Approach to exercise and disease management

Problem-Oriented Exercise Management (POEM)
-The cornerstone to approaching exercise for individuals with chronic disease and disability
-Developed in the late 1960’s
-Provides a systematic way of organizing extremely complex problems into simpler parts that make them easier to track and solve
– Consists of 5 steps (Collection of subjective data, Obtaining objective data, Assessment, Formulate a plan, Period reassessment (follow-up))
Collection of subjective data
Identifying and describing an individual’s problems in detail is of utmost importance. Medical history including review of past and current physical activity and exercise habits as well as any medical problems. All current medications and results of any recent medical and exercise tests should be obtained. You need to know who you are working with!
Obtaining objective data
Includes information collecting during a physical examinations and from laboratory studies. Once problem or problems have been identified then most appropriate exercise tests can be selected. Tests may provide measurements that confirm or rule out possible causes of symptoms.
Generate list of specific problems from subjective and objective data collected. May explain individual’s problems or lead to further assessment of problems that are not evident. Need to systematically track all problems.
Formulate a plan
Exercise prescription must include both short-and long-term individualized goals. Encouragement of developing SMART goals
Period reassessment (follow-up)
Frequent follow-up at a designated time schedule. May include re-assessments and conduction of exercise tests. Helps with tracking adherence and results of exercise training program as well as progression of symptoms and disease state.
Types of exercise tests
Aerobic tests, Anaerobic tests, endurance tests, strength tests, flexibility tests, neuromuscular tests, functional performance tests
Aerobic tests
Ability to sustain aerobic exercise is very important for completing activities of daily living. Most commonly tests via graded exercise tests. VO2max vs. VO2 peak. Transition from one intensity to another (pt of onset).
Anaerobic Exercise tests
Short-term exercise providing information on capability to do brief periods of high-intensity exercise. May not apply to non-athletic, older populations. Appropriate for athletes preparing for competition.
Endurance Exercise tests
Not many very good clinical endurance exercise tests. Potentially useful to assess exercise capacity of sedentary individuals after an exercise training program. (Ex. max distance walk to fatigue)
Strength Exercise tests
Resistance training incredibly important for those with skeletal muscle deficiencies/ weaknesses. Mode of testing needs to match problems being addressed and client’s situation. Aspects to look at- Max force generation, smoothness of contraction and relaxation, balance of extensor and flexor activation, resistance of fatigue. Often an over looked aspect of CV rehab programs.
Flexibility tests
Range of motion important for muscle force to be applied throughout full joint range during physical movement. Helps protect muscles, joints, and bones from strain and injury. Goniometry is more simple assessment method for flexibility.
Neuromuscular tests
Assessment of coordination and skill. Most useful with individuals with a neuromuscular disability or those with severe debilitation from chronic disease. Typically uses in physical and occupational therapy settings. (Ex. reaction time, hand-eye coordination, gait analysis)
Functional performance tests
Usually task oriented in design. Timed or ranked using a simple scale. May directly relate to mobility and strength of an individual. Should mimic real life, be objective, and be easy to administer.
Summary of exercise test measures
Exercise specialists who work with people with a chronic disease or disability must be able to employ tests of all types. need to use test results in development of exercise program. Some exercise specialists may enhance success by collaboration with other specialists who have complimentary expertise and skills.
SMART goal
Specific- Need to be defined precisely. Measurable- Needs to be quantified. Actionable (achievable)- Needs to be believed/ desired. Realistic- Needs to actually be achievable. Time oriented- Needs to have defined time frame