Physical activity and sedentary lifestyle: the role played by physiotherapists in changing behavior

PHYSICAL ACTIVITY AND SEDENTARY LIFESTYLE

Physical activity (PA) is defined as any body movement produced by skeletal muscles that requires energy expenditure. Exercise is a subcategory of PA, being planned, structured and repeated purposely to improve or maintain fitness and health. Sedentary behavior, on the other hand, refers to any waking behavior characterized by an energy expenditure of less than or equal to 1.5 metabolic equivalents while sitting, reclining, or lying down. Most office work, watching television and even driving a car, are examples of sedentary behaviors¹.

The World Health Organization (WHO) recommendations on physical activity and sedentary behavior include all populations, regardless of gender, cultural origin or socioeconomic status, and are relevant to people at all skill levels. Adults should engage in at least 150-300 minutes of moderate intensity aerobic physical activity, or 75-150 minutes of vigorous intensity, for substantial health benefits¹. The WHO further recommends that adults limit their sedentary time, substituting by any intensity of PA, even if light. It is estimated, however, that in 2016, 27.5% of adults and 81% of adolescents did not meet such recommendations¹.

Regular PA may reduce the risk of all-cause mortality and is associated with reduced risk of developing several comorbidities, including type 2 diabetes mellitus, cardiovascular diseases, depression and various types of cancer¹. Incentivizing PA for the general population as a form of treatment, disease prevention, and health promotion is therefore essential.

Despite acting mainly in tertiary care, almost exclusively in rehabilitating and curing sequelae, physical therapists have often been appointed as one of the main professionals responsible for promoting increased physical activity and reduction of sedentary behavior. Thus, physiotherapist play a role in planning and developing strategies to contemplate both rehabilitation, health promotion, and disease prevention actions².

Encouraging change in behavior, aiming at a physically active lifestyle and reduced sedentary time, goes beyond the walls of rehabilitation centers. In fact, rehabilitation alone has shown to be insufficient to describe functional gains in behavior change for a more active lifestyle³ or reduced sedentary behavior⁴.

Significant attention has been paid to interventions focused on behavior change through strategies that optimize self-confidence or self-efficacy to increase participation in physical activity and reduce sedentary behavior⁵. Goal setting; action planning; problem solving; background information and health consequences; pros and cons; and comparative imagination of future results are specific techniques considered promising for behavior change to increase participation in physical activity⁶.

In this context, physiotherapists should incorporate evidence-based strategies that go beyond prescribing exercise, to support autonomy and self-efficacy according to each individual⁷, and thus significantly impact the change in behavior.

ACKNOWLEDGMENTS

The author is supported by São Paulo Research Foundation (FAPESP) (process No. 2021/04198-6)

REFERÊNCIAS

• ¹
  World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Geneva: WHO; 2020.
• ²
  Bispo JP Jr. Fisioterapia e saúde coletiva: desafios e novas responsabilidades profissionais. Cienc Saude Colet. 2010;15(Suppl):1627-36. doi: 10.1590/S1413-81232010000700074.
  » https://doi.org/10.1590/S1413-81232010000700074
• ³
  Cindy Ng LW, Mackney J, Jenkins S, Hill K. Does exercise training change physical activity in people with COPD? A systematic review and meta-analysis. Chron Respir Dis. 2012;9(1):17-26. doi: 10.1177/1479972311430335.
  » https://doi.org/10.1177/1479972311430335
• ⁴
  Coll F, Cavalheri V, Gucciardi DF, Wulff S, Hill K. In people with COPD, there is limited evidence that exercise training reduces sedentary time, and behavior change techniques are poorly reported: systematic review and meta-analysis. Phys Ther. 2021;101(7):pzab097. doi: 10.1093/ptj/pzab097.
  » https://doi.org/10.1093/ptj/pzab097
• ⁵
  Freitas PD, Passos NFP, Carvalho-Pinto RM, Martins MA, Cavalheri V, Hill K, et al. A behavior change intervention aimed at increasing physical activity improves clinical control in adults with asthma: a randomized controlled trial. Chest. 2021;159(1):46-57. doi: 10.1016/j.chest.2020.08.2113.
  » https://doi.org/10.1016/j.chest.2020.08.2113
• ⁶
  Sawyer A, Lewthwaite H, Gucciardi DF, Hill K, Jenkins S, Cavalheri V. Behaviour change techniques to optimise participation in physical activity or exercise in adolescents and young adults with chronic cardiorespiratory conditions: a systematic review. Intern Med J. 2019;49(10):1209-20. doi: 10.1111/imj.14141.
  » https://doi.org/10.1111/imj.14141
• ⁷
  Karloh M, Matias TS, Mayer AF. Lack of responsiveness of the PRAISE tool to pulmonary rehabilitation: instrument or protocol limitation? Physiotherapy. 2020;106:215-6. doi: 10.1016/j.physio.2019.09.001.
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Publication Dates

• Publication in this collection
  29 Aug 2022
• Date of issue
  Apr-Jun 2022