Chapter 5

Exercise Therapy for Physical Therapist

Naruemon Leelayuwat

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.68390

Abstract

This chapter describes exercise therapy in terms of definition, objectives, concept, tech-
niques, mechanisms, and equipment. Mechanisms explaining the effect of exercise train-
ing on treatments for other diseases are included. In addition, new biomarkers capable
of evaluating exercise performance capacity and progress in training and early detection
of overtraining are provided. Very promising are mainly small non‐coding microRNAs
(miRNAs). Important background knowledge for exercise therapy is also provided. The
knowledge covers the exercise for healthy and unhealthy people. The former includes
sedentary and sport player. The latter includes patients with various diseases, for exam-
ple, metabolic diseases, cardiovascular disease, orthopedics, etc. Importantly, all the
knowledge was presented in latest information.

Keywords: physical activity, physical therapy, movement, oxidative stress, microRNA,

sports, diseases

1. Introduction

Exercise therapy is defined as a regimen or plan of physical activities designed and prescribed
to facilitate the patients to recover from diseases and any conditions, which disturb their
movement and activity of daily life or maintain a state of well‐being [1] through neuro re‐
education, gait training, and therapeutic activities. It is systemic execution of planned physi-
cal movements, postures, or activities intended to enable the patients to (1) reduce risk, (2)
enhance function, (3) remediate or prevent impairment, (4) optimize overall health, and (5)
improve fitness and well‐being [2].

© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
76 Clinical Physical Therapy

This therapy may relate specific muscles or parts of the body, to general and strenuous activi-
ties that can return a recovering patient to the peak of physical condition. It is highly repeti-
tive and intensive and requires time and dedication on the part of the patients to encourage
neuroplasticity. The therapy is performed by professionals with an educational background
in exercise physiology, exercise science, or other similar degree. To succeed goal‐oriented
treatment, the personnel must [2].

1. Provide comprehensive and personalized patient/individual management.

2. Implement a variety of therapeutic interventions that are complementary (e.g., heat appli-
cation before joint mobilization and passive stretch, followed by active exercise to use new
mobility in a functional manner).

3. Rely on clinical decision‐making skill.

4. Promote patients’ independence whenever possible through the use of home manage-
ment, self‐management exercise programs, and patient‐related instruction.

In-house physical therapy by family, friends, or caregivers to deliver the appropriate exercise
therapy in the home can greatly decrease healthcare costs which may limit the intervention.
Therefore, training and educating these persons are important in effective exercise therapy.

Exercise therapy can be called Activity‐Based Therapy, Activity‐Based Recovery Therapy,

Neuro‐based Therapy, and Restorative Therapy.

1.1. Important background knowledge to understand exercise therapy

Background knowledge needs to be understand [3].

Planes of movement

There are three planes of movement.

a) Movement in horizontal plane (transverse plane): This plane divides the body into upper
and lower halves. Movements in transverse plane occur parallel to ground.

b) Movement in frontal plane (coronal plane): This plane divides side to side movements, for
example, bringing the head to each of the shoulders.

c) Movement in vertical plane (sagittal plane): It is the plane that divides the body or body
segment into the right and left parts. Movements in this plane include forward and back-
ward motions such as nodding of the head.

Kinematics is the area of biomechanics that include description of motion without regard for
the forces producing it. They include.

a) Types of motion. There are four types of motion:

• Rotatory motion, which is the movement of an object around a fixed axis in a curved path.
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• Translatory motion, which is the movement of an object in a straight line.

• Curvilinear motion, which is a combination of rotatory and translatory motions.

• General plane motion, which the object is segmented and free to move.

b) Location of motion: Motion at a joint may occur in transverse, frontal, or sagittal planes.
c) Direction of motion: Movement may occur either in clockwise or anticlockwise direction.

d) Magnitude of motion can be given either in degrees or radians.

Kinetics is biomechanics that concerned with the forces maintaining equilibrium or producing
motion and are described as either external or internal forces.

Center of gravity (COG) is the point which the force of gravity acts effectively independently
on position of body. The COG of human body lies approximately at S2, anterior to sacrum.

Line of gravity (LOG) is the line that lies vertically through center of gravity.

Base of support is the area which is supported.

Equilibrium results when the forces acting upon a body are balanced and the body remains at
rest.

Fixation and stabilization: Fixation is the state of immobility, and stabilization is the state of
relative immobility.

Force is that which alters the state of rest of a body or its uniform motion in a straight line

Lever is a rigid bar that rotates around on axis.

Mechanical advantage is efficacy of force in relation to lever depends on two factors.

Pulley is a grooved wheel which rotates about a fixed axis by a rope that passes round it. The
axis is supported by a frame work or block. There are two types of pulleys: (1) fixed pulleys
and (2) movable pulleys.

Starting position is the first posture before the following movement during the exercise ther-
apy. There are five fundamental starting positions: standing, kneeling, sitting, lying, and
hanging. Equilibrium and stability are maintained in these positions by balance of forces act-
ing upon the body.

2. Objectives of exercise therapy

The objectives of exercise therapy are as following;

a) Promote activity and minimize the effects of inactivity, increased independence

b) Increase the normal range of motion.

78 Clinical Physical Therapy

c) Improve strength the weak muscles.

d) Improve the performance in daily activities.
e) Enable ambulation.

f) Release contracted muscles, tendons, and fascia.

g) Improve circulation.
h) Improve respiratory capacity.

i) Improve coordination.
j) Reduce rigidity.
k) Improve balance.
l) Promote relaxation.
m) Increased motor or sensory function.
n) Reduction of medication, reduction of hospital visits, and increased overall health.

The most important goal of exercise therapy is an optimal level of physical fitness by the end
of the intervention. The physical fitness a state characterized by good muscle strength com-
bined with good endurance.

3. Concept

Exercise therapy based on the independent movement which depends on individual goals.
It aims to improve the ability to achieve optimal daily functioning. To achieve the goal
of exercise therapy, the practitioner needs to understand the disablement process which
include [4]
The disablement process

a) Impairment: A loss or abnormality of anatomic, physiologic, or psychologic structure or

function.

b) Functional limitation: A limitation of the whole person performance, task in an efficient,

typically expected, or competent manner, or a physical action activity.
c) Disability: The inability or a limitation to perform the performance of actions, or tasks.

There are three models of the disablement process:

a) World Health Organization’s (WHO) International Classification of Impairments, Disabili-

ties, and Handicaps (IDICH) [5].
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b) NAGI scheme [6].

c) Modified disablement model [2]. This model exhibits the complexity of the relationships
among pathology, impairments, functional limitations, disability, risk factors, interven-
tions, quality of life, and prevention, wellness, and fitness.

4. Patient management

Physical therapist’s approach to patient management involves examination, evaluation, diag-

nosis, prognosis, and intervention [2].

4.1. Therapeutic exercise intervention model

A three‐dimensional model has been created to assist the clinician in the clinical decision‐
making process regarding exercise prescription. The model includes

Elements of the movement system: These elements relate to the purpose of each activity or
technique

a) Support

b) Base

c) Modulator

d) Biomechanics

e) Cognitive/affective

The specific activity or technique chosen

a) Posture

b) Mode

c) Movement

The specific dosage

a) Type of contraction

b) Intensity

c) Speed

d) Duration

e) Frequency
80 Clinical Physical Therapy

f) Sequence

g) Environment

h) Feedback

The therapist must continually monitor the exercise to determine the need for modification
to increase or decrease difficulty to ensure continual progress is being made with minimal
setbacks. In addition, exercise therapy can be complemented with adjunctive interventions
if the additional intervention can lead to a higher level of functional outcome in a short time.

5. Techniques

The techniques of exercise therapy used in treatment may be classified as follows [7].

5.1. Passive movement

Passive movements

Passive movements (Motion Therapy, Continuous Passive) provide continuous passive

motion to the applied joint. The apparatus can be used immediately after the operation to
improve the range of motion, reduce pain, discomfort, and healing. This machine is adjust-
able, easily controlled, versatile, and usually electrically operated.

a) Relaxed passive movements

The physiotherapist performed these movements for the patients. The physiotherapist needs
knowledge of the anatomy of joints. The same direction and range of the movements are the
same as those performed in the active movements. The physiotherapist moves the joint d
through the existing free range and within the limits of pain.

b) Accessory movements

These movements are parts of any normal joint movement but may be absent or limited in
abnormal joint conditions. They consist of rotational or gliding movements which cannot be
separately performed as a voluntary movement but can be performed by the physiotherapist.

Passive manual mobilization techniques

a) Mobilizations of joints

The physiotherapist performed these movements which are usually small repetitive oscilla-
tory, rhythmical, localized functional, or accessory in various amplitudes within the available
range. These can be done quite strongly or very gently and are graded according to the part
of the available range in which they are performed.
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b) Manipulations of joints

- Physiotherapists

The movements are performed by the physiotherapist. They are accurately localized, single,
quick decisive movements, which have small amplitude and high velocity completed before
the patient can stop it.

- Surgeon/physician

The movements are performed by a surgeon under anesthesia or physician to receive further
range. The maintaining of the increase in movement must be performed by the physiotherapist.

c) Controlled sustained stretching of tightened structure:

The increase in range of movement can be done by passive stretching of muscles and other
soft tissues. The stretching adhesions in these structures and lengthening of muscle increase
the movement by inhibition of the tendon protective reflex.

5.2. Active exercise

Movement performed or controlled by the voluntary action of muscles, working in opposi-

tion to an external force

Voluntary

a) Assisted active exercise

In this type of exercise, the patient tries to perform the movement by himself/herself. However,
his/her muscular action is insufficient for the production or control of full range of movement.
To complete it, an external force needs to be added. If the muscle power increases, the assis-
tance given must decrease.

b) Free exercise

Free exercises are those which are performed by the patient’s own muscular efforts without
the assistance or resistance of any external force, other that of gravity.

c) Assisted‐resisted exercise

This type of exercise constitutes a combination of assistance and resistance during a single
movement.

d) Resisted exercise

The external force may be applied to the body levers to oppose the force of muscular contrac-
tion and there will be increase in muscle power and hypertrophy.
82 Clinical Physical Therapy

Resisted exercise technique is classified into six major categories:

• Endurance training

• Resistance training

• Muscle stretching exercises (flexibility training)

• Balance training
• Coordination training

• Agility training
• Body mechanics and awareness training

• Enhance function
• Gait and locomotion training
• Plyometric exercise (power training)

Exercise preparation

Before exercise training, a patient should be evaluated by a physician. It is important to

exclude patients with ventricular hypertrophy, valvular heart disease, dangerous arrhyth-
mias, and malignant hypertension. Other cardiac cases, and patients at risk, such as those
with exercise‐induced asthma, obesity, or diabetes, should perform an exercise stress test
under careful medical supervision. Blood pressure and heart rate and the electrocardiogram
(ECG) must be monitored throughout the exercise to confirm their cardiovascular function.

Aerobic or endurance training

In endurance training program, there are three important variables, including frequency,
intensity, and duration. The recommendations by the American College of Sports Medicine
(ACSM) are as follows:
• Frequency—Appropriate frequency of the aerobic exercise should be 3–5 days per week.
• Intensity of training—64/70—94% of maximum heart rate (HR max), or 40/50—85% of
maximum oxygen uptake reserve (VO2R) or heart rate reserve (HRR).

• Duration of training—The appropriate duration of training should be intermittent

or continuous aerobic exercise for 20–60 min (minimum of 10‐min bouts accumulated
throughout the day).

The duration of training is dependent on the intensity of the exercise. Thus, lower‐intensity
exercise should be performed over longer duration (≥30 min), and conversely, higher levels of
intensity should be performed at least 20 min or longer. Moderate‐intensity exercise of longer
duration is recommended for untrained adults, because total fitness is more readily attained
with exercise sessions of longer duration and because potential hazards and adherence prob-
lems are associated with high‐intensity activity.
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Exercise for healthy individuals

Continuously aerobic exercises that use large muscle groups are recommended including
western and eastern style:

Western style

• Cycling

• Swimming

• Walking

• Running

• Jogging

• Aerobic dance/exercise classes

• Dancing

• Stair climbing

• Rowing

• Skating

• Jumping rope

• Cross‐country skiing

Eastern style

• Tai chi

• Yoga

• Arm swing exercise (Figure 1)

• Wand exercise (Figure 2)

The maximal HR can be calculated by the following formula: HR max = 220 – age.

The exercise session should consist of three periods. Starting with a warm-up period of
approximately 10 min which combines calisthenic-type stretching exercises (without equip-
ment). This follows by progressive aerobic activity that should increase the heart rate close to
the prescribed heart rate for the session. Then, endurance training at the targeted heart rate
for 20–60 min is performed and following by a cool‐down period of 5–10 min.

Exercise for patients

A less strenuous exercise training regimen must be used, with the training heart rate not
exceeding 50–60% of maximum O2uptake (VO2max) or a heart rate of 130 beats per minute (/
min). In elderly patients and patients at risk, the intensity, frequency, and duration of therapeu-
tic exercise should be established for each patient individually with medical evaluation before.
84 Clinical Physical Therapy

Figure 1. Arm swing exercise.

Figure 2. Wand exercise.
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Karvonen method should be employed to determine the target heart rate for the ill or elderly
patient: Target HR = (220—age—resting heart rate × % intensity selected) + resting HR.

Progression

In endurance training, progression can happen by increasing the intensity or the duration.
Several factors affecting the suitable rate of progression including age, current activity levels,
exercise goals, and physiologic limitations should be considered. Most importantly, progres-
sion rate should be used that results in long‐term participation. Being too aggressive can
increase dropout rates because of injuries and/or perceived excessive discomfort. In addition,
a progression of balance ability can be enhanced more by the exercise on the unstable support
surface than exercise on the stable support surface.

a) Special techniques There are many special techniques used in exercise therapy [6]

• Frenkel’s exercises are used to treat the incoordination which results from many other
diseases, for example, disseminated sclerosis. Dr. H.S. Frenkel was Medical Superinten-
dent of the Sanatorium “Freihof” in Switzerland toward the end of the last century.

• Proprioceptive neuromuscular facilitation (PNF) is an approach in which treatment is di-

rected at a total human being, not just at a specific problem or body segment. This meth-
od was developed by Dr. Herman Kabat and Ms. Margaret Knott in 1946 and 1951 [7].

• Hydrotherapy refers to the use of multi‐depth immersion pools or tanks that facilitate the
application of various established therapeutic interventions including stretching, joint
mobilization, strengthening, etc.

• Breathing exercises are designed to retrain the muscles of respiration, improve ventila-
tion, lessen the work of breathing, and improve gaseous exchange and patient’s overall
function in daily living activities.

6. Mechanisms

Uptodate, there are many mechanisms explaining the beneficial effects of exercise therapy.
These include enhancing antioxidant defenses. Very promising are mainly small non‐coding
microRNAs (miRNAs).

6.1. Mechanisms that enhance antioxidant defenses

An important mechanism that contributes to many disease is oxidative stress [8], although
exhaustive and/or unaccustomed exercise in both aerobic and anaerobic exercise can gener-
ate excessive reactive oxygen species (ROS) according to mitochondrial enzymes, NADPH
oxidases, and xanthine oxidases. This results in oxidative stress‐related tissue damages and
impaired muscle contractility. Moderate exposure to ROS is needed to induce adaptive
responses of the body such as the activation of antioxidant defense mechanisms [9]. Regular
86 Clinical Physical Therapy

exercise is well known to benefit health by enhancing antioxidant defenses in the body [10],
thereby leading to a reduced generation of free radicals both at rest and in response to exer-
cise stress. Therefore, exercise training‐induced antioxidant activity decreases risk of many
diseases.

In the elderly, sarcopenia is characterized by structural, biochemical, molecular and functional

muscle changes. An imbalance between anabolic and catabolic intracellular signaling path-
ways and an increase in oxidative stress both play important roles in muscle abnormalities.
Regular exercise is promoted as a therapeutic strategy for age‐associated endothelial dysfunc-
tion. However, sex was shown to affect the antioxidant response in the elderly. Improvements
in endothelial function are found with endurance exercise in older men, but are reduced or
absent in older women. This may be due to sex hormones modulating vascular adaptations to
exercise training by influencing antioxidant defense systems, mitochondrial function, oxida-
tive stress, and intracellular signaling [11].

6.2. Mechanisms that decrease the risk of developing cancer

In addition, exercise is known to be one of several lifestyle factors that lower the risk of cancer
and is associated with lower relapse rates and better survival. The indirect effects included
changes in vitamin D, weight reduction, sunlight exposure and improved mood. The direct
effects included insulin‐like growth factor, epigenetic effects on gene expression and DNA
repair, vasoactive intestinal peptide, and antioxidant pathways, heat shock proteins, testos-
terone, irisin, immunity, chronic inflammation and prostaglandins, energy metabolism and
insulin resistance [12].

6.3. Mechanisms that are responsible to cardioprotection

Importantly, exercise protects cardiovascular system through the modulation of

a) cardiac performance directly,

b) endothelial and vascular functions,

c) systemic risk factors. Both moderate‐ and high‐intensity exercise training were shown to
improve aerobic capacity of metabolic syndrome patients [13].

Moreover, Wand Exercise which is Thai mode of exercise significantly reduced body mass,
total fat mass, waist and hip circumferences and increased flexibility, functional capacity
(determined by 6MWD), physical health dimension and vitality of mental health dimension
of the QOL [14]. The results showed that Thai Wand Exercise training decreased obesity,
improved physical health status, and vitality. Therefore, this easy and low impact exer-
cise program is a good approach to reduce cardiovascular risks. Data on cardioprotective
effects of low‐intensity exercise are controversial. This could be due to the fact that low‐
intensity exercise may not meet the recommended minimum threshold of exercise intensity
form improving cardiorespiratory endurance [15]. However, our research group found that
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low‐intensity exercise improved aerobic capacity of overweight and normal weight sed-
entary young adults [16]. Exercise also mediated improvement in hyperglycemia‐induced
cardiovascular dysfunction in patients with type 2 diabetes [10]. Exercise training also
improved insulin resistance‐induced lipotoxicity, mediated protection against pro‐inflam-
matory cytokines and improved pro‐survival signaling cascade. An appropriate duration
and intensity of exercise can decrease myocardial dysfunction through the improvement
of maximum oxygen consumption (VO2max), left ventricular ejection fraction (LVEF), LV
diastolic and systolic volumes, ventilatory threshold, cardiac output and diastolic function
(E/A ratio) [13, 17–25].

6.4. Mechanisms that improve respiratory function

Exercise training has been shown to improve pulmonary function in patients with type 2 dia-
betes [26]. Exercise training improves exercise tolerance and health‐related quality of life in
patients with very severe COPD [27]. RME training led to a significant increase in respiratory
muscle endurance in children with CF [28]. In addition, pulmonary rehabilitation reduced
expiratory flow limitation (EFL) in COPD patients [29].

6.5. Mechanisms that treat orthopedic patients

A systematic review revealed that short‐term Traditional Chinese exercise (TCE) was poten-
tially beneficial in terms of reducing pain, improving physical function and alleviating stiff-
ness for patient [30]. In individuals operated with total knee arthroplasty, the 12‐month
progressive home exercise program starting 2 months after the operation comparing to usual
care improved maximal gait velocity, cadence and stance time [31]. This may be due to exer-
cise loading in the cartilage‐subchondral bone (SB) unit in attenuation of post‐traumatic
osteoarthritis development [32].

6.6. Mechanisms that mediate differential expression of microRNAs

MicroRNA is a non‐coding RNA which is increasingly interesting from scientists in many

fields including Physical therapist [33]. It has been shown to regulate many process in our
body, for example, muscle‐specific miRs (miR‐1, miR‐133 and miR‐499), the vascular wall of
the vascular smooth muscle cells miR‐222, EC miR‐126, and the pathophysiology of Diabetic
heart disease.
Exercise training, both acute endurance and resistance in healthy male volunteers, was shown
to enhance miR‐133 expression in the vastus lateralis muscles [34, 35]. Moreover, endurance
exercise elevated circulating levels of miR‐133 in healthy individuals after either an acute bout
of aerobic exercise, or endurance training [36, 37]. Marathon training also increased miR‐133
level which is appeared to be associated with improved VO2max [38]. Similarly, T2DM mice
which did a 10‐week swimming exercise had increased miR‐133 expression in cardiac tissue.
Their contractile function improved and matrix metallopeptidase‐9 (MMP‐9), an extracellu-
lar matrix regulator protein decreased [39]. Since miR‐133 is reported to be expressed and
enriched in both cardiac and skeletal muscles [40], it is possible that miR‐133 is secreted from
88 Clinical Physical Therapy

skeletal muscle into the circulation after a bout of exercise, which then travels to the cardio-
myocytes to suppress fibrotic markers and reduce cardiac hypertrophy.

6.7. Mechanisms that treat neurological patients

In Parkinson’s disease patients, aerobic exercise training [28] may be altering central nervous
system pathways that regulate the physiologic or cognitive processes controlling olfaction
[41]. In spinal cord injury patients, the exercise training has been considered to improve spinal
cord function not only through enhancement, compensation, and replacement of the remain-
ing function of nerve and muscle but also improve the function in different levels from end‐
effector organ such as skeletal muscle to cerebral cortex through reshaping skeletal muscle
structure and muscle fiber type, regulating physiological and metabolic function of motor
neurons in the spinal cord and remodeling function of the cerebral cortex [42].

7. New biomarkers capable of evaluating exercise performance capacity

and progress in training

1. Blood biomarkers—include glutamine, glutamate, cortisol, IL‐6, testosterone, cholesterol,

glucose, leptin, cortisol, ACTH, hematocrit, hemoglobin, norepinephrine, epinephrine, im-
munological parameters, and creatinine kinase.

2. Physiological measurements—include resting heart rate, resting systolic blood pressure,

and resting diastolic blood pressure but not heart rate variability.

3. Psychological measurements—include mood states for tension, fatigue, confusion, reac-

tion time, vigor, anger, and depression. Such parameters may reflect a highly individual
nature of the psychological response to overtraining. However, a trend for impaired sleep
patterns, increased wakefulness, decrements and stability in sleep quality and increased
levels of stress may be observed.

miRNAs meet most of the requirements for good biomarkers, such as easily accessible sample
collection, minimally invasive and remarkable stability in body fluids. In addition, miRNAs
affect many processes and play a crucial role not only in cell differentiation, proliferation
and apoptosis, but also affect extracellular matrix composition and maintaining processes
of homeostasis. They play significant role in the regulation of physiological adaptation to
exercise, such as skeletal muscle and cardiomyocyte hypertrophy, mitochondrial biogenesis,
vascular angiogenesis and metabolic processes [33].

8. Early detection of overtraining

Some patients may perform the prescribed exercise program too hard leading to overtraining
[43, 44]. Such overload can result in fatigue and acute decreases in performance either directly
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after a single intense training session, or following the training. However, in the normal course
of training and recovery, this overload then leads to a positive response, adaptation, and conse-
quent improvement in performance. If the balance between overload and recovery is not man-
aged properly, a positive training response does not occur and performance is not enhanced.
To reach a true diagnosis of overtraining syndrome, it is necessary to exclude the presence of
non‐communicable diseases (e.g., disorders involving the thyroid or adrenal gland, anemia,
diabetes, and iron deficiency), infectious diseases (e.g., hepatitis, myocarditis and glandular
fever), and other major disorders or feeding behaviors (e.g., bulimia and anorexia nervosa). In
addition, Psychomotor speed: possibly a new marker for overtraining syndrome.

Additional information

However, up-to-date there has been slight improvement in the tools available for the diagno-
sis of overtraining syndrome [45, 46]

9. Equipment

There are many kinds of equipment for exercise therapy including [7]:

a) Hydrotherapy equipment (tank, bath, chair).

b) Electrotherapy (shortwave medical diathermy, muscle stimulator, interferential therapy

unit, ultrasound therapy unit, transcutaneous nerve stimulation.

c) Heat and cold therapy equipment (paraffin wax bath, moist heat therapy unit, moist heat
therapy unit, stream/hot pack, infrared lamp).
d) Treatment equipment (massage cum treatment table, hi‐low mat platform, tilt table, ­activity
mattress, continuous passive motion unit, medicine ball, parallel bar, equilibrium board).

e) Multi exercise therapy unit (complex exercising unit).

f) Shoulder, arm, hand, leg, knee, foot exercise unit.

g) Suspension unit.

h) Mobility aids (Walkers, crutch, cane).

i) Massage: Massage signifies a group of procedures, which are usually done with hand
on the external tissue of the body in a variety of ways either with a curative, palliative or
hygienic point of view.

• To improve mobility of the soft tissues.

• To reduce muscle spasm and pain under abnormal conditions.

90 Clinical Physical Therapy

• To reduce edema.

• To increase circulation.

• To mobilize secretions in the lung.

• To induce local and general relaxations.

Acknowledgements

I appreciate Khon Kaen University for providing me a grant, opportunity, and facility to write
this chapter. I thank Exercise and Sport Sciences Development and Research Group for the
financial support for this chapter. Moreover, I also thank all participants for their excellent
participation in my researches.

Author details

Naruemon Leelayuwat

Address all correspondence to: [email protected]

Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;
Exercise and Sport Sciences Development and Research Group, Khon Kaen University, Khon
Kaen, Thailand

References

[1] Kottke FJ, Stillwell GK, Lehmann JF, editors. Krusen’s Handbook of Physical Medicine
and Rehabilitation. 3rd ed. Philadelphia, Pa: WB Saunders Co; 1982

[2] Hall CM, Brody LT. Therapeutic Exercise: Moving Toward Function. 2nd ed. Philadelphia:
Lippincott Williams & Wilkins; 2005

[3] http://bie.telangana.gov.in/Pdf/Biomechonics.pdf [Accessed: December 12, 2016]

[4] American Physical Therapy Association. A guide to Physical Therapist practice, I: A

description of patient management. Physical Therapy. 1995;75:709–764

[5] World Health Organization. International classification of impairments, disabilities, and

handicaps: a manual of classification relating to the consequences of disease, published
in accordance with resolution WHA29.35 of the Twenty-ninth World Health Assembly,
May 1976. Geneva 1980

[6] Nagi SZ. Disability, and Rehabilitation. Columbia, OH: Ohio State University Press; 1969
 Exercise Therapy for Physical Therapist 91
http://dx.doi.org/10.5772/intechopen.68390

[7] Nagavani C. Textbook of Biomechanics and Exercise Therapy. Available from: https://
static1.squarespace.com/static/554d3c40e4b04605cb444b18/t/5550e0f2e4b0e93349
b5e684/1431363828551/ [Accessed: December 12, 2016]

[8] Alfadda AA, Sallam RM. Reactive oxygen species in health and disease. Journal of
Biomedicine and Biotechnology. 2012;2012:936486. DOI: 10.1155/2012/9364862012

[9] He F, Li J, Liu Z, et al. Redox mechanism of reactive oxygen species in exercise. Frontiers
in Physiology. 2016;7:486. DOI: 10.3389/fphys.2016.00486

[10] Leelayuwat N, Tunkumnerdthai O, Donsom M, et al. An alternative exercise and its ben-
eficial effects on glycaemic control and oxidative stress in subjects with type 2 diabetes.
Diabetes Research and Clinical Practice. 2008;82:e5–8. Epub 2008 Sep 23

[11] Moreau KL, Ozemek C. Vascular adaptations to habitual exercise in older adults: Time
for the sex talk. Exercise and Sport Sciences Reviews. 2017;45:116-123 Jan 13. DOI:
10.1249/ JES.0000000000000104. [Epub ahead of print]

[12] Thomas RJ, Kenfield SA, Jimenez A. Exercise‐induced biochemical changes and their
potential influence on cancer: A scientific review. British Journal of Sports Medicine.
2016;0:1-8. pii: bjsports‐2016‐096343. DOI: 10.1136/bjsports‐2016‐096343. [Epub ahead of
print]

[13] Tjonna AE, Lee SJ, Rognmo O, et al. Aerobic interval training versus continuous mod-
erate exercise as a treatment for the metabolic syndrome: A pilot study. Circulation.
2008;118:346–54

[14] Puengsuwan P, Promdee K, Sruttabul W, et al. Effectiveness of Thai Wand Exercise train-
ing on health‐related quality of life in sedentary older adults. Chulalongkorn Medical
Journal. 2008;52:120–122

[15] Albright A, Franz M, Hornsby G, et al. American College of Sports Medicine posi-
tion stand: Exercise and type 2 diabetes. Medicine & Science in Sports & Exercise.
2000;32:1345–1360. DOI: 10.1097/00005768‐200007000‐00024. [PubMed] [Cross Ref]

[16] Prasertsri P, Boonla O, Phoemsapthawee J, et al. Arm swing exercise improves exercise
capacity and oxygen consumption in overweight and normal weight sedentary young
adults. JEPonline 2017;20(1):111–124

[17] Brassard P, Legault S, Garneau C, et al. Normalization of diastolic dysfunction in

type 2 diabetics after exercise training. Medicine & Science in Sports & Exercise.
2007;39:1896–1901
[18] Hafstad AD, Boardman NT, Lund J, et al. High intensity interval training alters substrate
utilization and reduces oxygen consumption in the heart. Journal of Applied Physiology.
2011;111:1235–1241

[19] Lee S, Park Y, Zhang C. Exercise training prevents coronary endothelial dysfunction in
type 2 diabetic mice. American Journal of Biomedical Sciences. 2011;3:241–252
92 Clinical Physical Therapy

[20] Dunstan DW, Daly RM, Owen N, et al. High‐intensity resistance training improves gly-
cemic control in older patients with type 2 diabetes. Diabetes Care. 2002;25:1729–1736

[21] Byrkjeland R, Njerve IU, Anderssen S, et al. Effects of exercise training on HbA1c and
VO2 peak in patients with type 2 diabetes and coronary artery disease: A randomised
clinical trial. Diabetes and Vascular Disease Research. 2015;12:325–333

[22] DeBlieux PM, Barbee RW, McDonough KH, et al. Exercise training improves cardiac
performance in diabetic rats. Proceedings of the Society for Experimental Biology and
Medicine. 1993;203:209–213

[23] Broderick TL, Poirier P, Gillis M. Exercise training restores abnormal myocardial glu-
cose utilization and cardiac function in diabetes. Diabetes/Metabolism Research and
Reviews. 2005;21:44–50

[24] De Angelis KL, Oliveira AR, Dall’Ago P, et al. Effects of exercise training on autonomic
and myocardial dysfunction in streptozotocin‐diabetic rats. Brazilian Journal of Medical
and Biological Research. 2000;33:635–641

[25] Rodrigues B, Jorge L, Mostarda CT, et al. Aerobic exercise training delays cardiac dys-
function and improves autonomic control of circulation in diabetic rats undergoing
myocardial infarction. Journal of Cardiac Failure. 2012;18:734–744

[26] Tunkamnerdthai O, Auvichayapat P, Donsom M, et al. Arm swing exercise improved

the pulmonary function of the patients with type 2 diabetes. Journal of Physical Therapy
Science. 2015;27:649–654

[27] Paneroni M, Simonelli C, Vitacca M, et al. Aerobic exercise training in very severe
chronic obstructive pulmonary disease: A systematic review and meta‐analysis.
American Journal of Physical Medicine & Rehabilitation. 2017 Jan 17. DOI: 10.1097/
PHM.0000000000000667. [Epub ahead of print]

[28] Bieli C, Summermatter S, Boutellier U, et al. Respiratory muscle training improves

respiratory muscle endurance but not exercise tolerance in children with cystic fibro-
sis. Pediatric Pulmonology. 2017; 52: 331-336. DOI: 10.1002/ppul.23647. [Epub ahead of
print]

[29] Theodorakopoulou EP, Gennimata SA, Harikiopoulou M, et al. Effect of pulmonary reha-
bilitation on tidal expiratory flow limitation at rest and during exercise in COPD patients.
Respiratory Physiology & Neurobiology. 2017; 238: 47-54. pii: S1569‐9048(16)30260‐9.
DOI: 10.1016/j.resp.2017.01.008. [Epub ahead of print]

[30] Zhang Y, Huang L, Su Y, et al. The effects of traditional Chinese exercise in treating knee
osteoarthritis: A systematic review and meta‐analysis. PLoS One. 2017;12(1):e0170237.
DOI: 10.1371/journal.pone.0170237. eCollection 2017
 Exercise Therapy for Physical Therapist 93
http://dx.doi.org/10.5772/intechopen.68390

[31] Anneli H, Nina SK, Arja H, et al. Effect of total knee replacement surgery and postopera-
tive 12 month home exercise program on gait parameters. Gait and Posture. 2017;53:92–
97. DOI: 10.1016/j.gaitpost.2017.01.004. [Epub ahead of print]

[32] Iijima H, Ito A, Nagai M, et al. Physiological exercise loading suppresses post‐trau-
matic osteoarthritis progression via an increase in bone morphogenetic proteins expres-
sion in an experimental rat knee model. Osteoarthritis Cartilage. 2016 Dec 10. pii:
S1063‐4584(16)30468‐X. DOI: 10.1016/j.joca.2016.12.008. [Epub ahead of print]

[33] Polakovičová M, Musil P, Laczo E, et al. Circulating microRNAs as potential biomarkers

of exercise response. International Journal of Molecular Sciences. 2016 Oct 5;17(10). pii:
E1553

[34] Russell AP, Lamon S, Boon H, et al. Regulation of miRNAs in human skeletal muscle
following acute endurance exercise and short‐term endurance training. The Journal of
Physiology. 2013;591:4637–53

[35] Nielsen S, Scheele C, Yfanti C, et al. Muscle specific microRNAs are regulated by endur-
ance exercise in human skeletal muscle. The Journal of Physiology. 2010;588:4029–37

[36] Nielsen S, Akerstrom T, Rinnov A, et al. The miRNA plasma signature in response to
acute aerobic exercise and endurance training. PLoS One. 2014;9:e87308

[37] Uhlemann M, Mobius‐Winkler S, Fikenzer S, et al. Circulating microRNA‐126 increases

after different forms of endurance exercise in healthy adults. European Journal of
Preventive Cardiology. 2014;21:484–491

[38] Mooren FC, Viereck J, Kruger K, et al. Circulating microRNAs as potential biomark-
ers of aerobic exercise capacity. American Journal of Physiology. Heart and Circulatory
Physiology. 2014;306:H557–H563

[39] Mishra PK, Awe O, Metreveli N, et al. Exercise ameliorates diabetic cardiomyopathy by
inducing beta2adrenergic receptors and miR‐133a, and attenuating MMP‐9. The FASEB
Journal. 2011;25:1032–1034

[40] Rawal S, Manning P, Katare R. Cardiovascular microRNAs: As modulators and diagnos-

tic biomarkers of diabetic heart disease. Cardiovascular Diabetology. 2014;13:44

[41] Rosenfeldt AB, Dey T, Alberts JL. Aerobic exercise preserves olfaction function in
individuals with parkinson’s disease. Parkinson’s Disease. 2016;2016:9725089. DOI:
10.1155/2016/9725089. Epub 2016 Nov 23
[42] Fu J, Wang H, Deng L, et al. Exercise training promotes functional recovery after spinal
cord injury. Neural Plasticity. 2016;2016:4039580. DOI: 10.1155/2016/4039580. Epub 2016
Dec 6

[43] Kreher JB, Schwartz JB. Overtraining syndrome: A practical guide. Sports Health. 2012
Mar;4:128–138
94 Clinical Physical Therapy

[44] Nederhof E, Lemmink KA, Visscher C, et al. Psychomotor speed: Possibly a new marker
for overtraining syndrome. Sports Medicine. 2006;36:817–828

[45] Urhausen A, Kindermann W. Diagnosis of overtraining: What tools do we have? Sports

Medicine. 2002;32(2):95–102

[46] Meeusen R, Duclos M, Foster C, et al. European College of Sport Science; American
College of Sports Medicine. Prevention, diagnosis, and treatment of the overtraining
syndrome: Joint consensus statement of the European College of Sport Science and the
American College of Sports Medicine. Medicine & Science in Sports & Exercise. 2013
Jan;45:186–205. DOI: 10.1249/MSS.0b013e318279a10a