Promoting physical activity in different patient groups

Promoting physical activity has become an important issue in public health as well as in physiotherapy in order to increase health in different groups of patients and in the general population. The American College of Sports Medicine (ACSM) and the American Heart Association (AHA) released updated physical activity guidelines in 2007 (1). They recommend, for healthy adults under the age of 65, physical activity of moderate intensity 30 min a day, 5 days a week, or of vigorous intensity 20 min a day, 3 days a week, and 8 10 strength-training exercises with 8 12 repetitions of each exercise, twice a week. Another way of measuring the level of activity is counting the number of steps taken per day, by using a pedometer or accelerometer. The idea behind 10,000 steps originally came up in Japan and was initially not based on scientific research. A quick search on PubMed in October 2009 using the text words ‘‘10,000 steps’’ gives close to 1000 hits, indicating that this concept of enhancing physical activity has been used in many population groups. Walking has thus become a popular way of exercising in health promotion. In this issue of Advances in Physiotherapy, a joint article from New Zealand and UK, by Macpherson and co-workers, investigates whether individuals who walk 10,000 steps at faster and slower speeds meet the recommendations to expend 150 kcals and spend 30 min in moderate intensity physical activity. Their results indicate that walking 10,000 steps at a low speed may achieve 150 kcals of energy expenditure, but when more than 30 min is spent on this task, the intensity is less likely to reach recommended levels. Graded increases in walking speed may thus be beneficial. Another study also using walking tests is presented by JanaudisFerreira and co-workers from Sweden. They used two different 6-min walking tests to investigate whether there is any difference in training effects following a training period with or without oxygen supplementation in patients with moderate to severe chronic obstructive pulmonary disease (COPD). The authors recommend that supplemental oxygen during physical training should not be routinely used and that further research is needed. From India, Syed and co-workers present a crossover study where active breathing technique is compared with conventional chest physiotherapy on airway clearance in bronchiectasis patients. They found both methods equally effective, but the patients preferred the active breathing technique, which therefore could be recommended in this patient group. Ǿsterås and co-workers from Norway present a study on dose response effects of graded therapeutic exercises in patients with long-standing subacromial pain. They compared a high dose with a low dose of the same repetitive exercise programme. The highdose group had significantly better results than the low-dose group with respect to pain, function, range of motion and isometric strength. There seems to be a relationship between exercise dose and treatment response. The authors suggest further studies using this high-dose regimen compared with surgery. Kilpikoski and co-workers from Finland present a secondary analysis of a randomized controlled trial with 1-year follow-up, on centralizing low back pain. They examined whether adults with centralized low back pain achieve better treatment outcomes when treated by individually designed therapy, compared with being given advice to stay active. The results suggest that centralizers have a tendency to achieve better treatment outcomes when treated with individually designed therapy than when being given advice to stay active. Thus, the results also show the role of the physiotherapist in treatment of this patient group. Improving gait function and the ability to stand up are important parts in neurologic rehabilitation. Maeland and co-workers from Norway, examined the effects of a progressive resistance exercise programme on gait function in adults with spastic diplegia. They found no difference in the 6-minute walking test from baseline to 8 weeks between the exercise group and the control group, participating in individual training or training as usual. Thus, resistance exercises do not seem to be enough to improve walking capacity in this patient group. Contrary to this, Morris and co-workers from Australia, found in a AB single-system trial, that progressive resistance strengh training increased muscle strength and ability to stand up in traumatic brain injury, in a community-based programme. Advances in Physiotherapy. 2009; 11: 177 178