A theoretical model for exercise progressions
Blanchard & Glasglow’s rehabilitation models (Blanchard & Glasglow, 2014; Blanchard & Glasglow, 2017) can be utilised for visually understanding progressions/regression of exercises (Fig. 1 & Fig. 2).
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Brody & Hall's exercise progression model (Brody & Hall, 2010) can be used to understand how to progress exercises.
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These models can be used as adjuncts to the framework of exercise prescription.
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Figure 1. A theoretical model to describe progressions and regressions for exercise rehabilitation. (Blanchard & Glasgow, 2014).
Figure 2. (Blanchard & Glasgow, 2017). Blanchard and Glasgow’s model applied to a larger rehabilitation programme with multiple facets of exercise intervention.
1.
Consider the stage of healing, relevant impairments and appropriate contextual factors to create goals
List the goals of rehabilitation that will lead to achieving functional goals along the vertical axis.
These goals will be both achievable and challenging and can be an individual skill, or a set of skills e.g. improve ROM or hopping or return to running.
2.
Considerations to acknowledge when creating an initial program include (Brody & Hall, 2010):
- Which muscle groups require training, which other muscles work with it, and which contraction type is needed for functional activities
- What range or position does the muscle have to function? At what speed?
- What type of training is required? i.e. strength, endurance, power or hypertrophy
- What is the patient's training history/current status?
- What is the most appropriate way to load tissues for this patient given their history/current status?
- What precautions are present?
- What stage is healing is most likely?
Prescribe the starting exercise
The first triangle (1) of Blanchard & Glasgow's model is the safest and most controlled level of the exercise. The (1) doesn’t fundamentally change throughout the rehabilitation.
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The exercise in this first triangle will stay as an exercise where implicit processes are dominant (i.e. an external stimulus is not added yet).
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Advancing through the rehabilitation requires progressing exercises. This is represented within the model through the red arrows OR the boxes added to the initial triangle and denoted by '(2), (3), (4)' etc...
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Rehabilitation programs should always aim to be low-risk, high demand (Mendiguchia & Brughelli, 2011).
3.
NOTE: It is common in patients who are at later stages of rehabilitation and demonstrate stable symptoms, to progress exercises using a flexible approach with an increase in volume being balanced concomitantly with a challenge variable.
Conversely, if the patient demonstrates unstable symptoms, exercise changes should be kept to a minimum to ensure changes to symptoms can be identified and modified.
Progress the exercise
Ultimately, there are two overarching ways to progress the initial exercise to continuously challenge the patient but must remain in balance with exercise load and daily load (optimal loading) (Fig. 3 below).
1. Increase the total exercise volume.
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Can be applied by increasing frequency, intensity or duration when:
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the current volume is tolerated by the patient without an increase in symptoms
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The amount of volume increased depends on the current function versus the functional goal (Brody & Hall, 2012)
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An increase in volume is represented by the red arrows throughout the above models
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2. Change the exercise challenge without directly increasing total exercise volume.
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Can be applied when:
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an increase in volume may not be indicated because of tissue healing stages, OR
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if an increase in volume exacerbates the patients symptoms, OR
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if patient contextual factors inhibit the ability to increase volume i.e. physical job
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Try to apply the principle of specificity with the functional goals in mind i.e muscle contraction type or starting position​
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NOTE: While volume is not directly manipulated, the type of stress on tissues is changed and challenges the motor control of the initial exercise. Therefore, there should be a concurrent regression in the duration, speed, distance and other parameters previously prescribed to protect healing tissue and to minimise potential overloading.
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4.
This process is repeated until ‘end-stage’ rehabilitation, where components can be interchanged, removed or added at any point throughout and the athlete/patient begins to incorporate components of different goals, into more sports-specific skills and is represented in Fig. 2 above.
For example, including a strength exercise with balance exercise. This is represented through the merging of colours between various goals and represents the non-linear type process of rehabilitation.
5.