Health Behaviour Change

This article was written by Physiotherapist Jessica Anderson from On Track Physiotherapy (Special interests in promoting health and wellness in the Stroke and ABI population)

We all make decisions about our health every day but what makes us choose one thing over another?

One thing we see as Health Professionals is the many ways in which our patients choose to act when it comes to their health. With the incidence of chronic diseases increasing, our role as health professionals in facilitating health behaviour change has never been more important.

When it comes to making health behaviour changes, research shows that knowledge and motivation are not sufficient. An individual must be in a stage of readiness to change as well as having a good understanding of the barriers and facilitators likely to influence their success. People are part of a complex set of environments, relationships and personality traits. All of which offer multiple levels of influence

As Physiotherapists, we see our patients come back time and again having not done their exercises. Rather than labelling them as ‘non-compliant’, it may be more appropriate to find out WHY

Questions to ask when identifying barriers

  • What is important to YOU? What are your Priorities? What are your Values?
  • What are the costs of engaging in the behaviour vs not engaging? E.g. A smoker may feel the difficulties of quitting far outweigh the long term health benefits.
  • What barriers are stopping you from changing?
    • Social networks?
    • Cultural expectations?
    • Fear of failure?
    • Time
  • What will it take to help you overcome these barriers?

As health professionals we always want to deliver a service that is helping someone improve their health. It can be difficult when we cannot get the desired outcomes for both the patient and ourselves.

Establishing what Stage of Change our patient is in can ensure our intervention is targeted and relevant and ensures efficient use of resources.

The lack of Physical activity in Stroke Survivors

Author: Jessica Anderson – Stroke rehabilitation/Brain Injury Rehabilitation Specialist

Did you know?

  • Stroke survivors are the least active of all chronic health conditions
  • Stroke survivors are at 30% risk of further stroke, 18% of which will be fatal
  • Exercise along with diet modification, anti hypertensives, cholesterol lowering meds and aspirin could lower risk of secondary stroke by 80% (1)

How can Physiotherapy help?

  • Prescription of Exercise Programs based on individual impairments and ability
  • Advice about what types of exercise and activity may suit each individual
  • Health coaching and identification of barriers and facilitators to regular activity
  • Behaviour change strategies to ensure long term activity adherence (1, 2, 3)
  • Support patients to build up their exercise gradually and safely 

Consequences of Inactivity and Low fitness

  • Muscle atrophy – increased intramuscular fat – Increased inflammatory cytokines 
  • Abnormal glucose metabolism – Increased risk of further stroke 
  • Increased risk of osteoporosis & fall with fracture by up to 7 times
  • Social isolation – Fatigue – Depression and anxiety
  • Reduced participation in meaningful social roles and hobbies
  • Increased care needs (1, 4)

Benefits of Physical Activity in Stroke Survivors

  • Improvement of depressive symptoms   
  • Improvement of executive function and memory
  • Reduced risk of cognitive impairment 
  • Improve skill acquisition by priming the brain with neurotrophic factors
  • Improve post stroke fatigue   
  • Increased independence with activities of daily living and participation in social roles
  • Improve quality of life
  • (1, 4)
Finding the exercise a person is motivated to do is the best type of exercise!

Physical activity recommendations for stroke survivors (1)

Aerobic exercise: 
– 3 to 5 days per week
– 20 to 60 min sessions of a moderate intensity (or multiple shorter sessions)

Strength training:
– 2 to 3 days per week
– 1 to 3 sets of 10-15 reps of all major muscle groups 

– Stretches 2-3 days per week paired with aerobic or strength training
– Neuromuscular/balance 
– Used as an adjunct to aerobic and strength training on 2-3 days per week

Any movement or activity is better than none!

  • Billinger, S. A., Arena, R., Bernhardt, J., Eng, J. J., Franklin, B. A., Johnson, C. M., . . . Tang, A. J. S. (2014). Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. 45. doi:10.1161/str.0000000000000022 
  • Fini, N. A., Holland, A. E., Keating, J., Simek, J., & Bernhardt, J. (2017). How Physically Active Are People Following Stroke? Systematic Review and Quantitative Synthesis. Physical Therapy, 97(7), 707-717. doi:10.1093/ptj/pzx038 
  • Morris, J. H., Macgillivray, S., & McFarlane, S. (2014). Interventions to promote long-term participation in physical activity after stroke: a systematic review of the literature. Arch Phys Med Rehabil, 95(5), 956-967. doi:10.1016/j.apmr.2013.12.016 
  • Ploughman, M., & Kelly, L. P., (2016). Four birds with one stone? Reparative, neuroplastic, cardiorespiratory, and metabolic benefits of aerobic exercise poststroke. Curr Opin Neurol, 29  
  • Turan, N. T., Nizam, A., Lynn, M. J., Egan, B. M., Le, N-A., Lopes-Virella, M. F., … Chimowitz, M. I. (2017). Relationship between risk factor control and vascular events in the SAMMPRIS trial. Neurology, 88 (4), 379-385 

Treating Vestibular Disorders

Author: Jess Hennell (Physiotherapist) – Special Interest in Vestibular Disorders

“Vertigo and dizziness affects more than 1/3 of people over the age of 50” – RACGP

It can lead to people requiring time off work, presentations to the emergency department and falls resulting in serious injuries or fractures. Vertigo is a type of dizziness that feels as though the room around you is spinning. The severity of symptoms can range from mild to severe and may involve nausea and vomiting. 

Upon diagnosing the type of Vertigo a person has, various Vestibular rehabilitation techniques can be recommended and prescribed. For Benign Paroxysmal Vertigo (BPPV), various canal repositioning techniques can be implemented to address the canal in concern. With other Vestibular conditions a range of exercises and treatments are prescribed after a detailed assessment. These treatments may include gaze stability exercises, habituation/compensatory strategies and balance/falls prevention exercises. (7) Time is spent to educate clients to ensure they are completing their exercises at the correct level and to encourage them to return to normal life activities. 

Clients are reviewed regularly during their treatment period and treatments will be progressed at the frequency that best suits the individual. Both research studies and our clinical experience indicate that the longer an individual waits for treatment the more an individual can develop activity avoidance behaviour. This can exacerbate their symptoms and impact on their quality of life.

Specific Exercises

Rehabilitation program can include gaze stability exercises, habituation and balance/postural control 

Reducing Symptoms

Symptoms that can be improved with vestibular rehab can include dizziness, vertigo and imbalance

Jess demonstrating a Hall-pike manoeuvre

Who benefits from Vestibular Rehab?

Clients who are experiencing:
 –  Dizziness
 –  Vertigo
 –  Feeling off balance
 –  Falls or near misses for falls
 –  Visual blurring with head movement (1)
 There is strong to moderate evidence that vestibular rehab is safe and effective for a range of peripheral vestibular conditions (1, 2) including:
 –  BPPV
 –  Vestibular neuritis or Labyrinthitis
 –  Post removal of Acoustic Neuroma

Vestibular rehab can also be used to assist with:
–  Persistent postural-perceptual dizziness (3PD) (3)
–  Post concussion syndrome (4)
–  Multiple sclerosis (5)
–  Meniere’s disease (residual symptoms between episodes) (6) 

3 reasons to refer for Vestibular Rehab

­1) Early initiation of Vestibular rehabilitation may result in improved recovery of balance, reduced symptom complaints and improved functional recovery (1)
2) For clients with BPPV, treating with an appropriate canal repositioning technique can reduce falls in this population by around 65% (8)
3) It can improve both symptoms and function and result in benefits to quality of life!  (1)

Are you ready to work from home?

As a business owner I’m sure like every other business owner out there you have been watching the COVID-19 updates religiously. After this evening’s (22nd March 2020) press conference from the Prime Minister to practice better social distancing, working from home for those who are able will become more of a reality from this week onwards.

So are you prepared?

Here are a few tips to help set you up.

Having a room dedicated to your home office will help you be less distracted and more productive. Moreover, having an adequately sized desk and clean desk will enhance your productivity. It will prevent you from constantly looking under piles of paperwork trying to find your mouse or constantly moving stacks of paper around then inadvertently losing an important document you are trying to cite.

2. Chair:
Having an ergonomic chair with good back and lumbar support, good seat cushioning and enough functions that you can tailor it to your size is important. After all, you could be sitting in your chair for hours on end and this is where most people end up with back and neck pain.

3. Correct set-up
Ensuring you have your screen, mouse, keyboard, desk and chair set-up ergonomically is crucial. You shouldn’t have to reach too far forward or reach up to your keyboard. This is another way to ensure you can work pain-free over the coming months. If unsure, we are starting to offer ergonomic assessments online given the social distancing restrictions. (We’re trying to do our part too!) Enquire with us further if you think this could be beneficial to you.

4. Accessories
There are boundless accessories on the market these days. Monitor screen arms, stand-up desks, foot stools the list goes on. Don’t underestimate a good mouse pad either! There are plenty of things on the market that will help you ensure your desk set-up is tailored to your size and job description.

5. Webcam and Headset
There will be plenty of tele-conferencing in coming months so make-sure you have access to a webcam or think about purchasing one if you are client facing. There is nothing worse than trying to impress someone with a pixelated version of you.
Get an external mic or headset. Often the computer mic is ineffective and will make you sound like a robot. It won’t help you much if you’re trying to get a deal over the line.

I hope this post helps you in a small way. At On Track Physiotherapy we know the average 21st century worker is a desk jockey so we are passionate about keeping with the times and ensuring people are able to work productively and pain free.

A Case-study: To prescribe or not to prescribe?

One of the most commonly asked for items are standing desks but this does not always mean it is the correct solution. 

Finding out why a client wants a standing desk is important. More often than not, they are in pain whilst working and need a solution to their pain. Pain and injury can decrease productivity and also cause time-off work. Besides, pain can often make people irritable not only to clients but also towards fellow co-workers, family and friends. This can quickly cause resentment and negativity in a work place.

In my last few workstation assessments instead of standing desks I have actually looked at other things such as keyboard and mouse, screen set-up and office chairs. Often educating my clients on how to set their workstation up goes a long way as it often solves their problems quickly. This is important as you can have the fanciest tools but if you don’t know how to use them it won’t fix your problem.

Contact On Track Physiotherapy if you would like more information on how our individually tailored assessments might benefit your workplace or workers.