Merriam Webster defines "exercise" as a particular movement or series of movements done to become stronger and healthier, and "therapeutic" as of or relating to the treatment of disease or disorders by remedial agents or methods, producing good effects on your body or mind. Put them both together and you have the crux of what we, as rehabilitation professionals, do-we instruct and guide our patients and clients in movements and activities designed to improve their physical and mental well-being and to maximize performance of activities of daily living and recreational pursuits. While a lot of what we do in the name of therapeutic exercise addresses activity limitations and participation restrictions, much can be accomplished at the impairment level and sometimes even at the pathology level to offset potential issues before they create functional problems.

Since therapeutic exercise is such a large part of what we do, it stands to reason that rehabilitation professionals need up-to-date information on the use of this valuable intervention for their patients and clients. This issue of Topics in Geriatric Rehabilitation focuses on just that.

"A Framework for Exercise Prescription" by Wendy K. Anemaet and Amy Stone Hammerich breaks down why we use therapeutic exercise and provides a scientific backdrop upon which to base decisions regarding what kind of exercise and how much, how frequent, and how long it is indicated. Current exercise research trials are used to support the framework, and where research trials are lacking, the authors provide the physiologic evidence that underpins each level of the framework and should guide clinical decisions. This allows rehabilitation professionals to apply the art of therapeutic exercise within a solid framework of the science of exercise and provokes thought regarding why we do, what we do, and what is most effective and efficient.

This framework is further illustrated in Wendy K. Anemaet's "Application of the Framework for Exercise Prescription: A Patient With Acute Cerebrovascular Accident," in which principles and practices described in the framework are applied to the care of an individual who has an acute neurologic condition. Evidence supporting each type of exercise and prescription parameters provides readers rationale for this skilled intervention and demonstrates how rehabilitation professionals can apply the science of exercise to specific patient scenarios.

Amy Stone Hammerich describes a frequently occurring condition in older adults in "Lumbar Spinal Stenosis and Exercise Prescription." She details the implications of this condition for patients and clients and discusses the current thought on how to effectively manage these individuals. Through synthesis of the literature available on exercise with this population, the author provides rehabilitation professionals guidance on exercise prescription at every phase of the condition.

Many older adults have issues with balance without having a specific clinical condition leading to balance disturbance. In "Balance Retraining in Community-Dwelling Older Adults: Highlights of Intervention Strategies That Hold Promise in Physical Therapy Practice," Nancy F. Mulligan, Barbara A. Tschoepe, and Marcia B. Smith address the factors contributing to this and ways to remediate balance deficits through exercise.

Both traumatic and insidious rotator cuff pathologies occur frequently in older adults. While surgical repair may be the most common method of dealing with these pathologies, it may not be the most efficacious in older adults. In "Conservative Rotator Cuff Treatment," Dade S. Smith discusses the current literature on the use of therapeutic exercise instead of surgical repair for the management of older individuals who have injured their rotator cuff and how rehabilitation professionals can facilitate nonsurgical recovery of these injuries.

The high prevalence of diabetes as well as damage to peripheral neurons through disease, disorders, and conditions often result in the development of peripheral neuropathy. While this is a difficult condition to address and often leads to many functional limitations, therapeutic exercise may offer remediation of the condition and improvement in function for these patients. The current literature on this topic is detailed in "Peripheral Neuropathies and Exercise."

The final article in this issue addresses another common comorbidity present in many older adults, chronic obstructive pulmonary disease. Laura Sage reviews the use of various types and prescriptions of exercise with these individuals in "Chronic Obstructive Pulmonary Disease in Geriatric Rehabilitation: Implications for Therapeutic Exercise" and how rehabilitation professionals can use therapeutic exercise as a mainstay to facilitate improvement and prevent functional decline in these individuals.

This issue of Topics in Geriatric Rehabilitation on "therapeutic exercise" provides rehabilitation professionals a framework from which to develop sound exercise prescription as well as current best evidence on some of the more frequently encountered cardiopulmonary, neurologic, and orthopedic conditions. This should be a springboard for application of these same concepts to other patient and client situations at the pathology, impairment, functional, and participation levels, with the overall end result of effectively and efficiently maximizing those "good effects on the body and mind" for their patients and clients mentioned by Merriam Webster.

-Michelle M. Trotter, PT, and

Wendy K. Anemaet, PT, PhD, GCS, CWS, GTC, COS-C

Issue Editors