ACSM's Exercise Management for Persons With Chronic Diseases and Disabilities, ed 2.

Durstine JL, Moore GE, eds. Champaign, IL 61825-5076, Human Kinetics, 2003, hardcover, 384 pp, illus, ISBN: 0-7360-3872-8, $49.

This is the second edition of a text originally published in 1997. The principal difference between the first and second editions is the addition of numerous cases studies to illustrate the authors' recommendations for exercise for people with a variety of chronic diseases and disabilities. In addition, the second edition includes new chapters dealing with physical activity for children and youth, 5 new chapters on pulmonary diseases, and new chapters on atrial fibrillation and fibromyalgia. The original chapter on organ transplantation has been divided into 3 chapters on cardiac transplant, lung and heart-lung transplantation, and abdominal organ transplant, which includes kidney, liver, and pancreas transplantation.

The current edition contains 49 chapters and 4 appendixes. The editors and the 61 contributors come from a wide variety of specialties, health care facilities, and geographic regions, which adds to the breadth and depth of this text.

The introduction chapter and the second chapter, "Framework," describe how to use this text and briefly describe the problem-oriented medical management system developed in the late 1960s. The framework chapter also includes information on data gathering, assessment, and exercise tests and measures. Although the chapter itself does not directly address the issues of reliability or validity or include specific tests and measures, the 4 suggested readings do address these issues. It briefly discusses the effects of and interaction between exercise and medicines, including paradoxical effects, adverse effects, effects on muscle, ergogenic aids, and exercise dose-response.

The text is divided into 8 sections excluding the appendixes. The sections are "Framework," "Cardiovascular Diseases," "Pulmonary Diseases," "Metabolic Disease," "Immunological/Hematological Diseases," "Orthopedic Diseases and Disabilities," "Neuromuscular Diseases," and "Cognitive, Physiological, and Sensory. Diseases." The conditions covered in these sections are representative of the diseases and illnesses that health care professionals involved in the exercise and management of people with chronic disease and disabilities are most likely to encounter.

The case studies are easy to understand and are the major strength of this text. Although there is some variation in the format of the case studies, many introduce the case with a SOAP note. Although SOAP notes have been criticized for being very repetitive and for creating difficulties in following a patient's progress from one note to the next, the use of SOAP notes to introduce these cases does not present a problem. The cases also include exercise program goals, and descriptions (in tabular form) of the mode, frequency, duration, intensity, and progression of the suggested exercise program.

The book does not contain a great deal of information about individual conditions; the editors clearly state in the preface that they assume that those using the book will have a good working knowledge of exercise science and will require only simple guidance in areas outside their own areas of primary specialization. Each chapter includes a list of suggested readings for those readers who want or need more background information regarding a particular illness or condition. These suggested readings imply that the cases and recommendations are based on information from other textbooks and peer-reviewed journals. No references, however, are provided to support specific statements in the text. Although some of the suggested readings are recent, many are more than 5 years old. With today's emphasis on evidence-based practice, this could present a concern for the clinician.

Appendix A is a comprehensive and up-to-date list of medications that may alter a person's response to exercise. Readers familiar with the ACSM's Guidelines for Exercise Testing and Prescription will recognize the format of appendix B, which lists (in tabular form) the effects of medications on heart rate, blood pressure, electrocardiography, and exercise capacity. The effects of noncardiovascular and nonrespiratory drugs on exercise capacity are covered in appendix C, and a list of Web sites for each of the clinically relevant sections can be found in appendix D.

This is a reader-friendly text and should be useful to anyone working with people with chronic diseases or disabilities. It would be particularly useful to physical therapist students and new physical therapists.

John P Sanko, PT, EdD

University of Scranton 

Scranton, Pa

Dr Sanko is an Associate Professor and Chair of the Department of Physical Therapy. His teaching responsibilities include cardiovascular and pulmonary physical therapy and research.