Group exercise programmes

Question 1

Why Exercise?

Answer 1

• To improve or maintain physical well-being • Prepare for an upcoming athletic event
• Build up cardiovascular fitness
• To relieve anxiety
• Build up muscular strength/muscular endurance • Slim down/weight loss
• Social interactions with others

Question 2

Classes: Advantages

Answer 2

• Economic
• Cheaper
• More people at once
• Socialisation
• Mutual support
• Encourages adherence to exercises
• Encourages a wellness approach to health
• Greater self locus of control

Question 3

Classes: Disadvantages

Answer 3

• Quality control
• Individual needs may not be met
• Groups dynamics – negative at times
• Management of difficult members
• Requires space

Question 4

Common clinical areas for classes

Answer 4

• Cardiovascular • Balance
• Falls Prevention • Obstetrics
• Obesity
• Chronic Diseases • Health Ageing
• Work Re-training • Sports Readiness • Stroke / ABI
— Chronic pain — Osteoporosis
— Respiratory
— Children with movement
difficulties
— Pre-/Post-Surgery — Cardiac Rehab

Question 5

DESIGN OF AN EXERCISE CLASS

Answer 5

• Physiotherapist well situated to be flexible in design and application:
• Ongoing observational assessment
• Clinical reasoning
• Pathology specific knowledge
• Body mechanics knowledge

Question 6

Elements to consider

Answer 6

• Objectives and aims of class
• Group size
• Selection of patients:
• Pathology, movement, functional goal • ….what is the commonality?
• Assessment of class effectiveness
• Monitoring
• Mechanisms for individuals during / before / after
• Risk management
• Safety considerations
• Environmental needs – open vs closed environment/surfaces

Question 7

DESIGN OF AN EXERCISE CLASS

Answer 7

Consider objectives / goals of class: 
• Functional
• Weight loss
• Balance / ↓Falls
• Muscular Strength
• Coordination
• Socialisation/wellness?
Objectives/goals influence:
• Patient/client number and homogeneity within the group • Environmental needs
• Recruitment strategies
• Influence planning or structure and content

Question 8

Group size

Answer 8

• Influenced by type of class (goal)
• Environmental constraints
• Risk management issues (safety)
• Seriou sproblems canarise!
• Quality vs economy

Question 9

Selection of Patients

Answer 9

• Pre-screening process and needs
• Appropriate patients
• Criteria set for inclusion / exclusion
• Will they fit into the class (goals meet)
• Safe to complete exercise using ESSA pre- exercise screening questionnaire?
• Must know:
• Medical history
• Contra-indications for involvement
• Pre-class testing
• Agreed upon(shared planning)

Question 10

Monitoring: Ongoing basis

Answer 10

Monitoring: Ongoing basis
• Consider the individual prior to enrolling in group • Functional level – subgroups?
- monitor within class so is effective for everyone
• Ongoing (individual) monitoring during class • Current intensity
• Progress/regress exercise
• Rest breaks
• Individual feedback/correction in a timely manner • Ensure session is inclusive
• Document EVERYTHING!

Question 11

Establish a baseline to measure improvements

Answer 11

• Outcome measures
• Baseline / status of client/patient
• Increase compliance – act as motivational tool, competition
• Considerations when selecting an outcome measure
• Valid, reliable, repeatable – how can you optimise this if you were
running a group?
• Testing targeted impairments, function, participation – that you anticipate will change in response to class

Question 12

DESIGN OF AN EXERCISE CLASS

Answer 12

Monitor class outcomes in relation to the goal and value for money – balancing economics vs optimal clinicial outcomes
• Need to consider:
• Cost effectiveness vs. clinical effectiveness • Effectiveness of program as a whole

Question 13

Risk assessment - Safety

Answer 13

Identify sources of potential risk:
 • Environment
• Equipment
• Exercises
• Patients • Falls

Question 14

Setting up the environment

Answer 14

— Can everyone see/have access to leader when needed?
— Is the environment safe? – obstacles, support — Is there enough space?
— Is the equipment at hand?
— Equipment in good repair?
— Can everyone hear you?
— Music?
— Warm/cool enough? – temperature of room/pool….?

Question 15

Workstation/Circuit classes

Need to design each ‘Work area’

Answer 15

Definition:
— Where exercises of functional motor tasks, components of functional tasks or impairments are carried out/practised
Purpose:
— To address the specific problems of each patient / to manage deficits in:
◦ Balance & mobility
◦ Upper limb function
◦ Bed mobility / transfers ◦ Wheelchair ambulation ◦ Cardiorespiratory health ◦ Pain

Question 16

Steps required to deliver a workstation model group class:

Answer 16

1. Individual assessment to establish individual deficits
2. Outcome measures that reflect impairments and functional motor ability / participation
3. Diversity yet flexible work station set up
   ◦ Balance/mobility/upper limb function
   ◦ Tailored to meet specific identified problems of participant
4. Weekly monitoring of client post previous session, during week, illness, falls etc.
5. Graded tasks in each station
   • Regression and/or progression options?
6. Foster active participation / self management • Transference to home / community setting • Home Exercise program
   • Self monitoring of results/performance
7. Re-assess at conclusion of program for • Success
   • Ongoing functional needs

Question 17

Principles for Physiotherapists in work station model delivery

Answer 17

Use clear instruction sheets with pictures and recording mechanisms - individual for each patient
The Physiotherapist acts a coach, trainer, assists, supervises or consults with more able participants
• Physiotherapist must train each participant for each station
• Provide strategies to solve everyday functional problems to transfer to home environment
• Challenging but SAFE
• Move participants through stations / circuit
• Modify / progress – aim for success and safety

Question 18

Each work station should provide:

Answer 18

— Active participation by patients / clients of all levels of ability to carry-out tasks
— Potential for graded tasks or variable levels for independent client self set-up, at individual levels

Question 19

Benefits of work station model of service delivery

Answer 19

— Increase intensity/duration of rehabilitation (Carr & Shepherd 2003) — Cost effective as no increase in delivery costs
— Group dynamics influence participation in program
(Ada et al 1999, Williams et al 2009)
◦ Improved participation and compliance to therapy session ◦ Enhanced motivation
— Effects of attention focus, self-control and group training on motor learning — Improvement in non physical symptoms e.g. fatigue (Williams et al 2009)

Question 20

Benefits of traditional group exercise classes:

Answer 20

— Can be safer
◦ Less able group
— Improved group dynamics / competition / self reflection compared to peers
— Group of similar level clients
— No need for individualized instructions
— Less active / independent participation needed

Question 21

Disadvantages of traditional group exercise classes:

Answer 21

• Increased equipment needs – costs

* Less targeted / less challenging for participants • Less active / independent participation needed

Question 22

Principles for Physiotherapists in traditional class delivery model — Establish goals of the class

Answer 22

— Follow same principles for establishment as for workstation / circuits
◦ Assess / Re-assess
◦ Optimise individualisation where possible
◦ Consider appropriateness of participant in line with the goals of the class
◦ Foster transference of tasks into everyday life (education, provision of home exercise programs)

Question 23

Getting the ‘balance’ right

Answer 23

• Make it fun
• Use technology
• Age/culture specific • Educate on benefits • Foster transference