By: Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, CNPT, NSCA-CPT, Cert-DN
I know, I said it. And you are wondering why in the heck a physical therapist, personal trainer, and strength coach would ever say such a thing?!
A few years ago a group of researchers published a wonderful editorial piece in the British Journal of Sports Medicine. Titled It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet, the article stirred the pot and highlighted important data on weight loss. The literature highlighted how many sports medicine, physio, and personal training professional are biased to exercise as the main mode for weight loss. Furthermore, the authors came out and boldly stated that physical activity does not promote weight loss. That's right, physical activity does not promote weight loss.
If these researchers are right, then why is the American Physical Therapy Association (APTA) hanging their professional "hat" on PTs promoting physical activity? Why is it that the most common "exercise" recommendation by PTs and general practitioners (GPs) is simple walking (aside from a home exercise program for a problem-focused issue)? PTs and MDs for years have touted that patients should be "moving", and now our professional organization (APTA) is riding the erroneous bandwagon that simply moving is enough for health and weight loss.
To make matters worse the APTA is way behind other organizations on integrating nutrition education within the profession. For years exercise scientists have been educated on nutrition. Athletic trainers, thanks to the National Athletic Trainers' Association (NATA), are required to take several nutrition courses and are even tested on it during their board exam. Even more, the NATA even have position statements relative to nutrition and their practice (https://www.nata.org/practice-patient-care/health-issues/nutrition)! The National Strength and Conditioning Association (NSCA) has three parts to their strength and conditioning certifying exam with one whole part dedicated to nutrition. And the APTA... has passed a house of delegate statement simply stating: "PTs can do nutrition". They stake such a claim on the APTA website with a list of legalese and "compliance", without any initiative to change their mantra of "keep moving" to lose weight and for better health (http://www.apta.org/PatientCare/Nutrition/).
Unfortunately the data just don't support that movement alone, especially physical activity, is enough for weight loss. Exercise is progressive, planned, and structured: but does it even promote the weight loss we professionals think it does? According to new research, exercise is only a small factor for weight loss with diet making the biggest contribution. The data show that exercise promotes increased energy uptake (e.g. people ate more calories) as they exercise. As such, people often will begin to exercise, eat more, and then lose very little weight progressively over time. Often times clients regain or yo-yo their weight up, down, and up again. Even more worrying is that clients seek trendy and dangerous diets and methods to lose weight once their first few attempts at weight loss have failed.
So what do we as medical professionals convey to our patients and clients regarding weight loss? First: physical activity is not enough. The APTA needs to refocus their mission. Movement may be great but we as PTs need to be more holistic and all-encompassing. Food has physical and functional ramifications which falls into the wheelhouse of a well-educated PT. Second, exercise is fair for weight loss but one must also examine their diet. Some studies show that diet factors in to about 60-80% of weight loss; why should PTs be ignoring this factor and just babbling on about walking for hours?!
As physical therapists we need to be educating patients on what a healthy diet looks like and promoting healthy eating patterns such as whole-food, plant-based diets. One of the best ways to begin counseling clients on nutrition is through integrating nutrition into PT schools. The other way is for licensed PTs and PTAs to consider taking the Nutritional Physical Therapy courses on nutrition for PTs at www.nutritionalphysicaltherapy.com. Dr. Sean Wells and Dr. Anik Lauzon guide students through 3 courses:
Introduction to Nutrition for PTs (IN)
Nutrition Assessment and Prescription for PTs (NAP)
Specialized Nutrition for PTs (SNP)
All three courses are approved for continuing education for PTs by the Florida Physical Therapy Association (FPTA), a chapter of the APTA. Enroll today and share the message to your friends and colleagues: we need to end the mantra that physical activity is enough for clients to lose weight and feel better!
MALHOTRA, A., NOAKES, T. & PHINNEY, S. 2015. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. British journal of sports medicine, bjsports-2015-094911. https://www.ncbi.nlm.nih.gov/pubmed/30414399
MYERS, A., DALTON, M., GIBBONS, C., FINLAYSON, G. & BLUNDELL, J. 2019. Structured, aerobic exercise reduces fat mass and is partially compensated through energy intake but not energy expenditure in women. Physiology & behavior, 199, 56-65. https://www.sciencedirect.com/science/article/abs/pii/S0031938418305110