Relevance of Nutrition in Physiotherapy
Introduction[edit | edit source]
Consuming a suboptimal diet is a significant, and preventable, risk factor for various non-communicable diseases.[1]
It has been reported that in 2017, 11 million deaths and 255 disability-adjusted life-years (DALYs) could be attributed to dietary risk factors, including high intake of sodium, low intake of whole grains, and low intake of fruits.[1]
Other dietary features associated with mortality include suboptimal intake of:[2]
- Nut and seeds
- Processed meats
- Seafood omega-3 fats
- Vegetables
- Sugar-sweetened beverages
- Polyunsaturated fats
- Unprocessed red meats
Physiotherapists provide holistically driven interventions to their clients with a primary focus on exercise. However, because client factors like diet can have such a significant impact on a patient's outcomes, and their ability to engage in exercise rehabilitation, it is important that physiotherapists understand the key role that nutrition plays in recovery from injury and disease.[3]
Malnutrition[edit | edit source]
Malnutrition is often found in older adults and is a leading risk factor for disability, morbidity, and mortality.[4] It is estimated that between 30 and 50 percent of older adults in rehabilitation settings are malnourished.[5] Malnutrition has a negative impact on functional recovery and quality of life following discharge from rehabilitation facilities. Aside from inpatients, it is estimated that 10 to 30 percent of older adults living in the community are malnourished.[5]
Risk factors for malnutrition include:[6]
- Changes in dentation (chewing, swallowing can become difficult
- Changes in cognition (may not remember eating or not
- Poly-pharmacy (the interaction of multiple medications may decrease absorption of nutrients)
- Financial hardship
Physiotherapists should be aware of the risks associated with malnutrition as it can have significant impact on a patient’s ability to engage and progress in rehabilitation. It is also associated with a number of the conditions discussed below.
Chronic Conditions[edit | edit source]
There is considerable research to show that dietary factors can impact an individual’s risk of developing various chronic diseases including:[2][7]
- Obesity
- Type 2 diabetes
- CVA
- Some cancers
In particular, increasing the amount of plant, fruit and vegetables can have a positive impact on general health. A number of studies have shown an inverse association between the amount of fruit and vegetables consumed and coronary heart disease, stroke, cardiovascular disease, total cancer and all-cause mortality.[7][8]
Various suggestions have been made to explain the relationship between cardiovascular risk and fruit, vegetable and legume consumption:[8]
- The antioxidants and polyphenols in fruits and vegetables (e.g. vitamin C, vitamin E, and carotenoids), might prevent lipid oxidation in artery walls, lower blood pressure, and improve endothelial function
- There may be an inverse relationship between potassium and magnesium and blood pressure
- Dietary fibre (found in fruit and vegetables) reduces the insulin response to carbohydrates, as well as lowering total cholesterol and low-density lipoprotein (LDL) cholesterol
- Consuming legumes (which also contain fibre and phytochemicals) can also reduce blood pressure, total cholesterol, LDL cholesterol and triglycerides
COPD[edit | edit source]
COPD can also be positively impacted by diet. It has been found that nutritional support for patients with COPD can improve:[9][10]
- Total intake
- Anthropomorphic measures
- Grip strength
- Quality of life
- Exercise capacity
Neurological Conditions[edit | edit source]
There is evidence demonstrating that healthier eating can result in decreased disability in both Parkinson’s and Multiple Sclerosis.[6]
Parkinson’s[edit | edit source]
It has been found that adopting a healthy diet may help to reduce some of the nonmotor symptoms that precede a Parkinson’s diagnosis.[11] In general, it is thought that a well-balanced might be neuroprotective for Parkinson’s (e.g. including numerous servings of vegetables and fruits, moderate amounts of omega-3 fatty acids, tea, caffeine, and wine)[12]. However, it has also been found that certain nutrients (e.g. milk) might increase an individual’s risk for Parkinson’s.[12]
Multiple Sclerosis (MS)[edit | edit source]
It has also been found that a healthy diet and corresponding healthy lifestyle is related to reduced disability and symptom burden.[13] Interestingly, there is also strong evidence to suggest that childhood / adolescent obesity might have a causal role in MS susceptibility.[14]
Sarcopenia / Muscle Weakness[edit | edit source]
Sarcopenia is a disease associated with aging that is characterised by the loss of lean tissue mass.[15][16] Adults lose between three and eight percent of muscle mass per decade after the age of 30. Over time, this loss contributes to a decrease in muscle strength and power, which are important predictors of balance, falls and mortality.[16]
The cause of sarcopenia is multifactorial and its onset is insidious. It can, however, be worsened or hastened by physical inactivity and poor nutrition.[16] This can be rapid - i.e. three days of bed rest can cause more than a kilogram of muscle mass loss in older patients - or it can occur in the community in individuals who have a sedentary lifestyle and inadequate diet (particularly a lack of proteins and micronutrients like vitamin D).[15]
It is generally acknowledged that sarcopenia should be managed with:[15]
- Physical exercise
- Optimisation of protein intake
- Vitamin D supplementation
It has also been found that a higher quality diet throughout adulthood is associated with improved performance in older adults.[17] A diet of higher quality is one that includes a higher consumption of:[17]
- Fruit
- Vegetables
- Wholegrain bread
And a low consumption of:[17]
- White bread
- Added sugar
- Processed meat
Particularly relevant for physiotherapists is the concept of rehabilitation nutrition[18] Rehabilitation nutrition refers to the combination of nutrition care and rehabilitation. It may help to improve:[18]
- Physical and mental function
- Activities of daily living
- Quality of life
The major causes of disability for patients in rehabilitation facilities (i.e. stroke, hip fracture, and hospital-associated deconditioning) are often complicated by malnutrition and sarcopenia.[18] And while there is clear evidence that resistance exercise can help various patient populations on bed rest combat the loss of muscle mass and function, it will only be effective if it is accompanied by a diet that has sufficient protein and energy. This will ensure that the potential for a synergistic anabolic response is optimised.[16]
Muscle Health[edit | edit source]
Older Adults and Malnutrition[edit | edit source]
Athletic Performance[edit | edit source]
Bone Health[edit | edit source]
Chronic Obstructive Pulmonary Disease[edit | edit source]
Inflammation and Pain[edit | edit source]
Neurological conditions[edit | edit source]
Pregnancy[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019; 393(10184):1958-1972.
- ↑ 2.0 2.1 Micha R, Peñalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in the United States. JAMA. 2017;317(9):912-924.
- ↑ Phadke CP. Why Should Physical Therapists Care about Their Patients' Diet? Physiother Can. 2017;69(2):99-103. doi: 10.3138/ptc.69.2.GEE.
- ↑ Severin R, Berner PM, Miller KL, Mey J. The Crossroads of Aging: An Intersection of Malnutrition, Frailty, and Sarcopenia. Topics in Geriatric Rehabilitation. 2019; 35(1): 79-87.
- ↑ 5.0 5.1 Marshall S, Bauer J, Isenring E. The consequences of malnutrition following discharge from rehabilitation to the community: a systematic review of current evidence in older adults. Journal of Human Nutrition and Dietetics. 2014; 27(2): 133-41.
- ↑ 6.0 6.1 Berner P. Nutrition Relevancy in Physiotherapy Course. Physioplus, 2020.
- ↑ 7.0 7.1 Aune D, Giovannucci E, Boffetta P, Fadnes LT, Keum NN, Norat, T et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-A systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol. 2017; 46: 1029-1056.
- ↑ 8.0 8.1 Miller V, Mente A, Dehghan M, Rangarajan S, Zhang X, Swaminathan S et al. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet. 2017; 390: 2037-2049.
- ↑ Collins PF, Stratton RJ, Elia M. Nutritional support in chronic obstructive pulmonary disease: a systematic review and meta-analysis. The American journal of clinical nutrition. 2012; 95(6): 1385-95.
- ↑ Hanson C, Bowser EK, Frankenfield DC, Piemonte TA. Chronic Obstructive Pulmonary Disease: A 2019 Evidence Analysis Center Evidence-Based Practice Guideline. Journal of the Academy of Nutrition and Dietetics. 2020. S2212-2672(19)31696-X.
- ↑ Molsberry S, Bjornevik K, Hughes KC, Healy B, Schwarzschild M, Ascherio A. Diet pattern and prodromal features of Parkinson disease. Neurology. 2020; 95(15): e2095-e2108.
- ↑ 12.0 12.1 Seidl SE, Santiago JA, Bilyk H, Potashkin JA. The emerging role of nutrition in Parkinson's disease. Frontiers in aging neuroscience. 2014;6:36.
- ↑ Fitzgerald KC, Tyry T, Salter A, Cofield SS, Cutter G, Fox R, Marrie RA. Diet quality is associated with disability and symptom severity in multiple sclerosis. Neurology. 2018; 90(1): e1-e11.
- ↑ Gianfrancesco MA, Barcellos LF. Obesity and multiple sclerosis susceptibility: a review. Journal of neurology & neuromedicine. 2016; 1(7): 1-5.
- ↑ 15.0 15.1 15.2 Rondanelli M, Cereda E, Klersy C, Faliva MA, Peroni G, Nichetti M et al. Improving rehabilitation in sarcopenia: a randomized-controlled trial utilizing a muscle-targeted food for special medical purposes. J Cachexia Sarcopenia Muscle. 2020. Epub ahead of print.
- ↑ 16.0 16.1 16.2 16.3 English KL, Paddon-Jones D. Protecting muscle mass and function in older adults during bed rest. Current opinion in clinical nutrition and metabolic care. 2010; 13(1): 34-39.
- ↑ 17.0 17.1 17.2 Robinson SM, Westbury LD, Cooper R, Kuh D, Ward K, Syddall HE et al. Adult Lifetime Diet Quality and Physical Performance in Older Age: Findings From a British Birth Cohort. J Gerontol A Biol Sci Med Sci. 2018; 73(11): 1532-7.
- ↑ 18.0 18.1 18.2 Wakabayashi H, Sakuma K. Rehabilitation nutrition for sarcopenia with disability: a combination of both rehabilitation and nutrition care management. Journal of cachexia, sarcopenia and muscle. 2014; 5(4): 269-77.
