MINISTRY OF SOCIAL DEVELOPMENT (MSD)

It is well established that length of time out of the workforce the lower likelihood of return to work.

For example, 20 days out of the work environment evidence a 70% chance of returning to work, while 45- and 70-days evidence respectively 50% and 35% chances of return-to-work. For those with chronic medical conditions, the likelihood of a successful return to work is even lower. Successful return-to-work of those with medical conditions or chronic injuries requires a systematic evidence-based approach. The different aspects of return-to-work like recovery of fitness, strength, and self-confidence, and the ability to deal with the mental and physical demands of work can be overwhelming. A systematic approach deals with those aspects in a step-by-step manner.

Carefully prescribed and supervised exercise is essential to induce physical recovery and prepare patients with chronic ailments to deal with work task demands in any return-to-work programme. A physical rehabilitation focus reduces the risk of re-injury or episodes of physiological distress at work requiring medical management such as calling for an ambulance. The physical recondition programme, therefore, needs to consider stable physiological responses to physical stressors of varying types and intensities. The aim should be condition to a level that ensure consistent stable physiological responses during job-specific physical demands. The programme also needs to consider continued support during the early stages of return to work.

The benefits of improving the physical fitness and strength of individuals who has medical conditions and who have been out of the workforce for extended periods include:

  • Exercise can help with faster physical recovery and improved functionality.

  • Exercise will improve the individual’s mental health.

  • Exercise impact positively on self-esteem and, self-image.

  • Exercise enhances the likelihood of participation in social activities and relationship building.

  • Exercise in a safe environment can provide support for the individual to recover from the medical condition.

  • Exercise can improve the individual’s ability to face mental or physical challenges.

  • Exercise can prepare the individual to physiologically cope with work-related physical demands of the work role.

At OraKinetics we follow a systematic evidence-based approach to help individuals to recover after medical events. The aim to ensure stable physiological responses (e.g., heart rhythm, blood pressure, glucose, ventilation, feelings of perceived exertion) when they return to activities of daily living and work.

The approach we follow with contract referrals from MSD include the following aspects:

  • Baseline screening and assessments. These measurements are used to design effective and safe exercise programmes and to track the physical readiness to return to work.

  • Management of existing conditions in collaboration with existing medical care the patient receives. 

  • Identifying and prescribing corrective exercises for existing additional musculoskeletal issues (e.g., spine, shoulder, knee, or hip) that might be related to the patients’ primary health issue.

  • Tailored physical conditioning for 10-weeks. 

  • Re-testing and progress reporting.

The exercise prescription and training process at OraKinetics Clinic includes:

1. Individual Programme Prescription

Every person receives an individualized exercise prescription based on test results and health and musculoskeletal profile.

2. Pre- and post-training screening

Everyone is screened for signs of pains and ailments before every exercise session. This includes measures of blood pressure, resting heart rate, SaO2, breathing rate, ECG, temperature, complexion, and how they felt after the previous training session. Adjustments to training are made according to responses. All measurements are documented and used to track progress.

3. Supervised exercise training

Constantly screened and supervision during every training session.

4. Setting strength and fitness goals

Strength and fitness goals are set based on baseline test results. The aim is to reach at least 50% of age-gender adjusted normative strength and cardiovascular fitness.

5. Re-prescription

Programmes will be adjusted based on participants feedback, resting and exercise vitals and ability to perform exercises (e.g., tempo, rhythm, and smoothness of execution). Re-prescription includes adjustments to sets, reps, number of exercises and type of exercises. Participants are guided towards whole-body and job-specific exercises.

6. Return-to-work reconditioning

Patients/participants with a health condition typically present with cardiovascular fitness levels of lower than 9 Mets. As stated previously, several studies published over the last ten years have emphasized the prognostic significance of cardiovascular fitness. Typically, an exercise capacity of lower than 5 Metabolic Equivalents (METs) correlates with higher mortality risk whereas 9 Mets or higher identify a cohort with excellent long-term prognosis, regardless of the underlying extent of disease. We aim to improve cardiovascular fitness to at least 8 Mets and for this reason, we believe that a total duration of 20-week will produce the best results with a return-to-work programme. The aim would be to phase participants back to work after about 15-weeks but to provide continued support during the first 5-weeks back at work.

First 10-weeks:

The first 10-weeks of the intervention programme focus on improving health-related fitness by targeting areas of concern (e.g., low back pain, hypertension, body weight, glucose control/diabetes, respiratory conditions and diagnosed heart disease issues under treatment). The goal is to improve cardiovascular fitness and establish stable cardiovascular responses to exercise. Improving heart rhythm, blood pressure, SaO2, ventilation, glucose, perceived exertion, and heart rate responses on exercise will improve participants ability to manage physical and psychological induced work stressors. The ideal us to improve cardiovascular fitness to a low level of risk (e.g., larger than 9 Mets). The second the goal during the first 10-weeks is to improve the baseline strength of the major muscle groups/joints. Typically, 2 to 3 sets of 12 to 15 reps at training loads equal to 30 to 50% of age-adjusted normative strength scores for the major muscle groups on exercise machines.

Second 10-weeks:

If required the programme will transition into a second 10-weeks training utilising exercises that duplicate or mimic job-related activities. Job type activities like stair climbing, pulling, pushing, lifting, and carrying objects will be incorporated to prepare individuals who plan to enter physically challenging work environments. These sessions are fully supervised to ensure proper execution, and timely adjustments to reduce the risk of injury and to induce effective physical challenges.