Physiotherapists are experts in the human movement system and in exercise prescription. But what is the ultimate goal of this work? The innovators behind, “Dance for PD,” provide a potential answer.
The big idea
A little more than a year ago, I went to a talk given by two of the developers of Dance for PD. One was David Leventhal, a founding teacher of Dance for PD, and the other was a person living with Parkinson’s Disease. If you’re not already familiar with Dance for PD, it is an initiative that teaches dance and movement to persons living with Parkinson’s disease.
The person living with Parkinson’s disease was a former choreographer. Dance for PD had been revolutionary for her. The program brought something back into her life that she had thought lost in the melee of diagnosis and prognosis that followed the onset of her symptoms. Despite these symptoms, which included her inability to overcome inertia, she learned that, “I may not be able to walk across a room, but I could dance across it”.
My take on things…
Of the things that were imprinted on me that night, this one reciprocal truth was clear: physical activity can be a road back to our identity and, in turn, the degree to which our identity is dependent on physical activity may reflect the degree to which we will be active. I want to take a few minutes to unpack these thoughts.
Who am I now?
First, the role that physical activity can play in helping us to recover our identity. As physiotherapists, we help people at the time in their lives when their identity has taken a major hit. This is as true for a soccer player experiencing a knee injury, as for a parent who is facing an acute brain injury, or a traveler who is dealing with kidney failure and is now dependent on in-centre dialysis. Health crises can challenge not only our physical capacities, but our very sense of self: “Who am I now?” Our role as physiotherapists is ultimately to work in collaboration with our patients as they re-establish their identity. In some cases, this happens in short course; in others the road is longer.
A rose by any other name?
The second part of this reciprocal truth has led me to reconsider how I choose to interpret ’non-adherence’. The World Health Organization defines adherence as “the extent to which a person’s behavior – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider.” I avoid the term compliance in this context. The World Health Organization discussed this differentiation, but my concern stems from my work as a vascular scientist. Compliance is the degree to which something bends to an externally applied force; which is not a very patient-centered idea.
A third term used in medication literature is ‘persistence’, defined as “the duration of time from initiation to discontinuation of therapy.”
While there is yet no consensus on the interchangeability of these terms, we should consider how the language we choose aligns with our professional values.
Preserving oneself and our ability to express ourselves
So, how does identity relate to how physically active we choose to be? What if, when a person doesn’t adhere to a physical activity recommendation, it doesn’t reflect a lack of knowledge or disobedience to authority figures, but rather something else? What if adherence is only a reflection of the degree to which a person recognizes PA as an integral component of their identity?
We often talk about individuals who have experienced a significant health crisis as being ‘ready to change’. The reality of their situation is upon them: don’t exercise and never return to the life you knew. Start to exercise and rediscover the life that was yours. When the fear of losing one’s ‘self’ is immediate, people will find themselves ready to commit to change.
For some people engaged in exercise-related professions it may be hard to imagine people whose identity isn’t grounded in physical activity. Many people have negative associations with physical activity from their childhood.*
Moreover, the media often portrays images of people who are ostensibly healthy, yet engender unhealthy approaches to life. To paraphrase the patient-partner from Dance for PD, a person may not identify with being a ‘gym rat’. However, they will commit to a program of therapeutic exercise in order to enable them to express themselves through dance: I train to maintain my ability to do what it is that I enjoy.
How does this thought influence my practice?
The above reminds me that unlocking my patients’ internal motivations is imperative to a successful outcome. It helps me to reconsider therapy goals less in terms of those which are traditionally defined by our profession (SMART goals), but in the language and objective of the patient themselves. Also, there is a need for clear links between the objectives of my exercise prescription and what my patient wants to do on an ongoing basis to be physically active.
I’ve opened my thinking on physical activity to consider all of the different forms of movement, particularly those which incorporate art or a sense of fun within them. As the developers of Dance for PD reminded me, the aesthetics of movement are as important as its function. That movement is a mode of expressing ourselves in the world.
To close out their talk, the two Dance for PD speakers transformed into performers, and moved us all with a powerful ballet. By teaching people with PD how to express themselves through movement and dance, and in turn, by witnessing such movement as an audience, we contribute to the development of their identity. That a person is a person because of people is an African Philosophy espoused by a number of great minds, including Nelson Mandela and Desmund Tutu. A person is a person, because we as people help them to re-establish the form and function of their movement, and witness these efforts. I am very lucky to belong to a profession where this is my daily charge and challenge.
If you’re interested in learning more about how dance and song are being incorporated as a therapeutic modality for patients with various conditions, check out:
Dance for Depression (review article) – Better evidence is needed, but a good review on Dance as an intervention for Depression.
Dance and Dystonia (video)
Dance Walk Fitness (video) – A reminder that physical activity should be fun!
Why I Lived in Mortal Dread of Public Speaking – An exceptional TedTalk by Megan Washington on the role of song in overcoming a speech impediment, “Singing for me is sweet relief. It is the only time when I feel fluent. It is the only time when what comes out of my mouth is comprehensively exactly what I intended.”
Dance for PD Training Workshops – For professionals and instructors
What do you recommend that helps you to unlock your patients’ motivation?
Which term do you prefer to use: compliance, adherence, or persistence?
Can ‘fun’ be a core criterion guiding our clinical decision-making with respect to exercise prescription?
About Trisha Parsons
Trisha is a physiotherapist, scientist, and faculty member at Queen’s University in Kingston, ON. Her work is in the field of Renal Rehabilitation. As an AMS Phoenix Fellow she is evaluating strategies to develop and sustain narrative competence in physiotherapists in order to support the delivery of patient-centered care for persons with complex health conditions.
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