Exercise Prescription For People Research Articles

#596 The Borg Scale—efficient and safe for exercise prescription in self-administered balance and strength exercise in patients with CKD

Abstract Background and Aims With the continued rise in chronic kidney disease (CKD), there is a critical need for sustainable, home-based exercise interventions. While supervised, centre-based exercise improves physical performance in CKD patients, unsupervised, self-administered exercise poses challenges in ensuring adherence, safety, and efficacy. This study investigates the Borg Rating of Perceived Exertion (RPE) scale, a subjective measure of exertion, as a method for prescribing and monitoring the intensity of balance and strength exercise in non-dialysis dependent CKD patients. The aims of this study were: Method This sub study of the RENEXC-trial included 148 patients with CKD stages 3-5, with a mean age of 66 ± 14 years and mean measured GFR of 22 ± 8 ml/min/1.73 m2. Patients were prescribed 90 minutes/week of balance or strength exercise at a Borg RPE of 13-17 (corresponding to an exercise intensity of somewhat hard to very hard), along with 60 minutes/week of endurance exercise. Exercise programs were individually prescribed by a physiotherapist according to randomization and each patient's baseline performance and were performed at home or in a gym according to the patient's preference. Duration and RPE of the performed exercise were reported in an exercise diary. Progress was monitored by the physiotherapist through phone contact, every week for the first three months of the study and every other week for the rest of the study year. The continuous follow up provided motivation and enabled adjustments of the exercise program to maintain the goal RPE, adapt intensity and the weekly duration of exercise. Outcome measures included the Berg Balance Scale (BBS) and Functional Reach Test (FRT), the 30-second sit-to-stand test (30STS) and isometric quadriceps strength (IQS). Balance and strength measures were evaluated at baseline and after 12 months of exercise. Previous publications of the RENEXC-trial showed no difference between patients who performed balance exercise and patients who performed strength exercise; therefore, this sub-study analysed all included patients as one group. Results Of 148 participants, 112 completed the study. At 12 months, 79% reported performed exercise, with 86% of these patients adhering to the prescribed intensity. The median (25th-75th percentile) exercise intensity was a RPE of 14 (13-15) on the Borg scale, and the median (min-max) exercise duration was 48 (0-241) minutes/week. Only 18% of the patients reached the 90-minute/week target. No exercise-related incidents were reported. Significant improvements were noted in BBS (p = 0.0464), FRT (p = 0.009), 30STS (p = 0.047), and IQS (right/left p = 0.022 / p = 0.049). Conclusion The Borg RPE scale is an effective and safe method for prescribing and monitoring self-administered balance and strength exercise in patients with CKD. Using the Borg scale for prescribing and monitoring exercise intensity during balance and strength exercise resulted in a good level of adherence to the 12-months exercise program and the prescribed exercise intensity. As no exercise related incidents were reported, we conclude that the self-administered exercise was safe to perform. Significant improvements in balance and strength were observed with a moderate to high exercise intensity prescription within a wide range of performed weekly duration of exercise, suggesting the Borg scale's value in exercise prescription in both well- and deconditioned patients with CKD. These findings show that the integration of the Borg scale into routine exercise prescription in people with CKD can promote patient autonomy and efficient resource utilization in healthcare.

Exercise Prescription for People With Metastatic Cancer of the Skeleton

ABSTRACT Exercise is increasingly accepted as a therapy in the management of cancer, and is now described as a medicine, giving rise to a new discipline in clinical practice and research termed exercise oncology. Exercise medicine has been evaluated in clinical trials and implemented in patient care at all phases of disease and treatment trajectory. Advanced disease involving bone metastases presents considerable challenges in terms of patient assessment and exercise prescription. Over the past decade research evidence has accumulated attesting to the safety and efficacy of appropriately designed exercise medicine interventions. Combined with a need for well-developed guidelines, an expert consensus has been developed. Through a rigorous process the overarching recommendation was that exercise professionals should work with the patient and their health care team to balance the risk of adverse events due to participation in exercise therapy against the risk of more rapid patient decline through not exercising, as well as the potential loss of health benefits that could be realized through exercise. This is the basic tenet of health care and withholding or not offering a therapy that is likely to provide greater benefit than the potential risk it may cause for fear of that risk is untenable.

Many physiotherapists lack preparedness to prescribe physical activity and exercise to people with musculoskeletal pain: A multi-national survey

ObjectivesDetermine physiotherapists’ (i) awareness of physical activity, and exercise prescription guidelines; (ii) perceived role, knowledge, confidence, skills and training in prescribing and progressing aerobic exercise and resistance training to people with musculoskeletal pain; (iii) professional development preferences; and (iv) perceived influences of external factors on exercise prescription for people with musculoskeletal pain. DesignMulti-national cross-sectional survey. MethodsAn open online survey was developed specifically for this study. Results1,352 physiotherapists from 56 countries participated. The majority of respondents correctly stated physical activity guidelines for adults (60%) and children (53%), but only 37% correctly stated guidelines for older adults. Eleven percent and 16% could name an accepted guideline for aerobic exercise and resistance training, respectively. Most agreed their role included prescribing aerobic exercise (75%) and resistance training (89%). Fewer reported they had the confidence, training or skills to prescribe aerobic exercise (38–50%) and resistance training (49–70%). Workshops were the most preferred (44%) professional development option. Most respondents believed appointment scheduling and access to equipment and professional development (62–79%) affected their ability to prescribe effective exercise. ConclusionMany physiotherapists lack knowledge and training to provide physical activity advice, and to prescribe aerobic exercise and resistance training to people with musculoskeletal pain.

Application of the Modified Incremental Step Test for Pulmonary Rehabilitation.

A Modified Incremental Step Test (MIST) performed in the home may facilitate entirely home-based pulmonary rehabilitation programs. The aims of this study were to investigate the reliability and responsiveness, and the utility of the MIST for exercise prescription in people with stable chronic lung disease. The MIST was undertaken at the center and home in random order, before and after pulmonary rehabilitation, with 2 tests at each time point. Reliability was assessed using intraclass correlation coefficient. Responsiveness was evaluated as effect size. The minimal important difference was appraised using distribution and anchor-based methods. In a substudy, physiological responses to MIST were measured by a portable metabolic system, followed by a constant step rate test at 60% of peak oxygen uptake (VO2peak), to evaluate utility for exercise prescription. Forty-six participants were recruited (29% of eligible candidates). There was excellent reliability for number of steps recorded in home- and center-based settings (intraclass correlation coefficient = 0.954, 95% CI = 0.915-0.976). A small-moderate effect size was demonstrated following pulmonary rehabilitation (0.34), and the minimal detectable change was 7 steps. All participants in the substudy achieved 60% of VO2peak and achieved steady state by the fourth minute, with 60% of VO2peak corresponding to a mean 37% (95% CI = 29-44) of the MIST final level. The MIST is reliable and responsive to pulmonary rehabilitation in people with stable chronic respiratory disease. It provides new opportunities to assess exercise capacity, prescribe exercise training, and reassess exercise program outcomes in environments where established field walking tests are not feasible. Pulmonary rehabilitation is a highly effective treatment that is underutilized worldwide. Home-based pulmonary rehabilitation may improve access for patients and deliver equivalent clinical outcomes but is limited by the availability of a robust exercise test that can be used at home to assess exercise capacity and prescribe training intensity. This study tested the clinimetric properties of the MIST and demonstrated a new way to assess exercise capacity, prescribe exercise training of an appropriate intensity, and reassess exercise capacity in environments where established field walking tests are not feasible.

Exercise prescription for people with mental illness: an evaluation of mental health professionals' knowledge, beliefs, barriers, and behaviors.

Objective:The aim of this study was to understand the knowledge, beliefs, barriers, and behaviors of mental health professionals about physical activity and exercise for people with mental illness.Methods:The Portuguese version of The Exercise in Mental Illness Questionnaire was used to assess knowledge, beliefs, barriers, and behaviors about exercise prescription for people with mental illness in a sample of 73 mental health professionals (68.5% women, mean age = 37.0 years) from 10 Psychosocial Care Units (Centros de Atenção Psicossocial) in Porto Alegre and Canoas, state of Rio Grande do Sul, Brazil.Results:Most of respondents had received no formal training in exercise prescription. Exercise ranked fifth as the most important treatment, and most of the sample never or occasionally prescribed exercise. The most frequently reported barriers were lack of training in physical activity and exercise prescription and social stigma related to mental illness. Professionals who themselves met recommended physical activity levels found fewer barriers to prescribing physical activity and did so with greater frequency.Conclusion:Exercise is underrated and underused as a treatment. It is necessary to include physical activity and exercise training in mental health curricula. Physically active professionals are more likely to prescribe exercise and are less likely to encounter barriers to doing so. Interventions to increase physical activity levels among mental health professionals are necessary to decrease barriers to and increase the prescription of physical activity and exercise for mental health patients.

Change in [formula omitted]O2peak in Response to Aerobic Exercise Training and the Relationship With Exercise Prescription in People With COPD: A Systematic Review and Meta-analysis

Despite the wide-ranging benefits of pulmonary rehabilitation, conflicting results remain regarding whether people with COPD can improve their peak oxygen uptake (V˙O2peak) with aerobic training. The goal of this study was to investigate the effect of aerobic training and exercise prescription on V˙O2peak in COPD. A systematic review was performed by using MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases for all studies measuring V˙O2peak prior to and following supervised lower-limb aerobic training in COPD. A random effects meta-analysis limited to randomized controlled trials comparing aerobic training vsusual care was conducted. Other study designs were included in a secondary meta-analysis and meta-regression to investigate the influence of program and patient factors on outcome. A total of 112 studies were included (participants, N= 3,484): 21 controlled trials (n= 489), of which 13 were randomized (n= 288) and 91 were uncontrolled (n= 2,995) studies. Meta-analysis found a moderate positive change in V˙O2peak (standardized mean difference, 0.52; 95%CI, 0.34-0.69) with the intervention. The change in V˙O2peak was positively associated with target duration of exercise session (P= .01) and, when studies > 1 year duration were excluded, greater total volume of exercise training (P= .01). Similarly, the change in V˙O2peak was greater for programs > 12weeks compared with those 6 to 12weeks when adjusted for age and sex. However, reported prescribed exercise intensity (P= .77), training modality (P > .35), and mode (P= .29) did not affect V˙O2peak. Cohorts with more severe airflow obstruction exhibited smaller improvements in V˙O2peak (P< .001). Overall, people with COPD achieved moderate improvements in V˙O2peak through supervised aerobic training. There is sufficient evidence to show that programs with greater total exercise volume, including duration of exercise session and program duration, are more effective. Reduced effects in severe disease suggest alternative aerobic training methods may be needed in this population. PROSPERO; No.: CRD42018099300; URL: https://www.crd.york.ac.uk/prospero/.

Exercise and Depressive Disorder.

Depression is a psychiatric disorder characterized by low mood, loss of interest/enjoyment, and reduced energy and one of the five leading causes of disability and a major contributor to all-cause mortality worldwide. People with depression have, between others, a reduced life expectancy, worse quality of life and cardiorespiratory fitness, and increased risk of type 2 diabetes, compared to the general population. Furthermore, the economic burden of mental disorders including depression is evident, and it is expected to increase to more than double by 2030. Therefore, reducing the growing burden of mental disorders such as depression should be a health priority. Improved prevention and treatment are two key factors that may reduce the burden of depression. Pharmacological- and psychotherapy-based interventions have been traditionally considered for treating depression disorders; however, there is an increasing amount of scientific evidence confirming that physical activity and physical exercise should be highly considered in prevention and treatment of depressive disorders. In this chapter, we aim to summarize and discuss the research progress of physical activity and exercise in prevention and treatment of depressive disorder. Specifically, we summarized and discussed the research progress of the prognostic use of physical activity for incident depression, the importance of sedentary behavior and other outcomes typically improved by physical activity/exercise such as cardiorespiratory fitness for future depression, the research progress of the evidence of the benefits of exercise in people with depression disorders, the resistance training effects in adults and older adults with depression, and the recommendations for the prescription of exercise for people with depression.

Rationale and methods for the Exercise for Type 1 Diabetes Education program: a pilot randomized controlled trial of an education program to support adults with type 1 diabetes mellitus (T1DM) to undertake exercise

ObjectiveRegular exercise in people with type 1 diabetes mellitus (T1DM) can result in considerable improvements in health and reduction in cardiovascular events and death. However, a large proportion of people...

Intentions of Canadian health professionals towards recommending exercise for people living with ALS

BackgroundTo provide a nationwide overview of the attitudes, social pressure, perceived ability and intentions of health professionals toward exercise prescription for people living with ALS (pALS).MethodsAn online survey of physician and non-physician health professionals (HPs) working in academic ALS clinics across Canada.ResultsThe response rate was 48% (84/176) with 30% of respondents identifying as physicians, 63% as other HPs and the remainder as administrative or research personnel. Respondents were sharply divided in their intentions to provide exercise counsel: 24% unlikely and 45% likely. Respondents with low intentions were HPs that considered this activity outside their scope of practice. Measures of intention and attitude were more positive for flexibility compared to strength and aerobic exercise. Perceptions of social pressure and ability to provide exercise counsel were significantly correlated with intention across the three exercise modes in all respondents. Qualitative themes identified as barriers to exercise prescription were lack of confidence or competence (31% physicians, 32% HP), patient tolerance (30% HP), lack of evidence (22% physicians) and lack of infrastructure (22% physicians).ConclusionsWhile “lack of evidence” for the benefit of exercise was a deterrent for physicians, the larger issue for all respondents was building competence and confidence in exercise prescription for pALS.

Internet-based Physical Activity Promotion and Exercise Prescription for People With Multiple Sclerosis

Internet-based Physical Activity Promotion and Exercise Prescription for People With Multiple Sclerosis

Exercício físico em pessoas com diabetes: revisão sistemática de literatura

Introdução: A Diabetes mellitus é caraterizada como um conjunto de alterações metabólicas, manifestada por hiperglicemia crónica. A atividade física surge neste contexto como uma estratégia positiva no processo terapêutico da diabetes. Objetivo: Avaliar os efeitos do exercício físico em pessoas com diabetes. Método: Revisão Sistemática da Literatura através do método PICO com a seguinte questão de pesquisa: Quais os benefícios do exercício físico na pessoa com diabetes? A pesquisa foi realizada com recurso a plataformas de bases de dados eletrónicas EBSCOhost, Medline e BVS tendo identificado, selecionado e avaliado a qualidade metodológica, incluindo artigos em acordo com as recomendações do PRISMA. Resultados: Foram incluídos 10 estudos que cumpriam os critérios de elegibilidade e qualidade metodológica definidos para esta revisão. O exercício físico traz benefícios para a pessoa com diabetes nomeadamente a nível da redução da glicose plasmática em jejum e dos valores da hemoglobina glicada, assim como, melhoria da qualidade de vida. Conclusões: A prescrição de exercícios físico em pessoas com diabetes pode ser um adjuvante no tratamento desta condição com benefícios no controlo metabólico e qualidade de vida. Descritores: Diabetes; Exercício Físico; Glicémia; Enfermagem em Reabilitação.

Detección de la población mayor susceptible de prescripción de un programa de ejercicios en Atención Primaria para prevenir la fragilidad

AimIdentify the population over 70 year's old treated in primary care who should participate in a physical exercise program to prevent frailty. Analyze the concordance among 2criteria to select the beneficiary population of the program. DesignPopulation-based cross-sectional study. SettingsPrimary Care. ParticipantsElderly over 70 years old, living in the Peñagrande neighborhood (Fuencarral district of Madrid) from the Peñagrande cohort, who accepted to participate in 2015 (n = 332). Main measurementsThe main variable of the study is the need for exercise prescription in people over 70 years old at the Primary Care setting. It was identified through 2different definitions: Prefrail (1-2 of 5 Fried criteria) and Independent individuals with physical performance limited, defined by Consensus on frailty and falls prevention among the elderly (independent and with a total SPPB score <10). ResultsThe 63,8% of participants (n = 196) need exercise prescription based on criteria defined by Fried and/or the consensus for prevention of frailty and falls in the elderly. In 82 cases the 2criteria were met, 80 were prefrail with normal physical performance and 34 were robust with a limited physical performance. The concordance among both criteria is weak (kappa index 0, 27). ConclusionAlmost 2thirds of the elderly have some kind of functional limitation. The criteria of the consensus document to prevent frailty detect half of the pre-frail individuals in the community.

Exercise Professionals with Advanced Clinical Training Should be Afforded Greater Responsibility in Pre-Participation Exercise Screening: A New Collaborative Model between Exercise Professionals and Physicians

Regular exercise improves health but can also induce adverse responses. Although such episodes are rare, many guidelines for pre-participation exercise screening have historically had a low threshold for recommending medical clearance prior to the commencement of exercise, placing the responsibility for decision making about exercise participation on physicians. The ‘clearance to exercise’ model still occurs widely in practice, but creates cost burdens and barriers to the uptake of exercise. Moreover, many physicians are not provided the training, nor time in a standard consultation, to be able to effectively perform this role. We present a model for pre-participation exercise screening and the initial assessment of clients wishing to commence an exercise programme. It is designed to guide professional practice for the referral, assessment and prescription of exercise for people across the health spectrum, from individuals who are apparently healthy, through to clients with pre-existing or occult chronic conditions. The model removes the request that physicians provide a ‘clearance’ for patients to engage in exercise programmes. Instead the role of physicians is identified as providing relevant clinical guidance to suitably qualified exercise professionals to allow them to use their knowledge, skills and expertise in exercise prescription to assess and manage any risks related to the prescription and delivery of appropriate exercise programmes. It is anticipated that removing unjustified barriers to exercise participation, such as mandated medical review, will improve the uptake of exercise by the unacceptably high proportion of the population who do not undertake sufficient physical activity for health benefit.

Implementation in action: how Australian Exercise Physiologists approach exercise prescription for people with mental illness

Background: Accredited Exercise Physiologists (AEPs) are trained to deliver exercise and physical activity interventions for people with chronic and complex health conditions including those with mental illness. However, their views on exercise for mental illness, their exercise prescription practices, and need for further training are unknown.Aims: To examine the way in which Australian AEPs prescribe exercise for people with mental illness.Methods: Eighty-one AEPs (33.3 ± 10.4 years) completed an online version of the Exercise in Mental Illness Questionnaire. Findings are reported using descriptive statistics.Results: AEPs report a high level of knowledge and confidence in prescribing exercise for people with mental illness. AEPs rate exercise to be at least of equal value to many established treatments for mental illness, and frequently prescribe exercise based on current best-practice principles. A need for additional training was identified. The response rate was low (2.4%) making generalisations from the findings difficult.Conclusions: Exercise prescription practices utilised by AEPs are consistent with current best-practice guidelines and there is frequent consultation with consumers to individualise exercise based on their preferences and available resources. Further training is deemed important.

Factors associated with pain and disability reduction following exercise interventions in chronic whiplash

Some studies support the prescription of exercise for people with whiplash-associated disorders (WAD); however, the response is highly variable. Further research is necessary to identify factors which predict response. This is a secondary analysis of a randomized, multicentre controlled clinical trial of 202 volunteers with chronic WAD (grades 2 and 3). They received either neck-specific exercise with, or without a behavioural approach, or prescription of physical activity for 12 weeks. Treatment response, defined as a clinical important reduction in pain or disability, was registered after 3 and 12 months, and factors associated with treatment response were explored using logistic regression. Participation in the neck-specific exercise group was the only significant factor associated with both neck pain and neck disability reduction both at 3 and 12 months. Patients in this group had up to 5.3 times higher odds of disability reduction and 3.9 times higher odds of pain reduction compared to those in the physical activity group. Different baseline features were identified as predictors of response depending on the time point examined and the outcome measure selected (pain vs. disability). Factors associated with treatment response after exercise interventions differ in the short and long term and differ depending on whether neck pain or disability is considered as the primary outcome. Participation in a neck-specific exercise intervention, in contrast to general physical activity, was the only factor that consistently indicated higher odds of treatment success. These results support the prescription of neck-specific exercise for individuals with chronic WAD.

Investigating the exercise‐prescription practices of nurses working in inpatient mental health settings

Nurses working in mental health are well positioned to prescribe exercise to people with mental illness. However, little is known regarding their exercise-prescription practices. We examined the self-reported physical activity and exercise-prescription practices of nurses working in inpatient mental health facilities. Thirty-four nurses completed the Exercise in Mental Illness Questionnaire - Health Practitioner Version. Non-parametric bivariate statistics revealed no relationship between nurses' self-reported physical activity participation and the frequency of exercise prescription for people with mental illness. Exercise-prescription parameters used by nurses are consistent with those recommended for both the general population and for people with mental illness. A substantial number of barriers to effective exercise prescription, including lack of training, systemic issues (such as prioritization and lack of time), and lack of consumer motivation, impact on the prescription of exercise for people with mental illness. Addressing the barriers to exercise prescription could improve the proportion of nurses who routinely prescribe exercise. Collaboration with exercise professionals, such as accredited exercise physiologists or physiotherapists, might improve knowledge of evidence-based exercise-prescription practices for people with mental illness, thereby improving both physical and mental health outcomes for this vulnerable population.

A call to action: exercise as treatment for patients with mental illness.

Mental illness affects the lives of a significant number of Australians. In addition to pharmacological and psychological interventions, exercise has demonstrated benefits for people with mental illness including symptom reduction, improved cardiovascular risk profile and improved physical capacity. Unfortunately, evidence shows that clinician-delivered exercise advice is not routinely offered. This is despite patient acceptability for exercise. This article summarises the recent evidence supporting the prescription of exercise for people with mental illness and offers a model incorporating basic exercise prescription, and referral pathways for specialised advice. Current exercise prescription patterns for people with mental illness may not meet patient expectations; therefore, clinicians should consider exercise referral schemes to increase the accessibility of interventions for people with a mental illness.

Exercise prescription for people with hip or knee osteoarthritis: accounting for co-morbidities

Exercise prescription for people with hip or knee osteoarthritis: accounting for co-morbidities

The Feasibility of Cardiopulmonary Exercise Testing for Prescribing Exercise to People After Stroke

Despite the importance of exercise training in mitigating cardiovascular risk, the development of exercise programs for people poststroke has been limited by lack of feasibility data concerning cardiopulmonary exercise testing (CPET) to inform the exercise prescription. Therefore, we examined the feasibility of CPETs for developing an exercise prescription in people ≥3 months poststroke. CPET results from 98 consecutively enrolled patients poststroke with motor impairments and 98 age- and sex-matched patients with coronary artery disease were examined at baseline and after 6 months of exercise training. The proportion of patients with stroke and coronary artery disease attaining an intensity sufficient for prescribing exercise at baseline was 68.4% versus 82.7%, respectively (P=0.02) and 84.7% versus 83.8% (P=0.9) at 6 months. Women were less likely than men poststroke to achieve a sufficient intensity at baseline (40% versus 80.9%, P<0.001) but not at 6 months (78.3% versus 87.1, P=0.3). A clinically relevant abnormality occurred in 11.2% of stroke and 12.2% of patients with coronary artery disease on baseline CPETs (P=0.8) and 10.6% of stroke and 5.9% of patients with coronary artery disease on the 6-month CPET (P=0.4). No serious cardiovascular events occurred during 349 CPETs. Most patients after stroke achieved a level of exertion during the CPET sufficient to inform an exercise prescription. At least 1 of 10 patients poststroke developed a clinically relevant abnormality on baseline and postprogram CPETs with no serious cardiovascular events. These data support the feasibility and safety of CPETs for prescribing exercise poststroke. Strategies to improve use of baseline CPETs for women poststroke require further investigation.

Orthopedic Rehabilitation Science: Principles for Clinical Management of Bone

Understanding musculoskeletal anatomy and physiology underpins physiotherapy practice. Physiotherapists are at the forefront of promoting good bone hygiene and, consequently, require an in-depth understanding of bone. This knowledge can be used to understand disease prevention or progression and can serve as a foundation on which to base effective treatment regimens. Orthopedic Rehabilitation Science is an important textbook for the clinician and budding scientist that highlights all aspects of bone biology and physiology; it provides an overview of the pertinent issues in the management of bone disorders from the cellular level to the whole bone and across the lifespan. Orthopedic Rehabilitation Science is divided into three sections: (1) basic bone biology and physiology, (2) bone biomechanics and (3) common musculoskeletal pathologies. Within each section, clinically relevant key features are highlighted. Section 1 provides a description of basic bone biology, including the physiology of the basic multicellular unit, key indicators of bone metabolism and the process of bone turnover. Dr. Lundon describes the diagnostic tools used to establish bone formation or turnover rate and summarizes imaging tools involved in bone quality assessment. In particular, Lundon reviews dual energy x-ray absorptiometry (DXA), considered the “gold standard” for assessing bone density (e.g., osteoporosis), quantitative ultrasonography and peripheral quantitative computed tomography (pQCT). The importance of pQCT is that it can describe volumetric bone mineral density and bone geometry and can separate cortical from trabecular bone. In Section 2, Dr. Lundon summarizes bone biomechanics and the response to physical activity. Several key, peer-reviewed studies are cited that discuss the impact of exercise on bone health across the lifespan. The important parameters of exercise prescription, such as type, duration and site are discussed. Lundon emphasizes the lifespan approach by reviewing the impact of exercise on bone health across age groups, from peak bone mass accrual in adolescents to the loss of bone mass in the post-menopausal phase. This is particularly relevant for exercise prescription in people with compromised low-bone mass, such as those at risk of developing osteoporosis. This section concludes with a chapter on fracture healing (traumatic, fragility and stress fractures) and suggests evidence-based treatment approaches. Physiotherapists can be key stakeholders by acting as catalysts in the secondary prevention of osteoporosis after a fragility fracture. Section 3 of Orthopedic Rehabilitation Science is key for clinicians. The information from Sections 1 and 2 is successfully translated into relevant information for practicing clinicians. One skeletal disorder that is discussed in detail is osteoporosis, a condition of skeletal fragility characterized by low bone mass and affecting 25% of women and 12% of men over the age of 50 years in Canada. Osteoporosis costs approximately $1.3 billion dollars annually in Canada, most of which is related to hip fractures. Physiotherapists are important health providers in the treatment of osteoporosis and prevention of disease progression. The chapter on metabolic bone diseases provides an overview of osteoporosis, including diagnostic tools, clinical assessment and, finally, a review of pharmacology and therapeutic management strategies. This book provides a solid understanding to guide clinicians toward a better background of bone-related issues. Throughout Section 3, highlighted textboxes provide “Clinical Notes” for the practicing clinician. For example, in the section on osteoporosis, there is a referenced summary that reviews the general and specific management of acute compression fractures. More information and clinician sidebars on related joint pathologies, such as osteoarthritis and rheumatoid arthritis, would further add to the textbook. Lastly, a section on the important role that physiotherapists play in the prevention of disease progression is warranted. Orthopedic Rehabilitation Science is an important and timely textbook to provide evidence-based clinical information for physiotherapists. It provides a theoretical basis for treatment and clinically relevant information to assist in the treatment and prevention of bone-related pathologies.