"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Friday, June 1, 2012

Adverse Reponse to Exercise: Rare or Common?

We just don't know.

This study Adverse Metabolic Response to Regular Exercise: Is It a Rare or Common Occurrence? was reported in PLoS One yesterday (online).

This is the first study like this I've ever seen. According to the study authors:
"Whether there are people who experience adverse changes in cardiovascular and diabetes risk factors has never been addressed."
This just underscores the need for physical therapists to monitor basic, cardiovascular signs in response to exercise.
  • Blood pressure
  • pulse
  • respiratory rate
  • oxygen stauration
  • rate of perceived effort
  • et al
Acocrding to Jette and Jewel in the April 2012 PT Journal:
  • only 11% of physical therapists routinely measure blood pressure
  • only 38% of physical therapists routinely measure Body Mass Index (BMI)
  • only 21% of physical therapists routinely advise patients to quit smoking
  • only 29%% of physical therapists routinely complete a neurological examination in diabetic patients
  • only 26% of physical therapists routinely complete a footwear examination in diabetic patients
  • only 6% of physical therapists routinely measure gait velocity in their older patients
I'd like to see physical therapists advocate to change our state practice acts so that we could penetrate the skin and collect blood samples to measure important factors in assessing exercise response, included in this study:
  • fasting plasma HDL-cholesterol (HDL-C)
  • triglycerides (TG)
  • insulin (FI)
At least one state physical therapists' association was successful in 2011 in increasing their scope of practice to allow penetration of the skin.

But, before changing state practice acts we need to measure the basic stuff.

Otherwise we'll never know.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

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