than half of adults do not meet the recommendations for daily PA.6 Furthermore, survival itself is at risk with inadequate PA; physical inactivity is estimated to cause as many deaths as does tobacco use.7 Life expectancy of the world population is estimated to increase by 0.68 years if people were more physically active.7 Obesity, heart disease, and diabetes are clearly leading causes of death and disability in the United States. They also are the leading causes of health care spending, accounting collectively for nearly 90% of health care expenditures.8 Although being physically active in the face of a lifestyle-related noncommunicable disease poses major dilemmas, behavioral and environmental changes can modify the severity of many conditions. To truly promote change in how often adults and children engage in PA, however, requires community support9 and strong reinforcement from each member of the health care community. Physical therapists are uniquely positioned to provide specific education about PA during individual therapeutic interventions and to participate in delivering evidence-based interventions about active lifestyle in community-based primary prevention initiatives.10 We believe it is imperative for physical therapists to seek evidence-based community- and population-level strategies to actively promote healthy types and levels of PA across the life span. This imperative is embedded in the expectation that physical therapists seek best practice ways to enhance health and quality of life, not just deliver episodic reactive interventions. We believe the physical therapy community must embrace 3 priorities to be effective in promoting PA as a health- and life-enhancing behavior. First, we must become thoroughly informed about the contemporary landscape of lifestyle-­related noncommunicable diseases in children and adults and the role that PA and reduction in sedentary behavior can play in prevention, treatment, or management of these diseases. Second, physical therapists must demonstrate a publically visible commitment to prevention and health promotion as a complement to their work in rehabilitation11 and embrace a broader perspective about how to use their expertise in movement and the movement system to enhance the quality of life in more than their individual patients. Third, expanded efforts must be made to teach, learn, and practice in the kind of interprofessional environment required to make meaningful change in the health status of this country.12 Moving deliberately toward these goals with interprofessional partners, including public health, is critical for us to reach our professional vision of “transforming society by optimizing movement to improve the human experience.”3 In agreement with Dean et al,1 we understand that these changes require effort to strengthen curricula, expand contact with public health professionals during clinical education, shift practice expectations to include the delivery of prevention and PA messages to all patients, and become involved in advocating policy changes that yield a physically active and less sedentary population. The current illness-focused health care system in the United States generally is reactive and needs to shift to a proactive system that promotes wellness in an effort to prevent disease. Although health care providers may find a focus on prevention difficult because of their traditional focus on diagnosis and treatment of illness, physical therapists are uniquely positioned to lead others in shifting to a broader perspective of practice obligations. Making a transition to promote PA at the individual, community, and population levels to reduce risk of and sequelae from a lifestyle-­related noncommunicable ­disease, ­promote wellness, and enhance quality of life is not only an opportunity, but also an obligation of all health care providers. Greater and stronger partnerships and interaction among physical therapists, other health care providers, and public health experts are fundamental to achieve this transition. For physical therapy, it is time to act.