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Numerous studies have demonstrated the positive health benefits of increased fitness levels achieved through regular physical activity and exercise. These benefits accrue in healthy individuals as well as in those participating in secondary and tertiary prevention programs. Physical therapists promote increased fitness to their patients by developing and implementing plans of care that incorporate exercise and physical activity as well as by providing education about the positive health benefits of an active lifestyle. These efforts occur most easily in outpatient and community-based physical therapy practices serving patients with less involved and/or reversible functional limitations or disabilities. In addition, these settings usually have the necessary equipment and facilities with which to perform exercise testing, training, and education. However, patients in acute, rehabilitation, and home health environments also require progressive increases in fitness levels to support functional recovery and adaptation. Development of a plan of care incorporating fitness principles in any practice setting depends upon a physical therapist's understanding of contemporary concepts and terminology pertaining to fitness and of the elements of an exercise prescription. The purpose of this paper is to review fitness principles and elements and to demonstrate their application for adult patient management across the continuum of physical therapy practice. Emphasis is placed on health-related physical fitness and its contribution to the rehabilitation of impairments, functional limitations, and disabilities.

INTRODUCTION

Contemporary public health efforts emphasize an active lifestyle to maintain or enhance fitness levels for general health. For example, physical activity is the first of 10 leading health indicators developed by the US Department of Health and Human Services.1 In addition, the US Surgeon General recommends that adults engage in at least 30 minutes of moderate-intensity physical activity on most if not all days of the week.2 This focus on an active lifestyle is prompted in part by studies that demonstrate the positive health benefits resulting from increased cardiorespiratory fitness. Investigators have reported decreased risk of death from all causes in both genders3,4 as well as decreased risk for development of coronary heart disease,5 stroke,6,7 and metabolic syndrome.8 Fit older adults also may accrue protective benefits.9 Promotion of physical activity as part of a general primary prevention program is an understandable public health initiative in light of these research findings.

The usefulness of progressive physical activity in secondary and tertiary prevention efforts also is well documented. In 2004, the American Heart Association published exercise and physical activity guidelines for individuals poststroke based on an accumulation of individual studies demonstrating these interventions resulted in improvements in aerobic capacity and sensorimotor function.10 A recent systematic review indicated that increased activity levels assist with weight loss and prevention of weight regain in overweight and obese individuals.11 In addition, a meta-analysis of studies of controlled physical activity reported improvements in cardiorespiratory fitness, symptoms, and vigor in cancer survivors12 while another indicated exercise-induced increases in physical performance, cognitive function, and behavior in patients with cognitive deficits and dementia.13 Finally, other summaries of evidence suggest a role for physical activity in the management of low back pain, osteoarthritis, osteoporosis, and various neuromuscular diseases although a dose-response relationship between activity levels and outcomes has yet to be identified for specific conditions.14,15

Physical therapists promote increased fitness to their patients by developing and implementing plans of care that incorporate exercise and physical activity as well as by providing education about the positive health benefits of an active lifestyle.16-18 These efforts occur most easily in outpatient and community-based physical therapy practices serving patients with less involved and/or reversible functional limitations and disabilities (ie, athletic injuries, early stages of arthritis, transient ischemic attack, etc.). In addition, these settings usually have the necessary equipment and facilities with which to perform exercise testing, training, and education. However, patients in acute, rehabilitation, and home health environments also may benefit from a plan of care that lays the foundation for increased fitness levels.

Development of a plan of care incorporating fitness elements in any practice setting depends upon a physical therapist's understanding of contemporary concepts and terminology pertaining to fitness and of the elements of an exercise prescription. The purpose of this paper is to review fitness principles and elements and to demonstrate their application for adult patients across the continuum of physical therapy practice. Emphasis is placed on health-related physical fitness and its contribution to the rehabilitation of impairments, functional limitations, and disabilities.

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