What is the physiotherapy management for dyslipidaemia?

Physiotherapy Management of Dyslipidemia

Regular moderate-intensity aerobic exercise combined with resistance training should be prescribed as the cornerstone of physiotherapy management for dyslipidemia, with structured programs demonstrating significant improvements in lipid profiles comparable to dietary interventions alone. 1

Exercise Prescription Framework

Aerobic Exercise Recommendations

• Moderate-intensity aerobic exercise should be the starting point for previously sedentary individuals with dyslipidemia, as prolonged moderate-intensity activity initiates clearance of plasma LDL cholesterol and triglycerides. 1

• High-intensity aerobic exercise (>85% maximum capacity) produces superior lipid profile improvements compared to moderate intensity, with effects surpassing those of general physical activity by enhancing lipoprotein lipase activity and HDL cholesterol levels. 1, 2

• A dose-response relationship exists between exercise intensity/duration and lipid improvements, where increased caloric expenditure through higher intensity and/or longer duration positively influences the lipid profile. 1

• HDL cholesterol responds most consistently to aerobic exercise, while LDL cholesterol and triglycerides require more intense activity levels to achieve reductions. 1, 2

Resistance Training Recommendations

• Resistance training presents a viable alternative to aerobic exercise and can be effective as an independent intervention for dyslipidemia management. 1

• Volume of movement (increased sets/repetitions) has greater impact on lipid profiles than intensity during resistance training, meaning moderate-intensity (50-85% 1RM) is as effective as high-intensity (>85% 1RM) training. 1

• The addition of resistance training to aerobic exercise supplements and possibly enhances lipid profile effects, with no reduction in benefit and additional physiological systems impacted. 1

Combined Exercise Modalities

• Combination of aerobic and resistance training should be recommended when feasible, as these modalities produce complementary effects: aerobic exercise increases HDL cholesterol and decreases triglycerides, while both modalities contribute to LDL cholesterol reduction. 1, 3

• Combined exercise programs (3 sessions weekly for 30 weeks) demonstrate significant improvements in LDL cholesterol (p<0.005) in dyslipidemic patients referred from primary care. 4

Integration with Weight Management

• Weight reduction of even 5-10% of baseline body weight improves lipid abnormalities and should be targeted through exercise-induced caloric deficit of 300-500 kcal/day. 1

• Each 10% reduction in body weight associates with approximately 7.6% reduction in LDL cholesterol, demonstrating the critical role of exercise in weight management for dyslipidemia. 5

• Regular physical exercise of moderate intensity is essential for maintaining body weight near target and preventing type 2 diabetes in dyslipidemic individuals with insulin resistance. 1

Structured Program Implementation

• Intensive lifestyle education programs incorporating exercise should be structured and supervised rather than general recommendations, as standard lifestyle advice alone shows little effect on lipid levels. 1, 5

• More intense interventions (supervised aerobic programs 3x weekly) produce measurable improvements: total cholesterol reduction of 4-6%, LDL cholesterol reduction of 6-15%, triglyceride reduction of 4-18%, and HDL cholesterol increase of 5-14%. 3, 5

• Exercise capacity improvements (1.6-1.9 METS increase) occur alongside lipid improvements in supervised programs, providing additional cardiovascular benefits. 5

Behavioral Change Strategies

• Use the OARS method (Open-ended questions, Affirmation, Reflective listening, Summarizing) when counseling patients about exercise adherence. 1

• Set SMART goals (Specific, Measurable, Achievable, Realistic, Timely) for exercise progression, following up on goals with shared record-keeping. 1

• Involve partners or household members who may influence the patient's exercise habits and lifestyle. 1

• Tailor exercise advice to individual patient's culture, habits, and physical situation to maximize adherence. 1

Timeline and Monitoring

• Evaluate lifestyle intervention effectiveness at 3-6 month intervals, as maximal exercise intervention typically produces measurable lipid changes within this timeframe. 1

• Lipid profiles should be reassessed 8-12 weeks after initiating structured exercise programs to evaluate response and adjust intensity/duration accordingly. 1

Special Populations

• Patients with diabetes and dyslipidemia particularly benefit from combined exercise and weight loss, as physical activity leads to decreased triglycerides, increased HDL cholesterol, and modest LDL cholesterol lowering. 1

• Overweight patients (BMI ≥25 kg/m²) or those with central obesity should prioritize both exercise and caloric restriction, as the combination produces superior results to either intervention alone. 1

Common Pitfalls to Avoid

• Do not recommend standard lifestyle advice without structured programming, as unstructured general recommendations show minimal effect on lipid levels. 5

• Avoid prescribing only low-intensity activity for patients capable of higher intensity, as the dose-response relationship clearly favors more intense exercise for LDL and triglyceride reduction. 1

• Do not separate exercise prescription from dietary counseling, as combination therapies produce complementary effects that are more efficacious than either intervention alone. 3

• Recognize that lipoprotein(a) is genetically determined and cannot be improved through exercise, so focus efforts on modifiable lipid fractions. 2