The Best Time To Refer to Exercise Physiology

Have you ever wondered where in the rehab process Exercise Physiology fits? When is the best time to start an EP program in order to get the most out of it?

The quick and easy, highly-biased, answer is….

Exercise Physiology is always appropriate at any time of a rehab process.

Is this bias?

Sure, but there is literally not one scenario where you would say that increasing activity is NOT beneficial.

Now, we need to keep a commercial hat on and be reasonable with our recommendations when suggesting to engage an EP and we understand that rather than involving an EP for every single customer or claimant, we should be encouraging a referral for the customers who would MOST benefit from it because it’s the IDEAL time for them to start increasing their activity levels.

So let’s perhaps dig into what we mean by what is the IDEAL time to start an Exercise Physiology program.

 

The Perfect Referral

The perfect combination for a referral to us, that makes our life easier, and yours, is:

  • It occurs EARLY in the rehab process before psycho-social factors can become too entrenched
  • It’s for a motivated participant who is interested in improving their health and/or returning to work
  • They have a supportive GP, Specialist, and greater treating team who understand the importance of incorporating safe movement.

This combination leads to quicker results as there is less time needed to educate and motivate the claimant into the benefits of taking control of their life.

 

But Perfect Is Rare

We do get these “perfect” referrals occasionally, but they’re rare. And that’s because claimants are human, and being managed by other humans. There can be a lot of complications and BPS factors that may present throughout the course of a program.

So, what’s a more realistic referral to expect?

Well these programs tend to start a bit later than they should (sometimes years!), diagnosis may be complicated, motivation may be lacking, goals are uncertain, they have fear of pain and very likely, fear of change.

With our exercise physiologists specialising in return to work, none of these complications are new to us.

Why Earlier Is Better

With most conditions, the earlier we get started the better. There are a few reasons for this:

  • Minimise strength loss
  • Decrease chance of developing chronic pain and fear behaviours
  • Take advantage of higher motivation
  • Maintain confidence
  • Decrease the length of rehab time and the number of health providers involved

That said, “early” is subjective and can vary across conditions so let’s perhaps take a look into the various conditions that we typically are called on to help out with and look at some the respective “ideal” times to refer to EP for each:

Musculoskeletal

Generally, exercise physiology is most appropriate approximately 12 weeks after an injury.

The earlier the better. We can also even provide exercise for uninjured sites of the body before the injured site is ready for attention. Many people don’t realise that an injury to the knee, for example, can lead to loss of strength in the arms. With the injury and pain, claimants drop, or even stop, all physical activity, resulting in whole-body strength and function loss!

Cardiac and Neuro

Patients have usually been through an in-patient rehab program with their hospital (which already consists of exercise) but once they’re out in the community they should be getting back to life, physical activity and other aspects of a normal life, therefore, EP is great to incorporate upon discharge from the in-patient facility.

Fatigue

Although fatigue conditions can take a while to develop, or can be a side effect of other conditions, earlier is still better, for the reasons listed above. The longer a “disability” goes unaddressed, the longer they don’t get the support they need and the more things they try that don’t work (or even make it worse) the harder it will be to get better due to worsened fatigue and lower confidence.

No matter what stage they’re in, we recommend using our secret weapon to help claimants take control of their fatigue. 

What About Cancer?

It is now well accepted through years of research, that exercise has a place in all stages of cancer – during and post active treatment.

Exercise physiology can also help prior to cancer-specific treatment by improving physical fitness and thereby decreasing the amount lost during and after treatment. Programs prior to treatment can also support education around the importance of exercise, nutrition, and sleep hygiene as well as strategies such as pacing. With cognitive fatigue being a common side-effect post-treatment, implementing the education prior to treatment may be beneficial in the learning process.

During cancer, exercise has been shown not only to decrease fitness loss but also to enhance treatment results.

Post cancer is probably the most common use of exercise physiology, to build function back up with whole-person approach.

If you’re still unsure what’s best for you and your claimant, feel free to call or email me!

 

Now Is Better Than Never

Ok, so I’ve been focusing on early intervention. But anytime is better than no time. As alluded to there are likely to be a few more barriers, but most barriers are climbable.

Exercise is magic. The body responds to exercise by adapting.

Psychosocial issues can be a major barrier, but using Motivational Interviewing and working closely with a team including Rehab Provider/OTs, Psychologists, GPs and Physios will always yield the best results

 

Cheatsheet – Refer To Exercise Physiology When:

  •  You need to assess functional capacity
  •  You need to assess engagement and motivation
  •  The client needs support returning to work
  •  The client wants to or would benefit from, improved health and wellbeing
  •  The client is new to rehab
  •  They’ve been on claim for a while, and there are no improvements being made, especially in the last 3 months

 

If you’re ever unsure free to contact us or you can make a referral and we can decide from there. We always start with an Initial Assessment and a detailed report to determine what the goals and barriers are, if and how we can help.

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