Precision Physical Therapy: Curriculum Needs in the Epigenome Era
Purpose: The primary aim for this symposium is to highlight some key genomic and epigenomic principles that can inform the contemporary scientific rationale for many physical therapist interventions. By remaining abreast of this rapidly expanding field, educators can expertly tailor curriculums to determine how to deploy this information into the curriculum. This symposium will include outcomes from our laboratory where we used genomics and epigenomics to establish an optimal dose of exercise for people with paralysis.
Methods and/or Description of Project: An introduction to the human genome and epigenome will focus on major concepts important to understanding these contemporary principles including methylation and histone modification. Next, intuitive links between exercise, health and epigenetics will be discussed with a focus on how a physical therapy student can understand the plasticity and the ultimate power of their exercise-based prescriptions. Key findings from our own laboratory where we used genomics and epigenomics to determine an optimal intervention for people with paralysis will be presented. Specifically, genomic analysis was carried out on 20 individuals with spinal cord injury. An intervention using various doses of electrically induced exercise was implemented to determine the dose that optimizes regulation of the gene signaling in humans. Repeated Measures ANOVAs and False Discovery Rates (FDR) were used to test the impact of electrically induced exercise training on gene signaling pathways. Strategies to seamlessly embed these principles into various pre-existing courses will be presented.
Results/Outcomes: Key concepts and principles that enable people without extensive background in genetics will be succinctly presented, including several definitions to understand some confusing language. The explanations will be succinct and serve as an example of how this information should be presented to DPT students. Using a real-life example, we show that electrically induced muscle exercise up regulated 19 gene signaling pathways and over 400 genes associated with skeletal muscle metabolism (p < 0.05; FDR < 0.25). A specific gene known to regulate mitochondria, PGC1a, was significantly up regulated (p < 0.05) and showed epigenetic tagging of the primary site that promotes this gene. Elements of these key principles embedded in pre-existing pathology and/or movement control courses within a curriculum will be presented.
Conclusions/Relevance to the conference theme: Physical therapists, along with all other health care disciplines, will be affected by the rapid progression of precision health care. Each year, more examples emerge of ways that individual patient genetic signatures can be used to optimize treatment. Tailoring exercise recommendations to individual patient genotypes will be a future application for precision physical therapy, especially in clients with pre-existing pathology. As knowledge is gained about the power of environmental influences, including the social determinants of health and life style factors, on epigenetic regulation, our students will need to be astute consumers of this knowledge that will be part of the new frontier in health care.