For many overweight and obese Americans, exercise is a real pain -- in the back or the knees or the ankles. Even simple actions such as walking or climbing stairs can cause discomfort. Excess weight stresses joints, affects proper movement and predisposes them to osteoarthritis, tendonitis, overuse injuries and a host of other health problems. Using various methods, physical therapists (PTs) are helping the overweight and obese get more active and fit by teaching them how to move in ways that are pain-free and even fun.

Prevention Profession

"We have become a profession that is more likely to be involved in prevention," says Susan Deusinger, PT, PhD, professor of neurology and physical therapy at Washington University School of Medicine in St. Louis. "Obesity is just one of those areas in which prevention is needed." Being both overweight and inactive compromises a person's health and longevity, says Deusinger, who is also director of the school's physical therapy program.

PTs can help obese patients become more functionally independent by teaching them correct posture and movement patterns. They can also encourage them to lose weight through diet and exercise. Through the On the Move™ exercise program offered by the school's physical therapy clinics, overweight and obese patients can learn to move correctly and more frequently. "This program is a bit unusual, because it's a group intervention, and it's delivered to people who you might consider otherwise healthy," says Deusinger, the program's director. Many clients stopped exercising after suffering an injury from moving improperly or progressing too rapidly. "We have a lot of fun finding creative ways for our patients to move without pain," Deusinger says.

Surgical Solution

PTs also play a role before and after gastric bypass or bariatric surgery, a popular, though risky, option for the obese. Working with psychologists, registered dietitians and physicians, PTs evaluate prospective gastric bypass or bariatric surgery patients, prepare them for the procedure and guide their recuperation.

At Washington University School of Medicine's Weight Management Program, Tamara Burlis, DPT, designs preoperative exercise programs for gastric bypass patients. "The better shape they are in, the better they tolerate surgery," she says. After surgery, Burlis makes sure patients can function independently before discharge. She teaches them deep breathing and lower-extremity exercises to help deter pneumonia and deep vein thrombosis.

As an instructor in the school's physical therapy program, Burlis also leads On the Move classes and sessions of Worksite Opportunities for Wellness, a trial program that brings exercise classes and nutrition education to workplaces.

Encouraging Kids to Lose Weight

PTs are also working to prevent overweight kids from becoming overweight adults.

Once a week, Donna Trotter, PT, sees patients at the Pediatric Weight Management Clinic at Vanderbilt Children's Hospital in Nashville. Working with registered dietitians and physicians, she evaluates and treats overweight children and teens. A certified sports clinical specialist, Trotter teaches patients how to avoid low-back pain, tendonitis and overuse injuries commonly caused by the stress of carrying excess weight. She helps them increase flexibility, strengthen body parts and find fun ways to boost their activity level. "You have to cheer on each little victory," she says. "I explain that this is not a diet. I tell them that if they maintain their weight, they can grow into their body."

Part of Every PT's Practice

Some PTs, such as Michael Dionne, PT, focus on treating patients of significant size. Founder of Choice Physical Therapy, in Gainesville, Georgia, Dionne specializes in bariatric ergonomics. He counsels medical facilities on managing extremely large patients and provides on-site safety training for bariatric rehabilitation facilities.

But given the rising prevalence of obesity, all PTs should view treating the obese as part of their practice, urges Deusinger, who offers these suggestions to her colleagues:

• Educate Yourself: Understand the relationship between body composition and various health risks. Learn to assess body composition through measures such as body-mass index and waist circumference. Share that information with patients.
• Expand Your Vision: Make it a habit to monitor all patients' body composition. Routinely weigh patients, and record their waist circumference.
• Check Your Attitude: To effectively treat obese people, make sure you're not harboring a bias against them.