DeLateur defined therapeutic exercise as the prescription of physical movement to correct a deficit, improve musculoskeletal function, or maintain good physical condition.

Therapeutic exercises can range from specific activities targeting certain muscles or body parts to more general and vigorous activities that can help a person reach their optimal physical condition.

Goals of therapeutic exercise:

  • Joint mobilization

  • Improvement of stiff muscles, tendons, fascia

  • Joint range of motion enhancement

  • Improved circulation

  • Improved respiratory capacity

  • Enhanced coordination

  • Reduced stiffness

  • Better balance

  • Promotion of relaxation

  • Increased muscle strength and, if possible, achieving and maintaining maximal voluntary contraction (MVC)

  • Enhanced exercise performance and functional capacity (endurance)

The last two goals reflect overall individual physical fitness, which is characterized by good muscle strength combined with endurance. Regardless of the type of exercise initially required and applied to treat a specific condition, the final goal of rehabilitation is to achieve, whenever possible, an optimal level of physical fitness by the end of therapy.

Medical Assessment

Before beginning an exercise program for fitness or intensive therapeutic purposes, a patient should undergo a medical evaluation, including a detailed history, thorough clinical examination, and appropriate lab tests. In cases of cardiac history, it’s essential to rule out valvular disease, ventricular hypertrophy, dangerous arrhythmias, and benign hypertension.

Approach Theories

Therapeutic exercise aims to achieve and maintain physical fitness and includes the following categories, each with a specific purpose:

  • Endurance exercise

  • Resistance exercise

  • Flexibility exercise

Endurance Exercise

An endurance program includes three variables: frequency, intensity, and duration. According to the American College of Sports Medicine (ACSM):

  • Frequency: Aerobic exercise 3–5 times/week

  • Intensity: 64/70–94% of HR max, or 40/50–85% of VO₂ reserve (VO₂ R) or HR reserve (HRR)

  • Duration: 20–60 minutes of continuous or interval aerobic activity (at least 10-minute bouts summing up during the day). Lower intensity activities should last longer (≥30 minutes), while higher-intensity ones should last at least 20 minutes. Longer moderate-intensity sessions are recommended for non-athletes.

Application in Healthy Individuals

Recommended exercises should involve large muscle groups, be aerobic in nature, and be performed continuously, such as walking, jogging, running, dancing, stair climbing, cycling, swimming, rowing, skating, jumping, aerobic classes, and cross-country skiing.

Exercise Session Components:

  • Warm-up period (~10 min): Stretching and progressive aerobic activity to increase HR near target

  • Endurance activity (20–60 min)

  • Cool-down (5–10 min)

Application in Patients

In high-risk patients (e.g., cardiac or respiratory conditions), a less intense program should be used, ensuring HR doesn’t exceed 50–60% of VO₂ max or 130 bpm if VO₂ data is unavailable. Exercise plans must be individualized following medical evaluation.

Progression

Progression is essential for continuous improvement. In endurance training, this can be achieved by increasing either intensity or duration.

Resistance Exercise

Resistance training improves strength, walking speed, stair-climbing endurance, balance, lean mass, and reduces fat. It positively affects risks associated with coronary artery disease, osteoporosis, diabetes, and cancer. It also helps reduce low back pain and related injuries.

Forms of Resistance Exercise:

  • Isotonic: Dynamic movement with constant load but uncontrolled speed; includes free weights and machines.

  • Isometric: Static contraction without movement; useful when joint motion is painful or contraindicated.

  • Isokinetic: Controlled movement at constant angular velocity using machines like Cybex, creating maximal tension throughout the motion.

PNF Technique

Proprioceptive Neuromuscular Facilitation is a technique that strengthens muscles by applying resistance to muscle contractions. It is suitable for patients with upper motor neuron lesions and spasticity, as well as for initiating contraction in cases of peripheral nerve injuries.

Flexibility Exercise

Flexibility exercises maintain or improve joint range of motion. They should be slow, controlled, and progressive.

Three main types:

  • Static stretching: Hold muscle at mild discomfort for 15–30 seconds; low injury risk.

  • Dynamic stretching: Uses bouncing movements, which carry a higher risk of strain.

  • PNF stretching: Alternates contraction and relaxation for maximum flexibility gains; typically requires a trained therapist.

Stretching Frequency

At least 2–3 times/week. For each stretch: 2–4 reps of 15–30 seconds static or 6 seconds contraction followed by 10–30 seconds assisted PNF stretch. Include during warm-up or cool-down.

AAROM Exercises

Used when muscles are weak or joint pain limits motion. Avoid forcing joints/tissues past pain thresholds.

PROM Exercises

Applied when patients can’t actively move. Passive range of motion helps prevent stiffness and contractures using manual or machine-assisted stretching.