Introduction

For most adults, an exercise program including aerobic, resistance , flexibility,

and neuromotor exercise training is indispensable to improve and maintain
physical fitness and health. An exercise training program ideally is designed
to meet individual health and physical fitness goals within the context of
individual health status, function, and the respective physical and social
environment[1]. Physical activity  and fitness are associated with a lower
prevalence of chronic diseases, such as heart disease, cancer, high blood
pressure , and diabetes.[2]

Therapeutic exercise  is one of the core skills upon which the profession of
physiotherapy is based. By considering definitions of therapeutic exercise,
physical activity, and exercise, it is possible to see that, although therapeutic
exercise contains the components of both physical activity and exercise, it also
provides a systematic exercise programme for remediation of impairments
and improvement of function [3].

What is the difference between physical activity and exercise? Physical activity
refers to the contraction of skeletal muscle that produces bodily movement
and requires energy. Exercise is a 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 [4].

Designing a therapeutic exercise programme

A programme may include a range of different types of exercise such as those
for improving or preventing deterioration in aerobic capacity, muscle
strength, power and endurance, flexibility or range of movement, balance,
coordination, and agility.

 Many different professionals are involved in delivering advice on physical

activity and exercise to various population groups, We, as
Physiotherapists, are equipped with special skills to provide therapeutic
exercise programmes. We have an understanding of the underlying disease
process or pathology, exercise physiology, biomechanics, and physical
principles.
 Physiotherapists need to identify appropriate treatment goals in
conjunction with the patient [5].
In general, all exercise training and sport sessions should

1. Start with a 10–15-min dynamic warm-up period

2. Follow with 20–60 min of exercise training
3. Finish with a 10-min cool-down period with less intensive activities and
stretching.
Between the training sessions, there must be enough time to recover.

Common training principles

Overload A system must be exercised at a level beyond which it is presently

accustomed for a training effect to occur. The system being exercised will
gradually adapt to the overload or training stimulus being applied, and this
will go on happening as long as the training stimulus continues to be
increased until the tissue can no longer adapt. The training stimulus applied
consists of different variables such as intensity, duration, and frequency of
exercise. It is important to give the system being exercised enough time to
recover and only apply a training stimulus again when the system is no longer
fatigued[5].

Specificity Any exercise will train a system for the particular task being
carried out as the training stimulus. Examples below:

 A training programme including muscle strengthening will train the

muscle in the range that it is working and the way that the muscle is being
used, i.e. isometrically, concentrically, or eccentrically. It is important that
any exercise to strengthen muscle targets the muscle range and type of
muscle work specific to the task required.
 Riding a bicycle requires concentric knee extension from mid-to inner
range, as the pedal is pushed down to propel the bicycle along. cyclist
wishing to increase the strength of his quadriceps will need to train
concentrically in mid-to inner range. Depending on the presenting
problem, the required task should become part of the training programme
at an appropriate stage [5].
Reversibility The beneficial effects of training begin to be lost as soon as
training stops. This happens in a similar time frame as it takes to train the
system [5].

Individuality Variation in response to a training programme will occur in a

population as people respond differently to the same training programme.
This response can be explained by: the initial fitness level of the individual;
their health status; and their genetic makeup. Training programmes should be
designed to take this into account.
 Some individuals will have a predisposition to endurance training and
some to strength training.
 Some will respond well to a training programme and others much more
slowly.
 Individuals with a lower fitness level before starting an exercise
programme show improvement in fitness more quickly than those who are
relatively fit before training begins.
 Some individuals with health conditions may not be able to work at the
same kind of intensity as a healthy individual and so will take longer to
achieve a training goal [5].
Motor learning Motor learning is concerned with the acquisition of motor
skills and how the individual interacts with the task to be learned and the
environment. This uses perception or sensing, cognition, and motor
processes. Learning a skill is a relatively permanent change in an individual
and there are several stages that the person will go through before the skill is
retained.

1. Initially, a person may be unable to perform a task. With practice, they

will achieve the task but it will not be carried out efficiently.
2. With further practice and feedback, the person will be able to carry out
the task to a reasonable standard but they may forget how to do it if
they do not do the task regularly.
3. In the final stage, the person will carry out the task efficiently, in a
skilled manner and will not forget how to do the task.
When teaching a patient an exercise

 Explain or demonstrate how to carry out the exercise, doing this as a whole
if the exercise is simple or breaking a complex exercise into parts.
 When the person is able to carry out the component parts, the exercise
should be practiced as a whole.
 Both the physiotherapist and the person should evaluate how well the
exercise was performed and if the exercise task was completed.
 The physiotherapist should allow the patient a short time to evaluate their
own performance, before providing feedback prior to subsequent practice.
 Practicing a skill (or exercise) in a varied manner, for example at different
speeds or in different environments, will help with learning [5].
Safety Whenever an individual exercise, there is a risk that they may injure
themselves. Safety factors are considered here in relation to the
physiotherapist. the environment and the patient or person carrying alit the
exercise [5].
Basic Exercise Principles

Practicing the basic exercise principles is crucial for developing an effective

fitness training program. The principles of exercise apply to everyone at all
levels of physical training, from the Olympic champion to the weekend golfer.
You can easily remember the basic principles of exercise if you use the so-
called FITT factors, where FITT stands

1. Frequency,
2. Intensity,
3. Time, and
4. Type of activity. [6]
The video below summerizes FITT Principle (ACSM recommends to use the
FITT method[7])

[8]

Frequency (how often): Exercise should be carried out 3-5 days a

week.

Training three times a week produces significant training effects; however,

training 5 days a week at a lower-intensity exercise may be more manageable
for some people. Little additional benefit is seen with more than five training
sessions a week, and the risk of injury is increased. Training twice a week does
not produce increases in VO 2max; however, it may produce some functional
changes and it is probably better than no exercise at all [5]. Moderate-
intensity aerobic exercise done at least 5 d ∙ wk or vigorous-intensity aerobic
exercise done at least 3 d ∙ wk or a weekly combination of 3–5 d ∙ wk of
moderate and vigorous-intensity exercise is recommended for most adults to
achieve and maintain health/fitness benefits [7].

Intensity (how hard)

Intensity can vary between light, moderate and vigorous intensity activities.
For example, walking slowly is a low intensity activity, walking briskly or
shooting around a basketball is a moderate intensity activity and running
(>5mph) is a vigorous intensity activity. A good rule of thumb is that a person
doing moderate-intensity aerobic activity can talk, but not sing. A person
doing vigorous-intensity activity cannot say more than a few words without
pausing for a breath [9].

Intensity can be monitored by heart rate in most patients, although some

patients may have pathology or be on drug treatment that affects their HR
response to exercise (in which case HR cannot be used to monitor exercise
intensity). The short video below shows hart rate calculation

[10]

Measures of perceived effort and affective valence (i.e.the pleasantness of

exercise) can be used to modulate or refine the prescribed exercise intensity.
eg Borg Rating of  Perceived Exertion  (RPE) Scales, Talk Test [7].

Time (duration or how long)

A total of 20-60 minutes of continuous or intermittent aerobic activity a day

should be performed. The activity can be divided into a minimum of lO-
minute bouts throughout the day. The duration of training is dependent on
intensity. Individuals starting at the lower end of the training band need to
sustain exercise longer (30-60 minutes) to achieve training effects [5].

Type

Refers to the sort of activity to complete eg Aerobic activities like walking,

jogging, biking, swimming or dancing or strengthening activities such as
exercises using exercise bands, weight machines or hand-held weights.

Putting it together
150 minutes of moderate to vigorous physical activity is recommended each
week. For some, a serious behavior change is needed and for others, a
modification to current behaviors is more appropriate. When adopting or
modifying a physical activity routine, it is important to set realistic goals. Too
often, individuals expect to lose unrealistic amounts of weight, run faster and
longer and start seeing drastic body composition changes instantly. Instead,
use the acronym S.M.A.R.T.

 Specific is the what, where and how of the goal.

 Measurable is how you will evaluate whether or not you met the goal.
 Achievable is setting a goal that you can accomplish.
 Realistic is setting a goal that is challenging, but attainable.
 Timely relates to when you want to achieve your goal by, and what time
frame you have to reach your goal.
Putting the FITT principle together, one can effectively plan an exercise
routine and set a S.M.A.R.T. goal