Therapeutic Exercise Prescription

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Introduction

Exercise prescription

“A balance between (he)art and science”

Proper therapeutic exercise prescription should consider:

Appropriate exercise for a specific patient on a 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

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. 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.

Adherence to Therapeutic Exercise Prescription

Patients' engagement with therapeutic exercise, their adherence to the prescribed exercises and the outcomes can be strengthened when “the mechanisms of trust, motivation and confidence are activated.” 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. 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. 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.

Read more about goal setting: SMART Goals and Goal Setting in Rehabilitation

Set goals with your patient based on functional limitations, impairments and activity restrictions. The International Classification of Functioning, Disability and Health Framework is a valuable tool.

Select the correct level of exercise for the patient on that specific day and progress as tolerated.

Routine Therapeutic Exercise Prescription Barker K, Eickmeyer S. Therapeutic exercise. Medical Clinics. 2020 Mar 1;104(2):189-98.

Stretching and mobility exercises – daily

Balance – daily

Strengthening – 3 to 5 times a week

Cardiovascular

Core exercises

Read more about Physical Activity Guidelines:

Warm-up

This should be cardio intensive exercise

Why warm-up:

Beneficial to performance

increased temperature – this allows internal changes such as increased blood flow and metabolic responses 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.

Increase heart rate

Breathing rate

Range of Motion

Increases blood flow

Increased flow of synovial fluid

Decreases waste in the joint

Decreases pain

Read more about benefits of Range of Motion here: Pp page

Strength Training Considerations

Sets: 1 to 3 sets

1 set for untrained populuations

Multiple sets for trained populations and lower extremity exercises

Repetitions

10 repetitions (maximises increase in strength, endurance and power

Establish 1 Repetition Maximum

Working weight should be 60 to 80 % of this

Use superset format

Rest intervals 30 to 60 seconds

Frequency: each major muscle group should be trained 2 to 3 times a week

Duration: minimum of 6 weeks

Progression: 3 to 10 % per week (based on the total volume of work)

Provide 10 different exercises

Single versus Multiple sets

Single set programmes for an initial training period in untrained individuals result in similar strength gains as multiple set programmes

Trained individuals performing multiple sets generated significantly greater increases in strength and were superior to single sets Wolfe et al 2004

Why 10 repetitions

3 X 5 increase in strength

3 X 10 increased in strength, endurance, power

3 x 20 increase in endurance

Davies 1986

Why super sets Kelleher 2010

Super set: sets proceed from one muscle group to another without rest

Super set sets increase the following compared to traditional exercise:

increased energy expenditure

Greater post-exercise oxygen consumption

Supersets increase energy expenditure and have a fixed exercise volume with limited exercise time available

Dosage

Frequency: each major muscle group should be trained 2 to 3 times per week

Duration: minimum of 6 weeks

Progression: 3 to 10% per week

10 different exercises

Immediate cardio shortens recovery???

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