Rehabilitation part 2.ppt
- 3. Definition ā¢ The systematic performance or execution of planned physical movements, postures, or activities intended to enable the patient/client to: ļ§ Remediate or prevent impairments ļ§ Enhance function ļ§ Reduce risk ļ§ Optimize overall health ļ§ Enhance fitness and well-being
- 4. ā¢ In the simplest terms, therapeutic exercise involves movement prescribed to correct impairments, restore muscular and skeletal function and/or maintain a state of well-being ā¢ Therapeutic exercise is one of the core skills upon which the profession of physiotherapy is based.
- 6. Exercise has been shown to: ā¢ Benefit cardiovascular and respiratory function ā¢ Reduce cardiovascular and respiratory function ā¢ Decrease morbidity and mortality ā¢ Decrease anxiety and depression ā¢ Reduce pain ā¢ Improve cognitive function ā¢ Enhance physical function and independent living in older individuals ā¢ Enhance feelings of well-being ā¢ Reduce risk of falls in older individuals ā¢ Prevent or mitigate functional limitations in older adults ā¢ Enhance performance of work, recreational, and sport activities
- 8. What is the difference between physical activity and exercise? ā¢ Physical activity refers to the contraction of skeletal muscle that produces bodily movement and requires energy. Exercise is physical activity that is planned and is performed with the goal of attaining or maintaining physical fitness. Physical fitness is a set of traits that allows an individual to perform physical activity
- 9. The U.S. Department of Health and Human Services published Physical Activity Guidelines in 1996 and more recently in 2018. ā¢ Recommendations for adults include at least 150 minutes a week of moderate-intensity aerobic activity, or 75 minutes a week of vigorous-intensity aerobic activity, or an equivalent combination of the two. ACSM defines moderate intensity is defined as 3 to 5.9 metabolic equivalents (METs), 45-63% VO2 max, or 64-91% of maximum heart rate. They define vigorous intensity is defined as greater than 6.0 METs, 64-91% VO2 max, or 77-93% of maximum heart rate (please also refer to Table 1). Children and adolescents are encouraged to perform 60 minutes or more of physical activity daily, including aerobic, muscle-strengthening and bone- strengthening activities.
- 13. ā¢ There are several methodologies to exercise prescription. One of the easier methods is the Frequency, Intensity, Time, and Type (FITT). The ACSM also recommends FITT-VP (Frequency, Intensity, Time, Type, Volume, and Progression). Utilizing these methodologies parallels writing a traditional medication prescription. Each component of the prescription provides a patient with specific information to incorporate aerobic, resistance, flexibility, and neuromotor exercise training into a fitness program.
- 15. Bottom Line Up Front (BLUF) ā¢ Exercise is the best āmedicineā around ā¢ Assess physical activity in ALL patients ā¢ Only RARE patients needs GXT before exercise ā¢ GXT pts with symptomatic CV/pulm dz ā¢ The Prescription is: Be āFITTā ā Frequency: 5 days a week (or more) ā Intensity: moderate intensity, 5-6 on 10 scale ā Time: 30 minutes aerobics (10-min chunks OK) ā Type: ā¢ Aerobic activity ā¢ Muscular strengthening activity ā¢ Flexibility activity (in elderly/sick) ā¢ Balance training (if fall risky)
- 16. Physicians and their Patients ā¢ 47% of primary care physicians include an exercise history as part of their initial examination (self report) ā¢ Only 13% of patients report physicians giving advice about exercise ā¢ Physically active physicians are more likely to discuss exercise with their patients
- 17. ACSM & AHA 2007, HHS 2008 Physical Activity Recommendations Healthy Adults age 18-64 ā¢ Aerobic Physical Activity ā Moderate intensity: 150 minutes/wk, OR Vigorous intensity: 75 minutes/wk (or a combo) ā 10 min at least, preferably spread throughout week ā¢ Muscle Strengthening Activity ā 2 or more days/wk ā 8-10 exercises ā 8-12 reps (one set)
- 18. ā¢ Indications & benefits ā¢ Contraindication ā¢ Side-effects ā¢ Drug interactions ā¢ Cost ā¢ Dose, frequency, duration
- 19. Indications for Exercise ā¢ Longevity ā¢ Quality of Life ā¢ Socialization ā¢ Weight control ā¢ Disease prevention ā¢ Disease management ā¢ ā¦.(I could go on)
- 20. Longevity The more you exercise, the lower your risk of death 0 0.2 0.4 0.6 0.8 1 1.2 0 90 180 330 420 Relative Rick of Death Minutes per Week of Moderate- or Vigorous-Intensity Exercise Risk of Death
- 21. Dose-response Curve for Exercise
- 22. Death Prevention: Attributable Deaths (%) from various health conditions Aerobics Center Longitudinal Study (ACLS), Cooper Institute ā¢40,842 men; 12,943 women
- 23. Strong Evidence of Benefit from Physical Activity forā¦ ā¢ Lower risk of: ā Early death ā Heart disease ā Stroke ā Type 2 diabetes ā High blood pressure ā Dyslipidemia ā Metabolic syndrome ā Colon and breast Ca ā¢ Prevention of wt gain ā¢ Wt loss w/dieting ā¢ Improved C-R & muscular fitness ā¢ Prevention of falls ā¢ Reduced depression ā¢ Better cognitive fxn (older adults)
- 24. Moderate evidence forā¦ ā¢ Wt maintenance after loss ā¢ Lower risk of hip fx ā¢ Increased bone density ā¢ Improved sleep quality ā¢ Lower risk lung and endometrial Ca
- 25. Contraindications for Exercise ā¢ Acute cardiac event happening now ā¢ Uncontrolled arrhythmia causing sxs ā¢ Severe aortic stenosis ā¢ Uncontrolled heart failure ā¢ Acute pulmonary embolism ā¢ Acute myocarditis ā¢ Dissecting aneurysm
- 26. Side effects of exercise ā¢ Slight risk of Musculoskeletal injury ā Increases with duration & intensity ā¢ RARE cardiac events ā FAR outweighed by benefits to heart! ā 25-50% decrease in CVD in exercisers
- 27. ā¢If we had a pill that conferred all the benefits of exercise, physicians would prescribe it to every patient. Our health care system would find a way to make sure that every patient had access to this āwonder drug.ā
- 28. Use the Sports and Exercise Medicine approach to patients ā¢ Every patient is a potential āathleteā who needs exercise for HEALTH, not competition ā¢ Physical activity is a VITAL SIGN--a STRONG PREDICTOR OF HEALTH ā¢ Every exam is a pre-participation eval ā¢ Conclude exams with activity clearance and Exercise Rx
- 29. How to Write an Exercise Prescription
- 30. Rx: Be āFITTā ā¢Frequency ā¢Intensity ā¢Time (duration) ā¢Type
- 31. Frequency ā¢ 5 days a week ā¢ Even more is even better! āDose-response curve!
- 32. Intensity ā¢ Moderate Exercise ā Equivalent of BRISK WALK ā Noticeably accelerates RH ā Able to talk ā¢ ātalk testā ā RPE 5-6 out of 10
- 33. Exercise Intensity: Relative Perceived Exertion Use 1-10 Scale
- 34. Examples of Moderate Intensity ā¢ Brisk walking ā¢ Household cleaning: vacuum, mop, wipe ā¢ Mowing lawn ā¢ Shooting hoops ā¢ Recreational badminton ā¢ Ballroom dance ā¢ Golf & pulling clubs ā¢ Leisurely sports ā¢ Leisurely biking, swimming
- 35. Intensity ā¢ Vigorous Exercise ā Equivalent of jogging ā Fail ātalk testā ā RPE 7-10 out of 10
- 36. Examples of Vigorous Intensity ā¢ Jogging, running ā¢ Shoveling ā¢ Heavy farming ā¢ Competitive sports ā¢ Cross country skiing ā¢ Intense biking, swimming
- 37. Time (Duration) ā¢ Accumulate 30 minutes a day ā 10 minute chunks OK ā¢ More is better!
- 38. Type ā¢ Aerobic Activity AND ā¢ Muscle Strengthening
- 39. Muscular Strengthening ā¢ Exercise large muscle groups ā¢ 8-12 reps; should fatigue by last rep ā¢ Rest 2-3 minutes between exercises ā¢ 1 set good, 2 sets better ā¢ Rest day in between
- 40. What about Older Adults >65, or those with chronic diseases? ā¢ Aerobic exercise: same ā¢ Strength exercise: same, except 10-15 reps ā Slightly lighter weights ā¢ Flexibility activity 2 days/wk, 10 min ā¢ Balance exercise if at risk for falls, 3x/wk Nelson ME et al. Physical activity and public health in older adults: Recommendation from the ACSM and the AHA. Med Sci Sports Exer 2007;39(8):1435.
- 41. What about Children/Adolescents? ā¢ Do 60 minutes or more of physical activity every day ā Mostly moderate or vigorous ā Vigorous activity at least 3 days/wk ā¢ Strength exercise 3 days/wk HHS guidelines October 2008
- 42. Take Home Pearls ā¢ Exercise is the best āmedicineā around ā¢ Assess physical activity in ALL patients ā¢ Only RARE patients needs GXT before exercise ā¢ GXT pts with symptomatic CV/pulm dz ā¢ The Prescription is: Be āFITTā ā Frequency: 5 days a week (or more) ā Intensity: moderate intensity, 3-6 on 10 scale ā Time: 30 minutes aerobics (10-min chunks OK) ā Type: ā¢ Aerobic activity ā¢ Muscular strengthening activity ā¢ Flexibility activity (in elderly/sick) ā¢ Balance training (if fall risky)
- 43. Therapeutic exercise may include: ā¢ aerobic and endurance conditioning and reconditioning; ā¢ agility training; ā¢ body mechanics training; ā¢ breathing exercises ā¢ coordination exercises; ā¢ developmental activities training; ā¢ movement pattern training; ā¢ neuromotor development activities training; ā¢ neuromuscular education or reeducation; ā¢ perceptual training; ā¢ range of motion exercises and soft tissue stretching; ā¢ relaxation exercises; ā¢ strength, power, and endurance exercises.
- 44. The most commonly included exercises fall into 4 groups ā¢ Strengthening exercises, usually performed with heavy resistance and fewer repetitions. ā¢ Endurance exercises that engage large muscle groups over a longer period of time, in the area of 50 to 60% VO2Max to achieve greater cardiovascular endurance. ā¢ Flexibility exercises achieved through stretching and movement. ā¢ Balance and coordination exercises that focus on maintaining an individual's centre of gravity.
- 48. agility training
- 57. range of motion exercises
- 64. the prosess of evidence based practice
- 66. a comprehensive outcomes oriented model on patient management (2013)
- 67. Diagnostic classification for the musculoskeletal system ā¢ Primary prevention/risk for skeletal demineralization ā¢ Impaired posture ā¢ Impaired muscle performance ā¢ Impaired joint mobility,motor function,muscle performance,ROM associated with connective tissue disfunction ā¢ Impaired joint mobility,motor function,muscle performance,ROM associated with inflamation ā¢ Impaired joint mobility,motor function,muscle performance,ROM associated with spinal disorders ā¢ Impaired joint mobility,motor function,muscle performance,ROM associated with fracture ā¢ Impaired joint mobility,motor function,muscle performance,ROM associated with joint arthroplasty ā¢ Impaired joint mobility,motor function,muscle performance,ROM associated with bony and soft tissue surgery ā¢ Impaired joint mobility,motor function,muscle performance,RMO,gait,locomotion and balance associated with amputation
- 68. Factors that influence a patients prognosis/expected outcomes ā¢ Complexity, severity, acuity of the patientās health condition ā¢ Patientās general health status and presence of comorbidities and risk factors ā¢ The patientās previous level of functioning or disability ā¢ The patientās living environment ā¢ Patientās and/or family goals ā¢ Patientās motivation and adherence and responses to prtvious interventions ā¢ Safety issuts and concerns ā¢ Extent of support (physical,emothional, social)
- 70. Independent learning activity ā¢ Critically analyze you own exercise history. Then identify how a regular regimen of exercise can improve your quality of life. ā¢ Research four health conditions(diseases, injuries or disorder s) that result in primary impairments of 1) musculoskeletal, 2) neuromuscular,3) cardiovascular or pulmonary,4) integumentary systems. Identify characteristic impairments (sight and systems) associated with each health condition and hypothesize what activity/functional limitations and participation restrictions are most likely to develop. ā¢ Using your current knowledge of examination procedures develop a list of specific tests and measures you would most likely choose to use when examining the patient whose primary impairments affect 1) musculoskeletal, 2) neuromuscular,3) cardiovascular or pulmonary,4) integumentary systems.