World Physical Therapy Day
Resources on physical activity and
non-communicable diseases
Contents
Introduction ............................................................................................................................... 2
About physical therapy ............................................................................................................... 3
Facts and figures about physical therapists .................................................................................. 4
About physical therapy and non-communicable diseases .......................................................... 5
About physical activity and child obesity .................................................................................... 6
About physical activity and cardiovascular disease ....................................................................... 9
About physical activity and diabetes ......................................................................................... 11
About physical activity and active ageing .................................................................................... 13
About physical activity and cancer ............................................................................................ 16
Journal articles about physical therapy ...................................................................................... 18
Notes about this booklet
The terms physical therapy and physiotherapy
refer to the same profession – some countries
use one term, some the other. When the words
physical therapy and physical therapist are used
in this document, they also refer to physiotherapy
and physiotherapist.
The information in this booklet may be
reproduced without charge. It is designed as a
resource, and does not necessarily represent an
official WCPT view or policy.
World Confederation for Physical Therapy | 1
Introduction
This booklet provides facts, research findings, statistics and articles to help you demonstrate the contribution of
physical therapists, as part of your World Physical Therapy Day events and campaigns.
World Physical Therapy Day falls on 8th September every year. It is an opportunity for physical therapists (known
in some countries as physiotherapists) all over the world to raise awareness about the crucial role their profession
plays in making and keeping people well, mobile and independent. The day was established in 1996, by the World
Confederation for Physical Therapy – the profession’s global body representing over 350,000 physical therapists in
106 countries.
WCPT has compiled this information for you to use freely. If you’re not sure what to organise for World Physical
Therapy Day yet, there are plenty of suggestions in the complementary booklet “World Physical Therapy Day: what
to do, how to do it, how to get noticed”.
2 | World Confederation for Physical Therapy
About physical therapy
Here is some basic information about physical therapy
for you to copy and use in any material you produce to
educate the public. If you refer to “physiotherapists” rather
than “physical therapists” in your country, do change the
text appropriately.
Physical therapists are experts in developing and
maintaining people’s ability to move and function
throughout their lives. With an advanced understanding
of how the body moves and what keeps it from
moving well, they promote wellness, mobility and
independence. They treat and prevent many problems
caused by pain, illness, impairments and disease, sport
and work related injuries, ageing and long periods of
inactivity.
Physical therapists work with people affected by a wide
range of conditions and symptoms, for example:
• painful conditions such as arthritis, repetitive strain
injury, neck and back pain
• cancer
• strokes, Parkinson’s disease and spinal cord injury
and limitations in movement and function
• use many treatment approaches to help individuals
regain their mobility and maximise their potential
• promote healthy lifestyles and exercise
• treat each patient/client as an individual and
thoroughly assess them to identify their needs
• treat sports injuries
• promote safe and healthy activities
• work with children with coordination, balance and
other movement problems to improve and maximise
their independence.
To achieve all this, physical therapists are educated
over several years, giving them a full knowledge of the
body’s systems and the skills to treat a wide range of
problems. This education is usually university-based
and at a level that provides full professional recognition
and allows them to practise independently. Continuing
education ensures that they keep up to date with the
latest advances in research and practice. Many physical
therapists are engaged in research themselves.
• heart problems
• lung disease
• trauma, such as road traffic accidents and landmines
• incontinence
They work in a variety of settings, including hospitals,
health centres, sports facilities, education and research
centres, hospices and nursing homes, rural and
community settings.
Here are some examples of how physical therapists
make a difference. They:
• use their skills to treat the underlying causes of pain
World Confederation for Physical Therapy | 3
Facts and figures about
physical therapists
Physical therapists work with people of all ages to bring
about improvements in their health and independence.
Physical therapists provide exercise prescriptions to
help people keep fit and achieve/maintain a healthy
weight.
Around 350 million people are obese worldwide.
Physical activity is one of the best means of countering
obesity.
Children and young people under the age of 18 need 60
minutes of moderate to vigorous physical activity each
day to promote and maintain health.
Adults need 30 minutes of moderate physical activity
five days a week, or 20 minutes of vigorous physical
activity three days a week to maintain health. Plus they
need to do muscle strengthening exercises at least
twice a week.
Research has shown that physical therapy exercise
prescriptions help women who experience
incontinence, osteoporosis or breast cancer surgery.
Studies have indicated that physical therapy treatments
have a major impact on conditions such as back and
neck pain.
Physical activity provided under the guidance and
supervision of a physical therapist reduces the risk of
heart attack, stroke, type 2 diabetes, colon cancer and
breast cancer.
Despite limited numbers of physical therapists in some
countries around the world, they have proved their
effectiveness at getting and keeping people healthy.
Physical therapists provide exercise programmes for
4 | World Confederation for Physical Therapy
conditions that affect the bones and muscles, such
as arthritis, back and neck pain, osteoporosis, joint
replacements, and urinary incontinence.
More detailed information about what physical
therapists do can be found in WCPT’s Description
of Physical Therapy at www.wcpt.org/policy/psdescriptionPT.
Physical therapists helping
people become fit at every age
This article by WCPT’s President, Marilyn Moffat, can be
published in newsletters, magazines and journals, or
passed to other publications as background information.
Movement and exercise are fundamental to leading
a healthy, happy life – whatever age you may be. The
World Health Organization says that inactivity is one of
the leading preventable causes of death worldwide, and
has made physical activity a public health priority.
Lack of exercise is a significant risk factor for chronic
non-communicable diseases (NCDs) like heart disease,
stroke, cancer, chronic respiratory diseases, and diabetes
– which now make up 60% of all deaths. Not only that,
but lack of exercise can cause lasting disability.
The profession of physical therapy, known in some
countries as physiotherapy, helps millions of people
every year to prevent and manage the effects of NCDs,
along with the effects of inactive lifestyles, aging, illness,
accidents, and the stresses and strains of life.
Physical therapists specialise in human movement
and physical activity. They identify physical and other
factors that prevent people from being as active and
independent as they can be, and then they find ways of
overcoming them.
Every year on 8th September, physical therapists around
the world use World Physical Therapy Day to draw
attention to the contribution the profession can make
to the health of individuals and nations. The message is
“Movement for Health”. This year we’re promoting the
message that keeping fit is an investment for the future,
no matter how old you are. We want people to be “Fit for
life”.
For aging adults, there’s nearly always potential to build
for a healthier happier future. I conduct workshops
around the world, demonstrating how aging adults
and patients with chronic health problems can improve
their health by learning how to exercise safely under the
guidance and instruction of physical therapists.
The effects of aging, unfortunately, begin in our 30s
and we decline thereafter unless we maintain a healthy
lifestyle. As we age fat mass increases and aerobic
capacity and muscle mass decrease if we don’t get
enough exercise. This means less oxygen is delivered to
key organs, making daily exercise even more difficult.
Routine daily activity can break the cycle, reverse the
decline, and lead to a longer life.
Studies have shown that older adults engaged in
regular physical activity demonstrate improved balance,
strength, coordination, motor control, flexibility and
endurance. Research also shows how effective physical
therapists are at treating and preventing back pain, joint
problems, balance disorders, strength decline – and
reducing high blood pressure and obesity.
At the other end of the age range, physical activity
is vitally important in children. Childhood obesity is
a significant risk factor for asthma, musculoskeletal
problems and depression as well as other NCDs. Physical
inactivity and poor posture in children can also cause
musculoskeletal problems that have a legacy long into
adult life.
But if children participate in physical activity they can
head off many of these conditions. Physical therapists
can help them overcome physical problems that may
restrict their ability to move.
Physical activity doesn’t just mean more healthy people,
but happier more productive people, whether young or
aging. It’s time for all of us to be fit for the future.d.
Marilyn Moffat, WCPT President
World Confederation for Physical Therapy | 5
About physical activity and
child obesity
According to the World Health Organization, childhood
obesity “is one of the most serious public health
challenges of the 21st century“
Source: www.who.int/dietphysicalactivity/en/
Obesity in childhood is linked with asthma,
musculoskeletal problems, hypertension, early signs of
cardiovascular disease, low self-esteem and depression.
In the long-term, it can increase the likelihood of being
an obese adult, and having a greater risk of cancer, type
2 diabetes and cardiovascular disease. Encouraging
children and their families to reach recommended levels
of physical activity is a cornerstone of obesity treatment
and prevention.
Participation in physical activity helps prevent many
chronic diseases. All physical therapists are experts
in movement and exercise, and the ways in which
it promotes health. Some physical therapists, called
paediatric physical therapists, specialise in working with
children. A physical therapy assessment is particularly
important for children who are obese. The assessment
can screen for musculoskeletal impairments and guide
therapeutic exercise and physical activity prescription.
Childhood obesity facts
Globally, over 40 million preschool children were
overweight in 2008. More than 75% of overweight and
obese children live in low-and middle-income countries.
Source: WHO www.who.int/features/factfiles/obesity/en/
Childhood obesity affects people regardless of their
income. The problem is global and is steadily affecting
many low-and middle-income countries, particularly in
urban settings.
Source: WHO www.who.int/mediacentre/factsheets/fs311/en/
Children’s choices, diet and physical activity habits are
6 | World Confederation for Physical Therapy
influenced by their surrounding environment.
Source: WHO www.who.int/features/factfiles/obesity/en/
Children who are obese have a high incidence of
musculoskeletal impairments.
Source: http://onlinelibrary.wiley.com/doi/10.1111/j.14401754.2011.02102.x/abstract
Rising levels of childhood obesity are being caused
mainly by a shift towards energy-dense foods high in fat
and sugars, and decreasing levels of physical activity.
Source: WHO www.who.int/dietphysicalactivity/childhood/en/
Defining child obesity
The World Health Organization defines childhood
obesity as having a body mass index (BMI) standardised
deviation score (SDS) above 2.0. Childhood growth and
BMI should be plotted on WHO age and gender specific
charts in tandem with national growth reference
charts. Measures of body composition such as waist
circumference should be used to describe obesity.
Source: WHO www.who.int/growthref/who2007_bmi_for_age/en/
index.html
Child obesity and physical activity
The World Health Organization recommends 60 minutes
of moderate to vigorous intensity physical activity
every day for children aged 5-18. Moderate activity
includes activities that raise the heart rate and cause
some breathlessness. Vigorous activity is exercise
that makes people huff and puff – and could include
dancing, household chores and sports like running
and football. Activities for children should be fun and
age-appropriate. In addition, families should be active
together because parents are the most important
agents of lifestyle change.
Source: WHO www.who.int/dietphysicalactivity/childhood_what_can_
be_done/en/index.html
Physical activity recommendations
Children from birth to age five should engage in daily
physical activity that promotes skill in movement and
lays the foundations of health-related fitness.
Source: National Association for Sport and Physical Education
guidelines on physical activity for children www.aahperd.org/naspe/
standards/nationalGuidelines/ActiveStart.cfm
Infants should interact with caregivers in daily physical
activities that are dedicated to exploring movement and
the environment and that promote skill development in
movement.
Source: National Association for Sport and Physical Education
guidelines on physical activity for children www.aahperd.org/naspe/
standards/nationalGuidelines/ActiveStart.cfm
Toddlers should engage in a total of at least 30 minutes
of structured physical activity and at least 60 minutes
per day of unstructured physical activity and should not
be sedentary for more than 60 minutes at a time, except
when sleeping.
Source: www.aahperd.org/naspe/standards/nationalGuidelines/
ActiveStart.cfm
Children under five should be physically active daily for
at least 180 minutes spread throughout the day.
Source: WHO recommendations 2010 in WCPT Active and Healthy.
The role of the physiotherapist in physical activity. General Meeting of
European Region of the WCPT 2012. Pages 13-14.
Children should accumulate at least 60 minutes, and
up to several hours, of age-appropriate physical activity
on all or most days of the week. This should include
moderate and vigorous physical activity with most
of the time being spent on activities where exercise
is intermittent. Children should participate in several
bouts of physical activity lasting 15 minutes or more
each day. Periods of inactivity of two or more hours are
discouraged for children, especially during the daytime
hours.
Source: National Association for Sport and Physical Education
guidelines on physical activity for children www.aahperd.org/naspe/
standards/nationalGuidelines/PA-Children-5-12.cfm
The role of the physical therapist
In cases of childhood obesity, a physical therapy
assessment covers: 1) parental beliefs around
healthy childhood growth and development; 2)
cardiorespiratory (exercise testing); 3) musculoskeletal
(including assessment of range of movement; strength;
flexibility; balance; coordination; posture; gait and bony
alignment); 4) sedentarism (eg screen-time); 5) sleep;
6) physical activity levels and perceived barriers to
reaching recommended levels.
Treatment includes: 1) general health literacy education
for child and parent 2) management of any associated
conditions (eg painful flat fee, knee pain, weak core)
identified in physical assessment; 3) age-appropriate
and fun exercise training to increase physical fitness;
4) assisting parent/s to make changes at home to
prevent obesity developing or progressing; 5) providing
education and practical strategies to improve sleep and
energy balance; 6) liaison and onward referral within the
interdisciplinary team.
Positive communication between the therapist and
family is essential. Many parents may not be aware
that their child’s weight is a problem. Ensuring that a
holistic assessment is used to identify areas where the
child may have functional difficulties (eg balance or low
cardiorespiratory fitness) may help the therapist discuss
the child’s health without solely focusing on shape or
size. In order to facilitate a child’s lifestyle change, it is
recommended that the full family works towards this.
Source: Júlíusson PB, et al., Overweight and obesity in Norwegian
World Confederation for Physical Therapy | 7
children: prevalence and socio-demographic risk factors.
Acta Paediatr. 2010 Jun;99(6):900-5. www.ncbi.nlm.nih.gov/
pubmed/20175763
O’Malley et al., A Pilot study to profiles the lower limb musculoskeletal
health in obese children. Pediatric Physical Therapy (in press). www.
mendeley.com/research/tracking-overweight-early-childhoodadolescence-cohorts-born-1988-1994-overweight-high-birth-weightpopulation
A review of evidence on the effect of physical activity
on the development of pre-school children concluded
that the availability of outside playing areas, and the
encouragement and involvement of adults, were
important in encouraging exercise.
Source: Timmons BW et al. Physical activity for preschool children how much and how? Can J Public Health. 2007; 98 Suppl 2:S122-34.
www.ncbi.nlm.nih.gov/pubmed/18213943
Children with illness or disabilities are more restricted in
exercise participation, and have higher levels of obesity
than their peers. Finding structures that support them
to participate brings psychological and social, as well
as physical, advantages. Professionals such as physical
therapists are well placed to ensure that activities are
appropriate.
Source: Murphy NA et al. Promoting the participation of children with
disabilities in sports, recreation, and physical activities. Pediatrics.
2008; 121(5):1057-61 http://aappolicy.aappublications.org/cgi/
content/full/pediatrics;121/5/1057
This information was produced with the kind assistance
of the International Organisation of Physical Therapists in
Paediatrics.
8 | World Confederation for Physical Therapy
About physical activity and
cardiovascular disease
Cardiovascular disease is the term used to describe
diseases affecting the heart and circulatory system, and
includes heart disease, stroke and raised blood pressure
(hypertension).
Exercise, particularly aerobic conditioning and strength
training, is one of the key interventions that can prevent
death and disability from cardiovascular disease.
Physical therapists are experts in prescribing these as
part of a structured, safe and effective programme.
For those already affected by cardiovascular disease, the
expert advice provided by physical therapists can help
bring a return to usual roles. Physical therapists help
people achieve a return to work, education, community
participation and fulfilled lives.
Cardiovascular general
Cardiovascular disease is now the leading cause of
deaths worldwide. Globally, 17.3 million people died
from cardiovascular disease in 2008, 30% of all deaths.
7.3 million were due to coronary heart disease and
6.2 million due to stroke. It is estimated that by 2030,
almost 23.6 million people will die from cardiovascular
diseases, mainly heart disease and stroke.
Source: World Health Organization www.who.int/mediacentre/
factsheets/fs317/en/
The death and disability rates caused by heart disease
and stroke for every country are available at: http://
whqlibdoc.who.int/publications/2011/9789241564373_
eng.pdf
It has been estimated that if everyone walked briskly at
4.8-6.4 kph (3-4 mph) on most days of the week, about
30% of deaths from cardiovascular disease would be
prevented each year.
Sources: Pate R et al. Physical activity and public health. JAMA.
1995;273(5):402-407. www.ncbi.nlm.nih.gov/pubmed/7823386
Wei M, Kampert et al. Relationship between low cardiorespiratory
fitness and mortality in normal-weight, overweight, and obese
men. JAMA. 1999;282(16):1547-1553. www.ncbi.nlm.nih.gov/
pubmed/10546694
Manson JE et al. A prospective study of walking as compared with
vigorous exercise in the prevention of coronary heart disease in
women. NEJM. 1999;341(9):650-658. content.nejm.org/cgi/content/
abstract/347/10/716
Tully M et al. Brisk walking, fitness, and cardiovascular risk: a
randomized controlled trial in primary care. Prevent Med. 2005;41:622628. www.ncbi.nlm.nih.gov/pubmed/15917061
Research involving people at risk of cardiovascular
disease has indicated that exercise supervised by
physical therapists, along with counselling from a
dietician, brings significant improvements in blood
pressure, weight, quality of life and other health
indicators after one year.
Source: Eriksson KM, Westborg CJ, Eliasson MC. A randomized trial
of lifestyle intervention in primary healthcare for the modification of
cardiovascular risk factors. Scand J Public Health. 2006;34(5):453-61.
www.ncbi.nlm.nih.gov/pubmed/16990155
Raised blood pressure
Raised blood pressure, which is a risk factor for heart
attack and stroke, can be controlled by exercise. One
study has indicated that endurance exercise brings an
average reduction of 10mm Hg for both systolic and
diastolic blood pressure readings.
Source: American College of Sports Medicine’s Guidelines for Exercise
Testing and Prescription. 6th Ed. Baltimore MD: Lippincott Williams &
Wilkins 2000. www.exrx.net/Store/Other/ACSMGuidelinesExTestingRx.
html
The type of strength training prescribed by physical
therapists can effectively reduce blood pressure in older
men and women.
Source: Martel GF et al. Strength training normalizes resting blood
pressure in 65- to 73-year- old men and women with high normal
blood pressure. J Am Geriatr Soc. 1999 Oct;47(10):1215-21. www.ncbi.
nlm.nih.gov/pubmed/10522955
Major analyses of available research have indicated that
exercise can reduce resting blood pressure by 3mm Hg
for resting systolic blood pressure.
Sources: Cornelissen VA, Fagard RH. Effects of endurance training
on blood pressure, blood pressure-regulating mechanisms, and
cardiovascular risk factors. Hypertension 2005 Oct; 46(4):667-75. www.
ncbi.nlm.nih.gov/pubmed/16157788
World Confederation for Physical Therapy | 9
Kelley GA, Kelley KS. Progressive resistance exercise and resting
blood pressure: a meta- analysis of randomized controlled trials.
Hypertension. 2000 Mar; 35(3):838-43. www.ncbi.nlm.nih.gov/
pubmed/10720604
This type of blood pressure reduction has been
associated with a 5-9% reduction in heart morbidity,
and a 8% to 14% reduction in the risk of stroke.
Source: Whelton et al. Primary prevention of hypertension: clinical
and public health advisory from The National High Blood Pressure
Education Program. JAMA. 2002 Oct 16;288(15):1882- 8. www.ncbi.
nlm.nih.gov/pubmed/12377087
Stroke
Exercise reduces the risk of stroke. Walking at 4.8 kph
(3 mph) for 5 hrs/wk brings a 46% lower risk of stroke,
compared with non-exercisers.
Sources: Hu F et al. Physical activity and risk of stroke in women. JAMA.
2000; 283(22):2961- 2967. www.ncbi.nlm.nih.gov/pubmed/10865274
Lee I et al. Exercise and risk of stroke in male physicians. Stroke.
1999;30(1):1-6. www.ncbi.nlm.nih.gov/pubmed/9880379
Structured exercise also brings improvement in all
measures of impairment and disability in people who
have had a stroke.
Source: Teixeira-Salmela et al. Muscle strengthening and physical
conditioning to reduce impairment and disability in chronic stroke
survivors. Arch Phys Med Rehabil. 1999 Oct; 80(10):1211-8. www.ncbi.
nlm.nih.gov/pubmed/10527076
In one study, patients who had had a stroke performed
strengthening and functional tasks three times a week
for four weeks, and gained significant improvements
in strength, walking speed, standing/sitting and
endurance.
Source: Dean CM et al. Task-related circuit training improves
performance of locomotor tasks in chronic stroke: a randomized,
controlled pilot trial. Arch Phys Med Rehabil. 2000 Apr;81(4):409-17.
www.ncbi.nlm.nih.gov/pubmed/10768528
Heart disease
Systematic reviews of evidence have shown that
therapeutic exercise provided by physical therapists is
beneficial to people with coronary heart disease, heart
10 | World Confederation for Physical Therapy
failure and chronic obstructive pulmonary disease.
Source: Taylor, NF et al. Therapeutic exercise in physiotherapy practice
is beneficial: a summary of systematic reviews 2002–2005. Australian
Journal of Physiotherapy. 2007, Vol 53(1): 7-15. www.ncbi.nlm.nih.gov/
pubmed/17326734
Reviews of evidence have shown that exercise-based
cardiac rehabilitation for patients with coronary heart
disease significantly improves health outcomes and
mortality rates.
Sources: Clark et al. Meta-analysis: secondary prevention programs for
patients with coronary artery disease. Ann Intern Med. 2005; 143:659672. www.annals.org/cgi/content/abstract/143/9/659
Taylor RS et al. Exercise-based rehabilitation for patients with coronary
heart disease: systematic review and meta-analysis of randomized
controlled trials. Am J Med. 2004; 116:682– 692. www.ncbi.nlm.nih.
gov/pubmed/15121495
A review of evidence has indicated that exercise
training in people who have had heart failure is safe and
effective.
Source: Smart N, Marwick TH. Exercise training for heart failure
patients: a systematic review of factors that improve patient mortality
and morbidity. Am J Med. 2004; 116: 693-706 www.ncbi.nlm.nih.gov/
pubmed/15121496
Telehealth interventions can help reduce cardiovascular
disease risk and help increase uptake of a prevention
programmes by those who do not access cardiac
rehabilitation.
Source: Neubeck L et al. Telehealth interventions for the secondary
prevention of coronary heart disease: a systematic review. European
Journal of Cardiovascular Prevention and Rehabilitation. 2009; Vol
16(3): 281-9 www.ncbi.nlm.nih.gov/pubmed/19407659
This information was produced with the kind assistance of
Julie Redfern.
About physical activity
and diabetes
Diabetes mellitus is a condition where the amount of
glucose in the blood is too high, causing tissue damage.
There are two types. Type 1 diabetes occurs when the
body is unable to produce any insulin. It cannot be
prevented. Type 2 diabetes develops when the body
isn’t producing enough insulin, or becomes resistant
to insulin. This type of diabetes can be prevented. Most
cases of type 2 diabetes are associated with being
overweight.
Exercise is one of the best ways to control or reduce
weight, and reduce risk of type 2 diabetes. Physical
therapists are experts in prescribing structured, safe and
effective exercise programmes.
Their advice can also help people who have health
complications as a result of diabetes. For example, they
can help those who have lost limbs through diabetesrelated amputations recover their mobility and adapt
their environment so that they have independence.
Physical therapists help people achieve a return to work,
education, community participation and fulfilled lives.
Diabetes facts
The World Health Organization (WHO) estimates that
346 million people worldwide have diabetes. This
number is expected to double by 2030.
Source: World Health Organization factsheet www.who.int/
mediacentre/factsheets/fs312/en/
Diabetes was traditionally more common in developed
countries, but modernisation and lifestyle changes
have meant it is increasingly prevalent in developing
countries. According to WHO, almost 80% of diabetes
deaths occur in low and middle-income countries.
Source: World Health Organization factsheet www.who.int/
mediacentre/factsheets/fs312/en/
Diabetes and its complications have a significant
economic impact on individuals, families, health
systems and countries. For example, WHO estimates
that in the period 2006-2015, China will lose $558 billion
in national income due to heart disease, stroke and
diabetes alone.
Source: World Health Organization factsheet www.who.int/
mediacentre/factsheets/fs312/en/
The death and disability rates caused by diabetes for
every country are available at: www.who.int/entity/
cardiovascular_diseases/en/cvd_atlas_29_world_data_
table.pdf
Exercise and diabetes
Exercise has a role in preventing and controlling
diabetes. According to the World Health Organization,
30 minutes of moderate intensity physical activity on
most days, along with a healthy diet, can help reduce
the risk of developing type 2 diabetes. Source: World Health
Organization www.who.int/mediacentre/factsheets/fs312/en/
Both resistance exercise and aerobic exercise are
effective at reducing glucose intolerance and reducing
the risk of diabetes.
Sources: Fenicchia LM et al. Influence of resistance exercise training
on glucose control in women with type 2 diabetes Metabolism. 2004
Mar;53(3):284-9. www.ncbi.nlm.nih.gov/pubmed/15015138
Castaneda C et al. A randomized controlled trial of resistance exercise
training to improve glycemic control in older adults with type 2
diabetes. Diabetes Care. 2002 Dec; 25(12):2335-41. www.ncbi.nlm.nih.
gov/pubmed/12453982
High-intensity progressive resistance training, in
combination with moderate weight loss, is effective in
controlling blood glucose levels in older patients with
type 2 diabetes.
Source: Dunstan DW et al. High-intensity resistance training improves
glycemic control in older patients with type 2 diabetes. Diabetes Care.
2002 Oct;25(10):1729-36. www.ncbi.nlm.nih.gov/pubmed/12351469
World Confederation for Physical Therapy | 11
Moderate aerobic exercise alone or with resistance
training improves glycemic control, waist circumference,
and protects heart in individuals with type 2 diabetes.
Source: Chudyk A, Petrella RJ. Effects of exercise on cardiovascular
risk factors in type 2 diabetes: a meta-analysis. Diabetes Care. 2011
May;34(5):1228-37. www.ncbi.nlm.nih.gov/pubmed/21525503
Regular, moderate exercise lowers risk of developing
diabetes in those who are overweight and with prediabetes.
Sources: Evans WJ. Effects of exercise on body composition and
functional capacity of the elderly. J Gerontol A Biol Sci Med Sci.
1995;50 Spec No:147-50. www.ncbi.nlm.nih.gov/pubmed/7493209
Christakos CN, Fields KB. Exercise in diabetes: minimize the risks and
gain the benefits. J Musculoskeletal Med. 1995;12:16–25.
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in
the incidence of type 2 diabetes with lifestyle intervention or
metformin. NEJM. 2002;346(6):393–403. www.ncbi.nlm.nih.gov/
pubmed/11832527
A 16 week high-intensity exercise programme results in
decreased diabetic medication regimes, lowered systolic
blood pressure, decreased abdominal adipose tissue,
and increases in strength, physical activity, and lean
muscle mass.
Source: Castaneda C, Layne JE, Munoz-Orians L, et al. A randomized
controlled trial of resistance exercise training to improve glycemic
control in older adults with type 2 diabetes. Diabetes Care.
2002;25(12):2335-41. www.ncbi.nlm.nih.gov/pubmed/12453982
Prevalence of diabetes by WHO Region
2000
2030 (predicted)
Africa
7,020,000
18,234,000
Eastern Mediterranean
15,188,000
42,600,000
The Americas
33,016,000
66,812,000
Europe
33,332,000
47,973,000
South-East Asia
46,903,000
119,541,000
12 | World Confederation for Physical Therapy
About physical activity and
active ageing
Physical therapists are exercise experts, providing
services to optimise physical ability in a wide range of
people. They prescribe exercise as part of a structured,
safe, and effective programme.
An important part of their role is to help people remain
active as they age. More than any other profession,
physical therapists prevent and treat chronic disease
and disability in aging adults through prescribed
activity and movement.
The World Health Organization encourages regular
physical activity for older adults, because it has been
shown to improve their independence and quality
of life (www.who.int/dietphysicalactivity/factsheet_
olderadults/en/). It says that older adults should engage
in at least 30 minutes of moderate-intensity physical
activity five days a week, if appropriate (www.who.int/
ageing/active_ageing/en/index.html).
Here is some information demonstrating the
contribution of physical therapists in keeping people
active as they age – particularly their role in maintaining
general health, preventing and treating cardiovascular
disease, and countering joint problems.
Improving functional ability
Older adults engaged in regular physical activity
demonstrate improved balance, strength, coordination,
motor control, flexibility and endurance. As a result,
physical activity can reduce the risk of falls – a major
cause of disability among older people.
Source: World Health Organization, “Physical activity and older adults”
www.who.int/dietphysicalactivity/factsheet_olderadults/en/
Participation in regular exercise programmes leads to
older adults having higher levels of function, greater
independence, and improved quality of life.
Source: Ellingson T, Conn VS. Exercise and quality of life in elderly
individuals. J Gerontol Nurs. 2000 Mar;26(3):17-25. www.ncbi.nlm.nih.
gov/pubmed/11111627
Exercise programmes can slow down functional
decline. Elderly adults can, with an appropriate exercise
programme, be helped to achieve levels of activity
that will bring health benefits, and slow the decline in
function that might normally be expected with age.
Source: Landin RJ, Linnemeier TJ, et al. Exercise testing and training
of the elderly patient. Cardiovasc Clin. 1985; 15(2): 201-18. www.ncbi.
nlm.nih.gov/pubmed/3912049
Even for those in their 80s and 90s, exercise
programmes can increase functional ability, postpone
disability and maintain independent living.
Sources: Spirduso WW Cronin DL. Exercise dose-response effects
on quality of life and independent living in older adults. Med Sci
Sports Exerc. 2001;33(6 Suppl):S598-608. www.ncbi.nlm.nih.gov/
pubmed/11427784
Hruda KV, Hicks AL, et al. Training for muscle power in older adults:
effects on functional abilities. Can J Appl Physiol. 2003;28(2):178-89.
www.ncbi.nlm.nih.gov/pubmed/12825328
Physical activity and exercise are inversely associated
with mortality and age-related morbidity.
Sources: Kushi LH, Fee RM, et al. Physical activity and mortality in
postmenopausal women. JAMA. 1997 Apr 23-30; 277(16): 1287-92.
www.ncbi.nlm.nih.gov/pubmed/9109466
Nied RJ, Franklin B. Promoting and prescribing exercise for the elderly.
Am Fam Physician. 2002 Feb 1;65(3):419-26. www.ncbi.nlm.nih.gov/
pubmed/11858624
Gregg EW, Cauley JA, et al. Relationship of changes in physical activity
and mortality among older women. JAMA. 2003 May 14; 289(18):237986. www.ncbi.nlm.nih.gov/pubmed/12746361
Promoting cardiovascular health
Regular exercise in older adults has many positive
effects on cardiovascular health, including increasing
cardiac output, maximum heart rate, endurance, and
arterial blood flow, and decreasing heart rate, blood
pressure, and risk of heart disease.
Source: Vincent KR, Braith RW et al. Resistance exercise and physical
performance in adults aged 60 to 83. J Am Geriatr Soc. 2002 Jun;
50(6):1100-7. www.ncbi.nlm.nih.gov/pubmed/12110072
World Confederation for Physical Therapy | 13
One study found that after eight months of regular
training, a group of 85-year-olds had increased walking
speed and increased maximal oxygen uptake and
decreased blood pressure. This resulted in reduced
health risk and improved independence.
Source: Puggaard L, Larsen JB, et al. Maximal oxygen uptake, muscle
strength and walking speed in 85-year-old women: effects of
increased physical activity. Aging (Milano). 2000 Jun;12(3):180-9. www.
ncbi.nlm.nih.gov/pubmed/10965376
Exercise decreases depression and anxiety in people
with osteoarthritis.
Source: Minor MA, Hewett JE et al. Efficacy of physical conditioning
exercise in patients with rheumatoid arthritis and osteoarthritis.
Arthritis Rheum. 1989 Nov; 32(11):1396-405. www.ncbi.nlm.nih.gov/
pubmed/2818656.
Land-based therapeutic exercise programmes have
been shown to reduce pain and improve physical
function in people with osteoarthritis of the knee.
Walking 10,000 steps is effective in lowering blood
pressure and increasing exercise capacity in individuals
with hypertension.
Source: Fransen M, McConnell S. Therapeutic exercise for people with
osteoarthritis of the hip or knee. A systematic review. J Rheumatol.
2002 Aug; 29(8):1737-45. www.ncbi.nlm.nih.gov/pubmed/12180738
Source: Iwane M, Arita M, Tomimoto S, et al. Walking 10,000 steps/
day or more reduces blood pressure and sympathetic activity in mild
essential hypertension. Hyperten Res. 2000;23:573-580. www.ncbi.
nlm.nih.gov/pubmed/11131268
For people with osteoarthritis of the knee, both high
intensity and low intensity aerobic exercise (stationary
cycling) are equally effective at improving functional
status, gait, pain, and aerobic capacity.
Improving joint health
Tai Chi exercise brings improved balanced and physical
functioning to people with osteoarthritis.
Source: Song R, Lee EO et al. Effects of tai chi exercise on pain, balance,
muscle strength, and perceived difficulties in physical functioning
in older women with osteoarthritis: a randomized clinical trial.
J Rheumatol. 2003 Sep; 30 (9): 2039-44. www.ncbi.nlm.nih.gov/
pubmed/12966613
Research indicates that exercise decreases pain,
increases function, increases balance, and increases
ability to exercise in people with osteoarthritis and
rheumatoid arthritis.
Sources: Minor MA, Hewett JE et al. Efficacy of physical conditioning
exercise in patients with rheumatoid arthritis and osteoarthritis.
Arthritis Rheum. 1989 Nov; 32(11): 1396-405. www.ncbi.nlm.nih.gov/
pubmed/2818656
O’Reilly SC, Muir KR et al. Effectiveness of home exercise on pain and
disability from osteoarthritis of the knee: a randomised controlled
trial. Ann Rheum Dis. 1999 Jan; 58(1): 15-9. www.ncbi.nlm.nih.gov/
pmc/articles/PMC1752761/
14 | World Confederation for Physical Therapy
Source: Brosseau L, MacLeay L, et al. Intensity of exercise for the
treatment of osteoarthritis. Cochrane Database Syst Rev. 2003;(2):
CD004259. www.ncbi.nlm.nih.gov/pubmed/12804510
Research indicates that regular exercise by people
with arthritis decreases the likelihood of developing
disability by 10% and protects against functional
decline.
Source: Feinglass J, Thompson JA et al. Effect of physical activity
on functional status among older middle-age adults with arthritis.
Arthritis Rheum. 2005 Dec 15; 53(6): 879-85. www.ncbi.nlm.nih.gov/
pubmed/16342096
Research provides strong evidence that for individuals
with rheumatoid arthritis exercise from low to high
intensity is effective in improving disease-related
characteristics, reducing cardiovascular disease, and
increasing functional ability
Source: Metsios GS, Stavropoulos-Kalinoglou A, et al. Association of
physical inactivity with increased cardiovascular risk in patients with
rheumatoid arthritis. Eur J Cardiovasc Prev Rehabil. 2009;16:188–94.
www.ncbi.nlm.nih.gov/pubmed/19238083
Improving mental health
Cardiovascular fitness is associated with increases in
brain volume, in both gray and white matter and thus
sparing of brain tissue in aging humans.
Source: Colcombe SJ, Erickson KI, Scalf PE, et al. Aerobic exercise
training increases brain volume in aging humans. J Gerontol A
BiolSci Med Sci. 2006;61(11):1166-1170. www.ncbi.nlm.nih.gov/
pubmed/17167157
Physical activity has been shown to improve mental
health and cognitive function in older adults and
contributes to the management of disorders, such as
depression and anxiety. Active lifestyles often provide
older persons with regular occasions to make new
friendships, maintain social networks, and interact with
other people of all ages.
A regular programme of aerobic exercise can slow
or reverse functional deterioration, reducing the
individual’s biological age by 10 or more years, and
potentially prolonging independence.
Source: Shephard RJ. Maximal oxygen intake and independence in old
age. Br J Sports Med. 2009 May;43(5):342-6. Epub 2008 Apr 10. http://
bjsm.bmj.com/content/early/2008/04/10/bjsm.2007.044800.short
This information was produced with the kind assistance of
Marilyn Moffat, Professor of Physical Therapy at New York
University and President of WCPT.
Source: World Health Organisation, “Physical activity and older adults”
www.who.int/dietphysicalactivity/factsheet_olderadults/en/
Research has indicated that increased levels of physical
activity reduces the risk of Alzheimer’s disease. Exercise,
along with cognitively stimulating activities, can reduce
some of the symptoms of the disease.
Sources: Penrose FK. Can exercise affect cognitive functioning in
Alzheimer’s disease? A review of the literature. Activities, Adaptation
& Aging 2005:29(4): 15-40. www.tandfonline.com/doi/abs/10.1300/
J016v29n04_02
Christofoletti G, Oliani MM et al. A controlled clinical trial on the effects
of motor intervention on balance and cognition in institutionalized
elderly patients with dementia. Clin Rehabil. 2008 Jul:22(7):618-26.
http://cre.sagepub.com/content/22/7/618.abstract
Aerobic exercises significantly reduced depressive
symptoms in people over 60.
Source: Penninx BW, Rejeski WJ et al. Exercise and depressive
symptoms: a comparison of aerobic and resistance exercise effects on
emotional and physical function in older persons with high and low
depressive symptomatology. J Gerontol B Psychol Sci Soc Sci. 2002
Mar;57(2):P124-32. www.ncbi.nlm.nih.gov/pubmed/11867660
World Confederation for Physical Therapy | 15
About physical activity
and cancer
Cancer is an umbrella term used to describe more than
100 different diseases with the common characteristic
of uncontrolled malignant cell growth. It is a leading
and growing cause of death worldwide, with the total
number of cases globally increasing, as the world
population grows and ages.
The link between physical activity and cancer
The growing global population with cancer faces
unique challenges – from their disease and from the
treatments they receive. Physical therapists can help
them achieve health and quality of life. The prescribed
exercises and lifestyle advice that physical therapists
provide can also help people reduce their risk of getting
cancer.
Source: American Cancer Society http://onlinelibrary.wiley.com/
doi/10.3322/caac.21142/full
Cancer facts
Cancer is a leading cause of death worldwide and
accounted for 7.6 million deaths (around 13% of all
deaths) in 2008.
Source: International Agency for Research on Cancer http://globocan.
iarc.fr/factsheets/populations/factsheet.asp?uno=900
Deaths from cancer worldwide are projected to
continue to rise to over 11 million in 2030. More than
30% of cancer can be prevented by modifying or
avoiding key risk factors, including:
• being overweight or obese
• physical inactivity.
Other risk factors include:
• tobacco use
• low fruit and vegetable intake
• alcohol use
• HPV-infection
• urban air pollution
• indoor smoke from household use of solid fuels.
Source: World Health Organization www.who.int/mediacentre/
factsheets/fs297/en/
16 | World Confederation for Physical Therapy
Getting adequate physical activity, maintaining a
healthy weight and eating a healthy diet can reduce the
chance of recurrence of many cancers and increase the
likelihood of disease-free survival after a diagnosis, say
new guidelines from the American Cancer Society.
Large population studies have identified a strong
association between lower levels of physical activity and
higher cancer mortality. Walking or cycling an average
of 30 minutes per day has been associated with a 34%
lower rate of cancer death and a 33% improved cancer
survival.
Source: Orsini N, Mantzoros C S et al. Association of physical activity
with cancer incidence, mortality, and survival: a population based
study of men. British Journal of Cancer. 2008 98: 1864-1869. www.
ncbi.nlm.nih.gov/pubmed/18506190
Increasing numbers of studies are indicating that
physical activity can reduce the incidence of cancer.
World Health Organization recommendations say that
undertaking 150 minutes of moderate intensity aerobic
physical activity a week can reduce the risk of breast
and colon cancers. The same amount of exercise can
also reduce the risk of diabetes and heart disease.
Source: Global Recommendations on Physical Activity for Health,
released by the World Health Organization in 2011 www.who.int/
dietphysicalactivity/factsheet_recommendations/en/index.html
According to the International Agency for Research
on Cancer: “Physical activity is one risk factor for
non-communicable diseases which is modifiable and
therefore of great potential public health significance.
Changing the level of physical activity raises challenges
for the individual but also at societal level.” www.un.org/
apps/news/story.asp?NewsID=37467&Cr=cancer&Cr1
Physical activity helps people with the effects of
treatment for cancer
A systematic review of controlled trials of physical
activity interventions in cancer survivors, during and
after treatment, showed that physical activity had a
significant effect. A large effect was shown on upper
and lower body strength, and a moderate effects on
fatigue and breast- cancer-specific concerns. Exercise
was generally well-tolerated during and after treatment,
with minimal adverse events. The study abstracted data
from over 82 studies.
Source: Speck RM, Courneya KS et al. An update of controlled physical
activity trials in cancer survivors: a systematic review and metaanalysis. J. Cancer Surviv. 2010 Jun;4(2):87-100. www.ncbi.nlm.nih.
gov/pubmed/20052559
A panel of experts convened by the American College
of Sports Medicine concluded that exercise training is
safe during and after cancer treatments and results in
improvements in physical functioning, quality of life and
cancer-related fatigue in several cancer survivor groups.
Source: Schmitz KH, Courneya KS et al. American College of Sports
Medicine roundtable on exercise guidelines for cancer survivors.
Med Sci Sports Exerc. 2010 Jul;42(7):1409-26. www.ncbi.nlm.nih.gov/
pubmed/20559064
Physical activity helps improve outcomes for people
with cancer
more than three hours per week. Among people who
have had colo-rectal cancer, a study found a 50% lower
rate of recurrence and related death in those who
exercised more than six hours per week.
Sources: Holmes, MD, Chen WY et al. Physical activity and survival after
breast cancer diagnosis. JAMA 2005 293: 2479-2486. www.ncbi.nlm.
nih.gov/pubmed/15914748
Meyerhardt J A, Giovannucci E L et al. Physical Activity and Survival
After Colorectal Cancer Diagnosis. Journal of Clinical Oncology
2006 Vol 24, No 22 (August 1): 3527-3534. http://jco.ascopubs.org/
content/24/22/3527.abstract
Current lack of physical activity among people with
cancer
Generally, cancer survivors display low levels of physical
activity. A study has reported that in Canada less than
22% of cancer survivors are physically active.
Source: Courneya KS, Katzmarzyk PT et al. Physical activity and
obesity in Canadian cancer survivors: population-based estimates
from the 2005 Canadian Community Health Survey. Cancer 2008
Jun;112(11):2475-82. www.ncbi.nlm.nih.gov/pubmed/18428195
This information was produced with the kind assistance of
Julie Walsh-Broderick, HRB Research Fellow, Department of
Physiotherapy, Trinity Centre for Health Science, St James’s
Hospital, Dublin
Studies have indicated a relationship between higher
physical activity levels and lower mortality in cancer
survivors. A recent meta-analysis reported that, postdiagnosis, physical activity reduced breast cancer
deaths by 34%, all causes mortality by 41% and disease
recurrence by 24%.
Source: Ibrahim EM, Al-Homaidh A. Physical activity and survival after
breast cancer diagnosis: meta-analysis of published studies. Med
Oncol. 2010 Apr 22. www.ncbi.nlm.nih.gov/pubmed/20411366
Studies also indicate the volume of exercise necessary
to bring benefits. The Nurses’ Health Study reported
50% fewer cancer recurrences in women who exercised
World Confederation for Physical Therapy | 17
Journal articles about
physical therapy
Here are some useful references for articles that show the
benefit of physical therapy in:
• hypertension
• cardiovascular disease
• stroke
• diabetes
• obesity
• chronic obstructive pulmonary disease.
Hypertension
ACSM’s Guidelines for Exercise Testing and Prescription.
6th Ed. Baltimore MD: Lippincott Williams & Wilkins 2000
Blumenthal JA, Sherwood A, et al. Exercise and weight
loss reduce blood pressure in men and women with
mild hypertension: effects on cardiovascular, metabolic,
and hemodynamic functioning. Arch Intern Med.
2000;160(13): 1947-58.
Miller ER, Erlinger TP, Young DR, et al. Results of the diet,
exercise, and weight loss intervention trial. Hypertension.
2002;40(5):612-618.
Tanaka H, Bassett DR, Howley ET, Thompson DL, Ashraf M,
Rawson FL. Swimming training lowers the resting blood
pressure in individuals with hypertension. J Hypertens.
1997;15:651-7.
Cardiovascular disease
Ades P. Cardiac Rehabilitation and Secondary Prevention
of Coronary Heart Disease. N Eng J Med. 2001; 345, 12.
Balady G et al. Cardiac rehabilitation programs. A
statement for healthcare professionals from the
American Heart Association. Circ. 1994;90:1602-10.
Brown A, Taylor R, Noorani H, Stone J, Skidmore
B. Exercise-based cardiac rehabilitation programs
18 | World Confederation for Physical Therapy
for coronary artery disease: a systematic clinical
and economic review. Ottawa, Canada; Canadian
Coordinating Office For Health Technology Assessment
(CCOHTA), 2003.
Brubaker PH, Kaminsky LK, Whaley MH. Coronary Artery
Disease: Essentials of Prevention and Rehabilitation
Programs. Champaign IL Human Kinetics, 2002.
Brubabaker PH, Warner JG, Rejeski DG, et al. Comparison
of standard and extended length participation in cardiac
rehabilitation on body composition, functional capacity,
and blood lipids. Am J Cardiol 1996;78:769-773.
Davies EJ, Moxham T, Rees K, Singh S, Coats AJS, Ebrahim
S, Lough F, Taylor RS. Exercise based rehabilitation for
heart failure. Cochrane Database of Systematic Reviews
2010, Issue 4. Art. No.: CD003331. DOI: 10.1002/14651858.
CD003331.pub3.
Frownfelter D, Dean E. Cardiovascular and Pulmonary
Physical Therapy. 4th Edition. St. Louis. Mosby Elsevier.
2006.
Heran BS, Chen JMH, Ebrahim S, Moxham T, Oldridge N,
Rees K, Thompson DR, Taylor RS. Exercise-based cardiac
rehabilitation for coronary heart disease. Cochrane
Database of Systematic Reviews 2011, Issue 7. Art. No.:
CD001800. DOI: 10.1002/14651858.CD001800.pub2.
www.ncbi.nlm.nih.gov/pubmed/21735386
National Institute for Health and Clinical Excellence.
Chronic heart failure: management of chronic heart
failure in adults in primary and secondary care. CG108.
London, UK: National Institute for Health and Clinical
Excellence; 2010.
National Institute for Health and Clinical Excellence.
Prevention of cardiovascular disease at population level.
London, UK: National Institute for Health and Clinical
Excellence; 2010.
Pollock M et al. Resistance Exercise in Individuals With
and Without Cardiovascular Disease: An Advisory
From the Committee on Exercise, Rehabilitation, and
Prevention, Council on Clinical Cardiology, American
Heart Association. Circ. 2000; 101: 828.
Seki E et al. Effects of Phase III Cardiac Rehabilitation
Programs on Health-related Quality of Life in Elderly
Patients with Coronary Artery Disease. Circ J. 2003; 67:
73-77.
Taylor RS, Brown A, Ebrahim S, et al. Exercise-based
rehabilitation for patients with coronary heart disease:
systematic review and meta-analysis of randomized
controlled trials. Am J Med. 2004 May 15;116(10):682-92.
of Systematic Reviews 2003, Issue 1. Art. No.: CD002925.
DOI: 10.1002/14651858.CD002925.
Pollock A, Baer G, Pomeroy VM, Langhorne P.
Physiotherapy treatment approaches for the recovery
of postural control and lower limb function following
stroke. Cochrane Database of Systematic Reviews 2007,
Issue 1. Art. No.: CD001920. DOI: 10.1002/14651858.
CD001920.pub2.
Royal College of Physicians Intercollegiate Stroke
Working Party. National Clinical Guidelines for Stroke. 3rd
ed. London, UK: Royal College of Physicians 2008
Vincent K, Vincent H. Resistance Training for Individuals
With Cardiovascular Disease. J Cardiopulm Rehab. 2006;
26: 207-16.
Saka O, Serra V, Samyshkin Y, McGuire A, Wolfe CCDA.
Cost-effectiveness of stroke unit care followed by early
supported discharge. Stroke 2009; 40(1): 24-29.
Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially
modifiable risk factors associated with myocardial
infarction in 52 countries (the INTERHEART study): casecontrol study. Lancet. 2004 Sep 11-17;364(9438):937-52.
Stroke Unit Trialists’ Collaboration. Organised inpatient
(stroke unit) care for stroke. Cochrane Database of
Systematic Reviews 2007, Issue 4. Art. No.: CD000197.
DOI: 10.1002/14651858.CD000197.pub2.
Stroke
Teixeira-Salmela LF, Olney SJ, et al. Muscle strengthening
and physical conditioning to reduce impairment and
disability in chronic stroke survivors. Arch Phys Med
Rehabil. 1999;80(10):1211-8.
Dean CM, Richards CL, Malouin F. Task-related circuit
training improves performance of locomotor tasks in
chronic stroke: a randomized, controlled pilot trial. Arch
Phys Med Rehabil. 2000;81(4):409-17.
Endres M, Gertz K, et al. Mechanisms of stroke protection
by physical activity. Ann Neurol. 2003;54(5):582-90.
English C, Hillier SL. Circuit class therapy for improving
mobility after stroke. Cochrane Database of Systematic
Reviews 2010, Issue 7. Art. No.: CD007513. DOI:
10.1002/14651858.CD007513.pub2.
Ouellette MM, LeBrasseur NK, et al. High-intensity
resistance training improves muscle strength, selfreported function, and disability in long-term stroke
survivors. Stroke. 2004;35(6):1404-9.
Outpatient Service Trialists. Therapy-based rehabilitation
services for stroke patients at home. Cochrane Database
Diabetes
Castaneda C, Layne JE, Munoz-Orians L, et al. A
randomized controlled trial of resistance exercise training
to improve glycemic control in older adults with type 2
diabetes. Diabetes Care. 2002;25(12):2335-41.
Dunstan DW, Daly RM, Owen N, Jolley D, De Courten
M, Shaw J, Zimmet P. High-intensity resistance training
improves glycemic control in older patients with type 2
diabetes. Diabetes Care. 2002 Oct;25(10):1729-36.
Evans WJ. Effects of exercise on body composition and
functional capacity of the elderly. J Gerontol A Biol Sci
Med Sci. 1995;50 Spec No:147-50.
Fenicchia LM, Kanaley JA, Azevedo JL Jr, et al. Influence of
World Confederation for Physical Therapy | 19
resistance exercise training on glucose control in women
with type 2 diabetes. Metabolism. 2004;53:284–289.
Greaves CJ, Sheppard KE, Abraham C, Hardeman W,
Roden M, Evans PH, Schwarz P, Image Study Group.
Systematic review of reviews of intervention components
associated with increased effectiveness in dietary and
physical activity interventions. BMC Public Health 2011
Feb 18;11(119):Epub
Orozco LJ, Buchleitner AM, Gimenez-Perez G, Roqué i
Figuls M, Richter B, Mauricio D. Exercise or exercise and
diet for preventing type 2 diabetes mellitus. Cochrane
Database of Systematic Reviews 2008, Issue 3. Art. No.:
CD003054. DOI: 10.1002/14651858.CD003054.pub3.
Umpierre D, Ribeiro PAB, Kramer CK, Leitao CB, Zucatti
ATN, Azevedo MJ, Gross JL, Ribeiro JP, Schaan BD. Physical
activity advice only or structured exercise training and
association with HbA1c levels in type 2 diabetes: a
systematic review and meta-analysis. JAMA 2011 May
4;305(17):1790-1799
Obesity
Dunstan DW, Daly RM, Owen N, Jolley D, De Courten
M, Shaw J, Zimmet P. High-intensity resistance training
improves glycemic control in older patients with type 2
diabetes. Diabetes Care. 2002 Oct;25(10):1729-36.
Hagberg JM, Graves JE, Limacher M, et al. Cardiovascular
responses of 70- to 79-yr-old men and women to
exercise training. J Appl Physiol. 1989;66(6):2589-94.
Shaw KA, Gennat HC, O’Rourke P, Del Mar C. Exercise for
overweight or obesity. Cochrane Database of Systematic
Reviews 2006, Issue 4. Art. No.: CD003817. DOI:
10.1002/14651858.CD003817.pub3.
Waters E, de Silva-Sanigorski A, Hall BJ, Brown T,
Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell
CD. Interventions for preventing obesity in children.
Cochrane Database of Systematic Reviews 2011, Issue 12.
Art. No.: CD001871. DOI: 10.1002/14651858.CD001871.
20 | World Confederation for Physical Therapy
pub3.
Chronic Obstructive Pulmonary Disease
American College of Chest Physicians, American
Association of Cardiovascular and Pulmonary
Rehabilitation [American College of Chest Physicians
(ACCP) and the American Association of Cardiovascular
and Pulmonary Rehabilitation (AACVPR)]. Pulmonary
rehabilitation: joint ACCP/AACVPR evidence-based
guidelines [with systematic review]. Chest 1997
Nov;112(5):1363-1396
American College of Sports Medicine. Guidelines for
Exercise Testing and Prescription. 7th ed. Champaign IL:
Human Kinetics, 2006.
Casaburi R, Patessio A, Ioli F, et al. Reduction in exercise
lactic acidosis and ventilation as a result of exercise
training in patients with obstructive lung disease. Am Rev
Respir Dis. 1991;143:9-18.
Casaburi R, Porszasz J, Burns MR, Carithers ER, et al.
Physiologic benefits of exercise training in rehabilitation
of severe COPD patients. Am J Respir Crit Care Med.
1997;155:1541–1551.
Casaburi R. Mechanisms of the reduced ventilatory
requirement as a result of exercise training. Eur Respir
Rev. 1995;5:25, 42–46.
Clark CJ, Cochrane LM, et al. Skeletal muscle strength and
endurance in patients with mild COPD and the effects of
weight training. Eur Respir J. 2000;15(1):92-97.
Coppoolse R, Schols A, Baarends EM et al. Interval versus
continuous training in patients with severe COPD: a
randomized clinical trial. Eur Respir J. 1999;14:258-263.
Gosselink R, Langer D, Burtin C, Probst V, Hendriks
HJM, van der Schans CP, Paterson WJ, Verhoef-de Wijk
MCE, Straver RVM, Klaassen M, Troosters T, Decramer
M, Ninane V, Delguste P, Muris J [Koninklijk Nederlands
Genootschap voor Fysiotherapie (KNGF) [Royal Dutch
Society for Physiotherapy]]. KNGF guidelines: Chronic
obstructive pulmonary disease clinical practice
guidelines [with systematic review]. Nederlands
Tijdschrift voor Fysiotherapie [Dutch Journal of Physical
Therapy] 2008;118(4 Suppl):1-60
Gosselink R, Troosters T, Decramer M. Effects of exercise
training in COPD patients: interval versus endurance
training. Eur Respir J. 1998;12:2S.
Gosselink R, Troosters T, Decramer M. Exercise training
in COPD patients: the basic questions. Eur Respir J.
1997;10:2884–2891.
Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year
of outpatient multidisciplinary pulmonary rehabilitation:
a randomized controlled trial. Lancet. 2000;355:362-368.
Hernandez MTE, Rubio TM, Ruiz FO, et al. Results of a
home-based training program for patients with COPD.
Chest. 2000;118:106-114.
Hirata K, Okamoto T, Shiraishi S. The efficacy and
practice of exercise training in patients with chronic
obstructive pulmonary disease (COPD). Nippon Rinsho.
1999;57(9):2041-5.
Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary
rehabilitation for chronic obstructive pulmonary
disease. Cochrane Database of Systematic Reviews 2006,
Issue 4. Art. No.: CD003793. DOI: 10.1002/14651858.
CD003793.pub2. http://onlinelibrary.wiley.com/
doi/10.1002/14651858.CD003793.pub2/abstract
Maltais F, LeBlanc P, Jobin J, et al. Intensity of training
and physiologic adaptation in patients with chronic
obstructive pulmonary disease. Am J Respir Crit Care
Med. 1997;155:555–561.
National Institute for Health and Clinical Excellence.
Chronic obstructive pulmonary disease: management
of chronic obstructive pulmonary disease in adults in
primary and secondary care. Update guideline. London:
National Institute for Health and Clinical Excellence 2010.
http://publications.nice.org.uk/chronic-obstructivepulmonary-disease-cg101
Ng LWC, Mackney J, Jenkins S, Hill K. Does exercise
training change physical activity in people with COPD? A
systematic review and meta-analysis. Chronic Respiratory
Disease February 2012; 9(1):17-26
Normandin EA, McCusker C, Connors ML, et al. An
evaluation of two approaches to exercise conditioning in
pulmonary rehabilitation. Chest. 2002;121:1085-1091.
Puhan MA, Gimeno-Santos E, Scharplatz M, Troosters T,
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exacerbations of chronic obstructive pulmonary disease.
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