The 2 Mistakes To Avoid With Exercise Prescription

Therapeutic exercise. It's a staple of a physiotherapist's toolbox.

No other intervention has as much research supporting it.

As movement clinicians, we know this. That's why we're always keen to learn a new exercise or identify a fresh twist on the tried and true exercises.

Prescribing the right exercise is important, but there are two big mistakes we make with exercise prescription that impacts the results we get.

A Mistake We're All Guilty of

It's so easy to fall into the trap of giving our patients too many exercises. We can slip into the belief that if three exercises are good, then six would be better. The problem though is giving too many exercises can easily overwhelm our patients and sabotage their recovery process.

With too many exercises, our patients will feel overwhelmed and deflate their motivation. When the 'ask' we make increases, the motivation required by a patient increases as well, making it harder to stay consistent and get results.

Why is it so easy to make this mistake?

It's easy to equate the value we provide as therapists with the number of exercises we give.

More exercises = more value.

It's an easy trap to fall into.

Exercise prescription becomes tied to boosting our self of sense, and decreasing our underlying insecurities.

A glaring hole that impacts patient success

We spend all our time educating our patients on the "what" (which exercises to give) that we skip helping our patients with the "how" & "when" of doing exercises. If a patient doesn't do their exercises or is inconsistent in doing them, then giving more exercises isn't going to help them reach their treatment goals.

Why do we revert to passive treatments with patients?

This is a question I've asked myself a lot over the past few years. I believe most, if not all, of us are strong proponents of active rehab, but there are patients for whom we seem to slide into providing passive treatment approaches.

But why is that? I think it comes down to a breakdown in supporting our patients building consistency with their exercises.

I think there are 5 steps that lead to the Spiral of Exercise Despair:

Step 1: Therapist gives patient exercises

Step 2: The patient doesn't do the exercises or has limited adherence

Step 3: Therapist gives more exercises over the coming sessions.

Step 4: Patient feels bad about not doing exercises and is vague in sharing about challenge with exercise.

Step 5: Therapist sees the lack of progress with exercise and reverts to passive treatments for the patient.

Every Patient is Unique

Approaching exercise prescription the same for an 80-year-old sedentary grandma will be very different than the 28-year-old triathlete.

Of course, that makes sense.

But there are a lot of patients in between those two extremes that we need to adjust our approach to exercise prescription.

What's the capacity of your patient?

When we give too many exercises to our patients, we ignore the exercise capacity of our patients.

When we give them more exercises, we're actually increasing the motivation they need to do those exercises. We have to remember that motivation can be a very fickle friend.

Suppose the patient has limited bandwidth, a lack of history with exercise habits, or maybe just limited energy because of persistent pain. In that case, giving too many exercises will increase the risk of exercise adherence failure. When we increase this risk of failure, we decrease the likelihood of that patient's treatment success.

So what's the answer?

Stay tuned tomorrow morning when I'll talk about how to get better results with our exercise prescription!

To Better Flow,

Andrew

PS Check out my latest podcast that I just released yesterday!