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Evolving Physical Therapy: Let’s Ditch the “Home Exercise Program”

by Ginger Garner PT, DPT, ATC/L
Evolving Physical Therapy: Let's Ditch the “Home Exercise Program"

Photo of textbook Integrative and Lifestyle Medicine in Physical Therapy
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Moving from HEP to IHP is outlined in the landmark text, Integrative & Lifestyle Medicine in Physical Therapy, available at OPTP.com

We are long overdue in the physical therapy profession to ditch the phrase “home exercise program.” Give me 3 minutes and I will explain why and how.

As therapists we play a vital role in helping folks navigate vulnerable and distressing situations. We don’t often consider the obvious – we are more than just movement specialists. We are also trauma specialists. Bessel van der Kolk’s research, and so many others’, all support that mindful movement plays a critical role in discharging and processing trauma.

In other words, just talking about it, isn’t enough. Van der Kolk’s landmark text, The Body Keeps the Score, explains how. 

To that end, we must consider the language we use to explain a condition or a treatment plan. Words have the power to empower or disempower. 

Rudyard Kipling had it right when he said, “Words are, of course, the most powerful drug used by humankind.” An article in the in the Journal of Sport and Orthopedic Physical Therapy, entitled, Sticks and Stones: The Impact of Language in MSK Health, reported, just “Like drugs, words have an ability to change the way another person thinks and feels. Words are capable of corrupting or enhancing thoughts. Words can generate good or bad emotions and prompt actions that can lead to positive or negative behavior change.

Evolving Beyond the “Home Exercise Program” in Physical Therapy

At Living Well Institute our mission is to teach people how to optimize their health through self-care, delivered via Integrative & Lifestyle Medicine. There is an enormous evidence-based to support using yoga and other mind-body medicine, as well as lifestyle medicine, in our therapy practices. We just have to master delivering it. 

The WHO, CDC, and scientific community at large recommend the verbiage “physical activity” over “exercise,” due to the fact that any movement an individual engages in- whether it be light house-keeping, playing with kids, or something of higher intensity such as biking or swimming is important for physical, mental and emotional well-being. Exercise is considered planned, structured, and purposeful physical activity, with a goal of increasing physical fitness- and at times brings up a chore-like or dreaded connotation. 

For these reasons, we propose a shift in language for rehab professionals from HEP (Home Exercise Program) to IHP (Individualized Home Program). Not only does IHP align with the health and scientific communities recommendations for healthier living, but it is also more accurate in describing what we actually do with patients. Far beyond prescribing exercises, we also counsel, educate, and propose lifestyle-related shifts to help improve performance, recovery and quality of life. At its root, an IHP improves self-efficacy and patient-centered care.

Not Your Grandma’s Home Exercise Program: What is in the Individualized Home Program (IHP)?

Dr. Ginger Garner, Evolving Physical Therapy: Let's Ditch the “Home Exercise Program”
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Dr. Ginger Garner, Founder of LWI

An individualized home program can consist of:

  1. Lifestyle & behavior change empowerment
  2. Sleep education 
  3. Pain education 
  4. Relationships and stress management 
  5. Physical activity and mind-body movement such as medical therapeutic yoga and mindfulness 
  6. Breathwork
  7. Mindset shifting strategies
  8. Supportive self-care practices
  9. Eliminating harmful environmental substances
  10. This is in addition to just the “exercise” that the phrase HEP implies. So this can also include manual therapies and other modalities like dry needling or cupping, for example.

An IHP communicates with clients that this program is based upon their individual needs. It is never based on an algorithm or other “one-size-fits-all” programming.

The Phrase “Home Exercise Program” is Self-Limiting to the Physical Therapy Profession

Dr. Garner teaching mindfulness in elementary school. Evolving Physical Therapy: Let's Ditch the “Home Exercise Program”
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Moving beyond the HEP across the lifespan. Dr. Garner working with elementary school students teaching mindfulness-based movement. (c)2018. Ginger Garner. All rights reserved.

An HEP communicates that we only prescribe “exercise,” which could not be further from the truth. It limits our profession and our ability to educate the public that we are coaches and therapists that can help across the lifespan. 

At LWI we have taught our clinicians to use “IHP” instead of “HEP” for more than 20 years. IHP  is based on a biopsychosocial approach to health and wellness which cannot be reduced to simply “exercise.”  Use of IHP also shows the critical importance of using an individualized, prescriptive approach to physical and occupational therapy, as well as mental health. 

An IHP is meant to empower the client. This plan is a collaborative effort between therapist and client, putting the client’s needs, goals, and starting place at the center of the plan. Therapists should be well versed in positive psychology, cognitive behavioral therapy, motivational interviewing, and other similar techniques to elicit a shift in beliefs and behaviors. 

True change comes from tapping into the inner wisdom and drive of each individual – we don’t “fix” people, we merely guide individuals, through a step-by-step method of empowerment, to take control of their health and lifestyle choices. 

Creating an IHP is a collaborative process, where we are not a sage on the stage, but a guide on the side. People understand then, that they are at the center of creating wellness. It isn’t in a pill, surgery, or prescription – the power to change their mindset is within themself. 

The IHP meets them where they are at in their stage of change, and approaches behavior change from a bite-sized, evidence-based, compassionate approach. If you would like free access to our FREE IHP worksheet, click here. 

Access our Free IHP Worksheet (excel format) to Get Started Today, at the link below

Sources

Stewart M, Loftus S. Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation. J Orthop Sports Phys Ther. 2018;48(7):519-522. doi:10.2519/jospt.2018.0610

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