Exercise Therapy

INTRODUCTION

Exercise Therapy

Karl Knopf, EdD

With contributions by:
Barbara McCarthy
Joan Worley
Content Editors:
Steve & Kim Downs
Lori McCormick
Mary Ann Wilson
Patricia Davoren
Editor and Typists:
Anna Billings
Toni Di Vittorio

Exercise Therapy (Third Edition)

Official course text for International Sports Sciences
Associations Specialist in Exercise Therapy program
10 9 8 7 6 5 4 3 2 1
Copyright 2013 International Sports Sciences Association. All
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DISCLAIMER OF WARRANTY
This study guide is informational only. The data and information
contained herein are based upon information from various published as well as unpublished sources and merely represents training,
health and nutrition literature and practice as summarized by the
authors and editors. The publisher of this study guide makes no
warranties, expressed or implied, regarding the currency, completeness or scientific accuracy of this information, nor does it warrant
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intended to direct their behavior or replace their independent professional judgement. If you have a problem with your health, or
before you embark on any health, fitness or sports training programs, seek clearance from a qualified health care professional.

Exercise Therapy

TABLE OF CONTENTS

Part 1
Fundamentals of Exercise Therapy

Part 2
Health Conditions

Part 3
Adaptive Programming

Part 4
Exercise Therapy Support Materials

iii

Exercise Therapy

TABLE OF CONTENTS
TABLE OF CONTENTS
PART 1: Fundamentals of Exercise Therapy
1. Therapeutic Exercise, 2
History, 3

2. Understanding the Disabled, 6

Evolution of Adaptive Physical Education for Adults with Disabilities, 7
Changing Attitudes Towards Disabled Persons, 8
Role of Exercise for the Disabled, 11

3. Exercise as Therapy, 12
Proper Exercise Is Therapeutic, 13
Designed for Action, 14
Fitness as Medicine, 17
Use It or Lose It, 17
Exercise and Disease, 19

4. Functional Fitness, 20
Summary, 23

5. Fundamentals of Exercise Therapy, 24

Benefits of Exercise Therapy Programs, 25
Designing an Exercise Therapy Program, 26
Exercise Participation Flowchart, 30
Fundamental Terminology for the Specialist in Exercise Therapy, 31
Proper Body Mechanics for the Instructor, 32
Effective Teaching Considerations, 34
Effective Communication Skills, 38

6. Muscles and Movement, 42

Anatomy for the Exercise Therapy Educator, 43
Exercise Therapy Kinesiology, 48
How Muscles Work Together, 59

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Exercise Therapy

TABLE OF CONTENTS
7. Contraindicated Exercises, 62
Doing It Right, 63
Facts and Myths about Exercise, 63
Risks vs. Benefits, 64
Beyond the Core, 65
Exercises to Avoid, 68
Exercise Therapy Exercise Considerations, 71

PART 2: Exercise Therapy for Chronic Conditions, 73

8. Overview of Chronic Conditions, 74
Exercise Is for Everyone, 75
Common Physical Health Problems Seen Among Older Adults, 76
Thoughts to Share with Clients, 77

9. Cardiorespiratory Conditions, 80
High Blood Pressure, 81
Low Blood Pressure, 82
Heart Disease, 82
Chronic Obstructive Pulmonary Disease, 83
Asthma, 86

10. Metabolic Conditions, 88

Diabetes, 89
Obesity, 91

11. Neurological Conditions, 94

Acquired Brain Injury, 95
Cerebral Vascular Accident, 96
Epilepsy, 100
Peripheral Vascular Disease, 103
Spinal Cord Injury, 104
Learning Disabilities, 106
Multiple Sclerosis, 107
Parkinsons Disease, 109

Exercise Therapy

TABLE OF CONTENTS
12. Orthopedic Conditions, 110
Arthritis, 111
Fibromyalgia Syndrome, 114
Neck Problems, 115
Low Back Problems, 116
Shoulder Problems, 118
Hip Problems, 120
Knee Problems, 120
Ankle Problems, 121
Osteoporosis, 122
Amputations, 123

13. Sensory Impairments, 126

Auditory Disorders, 127
Visual Impairments, 127

14. Other Health Conditions 130

HIV/AIDS, 131
Cancer, 132
Pregnancy, 133

PART 3: Adaptive Programming

15. Programming for Ambulation, 136
Transfers and Ambulation Aids, 137
Progressive Mobilization, 142
Ambulation Aids, 143
Gait Training, 147

16. Programming for Aquatics, 154

Water Exercise for Special Population, 155
Fitness Aquatics: Hydrogymnastics, 157
Assessment of Aquatic Skills, 159

17. Programming for Balance and Perceptual Motor Skills, 166

Balance Progressions, 169
Perceptual Motor Skills, 172
Fine Motor Tasks, 173

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Exercise Therapy

TABLE OF CONTENTS
18. Programming for Cardiovascular Fitness, 176
Cardiovascular Exercises, 177
Karvonens Formulas, 179
How to Take a Pulse, 180
Determining Target Heart Rate, 181

19. Programming for Flexibility and Range of Motion, 182

Flexibility, 183
Range of Motion, 183
Programming for Flexibility, 184
Range-of-Motion Exercises, 186
Active Range of Motion Worksheet, 189

20. Program for Muscular Strength and Endurance, 190

General Progressive Resistance Guidelines, 191
Strength Training, 191
Terminology, 192
General Guidelines for Adaptive Weight Training, 196
Sample Strength Training Program and Exercises, 198

21. Programming for Posture, 206

Assessment of Posture, 207
Procedures for Spinal Screening, 210
Posture Exercises, 211

PART 4: Exercise Therapy Support Materials

Appendix, 215
Abbreviations, 217
Support Materials, 218
Forms, 221
Glossary, 231
Index, 251

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Exercise Therapy

FROM THE AUTHOR

This edition of Exercise Therapy is designed for personal trainers, adaptive

fitness instructors, club owners and physical therapy aides. The material contained within this book is the result of twenty-five years of working with this
population. This new and improved book has been modified from previous
editions of Adapted Exercises for the Disabled Adult, co-authored with Dr.
Lasko, to better meet the needs of Specialists in Exercise Therapy.
The goal of this book is to provide you with practical information in a
straight-forth style. All the material was written to best reflect the most
current theories regarding exercise therapy. The book is organized in a
manner to take the reader through the logical sequence needed to develop a
therapeutic program.
As you enter the profession, I hope you will find the fulfillment and satisfaction that this career has provided me. I trust that this profession of serving
the under-served members of our society brings you the same rewards.
Lastly, go out and find a profession that you enjoy and youll never work a
day in your life.

Love what you do and

do what you love.

Therapeutic
Exercise
Sports Medicine

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THERAPEUTIC EXERCISE

UNDERSTANDING THE DISABLED

Evolution of Exercise Therapy Education

for Adults with Disabilities
Changing Attitudes Towards Disabled Persons
Role of Exercise for the Disabled

EXERCISE AS THERAPY
Proper Exercise Is Therapeutic
Designed for Action
Fitness as Medicine
Use It or Lose It
Exercise and Disease

FUNCTIONAL FITNESS
FUNDAMENTALS OF EXERCISE THERAPY
Benefits of Exercise Therapy Program
Designing an Exercise Therapy Program
Proper Body Mechanics for the Instructor
Effective Teaching Considerations
Effective Communication Skills

MUSCLES AND MOVEMENT

Anatomy for the Exercise Therapy Educator
Exercise Therapy Kinesiology
How Muscles Work Together

CONTRAINDICATED EXERCISES
Risks vs. Benefits
Facts and Myths About Exercise
Common Questions
Exercises to Avoid
Exercise Therapy Exercise Considerations

Fundamentals of
Exercise Therapy

Chapter

THERAPEUTIC EXERCISE

To p i c s c o v e r e d i n t h i s c h a p t e r
HISTORY

Therapeutic Exercise

CHAPTER 1
HISTORY
Therapeutic exercise is motion of the body or its
parts to relieve symptoms and improve function.
The roots of therapeutic exercise goes back to
ancient times, whether it was Cong Fou who prescribed particular postures and breathing exercises
for the priests for the relief pain or Hippocrates
(460 B.C.) who recognized the value in strengthening weak muscles to hasten convalescence and
improve mental outlook.

restore an athlete to peak performance. The application of therapeutic exercise will vary in its purpose
based on the goals of the client. In order for the
client to obtain the best outcomes it is essential that
before an exercise program is designed the client
should receive a comprehensive assessment. An
exercise program designed without a competent
medical evaluation may not only be inadequate but
detrimental to the client.

Before World War II physical therapy generally consisted of heat, massage or electricity. If exercise was
prescribed, it was only referred to in a vague
manner. During WWII, many VA Hospitals
employed physical medicine physicians to employ
corrective exercise to rehabilitate injured soldiers.
This was the advent of pro-active treatments
opposed to the passive days of a therapist working
on or doing for the client.

After an assessment by a trained medical professional, the next step is to establish goals and appropriate treatment plans. The treatment plan should be
designed based on clients goals, medical professionals
realistic expectations along with the following:

We now know that a properly designed exercise program can have a positive impact on the outcome of
most conditions.
Therapeutic exercise can vary from very specific
selected activities designed for particular muscle or
condition, to general and vigorous movements to

Functional limitations

Prognosis of condition

Psychological status

Socioeconomic support

Cultural reactions and expectations

Physical and emotional environment

Client/employers vocational plans

Ethical choices

Therapeutic Exercise

CHAPTER 1
from the front lines and were given a cap to hold
in their hand to beg. Thus the word handicapped is
a word and a mind set that we want to eliminate.
The role of a therapeutic exercise program should
include the prevention of further dysfunction and
should thrive to foster improvement, restoration or
even maintenance of:

Muscular strength and endurance

Cardiovascular and cardio respiratory

fitness

Mobility, flexibility and range of motion

Balance and stability

Coordination

Functional skills

Activities of daily living

When designing a comprehensive program consider:

While in everyday conversations the words disability, handicap, and functional limitation are used
interchangeably. However, for the purpose of this
text lets define some terms.

Goals and kinds of exercises

Safety and appropriateness

Clients age

Disabilityrefers to the restriction of or inability to

perform normal activities of daily living.

Previous conditions

Deformities

Functional Limitationsare disabilities that are not

as truly disabling yet become symptomatic when
performing a specific activity. The term functional
limitation may be more useful than the word disability because it is more descriptive and less
imposing. Thus the focus is on ability rather than
disability. Your role as Specialist in Exercise Therapy
is to minimize the Dis in disability.

Potential risks

DisABILITYwhere the focus is on ability or differently labeled

Handicapis a social disadvantage that results from
an impairment/disability that prevents a person
from engaging in a vocationally, socially and physically normal life.
The word handicap had its origins after World War
II when injured British soldiers returned home

When working in the field of exercise therapy, it is

critical that the practitioner be at the top of the
profession. There is no place in exercise therapy
for people who are well intentioned yet ill-prepared. The Specialist in Exercise Therapy must
rely on sound scientific knowledge rather than
antidotal information. If you plan to operate in
the shadows of the profession, then exercise
therapy is not where you belong. A Specialist in
Exercise Therapy must know proper biomechanics, safe movement, sound nutrition, up-todate exercise science and most importantly adhere
to a strong code of ethics. No one is more vulnerable than someone who desires to be healthy
again. The client will believe in you, dont betray
their trust in you by selling misinformation.

Therapeutic Exercise

CHAPTER 1
Most importantly, the exercise therapy arena is not
a place where a fake it until you make it practice
has any place. If you have any questions or concerns
err on the side of caution and refer out. Your client
will appreciate it and your credibility will increase
within the medical community. Always check your
sourceswhat is correct today can change
tomorrow. Stay current!
When working with able-bodied clients, an incorrect move may not cripple a personhowever
with a client who has entrusted you with their
recovery, a mistake can have serious ramifications.

Train your client in a smart not hard fashion.

Remind them to be patient, it took their body a long
time to get into the shape they are in and it will take
a while to get it to where they want it to be.
Remember, haste makes waste. They may have spent
a great deal of time and money to have the doctor
and therapist fix them; you as the fitness professional do not want to be responsible for undoing all
they have done.