521
Aerobic exercise in adult neuromuscular rehabilitation
Fig. 2. Perceived barriers to prescribing aerobic exercise in adult neuromuscular rehabilitation. Dark and light bars indicate the number of
respondents reporting the item as a barrier to prescribing aerobic exercise in respectively specialized centres and primary care. This concerned a
multiple response variable.
Need for support Application of aerobic exercise
The majority of respondents (77%) reported the need
for support to improve the application of AE in neuro-
muscular rehabilitation. Most support is needed with
respect to the screening procedure (54%) and dosing
of exercise (48%), while monitoring and evaluation
were reported by, respectively, 33% and 31% of re-
spondents. The preferred means of support was via
a guideline (71%), followed by the availability of an
(online) course (62%) and e-learning (58%). Although this survey indicates that AE is applied wi-
dely in adult neuromuscular rehabilitation, healthcare
professionals appear to be rather reserved with respect
to the training dose they prescribe, and to struggle
with determination of the target intensity. Therefore,
it is questionable whether AE is applied effectively in
current care.
The most optimal FITT factors for AE in NMD
have not yet been described (13, 14). In the general
population (23), and other clinical populations, such
as stroke (24), hypertension (25) and type 2 diabetes
(26), there is consensus that AE requires the frequent
(i.e. 3–5 days weekly) use of large muscle groups,
for prolonged periods of time (≥ 20 min per session).
Previous studies demonstrating positive effects of AE
in various NMD also made use of these characteristics
(5–9), and, in this respect, it is interesting to note that
a lower frequency is mostly used in clinical practice.
An important finding in line with this is that more
than half of the respondents reported underuse in
their current practice. Substantial underuse was also
reported in previous studies by both practitioners (27)
and patients (28), even though this concerned general
physical therapy treatment in NMD. A study in stroke
rehabilitation showed that, despite clear recommenda-
tions for moderate- to-vigorous intensity AE, physical
therapists commonly prescribed light intensities (19).
The authors relate this to safety concerns, which, sup-
ported by the perceived barriers in the current study,
DISCUSSION
This study provides an insight into the current appli-
cation of AE in adult neuromuscular rehabilitation in
the Netherlands from the perspective of a healthcare
professional. All respondents applied AE in various
NMD, and programmes generally included sessions
of more than 20 min, conducted 2 days per week,
over a period of 9–16 weeks, using several different
methods to target intensity and exercise modes. De-
spite the strong agreement among healthcare profes-
sionals that AE should be incorporated into treatment
programmes, they experienced several barriers. More
than three-quarters of respondents indicated the
need for support to improve the application of AE in
neuromuscular rehabilitation, preferably through the
development of guidelines and education, covering,
in particular, the screening procedure and dosing of
training programmes.
J Rehabil Med 51, 2019