Careers in therapeutic exercise Chapter 13 Careers in therapeutic exercise Chad Starkey

Chapter Objectives Acquaint you with the wide range of professional opportunities in the sphere of therapeutic exercise. Familiarize you with the purpose and types of work done by professionals in therapeutic exercise. Inform you about the educational requirements and experiences necessary to become an active, competent professional in the area. Help you determine if one of these professions fits your skills, aptitudes, and professional desires.

What Is Therapeutic Exercise? Systematic and scientific application of exercise and movement experiences to develop or restore muscular strength, endurance, or flexibility; neuromuscular coordination; cardiovascular efficiency; and other health and performance factors Programmed physical activity aimed at improving or restoring the quality of life Classified as being rehabilitative or habilitative

Core Competencies Core competencies for individuals who provide patient care have been developed by the Health and Medicine Division (formerly the Institute of Medicine) of the National Academies of Sciences, Engineering, and Medicine. Provide patient care. Work in interdisciplinary teams. Employ evidence-based practice. Apply quality improvement. Use informatics.

Reassessing Disability Focuses on what a patient can do; diminishes stigma International Classification of Functioning, Disability, and Health (ICF) (WHO, 2002) (see figure 13.1) Goal of therapeutic exercise professionals: help people restore lost function (rehabilitative therapeutic exercise) or acquire skills and functions considered normal or expected (habilitative therapeutic exercise)

Figure 13.1

Rehabilitative and Habilitative Therapeutic Exercise Defined Rehabilitative therapeutic exercise refers to processes and treatments that restore skills or functions that were previously acquired but have been lost because of injury, disease, or behavioral traits. Habilitative therapeutic exercise refers to processes and treatments leading to the acquisition of skills and functions that are considered normal and expected for an individual of a certain age and status. Professional opportunities in fitness and health were addressed in chapter 12. This chapter considers services for habilitative and rehabilitative therapeutic exercise.

Rehabilitative Therapeutic Exercise Exercise therapy for the rehabilitation of the following: Musculoskeletal injuries Athletic injuries (sports medicine, prehabilitation) Postsurgical trauma Cardiopulmonary rehabilitation Older populations Psychological disorders (mind–body relationship)

Habilitative Therapeutic Exercise Exercise therapy for habilitation of the following: Specialized habilitation (meet standards that exceed rather than merely meet those of the general population such as sport training, military boot camp, fire or police academy) Obese populations Children with developmental disorders General fitness

Sedentary Lifestyles Societal changes have negatively affected the health of a significant portion of the population. The information age has created a relatively sedentary group of people. Therapeutic exercise—even in the form of casual recreation—can offer a more balanced lifestyle.

Settings for Therapeutic Exercise Inpatient facilities (e.g., hospitals, residential facilities) Outpatient clinic settings (e.g., physical therapy offices) Sport team settings (e.g., athletic training clinics) Private practice (entrepreneurial) No matter the setting, you will have opportunities to work with other professionals; indeed, most health care facilities use a team approach in which representatives from several professions collaborate to plan and deliver patient care.

Roles for Therapeutic Exercise Professionals Credentials for each profession vary, overlap, and change regularly. Pay careful attention to the changing required employment standards for education, licensure, and so on. A strong science base and an active clinical education component are critical to your preparation and success. The need for multiskilled and multicredentialed individuals will increase as competition in the health care industry increases.

Athletic Trainer (AT) Responsible for the prevention, evaluation, management, treatment, and rehabilitation of athletic injuries Athletic and clinical settings (continued)

Athletic Trainer (AT) (continued) Education and credentials As of 2022, ATs seeking national certification must graduate from an entry-level master’s degree program accredited by Commission on Accreditation of Athletic Training Education (CAATE) Board of Certification (BOC), Canadian Athletic Therapists Association (CATA) Employment opportunities High schools, colleges/universities, pro sport teams, hospitals, sports med clinics, industrial rehab, other allied med settings

Clinical Exercise Physiologist Cardiac, pulmonary, and metabolic disease care Exercise testing and prescription Program administration Education and credentials Recommended undergraduate and graduate degree Specialized courses and certifications (ACSM) Exercise specialist (ES) Registered clinical exercise physiologist (RCEP) Required credentials vary by state Employment opportunities: growth of aging population mean more jobs

Occupational Therapist (OT) Helps people with physical, emotional, or mental disability restore or develop maximum level of independence by emphasizing acquisition and retention of functional skills Help improve concentration, motor skills, problem-solving Education and credentials National Board for Certification in Occupational Therapy, Inc. Physical therapy specialty certifications State licensure OT: master’s degree, some doctoral degrees COTA (certified OT assistants) two-year degree program

Physical Therapist (PT) Provides rehabilitative care to a diverse patient population with a wide range of injuries, illnesses, and diseases Education and credentials PT (plans, directs, implements patient care) Accredited master’s degree program (doctorate of PT required by 2020) State licensure Physical therapy specialty certifications Commission on Accreditation in Physical Therapy Education (CAPTE), NPTA Physical therapist assistant (PTA) Delivers care under direction of PT Accredited two-year program

Therapeutic Recreation Specialist Treats people with physical, cognitive, emotional, or behavioral disabilities to restore function and reduce or eliminate the effects of disability and develop independence; utilize leisure activities to restore function Education and credentials Bachelor’s degree in therapeutic recreation Internship under a certified recreation specialist National certification exam: certified therapeutic recreation specialists (CTRS) are credentialed by NCTRC Employment opportunities: limited growth because of cuts in hospital settings

Strength and Conditioning Specialist Maximizes physical performance, reduces the frequency of injury, and decreases the possibility of cardiovascular disease by designing programs for the specific needs of the individual (sport and activity specific) Education and credentials Bachelor’s degree in kinesiology preferred, required for some certifications Certifications recommended (such as National Strength and Conditioning Association Certified Strength and Conditioning Specialist) Current CPR certification

Are You Clinically or Technically Oriented? Do you prefer to devise solutions on your own, or would you rather follow a structured sequence of steps? Clinicians devise and develop therapeutic exercise plans and are called on to solve problems and make decisions. Technicians, in contrast, are experts at performing specific sets of skills (e.g., PTAs and OTAs) How might the way you answer this question impact your thinking about your career path?

Trends and Opportunities in Therapeutic Exercise Fulfill a societal need. Assist in attaining desired levels of fitness (habilitation). Assist in regaining lost function (rehabilitation). Cover a wide range of populations. Newborns to geriatrics (increased remote home health care) Athletes to unskilled performers All professions in this chapter place increased emphasis on identifying physical barriers to activity (e.g., issues of strength, range of motion, cardiovascular limitation) and biomechanical factors that may increase the risk of injury.