Foundations of Therapeutic Exercise

Therapeutic Exercise

Systematic planned performance of bodily movements, postures, or physical activities intended to remediate or prevent impairments, improve or restore physical function, reduce health-related risk factors, and optimize overall health, fitness, or well-being

Patients in Physical Therapy

Individuals who seek out or are referred for PT services because of physical impairments associated with movement disorders

Clients in Physical Therapy

Individuals with no impairments or functional deficits who wish to improve fitness, quality of life, or reduce risk of injury or disease

Therapeutic Exercise Interventions

Conditioning, stretching, neuromuscular control, postural control, balance, relaxation, breathing, & functional training

Primary PT Intervention Category – Therapeutic Exercise

Most utilized intervention; foundation of PT focused on the human movement system and physical function

Top 3 Intervention Categories in PT

Therapeutic Exercise, Manual Therapy, & Biophysical Agents

Movement System Practitioner - Requirements

Integrative knowledge, diagnostic ability, impairment identification, & intervention design

Interrelated components of physical function

Muscle performance, cardiopulmonary/endurance, mobility/flexibility, neuromuscular control/coordination, stability, balance

Muscle Performance

Muscular capacity to produce tension & do physical work

Components of Muscle Performance

Strength, power, & endurance

Cardiopulmonary Endurance

Ability to perform moderate-intensity, repetitive, total-body movements over time

Mobility/Flexibility

Ability to move freely without restriction

Passive Mobility

Mobility dependent on soft tissue extensibility

Active Mobility

Mobility requiring neuromuscular activation

Neuromuscular Control

Interaction of sensory & motor systems enabling coordinated movement based on proprioceptive and kinesthetic information

Coordination

Correct timing & sequencing of muscle firing with appropriate contraction intensity to effectively initiate, guide, and grade movement

Stability

Ability of the neuromuscular system to hold a body segment stationary or control a stable base during movement

Balance/Postural Equilibrium

Ability to align the body against gravity to maintain or move the COM within the BOS without falling

Primary Prevention

Health promotion activities designed to prevent disease in at-risk populations

Secondary Prevention

Early diagnosis and reduction of severity or duration of existing disease and its sequelae

Tertiary Prevention

Interventions aimed at limiting disability and improving function in individuals with chronic or irreversible conditions

Co-Management

sharing responsibility of a patient

Consultation

Providing or seeking professional expertise

Supervision

Delegation of some portion of treatment while remaining responsible for the care provided

Referral

Includes both directing a patient to or receiving a patient from another provider

Adherence to Exercise: Condition/impairment-related factors

acuity or chronicity, co-morbidities, pain, STGs with chronic impairments

Adherence to Exercise: Patient-related factors

understanding, motivation, fatigue/stress, time, perception, degree of control, background, beliefs/values, resources, gender (male>female)

Adherence to Exercise: Program-related factors

complexity, duration, instruction, supervision, feedback, salience, degree of input, location, scheduling, atmosphere, social support

Outcomes Assessed

Functional outcomes, tests/measures, disability indices, prevention measures, safety measures, QOL measures, patient satisfaction, health literacy, adherence to program