Therapeutic Exercise Principles
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Direct answer
How often, how hard, how long and what type — the FITT principle converts any clinical goal into an exercise prescription, and therapeutic exercise is simply deliberate, dosed physical activity prescribed to restore movement, strength, endurance, balance or flexibility. Exercise changes tissue only under the overload principle: the load must slightly exceed current capacity for adaptation to occur. Specificity (the SAID principle — specific adaptation to imposed demands) dictates that training matches the target task; reversibility reminds you that gains fade within weeks of stopping; and progression raises the dose as tolerance improves. Before the first session, screening for red flags and baseline vital signs is non-negotiable.
What you must remember
- FITT components — frequency, intensity, time, type — plus volume and progression in ACSM usage; every prescription must state all four or it is advice, not a prescription.
- Overload: subthreshold exercise maintains, suprasimal but tolerable exercise builds; the ten per cent rule caps weekly progression to protect healing tissue.
- Specificity: a patient who must climb stairs trains step-ups, not seated leg curls; strengthening transfers only along the trained pattern and velocity.
- Reversibility: strength and endurance measurably decline within two to four weeks of detraining, which is why interruption — bed rest, holidays, flare-ups — must be planned for.
- Intensity monitoring: heart rate (roughly 60–80 per cent of maximum for aerobic work), the Borg 6–20 rating of perceived exertion (12–16 as the usual training band) and the talk test; perceived exertion wins when medication blunts heart rate.
- Every session runs warm-up (5–10 minutes), conditioning and cool-down (5–10 minutes) — abrupt stops pool blood peripherally and provoke post-exercise hypotension and arrhythmia.
- Abnormal responses that end a session: chest pain, dizziness, disproportionate dyspnoea, a systolic pressure that falls instead of rising, or a heart rate above the set ceiling.
Prescribing for a deconditioned patient with type 2 diabetes
Take a 58-year-old office worker, haemoglobin A1c high, breathless on one flight of stairs. The goal the patient chooses is walking 30 minutes continuously to the market. Screen first: resting blood pressure and pulse, foot inspection for neuropathy and ulcers, retinopathy status (vigorous exercise may be restricted with proliferative disease), and the timing of insulin or sulfonylurea against hypoglycaemia — advise carrying glucose and exercising an hour after meals rather than fasting.
Write the FITT. Frequency: five days a week, because the glucose-lowering effect of a session fades within 24–48 hours. Intensity: moderate — perceived exertion 11–13, able to talk but not sing. Time: three 10-minute bouts building to 30 continuous minutes over six weeks. Type: brisk walking on level ground, or cycling if knees complain. Add resistance work on two non-consecutive days, 10–15 repetitions per major group, because muscle is glucose-consuming tissue.
Progress duration before intensity, recheck the feet at every visit, and record capillary glucose responses to early sessions so the physician can adjust drugs if needed. Reassess at six weeks with the same stair-climb test that exposed the problem. The prescription is working when the goal activity, not the physiotherapist's imagination, becomes the measure.
How the exam frames it
Scenario MCQs match principles to stories: the patient who stops training for three weeks and loses strength illustrates reversibility; the swimmer with strong arms but poor running legs illustrates specificity; the patient given three sets of ten with no load stated illustrates a prescription without dose. Short-note favourites include FITT, the Borg scale with its anchors (6 nothing at all, 20 maximal), warm-up and cool-down rationales, and contraindications to exercise. One viva distinction recurs: physical activity is any bodily movement, exercise is planned, structured and repetitive — the definition pair that opens most therapeutic exercise papers.
Frequently asked questions
What do the letters of FITT stand for?
Frequency, intensity, time and type — the four parameters every exercise prescription must specify.
What does the SAID principle demand of a patient training for stairs?
Training must replicate the target task — step-ups and loaded stair patterns, not isolated open-chain exercise alone.
How can exercise intensity be monitored without equipment?
The Borg 6–20 perceived exertion scale and the talk test; moderate work sits around 12–13 with speech possible but singing not.
Which physiological responses during exercise are abnormal?
Chest pain, dizziness, disproportionate breathlessness, ectopic beats and a falling systolic pressure — all are stop signals.
Why does a session end with a cool-down?
Gradual recovery prevents venous pooling, post-exercise hypotension and arrhythmia as the muscle pump switches off.