ARE WE THE EXERCISE EXPERTS? PART 2: SCIENTIFIC RESISTANCE EXERCISE DOSING IN PRACTICE

R. Handlery¹, M. Moffat², M. Studer³, D. Parker⁴

¹Arkansas Colleges of Health Education, Physical Therapy, Fort Smith, United States, ²New York University, Physical Therapy, New York, United States, ³Oregon State University, Physical Therapy, Corvallis, United States, ⁴Marquette University, Physical Therapy, Milwaukee, United States

Background: Exercise is the key intervention for combating noncommunicable diseases leading to morbidity, disability, and mortality as well as many of their risk factors. Exercise is also the primary intervention used in physical therapy to reduce impairments and enhance function for many diseases, disorders, and conditions. Physical therapists are often criticized for underdosing all types of exercise across various populations. Evidence exists to support the opinion that the field of physical therapy is inadequately utilizing the science of exercise prescription for resistance training.

Purpose: The purpose of this presentation (based on a three-part presentation series including aerobic exercise, resistance exercise, and balance exercise) will be to describe optimal resistance exercise prescription for individuals across the age spectrum with involvement of many bodily systems, utilizing the best available evidence.

Methods: Dosing of resistance exercise will be based on the evidence available to support resistance exercise interventions in practice and will present the FITT (frequency, intensity, time, and type) principles as well as the need for the three P’s for personalizing the exercise prescription (personality, preference, and psychosocial considerations). To make changes in muscular fitness, resistance exercise/training must be based on exercise science and must aim to increase the power of both type I and type IIA fibers, the mitochondrial volume density, the capillary density, the oxidative enzyme capacity, and the muscle protein synthesis and to change bone microarchitecture.

Results: The data strongly support the use of resistance exercise training in several ways including continuous and interval training as means of: increasing muscle performance, balance, joint mobility, quality of life, and function; altering cardiovascular parameters by increasing maximal work capacity, VO₂max, and serum lipid profiles; minimizing or reversing frailty; lowering the risk of mortality regardless of age; decreasing sarcopenia; reducing pain; reducing body fat and decreasing body mass index; altering white matter lesion progression; and improving long-term physical function in critically ill patients in ICU and in frail older adults in residential care facilities.
The benefits of resistance exercise span body systems (musculoskeletal, genitourinary, and neurologic) and are realized by persons with primary health conditions, comorbidities, and healthy individuals alike. Additionally, combining resistance with aerobic exercise improved functional capacity and reduced disability in individuals with 22 different chronic diseases [including Alzheimer’s disease, cancer, chronic fatigue syndrome, chronic kidney disease, chronic obstructive pulmonary disease, cognitive impairment, fibromyalgia, multiple sclerosis, osteoarthritis, Parkinson’s disease, peripheral arterial disease, rheumatoid arthritis, stroke, and type 2 diabetes].

Conclusions: The integration of scientifically prescribed resistance exercise has the ability to impact most every patient/client that physical therapists encounter. Appropriately determining resistance exercise dosing can produce the physiological changes needed to reduce morbidity and disability and have an impact on mortality. The key to change must be incorporated into educational programs, practice guidelines, and practice behaviors so that physical therapists are truly recognized as exercise scientists achieving the highest functioning outcomes possible for each patient/client.

Implications: The knowledge of scientific prescription of resistance exercise can have a major impact on the profession and its recognition as practitioners of choice for exercise interventions.

Funding acknowledgements: This work was not funded.

Keywords:
Resistance exercise
Exercise
Dosing

Topics:
Health promotion & wellbeing/healthy ageing/physical activity
Professional practice: other
Education

Did this work require ethics approval? No

Reason: This presentation describes ways in which physical therapist practice using resistance exercise interventions should be based on science so that dosing achieves maximum results at all times. It also is aimed at opinions that physical therapists do not use the science of exercise prescription in practice.