This is where we start. This is not unique to me; on the American Physical Therapy Association (APTA) webpage, the APTA describes Physical Therapists (PT's) as highly trained medical professionals that "understand how the body works and how to get you moving again." This boils down to "Movement = Life."
In this column, I will present a few of the negative effects of sedentary behavior (ironic to talk about this as I sit on my couch typing on my iPad with Big Bang Theory playing in the background) as well as the positive effects of movement (ok, full confession here: I am sitting while tapping my feet and marching – it's driving my fiancée nuts.)
The above APTA description depicts PTs as movement enablers. Sure, we like to talk in our medical jargon when we describe a patient's impairments or deficits. But, "so what?" Why bother gaining the last five degrees of range of motion in a stiff knee unless it is to play tennis, surf, walk down the aisle at your daughter's wedding, push a stroller containing your one year old niece, or whatever else you like doing. Doing involves MOVING. I am a movement specialist.
Specializing in movement involves both practical and academic components. It can be easy to get lost in the multitude of details that comprise the human body and forget the beauty that is the system as a whole. Let's get back to what matters that affects this system, the decreased function that first brought the patient in to see you. Regaining that lost function is the goal of the patient and must be our goal too.
This points towards the essential nature of what I do and how I see my role as a PT; I am a teacher of movement. Yes, we clear up the deficits or impairments that could be limiting factors while respecting the healing process, but really, at the heart of it, it's always about movement.
This idea took root in a corner of my brain during my Pediatrics class in PT school. We routinely watched minute long clips of infants and toddlers rolling and tumbling. They would change positions an absurd amount, sometimes even fifty times or more in a single minute. I remember how amazed I was to watch these kids squat, crawl, stand, walk, run, roll, headstand, twist, and play – all effortlessly. Amazing, right? Some of us might ask ourselves the question: "Why can't I do that anymore? I got old? I'm only 33 and I have never had a serious injury (knock on wood) so that can't be my excuse." To paraphrase a former teacher of mine, maybe it isn't about stopping movement because we get old, maybe it's that we get old because we stop moving. Babies move, kids move, adults... sit? There's a great image available on the internet that shows the evolution of humanity from primitive caveman to upright Homo sapiens to crunched up desk worker, underlined by the caption: "Something, somewhere, went terribly wrong." It's as if technology has simply made us revert to physically helpless babies, curled up in a reverse fetal position in some grotesque imitation of our birth.
As a facilitator of movement, this idea scares me. A loss of movement is a loss of a crucial part of our ability to achieve our potential as independent, productive, and contributing members of society. "Movement = Life." Sedentary behavior, on the other hand, just pushes us into a coffin that much sooner. It causes many negative effects on the body as a whole. Some of them can include:
Increased overall mortality (Walking Dead zombies aside, we stop moving when we die)
Increased fat production (think Ben Stiller at the end of the movie, Dodgeball)
Decreased muscle tone and strength (the classic "limp glutes and mushy abs syndrome")
Decreased cardiovascular endurance (how many distance runners are couch potatoes?)
Increased risk of cardiovascular diseases
Decreased mental function (ask my fiancée – I doze off within 20 min of sitting on the couch)
...and others. Unfortunately, what I listed above are just a few of the effects. As the iGeneration comes of age, we will likely see even more research published on the detrimental effects of sedentary behavior. What's even more alarming is that current research is beginning to show that sitting for the majority of your time cannot be FULLY counteracted by 30-60 min of daily exercise. Things aren't all doom and gloom, though. There is hope. So, what can we do about it?
We can move and encourage movement. Of course I'd say that (did you really think I'd say anything else?). If you've stuck with me to this point, you are obviously interested in this topic (or at least you are a completionist and don't like to quit now that you've read this far). Here are some of the benefits of regular exercise and movement:
Stronger immune system (help survive the apocalypse or the common cold)
Increased cardiovascular endurance (don't get winded taking the stairs at work)
Increased strength, increased fitness
Decreased mortality risk from many major diseases and health issues (save lives, save $$$)
Improved regulation of blood pressure, heart rate, sugar levels, sleep cycles, temperature, etc.
Improved quality of life, mental health, and confidence (feel better, be better)
Decreased stress and anxiety (how many of you could use this?)
...and so much more. With the challenges inherent in our modern healthcare system, a miracle drug like exercise should be much more widely utilized. While educating my patients on this is part of my role as a professional healthcare provider, others have also made this point. One of my personal favorites is the video, 23 ½ Hours: What is the single best thing we can do for our health? This video explains some of the benefits of exercise as medicine as well as the importance of consistent activity level throughout our daily life (https://www.youtube.com/watch?v=aUaInS6HIGo). The American College of Sports Medicine also has initiatives (https://www.exerciseismedicine.org) that seek to promote exercise as a clinical prescription. Many other people and groups have jumped on board and are working to get us moving. But how do we do it? Here are a few suggestions to incorporate more movement into your day:
Regular appropriate exercise (see above exercise benefits)
Sit on a therapy or exercise ball for seated activities (increased muscle activation, improved posture) or better yet, get a tread-desk
Take the stairs (no escalators, no elevators)
Park a little bit farther away (it really is ok to walk 50 extra feet)
Walk 3 laps around the house/office every hour (tell people your PT is making you do it when they look at you funny, they'll understand)
Drink extra water (extra water = extra walking to bathroom and back)
Take chapter breaks with reading or commercial breaks with TV (stand, walk, hop, balance, etc.)
Move or exercise with others (make it fun and engaging and people will want to do it)
Set a timer somewhere in your house to go off every hour (it will make you get up to turn it off)
Wear an activity monitor (get your 10,000 steps per day!)
These are some of the suggestions I give my patients. They don't work for everyone, but try them out. So, after a few thousand words, where are we? I believe it is right where we started, hopefully with a different appreciation of it. Movement really does equal life and to paraphrase the recent Runner's World article, sitting all day should be considered as bad as smoking (https://www.runnersworld.com/health/sitting-is-the-new-smoking-even-for-runners?page=single). This is where we end. Now, let's get up and move.
Danny Singles, PT, DPT, MA