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Exercise Therapy
Karl G. Knopf, EdD
Third Edition
Course Textbook for SPECIALIST IN EXERCISE THERAPY
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 (Edition 3)
Official course text for: International Sports Sciences Association’s Specialist in Exercise Therapy 1rogram
10 9 8 7 6 5 4 3
Copyright © 2019 International Sports Sciences Association.
Published by the International Sports Sciences Association, Carpinteria, CA 93013.
All rights reserved. No part of this work may be reproduced or transmitted in any form or by any electronic, mechanical, or other means, now known
or hereafter invented, including xerography, photocopying, and recording, or in any information storage and retrieval system without the written
permission of the publisher.
Direct copyright, permissions, reproduction, and publishing inquiries to:
International Sports Sciences Association, 1015 Mark Avenue, Carpinteria, CA 93013
1.800.892.4772 • 1.805.745.8111 (local) • 1.805.745.8119 (fax)
Disclaimer of Warranty
This text is informational only. The data and information contained herein are based upon information from various published and unpublished
sources that represents training, health, and nutrition literature and practice summarized by the author and publisher. The publisher of this text
makes no warranties, expressed or implied, regarding the currency, completeness, or scientific accuracy of this information, nor does it warrant
the fitness of the information for any particular purpose. The information is not intended for use in connection with the sale of any product. Any
claims or presentations regarding any specific products or brand names are strictly the responsibility of the product owners or manufacturers.
This summary of information from unpublished sources, books, research journals, and articles is not intended to replace the advice or attention
of health care professionals. It is not intended to direct their behavior or replace their independent professional judgment. If you have a problem
or concern with your health, or before you embark on any health, fitness, or sports training programs, seek clearance and guidance 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
Parkinson’s Disease, 109
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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
Karvonen’s 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 you’ll 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
1
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
1
Chapter
1
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
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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
Disability—refers to the restriction of or inability to
perform normal activities of daily living.
•
Previous conditions
•
Deformities
Functional Limitations—are 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
DisABILITY—where the focus is on ability or differently labeled
Handicap—is 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 it’s origins after World War
II when injured British soldiers returned home
4
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, don’t 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
sources—what is correct today can change
tomorrow. Stay current!
When working with able-bodied clients, an incorrect move may not cripple a person—however
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.
5