Therapeutic Exercise Prescription I

Physical activity

Any bodily movement produced by skeletal muscles that required energy expenditure

Exercise

Type of physical activity that involves planned, structured and repetitive bodily movement done to maintain or improve one or more components of physical fitness

Therapeutic exercise

Prescribed to promote recovery and restoration of function

Physical activity and exercise guidelines

2.5 to 5 hours of moderate intensity physical activity or 1.25 to 2.5 hours of vigorous intensity physical activity, an equivalent combination of moderate and vigorous activity and muscle strengthening activities at least two days a week

First A of behaviour change

Assess - physical activity levels, pain or swelling, rom, muscle strength, motor control, balance, cardiovascular capacity, acute angina or extreme fatigue, severe hypertension, post surgical precautions, post injury, recent fall

Second A of behaviour change

Advise - advice about appropriate exercises for condition, recommended amount of physical activity, needs to be tailored to individual

Third A of behaviour change

Agree on a smart goal - specific, measurable, achievable, relevant and time based

Fourth A of behaviour change

Assist - how can therapist assist client to complete exercises correctly, clear write instructions, pictures or videos for correct technique, diary or apps to monitor progress

Fifth A of behaviour change

Arrange - follow up or re assessment, ensure patient is doing exercises effectively, consider if exercises need to be progressed or regressed

Specificity

Training should be specific to sport performed, adaptions should be specific, need to consider energy source, muscle contraction, muscle group, velocity

Individualisation

Consider individual’s current condition, trainability, sports specific and personal goals

Progressive overload

Continual and gradual increase in training workload, can be achieved by increasing length of training by adding weights or changing the exercise challenge

Variety

Consider using multiple training types and methods, avoids boredom

Reversibility

Adaptions lost at a similar rate to which they are gained, can be avoided by maintaining two training sessions per week

Frequency

How often per week

Intensity

How hard exercise is - rpe, load, percentage of one rep max, percentage of max heart rate

Time

How long exercise is per session - seconds minutes or hours, number of reps or sets

Type

What exercise is being performed - strength, cardiovascular or aerobic, balance or control, flexibility

ACSM guidelines for rom - frequency

two to three times a week, greatest gains with daily exercise

ACSM guidelines for ROM - intensity

Stretch to the point of feeling tightness or slight discomfort

ACSM guidelines for ROM - time

Holding a static strength for 30-60 seconds has greater benefit

ACSM guidelines for ROM - type

Series of flexibility exercise for each major muscle tendon unit, static flexibility, dynamic flexibility, ballistic flexibility and PNF are effective, more effective when muscle is warm

Static flexibility

Passively held position - gravity, using another limb, therapist assisted or equipment assisted

Dynamic flexibility

Slow movement stretch

Ballistic flexibility

Bouncing or momentum stretch

PNF

Isometric contraction followed by relaxation

Why is flexibility prescription effective

Viscoelastic changes, neural changes, increased stretch tolerance