Sedentary Behavior! by Ross VonGlahn, PT, DPT

For further information, I recommend you reference the perspective article below by Wheeler et al, 2017 from the journal, Alzheimer’s & Dementia: Translational Research & Clinical Interventions, titled Sedentary behavior as a risk factor for cognitive decline? A focus on the influence of glycemic control in brain health.


Many of us know that exercise is good for you. However, the effects of exercise go beyond just looking good and feeling good. New research is being conducted, looking at the effects of exercise and disease prevention. However, is exercise enough? New literature suggests no. The benefits of exercising for the recommended 150 minutes per week may be cancelled out by sedentary behavior (sitting/laying) the rest of your waking day. Think about it. How much sitting do you do in a day? One hour? Five hours? Eight hours? Take some time to actually tally this up between driving to and from work, sitting at work, sitting for meals, and sitting in front of a screen. The number may surprise you. A survey by the U.S. National Health and Nutrition Examination Survey shows that on average people are sedentary greater than 9 hours per day, perform light activity 5 hours per day and perform 11.3 minutes of moderate to vigorous activity per day. Of the 150 minutes per week of recommended moderate to vigorous activity, nearly one-third of people do not meet this recommendation. The number of people not meeting this recommendation increases as age increases as well.

What is it about?

This article reviews the physiologic processes involved in regulation of glucose (sugar) in the brain as well as the effects of abnormal glucose levels in the brain. Glucose is the primary fuel for the brain and is essential for the proper functioning and health of the brain. When blood sugar is too high, the brain will regulate this by decreasing blood flow to the brain as to decrease the overall amount of glucose to the brain. When it is too low, the brain struggles to have enough energy source to work efficiently and may cause damage known as apoptosis (cell death). Also, when your brain accustomed to high glucose levels (hyperglycemia), it can experience relative hypoglycemia when it returns back to normal blood glucose values, leading to damage.

Why does this matter?

Think about eating a big meal, full of carbs and sugar. You will have a large spike in your blood sugar, which signals the brain to decrease blood flow to the brain, as well as release insulin from the pancreas. The insulin helps drive glucose into your cells, effectively lowering your blood glucose (ie, blood sugar). However, this tends to overshoot and leads to a “hypoglycemic event” as referenced in the above article. This hypoglycemic event can lead to apoptosis (cell death) in the brain. This is a process involved in Alzheimer’s and Dementia. They cite that those with type 2 diabetes are 50% more likely to develop dementia compared to those with normal blood sugar control and regulation.

Tying it all together

Reviewed in the above article, sedentary behavior increases the risk for diabetes and poor glucose control. By decreasing sedentary behavior, an individual may better regulate the hyperglycemic events that subsequently lead to a hypoglycemic event and causing damage to the brain. Limiting this undulating pattern of high blood sugar to low blood sugar may limit the damage to the brain and maintain brain health. It recommends that outside of the recommended 150 minutes/week of exercise, intermittent walking or light activity throughout the day may help control blood sugar and maintain brain health. Point of the story is, get up and move and move often.


Change Society, Make them Healthy!

As the current changes take place in the healthcare system, the Science of Medicine and the Art of Healing, rings true and our profession must take a stand by participating in the role of “wellness professionals”. We must strive to corner the market in this arena and present our level of expertise as we position ourselves for the future of healthcare. We have all the tools necessary and we need to put them into practice by being the conductors of healthy lifestyles in society.

At the World Economic Forum this year, the focus was on a new and rather upbeat topic:  the need for countries to invest in health to achieve long-term economic growth. “The time is right to elevate the conversation on health,” said Robert Greenhill, the managing director and chief business office of the forum.  “This year, there is a sense that the global economy is out of intensive care and embarking on rehabilitation. As we ask how, metaphorically, to improve the economy’s health, literally improving the population’s health is a good place to start.”

What an inspiring statement and a good choice of words to show our world is embarking on rehabilitation; this is an excellent segway for Physical Therapy to take the ball and roll with it!  It appears as a challenge for physical therapists to capitalize on this opportunity. We have heard a great deal about incorporating wellness into our profession and our vision for the last few years but I am uncertain we know how to put this into practice. We have the knowledge regarding exercise and fitness, but are we incorporating lifetime wellness into our discharge plans and daily practice of physical therapy? Everyone comprehends the benefit of transitional programs upon discharge from skilled physical therapy; personal training, performance enhancement, group fitness and small group training. Whether or not we choose to personally engage in these entities, we possess the knowledge to assist our patients and direct them to utilize or locate these programs as necessary. I view our role as therapists to ascertain whether or not our patients need the additional expertise, guidance or support to follow through with our directions and home program upon discharge.

In addition to the referrals as, appropriate, to the programs listed above, are we preparing our patients on a very basic level for lifetime wellness and exercise? Beyond the diagnoses for which they sought our care, are we educating them in healthy behaviors and fabricating plans for this in our discharge goals? We are in the perfect position to serve as role models to discuss weight loss principles for our OA patient. If our patient leads a sedentary lifestyle, there is a huge opportunity to share the research on inactivity and encourage them to step away from the chair. We can present the evidence between sitting time and premature mortality rates. I think we all realize individuals may be averse to exercise, however educating them on the benefit of how simply standing an extra 1-2 hours per day can burn enough calories to lose between 5-10# over a year’s time.

Prevention is a key in overall health, so do we appropriately discuss osteoporosis indicators for the patient population we treat that falls into this strata? Do we report the NIH recommendations for exercise as a way to keep our patients exercising upon discharge? Lastly, do we as a profession take responsibility for societal or global health? I have taken it upon myself to frequently write letters to MD’s to encourage referral of their patients for exercise, walking programs or strength training when they diagnosis them with chronic diseases, such as CAD, Diabetes, OA, Parkinsons, MS and Osteoporosis. Many times a MD will tell their patient to become more active but that individual may not comprehend how to take the next step. Our profession can assist with this task. We can also market the consumer for direct access to our services by informing the public of our skill set.

As a doctoring profession, we have all the tools and education to lead our consumers to a healthier lifestyle, however we need to ask ourselves how and when we are willing to use them. Each of us can play a major role in educating our patients to behavioral changes to promote wellness. Preventing disease as opposed to merely treating it must become an even greater priority. In this manner, we can all support our APTA Brand-Move Forward; Physical Therapy Brings Motion to Life!

Jean Darling PT, LAT is an Impact editorial board member and Vice President of Advanced Physical Therapy & Sports Medicine. She can be reached at

A Glimpse Into the Next 20 Years


The future of health care is at our doorstep.   Throughout the next 20 years, advances in medicine and technology will allow the industry to recalibrate its focus toward health and wellness strategies. PHYSICAL THERAPISTS have front row seats regarding these game-changing trends -- prevention, health coaching, personalized medicine, personal technology and a team approach will all share time on the playing field.

Prevention, first, will hopefully serve as a roadblock in the soaring costs of health care. Many insurance companies are now offering reimbursement, or have established a 100% payment for wellness programs. And, who is the best qualified to direct movement in our society regarding wellness? PHYSICAL THERAPISTS!  Many individuals seeking health care though a medical clinic are presenting with multiple issues from knee pain, to high blood pressure, to obesity.  We're here to help!

Health coaching presented through health care organizations, medical institutions, PHYSICAL THERAPY Clinics, and health clubs will assist by offering continued support to help people remain healthy. Alignments with corporations, which take an interest in their employees and keeping them physically well, shall increase with innovative approaches regarding their physical educational needs. It may even allow all types of working Americans to make the choice to live a longer, healthier life!

Personalized medicine should SOAR with new advances in health care and research-based decisions by the medical world.   Medicine will become more personalized with genetic advancements; these advances could lead to an increase in more individualized goal setting for patients. Currently, health care professionals are operating in a disease-management society -- hospitals are rewarded for keeping patients in house and staying full to capacity. Drug companies are compensated for successfully selling more drugs.  The shift to more personalized medicine will assist in keeping more people out of hospitals and, once again, who is highly qualified to take the “offensive approach” in this game-- PHYSICAL THERAPISTS!

Personal technology will help by offering the remote care needed to keep people out of hospitals. We are already noticing the trend toward “exercise prescription” on mobile devices, and the idea of providing general education and nutritional advice on these devices as well. The new, personal technology will expand to apps for modality uses that allow independent follow through at home.  Don’t get me wrong!  I am not advising that we remove the human factor from our approach to health care; I’m suggesting that we call a “time out” to be certain the technology is able to offer increased access but is driven and directed by educated, knowledgeable providers following appropriate, qualified assessments.

Especially in health care, this team approach is a winner in any setting.  With new advancements in appropriate technology enhancements, the treatment of the patient as an individual will be continuously improved. PHYSICAL THERAPY has positioned itself to be the catalyst to help propel our nation into a healthier game! Our profession has and will have unparalleled opportunities to take control of the health and wellness of our nation and, together, everyone will be winners within a healthier society!

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Pumpkin Spice Physical Therapy

All this fall weather and pumpkin spice latte talk has me thinking about Starbucks.

In the first blog post earlier this month, I discussed direct access – an import pillar in the physical therapy profession. To expand, today’s blog post will include a great example of how beneficial direct access can truly be.

In the early 2000’s, a physician named Dr. Robert Mecklenburg, chief of medicine @ Virginia Mason Medical Center, sat down to determine how his hospital could lower its healthcare costs; a major insurance company (Aetna) was threatening to remove them from their network due to high cost for care.

Since Starbucks was represented by Aetna @ this time, Dr. Mecklenburg reached out to the benefits manager @ Starbucks to determine how he could make their health care more financially efficient. Starbucks determined the most common healthcare costs for their companies were low back pain and headaches, and therefore Dr. Mecklenburg analyzed the entire process of how back pain patients passed through the healthcare system. He determined the following:

“90 percent of what we did was no help at all,” says Mecklenburg. “Does an appointment with an orthopedic surgeon, a neurologist, a neurosurgeon help for uncomplicated back pain? The evidence says no. Does an MRI help? No. As far as we could tell, the only thing the evidence showed [that] was worth anything was physical therapy.”

Naturally, Virginia Mason Medical Center changed their health care process so individuals with low back pain were seen first by a PT (a great example of direct access). This resulted in same-day treatments, reduced healthcare costs, and patient satisfaction through the roof!

In summary, go see your local ATPSM physical therapist, grab a pumpkin spice latte, and pray the Packers get it together!


PS: Below is a great visual of how direct access works can save resources!




Given October is National Physical Therapy Month, I wanted to take the time to discuss an important PT topic – a “pillar” in our profession that many people are not familiar with: direct access; hence our push for more education on the topic.

Many of my patients have grown accustom to hearing the phrases “don’t put your pain off” or “make your pain a priority”. The rationale behind these statements, and/or other similar ones, stems from one simple fact: it makes our job easier!

Why might you ask? It makes our job easier because your body heals faster when we correct problems before they progress. Just think - if you took the time to pull that one dandelion out of your garden each week, you likely wouldn’t end up with a garden full of weeds, since the spread of their seeds results in rapid multiplication. Similarly, if you paid the interest off your student loans, the interest wouldn’t compound and you wouldn’t have insurmountable debt (I promise I am not speaking from experience). There are countless examples in everyday life that mimic our bodies and reiterate the same concept: the sooner we address issues in life, the better off we are.

An article recently published by the Clinical Journal of Sports Medicine confirms this belief. The article looked at 200 athletes who had sustained a stress fracture in their low back. Patients who initiated physical therapy within the first 10 weeks returned to full activity an average of 25 days quicker than their counterparts who waited until after the 10-week mark (Selhorst et al., 2016). That’s an entire month people!!

Luckily, in Wisconsin, our mission of addressing pain ASAP is very feasible with direct access, which allows patients to be treated by a physical therapist without a physician’s referral.  "This allows us to streamline patients’ treatment, which results in a quicker recovery; not to mention a reduced expense. So, call your local ATPSM today, and let us help correct that small ache or pain before it becomes a field full of dandelions!"



Selhorst et al. (June, 2016).  Timing of physical therapy referral in adolescent athletes with acute spondylolysis: A Retrospective Chart Review.

Clinical Journal of Sports Medicine.

PT vs. Opioids. The Why. #ChoosePT

Recapping blog episode number one this month: opioids are a growing and significant problem and physical therapy is the proper solution.

Today’s agenda: Why? Prove it!

As most people can probably guess, a recent study reported that individuals’ (people currently seeking treatment for opioid addiction) primary goal for initially taking opioids was pain relief (Weiss et al., 2014). However, the majority of these same individuals then reported their main rationale for continuing opioid treatment was avoidance of withdrawal symptoms (Weiss et al., 2014); pain was no longer the culprit. To me, this situation has addiction written all over it.

As physical therapists, reducing pain/discomfort is the root of virtually all our interventions. If we can reduce patient pain ASAP (Science, 2017), therefore reducing the need for patient opioid dependency early, we can be the barrier that prevents the continuation of this addiction cycle. As the research article stated, people’s main reason they continue to take prescription pain medication is to prevent withdrawal symptoms; PT = less pain = less opioids = less withdrawal(s) = less people continuing opioids = less addiction. I wasn’t a math major, but that equation makes sense to me!


1. Weiss, R. D., Potter, J. S., Griffin, M. L., McHugh, R. K., Haller, D., Jacobs, P., … Rosen, K. D. (2014). Reasons for opioid use among patients with dependence on prescription opioids: The role of chronic pain. Journal of Substance Abuse Treatment47(2), 140–145.

Opioids versus Physical Therapy

Prescription medication abuse, specifically relating to “opioids” (the medical word for pain medication), has been well documented. It seems this issue is gaining increased mainstream attention in the media, however, one problem remains: what is the solution?

Although many solutions have been proposed, one has consistently remained atop the lists of many of these solution-seekers: physical therapy. In fact, the U.S. Surgeon General recently penned a letter, which was sent to physicians across the country, addressing this fast-growing issue. In addition to educating people about negative side effects of opioid abuse, related resources specifically listed physical therapy as primary alternative to treatment of chronic pain (APTA, 2016).

At Advanced Physical Therapy & Sports Medicine, we acknowledge the growing opioid epidemic and utilize many treatment interventions specifically aimed at reducing your pain. If reducing pain is your goal, APTSM is your solution!

For more constructive information on the overuse of opioids, please visit


APTA. (November, 2016).  Surgeon General Letter Urges Action on Opioids Recommends Treatment Guideline That Includes Physical Therapy.PT in Motion, 8(10), 46.

Diaphragmatic Breathing

To Breathe, Or Not To Breathe…That Is The Question!

“Just take a few deep breaths and everything will be ok”. Sound familiar? In many instances throughout our lives we are told this, or even reiterate this common practice subconsciously to ourselves during stressful times. So what is the method to this madness?

Believe it or not, there is actually a “correct” way to breathe that can provide optimal benefit both during times of high stress and absence of stress (if there is such a thing). Diaphragmatic breathing is a breathing technique that involves emphasizing using your diaphragm, a large breathing muscle below your lungs. Via many complex methods in our body that are initiated when participating in this form of breathing, this technique results in better breathing efficiency, lowering cortisol (stress hormone) levels in our body, improving our mood and attention, and many more positive health benefits. See below for a step-by-step tutorial in this technique.

For more questions about diaphragmatic breathing, regarding the technique or the benefits it can have for you, please reach out to your physical therapist or occupational therapist at your local Advanced Physical Therapy and Sports Medicine!

Breath in through your nose so your stomach elevates while your chest remains still

Breath in through your nose so your stomach elevates while your chest remains still

Figure 2. Exhale through your mouth, allowing your stomach muscles relax; again your chest should remain still

Figure 2. Exhale through your mouth, allowing your stomach muscles relax; again your chest should remain still


1)      Cleveland Clinic. (2016). Diaphragmatic Breathing. Retrieved from

2)      Ma, X., Yue, Z.-Q., Gong, Z.-Q., Zhang, H., Duan, N.-Y., Shi, Y.-T., … Li, Y.-F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in Psychology8, 874.