Anaerobic Activity Therapy (ACT)
The ACT treatment focused on developing individualized, constructive and pleasurable activities accompanied by reinforcement of progress. Staci Stevens, an exercise physiologist, who has previously worked on similar interventions, supervised this condition.
In order to gain an assessment of flexibility and strength at both pre- and post-test, participants in all conditions completed the shoulder flexibility test, which measures the flexibility in the right and left shoulders. All participants also completed the sit and reach test, which is the most widely used measure of flexibility and a primary component of most physical fitness tests. The test is designed to measure the extensibility of the hamstring muscles and the lower back articulations by evaluating the maximal reach an individual can make in a seated position. This test has excellent test–retest and intra-rater reliability (Gabbe, Bennell, Wajswelner, & Finch, 2004). Finally, all participants completed the hand dynamometer, which measures a person’s grip strength and is a good measure of loss of work capacity (Chengalur, Smith, Nelson, & Sadoff, 1990). It is fast, easy to perform, and produces a reliable report that is simple to record (Innes, 1999). Information from these tests were helpful in guiding the therapists’ 13-session protocol, which is summarized below.
Sessions 1–3.
The first three sessions involved engaging participants in therapy and offering them a detailed treatment rationale. The intervention was described to participants as involving activity scheduling and progress assessments. The treatment plan involved three phases: engagement and education, exercise prescription and monitoring, and maintaining functional gains. Behavioral goals for the program were explained to the participants and included energy system education, redefining exercise, prescribing appropriate exercise, increasing selected daily physical activities, and improving quality of life. The participants were assisted in translating these principles to certain physical activities employed in daily living. Participants were shown the principle of specificity in training for achieving functional gains and educated about its integral role within the exercise prescription. After learning to acknowledge the reality of their symptoms, participants received an explanation regarding the benefits of the pragmatic rehabilitative approach as well as the exercise model. Exercise progression was also described at this time. Participants were informed about the importance of gradually increasing anaerobic activity levels, and were asked to complete a daily exercise diary. Participants were requested to identify any goals and/or problems that they were experiencing with regards to exercise compliance.
Sessions 4–7.
The self-monitoring diaries were reviewed and the rationale for treatment was evaluated. The aim was for behavioral homework to reinforce gradual, consistent increases in selected physical activity and discourage rapid fluctuations in activity. Preliminary targets were set at a safe, achievable level to maximize the likelihood of success. Each individual was given an exercise program that included both pictures and descriptions. Additionally, flexibility and exercise program guidelines were provided along with an exercise diary that detailed each program. This diary had to be attended to daily, and the exercise frequency was fixed at three times per week. The participants were informed that some amount of muscle soreness should be expected as a result of the exercise activity. Participants were also taught the difference between muscle soreness that may be a result of the exercise program and muscle pain. Participants were urged not to progress too quickly by adding their own exercises or excessively increasing intensity levels within normal daily activities. The goal was to reinforce gradual increases in activity rather than to promote sudden amplifications. As an example of stretching and strengthening, the participant would start with one set of four repetitions for each exercise. If the patient was successful with this assignment and felt no physical repercussions or delayed recovery response, they would then be encouraged to gradually progress until there was one set of eight repetitions was reached. Next, the participant would increase to two sets, starting at two sets of four repetitions.
Session 8–13.
Homework was reviewed, problems were identified and dealt with, and targets were set for the following week. Preparations were continued for the maintenance of functional gains. New targets were established only after habituation was achieved to existing ones or if the participant consistently achieved his or her goals for a period of two weeks. The therapist conveyed a positive outlook, and all achievements were warmly reinforced.
In depth analyses of in vivo activity and symptom records confirmed behavioral progress and identified potential and actual behavioral setbacks. As a result, new behavioral prescriptions with scheduling modifications were developed. In these final sessions, strategies for preventing and dealing with setbacks and relapses were rehearsed. The importance of maintaining the principles of therapy after termination were also reinforced.
