Skip to main content

A Twenty-First Century Physical Therapy Health and Lifestyle Framework to Maximize Sleep and Function

  • Chapter
  • First Online:
Clinical Cases in Sleep Physical Therapy

Abstract

Designed to underpin physical therapy clinical practice guidelines in general, the health and lifestyle framework is consistent with contemporary twenty-first century epidemiological indicators. This framework extends beyond the traditional biomedical focus on pathology, to focus on the patient’s overall health including lifestyle practices and attributes. The relationship between sleep and lifestyle practices and attributes is bidirectional. Physical therapists have long managed the needs of patients with sleep disorders that often impair function. This chapter describes lifestyle practices and attributes that affect sleep including smoking, alcohol use, nutrition, weight, and stress, as well as level of conditioning including sedentariness, inactivity, and insufficient structured exercise—the latter being the traditional focus of physical therapists. Addressing lifestyle factors can prevent sleep disorders, minimize their impact, or both. Consistent with their scope of practice, physical therapists have a primary role in effecting lifestyle behavior change in patients with sleep disorders irrespective of their etiology.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Harvard Medical School Special Health. Improving sleep. Report. Boston, MA: Harvard Health Publishing; 2013.

    Google Scholar 

  2. Dean E, Lomi C. A health and lifestyle framework: an evidence-informed basis for contemporary physical therapist clinical practice guidelines with special reference to individuals with heart failure. Physiother Res Int. 2022;27:e1950. https://doi.org/10.1002/pri.1950.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dean E, Fagevik Olsén M. A health and lifestyle framework for management of post covid-19 syndrome based on evidence-informed management of post-polio syndrome: a narrative review. Eur J Physiother. 2022;24:56–60. https://doi.org/10.1080/21679169.2021.2000150.

    Article  Google Scholar 

  4. Dean E. Physical therapy practice in the 21st century: a new evidence-informed paradigm and implications. Invited Special Issue Editor. Physiother Theory Pract. 2009;25:327–462.

    Article  Google Scholar 

  5. Dean E, Al-ObaidI S, Dornelas de Andrade A, Gosselink R, Umerah G, Al-Abdelwahab S, et al. The first physical therapy summit on global health: implications and recommendations for the 21st century. Physiother Theory Pract. 2011;27(8):531–47. https://doi.org/10.3109/09593985.2010.544052.

    Article  PubMed  Google Scholar 

  6. Dean E, Dornelas de Andrade A, O’Donoghue G, Skinner M, Umereh G, Beenen P, et al. The second physical therapy summit on global health: developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases. Physiother Theory Pract. 2014;30(4):261–75. https://doi.org/10.3109/09593985.2013.856977.

    Article  PubMed  Google Scholar 

  7. Dean E, Skinner M, Myezwa H, Mkumbuzi V, Mostert-Wentzel K, Perez DP, et al. Health competency standards in physical therapist practice. Phys Ther. 2019;99(9):1242–54.

    Article  PubMed  Google Scholar 

  8. World Health Organization. International classification of functioning, disability and health. Geneva: WHO; 2001. p. ea54r21.pdf. https://www.who.int/classifications/international-classification-of-functioning-disability-and-health. Accessed 2 Oct 2022.

    Google Scholar 

  9. World Physiotherapy. International classification of functioning, disability and health. n.d.. https://world.physio/resources/glossaryICF. Accessed 2 Oct 2022.

  10. World Physiotherapy. Description of physical therapy. Policy statement. n.d.. https://world.physio/sites/default/files/2020-07/PS-2019-Description-of-physical-therapy.pdf. Accessed 2 Oct 2022.

  11. World Health Organization. Non communicable diseases. n.d.. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases#:~:text=Key%20facts,%2D%20and%20middle%2Dincome%20countries. Accessed 2 Oct 2022.

  12. Centers for Disease Control and Prevention. Sleep and chronic disease. n.d.. www.cdc.gov/sleep/about_sleep/chronic_disease.html. Accessed 3 Oct 2022.

  13. Caprara G. Mediterranean-type dietary pattern and physical activity: the winning combination to counteract the rising burden of non-communicable diseases (NCDs). Nutrients. 2021;13(2):429. https://doi.org/10.3390/nu13020429.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Elvén M, Hochwälder J, Dean E, Söderlund A. A clinical reasoning model focused on clients’ behaviour change with reference to physiotherapists: its multiphase development and validation. Physiother Theory Pract. 2015;31(4):231–43.

    Article  PubMed  Google Scholar 

  15. Dean E, Moffat M, Myezwa H, de Andrade D, Skinner M, Söderlund A. Toward core inter-professional health-based competencies to address the non-communicable diseases and their risk factors: curriculum content analysis. BMC Public Health. 2014;14:717. https://doi.org/10.1186/1471-2458-14-717.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rodrigues D’Aurea CV, Soares Passos G, Frange C. Insomnia: physiotherapeutic approach. In: Frange C, Coelho FMS, editors. Sleep medicine and physical therapy: a comprehensive guide for practitioners. Basel: Springer Nature; 2022. p. 61–73. https://doi.org/10.1007/978-3-030-85074-6.

    Chapter  Google Scholar 

  17. Frange C, Coelho FMS, editors. Sleep medicine and physical therapy: a comprehensive guide for practitioners. Basel: Springer Nature; 2022. https://doi.org/10.1007/978-3-030-85074-6.

    Book  Google Scholar 

  18. Harvard Medical School. Guide. Understanding inflammation. Boston, MA: Harvard Health Publishing; 2018.

    Google Scholar 

  19. Harvard Medical School Special Health. Fighting inflammation. Report. Boston, MA: Harvard Health Publishing; 2020.

    Google Scholar 

  20. Frange C, Santos Coelho FM. Sleep: definition, concept, new area for physical therapy. In: Frange C, Coelho FMS, editors. Sleep medicine and physical therapy: a comprehensive guide for practitioners. Basel: Springer Nature; 2022. p. 3–11. https://doi.org/10.1007/978-3-030-85074-6.

    Chapter  Google Scholar 

  21. Levy Andersen ML, Tufik S. Brief history of sleep medicine and its importance for overall health. In: Frange C, Coelho FMS, editors. Sleep medicine and physical therapy: a comprehensive guide for practitioners. Basel: Springer Nature; 2022. p. 21–7. https://doi.org/10.1007/978-3-030-85074-6.

    Chapter  Google Scholar 

  22. Ikehara S, Iso H, Date C, Kikuchi S, Watanabe Y, Wada Y, et al. Association of sleep duration with mortality from cardiovascular disease and other causes for Japanese men and women: the JACC Study. Sleep. 2009;32(3):295–301.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Consensus Conference Panel, Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med. 2015;11(6):591–2. https://doi.org/10.5664/jcsm.4758.

    Article  PubMed Central  Google Scholar 

  24. Harvard University. How sleep deprivation can cause inflammation. n.d.. https://www.health.harvard.edu/sleep/how-sleep-deprivation-can-cause-inflammation. Accessed 2 Oct 2022.

  25. Meier-Ewert HK, Ridker PM, Rifai N, Regan MM, Price NJ, Dinges DF, et al. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol. 2004;43(4):678–83.

    Article  CAS  PubMed  Google Scholar 

  26. Jaehne A, Loessl B, Bárkai Z, Riemann D, Hornyak M. Effects of nicotine on sleep during consumption, withdrawal and replacement therapy. Sleep Med Rev. 2009;13(5):363–77. https://doi.org/10.1016/j.smrv.2008.12.003.

    Article  PubMed  Google Scholar 

  27. Dias Gomes AC, Santos Coelho FM. Restless legs syndrome (Willis-Ekbom Disease) and periodic leg movements of sleep: an overview. In: Frange C, Coelho FMS, editors. Sleep medicine and physical therapy: a comprehensive guide for practitioners. Basel: Springer Nature; 2022. p. 3–11. https://doi.org/10.1007/978-3-030-85074-6.

    Chapter  Google Scholar 

  28. Branstetter SA, Krebs NM, Muscat JE. Nighttime waking to smoke, stress, and nicotine addiction. Behav Sleep Med. 2022;20(6):706–15. https://doi.org/10.1080/15402002.2021.1992408.

    Article  PubMed  Google Scholar 

  29. Cohrs S, Rodenbeck A, Riemann D, Szagun B, Jaehne A, Brinkman J, et al. Impaired sleep quality and sleep duration in smokers—results from the German Multicenter Study on Nicotine Dependence. Addict Biol. 2014;19(3):486–96. https://doi.org/10.1111/j.1369-1600.2012.00487.x.

    Article  PubMed  Google Scholar 

  30. Purani H, Friedrichsen AA. Sleep quality in cigarette smokers: associations with smoking-related outcomes and exercise. Addict Behav. 2019;90:71–6. https://doi.org/10.1016/j.addbeh.2018.10.023.

    Article  PubMed  Google Scholar 

  31. Sleep Foundation. Alcohol and sleep. n.d.. www.sleepfoundation.org/nutrition/alcohol-and-sleep. Accessed 2 Oct 2022.

  32. Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and sleep I: effects on normal sleep. Alcohol Clin Exp Res. 2013;37(4):539–49. https://doi.org/10.1111/acer.12006.

    Article  CAS  PubMed  Google Scholar 

  33. Park S, Oh M, Lee B, Kim H, Lee W, Lee J, et al. The effects of alcohol on quality of sleep. Kor J Fam Med. 2015;36(6):294–9.

    Article  Google Scholar 

  34. Malhotra A, Noakes T, Phinney S. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. Br J Sports Med. 2015;49(15):967–8. https://doi.org/10.1136/bjsports-2015-094911.

    Article  CAS  PubMed  Google Scholar 

  35. Ikonte CJ, Mun JG, Reider CA, Grant RW, Mitmesser SH. Micronutrient inadequacy in short sleep: analysis of the NHANES 2005-2016. Nutrients. 2019;11(10):2335. https://doi.org/10.3390/nu11102335.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. St-Onge M-P, Roberts A, Shechter A, Choudhury AR. Fiber and saturated fat are associated with sleep arousals and slow wave sleep. J Clin Sleep Med. 2016;12(1):19–24. https://doi.org/10.5664/jcsm.5384.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Harvard Medical School. Special health report. The diet review. Boston, MA: Harvard Health Publishing; 2020.

    Google Scholar 

  38. Scoditti E, Tumolo MR, Garbarino S. Mediterranean diet on sleep: a health alliance. Nutrients. 2022;14(14):2998. https://doi.org/10.3390/nu14142998.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Harvard Medical School. Foods that fight inflammation. Designing your diet to lower disease risk. Boston, MA: Harvard Health Publishing; 2021.

    Google Scholar 

  40. St-Onge M-P, Mikic A, Pietrolungo CE. Effects of diet on sleep quality. Adv Nutr. 2016;7(5):938–49. https://doi.org/10.3945/an.116.012336.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Psaltopoulou T, Sergentanis TN, Panagiotakos DB, Sergentanis IN, Kosti R, Scarmeas N. Mediterranean diet: relationship with anxiety and depression. Ann Neurol. 2014;75(4):614. https://doi.org/10.1002/ana.23990.

    Article  PubMed  Google Scholar 

  42. Barnard ND, Alwarith J, Rembert E, Brandon L, Nguyen M, Goergen A, et al. A Mediterranean diet and low-fat vegan diet to improve body weight and cardiometabolic risk factors: a randomized cross-over trial. Am J Clin Nutr. 2021;5:1–13. https://doi.org/10.1080/07315724.2020.1869625.

    Article  CAS  Google Scholar 

  43. Report of the EAT Lancet Commission. Healthy diets from sustainable food systems. 2019. https://eatforum.org/content/uploads/2019/07/EAT-Lancet_Commission_Summary_Report.pdf. Accessed 30 Sep 2022.

  44. Mills M. The comparative anatomy of eating. n.d.. https://www.adaptt.org/documents/Mills%20The%20Comparative%20Anatomy%20of%20Eating1.pdf.

  45. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1223–49.

    Article  Google Scholar 

  46. Harvard Medical School. The sensitive gut. Boston, MA: Harvard Health Publishing; 2022.

    Google Scholar 

  47. Zhang M, Hou Z-H, Huang Z-B, Chen X-L, Liu F-B. Dietary and lifestyle factors related to gastroesophageal reflux disease: a systematic review. Ther Clin Risk Manag. 2021;17:305–23. https://doi.org/10.2147/TCRM.S296680.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Müller A, Zimmermann-Klemd AM, Lederer A-K, Hannibal L, Kowarschik S, Huber R, et al. A vegan diet Is associated with a significant reduction in dietary acid load: post hoc analysis of a randomized controlled trial in healthy individuals. Int J Environ Res Public Health. 2021;18(19):9998. https://doi.org/10.3390/ijerph18199998.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Bhatia SJ, Reddy DN, Ghoshal UC, Jayanthi V, Abraham P, Choudhuri G, et al. Epidemiology and symptom profile of gastroesophageal reflux in the Indian population: report of the Indian Society of Gastroenterology Task Force. Indian J Gastroenterol. 2011;30(3):118–27. https://doi.org/10.1007/s12664-011-0112-x.

    Article  PubMed  Google Scholar 

  50. O’Callaghan F, Muurlink O, Reid N. Effects of caffeine on sleep quality and daytime functioning. Risk Manag Healthc Pol. 2018;11:263–71. https://doi.org/10.2147/RMHP.S156404.

    Article  Google Scholar 

  51. Vgontzas AN, Zoumakis E, Bixler EO, Lin H-M, Follett H, Kales A, et al. Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab. 2004;89(5):2119–26.

    Article  CAS  PubMed  Google Scholar 

  52. Mortimore IL, Marshall I, Wraith PK, Sellar RJ, Douglas NJ. Neck and total body fat deposition in nonobese and obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med. 1998;157(1):280–3. https://doi.org/10.1164/ajrccm.157.1.9703018.

    Article  CAS  PubMed  Google Scholar 

  53. Fattal D, Hester S, Wendt L. Body weight and obstructive sleep apnea: a mathematical relationship between body mass index and apnea-hypopnea index in veterans. J Clin Sleep Med. 2022;18:2723. https://doi.org/10.5664/jcsm.10190.

    Article  PubMed  Google Scholar 

  54. Arora T. Sleep doesn’t waste time, It’s good for the waist line. Sleep. 2015;38(8):1159–60. https://doi.org/10.5665/sleep.4884.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Wu Y, Zhai L, Zhang D. Sleep duration and obesity among adults: a meta-analysis of prospective studies. Sleep Med. 2014;15(12):1456–62. https://doi.org/10.1016/j.sleep.2014.07.018.

    Article  PubMed  Google Scholar 

  56. Sperry SD, Scully ID, Gramzow RH, Jorgensen RS. Sleep duration and waist circumference in adults: a meta-analysis. Sleep. 2015;38(8):1269–76. https://doi.org/10.5665/sleep.4906.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Palagini L, Bruno RM, Gemignani A, Baglioni C, Ghiadoni L, Riemann D. Sleep loss and hypertension: a systematic review. Curr Pharm Des. 2013;19(13):2409–19. https://doi.org/10.2174/1381612811319130009.

    Article  CAS  PubMed  Google Scholar 

  58. Chunnan L, Shang S. Relationship between sleep and hypertension: findings from the NHANES (2007-2014). Int J Environ Res Public Health. 2021;18(15):7867. https://doi.org/10.3390/ijerph18157867.

    Article  Google Scholar 

  59. Pires GN, Bezerra AG, Tufik S, Andersen ML. Effects of acute sleep deprivation on state anxiety levels: a systematic review and meta-analysis. Sleep Med. 2016;24:109–18. https://doi.org/10.1016/j.sleep.2016.07.019.

    Article  PubMed  Google Scholar 

  60. Nutt D, Wilson S, Paterson L. Sleep disorders as core symptoms of depression. Dialogues Clin Neurosci. 2008;10(3):329–36. https://doi.org/10.31887/DCNS.2008.10.3/dnutt.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Harvard Medical School Special Health. Anxiety and stress. Report. Boston, MA: Harvard Health Publishing; 2018.

    Google Scholar 

  62. Dean E, Söderlund A. Lifestyle medicine to address orthopaedic conditions: rationale and practice. In: Tatta J, Garner G, editors. Lifestyle medicine and orthopaedic physical therapy practice. Minneapolis, MN: Orthopedic Physical Therapy Products; 2022.

    Google Scholar 

  63. Frange C, Figueiro Reis MJ, Lottenberg Vago E, Santos Coelho FM. Subjective assessment of sleep. In: Frange C, Coelho FMS, editors. Sleep medicine and physical therapy: a comprehensive guide for practitioners. Basel: Springer Nature; 2022. p. 381–400. https://doi.org/10.1007/978-3-030-85074-6.

    Chapter  Google Scholar 

  64. Figueiro Reis MJ, Lottenberg Vago E, Frange C, Santos Coelho FM. Objective assessment of sleep. In: Frange C, Coelho FMS, editors. Sleep medicine and physical therapy: a comprehensive guide for practitioners. Basel: Springer Nature; 2022. p. 401–10. https://doi.org/10.1007/978-3-030-85074-6.

    Chapter  Google Scholar 

  65. SnoozeUniversity. Pittsburgh sleep quality index online calculator. n.d.. https://www.snoozeuniversity.com/psqi/. Accessed 3 Oct 2022.

  66. Perelman School of Medicine at the University of Pennsylvania. Pittsburgh Sleep Quality Index (PSQI). n.d.. https://www.med.upenn.edu/cbti/assets/user-content/documents/Pittsburgh%20Sleep%20Quality%20Index%20(PSQI).pdf.

  67. Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res. 2002;53(3):737–40. https://doi.org/10.1016/s0022-3999(02)00330-6.

    Article  PubMed  Google Scholar 

  68. Gradinger F, Glassel A, Gugger M, Cieza A, Braun N, Khatami R, et al. Identification of problems in functioning of people with sleep disorders in a clinical setting using the International Classification of Functioning Disability and Health (ICF) Checklist. J Sleep Res. 2011;20(3):445–53. https://doi.org/10.1111/j.1365-2869.2010.00888.x.

    Article  PubMed  Google Scholar 

  69. World Health Professions Alliance. Health improvement card. 2014. http://www.ifpma.org/fileadmin/content/Publication/2011/ncd_Health-Improvement-Card_web-1.pdf. Accessed 5 Oct 2022.

  70. World Health Professions Alliance. WHPA health improvement card. User guide for health professionals. 2017. http://www.whpa.org/ncd_health_improvement_card_professionals.pdf. Accessed 5 Oct 2022.

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dean, E., Skinner, M. (2023). A Twenty-First Century Physical Therapy Health and Lifestyle Framework to Maximize Sleep and Function. In: Frange, C. (eds) Clinical Cases in Sleep Physical Therapy. Springer, Cham. https://doi.org/10.1007/978-3-031-38340-3_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-38340-3_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-38339-7

  • Online ISBN: 978-3-031-38340-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics