Calorie Restriction and Physical Therapy

By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN

Diet crazes come and go in the hopes to correct health issues and for weight loss. Many diets are merely fads, not backed by evidence, and/or offer only short-term solutions. One dietary pattern that stands out from the pack is calorie restriction (CR), especially in regards to data on longevity. I have 2 peer-review publications in the area of CR and intermittent fasting, so I can share both the data and experiences of this diet. Let's take a quick look at calorie restriction and what physical therapists (PTs) need to know!

Calorie restriction is a dietary regimen where a person consumes typically 25-40% less calories than usual. In order to accomplish this calorie deficit a person must know their total daily caloric needs over several days. Calculating 25-40% of this total calorie needs a client can then reduce their calorie content of each meal in order to hit their calorie deficit. Usually there is not...

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Should PTs Use a New Model for Weight Loss?

By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN

For decades the predominant model that dictated weight gain, loss, or maintenance was the energy balance model (EBM). The EBM is rooted in one of the basic laws of thermodynamics. It goes without saying that food contains energy and it is typically measured in a unit known as calories (kilocalories in the dietary world). As a person consumes food it provides energy to do work such as exercise, activities of daily living (ADL), physical therapy, basic living functions, or even sport. Energy can come from recently consumed food or stored energy (e.g. fat, glycogen, or protein) from previously eaten food. 

Clinicians often explain weight loss to patients as “calories-in versus calories-out” or CICO, which directly relates to the EBM. In brief, CICO helps rehab professionals to explain to clients the balance between the energy coming into their body versus the energy they expend: too much food...

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Naysayers of Nutrition and Physical Therapy

"D" in the in professional abbreviation DPT stands for Doctor, as in Doctor of Physical Therapy. Our profession has made great leaps and bounds in its stride to becoming experts in movement, the neuromuscular system, and wellness. Much of our success has been through diligent efforts to improve the educational standards of our PT students. We've also continually raised the bar by encouraging most States to enact stricter continuing education standards, licensing, and rigorous specializations and fellowships. Such training and advanced education, along with our doctorate, prepares us to provide care in direct access, primary care, wellness centers, rehab facilities, hospital, gyms, and sports complexes to name a few. We are managing simple injuries now without much of the red tape and bureaucracy, while helping those with devastating diseases and ailments get better. Despite all the progress I feel we still have a stock of PTs that are holding us back, especially in...

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Should PTs Advocate for a Low Carb Animal Diet or a High Carb Plant Based Diet?

For the last several decades low carb advocates have pitched their diet as means to weight loss, better glycemic control, and even life extension. Many avid fans, like Noakes and Attia, have thrown around several low level studies or short term studies to support the low carb dietary pattern. Meanwhile, the data for more plant focused, carb rich diets like the Mediterranean and Whole food plant based diets have been gleaning more and more support. From prospective trials to population and epidemiology data, such plant focused diets seem to be the ideal pattern for physical therapists (PTs) to recommend to many clients. Let's take a look a recent National Institute of Health (NIH) trial comparing a low carb animal based diet to a high carb plant focused diet.

Published in Nature Medicine, the NIH trial was relatively small and focused on short term results. Researchers housed the participants in a NIH controlled facility, proving to increase the internal validity and controls of the...

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Best Weight Loss Tips for Physical Therapists

The holidays are here and our clients are busy hanging decorations and eating lots of holiday food. Most of this holiday food is loaded with extra calories from added sugars, fat, and processed junk. After climbing their ladders, lifting the boxes, and the stress of traveling and seeing family, they come crawling into our clinics or gyms with extra weight and a sore back.

What can we do as Doctors of Physical Therapy (DPTs)? Aside from our traditional physical therapy treatments like manual therapy and exercise, we should be using patient education for weight loss. Here are some of our top tips for PTs and weight loss.

Journal Your Foods

Holidays bring big emotions and lots of junk food. Many of this junk food is eaten without our clients' being aware they are eating hundreds, if not thousands, of extra calories. These calories add up quickly promoting weight gain, reducing glycemic control, and stimulating inflammation.

To improve your PT outcomes and shed some pounds, data...

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Top 3 Tips for Weight Loss During Physical Therapy

By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN

The Holidays Are Coming!

We have Halloween, Thanksgiving, Christmas/Passover/Kwanza, and New Years coming. Data show that most Americans will on average gain about 0.4% of body fat during this time, most coming just after Christmas. While 0.4% does not seem like much fat, consider some quick math: a 175 lb man would essentially gain 3/4ths of a pound during the holidays. This small weight gain seems insignificant unless you add this weight gain with other gaining periods in the year, and compound the weight gain every holiday season. In other words, consider if this 175 lb 20 year old gained 0.4% every year for the next 20 years. This would equate to an extra 7 lbs of fat just gained in a few months over 20 years!

How does any of this matter for physical therapy practice? Time and time again my team and I are asked, how can we as physical therapists (PTs) educate our clients to lose weight?...

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Physical Therapy, Weight Loss, and Arthritis

By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN

Weight Loss and Physical Therapy

Traditional physical therapy (PT) does an amazing job at treating dysfunction, pain, and problems. Preventative care and wellness, such as weight loss, was once taboo and often ignored by many physical therapists. However, today's Doctors of Physical Therapy (DPTs) are truly embracing more holistic treatments like nutrition, mindfulness, and sleep habits. Having physical therapy patients lose weight can help reduce inflammation, prevent health issues, and may improve PT outcomes. But what about stopping the weight gain in the first place? Weight gain prevention is vitally important, as it is much more difficult to lose the weight than it is to gain it. Given such interest in these topics, our team found it relevant to consider a recent study looking at weight gain and arthritis -- let's make the case for more PTs to start talking about patients preventing weight.

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Arthritis, PT, and Weight Loss

Last week, I slammed the Journal of Orthopedic and Sports PT (JOSPT) for not including nutrition in their CPGs regarding concussions. This week, I want to laud them for including a great meta-analysis on knee, hip, and spine osteoarthritis (OA) in relation to weight loss in this month's journal.

As physical therapists (PTs), we know that musculoskeletal disorders like knee, hip, and back OA account for a huge portion of healthcare spending. We also know that OA of these joints greatly impacts quality of life, function, and ultimately long-term disability. Physical therapists do their best to offer cutting-edge treatment like exercise and patient education.

Current research shows that people with arthritis can greatly reduce their pain, improve their movement, and restore their strength with physical therapy. Often the best treatments are active exercises, education, activity progression, and manual therapy to initially help to reduce pain. Dry needling has been shown to...

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Physical Therapists Should Be Promoting Weight Loss

Image: Obesity by Jesper Sehested using Creative Commons - (CC BY 2.0) 

Physical Therapists Should Be Promoting Weight Loss

By Dr. Sean M. Wells, DPT, PT, OCS, ATC, CSCS, CNPT, Cert-DN

Physical therapists (PTs) specialize in movement, exercise, and rehabilitation. Our role as healthcare providers extends into many facets  of life and wellness. From stress reduction to nutrition, PTs ought to consider interventions beyond the basic modalities.  Diet can have a substantial impact on weight loss and its commiserate reductions in pain and inflammation, and improvements in function. Regardless of what setting (e.g. outpatient, nursing home, acute care), PTs can educate patients on the benefits of weight loss and even provide simple steps to reducing weight. 

What are the best nutrition methods PTs can provide patients to reduce or even prevent obesity in the first place? A simple answer can be found in the literature centered on the Whole Food Plant-based Diet...

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PTs: Stop Telling Clients to Only Exercise to Lose Weight!

By: Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, CNPT, NSCA-CPT, Cert-DN

I know, I said it. And you are wondering why in the heck a physical therapist, personal trainer, and strength coach would ever say such a thing?!

A few years ago a group of researchers published a wonderful editorial piece in the British Journal of Sports Medicine. Titled It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet, the article stirred the pot and highlighted important data on weight loss.

The literature highlighted how many sports medicine, physio, and personal training professional are biased to exercise as the main mode for weight loss. Furthermore, the authors came out and boldly stated that physical activity does not promote weight loss. That's right, physical activity does not promote weight loss.

If these researchers are right, then why is the American Physical Therapy Association (APTA) hanging their professional "hat" on PTs...

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