Over the last month, we have achieved two phenomenal things: First, we hosted a webinar series with Leslie Eide on exercise physiology, where she showed us how to use the principles of exercise physiology to develop the best therapeutic exercise plans for our patients. Second, we highlighted our commitment to evidence-based practice and to educating our clients through our #researchmeetsreality social media competition.
What has really stood out for us at Onlinepethealth through these two events is how dedicated Vetrehabbers are to their patients; how they go above and beyond the call of duty, always striving to learn more, always desiring to uplift and educate our various communities. Truly, the Vetrehabber community is amazing. It seems that some of the nicest, hardest working, most professional and dedicated people choose to become Veterinary Rehabilitation Therapists! What else could explain it?
Today, continuing our quest to be constantly learning and improving, we zoom in on some of the take-home points learned in the series on Exercise Physiology. A read-through of this summary will reinforce the essentials and give you key points to take back to your patients and community.
First things: How to be truly effective:
- We need to take basic movement and turn it into a physical activity, and then into exercise.
- We need to be clear about our goals and the goals of the patient.
- We need to ensure that we take all five components of physical fitness into account.
- We need to balance stress and rest, and be specific with exercise.
- We need to consider the losses of inactivity and how we can rebuild those losses.
- Most importantly, we need to prepare our patients for life.
“Life happens, management fails. Go beyond the everyday to prepare your patients for life.” Leslie Eide.
As Leslie convinced me, and hopefully I can now convince you, we need to incorporate certain basic exercise principles into our rehabilitation programmes to prepare every patient for life – not only athletes or working dogs, but the couch potatoes, too!
Movement, Physical Activity and Exercise
“All exercise is physical activity and movement, but not all movement or physical activity is exercise.” Leslie Eide.
Movement for the sake of movement is necessary, but alone it is not enough for our patients. Similarly, physical activity is fantastic, but without a structure and goal – without turning it into exercise – its value in the lives of our patients is limited.
To turn movement and physical activity into exercise, we must be intentional about it. There needs to be a goal, a planned structure, repetitions and frequencies in order for our patients to derive the real benefits of exercise.
When we successfully transition from movement to exercise, we can look forward to numerous physiological changes and adaptations in our patients, including adaptations of the musculoskeletal system, improved cardiovascular function, improved respiratory function, improved muscle fibre recruitment, better coordination and efficiency of movement, and more.
Five Components of Physical Fitness
When it comes to physical fitness, we need to take the whole body into consideration, targeting all five components of fitness:
The ability of the heart and lungs to provide fuel to the body during exercise.
The amount of force a muscle can produce.
The ability of a muscle to perform continuous exercise without fatigue.
Normal extensibility of all soft tissues that allows full range of motion of a joint.
The amount of fat mass compared to lean muscle mass, bone and organs.
Through real life examples, Leslie highlighted again and again why these principles are so important, not only for our athletes, but for all our patients. Every patient we come into contact with needs the kind of exercise that involves these components, with each component functioning well and in harmony with the others.
Exercise that involves all five aspects yields maximum health and wellbeing in our patients.
Three Stages of General Adaptation
General adaptation has three phases – alarm, adaptation and exhaustion. These phases describe the physiological changes the body experiences when under any kind of stress, not only those placed on the body by exercise.
Of course, during exercise we don’t really enter the alarm phase, which is characterised by fight, flight or freeze. However, we will experience increased heart rate, cortisol release and adrenaline release, all of which are characteristic of this phase.
As the body gets into the adaptation or resistance phase, we start to see structural adaptations and changes as the body adapts to the exercise programme. We will see improved coordination, muscle hypertrophy, increased strength and endurance of the respiratory system, and several other valuable physiological changes and adaptations.
The exhaustion phase is something we really want to avoid in our patients. At this point, the body can no longer tolerate the physiological stresses and demands placed on it through exercise, and instead of adaptation, reversal may start to occur. At this point the patient is at a much greater risk of injury than during any other phase. To prevent exhaustion, regular inclusion of rest days is essential.
Be Specific with Therapeutic Exercises
“Specific exercises will elicit a specific adaptation, to promote a specific training effect.” Leslie Eide.
The physiological response we get will be determined by the exercise stimulus applied. We need to aim for three kinds of specificity:
- Mechanical specificity, which refers to the forces and movements applied to the body. These include changes in load through the joints and muscles. We can use increased weight bearing to increase strength training, or increased repetitions to build endurance.
- Neuromuscular specificity, which refers to the specific muscle recruitment patterns used to increase the efficiency of a movement. To train this area, we need to carefully select both the exercises and the speed of contractions involved.
- Metabolic specificity, which refers to the metabolic pathways used to perform an exercise. These may be aerobic or anaerobic in nature. Both pathways will improve through training, but we need to be specific about whether we are working towards activities that require endurance, or short bursts of high energy output.
Of course, ultimately, we need to focus on the goals of the owner, whether that is for the dog to be able to go hiking with the family or simply to navigate a flight of stairs.
Overloading our Patients
Without continuing to overload our patients, exercise will become ineffective. Essentially, we need to apply exercise at a greater intensity than the body is used to receiving in order to effect a physiological change.
This means progressively making exercises harder and harder as the patient adapts. That does not mean adding more and more exercises – it simply means manipulating the variables to make the overall workload of each session harder, so that we get closer to our goals.
We do this through judicious use of repetitions, sets, frequency, tempo, equipment and resistance to make our exercises progressively more challenging to the patient.
As we do this, we’ll need to consider the four areas where our overloading should apply:
Gradually increase the time spent exercising, as well as the effort over time.
Increase sets and/or duration of each set, and overall volume of work.
Add resistance or change the load by raising the fore or hind limbs onto a higher platform, or by lifting a limb.
We want to increase range of motion of soft tissues through movement.
Use it or Lose it: Reversibility
The reversibility principle teaches us that when training ceases or decreases significantly, the physiological adaptations made by the body will be lost. In our patients, a period of enforced crate rest after injury or surgery is the most common cause of reversal.
Total inactivity will lead to rapid muscle loss or atrophy; muscular endurance will decrease after two weeks of inactivity, and losses in flexibility are even more rapid. Cardiovascular endurance will decrease over time, and can be hard to gain back in individuals that were in training before the period of rest.
We can combat reversibility in our patients by targeting cardiovascular endurance, flexibility, muscular endurance without overload, and muscular strength in ways that are safe for the patient from the beginning of crate rest.
For patients on crate rest, focus on what you can do while restrictions are in place.
Taking it Beyond the Everyday
“Life Happens. Management fails. Go beyond the everyday to prepare your patients for life.” Leslie Eide.
We often think of this last piece of exercise physiology or therapeutic exercise as applying only to athletes, but Leslie stresses how incorrect this thinking is – and how potentially detrimental it is to our everyday patients. Consider your average non-athlete dog. There are small dogs who jump onto and off of unstable surfaces multiple times a day, often from a slippery surface; the doorbell rings, and all dogs go from a sleep to a sprint as they bolt towards the door, navigating obstacles in their path; on a walk, a squirrel dashes past, and within seconds all dogs are at full speed on uneven terrain.
No matter who our patients are, preparing their bodies for life is essential for reducing the risk of injury further down the line.
In this last lecture of the series, Leslie spoke about balance, reactive exercises, speed agility and quickness, and resistance training.
Balance applies to three areas:
The ability to maintain equilibrium in place without the action of external forces.
The ability to maintain equilibrium throughout the intended path of motion when external forces are present.
The ability to prepare, maintain, anticipate and restore the stability of the entire kinetic chain.
Reactive exercises are exercises where there is a loading phase, an amortisation or transition phase, and an unloading phase. An example would be dogs jumping off of beds or couches and immediately transitioning into another movement, such as running. Plyometrics, or stretch-shortening cycle exercises, are a good example of reactive exercises.
Speed, agility and quickness applies to the dog’s ability to move skilfully at faster speeds with greater precision – an important skill to develop in dogs with a hunting instinct, who love to chase things or run for the doorbell.
Resistance training is the last component, and is a great way to apply the overload principle. We need some creativity to use resistance successfully in dogs, but could start by using weight bearing exercises and variations. A lifted leg, or limbs on a raised platform, will increase load and resistance in the other limbs. Theraband and hydrotherapy are also great tools to use for resistance.
External weights in dogs
The value of external weights in our exercise regimen is an interesting point, and one we often seem to circle back to when discussing dogs and exercise. In human exercise, we add weights to increase load, difficulty and resistance. In dogs, we could do the same through the use of weight cuffs or a weighted vest, but there are some cautions – or should I say, there are too many unanswered questions when it comes to the use of weights in canine patients.
According to Leslie, research with humans using weight cuffs is interesting; although the initial response seems to be positive, over time using weight cuffs was found to have more negative effects than positive in the people using them.
There are many questions around how biomechanics, joint loading and gaiting are affected by the use of weighted cuffs. For this reason most practitioners, Leslie included, opt against their use in practice.
Weighted vests, on the other hand, could prove more valuable, especially in working dogs where we really need to push them to a greater physical capacity. But again, questions arise regarding patients who are predisposed to back pain.
Personally, I think that this subject needs quite a bit more investigating! And as Leslie says, right now, do we need to be using external weights in our patients? Or are the tools we have at hand sufficient?
The last month has really opened my eyes and broadened my perspective on therapeutic exercise programmes, how we should be structuring them, and what we should be including in them. We need to make sure that we are not just rehabilitating one limb, but the whole body. That includes the cardiorespiratory and metabolic systems that we rarely think about.
Our couch potato patients need to be given a great deal more attention when it comes to their bodies. Many of them lack balance, coordination, agility, and the ability to react to a stimulus with an appropriate muscle response. This might be a big part of the reason they incurred an injury in the first place, and why we are seeing them now. Retraining good neuromuscular responses and improving balance, coordination and strength may well be exactly what they need to stay healthy and injury free in their wonderful, everyday lives.
And when it comes to progression, we don’t need to keep adding ever more complex exercises. Rather, we need to build on the foundation created, manipulate our variables, and be clear, consistent and as simple as possible.
To help myself implement these strategies into my clinical work, I have created a therapeutic exercise checklist. Download, print, and keep it on hand for when you develop your next few therapeutic exercise programmes.
Download the free Therapeutic Canine Exercise Checklist here:
If you would like to learn more about therapeutic exercise and physiology, we have numerous webinars available in our members’ portal, including:
- Understanding Exercise Physiology, with Leslie Eide
- Canine Exercise in Extreme Environments, with Dr Michael Davis
- Therapeutic Exercise for Every Dog, with Debbie Torraca
- Ground Treadmill Therapeutic Exercise, with Robbie Porter
- Force Free Exercise in the Canine, with Robbie Porter
If you would like to read additional blogs: