PHYSIOTHERAPY

IS AN IDEALLY PLACED PROFESSION

TO PROVIDE THE PHYSICAL ACTIVITY
COMPONENT OF MULTIDISCIPLINARY
WEIGHT MANAGEMENT SERVICES
Introduction

Obesity is a strong predictor of adult morbidity and

mortality. Any loss of weight is beneficial in reducing
many of the complications of obesity.(1)
NICE guidance for the management of obesity
recommends that initial management comprises of
a variety of interventions to modify diet and physical
activity behaviours.(2)
Physical activity is important for maintaining long-term
weight loss and managing co-morbidities.(3, 4) NICE
guidance also suggests that effective weight management
interventions require multi-disciplinary teams.(2)

Size of the problem

24.4% of adult men and 25.1%

of adult women in England are obese.

(27)

18.9% of Year 6 (aged 10-11) children

and 9.3% of reception children (aged 4-5)
in England are obese.(28)

rates of obesity are seen across

Northern Ireland (23% in adults and
10% in children)(29), Scotland (27.1% in
adults and 16.8% in children)(30) and Wales
(23% in adults and 19% in children).(31)
Similar

2050 the prevalence of obesity is

predicted to affect 60% of adult men,
50% of adult women and 25% of children
in the UK.(32)
By

The Chartered Society of Physiotherapy 2015

Weight management

Physiotherapists have a role to play in the prevention and

management of obesity.(5) Obesity leads to restrictions in
movement, affecting engagement in physical activity.(6)
Exercise and movement is the keystone of the scope of
physiotherapy practice.(7) Along with a holistic, patientcentred, and problem solving approach, physiotherapists
have advanced knowledge and skills in:
anatomical, physiological, and psychosocial

mechanisms of health and disease

assessment and diagnosis
behaviour change
biomechanics
exercise prescription and therapeutic exercise
management of long-term conditions.

Physiotherapists are therefore ideally suited to

address the physical and psychological complexities
of obesity.(8) Physiotherapists provide valuable input
and expertise in the multi-disciplinary management
of obesity,(9) helping to optimise clinical outcomes and
patient experience.
While the importance of being physically active is well
recognised, in reality patients often experience difficulties
in doing so. It is important to facilitate patients to
increase physical activity at the right level, which can be
achieved by referral to a physiotherapist.(10) An assessment
and treatment plan from a physiotherapist will help
overcome the barriers to exercise.(8, 11)

2

Physiotherapy Works Obesity

A treatment plan for an obese patient may comprise of:

provision of personalised lifestyle advice, taking

into account individual attitudes, beliefs,
circumstances, cultural and social preferences,
and readiness to change

prescription, supervision, and progression of

appropriate physical activity to increase muscle

strength, flexibility, and endurance, and sustain
energy output to enhance and maintain weight
loss under safe and controlled conditions

management of associated conditions such

as arthritis, back pain, and other musculoskeletal

and chronic conditions, such as heart disease

co-ordination of comprehensive and sustainable

programmes of management in collaboration
with service users, other health and social care
professionals, and community services.

Getty images

Children and young people

Obese children, like adults, often present with a

number of musculoskeletal signs and symptoms
that may limit their time spent in physical activity.(12)
Being obese is detrimental to gross motor skill
performance, for example in upper and lower limb
coordination, balance, running speed and agility,
and strength.(13) These differences become more

The Chartered Society of Physiotherapy 2015

pronounced as children get older, suggesting the need

for early focus on motor skill development to encourage
overweight and obese children to be physically active.(14)
Physiotherapy-led exercise classes and multi-disciplinary
team interventions including physiotherapy input are
effective in significantly improving motor skills, activity
levels, BMI, and other anthropometry in children.(15-17)

Case study
June, a 43 year old woman weig
hing 153.6kg (BMI 47), was
referred to the award-winning
Glasgow and Clyde Weight
Management Service.On assessme
nt, she scored highly for
anxiety and depression and
reported very poor levels of
physical activity. She rated
her confidence in being able
to incorporate regular exercise
into her daily routine as
very low.
June attended a nine session
lifestyle intervention group
and the physiotherapy led Get
Started classes. Throughout
the initial exercise classes she
needed frequent rests, used
crutches to move about and repo
rted pain. June was supported
to safely increase her activity
levels both in the classes and
in her everyday life until she
was completing the exercise
class without rests and no lon
ger using the crutches.
She attended taster sessions in
badminton and belly dancing,
after which she accessed the
community-based exercise
referral scheme and took up pla
ying badminton twice a week
with a friend she had made on
the programme. She lost 13.3kg.

3

Physiotherapy Works Obesity

Bariatrics

There is mounting evidence

to demonstrate that physical
activity can improve weight
loss and other outcomes
following bariatric surgery.(18-22)
It is consistently seen as the most
important predictor of long-term
weight loss maintenance.(23) Most preoperative patients are insufficiently active,
and without support, fail to make substantial
increases in their physical activity postoperatively.(19)
Wiklund et al(24) found that even one year post-surgery
patients still experience social, physical, and mental
barriers preventing them from being physically active,
often related to side effects from the surgery and a lack
of support to increase physical activity. In particular,
patients with balance, gait or other physical or sensory
deficits should be referred to physiotherapy for support.
(24)
Patients with musculoskeletal conditions, which are
especially common among bariatric patients(25) should
also be referred.

Physiotherapy management

Recommended evidence-based approach for

the physiotherapy management of obesity.(5)

1. Assessment of the individuals medical history

2. Evaluation of current physical activity level
3. Provision of an individualised physical
activity program
4. Gradual progression of a physical activity program
5. Prescription of a cardiovascular training program
6. Prescription of resistance exercises
7. Prescription of moderate-intensity physical
activity, 30 min/d, 35 d/wk
8. Calculation of body mass index.
Note: Including education on strategies for adherence to an independent
exercise program is also recommended whenever possible.

The Chartered Society of Physiotherapy 2015

Measuring impact

Public Health England

have published a
weight management
economic assessment
tool, available at
http://www.noo.org.uk/
visualisation/economic_
assessment_tool to help
compare the costs of a weight
management intervention with
potential savings it may produce to help
make the case for investment. In addition, a
collection of resources on evaluation (CoRE) is
also available at http://www.noo.org.uk/core
to support high quality, consistent evaluation of
weight management interventions and increase
the evidence base.

Cost of ill health

with a BMI over 35kg/m2

cost twice as much in healthcare costs than
individuals with a BMI less than 25kg/m2.(33)
Individuals

cost of overweight and obesity to the

NHS in the UK was 5.1billion in 2006-07.(34)
The

The

wider societal cost of overweight and

obesity in England was estimated at
15.8billion per year in 2007 and is
projected to reach 49.9billion in 2050.(35)
Northern Ireland, obesity results in
260,000 working days lost each year
and costs the economy approximately
500million.(36) In Scotland the
total cost of overweight and obesity was
estimated as 1.4billion in 2007.(37)
In

4

Physiotherapy Works Obesity

Service
examples

Inpatient
Homerton University
Hospital provides
bariatric surgery for
obese patients. A
specialist
bariatric
physiotherapist
provides consistent
physiotherapy suppor
t
throughout the mu
lti-disciplinary car
e
pathway.
Patients with low
levels of physical
activity and musculos
keletal or cognitive
barriers are referr
ed for physiothera
py
assessment. The physi
otherapist supports
patients to optimi
se fitness, mobility
,
and weight loss pri
or to surgery throu
gh
motivational intervie
wing, collaborative
goal-setting
and
physical
activity
prescription.

plinary
Specialist multidisci

on Trusts
Hospital NHS Foundati
Aintree University
offers a
)
gement Service (AWMS
Aintree Weight Mana
patients
to
support programme
weight management
e comor
or
e
the presence of on
with BMI40, or in
morbidities a BMI35.
e provides
m within the servic
The physiotherapy tea
active in
ients to become more
support to enable pat
ed from
err
ref
way. Patients are
a safe and enjoyable
initial
an
g
in
nic and, follow
the consultant-led cli
gh one
rou
th
ted
ment, are suppor
ess
ass
py
era
oth
ysi
ph
hways based
ble physiotherapy pat
of a number of availa
ers they
ty levels and any barri
on their current activi
eir activity.
have to increasing th
o subsequent
MS has resulted in tw
The success of the AW
domiciliary
d
an
ded community
local authority fun
vices:
weight management ser
Management
gh Specialist Weight
Ashton, Wigan and Lei
alysis of
an
t
, Feel Great) Recen
Service (Lose Weight
itiative
in
at
Gre
se Weight Feel
the impact of the Lo
months
six
te
ple
com
of people who
4%
69.
at
th
wn
sho
s
ha
improve or
. Additionally, 96.5%
maintain or lose weight
improve or
cal activity, and 88.2%
maintain their physi
y of life.
maintain their qualit
e (LOSS) A
Obesity Support Servic
Aintree Liverpool
SS service
LO
e
th
at
study found th
ort
coh
e
tiv
pec
ros
ret
r 1 year,
ght loss of 2.51kg ove
resulted in a mean wei
weight loss,
ipants achieving 5%
with 28.9% of partic
of life.
rovement in quality
and a significant imp

The physiotherapis
t contributes to
a
multi-disciplinary
pre-admission group
,
providing education
on breathing and ear
ly
mobility exercises
for the approachin
g
inpatient stay. Th
is has resulted in
greatly improved pre
paratory levels in
patients and a reduct
ion in the average
length of stay post
bariatric surgery fro
m
4.6 days to 3.6 days.
Once home, patients
attend the Homerton
Physical Activity Cir
cuits and Education
(PACE) class.
The 12 week progra
mme
consists of educat
ion sessions abou
t
increasing physical
activity, followed by
circuit-based physi
cal activity statio
ns.
An ongoing evaluati
on of the service ha
s
shown that the six
minute walk distance
increased by an avera
ge of 89 metres.

Children and young people

of a service level agreement
The Activ8 programme, part
er Hamlets local authority
between Barts Health and Tow
siotherapy and dietician-led
public health team, is a phy
e children and young people
service for overweight and obes
from 0 to 18 years of age.
multi-disciplinary assessment
The programme team provides
have been referred by GPs
for children and families who
as well as more general advice
because of specific problems,
and training for early years
in local mosques and schools,
en can be referred to join an
and other health staff. Childr
group for ten weeks which aims
Activ8 exercise and nutrition
lthy lifestyle changes. Once
to enable children to make hea
programme they are invited to
children have completed the
and are monitored for up to
attend an ongoing activity club
been extended to target obese
a year. The programme has also
mothers-to-be and mothers.
showed that 70% of children
In 2009, data for the service
in BMI, which was maintained
participating had a reduction
at six-month follow-up.
The Chartered Society of Physiotherapy 2015

5

Conclusion

Obese individuals often have complex

bio-psychosocial barriers to physical activity
participation. Physiotherapists are uniquely
positioned to facilitate physical activity required
for weight management in these patients due
to their sound grounding in a range of relevant
areas. They autonomously and effectively
deliver high quality, personalised exercise and
lifestyle interventions to prevent and address
barriers to physical activity participation,
promoting physical and mental health and
wellbeing, and enabling obese people to move
and function as well as possible.

Physiotherapy Works Obesity

Further information
CSP Enquiry Handling Unit

!?

Tel: 0207 306 6666

Email: enquiries@csp.org.uk
Web: www.csp.org.uk

Acknowledgements

The CSP would like to thank the following people for their input: Vicki Downey, Kim Ferrier, Kate Gardner, Shiona Macorkindale, Alun Myers, Mairead OSiochru and
Claire Rigby.

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Publications

PHYSIOTHERAPY WORKS FOR OBESITY IS A POLICY BRIEFING

DOCUMENT FROM THE CHARTERED SOCIETY OF PHYSIOTHERAPY.
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1. National Institute for Health and Care Excellence. Obesity Clinical Knowledge Summary.
London: National Institute for Health and Care Excellence; 2012.
URL: http://cks.nice.org.uk/obesity#!topicsummary

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