Einstellung, Verhaltensweisen und Wissen bezüglich Krafttraining in der Physiotherapie

Zusammenfassung

Hintergrund Aufgrund des multisystemischen Vorteils wird Krafttraining in der Rehabilitation und zur Leistungssteigerung regelmäßig in der Physiotherapie eingesetzt. Kritiker*innen bemängeln jedoch, dass viele Physiotherapeut*innen Krafttraining inadäquat in der Therapie praktizieren.

Ziel Untersuchung der Einstellungen und Verhaltensweisen von Physiotherapeut*innen (PT) und Physiotherapieschüler*innen sowie -studierenden (PTS) in Bezug auf Krafttraining in Deutschland. Dabei soll der Wissensstand erfasst und Faktoren, die diesen beeinflussen, identifiziert werden.

Methode Mittels einer anonymen fragebogenbasierten Querschnittsstudie wurden die Kategorien Proband*innencharakteristik sowie Einstellung und Verhalten zum Krafttraining erhoben. Die Einstellung und das Verhalten während sowie außerhalb des Therapiesettings wurde evaluiert. Zudem wurde ein aus 13 Fragen bestehender Wissensteil durchgeführt. Die Ergebnisse zwischen PT und PTS wurden verglichen. Mithilfe logistischer Regression wurde überprüft, ob gewisse Verhaltensweisen (z. B. eigenständige Durchführung von Krafttraining), Einstellungen (z. B. Einschätzen der eigenen Fähigkeiten ein Krafttraining anzuleiten) oder demographische Merkmale (z. B. Berufserfahrung) den Wissensstand beeinflussen.

Ergebnisse 307 PT und 279 PTS nahmen an der Umfrage teil. Sie erachten Krafttraining als wichtig und fühlen sich sicher, dieses anzuleiten. Die schulische Ausbildung bereitet in ihren Augen inadäquat darauf vor, ein Krafttraining zu planen. 34 % der PT und 20 % der PTS konnten ≥ 60 % der Fragen im Wissensteil richtig beantworten. PT, welche die WHO-Empfehlungen, mindestens zweimal wöchentlich ein Krafttraining durchzuführen, umsetzen, haben eine größere Wahrscheinlichkeit, einen höheren Wissensstand im Bereich Krafttraining aufzuweisen. Männliche PTS und PTS, die der Meinung sind, dass Krafttraining in ihrer Profession richtig angewendet wird, haben mit größerer Wahrscheinlichkeit einen höheren Wissensstand.

Schlussfolgerung PT und PTS leiten regelmäßig Krafttrainingsübungen im Therapiealltag an. Es ist ihnen wichtig, die Muskelkraft ihrer Patient*innen zu verbessern. Der Wissensstand war zumindest in dieser Studie defizitär. Das eigenständige aktive Durchführen von Krafttraining scheint eine ideale Voraussetzung zu sein, damit dieses in der therapeutischen Praxis kompetent angewendet werden kann.

Abstract

Background Due to its multisystemic benefits, strength training is regularly used in rehabilitation and performance enhancement in physiotherapy. However, there has been discussion about whether physical therapists utilize strength training adequately.

Aim To investigate the attitudes and practices of physiotherapists (PT) and physiotherapy students (PTS) in Germany regarding strength training, including their level of knowledge and influencing factors.

Methods Using an anonymous questionnaire-based cross-sectional study, the categories of participant’s characteristics, attitudes, and behaviour towards strength training were collected. Attitudes and behaviours in therapeutic settings and their spare time activities were recorded. A knowledge section, consisting of 13 questions, was conducted. Results were compared between PT and PTS. Binomial logistic regression was used to examine whether certain behaviours (e. g. participation in strength training), attitudes (e. g. self-assessing their ability to guide strength training) or demographic characteristics (e. g. professional experience) influenced the level of knowledge.

Results 307 PT and 279 PTS participated in the survey. Improving the muscular strength of their patients is important to them. They feel confident in their abilities to prescribe strength training. Professional education didn’t prepare them optimally to prescribe and train patients on strength training. 34 % of PT and 20 % of PTS scored ≥ 60 % on knowledge items. Participants, who didn’t follow the WHO strength training recommendations to perform it at least twice a week, tended to have lower strength training knowledge. PTS who believe strength training is properly applied in their profession or male students exhibited higher levels of knowledge.

Conclusion PT and PTS regularly guide strength training exercises, emphasizing the importance of improving their patients’ muscle strength. However, their level of knowledge, at least in the knowledge section of this study, was low. Performing strength training regularly appears to be essential to apply it competently in therapeutic practice.

Schlüsselwörter

Krafttraining - körperliche Aktivität - Physiotherapie

Keywords

strength training - physical activity - physical therapy

• Literatur

• 1 World Health Organization, Hrsg. Global action plan on physical activity 2018-2030: more active people for a healthier world (2018). Im Internet:. https://iris.who.int/bitstream/handle/10665/272722/9789241514187-eng.pdf (Stand: 09.05.2023)
• 2 World Physiotherapy, Hrsg. Physical therapists as exercise and physical activity experts across the life span – Policy statement (August 2019). Im Internet:. https://world.physio/sites/default/files/2020-09/PS-2019-Exercise-experts.pdf (Stand: 09.05.2023)
• 3 Jette A, Delitto A. Physical therapy treatment choices for musculoskeletal impairments. Phys Ther 1997; 77: 145-154
• 4 Haff G, Triplett N. , Hrsg. Essentials of Strength Training and Conditioning. 4. Aufl.. Champaign: Human Kinetics; 2015
• 5 World Health Organization, Hrsg. Guidelines on physical activity and sedentary behavior (Februar 2020). Im Internet:. https://apps.who.int/iris/bitstream/handle/10665/336656/9789240015128-eng.pdf (Stand: 09.05.2023)
• 6 Maestroni L, Read P, Bishop C. et al. The Benefits of Strength Training on Musculoskeletal System Health: Practical Applications for Interdisciplinary Care. Sports Med 2020; 50: 1431-1450
• 7 Bemben D, Bemben M. Dose-response effect of 40 weeks of resistance training on bone mineral density in older adults. Osteopor Inter 2011; 22: 179-186
• 8 Carter J, Ray C, Downs E. et al. Strength training reduces arterial blood pressure but not sympathetic neural activity in young normotensive subjects. J Applied Physiol 2003; 94: 2212-2216
• 9 Chupel M, Direito F, Furtado G. et al. Strength Training Decreases Inflammation and Increases Cognition and Physical Fitness in Older Women with Cognitive Impairment. Front Physiol 2017; 8: 1-13
• 10 Silva-Batista C, de Brito L, Corcos D. et al. Resistance Training Improves Sleep Quality in Subjects with Moderate Parkinsonʼs Disease. J Strength & Cond Res 2017; 31: 2270-2277
• 11 White L, McCoy S, Castellano V. et al. Resistance training improves strength and functional capacity in persons with multiple sclerosis. Mult Sclerosis 2004; 10: 668-674
• 12 Waters D, Baumgartner R, Garry P. et al. Advantages of dietary, exercise-related, and therapeutic interventions to prevent and treat sarcopenia in adult patients: an update. Clinical Inter Aging 2010; 5: 259-270
• 13 Salo P, Häkkinen A, Kautiainen H. et al. Effect of neck strength training on health-related quality of life in females with chronic neck pain: a randomized controlled 1-year follow-up study. Health & Quality Life Outcomes 2010; 8: 1-7
• 14 Askling C, Karlsson J, Thorstensson A. Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scan J Med Science Sports 2003; 13: 244-250
• 15 Commission on Accreditation in Physical Therapy Education, Hrsg. Standards and required elements for accreditation of physical therapist education programs (September 2022). Im Internet:. www.capteonline.org/globalassets/capte-docs/capte-pt-standards-required-elements.pdf (Stand: 11.05.2023)
• 16 Zadro J, Ferreira G. Has physical therapists’ management of musculoskeletal conditions improved over time?. Brazil J Phys Ther 2020; 24: 458-462
• 17 Moffat M, Hegenscheidt S, Ng S. et al. Evidence-based exercise prescription: raising the standard of delivery. Inter Musculos Med 2012; 34: 21-36
• 18 Handlery R, Shover E, Chhoun T. et al. We Don’t Know Our Own Strength: A Survey of Strength Training Attitudes, Behaviors, and Knowledge in Physical Therapists and Physical Therapists Students. Phys Ther & Rehabil J 2021; 101: 1-13
• 19 Lowe A, Littlewood C, McLean S. et al. Physiotherapy and physical activity: a cross-sectional survey exploring physical activity promotion, knowledge of physical activity guidelines and the physical activity habits of UK physiotherapists. Brit Med J Open Sport & Exer Med 2017; 3: e000290
• 20 Bello B, Hartley S, Yeowell G. Nigerian physiotherapists knowledge, current practice and perceptions of their role for promoting physical activity: A cross-sectional survey. Plos one 2022; 17: e0266765
• 21 Pathare N, Conroy J, Gillard A. et al. Physical Activity: Levels, Knowledge, and Attitudes of Physical Therapy Students in the United States. Cardio Phys Ther 2020; 31: 57-65
• 22 Kisner C, Colby L, Borstad J. , Hrsg. Therapeutic Exercise Foundations and Techniques. 7. Aufl.. Philadelphia: F.A. Davis Company; 2017
• 23 Johnson T. Snowball sampling: introduction. Hoboken, NJ: Wiley StatsRef Stat Ref Online; 2014.
• 24 Szumilas M. Explaining odds ratios. J Can Academy Child & Adolescent 2010; 19: 227-229
• 25 White N, Delitto A, Manal TJ. et al. The American Physical Therapy Association's Top Five Choosing Wisely Recommendations. Phys Ther 2015; 95: 9-24
• 26 Levinger I, Goodman C, Hare D. et al. The reliability of the 1RM strength test for untrained middle-aged individuals. J Science & Med Sport 2009; 12: 310-316
• 27 Riebe D, Ehrman J, Liguori G. et al., Hrsg. ACSM’s Guidelines for Exercise Testing and Prescription. 10. Aufl.. Philadelphia: Wolters Kluwer; 2017
• 28 Cuthbert S, Goodheart G. On the reliability and validity of manual muscle testing: a literature review. Chiropractic & Osteopathy 2007; 15: 1-23
• 29 Severin R, Wang E, Wielechowski A. et al. Outpatient Physical Therapist Attitudes Toward and Behaviors in Cardiovascular Disease Screening: A National Survey. Phys Ther 2019; 99: 833-848
• 30 Kgokong D, Parker R. Physical activity in physiotherapy students: Levels of physical activity and perceived benefits and barriers to exercise. South African J Physiother 2020; 76: 1399
• 31 Tuna H, Bozan O, Elibol N. et al. Are the physical activity habits of Turkish physiotherapists associated with their physical activity promotion and counseling?. Physiother Theory and Practice 2022; 38: 189-200
• 32 Jadhav R, Gupta G, Nataraj M. et al. Knowledge, attitude and practice of physical activity promotion among physiotherapists in India during Covid 19. J Bodywork & Movement Ther 2021; 26: 463-470
• 33 Yona T, Ben A, Azmon M. et al. Physiotherapists lack knowledge of the WHO physical activity guidelines. A local or a global problem?. Musculoskel Science & Practice 2019; 43: 70-75
• 34 Brannan M, Bernardotto M, Clarke N. et al. Moving healthcare professionals – a whole system approach to embed physical activity in clinical practice. BMC Med Edu 2019; 19: 84
• 35 World Health Organization, Hrsg. Physical Activity Profile 2022 Germany (Juni 2023). Im Internet:. https://cdn.who.int/media/docs/default-source/country-profiles/physical-activity/physical-activity-deu-2022-country-profile.pdf?sfvrsn=76841d03_5&download=true (Stand 03.07.2023)
• 36 American Physical Therapy Association, Hrsg. DPT Admissions Process (Oktober 2024). Im Internet:. www.apta.org/your-career/careers-in-physical-therapy/pt-admissions-process#:~:text=Anatomy%20/%20A&P%201%20with%20lab,courses%20are%20required%20for%20admission (Stand 30.10.2024)
• 37 World Physiotherapy, Hrsg. Re: Physiotherapy education standards in Germany (Juni 2023). Im Internet:. www.physio-deutschland.de/fileadmin/data/bund/news/pdfs/GV_116-2023_A_2_Schreiben_der_WPT_support_university_education.pdf (Stand: 02.07.2023)
• 38 Cifu D, Kreutzer J, Kolakowsky-Hayner S. et al. The relationship between therapy intensity and rehabilitative outcomes after traumatic brain injury: a multicenter analysis. Archives Phys Med Rehabil 2003; 84: 1441-1448
• 39 De Salles B, Simão R, Miranda F. et al. Rest interval between sets in strength training. Sports Med 2009; 39: 765-777
• 40 Valenzuela T. Efficacy of Progressive Resistance Training Interventions in Older Adults in Nursing Homes: A Systematic Review. J Am Med Directors Ass 2012; 13: 418-428
• 41 Prusynski R, Gustavson A, Shrivastav S. et al. Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review. Phys Ther 2021; 101: 1-10
• 42 Meignié A, Duclos M, Carling C. et al. The Effects of Menstrual Cycle Phase on Elite Athlete Performance: A Critical and Systematic Review. Front Physiol 2021; 19: 12
• 43 Laubach L. Comparative muscular strength of men and women: a review of the literature. Aviation Space Environ Med 1976; 47: 534-542
• 44 Klika A, Yakubek G, Piuzzi N. et al. Neuromuscular Electrical Stimulation Use after Total Knee Arthroplasty Improves Early Return to Function: A Randomized Trial. J Knee Surg 2022; 35: 104-111
• 45 Braith R, Beck D. Resistance exercise: training adaptations and developing a safe exercise prescription. Heart Failure Rev 2008; 13: 69-79
• 46 Fragala M, Cadore E, Dorgo S. et al. Resistance Training for Older Adults: Position Statement from the National Strength and Conditioning Association. J Strength Conditioning Res 2019; 33: 2019-2052
• 47 Pollock M, Franklin B, Balady G. et al. AHA Science Advisory. Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: An advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association. Circulation 2000; 101: 828-833
• 48 Merino-Andrés J, de Mateos-López A, Damiano D. et al. Effect of muscle strength training in children and adolescents with spastic cerebral palsy: A systematic review and meta-analysis. Clin Rehabil 2022; 36: 4-14
• 49 American Council of Academic Physical Therapy (ACAPT), Hrsg. Exercise Physiology in Physical Therapy (Juni 2013). Im Internet:. https://acapt.org/docs/default-source/reports/ac-5-12_exercise_phys_tfreport_060413.pdf?sfvrsn=465db1d8_4 (Stand 30.10.2024)
• 50 World Physiotherapy Europe region, Hrsg. University education required for entry level Physiotherapists in Germany (Juni 2023). Im Internet:. www.physio-deutschland.de/fileadmin/data/bund/news/pdfs/GV_116-2023_A_3_Schreiben_der_ER-WPT_Letter_to_Germany_Federal_Health_Ministry_30.06.23.pdf (Stand: 02.07.2023)