A Reasoning Model for Choosing Exercise for the Individual

Rather than naming the best exercise for a condition, the speaker sets out four overlapping areas that guide exercise selection. Tissue capacity covers strength, load tolerance and mechanotransduction. Movement strategies may be adaptive or maladaptive, such as bracing or limping months after an injury. Beliefs, such as fear of moving, can limit loading, and adherence fails if the person finds an exercise irrelevant or dull. The areas interact: after ACL reconstruction, a squat strategy may shift load onto the uninjured leg. Once the aim is clear, clinicians adjust load, reps, sets, time, equipment and context, and decide whether to use general activity, graded exposure, symptom modification or a meaningful task. The biopsychosocial approach should not shrink to a psychosocial one. Factors that affect outcomes include goals, self-efficacy, exercise experience, enjoyment and preference, expectations, clear instructions, sleep, dosage, time constraints and accountability. Current activity, history, pathology, stress and nervous system sensitivity also shape a person's state. Conditioning can be pictured as a U shape, with the most room to change things at the sedentary and the highly active ends.