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 CONTEMPORARY ISSUES
IN PHYSICAL THERAPY AND
REHABILITATION MEDICINE

Jones and Bartlett’s

Contemporary Issues in Physical Therapy and
Rehabilitation Medicine Series

Series Editor
Peter A. Huijbregts, PT, MSc, MHSc, DPT, OCS, FAAOMPT, FCAMT

Other books in the series:

Now Available
Tension-Type and Cervicogenic Headache: Pathophysiology, Diagnosis, and Management
César Fernández-de-las-Peñas, PT, DO, PhD
Lars Arendt-Nielsen, DMSc, PhD
Robert D. Gerwin, MD

Orthopaedic Manual Therapy Diagnosis: Spine and Temporomandibular Joints

Aad van der El, BPE, BSc, PT, Dip. MT, Dip. Acupuncture

Coming Soon
Myofascial Trigger Points: Pathophysiology and Evidence-Informed Diagnosis and Management
Jan Dommerholt, PT, DPT, MPS, DAAPM
Peter A. Huijbregts, PT, MSc, MHSc, DPT, OCS, FAAOMPT, FCAMT

Clinical Prediction Rules: A Physical Therapy Reference Manual

Paul E. Glynn, PT, DPT, OCS, FAAOMPT
P. Cody Weisbach, PT, DPT

Post-Surgical Rehabilitation After Artificial Disc Replacement:

An Evidenced-Based Guide to Comprehensive Patient Care
John N. Flood, DO, FACOS, FAOAO
Roy Bechtel, PT, PhD
Scott Benjamin, PT, DScPT
58219_FMxx_FINAL.qxd 9/11/09 1:54 PM Page i

WELL NE SS
AN D P HY S I C AL TH E RAPY

SHARON ELAYNE FAIR, PT, MS, PhD

President of The Wellness Society
58219_FMxx_FINAL.qxd 9/11/09 1:54 PM Page ii

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Library of Congress Cataloging-in-Publication Data
Fair, Sharon Elayne, 1960-
Wellness and physical therapy / by Sharon Elayne Fair.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7637-5821-9 (pbk.)
ISBN-10: 0-7637-5821-3 (pbk.)
1. Physical therapy. 2. Physical fitness. 3. Health. I. Title.
[DNLM: 1. Physical Therapy Modalities. 2. Health Behavior. 3. Health Promotion. WB 460 F163w 2010]
RM700.F35 2010
615.8’2—dc22
2008055384
6048
Printed in the United States of America
13 12 11 10 09 10 9 8 7 6 5 4 3 2 1
58219_FMxx_FINAL.qxd 9/11/09 1:54 PM Page iii

Dedication

I dedicate this book to my daughter, Embury Elayne Fair-Russell, whom I love more than
the universe is big and always will, and my brother, Michael James Fair, who sacrificed
his life for our country and whom I continue to love and miss every single day.

■ iii ■
58219_FMxx_FINAL.qxd 9/11/09 1:54 PM Page iv
58219_FMxx_FINAL.qxd 9/11/09 1:54 PM Page v

Contents

Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi
Introduction by the Series Editor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
Chapter 1 The Basics of Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Section 1: Health and Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Health Promotion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Health Versus Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Summary: Health and Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Section 2: Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Primary Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Secondary Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Tertiary Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Prevention: Present and Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Summary: Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

■ v ■
58219_FMxx_FINAL.qxd 9/11/09 1:54 PM Page vi

vi ■ CONTENTS

Section 3: Healthy People. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Summary: Healthy People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Section 4: Wellness Models and Surveys . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Illness–Wellness Continuum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Ardell’s Models of Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
The Six-Dimensional Model of Wellness . . . . . . . . . . . . . . . . . . . . . 9
Holistic Model for Wellness and Prevention
Over the Life Span . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Perceived Wellness Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Humanistic Model of Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Summary: Wellness Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Section 5: Stages of Wellness: Examination, Evaluation,
Plan of Care, and Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Primordial Stage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Pre-Contemplation Stage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Contemplation Stage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Preparation Stage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Action Stage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Maintenance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Permanent Maintenance Stage . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Summary: Stages of Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Section 6: Surveys to Assess Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Summary: Surveys to Assess Wellness . . . . . . . . . . . . . . . . . . . . . . 20

Chapter 2 The Application of Wellness to Physical Therapy . . . . . . . . . . . . . 21

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Section 1: Wellness Practitioners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Disciplines That Contribute To and Impact Wellness . . . . . . . . . . . 22
Credentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Provider Expertise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Summary: Wellness Practitioners . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Section 2: Physical Therapy Services: Restorative, Maintenance,
Prevention, and Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Restorative Physical Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Maintenance Physical Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Prevention Physical Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Wellness Physical Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Standards of Care and Malpractice . . . . . . . . . . . . . . . . . . . . . . . . 25
Summary: Physical Therapy Services . . . . . . . . . . . . . . . . . . . . . . . 26
Section 3: Physical Therapy Education . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Summary: Physical Therapy Education . . . . . . . . . . . . . . . . . . . . . 28
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58219_FMxx_FINAL.qxd 9/11/09 1:54 PM Page vii

Contents ■ vii

Section 4: Why Should Physical Therapists Possess an Operational

Knowledge of Wellness? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Patient Questions Related to Wellness . . . . . . . . . . . . . . . . . . . . . . 30
Physical Therapists Are Wellness Role Models . . . . . . . . . . . . . . . . 30
Summary: Why Should Physical Therapists Possess an
Operational Knowledge of Wellness?. . . . . . . . . . . . . . . . . . . . . 31

Chapter 3 Physical Therapy and Wellness: Past, Present, and Future . . . . . . 33

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Section 1: Roots of Physical Therapy and Wellness . . . . . . . . . . . . . . . . . 34
Summary: Roots of Physical Therapy and Wellness . . . . . . . . . . . . 35
Section 2: Precursors of Wellness and Physical Therapy in the
United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Summary: Precursors of Wellness and Physical Therapy
in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Section 3: The First Half of the 20th Century: Birth of the Physical
Therapy Profession. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Summary: The First Half of the 20th Century: Birth of
the Physical Therapy Profession . . . . . . . . . . . . . . . . . . . . . . . . . 39
Section 4: The Second Half of the 20th Century: Physical Therapy
and Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
The 1960s Through the 1980s . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
The 1990s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Summary: The Second Half of the 20th Century:
Physical Therapy and Wellness. . . . . . . . . . . . . . . . . . . . . . . . . . 43
Section 5: Physical Therapy’s Expansion of Wellness in the
New Century . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
The Years 2000 Through 2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
The Years 2005 Through 2008. . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Summary: Physical Therapy’s Expansion of Wellness in the
New Century . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Section 6: Future Relationship Between Physical Therapy and
(Fitness) Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Summary: Future Relationship Between Physical Therapy
and (Fitness) Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Chapter 4 Physical Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Section 1: Physical Wellness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Diseases and Medical Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Pharmaceuticals and Drugs and Drug Wellness . . . . . . . . . . . . . . . 53
58219_FMxx_FINAL.qxd 9/11/09 1:54 PM Page viii

viii ■ CONTENTS

Nutrition and Nutritional Wellness . . . . . . . . . . . . . . . . . . . . . . . . 54

Aerobic Capacity and Aerobic Capacity Wellness. . . . . . . . . . . . . . 54
Muscular Fitness and Muscular Fitness Wellness . . . . . . . . . . . . . . 54
Flexibility and Flexibility Wellness . . . . . . . . . . . . . . . . . . . . . . . . . 55
Body Composition and Body Composition Wellness. . . . . . . . . . . . 55
Summary: Physical Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Section 2: Why Physical Therapists Should Possess an Operational
Knowledge of Physical Wellness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Restorative Physical Therapy Patients Present with
Impaired Physical Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Physical Therapy Patients/Clients Present with Impaired
Drug Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Physical Therapy Patients Present with Impaired Nutritional,
Fitness, and Body Composition Wellness . . . . . . . . . . . . . . . . . . 59
Physical Wellness Affects Physical Health . . . . . . . . . . . . . . . . . . . 59
Physical Wellness Is Linked to Mental and Social Health . . . . . . . . 60
Physical Wellness Can Affect the Ability to Engage and
Progress in Physical Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Physical Therapy Practice Is Expanding into the Fitness
Wellness Arena . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Physical Therapists Are Viewed as Wellness Experts and
Role Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Knowledge of Wellness and Physical Wellness Are Accreditation
Requirements in Entry-Level Physical Therapy Curriculum . . . . 63
Summary: Why Physical Therapists Should Possess an
Operational Knowledge of Physical Wellness . . . . . . . . . . . . . . . 63

Chapter 5 Physical Wellness and Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Section 1: Nutritional Wellness and Scope of Care of Physical
Therapy Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Summary: Nutritional Wellness and Scope of Care . . . . . . . . . . . . 67
Section 2: Basic Terminology and Concepts . . . . . . . . . . . . . . . . . . . . . . . 67
Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Beverages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Calorie and Caloric Intake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Carbohydrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Coffee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Dietary Reference Intake, Reference Daily Intake, and
Recommended Daily Intake . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
58219_FMxx_FINAL.qxd 9/11/09 1:54 PM Page ix

Contents ■ ix

Dietician (Versus Nutritionist) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Fats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Fiber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Fruits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Grains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Milk and Dairy Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Minerals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Oils and Fats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Protein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Protein-Rich Foods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Soda Beverages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Soups, Sauces, and Gravies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Substrates and Substrate Intake . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Sugary Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Vegetables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Vegetarians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Vitamins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Summary: Basic Terminology and Concepts . . . . . . . . . . . . . . . . . . 78
Section 3: Nutritional Wellness Pyramids . . . . . . . . . . . . . . . . . . . . . . . . . 78
Summary: Nutritional Wellness Pyramids . . . . . . . . . . . . . . . . . . . 82
Section 4: History of Nutritional Wellness . . . . . . . . . . . . . . . . . . . . . . . . 82
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Historical Nutrition Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Analysis of History of Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Summary: History of Nutritional Wellness . . . . . . . . . . . . . . . . . . . 84
Section 5: Systems Review of Nutritional Wellness . . . . . . . . . . . . . . . . . 84
Analysis of Nutritional Wellness Systems Review. . . . . . . . . . . . . . 86
Summary: Systems Review of Nutritional Wellness . . . . . . . . . . . . 86
Section 6: Tests and Measures of Nutritional Wellness . . . . . . . . . . . . . . . 86
Section 7: Nutritional Wellness Evaluation. . . . . . . . . . . . . . . . . . . . . . . . 95
Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
The Typical Patient/Client . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Categories of Reference Patients/Clients . . . . . . . . . . . . . . . . . . . . 99
Summary: Nutritional Wellness Evaluation . . . . . . . . . . . . . . . . . 100
Section 8: Nutritional Wellness Conditions and Diagnoses. . . . . . . . . . . 100
Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Vegetarianism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Athleticism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Summary: Nutritional Wellness Conditions
and Diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
58219_FMxx_FINAL.qxd 9/11/09 1:54 PM Page x

x ■ CONTENTS

Section 9: Prognosis, Plan of Care, and Goals . . . . . . . . . . . . . . . . . . . . 102

Nutritional Wellness Prognosis. . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Nutritional Wellness Plan of Care . . . . . . . . . . . . . . . . . . . . . . . . 102
Nutritional Wellness Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Prognosis of Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Plan of Care and Goals Related to the Food Groups . . . . . . . . . . 103
Plan of Care and Goals Related to Caloric Input . . . . . . . . . . . . . 104
Plan of Care and Goals Related to the
Nutritional Substrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Plan of Care and Goals Related to the Athlete . . . . . . . . . . . . . . . 106
Summary: Prognosis, Plan of Care, and Goals . . . . . . . . . . . . . . . 108
Section 10: Nutritional Wellness Interventions and
Global Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Global Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Summary: Nutritional Wellness Interventions
and Global Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Chapter 6 Physical Wellness and Fitness. . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Section 1: Scope of Physical Therapy Practice . . . . . . . . . . . . . . . . . . . . 110
Summary: Scope of Physical Therapy Practice . . . . . . . . . . . . . . . 110
Section 2: Basic Terms and Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Anabolic Steroids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Caloric Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Dehydration and Hydration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Examination of Fitness Wellness . . . . . . . . . . . . . . . . . . . . . . . . . 112
Isometrics, Isotonics, and Isokinetics . . . . . . . . . . . . . . . . . . . . . . 112
Substrate Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Warm-Up and Cool-Down . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Summary: Basic Terms and Concepts. . . . . . . . . . . . . . . . . . . . . . 114
Section 3: Examination: History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Analysis of the History of Fitness and Fitness
Wellness Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Summary: History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Section 4: Examination: Systems Review . . . . . . . . . . . . . . . . . . . . . . . . 117
Analysis of the Fitness Wellness Systems Review . . . . . . . . . . . . . 117
Summary: Systems Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Section 5: Examination: Tests and Measures . . . . . . . . . . . . . . . . . . . . . 119
Fitness Wellness Tests and Measures . . . . . . . . . . . . . . . . . . . . . . 119
58219_FMxx_FINAL.qxd 9/11/09 1:54 PM Page xi

Contents ■ xi

Fitness and Fitness Wellness Survey . . . . . . . . . . . . . . . . . . . . . . . 127

Fitness Tests and Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Summary: Tests and Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Section 6: Evaluation of Fitness and Fitness Wellness . . . . . . . . . . . . . . 135
Evaluation of the Fitness Wellness Survey . . . . . . . . . . . . . . . . . . 135
The Typical Patient’s/Client’s Fitness Wellness . . . . . . . . . . . . . . . 140
Evaluation of Aerobic Capacity . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Evaluation of Muscular Fitness . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Flexibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Summary: Evaluation of Fitness and Fitness Wellness . . . . . . . . . 143
Section 7: Fitness Wellness Condition/Diagnosis . . . . . . . . . . . . . . . . . . 144
Summary: Fitness Wellness Condition/Diagnosis . . . . . . . . . . . . . 144
Section 8: Fitness and Fitness Wellness Prognosis, Plan of Care,
and Goals/Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Plan of Care and Goals/Objectives. . . . . . . . . . . . . . . . . . . . . . . . 145
Plan of Care Related to Exercise Adherence. . . . . . . . . . . . . . . . . 149
Summary: Prognosis, Plan of Care, and Goals . . . . . . . . . . . . . . . 150
Section 9: Aerobic Capacity Wellness and Aerobic Capacity Plan
of Care and Goals/Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Variables of Aerobic Capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Aerobic Capacity Wellness Preferred Practice Pattern . . . . . . . . . 154
Aerobic Capacity Wellness Goals/Objectives . . . . . . . . . . . . . . . . 154
Aerobic Capacity Preferred Practice Patterns . . . . . . . . . . . . . . . . 155
Aerobic Capacity Goals/Objectives . . . . . . . . . . . . . . . . . . . . . . . 156
Summary: Aerobic Capacity and Aerobic Capacity Wellness . . . . 158
Section 10: Muscular Fitness and Muscular Fitness Wellness Plan
of Care and Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Muscular Fitness Wellness Preferred Practice Pattern . . . . . . . . . 159
Muscular Fitness Wellness Goals/Objectives . . . . . . . . . . . . . . . . 159
Muscular Fitness Preferred Practice Pattern . . . . . . . . . . . . . . . . . 161
Muscular Fitness Goals/Objectives . . . . . . . . . . . . . . . . . . . . . . . 162
Summary: Muscular Fitness and Muscular Fitness Wellness. . . . . 163
Section 11: Flexibility and Flexibility Wellness Plan of Care
and Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Flexibility Wellness Preferred Practice Pattern . . . . . . . . . . . . . . . 164
Flexibility Wellness Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Flexibility Plan of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Summary: Flexibility and Flexibility Wellness. . . . . . . . . . . . . . . . 168
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xii ■ CONTENTS

Section 12: Fitness and Fitness Wellness Interventions

and Global Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Global Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Summary: Fitness Interventions and Global Outcomes . . . . . . . . 170

Chapter 7 Physical Wellness and Body Composition . . . . . . . . . . . . . . . . . . 171

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Section 1: Scope of Physical Therapy Practice . . . . . . . . . . . . . . . . . . . . 172
Summary: Scope of Physical Therapy Practice . . . . . . . . . . . . . . . 172
Section 2: Basic Terms and Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Basal and Resting Metabolic Rate . . . . . . . . . . . . . . . . . . . . . . . . 173
Body Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Body Mass Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Body Classification: Ectomorph, Endomorph, Mesomorph . . . . . 173
Body Type: Android and Gynoid . . . . . . . . . . . . . . . . . . . . . . . . . 174
Caloric Input and Caloric Output. . . . . . . . . . . . . . . . . . . . . . . . . 174
Dietary-Induced Thermogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Examination of Body Composition Wellness . . . . . . . . . . . . . . . . 175
Fat Mass. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Hyperplasia and Hypertrophy of Fat Cells . . . . . . . . . . . . . . . . . . 175
Lean Body Mass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Obese. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Overfat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Overweight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Set Point Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Summary: Basic Terms and Concepts. . . . . . . . . . . . . . . . . . . . . . 176
Section 3: Examination: History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Analysis of History of Body Composition and Body
Composition Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Summary: History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Section 4: Examination: Systems Review . . . . . . . . . . . . . . . . . . . . . . . . 177
Analysis of the Body Composition Screen and Body
Composition Wellness Screens . . . . . . . . . . . . . . . . . . . . . . . . . 180
Summary: Systems Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Section 5: Examination: Tests and Measures . . . . . . . . . . . . . . . . . . . . . 180
Body Composition Wellness Tests and Measures . . . . . . . . . . . . . 181
Body Composition Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Summary: Tests and Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
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