Are your rehab or training programs creating an environmental disaster?

I have to give a hat tip to my mate Todd Hargrove for getting me thinking about the subject of environment and the effect it can have on movement behaviours. Here is a link to his recent blog piece "The environment for movement"

It is really important that we think about the environment that people will be using for increased activity or the exercises we have asked them to perform. The environment around them will affect the outcome of the activity or the exercises and we can help shape this environment for them to be successful in the tasks we want them to perform.

A question I ponder more and more is how many failed rehab or fitness programs are because of a lack of consideration of ENVIRONMENT and NOT the person or the program?

We have to consider the HUMAN BEING doing the exercise. You can discuss the relative evidence base or sets, reps and % of MVC of whatever exercise bias you hold. It really does not matter IF IT AINT GETTING DONE and the environment can directly affect that.

Our ENVIRONMENT can act as a constraint to either INCREASE exercise & exercise compliance or DECREASE it. Movements and actions will emerge based on the constraints placed upon them. When we are dishing out exercises this should be at the forefront of our minds, as these constraints will dictate how much of the exercises are performed and the way in which they will get done.

The environment could affect the AMOUNT of movement such as EVEN doing an exercise in the first place to manipulating the environment OF an exercise and the specific outcome.

My son and swimming

A personal example of the emergence of movement happened shortly after reading Todd’s blog. I went on holiday and fortunately we had a very shallow and warm swimming pool right outside our room. My son, who is 4, with a bit of cajoling managed to teach himself to swim! Cue proud dad moment.

The fact we had a shallow and warm (important when you are 4) pool meant my son was able with great confidence to get in the water without his arm bands. He was also able to push off the pool floor and touch down if needed. This aided his practice enormously.

The environment of having a shallow pool with no deep parts enabled AND contributed to his learning process. The location meant he could go any time he wanted and hence increased his practice time. The depth improved his confidence at not having an external aid and also acted as a safety net to make mistakes in learning non lethal : )

The ENVIRONMENT acted as a direct catalyst to confidence, compliance and outcome. A question we should all ask ourselves is “Does my treatment or fitness program do this?”

Are you self limiting?

It could also affect someone’s whole treatment or training approach!

How many therapists work out of rooms that you could not swing a cat in? If a treatment couch dominates the room then it will probably dominate the therapeutic approach too! This environment does not lend itself to the performance of exercise and coaching cues etc.

A trainer in a busy commercial gym may be affected via the amount of space or the equipment available to them. Hence their exercise programming may be limited to using small spaces and fixed resistance machines.

External & internal constraints

We have a number of different EXTERNAL constraints acting on us such as the environment someone is operating in, the task being performed, the instructions they are given and the equipment they use.

We also have INTERNAL constraints. These would be things like confidence, fear (of movement, reinjury etc) and movement skill (ability to perform a task). If your task is beyond any of these internal constraints there is more likely hood of it not getting done! A complicated lift, in a rehab or training context, for someone with low confidence, body awareness and movement skill may prove far to challenging and hence affect the outcome.

Then we may have Internal constraints such as confidence in using the equipment, body image and fear of getting it wrong and making things worse. A focus on fitting exercise/exercises in with the person and involving them rather than just dictating to them may have a profound impact on if they actually get done or not! In fact it could be more important than the exercise itself in many cases.

The concept of exercise itself may need to be reframed for someone with poor associations with exercises, we could regard this as an internal constraint, and many failed attempts to integrate exercise into their lives. Can we create fun movement tasks or activities to help movement emerge? Can we tie these in with physical activities they do enjoy and are more likely to perform?

Environment & an LBP example

An example could be getting someone with lower back pain that is sedentary more active as part of a rehab plan. If you say you have to do a specific type of exercise program in a gym then that may present external environmental problems. Someone has to be a member of a gym, get to the gym, the gym they are able to get to also has to have whatever equipment you have suggested they use. All of these factors may present barriers and hence must be considered and addressed. In contrast a walking program in a local park may yield better results for some with a much lower barrier to getting it done based on their location, preference and confidence.

Rather than just shoving an exercise down someone’s throat…..

Find out what activities they enjoy and feel capable of. Are they a regular exerciser or gym goer to begin with?

•  Explain the exercise/movement or activity, why they are doing it and the importance of it to their problem or goal.
•  Ask what is their opinion/perception of what you have asked them to do and their confidence in doing it.
•  Help set out when in their schedule would be best for them to realistically do it.
•  Making sure they have good instructions of what to do. A short video clip using a video phone can help.

At a recent course I ran the class brainstormed ways of creating loaded training without having to attend a gym. This can be a barrier for many people with this aspect of rehab or training.

Ideas included:

•  Sand bags
•  Bags filled with books
•  Bags of compost (they come in 20kg bags!)

Much as we aim to ‘meet the person where they are at’ with an educational approach to reduce barriers we should also do this with exercise to increase compliance.

In part two of this blog we will look at how factors such as environment and the other constraints that we have lightly discussed here will affect movement outcomes such as variability and skill development.