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Abstract

Physiotherapy plays a crucial role in disease prevention and health promotion. Non-communicable diseases (NCDs) are a leading cause of mortality and morbidity worldwide, and physiotherapy interventions can help prevent and manage conditions such as cardiovascular disease, arthritis, obesity, incontinence, falls and injuries, orthopaedic conditions, and sports injuries. Physiotherapists design exercise programs, provide education and promote lifestyle modifications to enhance joint functionality, reduce pain, and prevent complications. They also contribute to the prevention of chronic musculoskeletal disorders and promote overall health and well-being. Additionally, physiotherapy is involved in health promotion by empowering individuals to improve their health and increase control over it. Despite the challenges posed by the COVID-19 pandemic, physiotherapists continue to advocate for physical activity and provide services to clients, patients, and the community. It is crucial to prioritize and allocate resources to physiotherapy within primary healthcare, recognizing its significant role in secondary and tertiary care settings. Physiotherapy not only improves individuals' health but also enhances productivity and contributes positively to the economy. This article highlights the importance of physiotherapy in disease prevention, health promotion, and the overall well-being of individuals across their lifespan.
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Review Article
Empowering Wellness: Unveiling the Key Role of Physiotherapy in
Preventive and Promotive Health
Srikanta Padhan1, Avilash Mohapatra2
Abstract
Physiotherapy plays a crucial role in disease prevention and health promotion. Non-
communicable diseases (NCDs) are a leading cause of mortality and morbidity worldwide, and
physiotherapy interventions can help prevent and manage conditions such as cardiovascular
disease, arthritis, obesity, incontinence, falls and injuries, orthopaedic conditions, and sports
injuries. Physiotherapists design exercise programs, provide education and promote lifestyle
modifications to enhance joint functionality, reduce pain, and prevent complications. They also
contribute to the prevention of chronic musculoskeletal disorders and promote overall health
and well-being. Additionally, physiotherapy is involved in health promotion by empowering
individuals to improve their health and increase control over it. Despite the challenges posed
by the COVID-19 pandemic, physiotherapists continue to advocate for physical activity and
provide services to clients, patients, and the community. It is crucial to prioritize and allocate
resources to physiotherapy within primary healthcare, recognizing its significant role in
secondary and tertiary care settings. Physiotherapy not only improves individuals' health but
also enhances productivity and contributes positively to the economy. This article highlights
the importance of physiotherapy in disease prevention, health promotion, and the overall well-
being of individuals across their lifespan.
Keywords: Physiotherapy; Disease prevention; Health promotion; Non-communicable
diseases (NCDs); Exercise programs.
How to cite this article:
Srikanta Padhan, Avilash Mohapatra/Empowering Wellness: Unveiling the Key Role of Physiotherapy in Preventive and
Promotive Health/Indian J Prev Med. 2023;11(2)71-77.
Indian Journal of Preventive Medicine
Volume 11 Number 2, July - December 2023
DOI: http://dx.doi.org/10.21088/ijpm.2321.5917.11223.3
Author Affiliation: 1Ph.D Research Scholar, Department of
Community & Family Medicine, All India Institute of Medical
Sciences, Raipur 492099, Chhattisgarh, India, 2Physiotherapist,
Department of Surgical Discipline, All India Institute of
Medical Sciences, New Delhi 10029, India.
Corresponding Author: Srikanta Padhan, Ph.D Research
Scholar, Department of Community & Family Medicine,
All India Institute of Medical Sciences, Raipur 492099,
Chhattisgarh, India.
E-mail: srikantmph2019@gmail.com
Received on: 09.05.2023
Accepted on: 15.06.2023
INTRODUCTION
Physiotherapy is a eld of healthcare that
focuses on enhancing, cultivating, sustaining,
and reinstating the highest level of mobility
and functional capacity in individuals across
their lifespans. Its primary aim and concern is to
recognize and optimize the quality of life and
physical potential of each individual, encompassing
the domains of promotion, prevention, treatment,
Indian Journal of Preventive Medicine / Volume 11 Number 2 / July - December 2023
72
and intervention, as well as adaptation and
rehabilitation of health.1
The World Health Organization emphasizes
that physical inactivity stands as one of the
primary risk factors for global mortality, leading
to 3.2 million deaths annually.2 Additionally,
it is evident that physical activity can mitigate
the occurrence of non-communicable diseases.
Therefore, the role of the physiotherapy profession
becomes crucial. In the twenty- rst century,
chronic non-communicable diseases (NCDs) pose a
signi cant public health threat, closely associated
with unhealthy lifestyles. In order to alleviate the
burden of NCDs, collaborative efforts in health
promotion from various healthcare providers
are imperative. Physiotherapy not only strives to
deliver the highest standard of care to individuals
but also actively engages in promoting public
health initiatives.
Level of Prevention Definitions Mode of Intervention
Primordial Prevention Taking measures to avoid the
occurrence or formation of risk factors
Health Education
Health Promotion
Primary Prevention Preventing the onset of disease in the
presence of risk factors
Lifestyle Modification
Immunization
Secondary Prevention Preventing the occurrence of disease
complications
Early Diagnosis
Prompt, optimized, and sustained care
Tertiary Prevention Preventing the onset of disability or
mortality
Disability limitation
Rehabilitation
Quaternary Prevention Preventing unnecessary diagnosis and
treatment
Rehabilitation
Disability Prevention
Table 1: Levels of prevention in health
Recently physiotherapy have role in all level of
preventions from emergency till rehabilitation.
Previously physiotherapy was applied only some
limited diseases but now its role is unignorable in
different branches of medicine and rehabilitation.
Role of physiotherapy in disease Prevention
1. Role of physiotherapy in NCDs Prevention
Non-communicable diseases (NCDs) encompass
a wide range of chronic diseases that are not
transmissible, implying they cannot be acquired
from another individual. These diseases are
characterized by their prolonged duration,
typically exhibiting a gradual progression, and
serve as the primary contributors to adult mortality
and morbidity worldwide. Among NCDs, four
particular ailments are commonly recognized
as the leading causes of both mortality and
morbidity: cardiovascular diseases (including heart
disease and stroke), diabetes, cancer, and chronic
respiratory diseases (such as chronic obstructive
pulmonary disease and asthma).3
Individuals with chronic health conditions can
enhance their overall well-being by acquiring
knowledge on how to boost their physical activity
levels and engage in safe exercise practices, all
under the guidance and expertise of trained
physiotherapists. It is crucial to introduce physical
activity gradually, especially for individuals who
are overweight, un t, elderly, or living with chronic
ailments. Physiotherapists excel in this domain by
conducting thorough assessments of individuals,
suggesting exercise protocols that are both safe
and suitable for their speci c needs, and imparting
essential education on recognizing warning signs.
This makes them highly quali ed professionals to
prescribe physical activities and design exercise
programs tailored to address non-communicable
diseases.
2. Role of physiotherapy in CVD Prevention
Cardiovascular disease (CVD) refers to any
critical or abnormal condition affecting the heart
itself or its blood vessels, speci cally the arteries and
veins. It stands as a signi cant global and United
States cause of mortality, encompassing ailments
such as coronary heart disease, stroke, peripheral
vascular disease, congenital heart diseases like
Srikanta Padhan, Avilash Mohapatra/Empowering Wellness: Unveiling the Key Role of Physiotherapy in
Preventive and Promotive Health
Indian Journal of Preventive Medicine / Volume 11 Number 2 / July - December 2023
73
Aterial Septal Defect and Vetricular Septal Defect,
as well as myocardial infarction, among others.
Engaging in physical activity at an intensity
exceeding 40% of maximal aerobic capacity has
demonstrated substantial bene ts in reducing the
onset or progression of CVD. With each increase of
one metabolic equivalent (MET) in aerobic tness,
there is an associated decrease in premature death
by approximately 8-17%. Aerobic exercise enhances
cardiac output, maximum heart rate, endurance,
and arterial blood ow in individuals. Moreover, it
can improve their blood lipid pro les and promote
a healthy heart. For individuals already diagnosed
with cardiovascular disease, physiotherapists can
prescribe tailored aerobic exercise programs that
effectively reduce long-term risk.4
Engaging in aerobic conditioning activities such
as running, rowing, and walking, in addition to
incorporating resistance strength training exercises,
has been consistently linked to a decreased risk
of coronary heart disease. Furthermore, building
increased muscle strength can also contribute to a
lowered risk of experiencing a heart attack while
improving one's ability to perform daily activities.
The most effective approach to prevent heart
disease and heart failure is to maintain a healthy
lifestyle and mitigate risk factors. It is crucial to
prioritize physical activity, exercise regularly, and
adopt healthy habits. Regular physical activity and
exercise yield several bene ts, including:
Reduction in blood pressure and cholesterol
levels.
Decreased risk of experiencing an initial
cardiac event, such as a heart attack.
Positive impact on physical, mental, and social
well-being.
Improvement in other chronic conditions like
diabetes, obesity, depression, and certain types
of cancers.
3. Role of physiotherapy in Arthritis Prevention
Arthritis is a complex and wide ranging subject,
encompassing numerous types, subtypes, and
variations. It is characterized by acute or chronic
in ammation of the joints, often accompanied
by pain, stiffness, and structural damage in and
around the affected areas. Physiotherapists play a
crucial role in restoring function and preventing
disability for individuals dealing with arthritis.
They can develop tailored exercise programs to
alleviate pain and enhance joint functionality
and mobility. Additionally, physiotherapists
provide education about the condition, offering
guidance on necessary lifestyle modi cations to
manage the disease and minimize complications.
Managing arthritis requires long-term changes, and
graded exercises are implemented to reduce pain,
gradually progressing in intensity. Furthermore,
therapists provide advice on maintaining proper
body posture during daily activities to alleviate
pain and prevent further damage.5
Physiotherapy for arthritis encompasses more
than basic exercises or the use of modalities. It
extends to alternative activities like swimming,
which offers an excellent form of exercise while
minimizing joint pressure. Water based exercises
provide joint relief, aid in reducing body fat, and
enhance mood, coordination, and range of motion.
Additionally, poor body posture during prolonged
sitting and work activities can worsen arthritis
symptoms. Simple exercises performed at home or
in the workplace can help prevent arthritis. These
exercises may include neck rotations, head tilts, leg
raises, hamstring stretches, nger and thumb bends,
and wrist rotations to alleviate joint tension while
working at a desk. Furthermore, physiotherapists
offer guidance on proper ergonomics for computer
workstations and daily activities. They emphasize
correct postures, the use of ergonomic equipment,
and techniques for joint protection.
4. Role of physiotherapy in Obesity Prevention
Obesity is a signi cant and preventable cause
of death and disease worldwide. Since 1980,
the global prevalence of obesity has more than
doubled.6 Physiotherapists have a role to play in
educating clients about weight loss and assessing
and designing exercise programs. These programs
focus on modifying energy expenditure through
exercise. Individuals with obesity are more
susceptible to early onset arthritis and other
musculoskeletal problems due to their excess
weight. Physiotherapists develop exercise protocols
that promote weight reduction while ensuring joint
protection and preventing further complications.
To prevent weight regain, enhance weight loss,
and improve overall tness, it is recommended
to engage in a minimum of 150 to 300 minutes of
moderate physical activity per week or 75 to 150
Srikanta Padhan, Avilash Mohapatra/Empowering Wellness: Unveiling the Key Role of Physiotherapy in
Preventive and Promotive Health
Indian Journal of Preventive Medicine / Volume 11 Number 2 / July - December 2023
74
minutes of vigorous physical activity per week.
However, individuals aiming for weight loss are
advised to aim for a minimum of 200 to 300 minutes
of moderate to vigorous physical activity per week
to achieve sustainable weight loss in the long term.
Exercising to reduce obesity, with a speci c focus
on reducing fat mass, offers bene ts that go beyond
mere fat loss. Improved tness levels have been
linked to more positive clinical outcomes, including
a reduced risk of metabolic disease, cardiovascular
disease, Alzheimer's disease, and in ammation.7
5. Role of physiotherapy in Incontinence Prevention
Urinary incontinence (UI) is a prevalent condition
that often remains untreated. The prevalence
estimates vary depending on the population,
measurement period (e.g., daily or weekly), and
assessment tools used to determine severity. It is
estimated that approximately 50% of adult women
and 3% to 11% of adult men are affected by UI;
however, only 25% to 61% of affected women
seek medical care. Behavioural therapy focuses
on lifestyle modi cations, such as uid and diet
management, weight control, and bowel regulation,
to address UI. Educating individuals about bladder
irritants, including caffeine, is an important aspect
of treatment.8 In India, there is a signi cant lack
of awareness among women regarding pelvic
oor exercises and their bene ts in managing
incontinence.
Pelvic oor muscle training (PFMT) conducted
during pregnancy has been proven to reduce
the short-term risk of urinary incontinence in
women who did not experience prior symptoms.
Theoretically, targeted training to strengthen the
pelvic oor muscles holds the potential to prevent
urinary incontinence and pelvic organ prolapse.
Strength training could potentially increase the
volume of the pelvic oor muscles and elevate
the levatorani plate to a higher position within
the pelvis. When the pelvic oor muscles possess
suf cient stiffness, they have the potential
to counteract the rise in abdominal pressure
that occurs during physical exertion. Previous
studies on prevention have primarily focused
on training during pregnancy or after childbirth.
These studies have demonstrated that women
without incontinence exhibit signi cantly stronger
pelvic oor muscles in comparison to those with
incontinence.9
6. Role of physiotherapy in Fall & Injury Prevention
A fall is an incident that occurs when a person
unintentionally comes to rest on the ground,
oor, or a lower level. While falls can result in
fatal injuries, most are non-fatal. The risk of injury
from a fall can be in uenced by factors such as
age, gender, and overall health. Globally, falls are
the second leading cause of unintentional injury
deaths. Each year, an estimated 684,000 individuals
lose their lives due to falls, and around 37.3 million
falls require medical attention. Among all age
groups, adults aged 60 years and older experience
the highest number of fatal falls.10 As experts in
movement and function, physiotherapists play
a crucial role in helping individuals reduce their
risk of falls through personalized programs. These
programs may include exercise prescription, the
use of assistive technology like mobility aids, and
educational interventions. Exercise, particularly
when structured and guided by a physiotherapist,
is an effective component of fall prevention
programs. Additionally, physiotherapists may
directly assist individuals in addressing home
hazards, modifying footwear, and providing
education on fall risk reduction strategies.
To fully understand the scope of fall prevention
in the elderly, it's important to recognize the
common conditions and risk factors that contribute
to falls. Falls should be viewed as a symptom rather
than a diagnosis. Therefore, when an elderly patient
reports a history of falls, it's crucial to identify the
underlying causes. With this knowledge, a wide
range of preventative measures and treatment
options can be explored. Physiotherapy can be
a valuable tool not only for post-injury or post-
procedure recovery, but also for strengthening joints
and ligaments to prevent serious injuries. Pilates
and plyometric exercises are two rehabilitation
techniques that can be utilized for this purpose.
7. Role of Physiotherapy in the Prevention of
Orthopaedic Conditions
Physiotherapists who specialize in
Musculoskeletal/Orthopaedic disorders often
come across patients with chronic conditions and
unhealthy lifestyle behaviors. As a result, they are
well-positioned to promote health and wellness
among their patients, which can signi cantly
reduce the burden of non-communicable diseases
(NCDs) and chronic musculoskeletal disorders.
Srikanta Padhan, Avilash Mohapatra/Empowering Wellness: Unveiling the Key Role of Physiotherapy in
Preventive and Promotive Health
Indian Journal of Preventive Medicine / Volume 11 Number 2 / July - December 2023
75
Here are Six effective ways to prevent Orthopedic
Problems
1. Maintain a healthy weight: Excess weight
increases the risk of developing osteoarthritis.
It also places additional strain on joints,
weakening muscles and making injuries more
likely.
2. Stay active: Engaging in low impact exercises
such as stretching, walking, swimming,
and biking on level ground is bene cial for
individuals with orthopedic sensitivity. It's
important to avoid exercises that excessively
stress the joints, such as deep knee bends.
Regardless of age, striving to increase muscle
mass through appropriate exercises is crucial.
3. Develop a strong core: Strong core muscles
help balance the body's weight and reduce the
risk of back and spinal pain. Yoga and Pilates
are excellent exercises for strengthening the
core and promoting orthopedic health.
4. Stretch before exercising: Stretching before
and after exercise is essential to maintain
exibility, improve performance, and reduce
the risk of stress related injuries like sprains
and strains. Warm-up and stretching exercises
are particularly important before engaging in
weightlifting or high impact aerobics. These
exercises enhance exibility and help prevent
muscle and joint injuries.
5. Wear comfortable shoes: Choosing shoes with
proper sole and heel support promotes proper
alignment and prevents foot pain and joint
stress. Wearing faulty or improper footwear is
a leading cause of conditions such as plantar
fasciitis, metatarsal pain, and heel pain.
Regularly wearing high heels increases the
risk of developing back pain and knee pain,
especially in women.
6. Schedule regular check-ups: Regular visits to
your primary care doctor, ideally on a yearly
basis, are crucial for maintaining orthopedic
health. This is particularly important for
older adults who are more susceptible to
developing arthritis and experiencing injuries.
By discussing preventive measures, a primary
care doctor can help protect both orthopedic
and overall health.
Remember, "prevention is better than cure",
and implementing these preventive measures can
signi cantly contribute to the well being of your
musculoskeletal system and overall health.
8. Role of Physiotherapy in Sports injury
prevention
Sports and Exercise Physiotherapists play
a crucial role in the prevention and treatment
of injuries associated with sports and exercise,
regardless of age or ability level. Physiotherapy
serves as an effective means of injury prevention,
as many sports related injuries occur due to
imbalances in muscle strength and weakness.
Physiotherapists assess the biomechanical function
of athletes to identify and correct any movement
patterns that could potentially lead to future
injuries. It is essential for athletes to enhance their
strength, exibility, coordination, speed, and power
to mitigate the risk of injuries.
Sports injury prevention can be achieved through
adherence to a periodized training program, proper
nutrition and sleep, adequate hydration, and the
use of appropriate equipment for the speci c sport.
An optimal periodized training program involves
planning the sports season in well structured blocks
that allow suf cient time for building strength and
power, implementing conditioning methods for
endurance and aerobic tness, and incorporating
sport speci c skills into the overall plan. Maintaining
a balanced and nutritious diet is crucial for all
athletes, as it supports muscle tissue development
and repair, facilitates the transportation of oxygen
and essential nutrients throughout the body, and
ensures proper hydration levels. Biomechanical
assessments are conducted to identify any de cits
that may increase the risk of injury in a particular
sport. Once identi ed, a combination of corrective
exercises and hands-on treatment is employed to
address movement patterns and equip athletes
with the necessary tools to prevent future injuries.11
Lastly, the use of appropriate sports-speci c
equipment, footwear, and protective gear is
paramount in any sport. Inadequate or ill tting
shoes and equipment can lead to injuries during
sports activities. Ensuring access to up-to-date
clothing and equipment is essential in minimizing
risks and allowing athletes to focus on achieving
their best performance.12
Role of Physiotherapy in Health Promotion
Health promotion is de ned as the process
Srikanta Padhan, Avilash Mohapatra/Empowering Wellness: Unveiling the Key Role of Physiotherapy in
Preventive and Promotive Health
Indian Journal of Preventive Medicine / Volume 11 Number 2 / July - December 2023
76
Fig. 1: Role of physiotherapy at all levels of healthcare
of empowering individuals to enhance their
health by increasing control over it. Assessment,
communication, and improving health literacy
are key methods employed in promoting health.13
The World Physiotherapy (formerly known as
the World Confederation for Physical Therapy)
states that physical therapists provide services
aimed at developing, maintaining, and restoring
individuals' maximum movement and functional
ability. Physical therapists play a vital role in
maximizing people's quality of life across physical,
psychological, emotional, and social dimensions.14
As members of the health promoter community,
physiotherapists actively contribute to health
promotion, wellness, tness, and the prevention
and management of diseases and disabilities.
They serve as a crucial link between health and
healthcare delivery. Physiotherapists leverage their
expertise to support individuals and populations
in improving overall health and preventing health
issues. Their roles may encompass education, direct
intervention, research, and advocacy, all aligned
with the profession's objective of empowering
individuals to take charge of their own health.
Physiotherapists also adapt health advice to the
speci c community where individuals live, work,
learn, and engage in recreational activities. They
consider and address social determinants of health
when providing both clinical and community
services. Moreover, physiotherapists employ
specialized techniques to facilitate behavioral
changes and ensure the integration, accessibility,
and mutual reinforcement of clinical and
community treatments.
Even during the pandemic, physiotherapists
have continued to serve their clients and patients.
They maintain a strong focus on promoting
physical activity as a vital aspect of their duties
and responsibilities. Enhancing body function
and movement through physical activity remains
a central intervention in physiotherapy. Despite
the lurking risk of COVID-19 transmission,
physiotherapists persist in their role of promoting
physical and treating the pulmonary complications
during the pandemic. They are committed to
consistently advocating for physical activity among
clients, patients, and the broader community.
Health promotion holds particular signi cance
for the disabled population. While emerging
technologies have extended the lifespan of
individuals with disabilities, there may be a lag in
addressing the quality-of-life aspect. Promoting
healthy behaviors can serve as a powerful tool
to enhance the quality of life for patients with
disabilities and complement their medical
interventions.
CONCLUSION
A comprehensive approach to healthcare should
encompass all aspects of health promotion and
disease prevention. Physiotherapy, as a healthcare
discipline, is well-positioned to play a vital role in
primary healthcare. Physiotherapists must acquire
the necessary education and experience to address
Srikanta Padhan, Avilash Mohapatra/Empowering Wellness: Unveiling the Key Role of Physiotherapy in
Preventive and Promotive Health
Indian Journal of Preventive Medicine / Volume 11 Number 2 / July - December 2023
77
the requirements of health promotion and disease
prevention effectively. It is essential to prioritize
and allocate resources to physiotherapy within
and community healthcare, while recognizing
the signi cant role it already plays in secondary
and tertiary care settings. Physiotherapy not only
contributes to the overall health of individuals but
also enhances their productivity, leading to positive
contributions to a country's economy. The provision
of physiotherapy services should be conducted
within an environment of trust, respecting human
dignity, and guided by robust clinical reasoning
and scienti c evidence.
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Srikanta Padhan, Avilash Mohapatra/Empowering Wellness: Unveiling the Key Role of Physiotherapy in
Preventive and Promotive Health
... Exercise Prescription: Sports scientists design and implement exercise programs to enhance athletic performance, considering factors like strength, endurance, flexibility, and conditioning (Rothwell et al., 2020). Physiotherapists prescribe specific exercises to rehabilitate injuries, restore mobility, and improve functional capacity, often tailoring programs to the individual athlete's needs (Padhan and Mohapatra, 2023;Rambaud et al., 2022). Performance Enhancement: Sports scientists may use physiological testing, performance analysis, and nutrition guidance to help athletes reach their peak p e r fo r m a n c e l e v e l s ( B u r ke e t a l . ...
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Background Falls in older people have become a major public health concern worldwide, but a comprehensive assessment of the burden of falls for older people in mainland China has not been done. We aimed to investigate the burden of falls among older people at the national and subnational level in mainland China, and explore the trends from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Method Using data from GBD 2019, we estimated the burden of falls among people aged 60 years and older by sex and age group in terms of incidence, mortality, and disability-adjusted life-year (DALY) rates and assessed these indicators at the subnational level in 31 geographical units (hereafter called provinces). We investigated the overall trend in the burden of falls across these 31 provinces from 1990 to 2019, and assessed the change in the burden of falls by sex, age group (60–64, 65–69, 70–74, 75–79, and ≥80 years), and province between 1990 and 2019. Findings In 2019, in mainland China, the incidence rate of falls among people aged 60 years and older was 3799·4 (95% uncertainty interval [UI] 3062·4–4645·0) new falls per 100 000 population, and 39·2 deaths (21·8–48·8) per 100 000 population and 1238·9 DALYs (920·5–1553·2) per 100 000 population were due to falls. We found no significant difference in the burden of falls between males and females. The incidence, mortality, and DALY rates of falls for people aged 80 years and older were significantly higher than those in the other age groups, except for incidence rate, which was non-significantly different between the age 75–79 years group and the oldest age group. Large variations in the incidence and DALY rates of falls were observed across 31 provinces. Although between 1990 and 2019 we found no significant changes in overall mortality due to falls in all provinces and in DALY rates for 23 provinces (DALY rates significantly decreased in two provinces and increased in six provinces), we found large increases in the incidence rate of falls in both males (percentage change between 1990 and 2019: 82·9% [67·4–100]) and females (77·0% [63·3–91·8]). The percentage change in incidence rate of falls between 1990 and 2019 varied from 50·0% (42·2–59·5) for people aged 60–64 years to 123·8% (105·4–141·9) for people aged 80 years and older. All provinces had significant increases in the incidence rate of falls between 1990 and 2019, with Sichuan having the greatest increase (148·5% [125·5–171·4]) and Jilin the smallest increase (14·7% [3·6–26·1]). Interpretation Between 1990 and 2019, the incidence rate of falls increased substantially in older adults across mainland China, whereas the rates of mortality and DALY of falls among older people remained relatively stable, suggesting improvements in outcomes of falls. Nevertheless, falls remain an ongoing health burden for older people in mainland China, and there is an urgent need to introduce system-wide, integrated, and cost-effective measures to protect and support older people to minimise their risks and combat an increasing absolute burden as the population continues ageing. Funding Bill & Melinda Gates Foundation.
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Both observational and interventional studies suggest an important role for physical activity and higher fitness in mitigating the metabolic syndrome. Each component of the metabolic syndrome is, to a certain extent, favorably influenced by interventions that include physical activity. Given that the prevalence of the metabolic syndrome and its individual components (particularly obesity and insulin resistance) has increased significantly in recent decades, guidelines from various professional organizations have called for greater efforts to reduce the incidence of this condition and its components. While physical activity interventions that lead to improved fitness cannot be expected to normalize insulin resistance, lipid disorders, or obesity, the combined effect of increasing activity on these risk markers, an improvement in fitness, or both, has been shown to have a major impact on health outcomes related to the metabolic syndrome. Exercise therapy is a cost-effective intervention to both prevent and mitigate the impact of the metabolic syndrome, but it remains underutilized. In the current article, an overview of the effects of physical activity and higher fitness on the metabolic syndrome is provided, along with a discussion of the mechanisms underlying the benefits of being more fit or more physically active in the prevention and treatment of the metabolic syndrome.
Article
Background: About one-third of women have urinary incontinence (UI) and up to one-tenth have faecal incontinence (FI) after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both preventing and treating incontinence. This is an update of a Cochrane Review previously published in 2017. Objectives: To assess the effects of PFMT for preventing or treating urinary and faecal incontinence in pregnant or postnatal women, and summarise the principal findings of relevant economic evaluations. Search methods: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearched journals and conference proceedings (searched 7 August 2019), and the reference lists of retrieved studies. Selection criteria: We included randomised or quasi-randomised trials in which one arm included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Populations included women who, at randomisation, were continent (PFMT for prevention) or incontinent (PFMT for treatment), and a mixed population of women who were one or the other (PFMT for prevention or treatment). Data collection and analysis: We independently assessed trials for inclusion and risk of bias. We extracted data and assessed the quality of evidence using GRADE. Main results: We included 46 trials involving 10,832 women from 21 countries. Overall, trials were small to moderately-sized. The PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Two participants in a study of 43 pregnant women performing PFMT for prevention of incontinence withdrew due to pelvic floor pain. No other trials reported any adverse effects of PFMT. Prevention of UI: compared with usual care, continent pregnant women performing antenatal PFMT probably have a lower risk of reporting UI in late pregnancy (62% less; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; moderate-quality evidence). Antenatal PFMT slightly decreased the risk of UI in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; high-quality evidence). There was insufficient information available for the late postnatal period (more than six to 12 months) to determine effects at this time point (RR 1.20, 95% CI 0.65 to 2.21; 1 trial, 44 women; low-quality evidence). Treatment of UI: compared with usual care, there is no evidence that antenatal PFMT in incontinent women decreases incontinence in late pregnancy (very low-quality evidence), or in the mid-(RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; low-quality evidence), or late postnatal periods (very low-quality evidence). Similarly, in postnatal women with persistent UI, there is no evidence that PFMT results in a difference in UI at more than six to 12 months postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; low-quality evidence). Mixed prevention and treatment approach to UI: antenatal PFMT in women with or without UI probably decreases UI risk in late pregnancy (22% less; RR 0.78, 95% CI 0.64 to 0.94; 11 trials, 3307 women; moderate-quality evidence), and may reduce the risk slightly in the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; low-quality evidence). There was no evidence that antenatal PFMT reduces the risk of UI at late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; moderate-quality evidence). For PFMT started after delivery, there was uncertainty about the effect on UI risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; moderate-quality evidence). Faecal incontinence: eight trials reported FI outcomes. In postnatal women with persistent FI, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (very low-quality evidence). In women with or without FI, there was no evidence that antenatal PFMT led to a difference in the prevalence of FI in late pregnancy (RR 0.64, 95% CI 0.36 to 1.14; 3 trials, 910 women; moderate-quality evidence). Similarly, for postnatal PFMT in a mixed population, there was no evidence that PFMT reduces the risk of FI in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, low-quality evidence). There was little evidence about effects on UI or FI beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it. Authors' conclusions: This review provides evidence that early, structured PFMT in early pregnancy for continent women may prevent the onset of UI in late pregnancy and postpartum. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on UI, although the reasons for this are unclear. A population-based approach for delivering postnatal PFMT is not likely to reduce UI. Uncertainty surrounds the effects of PFMT as a treatment for UI in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches, and in certain groups of women. Hypothetically, for instance, women with a high body mass index (BMI) are at risk of UI. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups, and how much PFMT women in both groups do, to increase understanding of what works and for whom. Few data exist on FI and it is important that this is included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence. In addition to further clinical studies, economic evaluations assessing the cost-effectiveness of different management strategies for FI and UI are needed.
Chapter
Obesity is one of the most important reasons for reduced life expectancy within the “modern” world. The prevalence of overweight and obesity continues to increase both in developing and in developed countries. It is common in every age group, from pediatric to geriatric individuals, which serve as our future and heritage in the universe. It was clearly seen in reported studies around the world that overweight and obesity are still growing epidemic health problems. It is well known that obesity results in impaired health and premature death. Obesity does not only impair the physical and mental health of people but also impairs economic wealth of most communities. The heavy burden of treatment cost and reductions in effective labor power leads to financial losses all over the world. Obesity has a higher morbidity rate than diseases emanating from underweight. Primarily, we have to find a reasonable and sustainable solution to this problem, in order to reach the longer life expectancy and more qualified life span in the twenty-first century. The policy makers in health services and health professionals in medicine have important roles to prevent and cure this “contemporary” epidemic. Additionally, the most crucial step for people is to get rid of the prevailing inertia and take personal responsibility for their health development.
Treasure Island (FL): Stat Pearls Publishing
  • S Senthelal
  • J Li
  • S Ardeshirzadeh
  • Thomas Ma Arthritis
Senthelal S, Li J, Ardeshirzadeh S, Thomas MA. Arthritis. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2022 [cited 2023 Feb 19]. Available from: http://www. ncbi.nlm.nih.gov/books/NBK518992/.
Treasure Island (FL): Stat Pearls Publishing
  • L N Tran
  • Y Puckett
  • Urinary Incontinence
Tran LN, Puckett Y. Urinary Incontinence. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2022 [cited 2023 Feb 19]. Available from: http://www.ncbi.nlm.nih. gov/books/NBK559095/.