Exercise: special health needs (FS-11)

ICCrPT: Exercise training/rehabilitation for people with special health needs

Shane Patman (Australia), Cathy Evans (Canada), Natascha Plani (South Africa), Sumio Yamada (Japan)

Focused symposium

Sunday 3 May 2015, 10:45-12:15, Hall 405

ICCrPT: Exercise training/rehabilitation for people with special health needs

Patman S. 1, Evans C. 2, Plani N. 3, Yamada S. 4

1University of Notre Dame Australia, School of Physiotherapy, Fremantle, Australia, 2University of Toronto, Department of Physical Therapy, Toronto, Canada, 3Sklaar, Laidler and Associates Physiotherapy, Johannesburg, South Africa, 4Nagoya University, Graduate School of Medicine (Health Sciences), Nagoya, Japan

Learning objectives

  1. To update participants on contemporary evidence-based guidelines or recommendations for Exercise Prescription for people with Special Health Needs including those with obesity, cardiovascular dysfunction, and patients following (or during) critical illness
  2. For participants to learn ways to deliver these exercise programs to maximise the clinical benefits from available resources

Description

To prescribe exercise in the context of chronic conditions or special health needs, one needs to consider how the physiology of exercise training interacts with both the pathophysiology and medical management of the patient´s underlying condition. For example, a recent study demonstrated systemic muscle weakness in patients following cardiovascular surgery related to skeletal muscle proteolysis by showing 24-hour urinary excretion of 3-methylhistidine, an established marker of muscle proteolysis, during five days after surgery. This research and other evidence is challenging our previous understanding of skeletal muscle weakness after surgery as the results of mere deconditioning to being caused by inflammation or accelerated catabolism due to surgery. It was also found that this change in skeletal muscle weakness could be inhibited by electrical muscle stimulation in the immediate postsurgical period.

Obesity and its associated health consequences are an epidemic according to WHO and steadily becoming more prevalent in developing countries. Recent publications conclude that physical therapists, as direct access practitioners or members of multidisciplinary teams, should play a role in the health care of people with obesity and overweight. Physical therapists recognize the value of lifestyle-change strategies to supplement their key message of increased physical activity and exercise. Physical therapists have traditionally been considered key team members in pulmonary and cardiac rehabilitation but their unique roles are less well defined in relation to associated conditions such as obesity and overweight management.

Another unique patient population are those who have had episodes of critical illness, which impacts their long-term outcomes. These patients exhibit limited early activity which is carried over into the medium and long term, resulting in severe persistent limitations in upper and lower extremity strength, motor and sensory deficits difficulty with walking and activities of daily living, neuropsychological dysfunction and long term cognitive impairments, It leads to profound and persistent deterioration of physical function and quality of life and major disability . Research demonstrates that graded exercise, started early during the course of critical illness can significantly alter long term outcomes.

This symposium will explore the evidence underlying the current best practice recommendations for exercise training/ rehabilitation for people with special health needs such as those with chronic conditions (such as renal failure, cardiac dysfunction, pulmonary disease), obesity, or those impacted by critical illness (e.g. what we know about the baseline characteristics of these patient groups and how the evidence guides us toward the recommendations for type, frequency, intensity and duration of exercise training). This symposium will also incorporate an exercise physiology approach examining which energy systems could be utilised to explore the prescriptive elements.

Prescribing exercise in an economically sound way to improve health regardless of the resources within countries will be considered.

Implications / Conclusions

Exercise training is the foundation of physical therapy and is integral to the physical, metabolic, emotional, and spiritual robustness of people with special health needs and those recovering from critical illness . It is imperative in an era of ageing populations with increasing prevalence of chronic conditions that physical therapists are equipped with contemporary evidence-based knowledge to optimise the effectiveness of exercise prescription in those with special health needs, in a safe but meaningful manner, understanding the underlying physiological processes.

Keywords

Exercise; Rehabilitation; Cardiorespiratory

Funding acknowledgements

None

Relevance to WCPT and expected audience

Exercise is the foundation of physical therapy. Ageing populations, increasing chronic conditions and co-morbidities, and increasing prevalence of obesity and overweight in the population necessitate that physical therapists revisit and modify their foundations to ensure their physical activity and exercise prescription is effective in clients with complex special health care needs.

Target audience

Physical therapists managing clients with special health needs, particularly those with chronic conditions (renal, cardiac or pulmonary dysfunction), obesity, or those impacted by critical illness.