Exercise in rehabilitation medicine, ed 2.

Frontera WR, ed. Champaign, IL 61825, Human Kinetics, 2006, hardcover, 464 pp, illus, ISBN: 0-7360-5541-X, $95.

This second edition is edited by 3 physicians who assembled a group of 35 contributors from various health care fields. Since the publication of the first edition, each chapter has been updated and 3 additional chapters ("Cancer," "Human Immunodeficiency Virus," and "End-Stage Renal Disease") have been included to make the text current.

The text provides basic information on exercise physiology and its application to the clinical setting. The information in the text appears to be geared toward the physical medicine and rehabilitation physician and is a little too generic for the practicing physical therapist.

The text is divided into 4 parts. The first part, "Biological Considerations," contains 4 chapters that lay the foundation for the book. The first chapter describes the acute physiological responses to dynamic exercise. A small synopsis on the acute exercise response in diabetes mellitus and cardiorespiratory changes with inactivity is included. The next chapter focuses on the adaptations to endurance exercise training, and chapter 3 focuses on the adaptations to strength training. The final chapter of this part concentrates on training flexibility. I liked the research study comparison table in the flexibility chapter, which allows readers to compare recent evidence on static, ballistic, and proprioceptive neuromuscular facilitation stretching. These 4 chapters serve their purpose as a review of physiological changes that occur with therapeutic exercise.

Part II includes 3 chapters on special clinical considerations. The first chapter in this part reviews exercise capacity testing and contains several tables on exercise testing criteria and exercise protocols, with case examples. Behavioral approaches to prescribing physical activity for health and fitness are described in the next chapter. This chapter provides the reader with commonly used exercise questionnaires (eg, Physical Activity Readiness Questionnaire [PAR-Q], Patient-centered Assessment and Counseling for Exercise [PACE]). The final chapter in this section focuses on exercise and the prevention of chronic disabling illnesses, such as diabetes, cancer, and osteoporosis.

The third part of the text includes exercise in the rehabilitation of specific diseases and conditions. These 12 chapters cover patients with a wide variety of disabling conditions that affect the function of the heart, circulation, lungs, joints, endocrine system, bones, and neuromuscular system. This part is the strength of the text, with coverage of a broad spectrum of diseases. The weakness, however, is the lack of detail in exercise prescription. For example, the chapter on stroke is weighted heavily on biofeedback and function electrical muscle stimulation, with minimal information given on aerobic exercise and strength training. Also, I found the chapter on arthritis disappointing. There is no mention of fibromyalgia, and little is mentioned on arthritis in children. The chapter on respiratory diseases, however, is very complete, with several references related to lower and upper extremity exercise.

The final section of the text focuses on 2 populations: the aging individual and the elite athlete with a disability. I found the portion on wheelchair racing biomechanics and training techniques to be useful and applicable.

Overall, I believe the book would be more helpful if it provided readers with more specific instruction on exercise technique and dosage. The text is well written, but because of multiple contributors, format varies from chapter to chapter. Nevertheless, there are several strong features in this text, including the "summary of research studies" tables are found in many of the chapters and the case studies found at the beginning of many chapters. The focus of these cases is the medical management of patients with little detail on therapeutic exercises.

Although some of the disease-specific information will help physical therapists with clinical-decision making, this book is more appropriate for the rehabilitation resident or physician. However, I would include this text as a reference book in the rehabilitation medicine medical library.

Janice K Loudon, PT, PhD, SCS, ATC, is Associate Professor, Physical Therapy Program, University of Kansas Medical Center, Kansas City, Kan.

[DOI 10.2522/ptj.2007.87.1.116.1]