Exercise Prescription and the Upper Extremity

Exercise Prescription and the Upper Extremity

Patricia Callison, SPT

 

Background

Ever since high school, I have had an interest in exercise science and strength and conditioning. My personal interest developed into a professional interest as I pursued a Bachelor’s degree in Exercise and Sport Science, became a certified personal trainer, and eventually began my doctorate-level education in UNC’s DPT program. My clinical experiences as a PT student have challenged me to re-frame my previous exercise prescription knowledge in a therapeutic context. While the basic principles of exercise prescription are the same, the overall framework for exercise selection and progression in the context of injury or pain is quite different. Many therapists tend to under-dose the intensity of their patients’ exercise interventions. Therefore, it is important to have a foundational knowledge of exercise selection and be able to progress or regress these exercises as indicated.

This capstone project served as a way for me to review exercise prescription principles using current evidence, and teach these principles to first-year students. Teaching these concepts has helped me to solidify the knowledge myself so that I can better serve my patients in the future. For my capstone project, I presented a lecture as part of the first-year DPT course, Exercise Foundations and Prescription for Physical Therapists (PHYT 726). This lecture was split into two components: 1) A brief recorded lecture (24 minutes) on basic principles of exercise prescription, to be viewed before the class session, and 2) An in-person lecture and lab session (~2.5 hours) focused on Exercise Selection for the Upper Extremity, with case discussions. I chose to focus on upper extremity exercise selection because my 3rd clinical rotation was located at a clinic that received a high volume of referrals from an orthopedic shoulder surgeon in the Duke system. Therefore, I had a lot of experience with exercise prescription for the shoulder, and felt that I could provide good clinical insight on this topic during in-class discussions. I also created an evidence table of current concepts of periodization in individuals participating in resistance training, and a template for tracking exercises in treatment notes.

 

Statement of Need/Purpose

The purpose of this project was to provide background information on loading parameters and require students to think critically about exercise selection, progression, and regression based on different patient scenarios. Under-dosing is a common issue in clinical practice. It is important for physical therapy students to understand how to effectively program exercises in a way that causes a lasting change in the target tissue. The Exercise Prescription course equips students with this knowledge, and therefore served as an ideal platform for my capstone project. Given my clinical experience with upper extremity injuries, I aimed to address the need for understanding of proper exercise selection, modification, and dosing in the upper extremity.

Since many SPT’s have varying levels of background on exercise prescription (e.g., some have Exercise Science degrees and/or have worked as personal trainers in the past, while some have no prior experience), I wanted to create a presentation that would benefit all students, regardless of prior knowledge. Therefore, my capstone includes basic foundational principles, such as resistance training parameters and periodization, as well as more advanced, PT-specific concepts such as scaling exercise selection and intensity based on the phases of tissue healing, as well as documentation tips for tracking exercises in treatment notes. I also designed the in-person component as discussion-based group work so that individuals with more background knowledge on exercise prescription could assist those with less experience.

 

Products

Recorded Lecture Slides

Recorded Lecture Video (24 minutes)

• This lecture was presented as a pre-recorded video for students to watch prior to the in-person class session. It includes content on exercise prescription principles and how to apply these principles in a rehab context. Some of this content had already been covered at this point in the course, but was used mainly as a refresher before class to solidify the concepts and apply them during group discussions.

In-Class Lecture/Lab Presentation Slides

• This was the presentation and lab activity that was done in-person during class. The first part of class included lecture and interactive discussion on factors affecting selection and progression of upper extremity exercises. The majority of the class session was centered around the lab activity which involved 5 distinct case scenarios in which the students broke up into 5 groups to discuss how they would select exercises for these patients, including the type, intensity, volume, frequency, and progressions or regressions.

Kahoot Questions & Answers

• These are the questions that were included on the in-class Kahoot quiz, with the correct answers highlighted and a rationale for each answer. These questions were designed to gauge understanding of the concepts presented in the recorded lecture that was viewed by the students before class, and to mimic the style of the questions on the NPTE.

Evidence Table

• Current best evidence for the comparison of two periodization methods (linear periodization versus undulating periodization) as it relates to resistance training and strength gains

Activity Log Template

• This handout was provided as an additional resource for students to use on clinical rotations or in future practice to help with documentation of exercises performed during treatment sessions.

 

Evaluation/Feedback

During the planning phase of this project, I sought feedback from my committee members and incorporated their suggestions into my presentations. I was able to discuss my thoughts and receive feedback for improvement on the final product via email, Zoom meetings, and in-person meetings with my committee members. They provided tips on how to structure the learning activities, such as facilitating discussion and critical thinking, as well as how to prioritize information and divide it into two different lectures to maximize time for in-person group work.

Unfortunately, I was not able to extract data from the answers on the Kahoot quiz, however the distribution of answers on each question gave insight as to which topics needed more discussion during class.

I encourage those who view the recorded lecture to fill out this survey to give feedback on what went well and how it may be improved for use in future classes.

 

Self-Assessment

Overall, this project was challenging but beneficial to my growth as a professional. I discovered that I actually really enjoy teaching, and would consider incorporating this into my career in some capacity. Due to the short timeline for completion of the project (the curriculum for the course required the presentation to take place in late February), I was challenged to use my time and resources efficiently, which taught me valuable time management skills.

When reflecting on the project, I wish I had incorporated more opportunities for the students to practice cueing exercises. If I could do it over again, I might have included only 3-4 cases instead of 5, to allow more time for discussion and also incorporate cueing. However, the students were quite engaged during this class and I was satisfied with the level that each group contributed to the case discussions.

 

Acknowledgements

To Mike Lewek, thank you for your guidance as my capstone advisor and giving me ideas for how to structure the lectures while also giving me the freedom to make the presentation my own. I appreciate the continued email correspondence and Zoom meetings to check in, as well as the feedback you provided on my draft materials. I hope the content continues to be useful for the class going forward.

To Yana Ginzburg, thank you for taking the time to meet with me face-to-face. I appreciate you answering my many questions, both capstone-related and profession-related, and for being honest and insightful in your guidance.

To Katie Stone, thank you for your feedback on my cases and tips on how to make the presentation more interactive. My clinical rotation with you was part of my reasoning for choosing this topic, so I am grateful to have been able to use you as a resource on this project.

To Gary Johnson, although you were not part of my committee, your contribution to the in-class discussion was very valuable and was a great supplement to the lab session. It was nice having a seasoned sports PT present to provide clinical perspective to each of the cases.

 

References

See presentations and evidence table for all references included in the project.