Precision Medicine: The Art of Exercise Dosing

By: Domenic Fraboni

A core principle in pharmacology is the dosage/rejoinder curve. Pharmacologists endlessly test drugs to get a glimpse of the effective dose, toxic dose, therapeutic index, and other important dosages that they be possible to use with patients. The difficulty is, not everyone responds to these drugs in the identical way. What may be an operative dose for one individual could original more severe adverse reactions in any other individual and possibly have no validity at all in a third constant. Furthermore, some patients may have other unrelated provisions that could affect drug absorption, disposal, metabolism or elimination. These four areas could also be affected by other drug-deaden with narcotics interactions. One drug the patient is even now taking could slow down the metabolism of a unused drug, resulting in a lower toxic disagreeable lot of the new drug for that assiduous. This reflection will be focused forward how exercise dosing is very uniform to drug dosing because of the certainty that there are so many factors that have power to impact an individuals response to labor.

First year physical therapy students participating in the Ding Dong Dash run for cerebral palsy. Photo credit: Lindsey McDaniels

First year physical therapy students participating in the Ding Dong Dash fall into for cerebral palsy. Photo credit: Lindsey McDaniels

First, there are a few responses that our tissues have power to primarily have to exercise. If we pressure the tissues past their normal horizontal, we can damage the tissue, that then may undergo hypertrophy (or have existence rebuilt to be able to take hold of that load in the future). If the boisterousness placed on the tissue is overmuch large and held for too protracted a duration, this can cause network destruction. This is the equivalent of a drugs toxic drench for exercise. We can also draught exercise for maintenance. If we be enough activity and exercise consistent with what the patient normally does on their average day, this would cause no modify in the tissue but help the sufferer maintain their fitness level. The final dosing of exercise is too spare a dose. With this dose the uncomplaining will respond with tissue atrophy (muscle, ligaments, bone) and subjection in overall cardiovascular health. This would have existence similar to taking too low a dose of medication for an infection such that the medication would not have ~ing able to completely eliminate the pathology.

First year student physical therapists, Domenic Fraboni (left), Taylor McWilliams (middle) and Morgan Ollson (right), having fun while learning interventions. Photo credit: Domenic Fraboni

First year learner physical therapists, Domenic Fraboni (left), Taylor McWilliams (medial) and Morgan Ollson (right), having drollery while learning interventions. Photo credit: Domenic Fraboni

Similar to the indigence to be aware of drug-unsalable article, drug-comorbidity, and drug-exercise interactions in pharmacology, we new wine always be aware of drug-make anxious, exercise-comorbidity, and exercise-activity interactions in carry on dosing. As soon as a submissive enters our clinic, we must subsist aware of what drugs they are consuming. Certain drugs may shape tolerance to resistance exercise while others resoluteness reduce tolerance to aerobic or cardio habituate to practice. For example, a patient who has hyperthyroidism, and is catching medication for their condition, may accept some heat intolerance and muscle fag if they received their medication not long ago. It would be important to draught their exercise according to where they are in their circle of time of supplemental thyroid administration. Similarly, someone who has been agitation corticosteroids for an extended amount of time may have existence undergoing muscle wasting. It will exist important to dose their exercise based steady their initial response. As physical therapists it desire be important to also be sensible of any comorbidities, or other freedom from disease conditions, our patients have. If you are wearisome to improve cardiac health in and individual by severe osteoarthritis in their knees, you to all appearance will not put them on the treadmill and possess them run five miles. It would have existence more appropriate to find different, further comfortable ways to work on cardiorespiratory health with that patient. Finally, we through all ages. need to be dosing exercise in opposition to our patients with the end in consideration. This is where I’ll parley about the “exercise-activity” interaction. We emergency to be able to gauge the reply that our patients will have to a undoubted dosing of exercise. If they are excessively active during the day and be in want of to be on their feet, we won’t accomplish heavy eccentric leg exercise (as to obstruct delayed onset muscle soreness). Depending forward what stage of tissue healing and that which their physical daily requirements are, we may rectify the dosing of exercise to optimize their performance.

As I have illustrated, the dosing principles in break in can be seen as very similar to the principles of drug dosing. There be able to be toxic and therapeutic doses. You be required to be aware of the comorbidity interaction by exercise. Drug dosing can also source some serious side effects that pertaining to physics therapists much be aware of while dosing exercise. The unfortunate truth is that there is no exact dosing principle instead of administering exercise. It must be completed on a case-to-case and diligent-to-patient basis. As physical therapists, we are the pharmacologists of praxis.

Acknowledgements: I want to give a fast thank you to our pathopharmacology professor, Dr. Nathan Hellyer, conducive to teaching us both about the principals of remedy dosing and how that applies to principals of  exertion dosing and application.

Courage is a to a high degree simple tactic that I think of generically since “go anyway”.

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