Calling for the Death of Seated Exercise

This article is about “the death of seated exercises” just as much as it is the fact that Home Health patients are “seated exercising to death.”  I must apologize in advance, but this is a topic I am quite adamant about and will hopefully offend a few of you into feeling repentant about your seated exercising ways.

At this stage in the ever so slowly evolving profession of physical therapy we have firmly established ourselves in the epoch of functional training.  Before functional training there were gizmos and gadgets, before that progressive resisted exercise (PRE) of isolated muscle groups, and before that…I don’t know..maybe Iron Lungs and things of that sort. But needless to say, the research supports (my favorite phrase as a new grad) training functional activities both with and without loading to improve mobility and balance. In a profession that prides its self on the fervent pursuit of efficient and effective patient care, it seems there are a few of us who have missed the boat.

Now, I am not writing off ALL exercises performed in a seated position.  Ive seen Dr. Matt Lee work magic on a clients’ painful arthritic knees with the use of a simple heel slide exercise and the proper cuing.  But this article is an intentional affront to the use of the obnoxiously amorphous and ambiguous term that keeps rearing its ugly head in treatments notes across the country – “Seated Exercises.” (often this is followed by the equally nondescript and infuriating “supine exercises”…but please don’t get me started).

Just like treating patellar alignment for patellofemoral pain or stretching the hamstrings of a patient with sciatica, neglecting functional training and opting for a generic seated exercise set is an insult to the progression of our field.

When our home health patients are receiving help it is due to home bound status.  Think about that term for a second.  They are so weak, sick, injured, demented, etc. that the are literally Bound To The Home.  It is so difficult for them to leave the home that it has been deemed medically necessary for them to remain there.  What good is 10 reps of Musgrave Ankle Pumps (MAPs)* for restoring their freedom? Oh, your doing it to reduce the risk of DVT you say. Why not put them into one of many different positions that will progress them towards the ultimate goal of liberation from their own home? Walking, lunging, marching, rising on their tippy toes, even weight shifting for goodness sake, can have the same muscle pump effect you are so dutifully pursuing, but also places a more practical focus on the greater goal.

At this point I have to bring up the sobering reality that many of us are not challenging our patients enough.  Yes, they are old…and sick…and weak…and often somewhat confused…, but that doesn’t mean we should coddle them all the way to the grave.  If we are not placing our patients into positions that are difficult or unsteady when we, the trained professional, is present, then there is definitely no chance that they are going to attempt to do so when they are alone.

It is time we ask more of our patients and possibly ourselves.  Many of the home health clientele has limited exercise capacity to begin with.  So get creative and challenge multiple systems at once.  Transitional movements, gait progressions, and even some bed mobility tasks will have better day-to-day carryover than sitting and flopping around the distal end of some appendage.

When we go to the hardware store to get a drill we do not really want a drill, we want a hole.  In the same way our patients may be prescribed PT for “blah blah” diagnosis, but what they really want is their life back.

Life is short for us all, but for others it is even shorter.  We owe it to our patients and we owe it to ourselves to keep this in mind.  A PT visit is just another visit to us, but to a frightened aging client it is a second chance at freedom.

Written by Dr. Stephen Stockhausen PT, OCS

*This is in reference to a joke in Physical Therapy school.  Sorry, I couldn’t resist.

Please comment below with any questions.  We would love to get feedback as well should any of our ramblings be of help.