Assessment of exercise and functional capacity are widely used for the risk stratification and exercise programming parameters for populations undergoing rehabilitation in inpatient and outpatient settings. Physiatry care teams work with physical therapists and exercise physiologists to develop safe, effective, and customized exercise prescriptions for patients with cardiovascular disease, post-MI, organ transplant, chronic debility, stroke, spinal cord injury, traumatic brain injury, orthopedic trauma, chronic pain, and more.
Professional organizations such as the American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) emphasize the essential value and necessary competence in the areas of exercise testing, diagnostics, and prescription as part of rehabilitation care. Counseling is critical in rehabilitation, with emphasis on discussing "current activity level" and "provide advice, support" on PA needs at initial evaluation and follow up.
Publications from the American Academy of Physical Medicine and Rehabilitation (AAPMR) indicate the need for tailored exercise programming to accommodate the special needs of patients with complex conditions. Among patients with spinal cord injury, for example, emphasis of strengthening and stretching of joints and soft tissues may reduce later risk for injury. Among stroke survivors, emphasis of aerobic training and neuromotor components may mitigate future disease and risk for falls.
The application of exercise physiology principles to improving maximal fitness, muscle strength, and neuromotor control and mobility can reduce secondary disease risk and prevent physical disability in rehabilitating populations. Advanced medical knowledge of the nuances relating to early implementation of exercise after various acute events, such as stroke or heart transplant, will enable EMD&T physicians to provide safe, time-appropriate, and meaningful activity guidance with the consideration of special health needs.
The concept of prehabilitation is a form of healthcare intervention that takes place before a medical or surgical intervention with the aim to reduce side effects and complications, and enhance recovery. Exercise is a major component of prehabilitation across a wide range of surgical and medical interventions. In recent years, there has been an exponential increase in clinical studies and trials demonstrating the profound benefits of exercise-based prehabilitation and the importance of physical fitness assessment in the implementation of prehabilitation protocols. EMD&T trainees will play an increasingly critical role in benefiting a diverse and heterogeneous group of patients through accurately monitored prehabilitation activities.