The i3-s Strategy? Say what...
October 17, 2023
Patients commonly seek treatment for a primary condition, for example in the worker’s compensation space. An Exercise Physiologist’s goal is to prescribe an exercise programme that addresses the primary condition. However, patients can present with co-existing comorbidities which ultimately can impact their exercise programme. Patients with a comorbidity can participate in exercise if the prescribed exercise is appropriately modified to the presented comorbidities without impeding the effectiveness towards the primary condition or patient’s goals.
Part of an Exercise Physiologist’s role is to recognise a patient’s comorbidities and their associated contraindications and limitations to exercise. To assist with this process the i3-S strategy has been developed to assist in recognising comorbidity-related adaptations to exercise rehabilitation to a primary condition. It is broken into 4 steps: assess health status, comorbidity contraindications/restrictions, exercise adaptations and synthesis of information.
1. Assess Health Status
- Involves retrieving the relevant comorbid diseases of a patient.
- Once comorbidities have been identified, relevant clinical factors for each comorbidity can be examined.
2. Inventory of Comorbidity Contraindications and Restrictions
- Contraindications and restrictions are derived from each comorbidity identified in step 1.
- Medical clearance may be required to continue with exercise.
- Restrictions may limit a person’s ability to participate in exercise, however they don’t exclude a patient from all exercise however adaptations are required.
3. Inventory of Adaptations to Exercise
- Adaptations can be derived from each comorbidity identified in step 2.
- Adaptations to exercise are endless, they can be physiological, behavioural and environmental.
- In this stage, it is important to identify clinical signs, monitoring and parameters that are required to be throughout exercise programme.
4. Synthesis of Information
- This step involves combining the information collected in each step and implementing an individualised exercise program to the patient.
Ultimately, this strategy can be implemented to ensure an evidence-based exercise program is prescribed targeting their primary condition whilst taking into account their co-existing comorbidities. Throughout the process, emphasis is placed on applying clinical reasoning. Patients should be viewed in their whole rather than their index condition.
References:
- Dekker, J., de Rooij, M., & van der Leeden, M. (2016). Exercise and comorbidity: the i3-S strategy for developing comorbidity-related adaptations to exercise therapy. Disability and rehabilitation, 38(9), 905–909. https://doi.org/10.3109/09638288.2015.1066451
Caitlin Chase
Workers Compensation Specialist (AEP, ESSAM)
Exercise Rehabilitation Services ‑ WA
Each year, more than 53,000 knee replacements are performed in Australia, with that number steadily increasing. It's predicted that by the year 2030, this number will rise to over 150,000. Unfortunately, genetics play a significant role in whether you will develop osteoarthritis and require a knee replacement. However, there are several proactive steps you can take to reduce your risk. Weight Management Maintaining a healthy weight is important for reducing the risk of knee osteoarthritis. Excess weight puts additional stress on your knees, increasing the risk of developing osteoarthritis. Live an Active Lifestyle Engaging in a variety of exercises, including both strength training and aerobic activities, is essential for maintaining healthy knees. Strength training helps build muscle around the knee, providing better support and reducing the strain on the joint. Aerobic exercises, such as walking, swimming, and cycling, improve cardiovascular health and promote overall physical fitness. A well-rounded exercise routine can help reduce the risk of injury and osteoarthritis. Avoid Repetitive Knee Injuries Preventing knee injuries is another key factor in reducing the risk of needing a knee replacement. It’s been shown that people who have had multiple knee injuries and or surgeries are more likely to develop knee osteoarthritis later in life. Brody Kilbey Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services – WA
Central Park will be hosting the Step-up for MSWA charity event on Sunday, the 22nd of June 2025! Below are some tips on training in the lead up to the event, and what you can do to prepare day of! Training tips: Take the stairs The best way to train is to do more of what you’ll be doing—climb more stairs and increase your daily walking. Add high-intensity activities like running, cycling, or incline walking to boost endurance, especially if you're aiming for a fast finish. No fitness watch? Most smartphones can track your steps! Sleep & eat well Aim for 7–9 hours of sleep and fuel your body with a balanced diet: lean protein, whole carbs, and minimal processed foods. Good sleep and nutrition help with both performance and recovery. Build strength Stronger legs and joints help prevent injury. Include squats, lunges, and calf raises in your routine to support stair climbing. How to prepare on the day: Eat smart Have a light, balanced meal about 1–2 hours before the event. Include carbs for energy and stay hydrated. Dress appropriately Wear comfortable workout gear and proper shoes with good grip and support. Bring essentials Pack a water bottle, a sweat towel, and any medical needs (like asthma puffers). Pace yourself Keep a steady pace and listen to your body. Stay positive Remember you're climbing for a cause—supporting people living with MS! Be sure to enjoy the experience!
1. Time of Day Identify, if you haven’t already, if you are a morning person or a night owl. Now I don’t necessary mean whether you struggle to wake up before 8am or find it impossible to fall asleep until the clocks strikes 12. I mean, identify when the BEST time is for YOU to complete 45-60 minutes of uninterrupted regular structured exercise (RSE). This can take time, but once you do find the ideal time of day for your RSE, stick to it, make plans AROUND your RSE time and make that time for yourself. Be firm but also be fair to yourself when life inevitably creeps back in to dismantle your routines. Find ways to work around it, and make it work for you. 2. Buddy System Call on a partner, friend, family member, colleague, or your furry loved ones. This person should ideally be someone who you can hold accountable, and who you know will hold you accountable. In no way do you have to train together, bonus points if you do, but they are there to encourage, support, and empower you to get to your fitness destination. 3. Goal Setting Like a lot of aspects in our lives a way to maintain consistency throughout your fitness journey is goal setting. Goal setting is a very powerful way to turn a dream or a thought into an actionable and achievable task. The simplest way to set a goal is to follow the SMART goal process. Specificity: What is it you are looking to target? Improve strength – okay, stronger in what exactly? Lose weight – absolutely, how much weight? Measurable: Can the above specific goal be measured if so, how? Achievable: Is the goal realistic or is it far-fetched. It's okay to have big goals, but it's more important to break your big goals down into smaller, more achievable goals. Relevant: Apply the goal to your life, a goal becomes reality before you know it if the goal has relevance to you. i.e. a running race coming up, would require you to train more, or maybe your wedding is on the horizon and you want to be in the best shape of your life. Time bound: The final element of any excellent goal is setting a time-based deadline. Now this doesn’t mean it’s the end, far from it, this is where you will evaluate your goal against your performance, and in turn, set another goal. 4. Have a Spot This can mean a lot of different things for a lot of different people, and can greatly depend upon your goals (yes, a call back). For many people obtaining a gym membership is the ideal way to train and maintain consistency, for others, a home-based gym with the necessities is all they need, for some a good pair of running shoes and their favourite running loop. Having a dedicated space is very important however, can be different for everyone, find what works the BEST for you. 5. Practice Like many aspects of our life, the more we do any one thing, the better we get. The same applies to behavioural changes like consistency. The first weeks can be easy because its new and exciting, or it can be daunting because its new and terrifying. However, in a roundabout sort of way, the key to consistency specifically with exercise, is finding the BEST form of exercise for YOU. Find the one where you get the most enjoyment from and run with it (pun intended). Lachlan Simpson Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services ‑ QLD
