Innovation in Wellness and Prevention
Group exercises classes for improved function and fun.
By Patrice Hazan, PT,DPT,GCS,MA
The medical model of care is changing to emphasize wellness and prevention, especially in the management of chronic conditions. We need to focus not only on getting our patients well but also on keeping them well.
Currently, there is an all-too-common and frustrating scenario occurring in the treatment of our geriatric patients. After completing a successful duration of individual therapy, patients are discharged with a home exercise program and recommendations for community resources, only to return to the physical therapy clinic after a few months due to lack of exercise at home. It’s like a revolving door of physical therapy. We know that patients need to continue to exercise to maintain the gains they make during individual therapy. Unfortunately, an abundance of research shows patients have poor compliance with home exercise programs with a mere 42 to 44 percent estimated adherence to the prescribed home exercise program.1
Physical therapists (PTs) recognize lack of adherence to home exercise programs as a clear limitation to patients’ long-term success and outcomes.2 Studies are being conducted to evaluate the adherence (and lack thereof) to home exercise programs so solutions can be created to increase compliance with the discharge recommendations provided.3,4
Why not create alternative solutions to the home exercise program? Physical therapy knowledge and expertise can be used to develop wellness programs for our patients. More effective answers to a home exercise program need a paradigm shift. An alternative solution to nonadherence to the home exercise program is a system of physical therapy group exercise classes.
We know that wellness includes aerobics, strengthening, balance, and flexibility so physical therapy theory and concepts can be combined with the use of fun music to incorporate these components into a wellness system of care for our patients. This is an opportunity for innovation and leadership within the physical therapy profession to design programs that can make a profound impact on improving our patients’ lives, moving beyond the rehabilitation to keep patients healthy and well.
The American Physical Therapy Association (APTA) has advocated for an annual wellness examination for seniors managing chronic conditions.5 Jennifer Gamboa, PT, DPT, OCS, and David Taylor, PT, DPT, OCS, were speakers at the June 12 session “Implementing the Annual Physical Therapy Examination into Your Practice” at NEXT 2014. Beyond the examination, our profession can create and implement medically based options for our patients. Providing comprehensive wellness programs for individuals managing chronic conditions corresponds with the APTA declaration that physical therapists are movement system experts, examining and treating movement and health and wellness as a whole.6
Developing Evidence-Based Programs Comprehensive wellness includes aerobics, strengthening, balance, and flexibility. Therefore, a physical therapy group wellness system of care must include these components. Physical therapy education and training does not traditionally include low-impact aerobics or use of music with exercise. Group exercise and low-impact aerobics are innovative ways to increase strength, balance, endurance, cognition, and flexibility.
For example, as clinicians, we provide interventions that shape the sensorimotor environment to facilitate reorganization according to principles of neuroplasticity. To effectively improve balance, patients need a wide variety of vestibular, sensory, cognitive, and motor challenges. Performing the same exercise over and over will not provide the stimulus to sufficiently increase the brain’s neural synapses and pathways to improve balance.7 Group physical therapy can provide a wide variety of challenges through classes including vestibular, motor, sensory, and cognitive exercise options, changing the class to meet the needs of the participants.
Group physical therapy exercise is further supported by the enrichment theory that states that a complex environment “strengthens synaptic transmission and plasticity, increases survival or decreases apoptosis of regenerating neurons, and enhances expression of molecules involved in neuronal signaling.”8
The benefits of a positive group environment are confirmed by the engagement theory, which states, “other factors such as attention, motivation, passion, trust and dedication, desire, and personal connection can be critical factors correlated with neuroplasticity.”9 The social support and encouragement of the group setting promotes these factors.
Music is such a valuable tool that is underutilized in traditional physical therapy. Not only is music fun, but it will motivate as well as facilitate physical training, ease of movement, coordination, and cognitive training. A study by Satoh et al. (2014) demonstrated that Physical exercise combined with music produced more positive effects on cognitive function in elderly people than exercise alone. They attributed this improvement to “the multifaceted nature of combining physical exercise with music, which can act simultaneously as both cognitive and physical training.”10
Exercise classes led and supervised by physical therapists would allow patients to not only maintain strength gains, but also continue to progress. According to research on the intensity of training, exercise needs to be challenging enough to make a difference in strength and endurance. Performing the same exercises over and over at the same level may be better than no exercise, but will not be sufficient to allow for continued improvement.11 The supervision and reassessment provided by a physical therapist will allow for continual upgrading of the program.
As movement experts, physical therapists are specialists in functional training— exercises designed to mimic functional activities—such as bending to pick something up. These exercises allow the safe incorporation of multiple muscle groups in functional patterns that will translate into improvement of functional activities that keep individuals active and independent.12 Functional exercises and activities can be creatively integrated into group classes with bands, weight, and closed chain exercises. Interestingly, combining both strength and endurance training in the elderly has been found to be the “optimum strategy to improve both neuromuscular and cardiorespiratory functions.”13
Low-impact aerobics effectively combines functional strengthening with aerobics training, increasing the heart rate and improving strength simultaneously.
An abundance of research has demonstrated that aerobic exercise will improve cognitive abilities.14,15 Low-impact aerobics not only gets the heart rate into a training zone, promoting cognitive benefits, but also provides cognitive challenges in sequencing, motor planning, balance and reaction time, and coordination training by using the music and the beats per minute in a challenging manner. Aerobic exercise and dance have been demonstrated to help prevent cognitive decline and to modify the disease progression of individuals with Parkinson’s disease.16
The geriatric demographic is the most medically complex population with most seniors managing not just one but several chronic conditions.17 Due to this, the risk of injury with exercise is much higher for these individuals than for other populations. As the most qualified professionals when it comes to movement, physical therapists can help these individuals work out to their maximum potential by designing exercise programs and providing instruction and education on precautions, modifications, and adaptations to exercise.
According to the Centers for Disease Control (CDC), one out of every three seniors falls each year.17 Physical therapists are also experts in fall prevention. By offering these programs we can identify individuals at risk for falling and provide early intervention through exercise and recommendations for appropriate assistive devices and home modifications.
Finally, by offering these wellness classes, physical therapists may be able to catch problems before they become serious concerns.
Why You Should Offer Classes from a Business Standpoint Not only is expanding your private practice to include group exercise classes good for your patients, it is good for your business. Wellness and prevention for individuals managing chronic conditions offer a wealth of business opportunities for our physical therapy entrepreneurs.18 In this competitive environment of physical therapy, clinics are looking for ways to stand apart from other clinics by creating niche markets. Offering group classes will increase referrals and profits for individual therapy as well as diversify revenue to include a cash-based component. Group exercise classes offer a holistic, patient-centered approach to patient care. Referrals for individual therapy are generated directly and indirectly from offering group therapy exercise classes in your clinic. They come directly from clients coming to the group programs and indirectly due to the fact that offering these unique, skilled classes for wellness will make your clinic known as the leader in innovative geriatric rehabilitation in your community.
Offering Group Physical Therapy Classes for Wellness and Prevention: A System of Care Offering group classes for wellness and prevention is not a simple proposal. It is not a matter of offering a single class. It is a system of care with a wide range of functional classes that begins with a detailed initial physical therapy evaluation. This evaluation will allow the physical therapy to place the patient in the appropriate classes and allow for identification of adaptations, modifications, and instruction in precautions as well as individualized disease-specific education. A wide variety of functional classes must be offered to meet the extensive needs of this population. This means that each class is specialized to meet a certain functional level. Wellness includes aerobics, strengthening, balance, and flexibility, so class offerings should include all of these components as well.
Benefits of physical therapy are demonstrated by outcome measures. The same is true for group exercise classes. Outcome measures are part of the assessment and re-assessment and should be used to track progress and to market the programs.
Most importantly, these offerings need to be successful long term, which means they have to be fun! No one will want to come for very long if they are not having fun. This is where physical therapy knowledge and exercise should mix with music and creativity to keep our patients well.
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16. Duncan RP, Earhart GM. Randomized controlled trial of community-based dancing to modify disease progression in Parkinson disease. Neurorehabil Neural Repair. 2012 Feb; 26(2):132-143.
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Patrice Hazan, PT, DPT, GCS, MA, has a doctorate in physical therapy from Des Moines University and a master’s degree in gerontology from Roosevelt University. In addition, she is a board-certified geriatric clinical specialist and a member of the Academy of Geriatrics with the American Physical Therapy Association as well as a member of the Private Practice Section of the APTA. She is the owner, founder, and chief executive officer of GroupHab Physical Therapy and Wellness. With a love and passion for wellness, she has created a geriatric private practice around holistic care and postrehabilitation wellness exercise classes.