Clinician's Commentary on Doehring et al.1

I read this article with great interest from three perspectives— those of a physiotherapist, a certified diabetes educator (CDE), and an academic lecturer. The study results are both encouraging and sobering, and they provide an opportunity for the physiotherapy profession to answer the call to significantly contribute to preventing behaviour leading to death, disability, and rising health care costs. In their practice, physiotherapists encounter patients and clients every day who have unhealthy behaviour. Lack of physical activity, poor nutrition, smoking, excessive drinking, stress, and inadequate sleep have all been linked to the majority of non-communicable chronic diseases around the world, and they are the major causes of morbidity and mortality. 2 Diabetes, cardio-vascular disease, lung disease, and cancers are strongly associated with lifestyle risk factors and are largely preventable. 2 Exercise and movement form the basis of physiotherapy practice. Physiotherapists provide holistic, patient-centred care with advanced clinical reasoning. They also have advanced knowledge of and skills in the anatomical, physiological, and psychological mechanisms of health and disease; assessment and diagnosis; behavioural change; biomechanics; and exercise prescription and therapeutic exercise. Physiotherapists are therefore ideally suited to address lifestyle risk factors, particularly lack of physical activity and exercise, and they routinely provide therapeutic exercise programmes as part of their treatment plans. A well-designed therapeutic exercise program can provide the healing stimulus that restores joint range of motion, neuromuscular strength, and power as well as aerobic and anaerobic metabolic system integrity. Physical activity and exercise are acknowledged as being one of the primary modifiable risk factors in preventing and treating type 2 diabetes, 3,4 and they are a key component of diabetes self-management. 3,4 Specifically, regular physical activity has been shown to prevent the development of complications resulting from diabetes; reduce the need for hypoglycemic agents; 3 and reduce premature, all-cause mortality in individuals with diabetes. 4 Considering the exponential increase in the prevalence of type 2 diabetes, it is very likely that physiotherapists working in all settings, particularly in private and home care, will be confronted more frequently with patients with this disease in the near future. Approximately 80% of all patients visiting physiotherapists in outpatient settings have diabetes, prediabetes, or risk factors associated with diabetes. 5 These patients are at elevated risk for microvascular and macrovascular complications, retinopathy, nephropathy, and neuropathy. 6 As a result, physiotherapists working in community settings need to be aware of medical safety and the impact of …