By Dr. Sean M. Wells, DPT, PT, OCS, CNPT, ATC/L, CSCS, NSCA-CPT, Cert-DN
I was excited to see a recent publication in our APTA’s PTJ titled Precision Medicine and Physical Therapy: A Health Living Medicine Approach for the Next Century. I have been following the primary author, Rich Severin, on Twitter for some time now and enjoy his perspectives. Overall the article dives into much of what my team and I practice – I earnestly hope it is something other PTs (physical therapists) begin to practice too. In this light, I’d like to discuss some of the important topics in this article.
First, it goes without saying that general health has an impact on physical therapy, functioning, and quality of life. Chronic health conditions like heart disease, high blood pressure, and diabetes makes healing difficult and are linked with other disease states that cause physical damage to other tissues (e.g. high blood pressure damages the kidneys). Functionally clients struggle with these diseases because they often impair the neuromuscular system, thereby reducing muscular endurance, strength, coordination – all which reduce walking, lifting, and posturing. Reducing functional capacity equates to less participation in life and more pain, which all translate to a lower quality of life.
Second, Chronic conditions don’t simply come with age, as many lay people believe. Chronic disease states come with poor behavioral choices in life, not merely genetics and age. The precision medicine notion from the 2000s era highlighted how physical therapists (PTs) and medical doctors could be treating patients with gene-level interventions to eradicate chronic disease. The notion that we all had genes that code for chronic diseases like obesity or cancer seemed to point us in a direction that postulated precision medicine was the only way forward in medicine and rehabilitation. Fortunately researchers found that epigenetics had a major impact on these chronic disease states, and that lifestyle and behaviors truly matter. In other words, our interaction with the environment and our own actions can alter disease states and disability. A great example of this is exercise’s ability to reduce DNA damage in our tissues. In some ways precision medicine wasn’t so precise and we needed to look at patients’ lifestyle + genes!
Third, if behaviors and lifestyle matter, what do we call this next approach? Well, Severin and his colleagues used the term Healthy Living Medicine, a name that should sound familiar with many PTs and fitness professionals. Other organizations and authors have used similar terms before: Lifestyle Medicine, Preventative Medicine, and Integrative Medicine have been buzz words the last decade. I think the Physicians for Responsible Medicine’s Lifestyle Medicine approach is much akin to the Healthy Living Medicine approach, with a focus on diet, physical activity, sleep, stress management, and social interactions. Some have called these factors social determinants of health (SDOH), especially those within the Wellness SIG of the APTA. Whatever you call them, these factors contribute significantly to disease state, pain, and functioning.
Fourth and finally, I think it’s important for PTs and clients to understand that this article shows that medicine and rehab should be comprehensive and holistic. We can’t ignore the heavy alcohol use and lack of sleep in our clients with chronic lower back pain. Patients with obesity must be educated that their diet rich in animal fats and processed foods will struggle to lose weight and reduce their inflammation without a paradigm shift in lifestyle changes. The reciprocal relationship between an unhealthy lifestyle, chronic diseases, and physical disability is much more clear. We as PTs need to do a better job of touching on those lifestyle factors like diet, sleep, substance use, and stress management. I appreciate DPTs cannot be specialists in all things – no one can; however, we can screen patients, refer patients, or at least begin the conversation!
Big thanks to Severin et al for the pub! Keep ‘em coming…
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Keywords: nutrition, diet, continuing education, online, weight loss, health, PT, physical therapy, learning, disease, rehab, prevention, DPT