Are we as Physios doing enough to address the growing global burden of non- communicable diseases (NCD’s)? Are we adequately screening for these risk factors thereof and addressing lifestyle and behavioural changes in our consultation sessions. Are we aware that the risk factors for NCD’s might have an even bigger impact on the musculoskeletal system, injury recovery, rehabilitation and functional ability of our patients?
These are all questions that run through my mind. A few years ago I worked in public hospital in South Africa, and during my second year there I stumbled across the Global health course on Physiopedia. Little did I know the effect that that course would have on me personally as well as professionally. Not only did it open my eyes to the burden of NCD’s and the negative effects it has globally- but most importantly- it opened my eyes to the important role we as Physios have in global health. With all that being said, I have learned that the way to get people passionate about something is to help them understand it better.
One of our roles as Physios is to advocate for healthy lifestyles, prevent and address risk factors for NCD’s as well educate the people- our patients- about everything related to living a better and healthier lifestyle. Below I mention a few risk factors for NCD’s and briefly elaborate on each of them to show the real effects they have/ can have on our patients
Physical inactivity ( leading to sedentary lifestyles):
Physical inactivity is one of the main contributors of Non-communicable diseases. (In some countries even the leading cause.)
Physical inactivity have detrimental effects on joint and bone health. It links directly to joint degeneration and a reduction in synovial fluid production. Some studies suggests that the lack of physical activity affects the absorption and storage of calcium in the body and have a direct relationship with decreased bone density.
Research has proven numerous negative effects of physical inactivity on the musculoskeletal system but also proved to be an independent risk factor of increased back pain.
Physical inactivity have a negative chain reaction in chronic pain patients: physical inactivity not only increase the risk of back pain in patients but also that of other musculoskeletal problems. A chronic pain patient, can developed fear of movement (move and walk less), and will get no benefits of natural pain relief and have an increased perception of pain, and due to the increased sensation of pain become physically inactive. A patient who is physically inactive, is at large risk to get back pain or musculoskeletal pain, and due to the lack of movement will become a chronic pain patient,
Smoking:
Smoking is not only the leading cause for chronic respiratory diseases and a risk factor for non-communicable diseases but also has detrimental effects on the general health of the musculoskeletal system.
Years of smoking (including secondhand smoke) are linked to decreased bone density and increased fractures. High caffeine and alcohol consumption (which usually accompanies smoking) also proved to result in increased bone loss.
Smoking delays tissue healing and increase complications post injury (mainly musculoskeletal injuries ex fractures and trauma-related injuries)
Smoking has direct negative effects on local inflammation of the musculoskeletal system, and is also known as an independent risk factor for epicondilitis.
Smoking decrease a persons (our patients) threshold of pain. A decrease pain threshold, increased inflammatory markers and delay in tissue healing due to smoking aggravates and progress specifically back pain and arthritis.
Obesity and unhealthy diets:
Exercise and quality of physical activity is compromised in a system where there is a lack of macro and/ or micro nutrientsIncreased BMI have a direct negative effect on biomechanics as well as energy expenditure.
Excessively high body mass limits a person’s functional capacity and overcompensatory biomechanics and methods to augment mobility contribute to musculoskeletal strain.
Osteopenia and Osteoporosis (bone demineralisation conditions) are directly linked to nutritional intake and physical activity in adults.
Low bone mineralisation serves like a chain reaction: it increase the patients risk for cardiovascular diseases but also affects the targeted prescription of exercise.
Western lifestyle practices contribute to a negative calcium balance. Education regarding the importance of calcium intake and maintenance of positive calcium levels should be discussed with the patient. (Calcium intake is affected by sedentary lifestyles, smoking and high alcohol and caffeine consumption.)
Increased body mass also has negative effects on the constituents of bone which leads to decreased bone strength and increased bone fractures.
Increased BMI and increased waist circumference increase your risk for cardiovascular diseases, high blood pressure, diabetes type 2, osteoarthritis and back pain.
* If needed - patient should be referred to a dietician for extensive counselling and diet adaptation.
Sleep:
According to recent research studies the western cultures specifically, are largely sleep deprived.
The average of sleep per night (per adult) decreased from an average of 7.9 hours per night to 6.3 hours per night.
Lack of sleep increase the risk for all communicable as well as non- communicable disease. In particular lack of sleep is a major risk factors for Alzheimers disease and cancer.
Recommended average of sleep time per night for adults is 7-9hours. (Based on specific lifestyle factors the amount of hours sleep might increase)
A critical part of our immune system is known as the natural killer cells, mainly fights and kill cancer cells. A lack of sleep decrease the amount of these cells dramatically.
Sleep deprivation leads to a delay in reaction time and impair the ability to focus which then secondarily lead to an increased risk of injury. Sleep deprivation leads to a 20% decrease in physical performance and 40% decrease in alertness.
The relationship between sleep and chronic pain.We all know that most chronic pain patients suffer from sleep disturbances. But can a lack of sleep in return worsen the perception of pain? Poor sleep interferes with the processing of pain and results in a neurobiological dysfunction. (The sleep-wake cycle and the modulation of pain share a common neurobiological system-known as the central serotoninergic neurotransmission.)
In short sleep and pain follow the chicken and egg problem. Are we as Physios addressing sleep disturbances in our chronic pain patients? Are we aware of the important link between sleep and pain relief?
Stress:
Stress and mental health goes hand-in-hand and has negative effects on musculoskeletal health and functional capacity of our patients.
In todays life- stress is more common- and therefore affects us and our patients much more negatively than in previous times.
In daily life there are always sudden and intense matters to which our bodies react. The bodies stress system reacts to this by causing a total physiological unbalance, where it switch off all the regular bodily systems and only focus on the vital systems and organs. In this process the body produce and secrete a hormone called cortisol. In the (day and time) life we live the amount of mental, physical, emotional, academic stress occurs continuously, and the body reacts by producing cortisol continuously. That leaves the us and our patients with an immense amount of cortisol in our bodies. Simply put, our “feel-good hormones” : oxytocin, serotonin and dopamine helps to counter excess/ unbalanced cortisol levels. Theoretically this will restore normal balance. In modern times however, we have suppressed the positive effects of these “feel-good hormones, and our bodies have forgotten how to restore normal balance. Our busy schedules and a lack of time worsen this balance restoration process. If ever you wondered why theres a sudden need/ hype for mindfulness, yoga and relaxation? This is it. Reduction of stress and retraining of our bodies natural balance system between cortisol and “feel-good” hormones.
As Physios, I belief we are in the best possible position to address these risk factors in all of our patients. We have the potential to play a primary prevention role in preventing NCD’s and ultimately improve our patients quality of life.
References:
Philip, P., Taillard, J., Sagaspe, P., Valtat, C., Sanchez-Ortuno, M., Moore, N., … Bioulac, B. (2004). Age, performance and sleep deprivation. Journal of Sleep Research, 13(2), 105–110. https://doi.org/10.1111/j.1365-2869.2004.00399.x
Warburton, D. E. R., Nicol, C. W., & Bredin, S. S. D. (2006). Health benefits of physical activity: the evidence. CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 174(6), 801–809. https://doi.org/10.1503/cmaj.051351
Lee, I.-M., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., Katzmarzyk, P. T., & Group, L. P. A. S. W. (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet (London, England), 380(9838), 219–229. https://doi.org/10.1016/S0140-6736(12)61031-9
Aweto, H. A., Oligbo, C. N., Fapojuwo, O. A., & Olawale, O. A. (2013). Knowledge, attitude and practice of physiotherapists towards promotion of physically active lifestyles in patient management. BMC Health Services Research, 13(1), 21. https://doi.org/10.1186/1472-6963-13-21
Dean, E., & Söderlund, A. (2015). What is the role of lifestyle behaviour change associated with non-communicable disease risk in managing musculoskeletal health conditions with special reference to chronic pain? BMC Musculoskeletal Disorders, 16(1), 87. https://doi.org/10.1186/s12891-015-0545-y
Dean, E., Dornelas de Andrade, A., O’Donoghue, G., Skinner, M., Umereh, G., Beenen, P., … Wong, W. P. (2014). The Second Physical Therapy Summit on Global Health: developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases. Physiotherapy Theory and Practice, 30(4), 261–275. https://doi.org/10.3109/09593985.2013.856977