Physio findings: Public Health

Physios need training to combat chronic illness  

Physiotherapists are well placed to help patients avoid lifestyle-related diseases, say researchers - but they need more professional support and relevant education.

The team surveyed 163 primary-care physiotherapists in Ireland about how they assessed their patients’ risks, and what action they took to manage them.

Small lifestyle changes can significantly affect the risk of developing conditions such as cancer, diabetes, ischaemic heart disease, chronic lung disease, hypertension and stroke, they note.

The commonest risk factor the physios assessed was lack of physical activity, identified and followed up by 78 per cent of those surveyed. Unhealthy diet was picked up by 55 per cent.

But the physios said they had little time to talk to patients about other high-risk behaviour such as smoking or drinking, and they doubted their expertise in that area. Assessment and management of risk factors were only carried out intermittently.

‘The findings highlight an untapped potential in relation to physiotherapists addressing lifestyle-related risk factors,’ say the authors, from University College Dublin, Dublin City University and the Steno Diabetes Centre in Denmark.

They stress the need to develop practice standards, clinical competencies and a relevant professional education curriculum to help prevent and manage chronic disease.

O’Donoghue G et al. Assessment and management of risk factors for the prevention of lifestyle-related disease: A cross-sectional survey of current activities, barriers and perceived training needs of primary care physiotherapists in the Republic of Ireland. Physiotherapy 2014; http://dx.doi.org/10.1016/j.physio.2013.10.004

Women’s health

Electricity aids stress incontinence
Women with stress incontinence make more progress when mild electrical stimulation is added to their exercise programme, say researchers. Yet urge incontinence doesn’t respond so well.

A team of physiotherapists studied 64 women with either stress incontinence (in which leakage is triggered by a sudden movement such as a sneeze) or urge incontinence (a sudden need to urinate at once).

All the women carried out an eight-week programme of pelvic-floor and abdominal exercises. Women with each condition were randomly allocated to do either exercise only, or exercise with added electrical stimulation.

The study’s outcome measures were quality of life, pelvic muscle strength, leaks and frequency of urination.

All the exercisers improved, while a control group of women who didn’t exercise got worse. Exercisers with stress incontinence improved even more when they also had electrical stimulation. But it didn’t help those with urge incontinence – those who just exercised did better than those who also had electrical stimulation.

‘The addition of electrical stimulation appears most useful for muscle reeducation in women with weak pelvic floor muscles,’ say the authors. Firra J et al. Paradoxical Findings in the Treatment of Predominant Stress and Urge Incontinence: A Pilot Study With Exercise and Electrical Stimulation. Journal of Women’s Health Physical Therapy 2013; http://dx.doi.org/10.1097/JWH.0000000000000003

Older people

Exercise offers hope even for failing hearts  
Exercise training can increase health-related quality of life for older men with heart failure, a systematic review has shown.

The 530 men who took part in seven studies also significantly improved their ability to walk briskly for six minutes.

But the researchers found that exercise had no effect on other measures including deaths, hospital admissions, or aerobic fitness as measured by oxygen uptake.

‘The long-term efficacy and safety of exercise training in elderly heart failure patients require further study based on large and rational-designed controlled clinical trials,’ say the authors. Chen YM & Li Y. Safety and efficacy of exercise training in elderly heart failure patients: a systematic review and meta-analysis. International Journal of Clinical Practice 2013; http://dx.doi.org/10.1111/ijcp.12210

Comments & Conclusions

• Obese men who followed a 12-week health-lifestyle course run by their favourite football clubs lost nearly 5kg more, on average, than men who didn’t take part, a randomised controlled trial shows. The Football Fans in Training programme has run for three seasons at Scottish Professional Football League clubs. Hunt K et al. Lancet 2014; http://dx.doi.org/10.1016/S0140-6736(13)62420-4

• Virtual reality games can improve motor function in children with developmental coordination disorder, a small study suggests. Ashkenazi T et al. Pediatric Physical Therapy 2013; http://dx.doi.org/10.1097/PEP.0b013e3182a74398

• A study of 21 couples, aged 18 to 35, disproved the myth that sex burns off more calories than a workout – but noted that participants find it a lot less strenuous than 30 minutes on a treadmill. Frappier J et al. PLOS One 2013; http://dx.doi.org/10.1371/journal.pone.0079342

• Women with the best chance of uncomplicated pregnancy are those in paid employment, of normal weight and blood pressure, who ate plenty of fruit before conception and don’t misuse alcohol or other drugs. Chappell LC et al. BMJ 2013; http://dx.doi.org/10.1136/bmj.f6398

• Researchers reviewed 44 studies of work-related upper-limb disorders, covering 6,580 participants, but found little high-quality evidence about the effects of exercise, ergonomic adjustments or behavioural interventions. ‘Studies are needed that include more participants, that are clear about the diagnosis of work-relatedness and that report findings according to current guidelines,’ they concluded. Verhagen AP et al. Cochrane Database of Systematic Reviews 2013; http://dx.doi.org/10.1002/14651858.CD008742.pub2

• A study of non-smokers in sedentary jobs found that those who were most active and fit were also the least likely to have moderate or severe gum disease. Eberhard J et al. Journal of Clinical Periodontology 2014; http://dx.doi.org/10.1111/jcpe.12183

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