Exercise program

design for special

population
ALAGAPPAN THIYAGARAJAN
ORTHOPAEDIC AND SPORTS PHYSIOTHERAPIST
Who are special population?
 Cardiovascular – Myocardial infarction, angina, peripheral vascular disease, congestive heart
failure, revascularization, heart valve disorders, and/or conduction disorders.
Pulmonary – Chronic obstructive pulmonary disorder, chronic restrictive pulmonary disorder,
pulmonary hypertension, and/or asthma.
Metabolic – Diabetes (Type I and II), overweight/obesity, pre-diabetes, metabolic syndrome,
thyroid disorders, and/or end-stage renal disease.
Immunological – AIDS/HIV, fibromyalgia, chronic fatigue syndrome, anaemia, autoimmune
disorders (e.g., lupus, rheumatoid arthritis), and/or blood clotting disorders.
Musculoskeletal – Osteoporosis, limb amputations, osteoarthritis, lower back conditions, frailty,
joint disorders, joint replacements, sarcopenia, posture disorders, and cystic fibrosis.
Neuromuscular – Stroke, brain injury, spinal cord disorders, multiple sclerosis, cerebral palsy,
Down’s syndrome, Parkinson’s disease, epilepsy, balance disorders, and muscular dystrophy.
Cancer – Multiple body systems affected.
Psychological/behavioral – Disordered eating, body image disorders, depression, and chemical
dependency. Special populations also include those groups of people with unique traits that are not
necessarily afflicted by a chronic or temporary health condition.
 Females that are pregnant, postpartum and menopausal.
 Older adults.
 Children and adolescents with specific exercise prescription needs
What determines exercise program
design
 24 years old male with no co morbid, has problem on l5-s1 disc
pathology, whats your exercise program design ?
 74 years old female with recently diagnosed parkinsonism, has
history of DM,HT,Heart disease, what your home care exercise plan?
 A 6 years old female, has diagnosed with costochondirtis whats your
program design?
 A 24 years old football athlete with post acl reconstruction with 6
weeks old wants to do skill specific program, whats your plan?
 60 years old sedentary male admitted in hospital followed by post
hernia repair, the general consultant refers chest physiotherapy
what's your treatment plan?
Theory behind exercise prescription
 FITT (frequency,intensity,type,time)principle
 SAID("Specific Adaptation to Imposed Demands.“) principle
 Overload ,specificity, Adaptation,Recovery,Reversibility, indiduvality
principle(sports practice)
 Look for where you patient physical activity stages of Precontemplation,
contemplation, Preparation,action, Maintenance
 The Five-A's Model to Facilitate Behavioural Changes of Patients in the
Context of Promoting Physical
Activity.(assess,advice,agree,assist,advice)
 Consider implementing health and skill related fitness on your
prescription
 Use theories like learning, and periodization on to your prescription
 Depend on varieties of protocol, get knowledge with patient set point
For patients who need special
considerations, keep the following in
mind:
 The program should begin with low-to-moderate intensity and then
progress gradually.
 The nature of the program depends on the current health status and
physical condition of the client, as well as any other factors identified in
the interviewing or screening process.
 To cater to the needs of clients with chronic illnesses or who require
special considerations, be sure to acquire the necessary education and
skills.
 Maintain close communication with the patients primary healthcare
provider, as well as obtain and adhere to his or her recommendations
and guidelines for programming.
 When providing information to a patients healthcare provider, utilize
SOAP notes for documentation of client encounters, health status, and
progress.
 Plan according to patient needs, always work on progression
Hindrance to our plans of
prescription
 The team work in clinical set up
 Other related professionals(eg- yoga, fitness guru, new varieties of
training)
 Lack of planning by the physiotherapist
 Patients who feel always they are right ,therapist is wrong
 Passive bound therapy application (pain management)
 Sticking to one monotonous protocol and the owner and his team
mates
 Relaying on new techniques both on active and passive application
What evidence says

 There are lot of documents related to your patients requrirement

 Depend on books
 Implement your past experiences
 Seek for evidence
 Follow the patient requirement with a tailored made protocol
Recommended readings

 Paul chek program design

 American council on exercise- medical exercise specialist /health
fitness
 Thank you