Therapeutic Exercise Prescription: Difference between revisions
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** [[Goal Setting in Rehabilitation|Goal Setting in rehabilitation]] | ** [[Goal Setting in Rehabilitation|Goal Setting in rehabilitation]] | ||
* Set goals with your patient based on functional limitations, impairments and | * Set goals with your patient based on functional limitations, impairments, activity and participation restrictions. The [[International Classification of Functioning, Disability and Health (ICF)|International Classification of Functioning, Disability and Health]] (ICF) Framework is a valuable tool to use. | ||
* Select the correct level of exercise for the patient on that specific day and progress as tolerated. | * Select the correct level of exercise for the patient on that specific day and progress as tolerated. | ||
| Line 77: | Line 77: | ||
==== Strength Training Considerations ==== | ==== Strength Training Considerations ==== | ||
Some foundations of strength exercise to consider include<ref name=":1" />: | |||
1 set for untrained | * Sets: 1 to 3 sets | ||
** 1 set for untrained populations | |||
** Multiple sets for trained populations and lower extremity exercises | |||
*Establish 1 Repetition Maximum (1 RM) | |||
**Working weight should be 60 to 80% of this | |||
**You can read more about 1 RM [[Strength Training#Repetition Maximum for Weight Training|here]] | |||
* Repetitions | |||
** 10 repetitions (maximises increase in strength, endurance and power) | |||
*** 3 X 5 increase in strength | |||
*** 3 X 10 increased in strength, endurance, power | |||
*** 3 x 20 increase in endurance | |||
** to volitional fatigue | |||
** More recently loading and dosage recommendations have been prescribed along the "repetition continuum" or the "strength-endurance continuum".<ref name=":3">Schoenfeld BJ, Grgic J, Van Every DW, Plotkin DL. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927075/pdf/sports-09-00032.pdf Loading recommendations for muscle strength, hypertrophy, and local endurance: A re-examination of the repetition continuum.] Sports. 2021 Feb;9(2):32.</ref> This continuum proposes the following<ref name=":3" />: | |||
*** muscle strength - low repetitions with heavy loads: 1 - 5 repetitions per set with 80% - 100% of 1 -repetition max (1RM) | |||
*** muscle hypertrophy – moderate repetitions with moderate loads: 8 - 12 repetitions per set with 60% - 80% of 1RM | |||
*** muscle endurance – high repetitions with light loads: 15 + repetitions per set with loads below 60% of 1RM | |||
* Use superset format | |||
* Rest intervals: | |||
** 30 to 60 seconds between sequential sets | |||
** isometric exercises - 1 minute recovery between sets | |||
** isotonic exercises - 30 seconds to 60 second recovery between sets | |||
** isokinetic exercises - 2 to 4 minutes recovery between sets | |||
* Frequency: each major muscle group should be trained 2 to 3 times a week | |||
10 | * Duration: minimum of 6 weeks<ref>Ralston GW, Kilgore L, Wyatt FB, Baker JS. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684266/pdf/40279_2017_Article_762.pdf The effect of weekly set volume on strength gain: a meta-analysis.] Sports Medicine. 2017 Dec;47:2585-601.</ref> | ||
* Progression: 3 to 10% per week (based on the total volume of work) | |||
* Provide 10 different exercises | |||
You can read in more detail about designing a strength training programme [[Strength Training#Designing a Strength (Resistance)Program|here]]. | |||
==== Flexibility ==== | |||
Painful, irritable, hypertonic tissue - 5 to 10 second stretch | Painful, irritable, hypertonic tissue - 5 to 10 second stretch | ||
Revision as of 15:51, 18 June 2024
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Introduction[edit | edit source]
Exercise Prescription - “A balance between (he)art and science”[edit | edit source]
Proper therapeutic exercise prescription should consider[1]:
- Appropriate exercise for a specific patient on that specific day
- exercise protocols can be used when appropriate, but it has to match with the patient on the day
- the phases of healing when prescribing therapeutic exercise
- if you'd like you can read more about:
- the patient’s tolerance level
- Exercise therapy is often used as a supplement to maintain the effects of manual therapy.
- For example in persons with non-specific chronic neck pain, therapeutic and stabilisation exercises after manual therapy have been shown to have more positive effects such as increased range of motion and decreased pain.[2]
Adherence to Therapeutic Exercise Prescription[edit | edit source]
- The involvement and engagement of patients in therapeutic exercise, their commitment to following the prescribed routines and the the resulting outcomes can be enhanced by activating trust, motivation and confidence mechanisms.[3]
- Ways to develop trust is by building a therapeutic alliance and developing a rapport with the patient. This will also assist in a holistic approach and identifying the patient’s needs and beliefs.
- Understanding what a patient’s goals are will help rehabilitation professionals create a tailored exercise programme and with personalised advice and education, this may increase the patient’s motivation and adherence.[3] Read more about goal setting:
- Set goals with your patient based on functional limitations, impairments, activity and participation restrictions. The International Classification of Functioning, Disability and Health (ICF) Framework is a valuable tool to use.
- Select the correct level of exercise for the patient on that specific day and progress as tolerated.
- You can read more about adherence to exercise prescription:
Routine Therapeutic Exercise Prescription[edit | edit source]
General therapeutic exercises to include are[1]:
- stretching and mobility exercises – daily
- balance exercises – daily
- strengthening exercises– 3 to 5 times a week
- cardiovascular exercise
- core exercises
Components of Therapeutic Exercise[edit | edit source]
Warm-up[edit | edit source]
- This should be cardio intensive exercise.
- Benefits of warm-up include:
- beneficial to subsequent exercise performance via increase in ATP turnover and muscle cross bridge cycling rate[4]
- increased temperature – this allows internal changes such as increased blood flow and metabolic responses[5]
- improved oxygen delivery[6]
- increased blood flow[6]
- faster muscle contraction and relaxation[6]
- improved force development[6]
- improved reaction time[6]
- decreased skeletal muscle viscosity and resistance[6]
- increased compliance of ligaments and tendons[6]
- increased and enhanced metabolic reactions[6]
Range of Motion Exercises[edit | edit source]
Benefits of range of motion exercises include:
- increased blood flow
- increased flow of synovial fluid[7]
- decreases waste in the joint[8]
- decreased pain[9]
Read more about benefits of range of motion exercises here.
Strength Training Considerations[edit | edit source]
Some foundations of strength exercise to consider include[1]:
- Sets: 1 to 3 sets
- 1 set for untrained populations
- Multiple sets for trained populations and lower extremity exercises
- Establish 1 Repetition Maximum (1 RM)
- Working weight should be 60 to 80% of this
- You can read more about 1 RM here
- Repetitions
- 10 repetitions (maximises increase in strength, endurance and power)
- 3 X 5 increase in strength
- 3 X 10 increased in strength, endurance, power
- 3 x 20 increase in endurance
- to volitional fatigue
- More recently loading and dosage recommendations have been prescribed along the "repetition continuum" or the "strength-endurance continuum".[10] This continuum proposes the following[10]:
- muscle strength - low repetitions with heavy loads: 1 - 5 repetitions per set with 80% - 100% of 1 -repetition max (1RM)
- muscle hypertrophy – moderate repetitions with moderate loads: 8 - 12 repetitions per set with 60% - 80% of 1RM
- muscle endurance – high repetitions with light loads: 15 + repetitions per set with loads below 60% of 1RM
- 10 repetitions (maximises increase in strength, endurance and power)
- Use superset format
- Rest intervals:
- 30 to 60 seconds between sequential sets
- isometric exercises - 1 minute recovery between sets
- isotonic exercises - 30 seconds to 60 second recovery between sets
- isokinetic exercises - 2 to 4 minutes recovery between sets
- Frequency: each major muscle group should be trained 2 to 3 times a week
- Duration: minimum of 6 weeks[11]
- Progression: 3 to 10% per week (based on the total volume of work)
- Provide 10 different exercises
You can read in more detail about designing a strength training programme here.
Flexibility[edit | edit source]
Painful, irritable, hypertonic tissue - 5 to 10 second stretch
Stay less than 4 out of 10 pain
Muscle, a little tight (after exercise)
3 x 30 seconds , 2 to 3 times a day
Very limited muscle length
stretches more than 1 minute long
stay less than 4 out of 10 pain
Joint capsule
20 x 5 seconds or sustained stretch
Creep principle
Cardiovascular training
5 to 7 days a week
Recommendation: 150 minutes of moderate intensity/ week
Aerobic exercise
3 to 5 days a week for 20 to 60 minutes at an intensity that achieves 55 yo 90 % of the maximum heart rate (220 - age)
Risk Assessment
Patient risk is your risk
Low
Medium
High
Vital Signs
Vitals should always be taken before, during and after exercise
Pre-exercise BP greater than 200mmHg systolic or 120mmHg diastolic is a contraindication to exercise
Normal for systolic blood pressure to rise between 160 and 200 mm Hg during exercise
Diastolic should remain the same or slightly drop.
Increase of 10mm = stop
Hypertension
Stage 1 - systolic 140 - 159 Diastolic 90 - 99
Stage 2 - systolic 160 - 179 Diastolic 100 - 109
Stage 3- systolic over 180 Diastolic over 110
Low Risk
No angina
no unusual shortness of breath
No light-headedness
No dizziness
BP must be below 200/90 to exercise
Stop exercise if systolic drops 10 mmHg with activity
Diastolic can increase 10mmHg with activity
Moderate Risk
Presence of angina
Light-headedness
Unusual shortness of breath
Dizziness occuring at high levels of exertion
Vitals are slightly outside of norms (under 200 diastolic 90)
Remain constant during exercise
High Risk
Dizziness at low levels of exertion
Vitals are outside of norms and fluctuate during treatment (over 200 or diastolic over 100 is a contraindication)
Sub Heading 2[edit | edit source]
Sub Heading 3[edit | edit source]
Resources[edit | edit source]
- bulleted list
- x
or
- numbered list
- x
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Jackson, R. Exercise Prescription. Plus. Course. 2024
- ↑ Demir O, Atıcı E, Torlak MS. Therapeutic and stabilization exercises after manual therapy in patients with non-specific chronic neck pain: a randomised clinical trial. International Journal of Osteopathic Medicine. 2023 Mar 1;47:100639.
- ↑ 3.0 3.1 Wood L, Foster NE, Dean SG, Booth V, Hayden JA, Booth A. Contexts, behavioural mechanisms and outcomes to optimise therapeutic exercise prescription for persistent low back pain: a realist review. British Journal of Sports Medicine. 2024 Feb 1;58(4):222-30.
- ↑ McGowan CJ, Pyne DB, Thompson KG, Rattray B. Warm-up strategies for sport and exercise: mechanisms and applications. Sports medicine. 2015 Nov;45:1523-46.
- ↑ Silva LM, Neiva HP, Marques MC, Izquierdo M, Marinho DA. Effects of warm-up, post-warm-up, and re-warm-up strategies on explosive efforts in team sports: A systematic review. Sports Medicine. 2018 Oct;48:2285-99.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 Bushman BA. The Value of Warm-Up and Cool-Down. ACSM's Health & Fitness Journal. 2024 Mar 1;28(2):6-9.
- ↑ Neves M, de Freitas Tavares AL, Barbosa Retameiro AC, Reginato A, da Silva Leal TS, de Fátima Chasko Ribeiro L, Flor Bertolini GR. Effects of Exercise on The Knee Joint in an Experimental Rheumatoid Arthritis Model. Journal of Morphological Sciences. 2021 Jan 1;38.
- ↑ Roberts HM, Law RJ, Thom JM. The time course and mechanisms of change in biomarkers of joint metabolism in response to acute exercise and chronic training in physiologic and pathological conditions. European Journal of Applied Physiology. 2019 Dec;119:2401-20.
- ↑ Rocha TC, Ramos PD, Dias AG, Martins EA. The effects of physical exercise on pain management in patients with knee osteoarthritis: A systematic review with metanalysis. Revista brasileira de ortopedia. 2020 Dec 2;55:509-17.
- ↑ 10.0 10.1 Schoenfeld BJ, Grgic J, Van Every DW, Plotkin DL. Loading recommendations for muscle strength, hypertrophy, and local endurance: A re-examination of the repetition continuum. Sports. 2021 Feb;9(2):32.
- ↑ Ralston GW, Kilgore L, Wyatt FB, Baker JS. The effect of weekly set volume on strength gain: a meta-analysis. Sports Medicine. 2017 Dec;47:2585-601.
