September 8th was celebrated as World Physical Therapy Day. The day is celebrated to recognize the work that physical therapists do for their patients and community. In India, there is little awareness about the field and through this article I take an opportunity to shed light on the importance of this field especially in active ageing.

Physical therapists (also known as physiotherapists) work with people of all ages to bring about improvements in their health and independence. They 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. Physical therapists provide exercise regimes for conditions that affect the bones and muscles, such as arthritis, back and neck pain, osteoporosis, joint replacements, and urinary incontinence. 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.

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 specifically prescribed activity and movement. However, the importance of physical therapy in older adults as a part of life rather than as a remedy for disease is not understood.

Older adults engaged in regular physical activity demonstrate improved:

• balance
• strength
• coordination and motor control
• flexibility
• endurance.

Another important role physical therapy attains is to retrain the patient to do everyday tasks.

A vast number of conditions are treated effectively with physical therapy intervention. Examples of specific diseases and conditions that may affect older people and be improved with physical therapy include:

• Arthritis
• Osteoporosis
• Cerebral Vascular Accident (Stroke)
• Cancer
• Parkinson's Disease
• Urinary and Fecal Incontinence
• Amputations
• Cardiac and Pulmonary Diseases
• Dementias
• Alzheimer's Disease
• Coordination and Balance Disorders
• Functional Limitations related to mobility
• Sports/Orthopedic Injuries
• Joint Replacements
• Hip Fracture

Arthritis is most common among older adults however the symptoms for everyone are different. Physical therapists design specific regimen which emphasize strength, range of motion, balance, and coordination according to the symptoms. Osteoporosis can lead to falls and bones can be injured and hence it is important to have proper intervention. The role of physical therapists is to make people more stable in relation to gravity, doing extension exercises to keep posture erect.

Strokes and Parkinsons’ disease also require physical therapy. These diseases are more common among older patients. The challenge here is to retrain brain to use the paralyzed or weaker parts of the body as good as the healthy part. In Parkinson’s disease, the goal is to keep the patient’s trunk flexible to avoid ‘robotic’ movements.

Physical therapy is helpful in dementia and Alzheimer’s disease as well. The objective here is to maintain function and making the patients remember the movements from the past such as dancing etc. which are most effective in maintaining balance as well as falls prevention.

 Balance is another issue with older people.  Balance requires co-ordination of multiple body organs such as vision, proprioception, vestibular organs etc. and hence physical therapy which exercises these various organs and help adults maintain balance is essential.

Physical therapy can also help alleviate some of the pain associated with cancer. The correct exercises after mastectomy can reduce swelling and improve range of motion. The therapist has to determine the right exercise and right amount based on clinical judgment (rather than patients just moving around as much as they can stand to at home)."

Incontinence is another area where physical therapy can be helpful. This is an exercise in locating the muscles that control that and operating them at will. Social timing is also important -- knowing how soon after drinking something you will need to use the restroom and planning for that. A physical therapist can help establish such patterns.

Challenges:

The biggest challenge for physical therapists while working with older adults is to understand that No two 'old' people are the same. Every person of any age has an individual background, say an auto accident, football injury, genetic predispositions. In addition, the old age quirkiness requires immense diligence and patience on the part of physical therapists. In addition, it requires support of the family members to help older adults stick to their physical therapy regime. Moreover, it requires understanding of the importance of mobility and independence for older adults to make physical therapy successful for active ageing.