1. Careers in therapeutic exercise
Chapter 13
Careers in therapeutic exercise
Chad Starkey

2. Chapter Objectives
Acquaint you with the wide range of professional opportunities in the sphere of therapeutic exercise.
Familiarize you with the purpose and types of work done by professionals in therapeutic exercise.
Inform you about the educational requirements and experiences necessary to become an active, competent professional in the area.
Help you determine if one of these professions fits your skills, aptitudes, and professional desires.

3. What Is Therapeutic Exercise?
Systematic and scientific application of exercise and movement experiences to develop or restore muscular strength, endurance, or flexibility; neuromuscular coordination; cardiovascular efficiency; and other health and performance factors
Programmed physical activity aimed at improving or restoring the quality of life
Classified as being rehabilitative or habilitative

4. Core Competencies
Core competencies for individuals who provide patient care have been developed by the Health and Medicine Division (formerly the Institute of Medicine) of the National Academies of Sciences, Engineering, and Medicine.
Provide patient care.
Work in interdisciplinary teams.
Employ evidence-based practice.
Apply quality improvement.
Use informatics.

5. Reassessing Disability
Focuses on what a patient can do; diminishes stigma
International Classification of Functioning, Disability, and Health (ICF) (WHO, 2002) (see figure 13.1)
Goal of therapeutic exercise professionals: help people restore lost function (rehabilitative therapeutic exercise) or acquire skills and functions considered normal or expected (habilitative therapeutic exercise)

6. Figure 13.1

7. Rehabilitative and Habilitative Therapeutic Exercise Defined
Rehabilitative therapeutic exercise refers to processes and treatments that restore skills or functions that were previously acquired but have been lost because of injury, disease, or behavioral traits.
Habilitative therapeutic exercise refers to processes and treatments leading to the acquisition of skills and functions that are considered normal and expected for an individual of a certain age and status.
Professional opportunities in fitness and health were addressed in chapter 12. This chapter considers services for habilitative and rehabilitative therapeutic exercise.

8. Rehabilitative Therapeutic Exercise
Exercise therapy for the rehabilitation of the following:
Musculoskeletal injuries
Athletic injuries (sports medicine, prehabilitation)
Postsurgical trauma
Cardiopulmonary rehabilitation
Older populations
Psychological disorders (mind–body relationship)

9. Habilitative Therapeutic Exercise
Exercise therapy for habilitation of the following:
Specialized habilitation (meet standards that exceed rather than merely meet those of the general population such as sport training, military boot camp, fire or police academy)
Obese populations
Children with developmental disorders
General fitness

10. Sedentary Lifestyles
Societal changes have negatively affected the health of a significant portion of the population.
The information age has created a relatively sedentary group of people.
Therapeutic exercise—even in the form of casual recreation—can offer a more balanced lifestyle.

11. Settings for Therapeutic Exercise
Inpatient facilities (e.g., hospitals, residential facilities)
Outpatient clinic settings (e.g., physical therapy offices)
Sport team settings (e.g., athletic training clinics)
Private practice (entrepreneurial)
No matter the setting, you will have opportunities to work with other professionals; indeed, most health care facilities use a team approach in which representatives from several professions collaborate to plan and deliver patient care.

12. Roles for Therapeutic Exercise Professionals
Credentials for each profession vary, overlap, and change regularly.
Pay careful attention to the changing required employment standards for education, licensure, and so on.
A strong science base and an active clinical education component are critical to your preparation and success.
The need for multiskilled and multicredentialed individuals will increase as competition in the health care industry increases.

13. Athletic Trainer (AT)
Responsible for the prevention, evaluation, management, treatment, and rehabilitation of athletic injuries
Athletic and clinical settings
(continued)

14. Athletic Trainer (AT) (continued)
Education and credentials
As of 2022, ATs seeking national certification must graduate from an entry-level master’s degree program accredited by Commission on Accreditation of Athletic Training Education (CAATE)
Board of Certification (BOC), Canadian Athletic Therapists Association (CATA)
Employment opportunities
High schools, colleges/universities, pro sport teams, hospitals, sports med clinics, industrial rehab, other allied med settings

15. Clinical Exercise Physiologist
Cardiac, pulmonary, and metabolic disease care
Exercise testing and prescription
Program administration
Education and credentials
Recommended undergraduate and graduate degree
Specialized courses and certifications (ACSM)
Exercise specialist (ES)
Registered clinical exercise physiologist (RCEP)
Required credentials vary by state
Employment opportunities: growth of aging population mean more jobs

16. Occupational Therapist (OT)
Helps people with physical, emotional, or mental disability restore or develop maximum level of independence by emphasizing acquisition and retention of functional skills
Help improve concentration, motor skills, problem-solving
Education and credentials
National Board for Certification in Occupational Therapy, Inc.
Physical therapy specialty certifications
State licensure
OT: master’s degree, some doctoral degrees
COTA (certified OT assistants) two-year degree program

17. Physical Therapist (PT)
Provides rehabilitative care to a diverse patient population with a wide range of injuries, illnesses, and diseases
Education and credentials
PT (plans, directs, implements patient care)
Accredited master’s degree program (doctorate of PT required by 2020)
State licensure
Physical therapy specialty certifications
Commission on Accreditation in Physical Therapy Education (CAPTE), NPTA
Physical therapist assistant (PTA)
Delivers care under direction of PT
Accredited two-year program

18. Therapeutic Recreation Specialist
Treats people with physical, cognitive, emotional, or behavioral disabilities to restore function and reduce or eliminate the effects of disability and develop independence; utilize leisure activities to restore function
Education and credentials
Bachelor’s degree in therapeutic recreation
Internship under a certified recreation specialist
National certification exam: certified therapeutic recreation specialists (CTRS) are credentialed by NCTRC
Employment opportunities: limited growth because of cuts in hospital settings

19. Strength and Conditioning Specialist
Maximizes physical performance, reduces the frequency of injury, and decreases the possibility of cardiovascular disease by designing programs for the specific needs of the individual (sport and activity specific)
Education and credentials
Bachelor’s degree in kinesiology preferred, required for some certifications
Certifications recommended (such as National Strength and Conditioning Association Certified Strength and Conditioning Specialist)
Current CPR certification

20. Are You Clinically or Technically Oriented?
Do you prefer to devise solutions on your own, or would you rather follow a structured sequence of steps?
Clinicians devise and develop therapeutic exercise plans and are called on to solve problems and make decisions.
Technicians, in contrast, are experts at performing specific sets of skills (e.g., PTAs and OTAs)
How might the way you answer this question impact your thinking about your career path?

21. Trends and Opportunities in Therapeutic Exercise
Fulfill a societal need.
Assist in attaining desired levels of fitness (habilitation).
Assist in regaining lost function (rehabilitation).
Cover a wide range of populations.
Newborns to geriatrics (increased remote home health care)
Athletes to unskilled performers
All professions in this chapter place increased emphasis on identifying physical barriers to activity (e.g., issues of strength, range of motion, cardiovascular limitation) and biomechanical factors that may increase the risk of injury.