Exercise

CHAPTER NINE Group Exercise



The value of group exercise 121

Considerations for group exercise 122

Design of the exercise programme 129

This chapter gives an overview of group exercise. It explains the points to consider when deciding whether a group exercise programme is suitable in relation to the patient, the physiotherapist and the available space. The chapter also discusses how to plan and set up an appropriate exercise programme for a group of patients.



THE VALUE OF GROUP EXERCISE


Group exercise is widely used by physiotherapists for a variety of reasons. It may be used for:


image people with a specific condition, for example a cardiac rehabilitation class for patients following myocardial infarction or for those with heart failure

image patients at a similar stage of rehabilitation such as a group of patients who are now able to weight bear fully following knee injury

image people who require a particular treatment approach, for example a group of people learning to manage chronic back pain whilst exercising.

There are many advantages to exercising in a group for both patients and the people taking the group. The transition into a group may mark an important step in the patient’s recovery and show that progress is being made. For these patients and those who start their rehabilitation in a group, there are both psychological and social benefits to exercising in a group such as the opportunity to mix with people who are in a similar situation to themselves, to share experiences and to offer mutual support and encouragement. These benefits may enhance the overall improvement that may be made by an individual patient during the rehabilitation process. Patients may also be more likely to attend for a group exercise class because of the social support offered by the other members of the group and the feeling of ‘letting the others down’ if they do not attend.


For the people taking the group, it is usually an enjoyable, rewarding experience. There is also the obvious benefit of treating several patients together; however patients should be treated in the group situation only if they will benefit from this type of treatment. Groups should not be used for purely economical reasons.



CONSIDERATIONS FOR GROUP EXERCISE


When planning to set up a group exercise class, considerations fall into three broad areas: the patient, the physiotherapist and the environment. Safety considerations encompass all of these.



The patient



Assessment


Some patients will join a class as their primary treatment intervention and others will transfer into the class after a period of individual treatment or even continue to have some individual treatments alongside their attendance at the class. Prior to joining an exercise class, an individual patient assessment should take place. The assessment should include consideration of whether the patient is suitable to join the class.


For a patient who has been receiving individual treatment, the stage of rehabilitation and ability must be appropriate for the exercise group that they will join. Relevant past medical history or co-morbidities which could make the group exercise class unsuitable for the patient may become apparent at the assessment. If a patient with chronic obstructive pulmonary disease who was to join a pulmonary rehabilitation class also had osteoarthritis in their right knee and used a walking aid, it would usually be possible to safely adapt the exercises in the class for the patient without disrupting the class for other individuals. However certain other co-morbidities such as cardiac disease may make it impossible or unsafe for the patient to exercise in a group environment.


The person running the class would need to be aware of the patient’s other relevant co-morbidities which may be affected by participating in the exercise class, for example diabetes or asthma, and should make sure that the patient has appropriate medication for the management of these conditions with them.


A full assessment also allows identification of appropriate outcome measures and baseline measurement so that the patient’s progress can be monitored and the correct intensity of exercise can be prescribed. Finally the assessment is an opportunity to explore whether the group exercise class is the appropriate environment for the patient to continue their rehabilitation.



Ability/suitability to join the group exercise class


Other factors that should be considered before placing a patient in a group exercise class include:


image Supervision. The patient moving into a group should be able to work effectively in a situation with less supervision than that which they would receive during an individual treatment.

image Physical ability. The patient should be fit enough to effectively participate in the exercise programme for the duration of the class. The patient’s ability to balance should allow them to participate safely in the class.

image Ability to work with others. The patient should have the ability to work with others and understand and carry out instructions.

image Functional ability. The patient’s functional ability should allow them to do any functional activities related to participating in the class, for example taking shoes and socks off. It may also be important for the patient to be able to get up and down from the floor independently depending on the type of class they are joining.

image Timing of exercise class. As group exercise classes take place at a regular time in the same place, it is important to consider whether the patient is able to attend the class regularly in terms of their other commitments.


Preparation to join the group exercise class


If the patient is moving from an individual treatment situation to a group exercise class, they should have this explained to them as early as possible in the rehabilitation process so that there is the opportunity to discuss any worries or queries. The transition to the group exercise class will be smoother if the patient is familiar with any equipment used in the class and if some of the exercises used in the class have been introduced into their individual rehabilitation programme. Any patient joining a group exercise class should ideally be introduced to the physiotherapist who takes the class and also have an opportunity to see some or all of the class, so that they are aware of how the class runs and what they will be required to do in the class.


The patient should be given a full explanation about the intensity at which they will be working and how they can monitor that intensity, the exercises that they will do and how to use any equipment involved safely. The patient should also be given an explanation about what to do if they experience any untoward symptoms in the class, such as a sudden onset of pain in a joint or muscle, severe breathlessness or dizziness.



Clothing


The patient must wear appropriate clothing and footwear for the type of class that they are going to participate in. A minimum requirement would usually be sports shoes and tracksuit bottoms with a T shirt. For a knee class, it would be preferable for the patient to wear shorts. Any items that the patient is wearing that could stop the patient exercising safely should be removed. Long hair should be tied back. People who are not used to exercising will need specific advice about this so that they wear appropriate dress.



The physiotherapist


The physiotherapist leading the exercise class is responsible for the patients in the class and anyone else who may be helping with the delivery of the class. They are responsible for making sure that the class starts on time, that any equipment to be used has been set up and that they have an appropriate set of exercises for the patients in the class. It is useful for the physiotherapist to know the names of the patients who are in the class so that if anyone starts to exercise in an unsafe manner the problem can be quickly addressed.



Other staff involved in the class


The physiotherapist may be taking the class alone or with the help of one or more physiotherapy or rehabilitation assistants or colleagues from other professions. There needs to be enough staff present to supervise the patients properly. For classes for patients with certain conditions there are guidelines in place for the recommended staff–patient ratio. The physiotherapist leading the class should be aware of these and adhere to them. The other staff involved in the class should be introduced to the patients in the class and an explanation given to the patients about their role. This means that the other staff involved in the exercise class need to be clear about their role. They may be involved in helping patients use certain pieces of equipment safely or giving extra guidance to patients so that they are able to monitor exercise intensity. Evaluating how a patient carries out the prescribed exercises, progressing the prescription and adapting exercises to make them easier for the patient to carry out should be the responsibility of the physiotherapist leading the class.



Presentation


The way in which the physiotherapist leading the class presents themself to the patients in the class is important. Presentation should be professional and also appropriate to the participants in the class. The way a physiotherapist addresses a group of children will be different from the approach that they take with a class of older people. It is important not to be ‘over casual‘ or too formal. Patients will be more likely to attend the class if the physiotherapist is enthusiastic in presenting the exercises. The physiotherapist should be dressed in a manner appropriate to the class in case they need to demonstrate an exercise to the group.



Voice


The physiotherapist must speak clearly when running an exercise class. If patients cannot hear what the physiotherapist is saying, there is the danger that they may carry out an exercise in an unsafe manner. The physiotherapist needs to be sure that all participants can hear them properly. Patients will hear best if the physiotherapist stands at their front or side. Instructions should be given in a firm, assertive manner.


The physiotherapist should use simple language in short sentences to instruct the class and avoid the use of jargon. For example, rather than ask a class to ‘extend’ their knee, it is much clearer for the patient if they are asked to ‘straighten their leg’.


Voice can be used to indicate to patients how they should move by varying speed and tone. If the physiotherapist wants to emphasize that an exercise is carried out slowly, they can slow the delivery of their instructions a little. If they want the patients to lift a limb, then the command ‘up’ at the end of the instruction can be given in a higher tone.

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Nov 7, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Exercise

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