EXERCISE

THERAPY –
INTRODUCTION
DR. RISHITA KHURANA (PT)
1. Introduction to Exercise Therapy
Definition
Exercise therapy is the systematic and planned use of bodily movement or exercise to
prevent impairment, restore or improve function, maintain physical fitness, and
promote independence.
The exercise is selected according to the patient's:
 Condition
 Age
 Strength
 Mobility
 Pain
 Functional limitations
 Cardiovascular status
 Treatment goals
2. Aims of Exercise Therapy

A. Relief of Pain
 Exercise can help:
 Reduce pain
 Reduce muscle spasm
 Improve circulation
 Reduce stiffness
 Improve confidence in movement
Example: Gentle ROM exercises for a painful stiff joint.
B. Maintain and Improve Joint
Mobility
Exercise helps:
 Maintain available ROM
 Prevent stiffness
 Prevent contractures
 Restore lost movement
Example: Passive ROM after prolonged immobilization.
C. Improve Muscle Strength

Exercise is used to:

 Prevent muscle weakness
 Restore muscle strength after injury
 Improve muscle power
 Improve functional performance
Example: Quadriceps strengthening after knee surgery.
D. Improve Muscle Endurance

Endurance exercises allow muscles to work for a longer period without

excessive fatigue.
Example: Repeated walking or cycling.

E. Improve Cardiovascular and Respiratory Function

Exercise can improve:
 Cardiac efficiency
 Circulation
 Oxygen utilization
 Aerobic capacity
 Respiratory efficiency
F. Improve Balance and
Coordination
Exercise helps the patient:
 Maintain equilibrium
 Control posture
 Coordinate movements
 Perform skilled activities
Example: Balance training after stroke.
G. Improve Posture

Exercise can:
 Strengthen postural muscles
 Correct muscle imbalance
 Improve body alignment
 Develop postural awareness
H. Improve Functional Ability

The ultimate goal is often to improve activities such as:

 Rolling
 Sitting
 Standing
 Transfers
 Walking
 Stair climbing
 Activities of daily living (ADLs)
 This is particularly emphasized in functional re-education.
I. Prevent Complications

Exercise may help prevent:

 Joint contractures
 Muscle wasting
 Pressure-related complications
 Circulatory problems
 Loss of functional independence
3. Techniques / Types of
Exercise Therapy
Exercise therapy can be broadly classified according to the therapeutic objective.
1. Relaxation Exercises
 Used to reduce:
 Muscle tension
 Muscle spasm
 Anxiety
 Stress
Examples
 General relaxation
 Local relaxation
 Jacobson's relaxation
 Progressive muscle relaxation
 Mitchell's method
 Contrast method
2. Passive Exercises
 The movement is performed without active muscle contraction by the patient.
 The movement may be produced by:
 Physiotherapist
 Mechanical device
 External force

Examples
 Passive ROM
 Passive stretching
Uses
 Paralysis
 Severe weakness
 Unconsciousness
 Maintaining joint mobility
3. Active-Assisted Exercise

The patient performs the movement

but receives some assistance.
Assistance may come from:
 Therapist
 Healthy limb
 Pulley
 Another person
 Gravity-reduced position
Example: A patient with weak
shoulder muscles actively lifts the arm
while the therapist assists.
4. Active Free Exercise

The patient performs the movement independently without external

assistance or resistance.
Examples:
 Active knee extension
 Active shoulder elevation
 Ankle movements
5. Resisted Exercise
Resistance exercise is an exercise in which a muscle or muscle group contracts against an external
resistance to improve muscle strength, power, or endurance.

Resistance may be provided by:

 Therapist's hand
 Weights
 Resistance bands
 Machines
 Water
 Body weight
Purpose
 Mainly to improve:
 Muscle strength
 Power
 Endurance
6. Stretching Exercises

Stretching is a therapeutic exercise in which a muscle or soft tissue

is lengthened beyond its resting length to improve flexibility and
range of motion.

Used to improve:
 Muscle length
 Flexibility
 Joint ROM
 Soft-tissue extensibility
7. Strengthening Exercises

Muscle strength is the ability of a

muscle or muscle group to produce
maximum force against resistance
in a single effort.
 Example: The maximum force a
person can produce while lifting
or pushing a heavy weight once.
 Used to increase muscle force-
producing capacity.
8. Endurance Exercises

Definition: Endurance is the ability

of a muscle or the body to sustain
physical activity for a prolonged
period without excessive fatigue.

Designed to improve the ability to perform

activity for a longer duration.
Examples:
 Walking
 Cycling
 Swimming
 Step exercises
9. Balance Exercises
 Balance is the ability of a person to
maintain and control the position of Balance exercises are
the body within its base of support, used to improve:
both when the body is stationary
 Static balance
and when it is moving.
 Dynamic balance
Two types of balance:
  Postural control
Static balance – ability to maintain
a stable position while the body is Examples:
stationary.
 Single-leg standing
Example: Standing on one leg.
  Weight shifting
Dynamic balance – ability to
maintain stability while the body is  Reaching activities
moving or the base of support is
 Balance-board
changing.
Example: Walking, climbing stairs, activities
or reaching for an object.
10. Coordination Exercises

Used to improve:
 Timing
 Accuracy
 Smoothness
 Sequencing of movement
Examples:
 Frenkel's exercises
 Hand-to-target activities
 Reciprocal movements
11. Functional Re-education

 This teaches the patient to perform meaningful functional movements.

Examples:
 Lying → rolling → sitting → standing → walking

Other examples:
 Getting up from the floor
 Kneeling
 Crawling
 Transfers
 Stair climbing
4. Approach to the Patient's
Problem
Exercise therapy should not begin immediately without assessment.
The physiotherapist follows a systematic approach.
Step 1 – Patient History
Collect information about:
 Name, age and occupation
 Present complaint
 Onset and duration
 Mechanism of injury
 Pain
 Previous treatment
 Medical and surgical history
 Medication
 Functional limitations
 Lifestyle and activity level
Step 2 – Observation

Observe the patient for:

 Posture
 Body alignment
 Gait
 Swelling
 Deformity
 Muscle wasting
 Skin changes
 Breathing pattern
 General appearance
Step 3 – Assessment

Musculoskeletal Functional Status

 ROM
 Bed mobility
 Muscle strength
 Transfers
 Muscle tone
 Flexibility  Standing
 Joint stability  Walking
 Pain
 ADLs
Neurological
 Sensation
 Tone
 Reflexes
 Coordination
 Balance
 Motor control
Step 4 – Measurement of Vital
Parameters
 Vital signs should be assessed before, during when appropriate,
and after exercise, especially in patients with cardiopulmonary
disease, older adults, or those who are medically unstable.
The major parameters are:
 Temperature
 Pulse/heart rate
 Respiratory rate
 Blood pressure
 Oxygen saturation (SpO₂)
Measurement of Vital
Parameters
A. Body Temperature
Normal adult temperature
Approximately 36.5–37.5°C, although normal values vary with the person, site and time of measurement.
Common sites
 Oral
 Axillary
 Tympanic
 Temporal
 Rectal
Physiotherapy significance
 Temperature may be increased in:
 Fever
 Infection
 Inflammatory conditions
 If the patient has significant fever or is acutely unwell, vigorous exercise is generally postponed and the
medical status is considered.
B. Pulse / Heart Rate
Definition
Pulse is the rhythmic expansion of an artery produced by cardiac contraction.
Common site
Radial artery at the wrist.
Procedure
 Ask the patient to rest comfortably.
 Place index and middle fingers over the radial artery.
 Count the pulse.
 Usually count for 60 seconds for a resting assessment.
Record:
 Rate
 Rhythm
 Character
Exercise significance
 Heart rate generally increases with exercise.
 An unusually high, low, irregular, or inappropriate response may require modification or cessation of
exercise and further assessment.
C. Respiratory Rate

Definition
 Respiratory rate is the number of breaths taken per minute.
 Procedure
 Keep the patient relaxed.
 Observe chest or abdominal movement.
 One inspiration + one expiration = one breath.
 Count for 1 minute.
 Record:
 Rate
 Rhythm
 Depth
 Pattern
 Normal adult resting respiratory rate
 Approximately 12–20 breaths/minute.
D. Blood Pressure

Blood pressure is the pressure exerted by circulating blood against the

arterial walls.
It has two values:
Systolic BP
 Pressure during ventricular contraction.
Diastolic BP
 Pressure during ventricular relaxation.
It is recorded as:
 Systolic / Diastolic mmHg
Example:
 120/80 mmHg
E. Oxygen Saturation (SpO₂)

SpO₂ is an estimate of the percentage of hemoglobin carrying oxygen,

measured non-invasively using a pulse oximeter.
Procedure
 Place pulse oximeter on a suitable finger.
 Keep the hand relatively still.
 Wait for a stable reading.
 Record SpO₂ and pulse rate.
Normal value
 For most healthy people at sea level, approximately 95–100%.
 However, target values can differ in patients with chronic respiratory
disease, so the patient's prescribed/individual target should be followed.
Thank you