From Disease to Health: Physical Therapy Health Promotion Practices for Secondary Prevention in Adult and Pediatric Neurologic Populations

Abstract

Background and purpose: Over the last decade there has been a substantial increase in efforts to better understand how targeted physical activity and exercise interventions can be used to minimize secondary consequences arising from neurological damage in both adult and pediatric populations. This article offers an overview of contemporary research that addresses mediators of functional and neuroplastic adaptations associated with physical activity and exercise. We emphasize the important role that physical therapists can play to increase participation and improve well-being in adults and children with neurological disorders. We further highlight potential strategies to foster translation of evidence-based findings for use by clinicians and consumers.

Summary of key points: Engagement in physical activity can serve as a powerful promoter of health and well-being in adults and youth with neurologic disease, and has the potential to alter the course of disease processes. Physical therapists can play a key role in promoting fitness and wellness by encouraging active living, providing early diagnosis of disease and prescribing targeted activity interventions to improve fitness and participation, and helping individuals overcome personal and environmental barriers to an active lifestyle.

Recommendations for clinical practice: Physical therapists must adopt a model of rehabilitation that emphasizes secondary prevention in adults and youth with neurologic diseases. Physical therapists have a unique role in developing forward-thinking approaches in using innovative health and wellness strategies to promote positive changes in activity and exercise behaviors.

Figure 1

Progression of symptoms of Huntington's disease across the clinical stages of presyptomatic, prodromal (just prior to motor diagnosis), and early, moderate and advanced disease stages. Ross et al. Nat Rev Neurol. 2014;10(4):204-16

Figure 2

Preventive and neuroprotective mechanisms induced by regular physical exercise on the cognitive and motor functions. BDNF: brain-derived neurotrophic factors, eNOS: endothelial nitric oxide synthases, GDNF: glial cell line-derived neurotrophic factors, IGF-1: insulin-like growth factors, NGF: nerve growth factors, NO: nitric oxide, SOD: superoxide dismutase, VEGF: vascular endothelial growth factor. Reprinted from: Paillard T, Rolland Y, de Souto Barreto P. Protective effects of physical exercise in Alzheimer’s disease and Parkinson’s disease: a narrative review. J Clin Neurol. 2015;11:212-219.