In this blog, written as the Rio Olympics begin, I’d like to discuss the following proposition:
‘Physiotherapists are ideally- or well-placed to play a leading preventative and health promoting role in tackling sedentary lifestyle behaviours, by encouraging increased levels of regular physical activity to improve the health and wellbeing of individuals and communities.’
I can’t imagine many physiotherapists would disagree that our profession is well-placed, if not ideally-placed, to make a very significant contribution to public health through challenging and changing sedentary lifestyle behaviours.
Equally, many physiotherapists would I hope acknowledge that, while our profession makes a key contribution and with scope to play a greater role, it is not uniquely placed. Tackling sedentary lifestyle behaviours requires a whole-systems approach with physiotherapists playing their part working with many individuals, communities and organisations.
The prescription of exercise and physical-activity now feature prominently in public health interventions with ever-growing evidence linking inactivity with greater health risks, and health benefits with more physically active lifestyles.
Doctors are also prescribing exercise
As physiotherapists have extended their scope of practice to encompass the prescribing of certain medications, so too medical doctors and other health and fitness professionals are increasingly assessing and delivering exercise prescription. However some physiotherapists may regard exercise prescription as core to, and the sole preserve of, their profession. I have witnessed many heated debates on professional scope and boundaries, fuelling professional tribalism and defensiveness.
When it comes to promoting more physically-active lifestyles, while I regard physiotherapists as being well-placed to play a key role, I believe there is 'more than enough work to go around' and more crucially, a need for multiple interventions and approaches involving many stakeholders. So I welcome, for example, the recent introduction of exercise prescription into the curricula of medical students, as much as I welcome medical prescribing now being part of allied health professionals' curricula.
So let’s now consider the following assertion:
'As a physiotherapist I am an excellent/good/poor role model for promoting a physically active lifestyle to others, as evidenced by my own physically active lifestyle.'
As a student physiotherapist and throughout my professional career I have fulfilled what I perceive to be a commonly-held stereotype of physiotherapists – being ‘sporty and competitive’ – or at least being physically very active!
Professor Karen Middleton, CEO of the CSP, and many other physiotherapists I know, have been attracted to the profession through an interest in sport. This stereotype is of course by no means universally true and many students and qualified physiotherapists would not regard themselves as either sporty or competitive ... although I seldom meet any who would class themselves as physically inactive!
Must we be active to promote activity?
Is being physically active a pre-requisite for effectively promoting physical activity for others? Well first and foremost, adopting a physically active lifestyle is important for maintaining one’s own health and wellbeing. It also seems a reasonable expectation that, as a good role model, it adds credibility to ‘walk the talk’ and be able to draw on and share personal experience of changing one’s own activity lifestyle behaviour.
However, as a former British international athlete (8th in London marathon, 7th in Commonwealth Games marathon) – I would do 100 miles a week training. I doubt that as a clinical physiotherapist I role-modelled a level of physical activity that any of my sedentary patients would easily relate to.
With my athletics career over and a job involving prolonged periods of sitting, I now count daily steps walked and stairs climbed on my fit-bit rather than miles run, and so am perhaps better-placed as a role model. It is hard to shake-off a competitive instinct and in our recent Leeds Beckett University Step Challenge, a workplace scheme over six weeks designed to promote levels of staff activity through walking, running, cycling or swimming, incentivised by individual and team prizes, I covered 753 miles averaging 18 miles a day.
Yes of course I was first ... the taking part may be important for health benefits, but the winning still counts!
Professor Ieuan Ellis MCSP
Pro vice chancellor - Leeds Beckett University