Promoting Fitness, Function and Physical Activity in School-Based Physical Therapy

A child riding a Rifton adaptive tricycleCompetencies of school physiotherapists, as described in the Journal of Pediatric PhysiotherapyThey include knowledge and skills in pediatric physical therapy (PT), as well as knowledge of school structure, policies, and regulations.1 Of the nine competencies indicated, well-being and prevention are included.1 Consequently, the competencies of entry-level pediatric physical therapists include health and safety promotion.2 This article presents considerations for school physical therapists to promote student wellness, prevention, health, and safety using physical therapy strategies to improve fitness, function, and physical activity.

He International Classification of Functioning, Disability and Health (ICF) provides a framework for PT interventions.3 The ICF model for children uses the “F-word” structure.4 In this model the personal dimensions are: Fitness (body structure and function); Function (activity); and Friends (participation), while the contextual factors are: Family (environmental factors); and Fun (personal factors).4 The “F-words” model provides an outline for designing PT interventions to address academic and functional needs to optimize a student’s level of participation in school, home, and community activities.1

Fitness Guidelines

Fitness interventions may include health-related components, such as muscular strength, muscular endurance, cardiorespiratory endurance, flexibility, and body composition, and/or skill-related components, such as reaction time, agility, balance, power, speed, and coordination. to address student goals.5 It is essential to “dose” interventions to optimize results using the FITTE principles (Frequency, Intensity, Time, Type and Enjoyment) of the American College of Sports Medicine.5 For example, evidence suggests that strength interventions for students with cerebral palsy (CP) should be performed 2 to 4 times per week for 12 to 24 weeks at an intensity of 50 to 85% of 1 repetition maximum (RM).6 Evidence on intermediate/advanced levels of power training to improve speed and strength in youth with cerebral palsy indicates that youth should participate 2-3 times/week in 3-6 sets of 1-6 repetitions at 60-80% of 1 RM for 20-30 minutes/session for 8-12 weeks.7.8 The FITTE principles for aerobic training specify that youth should engage in 30 to 60 minutes a day of moderate to vigorous physical/aerobic activity (65 to 93% of maximum heart rate), such as brisk walking, swimming, running and riding a bike.5.8 Physical therapy is not typically performed at these high frequencies, so it is important for school physical therapists to provide students and families with referrals to community resources such as Special Olympics, Topps Soccer, or Challenger Baseball.

Ideas to promote continued activity at school include walk/roll events, active recess programs, and increased physical activity in physical education. Likewise, the National Center for Health, Physical Activity and Disability ( has many resources to promote fitness, function and physical activity. Introducing active movement in short 5- to 10-minute sessions throughout the day is another great way to decrease sedentary behaviors and the harmful effects of prolonged inactivity.9

Additionally, activity-based PT considers the student, task, and environment to ensure appropriate intervention dosage and design.10 For example, students with disabilities are often deconditioned with postural control challenges and musculoskeletal malalignment and often require adaptive equipment to successfully perform tasks or exercises.10 The best results are seen when adaptive equipment is compatible with school routines that promote participation. A student with decreased aerobic capacity and postural control problems may benefit from the use of a adaptive tricycle in therapy or wheeled mobility at school. A student who cannot walk with musculoskeletal malalignment when standing may use a Mobile support which provides support at the level at which the student has active control to encourage participation and use of the upper extremities. A student who requires an assistive device to ambulate may benefit from Pacemaker gait trainer to support body weight and alignment during gait training to improve aerobic and muscular endurance. The following video clip from Rifton provides creative ways to incorporate equipment into a student’s school day: Stay active, move forward.

It is important for the school physical therapist to monitor progress and results. Some measurement ideas include using a heart rate monitor or the OMNI-Rate of Perceived Exertion (RPE) scale for aerobic intensity.eleven Strength can be measured using 6-RM; manual dynamometry; or repetitions in a timed test (e.g., 30 seconds of sitting and standing MRI).12 Functional mobility can be measured using the Timed-Up-And-Go,13 and physical activity can be measured with a waist-mounted activity monitor while walking14 or a wrist-mounted activity monitor during upper extremity exercises.fifteen

It is important to promote physical fitness, function, and activity to improve the health and well-being of students with disabilities in the school setting. By improving overall fitness and functional mobility, students can participate in more school and classroom activities. School physical therapists are creative and collaborative. They have the skills to design activity-based physical therapy interventions, monitor outcomes, provide resource recommendations, and facilitate an “active school culture” to promote student fitness, functioning, and overall physical activity.

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