Exercise Prescription and the Lower Extremity
Alan Zhou, SPT
Prior to starting the physical therapy program, improving strength and conditioning, improving human movement, and optimizing performance were the driving forces that led me to my fascination with exercise and training. Outside of my personal history as a strength sport competitor, I have also previously helped coach conventional athletes, strength athletes, and recreational athletes. After starting the program and working with patients, I came to realize that many patients are chronically under-dosed in terms of exercise intensity1 and that is something I have taken on as my personal mission to try and address. I have always appreciated and admired how Athletic Trainers and Strength Coaches work with their athletes through the application of strength and conditioning. I believe that looking at physical therapy through the lens of a strength specialist allows physical therapists the ability to utilize unique methods of prescribing exercise parameters through evidence based methodologies.
Similarly, this Capstone project acts as another way for me to serve others within the program and explore my love for teaching and coaching. After being a teaching assistant for the Musculoskeletal II course for the 2nd year students, another opportunity to assist Dr. Mike Lewek and Dr. Jon Hacke with the 1st year students was too tempting to forgo. Teaching and sharing what little information I know not only gives me the opportunity to cement the knowledge for myself, but it also allows me to contribute back to a program that his given me experiences and opportunities I could not have gotten anywhere else. Creating a useful resource for students to use and reference with future patients is something that allows me to serve my classmates and community at large. The chance to interact with future UNC DPT graduates in this capacity and affect change (big or small) within the world of physical therapy is a privilege that seldomly presents itself. I had hoped to take advantage of the opportunity to try and honor the knowledge of those before me and to aid the ones after me.
For this project, I created a VoiceThread PowerPoint Presentation on exercise prescription for the lower extremity, taught the corresponding lab session, created an evidence table of current concepts with autoregulation, and created a quick reference handout for students and clinicians.
Statement of Need/ Purpose:
In the current UNC DPT curriculum, there seems to be a lack of clinically applicable content related to exercise selection and progression/regression. The current Exercise Prescription material gives a great theoretical background to the ideas behind the dosage of exercise, but many of the ideas do not immediately translate to clinical practice for some students. Due to the large variation in knowledge among students, it has also been noted that the challenge comes in bridging that vast knowledge gap between the hyper-experienced and the newcomers to exercise. There seemed to be a need for providing a framework for straightforward, practical application of strength and conditioning principles while also providing a novel, evidence-based methodology to the prescription of exercise.
Due to many clinical limitations and some of the inherent inaccuracies with traditional percentage based training,2–5 it seemed important to update the course with current evidence regarding the efficacy of autoregulatory training as an adjunct method of prescribing load intensity. I believed that the new course information should speak upon current concepts available in selecting loading parameters for patients along the continuum of care and provide tangible and immediately applicable skills for students going out on rotation.
Course instructors have also voiced that students seem to have trouble with exercise selection and determining how to increase or decreases the difficulty of the respective movements. Anecdotally, there appears to be a gap between UNC DPT students’ understanding of performance and physical therapy/rehabilitation. Bridging that gap, providing information, and understanding clinical application can be utilized for the betterment of patient treatment and care. WHO and the NSCA have released position statements in regard to resistance training6–8, so there is a need for students to synthesize those concepts and overlay the principles of strength and conditioning to optimally address patients’ functional deficits and impairments.
Final products/components are linked below, and were created/utilized to serve as an adjunct to the PHYT726 Exercise Foundations/Prescriptions course, in the Spring semester of the 1st year of the UNC DPT program.
- PHYT726 Exercise Foundations/Prescription VoiceThread
- Presentation is approximately 1.25 hours in length and establishes the framework of exercise prescription and introduces the idea of autoregulation as it relates to exercise intensity and load dosing for the lower extremity
- Zoom Lab Session (Video Link)
- Live lab session given via Zoom that was approximately 3 hours in length. The lab session was intended to give practical application to the VoiceThread concepts and act as a virtual learning session for introduction, discussion, and application of exercise prescription to the lower extremity.
- Exercise Prescription VoiceThread Handout
- Summarized and clinically applicable “quick guide” to autoregulation
- Capstone Evidence Table- Exercise Foundations
- Current best evidence available for the application of autoregulation methods as it relates to strength/resistance training
- Pre/Post Learning Assessment
- Learning quiz given pre- and post- VoiceThread presentation to assess effectiveness of teaching and student retention of concepts discussed
- UNC DPT Teacher Scholar Presentation Evaluation
- UNC DPT standardized survey to evaluate presenter/presentation quality/effectiveness
I incorporated feedback from my advisors and committee members to modify and improve the presentation and lab components of the project. Zoom meetings and multiple e-mail conversations were utilized in order to discuss how to best modify the framework I envisioned into a student friendly presentation. Important reference information was also provided for inclusion into the presentation. The advice and guidance from my committee members was invaluable for the not only improving the quality of the presentation, but also my own personal knowledge and growth. They provided numerous suggestions regarding formatting changes for enhanced learning, tips for improving the aesthetics of the slide information, and identified areas in my material that required further discussion and elaboration.
Retention of the lecture/VoiceThread material was assessed through a Google Forms quiz. Students were asked to take the quiz prior to watching the lecture and after watching the lecture. Of the students that submitted their responses, 90% increased their number of correctly answered questions by at least 2/10 questions. Additionally, I utilized the standardized UNC DPT presentation survey from Dr. Jon Hacke to assess the quality and effectiveness of my lab session. Students are able to provide a numeral assessment of the lab session while also providing free written comments/criticism. DPT1s completed and returned the survey. Of those that submitted feedback, the average score across the 9 categories was >97%. Many students stated they enjoyed the Zoom lab session as it explained the VoiceThread information and allowed for practical application of concepts. Constructive criticism stated the clinical case instructions could have been more explicit and more time could have been provided in order to review the new course material.
Looking back at this Capstone project, I feel that it has given me a great opportunity to re-examine my passion for human movement. It served as a reminder of why I chose physical therapy as a career and how I can continue to make changes in the profession. Although there are inherent struggles with being a DPT student, this teaching project provided many moments satisfaction when fellow students found value in the information I was teaching. Because of my project’s earlier than usual timeline, it also reminded me to be efficient with my schedule and taught me the value of appropriate work-life balance. Also, I have come to greatly appreciate the skills learned in regard to database searching, assessing literature quality, and synthesizing the most clinically applicable data from research articles. Without the wonderful lessons from Dr. Carol Giuliani or Dr. Charles Sheets, I would be lost in a sea of Boolean terms and psychometric data points. Lastly, this project has given me the ability and confidence to create and present professional material to clinicians and peers. This opportunity has enhanced my leadership capabilities and has not only improved my clinical understanding of exercise prescription but also my ability to teach and coach others.
First, I would like to take this time to say that working with you all has been a pleasure and I am beyond grateful for the opportunity to speak with you all.
Dr. Mike Lewek and Dr. Jon Hacke, thank you for being my advisors and allowing me this opportunity to teach within your course. It was a wonderful chance to help my fellow students and explore my interest in teaching. You all provided me with invaluable insight, tips, and recommendations for improving my approach to teaching students of varying backgrounds. Thank you for always moving the project forward and helping me stay on track with the goals. It has been a pleasure being your student in and out of the classroom. Your expertise and advice are greatly, greatly appreciated. I hope to stay in touch with you all moving forward!
Dr. Madison Franek and Dr. Kyle Cooper, thank you both for allowing me to reach out to you to become committee members for this project on such relatively short notice. Thank you, Dr. Cooper for providing your thoughts on areas for emphasis with my presentation and being the contact point for other clinicians. Thank you, Dr. Franek for providing such great resources on exercise selection and kick-starting my brainstorming for the project. Your integration of various frameworks for exercise prescription was integral to my formulating of thoughts for 1st year students.
Finally, I would like to thank my UNC DPT family and classmates for their continued support throughout this program. Without the shared laughs and support, I am not sure I would be here at this point.
- Lee PG, Jackson EA, Richardson CR. Exercise prescriptions in older adults. Am Fam Physician. 2017;95(7):425-432.
- Richens B, Cleather DJ. The relationship between the number of repetitions performed at given intensities is different in endurance and strength trained athletes. Biol Sport. 2014;31(2):157-161. doi:10.5604/20831862.1099047
- Helms ER, Byrnes RK, Cooke DM, et al. RPE vs. percentage 1RM loading in periodized programs matched for sets and repetitions. Front Physiol. 2018;9:247. doi:10.3389/fphys.2018.00247
- Helms ER, Kwan K, Sousa CA, Cronin JB, Storey AG, Zourdos MC. Methods for regulating and monitoring resistance training. J Hum Kinet. 2020;74:23-42. doi:10.2478/hukin-2020-0011
- Helms ER, Cronin J, Storey A, Zourdos MC. Application of the Repetitions in Reserve-Based Rating of Perceived Exertion Scale for Resistance Training. Strength Cond J. 2016;38(4):42-49. doi:10.1519/SSC.0000000000000218
- Faigenbaum AD, Kraemer WJ, Blimkie CJR, et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J Strength Cond Res. 2009;23(5 Suppl):S60-79. doi:10.1519/JSC.0b013e31819df407
- Fragala MS, Cadore EL, Dorgo S, et al. Resistance training for older adults: position statement from the national strength and conditioning association. J Strength Cond Res. 2019;33(8):2019-2052. doi:10.1519/JSC.0000000000003230
- Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462. doi:10.1136/bjsports-2020-102955
First image reference: https://barbellscholar.com/2019/01/07/top-10-barbell-squat-variations/