Therapeutic Exercise Prescription
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Introduction[edit | edit source]
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???
Rest Intervals
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
Resting between sets is therapeutic - 50% of ATP/CP stores are replenished after 30 seconds of rest
Inadequate rest intervals during exercises causes:
Increased lactic acid accumulation
fatigue
decreased neuromuscular control
decreased force production
decreased motor unit recruitement
Lactic acid
Excess accumulation signals CNS
Brain responds by sending weaker nerve impulses to working muscles
Results in decreased proprioception and kinesthesia
Decreased performance
Injury
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