Medical Exercise Therapy
Holten institute for Medical Exercise Therapy
Published in The Norwegian Physiotherapy Journal; Fysioterapeuten in 1968; Holten O. Treningsterapi. Fysioterapeuten 35(8):236-240.
Translated from Norwegian in 1999 by Tom Arild Torstensen,
This form of treating/exercising patients was sanctioned in march 1957 by the Norwegian health authorities as a special therapeutic system with the following criteria;
”A branch of exercise therapy where the patient performs exercises in specially designed apparatus, without manual assistance, but being constantly monitored by the physiotherapist. The apparatus must be designed to optimally stimulate the relevant functional quality in question, neuro-muscular, arthrogenous, circulatory or respiratory. To obtain this effect, the patient carries out the exercises from a defined starting position, in a specific range of motion, against a graded load. Medical Exercise Therapy is based on a minimum of one hour effective treatment (excluding dressing, undressing, shower/bath, etc). Prior to the treatment, a thorough assessment is carried out based on; 1. Muscle tests, 2. Specific joint test, and 3. Functional tests. From the patient´s history and this assessment, a diagnosis is determined and an optimal treatment is established. The therapy also includes re-assessment and adjustment of the exercise program when required. A maximum of five patients in a group setting are treated for one hour”.
A picture from Holten Institute in 1967 showing the interior from the exercise room. On the picture you can see a neck exerciser, a multiple purpose bench, three incline boards and dumbbells.
Här övervakar Odvar Holten en stegövning för en patient med en knäskada. Genom att med armarna dra i dragapparatens stång avlastar han en del av sin kroppstyngd vilken möjliggör ett högt antal repetitioner och set ( 3 set ggr 30 rep). Övningen koordineras och rörelsen sker inom ett komfortabelt rörelseomfång. Detta är en av sammanlagt 7-9 övningar i träningsprogrammet.
When planning my institute, I also had to consider other variables. Two of those were increasing patient motivation and their active coping strategy. In order to obtain this goal, the patients are working in a group setting where each patient has an individually designed exercise program for their movement disorder. The treatment gives the patient increased insight in how an exercise program can improve a painful condition.
Another important factor is the cooperation of the Norwegian Manual Therapy group and the implementation of an active exercise program in relation to pre and post manipulative procedures. Medical Exercise Therapy is integrated with the manipulative procedures to help maintain or improve the function of joints and their related structures after these procedures are performed.
The Holten Institutet
The patients’ journals and exercise charts (programs) are stored safely in the reception area. As patients come in for treatment, the exercise program for each patient is placed on a magnet wall.
Men and women are treated on separate days.
All patients with neck and back pain are also assessed according to the Norwegian Manual Therapy system including specific testing at segmental levels.
Information from the assessment helps to determine if active exercise therapy should be used as treatment. The assessment also helps to determine whether to use stabilizing exercises or mobilizing exercises or a combination of both. Other functional qualities to consider when choosing exercises are; joint mobility how to improve local/specific joints or more global joint mobility, muscle strength, muscular endurance, coordination and specific kinesthetic awareness. The above variables are the background for designing an individual exercise program.
The patient is then shown being instructed in the exercises and told the reason why the exercise(s) are used. Each exercise is then tested in order to establish the appropriate dosage. The dosage consists of the size of resistance applied, number of repetitions, number of sets, number of resting periods and the length of the resting period.
The first treatment lasts approximately 1 _ hours. Later treatments last approximately one hour, but some patients do have exercise programs that take 2 3 hours to finish.
Re-assessment of the exercise program is based on the patient’s reactions to the original design of the exercise program, including the patient maximum capacity when testing out the exercises. The patient’s pain experience and coordination with movement is continously evaluated and considered when regrading the exercises.
The design idea behind the MET apparatus is taken from the American body building apparatus. However, great care has been taken to design a type of exercise equipment to meet the needs of patients. In addition, traditional weight training equipment is part of the MET system.
The clinical experience so far is positive and gives good reasons to continue and further develop this exercise methodology.
Muscular strength, and endurance training shall give increased tolerance for loading (increased work capacity) making it possible to perform work and daily activities without developing muscular dysfunction and pain.
A well automized movement pattern with well developed muscular awareness (movement awareness) should prevent acute and local overloading.
The field where medical exercise therapy will be an appropriate treatment method will probably vary alot, but experience and research will as time passes on show which dysfunctions/movement disorders that will benefit mostly from medical exercise therapy. However, in addition to neuromuscular dysfunctions I would also like to mention respiratory and cardiovascular conditions as well as patients with rheumatic disorders as categories that usually benfit from the medical exercise therapy.
Medical Exercise Therapy is a new way of organizing the work place and work day to work effectively with exercise therapy. However, the treatment couch is still the most important place where the treatment takes place, but not the only place.
Holten Institute offers 4 different two-day basic courses on Medical Exercise Therapy; cervical dysfunction, back pain, upper extremity dysfunction, and lower extremity dysfunction. The participant will gain knowledge of how to apply graded exercise therapy for various patient categories.
Exercise manuals, videos and CD-Rom (Holten Institute’s Resource Guides-RGs that allows you to make personal exercise programs for your patients) can be ordered from Holten Institute
Holten Institute AB
SE 181 06 Lidingö
+46 8 446 05 57
+46 8 731 70 55