Clinician's Commentary on Smetaniuk et al.

Daily physical activity (PA) is an important aspect of healthy living.² Health care professionals, including physiotherapists, are in a prime position to help patients and clients begin or maintain an exercise programme, and those who are active themselves are more likely to counsel their patients to be active.³ A previous self-report study found that in the United States, 67% of physiotherapists and 72% of physiotherapy (PT) students met activity guidelines.³ Smetaniuk and colleagues¹ found that Master of Physiotherapy (MPT) students were active at a rate closer to that of the average population, because 74% did not meet the Canadian guidelines.⁴ Because this study used objective measures (e.g., accelerometry) to determine MPT students' activity levels, the results likely provide a more accurate portrayal of PA than previous work.⁵ Smetaniuk and colleagues¹ were able to elucidate some of the challenges that students face when trying to balance going to school, having a life outside of school, and achieving the recommended amount of PA.

This study corroborated previous work on the barriers to and facilitators of PA for students.^6,7 Priorities and life balance played key roles in determining whether the MPT students achieved the recommended PA, particularly when school had to come first (e.g., before a test). They were challenged to incorporate activity into their daily schedules, which necessarily included sitting during classes and while doing homework. An interesting comparison was that a barrier for other student populations was that PA was not a priority⁶ or that the students did not enjoy physical exertion.⁷ These MPT students, however, were aware that exercise should be a priority, and the results indicated that they often felt the need to prioritize school over exercise, not that they had a lack of interest in incorporating PA into their day.¹

A major shift is required when going from undergraduate studies, when students have more autonomy to make their own schedules, to the graduate level. The MPT programme is more like a full-time job, albeit one that includes several hours of preparation and review each night. Although anyone with a full-time job may experience similar barriers, students' need to study caused additional time constraints. Canadian adults are sedentary for approximately 10 hours per day,⁴ but this study found that the students were sedentary for more than 11 hours per day.¹ This finding highlights that the MPT programme requires students to sit for long periods, both in class and outside of class hours, despite their being taught about the importance of PA.

Previous studies have shown that, as a whole, physiotherapists are more active than the average population.³ Even as students, they are aware of the benefits of PA for themselves and for their future patients; it often seems ironic to be studying how to be healthy and not to be doing it themselves. The MPT students discussed their motivation to “live up to the reputation that physical therapists lead a healthier lifestyle than the general population”;^1(p.264) this pressure may cause additional stress and guilt for students, who know that they should be more active but must also achieve passing grades. It may also help explain why self-report studies have painted such a different picture of PT students' activity—people may be more likely to report on the week in which they fulfilled their exercise goals rather than the week they spent in the library studying for a final exam.

Smetaniuk and colleagues¹ present the idea that MPT students should be supported throughout the programme to increase their activity levels. My own programme at the University of Toronto uses several initiatives to help students maintain an active lifestyle, including free intramural sports and a 10-minute break for every 1 hour of class, when the MoveU team often comes in to lead a 5- to 10-minute workout. Although these initiatives help to decrease sedentary behaviour, they do little to shift priorities overall. For example, providing free intramurals helps to facilitate participation, but during a test week several students miss their intramurals so that they can spend more time studying.

As a student, I find it difficult to prioritize PA during busy times for reasons similar to those highlighted in Smetaniuk and colleagues'¹ research. Because the importance of PA is emphasized in class, I make sure to incorporate it into my day whenever possible, but prioritizing learning (and hence sitting) during this programme will allow me to achieve my goal of becoming a physiotherapist. The bright side of struggling to balance school, life, and PA is that it enables MPT students to better understand and empathize with future clients who may be dealing with similar prioritization problems in their own lives, making them better able to coach and support them.