**1. Introduction**

Exercise therapy is defined as a regimen or plan of physical activities designed and prescribed to facilitate the patients to recover from diseases and any conditions, which disturb their movement and activity of daily life or maintain a state of well‐being [1] through neuro re‐ education, gait training, and therapeutic activities. It is systemic execution of planned physical movements, postures, or activities intended to enable the patients to (1) reduce risk, (2) enhance function, (3) remediate or prevent impairment, (4) optimize overall health, and (5) improve fitness and well‐being [2].

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This therapy may relate specific muscles or parts of the body, to general and strenuous activities that can return a recovering patient to the peak of physical condition. It is highly repetitive and intensive and requires time and dedication on the part of the patients to encourage neuroplasticity. The therapy is performed by professionals with an educational background in exercise physiology, exercise science, or other similar degree. To succeed goal‐oriented treatment, the personnel must [2].


In‐house physical therapy by family, friends, or caregivers to deliver the appropriate exercise therapy in the home can greatly decrease healthcare costs which may limit the intervention. Therefore, training and educating these persons are important in effective exercise therapy.

Exercise therapy can be called Activity‐Based Therapy, Activity‐Based Recovery Therapy, Neuro‐based Therapy, and Restorative Therapy.

#### **1.1. Important background knowledge to understand exercise therapy**

Background knowledge needs to be understand [3].

#### *Planes of movement*

There are three planes of movement.


*Kinematics* is the area of biomechanics that include description of motion without regard for the forces producing it. They include.

	- Rotatory motion, which is the movement of an object around a fixed axis in a curved path.

**b)** Location of motion: Motion at a joint may occur in transverse, frontal, or sagittal planes.

**c)** Direction of motion: Movement may occur either in clockwise or anticlockwise direction.

**d)** Magnitude of motion can be given either in degrees or radians.

*Kinetics* is biomechanics that concerned with the forces maintaining equilibrium or producing motion and are described as either external or internal forces.

*Center of gravity (COG)* is the point which the force of gravity acts effectively independently on position of body. The COG of human body lies approximately at S2, anterior to sacrum.

*Line of gravity (LOG)* is the line that lies vertically through center of gravity.

*Base of support* is the area which is supported.

This therapy may relate specific muscles or parts of the body, to general and strenuous activities that can return a recovering patient to the peak of physical condition. It is highly repetitive and intensive and requires time and dedication on the part of the patients to encourage neuroplasticity. The therapy is performed by professionals with an educational background in exercise physiology, exercise science, or other similar degree. To succeed goal‐oriented

**2.** Implement a variety of therapeutic interventions that are complementary (e.g., heat application before joint mobilization and passive stretch, followed by active exercise to use new

**4.** Promote patients' independence whenever possible through the use of home manage-

In‐house physical therapy by family, friends, or caregivers to deliver the appropriate exercise therapy in the home can greatly decrease healthcare costs which may limit the intervention. Therefore, training and educating these persons are important in effective exercise therapy.

Exercise therapy can be called Activity‐Based Therapy, Activity‐Based Recovery Therapy,

**a)** Movement in horizontal plane (transverse plane): This plane divides the body into upper

**b)** Movement in frontal plane (coronal plane): This plane divides side to side movements, for

**c)** Movement in vertical plane (sagittal plane): It is the plane that divides the body or body segment into the right and left parts. Movements in this plane include forward and back-

*Kinematics* is the area of biomechanics that include description of motion without regard for

• Rotatory motion, which is the movement of an object around a fixed axis in a curved path.

and lower halves. Movements in transverse plane occur parallel to ground.

**1.** Provide comprehensive and personalized patient/individual management.

ment, self‐management exercise programs, and patient‐related instruction.

**1.1. Important background knowledge to understand exercise therapy**

treatment, the personnel must [2].

76 Clinical Physical Therapy

mobility in a functional manner). **3.** Rely on clinical decision‐making skill.

Neuro‐based Therapy, and Restorative Therapy.

Background knowledge needs to be understand [3].

example, bringing the head to each of the shoulders.

ward motions such as nodding of the head.

**a)** Types of motion. There are four types of motion:

There are three planes of movement.

the forces producing it. They include.

*Planes of movement*

*Equilibrium* results when the forces acting upon a body are balanced and the body remains at rest.

*Fixation and stabilization:* Fixation is the state of immobility, and stabilization is the state of relative immobility.

*Force* is that which alters the state of rest of a body or its uniform motion in a straight line

*Lever* is a rigid bar that rotates around on axis.

*Mechanical advantage* is efficacy of force in relation to lever depends on two factors.

*Pulley* is a grooved wheel which rotates about a fixed axis by a rope that passes round it. The axis is supported by a frame work or block. There are two types of pulleys: (1) fixed pulleys and (2) movable pulleys.

*Starting position* is the first posture before the following movement during the exercise therapy*.* There are five fundamental starting positions: standing, kneeling, sitting, lying, and hanging. Equilibrium and stability are maintained in these positions by balance of forces acting upon the body.

### **2. Objectives of exercise therapy**

The objectives of exercise therapy are as following;

**a)** Promote activity and minimize the effects of inactivity, increased independence

**b)** Increase the normal range of motion.


The most important goal of exercise therapy is an optimal level of physical fitness by the end of the intervention. The physical fitness a state characterized by good muscle strength combined with good endurance.

## **3. Concept**

Exercise therapy based on the independent movement which depends on individual goals. It aims to improve the ability to achieve optimal daily functioning. To achieve the goal of exercise therapy, the practitioner needs to understand the disablement process which include [4]

The disablement process


There are three models of the disablement process:

**a)** World Health Organization's (WHO) International Classification of Impairments, Disabilities, and Handicaps (IDICH) [5].

**b)** NAGI scheme [6].

**c)** Improve strength the weak muscles.

**e)** Enable ambulation.

78 Clinical Physical Therapy

**g)** Improve circulation.

**i)** Improve coordination.

**j)** Reduce rigidity. **k)** Improve balance.

**l)** Promote relaxation.

bined with good endurance.

**3. Concept**

include [4]

function.

The disablement process

**h)** Improve respiratory capacity.

**m)** Increased motor or sensory function.

**n)** Reduction of medication, reduction of hospital visits, and increased overall health.

The most important goal of exercise therapy is an optimal level of physical fitness by the end of the intervention. The physical fitness a state characterized by good muscle strength com-

Exercise therapy based on the independent movement which depends on individual goals. It aims to improve the ability to achieve optimal daily functioning. To achieve the goal of exercise therapy, the practitioner needs to understand the disablement process which

**a)** Impairment: A loss or abnormality of anatomic, physiologic, or psychologic structure or

**b)** Functional limitation: A limitation of the whole person performance, task in an efficient,

**c)** Disability: The inability or a limitation to perform the performance of actions, or tasks.

**a)** World Health Organization's (WHO) International Classification of Impairments, Disabili-

typically expected, or competent manner, or a physical action activity.

There are three models of the disablement process:

ties, and Handicaps (IDICH) [5].

**d)** Improve the performance in daily activities.

**f)** Release contracted muscles, tendons, and fascia.

**c)** Modified disablement model [2]. This model exhibits the complexity of the relationships among pathology, impairments, functional limitations, disability, risk factors, interventions, quality of life, and prevention, wellness, and fitness.

## **4. Patient management**

Physical therapist's approach to patient management involves examination, evaluation, diagnosis, prognosis, and intervention [2].

#### **4.1. Therapeutic exercise intervention model**

A three‐dimensional model has been created to assist the clinician in the clinical decision‐ making process regarding exercise prescription. The model includes

*Elements of the movement system*: These elements relate to the purpose of each activity or technique


*The specific activity or technique chosen*


*The specific dosage*


The therapist must continually monitor the exercise to determine the need for modification to increase or decrease difficulty to ensure continual progress is being made with minimal setbacks. In addition, exercise therapy can be complemented with adjunctive interventions if the additional intervention can lead to a higher level of functional outcome in a short time.
