Chapter 27: Exercise for Special Populations

Introduction

By this point in the textbook it should be apparent that therapeutic exercise includes a broad expanse of treatment options available to physical therapists and physical therapist assistants. Many previous chapters present concepts and examples that apply generally or to specific body regions, whereas others are specific to patients or populations (Older Adult, Women’s Health, Lymphatic Disorders). Regardless of the chapter, it is always incumbent on the therapist to use a patient-specific approach to therapeutic exercise, modifying the program based on movement system impairments, patient capacity, and ongoing assessment of the patient response to treatment.

Because exercise in most forms is beneficial for an individual’s overall health and well-being, some type of therapeutic exercise approach is appropriate for most patients as part of their plan of care. For some individuals, however, the exercise parameters (type, duration, intensity, frequency, etc.) may be harmful if applied at a level beyond their capacity due to their underlying health condition. Individuals who are managing chronic or degenerative disease processes typically require modified programs so as not to exacerbate symptoms or worsen their condition. This chapter focuses on providing information that will guide the implementation and successful application of exercises in some of these patient populations.

For most of the diseases and conditions included in this chapter, background information is available elsewhere for those interested in additional depth and breadth related to the topic. This chapter’s intent is to provide a short overview of the condition, summarize the major movement system impairments typically noted, and provide guidance related to the critical indications, precautions, and contraindications to therapeutic exercise. When available, evidence related to the application of exercise in these specific patient populations is provided.

WHO guidelines recommend 150 minutes per week of moderate intensity aerobic activity, 75 minutes per week of vigorous aerobic activity, and resistance exercises 2 times per week for adults aged 18 to 64. However, adjustments to these recommendations are needed for all individuals based on their exercise capacity and specific health risks or limitations.⁴³ This chapter aims to provide guidance for the physical therapy provider as they apply therapeutic exercises to those for whom adjustments should be considered because of their health condition.

Diseases and Conditions

Obesity

Definition and Description

Obesity is the condition in which individuals carry extra body weight, primarily in the form of stored body fat. Obesity is known to negatively impact health in many ways, including the increased incidence of several major disease processes that lead to morbidity and mortality.²⁵ Because of the many potential or realized diseases associated with obesity, it is considered a major health problem and challenge, especially in the United States.

Obesity is defined using the Body Mass Index (BMI), which is a person’s weight in kilograms divided by the square of ...