A new study says that when it comes to leisure time physical activity, the more the better—but that doesn't mean that cranking out 10 times the minimum activity recommendations makes you 10 times more likely to live longer than someone who just meets the recommendations (or exceeds them by a bit).

Researchers compared mortality rates with activity levels among 661,137 men and women over 14.2 years in an effort to gauge the dose-response relationship between leisure time physical activity (LTPA) and mortality generally, with a focus on finding out if an "upper limit" of activity exists in which the longevity benefits level off—or actually decrease.

Some of what they found is already widely accepted: namely, that adhering to the 2008 Physical Activity Guidelines for Americans of 75 vigorous-intensity or 150 moderate-intensity activity minutes a week significantly reduces mortality. Other findings were new, particularly when it came to how much activity produces the biggest longevity payoff. Results were published in the April 6, 2015, online version of JAMA Internal Medicine (abstract only available for free).

By using self-reported activity data from 6 large-scale studies and then converting those data to metabolic equivalent of task (MET) numbers, researchers were able to compare results even when the studies asked slightly different questions about physical activity. The study sample consisted of 291,485 men and 369,652 women, although with a rate of 95% Caucasian participants it was not representative of the US population.

The analysis found that individuals who met or engaged in twice the guideline recommendations (7.5 to 14.9 METs per week) lowered their risk of mortality by 31%, and those who exceeded recommendations by 2 to 3 times (15 METs to 22.4 METs per week) saw a 37% drop. However, that benefit tapered off and finally plateaued at 3 to 5 times the minimum. From that point on, no additional activity—even activity that exceeded the guidelines by 10 times or more—seemed to make a dent in longevity rates.

PT in Motion (04/07/2015)

A recently published study of patients with new low back pain (LBP) who received referral from a primary care provider concludes that not only is physical therapy a less expensive next step than advanced imaging, it's an approach that results in lower utilization costs over time.

Researchers Julie M. Fritz, PT, PhD, FAPTA, Gerard P. Brennan, PT, PhD, and Stephen J. Hunter, PT, PhD, OCS, analyzed utilization records and other health information for 841 individuals who consulted with a primary provider about uncomplicated LBP and were referred for management outside primary care within 6 weeks. Of those individuals, 385 received advanced imagining and 377 received physical therapy (the remaining 79 patients received a physician specialist visit or "other care," including chiropractic). The study focused on records obtained from 21 different providers around Salt Lake City, Utah, between 2004 and 2010.

What they found was that across the board, physical therapy was the less costly approach. Initial referral for physical therapy cost $504 on average (for an average 3.8 visits), compared with an average of $1,306 for magnetic resonance imaging (the technology used in "almost all" of the imaging, according to authors).

Even more dramatically, average subsequent costs over the next year were over 66% lower for the patients who began with a physical therapy referral--$1,871, compared with $6,664 charged to the imaging group over the same time period. Those differences remained largely in place even when researchers matched individuals for covariates including prior surgery, use of medication, osteoporosis, and mental health issues. Results of the study appear in the journal Health Services Research (abstract only available for free).

Authors found that patients who receive imaging as a first referral often follow a different path than those who receive physical therapy, writing that referral to imaging "increased the odds of surgery, injections, specialist, and emergency department visits within a year."

Researchers attribute some of the variation to perceptions around imaging. "Advanced imaging often 'labels' a patient's LBP that might otherwise be viewed as nonspecific and uncomplicated, causing heightened concern in some patients and providers and motivating additional care-seeking," they write.

On the other hand, they write, "physical therapy may avoid the negative consequences of a labeling effect from imaging" by "provid[ing] patients with an active approach to LBP, enhancing patients' perceived ability to self-manage their condition."

"This is important research, because it provides even more evidence that physical therapy is a less costly alternative to medication, surgery, and other invasive medical procedures," said Nancy White, PT, DPT, APTA executive vice president of professional affairs. "Not only do patients benefit from the improved outcomes resulting from an active approach to care, society benefits from the reduced financial burden on our health care system. The cost savings Fritz and her colleagues describe here are significant enough to be recognized by health policy makers, payers, and other health professionals."

Authors acknowledge that their study was limited to newly reported and uncomplicated LBP, and that patient-centered function or satisfaction outcomes were not recorded. Still, they write, for individuals with this type of LBP who have expectations for additional care beyond a primary provider, "physical therapy may be the preferred initial step instead of advanced imaging."

PT in Motion (04/07/2015)

One of the bad things to do as a worker especially in the medical field is the bend-lift-twist  movement, a sure way to hurt your back. The most common example is bending over a patient and then lifting him to scoot him up towards the head of the bed. To avoid injury, make sure you: call for assistance, raise the bed up so you won't bend and do the scooting in synchronized manner. Best of all, do core exercises like pilates.

Physical therapy for spinal stenosis is as effective as surgery and should be fully considered as a first-choice treatment option, according to a new study that is the first to directly compare a single, evidence-based physical therapy regimen with decompression surgery among patients who agreed to be randomly assigned to either approach.

The study focused on self-reported physical function among 169 participants diagnosed with lumbar spinal stenosis (LSS) after 2 years, but it also tracked function measurements along the way--at baseline, 10 weeks, 6 months, and 12 months. Researchers found that not only were 2-year effects similar for the 2 groups (87 who began with surgery and 82 who started with physical therapy), the increase in function followed similar trajectories from baseline on.

Research was conducted between 2000 to 2007, and limited to patients 50 years and older who had no previous LSS surgery and had no additional conditions including dementia, vascular disease, metastatic cancer, or a recent history of heart attack.

PT in Motion 04/07/2014

The Men's Health Diet Rules:

1. I will eat protein with every meal and every snack

2. I will never eat the worlds worst breakfast (no breakfast)

3. I will eat before and after exercise

4. I will eat it if it grows on a tree

5. I will eat the salad even if it makes me feel girly

6. I will not eat sugar water

7. I will follow these rules 80 percent of the time