As shown in , modifying risk factors through an intervention such as therapeutic exercise is an important tool for reducing or preventing the major components of the disablement process. Risk factors related to disablement are influences or characteristics that predispose a person to the process of disablement. As such, they exist prior to the onset of the pathology, impairments, functional limitations, or disability.Some factors that increase the risk of disability are biological characteristics, lifestyle behaviors, psychological characteristics, and the impact of the physical and social environments.

Some of the risk factors, in particular lifestyle characteristics and behaviors and their impact on the potential for disease or injury, have become reasonably well known because of public service announcements and distribution of educational materials in conjunction with health promotion campaigns, such as Healthy People 2000 and Healthy People 2010.Information on the adverse influences of health-related risk factors, such as a sedentary lifestyle, obesity, and smoking, has been widely disseminated by these public health initiatives. Although the benefits of a healthy lifestyle, which includes regular exercise and physical activity, are well founded and widely documented, initial outcomes of the previous national campaign, Healthy People 2000, suggest that an increased awareness of risk factors has not translated effectively into dramatic changes in lifestyle behaviors to reduce the risk of disease or injury. This demonstrates that increased knowledge does not necessarily change behavior.

Biological Factors
• Age, sex, race
• Height/weight relationship
• Congenital abnormalities or disorders (e.g., skeletal deformities, neuromuscular disorders, cardiopulmonary diseases or anomalies)
• Family history of disease; genetic predisposition

Behavioral/Psychological/Lifestyle Factors
• Sedentary lifestyle
• Use of tobacco, alcohol, other drugs
• Poor nutrition
• Low level of motivation
• Inadequate coping skills
• Difficulty dealing with change
• Negative affect

Physical Environment Characteristics
• Architectural barriers in the home, community, and workplace
• Ergonomic characteristics of the home, work, or school environments

Socioeconomic Factors
• Low economic status
• Low level of education
• Inadequate access to healthcare
• Limited family or social support

When active pathology exists, the reduction of risk factors by means of buffers (interventions aimed at reducing the progression of pathology, impairments, functional limitations, or disability) is appropriate.This focus of intervention is categorized as secondary or tertiary prevention of disability. Initiating a regular exercise program and increasing the level of physical activity on a daily basis or altering the physical environment by removing architectural barriers or using assistive devices for ADL are examples of buffers that can reduce the risk of disability.

This summary of the process of disablement has focused on key elements of this complex process. A basic understanding of the process and the various models and classification systems that have been developed over the past four decades provides a conceptual framework for practice and research, establishes a foundation for sound clinical decision making and effective communication, and sets the stage for delivery of effective, efficient, meaningful physical therapy care and services for patients.

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