Why Exercise?
- To improve or maintain physical well-being • Prepare for an upcoming athletic event
- Build up cardiovascular fitness
- To relieve anxiety
- Build up muscular strength/muscular endurance • Slim down/weight loss
- Social interactions with others
Classes: Advantages
- Economic
- Cheaper
- More people at once
- Socialisation
- Mutual support
- Encourages adherence to exercises
- Encourages a wellness approach to health
- Greater self locus of control
Classes: Disadvantages
- Quality control
- Individual needs may not be met
- Groups dynamics – negative at times
- Management of difficult members
- Requires space
Common clinical areas for classes
• Cardiovascular • Balance • Falls Prevention • Obstetrics • Obesity • Chronic Diseases • Health Ageing • Work Re-training • Sports Readiness • Stroke / ABI Chronic pain Osteoporosis Respiratory Children with movement difficulties Pre-/Post-Surgery Cardiac Rehab
DESIGN OF AN EXERCISE CLASS
- Physiotherapist well situated to be flexible in design and application:
- Ongoing observational assessment
- Clinical reasoning
- Pathology specific knowledge
- Body mechanics knowledge
Elements to consider
- Objectives and aims of class
- Group size
- Selection of patients:
- Pathology, movement, functional goal • ….what is the commonality?
- Assessment of class effectiveness
- Monitoring
- Mechanisms for individuals during / before / after
- Risk management
- Safety considerations
- Environmental needs – open vs closed environment/surfaces
DESIGN OF AN EXERCISE CLASS
Consider objectives / goals of class: • Functional • Weight loss • Balance / ↓Falls • Muscular Strength • Coordination • Socialisation/wellness? Objectives/goals influence: • Patient/client number and homogeneity within the group • Environmental needs • Recruitment strategies • Influence planning or structure and content
Group size
- Influenced by type of class (goal)
- Environmental constraints
- Risk management issues (safety)
- Seriou sproblems canarise!
- Quality vs economy
Selection of Patients
- Pre-screening process and needs
- Appropriate patients
- Criteria set for inclusion / exclusion
- Will they fit into the class (goals meet)
- Safe to complete exercise using ESSA pre- exercise screening questionnaire?
- Must know:
- Medical history
- Contra-indications for involvement
- Pre-class testing
- Agreed upon(shared planning)
Monitoring: Ongoing basis
Monitoring: Ongoing basis
• Consider the individual prior to enrolling in group • Functional level – subgroups?
- monitor within class so is effective for everyone
• Ongoing (individual) monitoring during class • Current intensity
• Progress/regress exercise
• Rest breaks
• Individual feedback/correction in a timely manner • Ensure session is inclusive
• Document EVERYTHING!
Establish a baseline to measure improvements
• Outcome measures
• Baseline / status of client/patient
• Increase compliance – act as motivational tool, competition
• Considerations when selecting an outcome measure
• Valid, reliable, repeatable – how can you optimise this if you were
running a group?
• Testing targeted impairments, function, participation – that you anticipate will change in response to class
DESIGN OF AN EXERCISE CLASS
Monitor class outcomes in relation to the goal and value for money – balancing economics vs optimal clinicial outcomes
• Need to consider:
• Cost effectiveness vs. clinical effectiveness • Effectiveness of program as a whole
Risk assessment - Safety
Identify sources of potential risk: • Environment • Equipment • Exercises • Patients • Falls
Setting up the environment
Can everyone see/have access to leader when needed?
Is the environment safe? – obstacles, support Is there enough space?
Is the equipment at hand?
Equipment in good repair?
Can everyone hear you?
Music?
Warm/cool enough? – temperature of room/pool….?
Workstation/Circuit classes
Need to design each ‘Work area’
Definition:
Where exercises of functional motor tasks, components of functional tasks or impairments are carried out/practised
Purpose:
To address the specific problems of each patient / to manage deficits in:
◦ Balance & mobility
◦ Upper limb function
◦ Bed mobility / transfers ◦ Wheelchair ambulation ◦ Cardiorespiratory health ◦ Pain
Steps required to deliver a workstation model group class:
- Individual assessment to establish individual deficits
- Outcome measures that reflect impairments and functional motor ability / participation
- Diversity yet flexible work station set up
◦ Balance/mobility/upper limb function
◦ Tailored to meet specific identified problems of participant - Weekly monitoring of client post previous session, during week, illness, falls etc.
- Graded tasks in each station
• Regression and/or progression options? - Foster active participation / self management • Transference to home / community setting • Home Exercise program
• Self monitoring of results/performance - Re-assess at conclusion of program for • Success
• Ongoing functional needs
Principles for Physiotherapists in work station model delivery
Use clear instruction sheets with pictures and recording mechanisms - individual for each patient
The Physiotherapist acts a coach, trainer, assists, supervises or consults with more able participants
• Physiotherapist must train each participant for each station
• Provide strategies to solve everyday functional problems to transfer to home environment
• Challenging but SAFE
• Move participants through stations / circuit
• Modify / progress – aim for success and safety
Each work station should provide:
Active participation by patients / clients of all levels of ability to carry-out tasks
Potential for graded tasks or variable levels for independent client self set-up, at individual levels
Benefits of work station model of service delivery
Increase intensity/duration of rehabilitation (Carr & Shepherd 2003) Cost effective as no increase in delivery costs
Group dynamics influence participation in program
(Ada et al 1999, Williams et al 2009)
◦ Improved participation and compliance to therapy session ◦ Enhanced motivation
Effects of attention focus, self-control and group training on motor learning Improvement in non physical symptoms e.g. fatigue (Williams et al 2009)
Benefits of traditional group exercise classes:
Can be safer
◦ Less able group
Improved group dynamics / competition / self reflection compared to peers
Group of similar level clients
No need for individualized instructions
Less active / independent participation needed
Disadvantages of traditional group exercise classes:
- Increased equipment needs – costs
* Less targeted / less challenging for participants • Less active / independent participation needed
Principles for Physiotherapists in traditional class delivery model Establish goals of the class
Follow same principles for establishment as for workstation / circuits
◦ Assess / Re-assess
◦ Optimise individualisation where possible
◦ Consider appropriateness of participant in line with the goals of the class
◦ Foster transference of tasks into everyday life (education, provision of home exercise programs)
Getting the ‘balance’ right
- Make it fun
- Use technology
- Age/culture specific • Educate on benefits • Foster transference
