Evidence regarding Therapeutic Exercise in Physiotherapy

Knowledge of exercise regimes and dosages, and expertise in movement disorders and clinical reasoning skills enable physiotherapists to develop, implement, monitor and modify therapeutic exercise programs. A systematic review on therapeutic exercise, Evidence-based clinical statement: A summary of systematic reviews on therapeutic exercise in physiotherapyshowed that exercise is a beneficial intervention for clients and patients across many different areas of physiotherapy. Exercise programs are more likely to be effective when intensive, individually designed, and linked with regular physiotherapist supervision and follow up.

Physiotherapists commonly teach exercises as part of treatment to help their patients and clients move and function better. Physiotherapists use evidence to update their practice and systematic reviews of the research literature provide the best form of evidence about the efficacy of therapeutic exercise. In a review of whether there is evidence that doing exercises could help improve the functioning of people who see a physiotherapist for treatment forty-nine systematic reviews on therapeutic exercise were found. These reviews showed that therapeutic exercise is beneficial for clients and patients across many areas of physiotherapy practice. Specifically there was strong evidence that therapeutic exercise can:

improve the muscle performance and mobility of people with multiple sclerosis
reduce pain and improve activity levels in people with osteoarthritis of the knee
reduce pain and improve activity levels in people with chronic low back pain
reduce sick leave in people with sub-acute and chronic low back pain
improve activity levels and lead to a faster return to work after lumbar disc surgery
reduce pain, and improve range of motion and activity in people with shoulder pain
reduce cardiac deaths for people with coronary heart disease
reduce deaths and improve exercise capacity in males with stable chronic heart failure
improve exercise capacity and reduce shortness of breath in people with chronic obstructive pulmonary disease
slow bone density loss in the spine of women after the age of menopause

The review demonstrated that therapeutic exercise was more likely to be effective when it was relatively intensive and there were indications that more targeted and individualised exercise programs were more beneficial than standardised programs. There were relatively few and minor adverse responses to exercise revealed in the review.

The types of exercise identified through the review that led to positive benefits included aerobic exercises, strengthening exercises, range of motion exercises, and exercises that practised specific skills such as balance training or the ability to maintain a contraction of certain muscles. In many areas of practice, although people did better with exercise there was no evidence that one type of exercise was more beneficial than another type of exercise.