Rehabilitation sport (rehabilitation sport) represents a legally anchored supplementary measure within the framework of medical rehabilitation, which serves in particular to enable sustainable participation in everyday and working life. This measure is anchored in §64 of the 9th Social Code. Rehabilitation sport is a targeted, holistic and thoroughly sportive training in groups.
The sportive load is adapted to the respective performance capacity, impairment and age of the participants. In practice, this means that each participant can participate according to his or her abilities without having to compete with other participants or fearing negative effects of the training. The sports program is carried out according to the guidelines of the professional associations for rehabilitation sports.
Information and documentation about the positive effects of GesundheitsSport are present in many media today. Through sport almost all parts of the body, such as muscles, bones, connective tissue, cardiovascular system, immune system and the central nervous system are positively addressed. Strengthening of the musculature: strength training of the musculature strengthens the skeletal muscles and the muscles of the left ventricle.
Strong skeletal muscles stabilize the spine and the extremity joints and have a positive effect on performance in everyday life and at work. Strong muscles make everyday and professional stress easier and less painful to manage. The energy turnover in the muscle cells and the oxygen supply to the muscles are increased, coordination within the muscles and among the muscle groups working together for a movement sequence improves.
Natural muscle loss due to sedentary activities and aging is halted. Strong skeletal muscles prevent falls, mitigate the effects of injuries and shorten the rehabilitation period. A higher proportion of muscles in the body leads to an increased basal metabolic rate and thus supports weight regulation.
Bones: Exercise and lots of movement from childhood on is the best protection against osteoporosis (bone loss), since bone growth depends on pressure and tension loads on the bones. Good strength values in the musculature are accompanied by good bone density values, as a result of which the overall bone stability (spine, pelvis and extremities) is increased. Strength training in particular offers the best prevention and treatment of osteoporosis compared to other forms of training.
Sport prevents falls in old age or moderates the effects of falls (injuries, immobilization, loss of function) and their consequences (possible need for care). Coordination: Improving coordination means that movements can be performed as economically as possible with the least possible use of the muscle chains necessary for the movement sequence. This saves energy and fatigue during strenuous activities occurs later.
Ability to maintain balance: Through improved balance reactions, the body is able to orientate itself towards the center of the body again and again and thus maintain balance. The frequency of falls is reduced and the risk of injury due to falls is decreased because faster and more targeted evasive movements are automated. Joints: The best protection for joints, joint capsules and ligaments is a strong musculature surrounding the joints.
Joint arthrosis can be delayed by regular strength training and mobilization exercises, since the joint cartilage is nourished in particular by unloaded movement. The improved joint mobility achieved by final (full range of joint mobility) mobilization exercises and stretching in rehabilitation sports allows a larger range of motion in everyday life and more economical, functional movement. Pain relief: In rehabilitation sports, the sporting load is adapted to the individual performance level and symptoms of the participants.
By strengthening their physical senses, participants gradually develop a sensitivity to which movements are good for them and which stresses and strains they can tolerate. Understanding and feeling that targeted movement is good for health and sustainable well-being is an important goal of rehabilitation sport. Physical exercise has a relaxing effect on muscles and psyche.
The relaxation of typically tense muscle groups caused by everyday misalignments and one-sided movements relieves pain and contributes to general well-being.Through the increase in strength, coordination and mobility, the body can master equal performance requirements more economically. In addition, movement and relaxation inhibits pain-conducting nerve fibers and calms the central nervous system. As a result, monotonous, repetitive, strength-sapping movements or static postures, e.g. in the office, can be mastered more painlessly and with more endurance.
The joint movements mobilizing during endurance training and the training of relaxation ability cause a loosening of tense muscle groups near the spine. This can prevent recurrent, unspecific back pain in particular, or alleviate existing pain. Negative reactions such as an increase in pain after exertion therefore occur only rarely and should be reported to the exercise instructor at the next lesson so that the exercise program can be adjusted accordingly.
This also takes away the fear of movement and strain for many participants, if they have already had bad experiences with sports before. Especially at the beginning of the rehabilitation measure, after longer breaks or after unaccustomed movements, a small, quite welcome muscle ache can occur. Rehabilitation sport promotes social contacts and has a high fun factor for most participants.
Cardiovascular system: endurance training (walking, jogging, aerobics, sports games in rehabilitation sports) leads to an increase in the performance of the cardio-pulmonary system (heart/pulmonary circulation system), the right and left ventricle of the heart are strengthened and enlarged, the lung capacity increases. The organs and the muscle cells are better supplied with oxygen and vital substances, which means that the muscles need less oxygen for the same load. In the long run, the heart rate decreases during exercise and the oxygen demand of the heart during exercise decreases.
Everyday stresses and strains such as climbing stairs, walking, strenuous hikes in mountainous terrain and jogging are easier to cope with because the muscles work more economically. Endurance sports lower blood pressure, blood sugar and cholesterol and reduce the risk of overweight, high blood pressure, stroke and diabetes. Digestive system: Exercise stimulates digestive activity, avoiding constipation (constipation) resulting from sedentary activities and lack of exercise.
Immune system: Strengthening the immune system reduces the risk of infection and the risk of certain types of cancer. The relapse rate of certain tumor diseases is also reduced by adapted physical activity. Sport makes an important contribution to overcoming the hub effects of tumor diseases such as fatigue (fatigue and poor performance caused by chemotherapy).
Psyche and learning aptitude: Sport makes it easier to concentrate and think; the learning aptitude of children and young people in particular is increased. Due to the improved oxygen supply to the brain, memory ability is retained longer in old age. To prevent memory loss, newly learned movement sequences in combination with music are particularly useful.
Stress loads can be better processed by sport. It prevents anxiety and mild depressive moods and supports their treatment by releasing “happiness hormones. “During the sports lesson, the participants have a “clear head” and are distracted from existing problems.
Since rehabilitation sport is carried out in groups, the exchange with other affected persons and the fun experienced together during the sports lesson can help to overcome psychological problems. Self-confidence is increased through improved performance and pain reduction. Sleep disorders, which are often associated with depression, occur less frequently.
In order to achieve lasting pain relief and increased performance and to avoid consequential damage, continuous exercise training is necessary. For this reason, rehabilitation sports clubs offer voluntary association membership and further participation in existing groups or supplementary sports activities at their own expense, following the regulation on health insurance. Sport is like brushing your teeth: preferably for 150 – 180 minutes per week during your lifetime!
Help for self-help! At home the pig dog lurks! rehabilitation sport is prescribed by a doctor – this can be general practitioners or specialists – without this prescription burdening the budget.The rehabilitation sport is carried out by non-profit, recognized rehabilitation sport clubs or the clubs of the corresponding associations (contractual partners of the health insurance companies).
Offerers in the region are to be found in the Internet or inquired with the health insurance company. The complaints for the medical prescription of rehabilitation sport are manifold. These can range from minor back problems to serious health problems or permanent disability.
The recognition of service providers (rehabilitation sports clubs) is carried out by the professional associations. The regulation for rehabilitation sport is then usually approved by the health or pension insurance companies or professional associations and financed in the appropriate scope of services. In the achievement catalog of the private health insurance companies Rehasport is not received, however the costs are taken over in most cases nevertheless.
It is in addition, possible to participate on private basis without medical prescription in the Rehasport. That can be either after expiration of the prescribed units or from the outset on private basis. A medical certificate of harmlessness/sports fitness from a doctor offers security for the participants and the trainers.
Today, rehabilitation sport is carried out on the basis of the framework agreement with the health insurance companies of 2011/revised 2016. Training on medical training equipment within the rehabilitation sport program is expressly prohibited. However, many clubs offer medical equipment training as a paid supplement to group sports.
Participation in the services financed by the health insurance funds (e.g. 50 units over 18 months, 45 minutes/unit, up to 15 participants/group) is free of charge and independent of other offers of the clubs that are subject to payment. However the BRSNW supports the voluntary association affiliation, so that the participants accomplish by the intensified connection to the association (in most cases the association fees are small) Rehasport as consistently and durably as possible beyond the 50 units. On voluntary basis achievements can be booked like further sport courses or medical equipment training “in addition”.
The professional associations are the DBS – German handicapped sports federation, LSB national sport federation, KSB circle sport federation and RSD Rehasport Germany. What is the legal scope of services?
- The offerers must be recognized and certified non-profit Rehasportverein or associations of the professional associations
- Obligatory are regular qualification measures for the association and the professional trainers
- 50 units a 1/2/(3) times a week within 18 months are the prescribed standard
- 90 – 120 units in cardiac sports or neurology within 24 – 36 months
- 1-2/week for 6 months, if the cost carrier is the pension insurance
- 45 minutes per unit, in cardiac sports at least 60 minutes
- Group size usually up to 15 persons
- The scope of services can be extended for medical reasons
- In exceptional cases, further approvals of follow-up prescriptions are granted by the health insurance companies or checked in advance by the medical service of the health insurance companies
Before the start of the rehabilitation sport measure, the trainer asks for information about the illness or complaint and the previous history in a detailed initial consultation.
Subsequently, the participant is assigned to a suitable group, in which the participants should stay until the end of the program if possible, so that a group cohesion can develop and the participants are known to the instructors. Information about existing pain, disabilities, internal risk factors and the individual goals of the participants is forwarded to the exercise leader of the appropriate group. If the group turns out to be unsuitable after a few units (e.g. over-underchallenge), a change of group can be made afterwards.
- Participation -sustainable participation- in job and everyday life
- Help for self-help and improvement of the quality of life
- Introduction of participants to long-term, independent and autonomous movement training
- Sustainable improvement of strength, mobility, coordination and balance, endurance, reaction, relaxation ability, social competence and memory
- Pain relief – as long as possible
- Increase of general physical resilience, performance and risk appetite
- Prevention of immobility
- Increase of body perception, improvement of self-assessment
- Mediation of motivation and fun with movement
- Prevention of civilization diseases such as overweight, high blood pressure, stroke
- Prophylaxis against diseases of the immune system
- Delaying degenerative age changes
- Fall prophylaxis
- Support for mental health
- Learning how to compensate for existing handicaps
- Inclusion
- Improvement of the quality of life
- Prevention of long-term consequential damage in diseases of the musculo-skeletal system, the cardiovascular system, the immune system and consequential damage due to disabilities
The group-specific content complies with the regulations of the professional associations. A Rehasportstunde consists of a warming up part, a function or main part, a cool down, information about medical backgrounds or health-oriented way of life, homework and each quantity fun. The warm-up part is about bringing the body and the head to operating temperature by running exercises, rhythmic exercises to music in different tempos, light endurance training, mobilization, coordination exercises and sports games.
The heart volume and the circulating blood volume increase and the breathing is deepened by the moderate load. The muscles and ligaments become more elastic as a result of the movement and more synovial fluid is formed in the joints. Injuries to the musculo-skeletal musculoskeletal system can be prevented by warming up and loosening up before increased sporting activity.
In addition to the physical warming up, the lesson also focuses on the “social warming up” of the participants among themselves and the integration of new “fellow athletes”. The contents of the warm-up program should be adapted to the following athletic strain. If it is cold, the warm-up will be longer.
As a self-control of the load, the participants can measure their pulse and/or breathing rate. In the main part or functional part, participants are offered functional exercises or endurance training according to the current training goal of the hour. Depending on the symptoms, the handycaps, the age and the performance of the participants, a different focus is set in each hour.
Information on medical contexts and the effectiveness of the exercises support the compliance (motivation/cooperation) of the participants. Exercise and training goals are the improvement of motor skills including strength, coordination, balance, endurance, flexibility, body awareness, integration and fun. The functional exercises (strength training, coordination exercises, endurance exercises through running, walking, sports games, loosening exercises, stretching) can be performed as individual partner or group exercises with or without small equipment (dumbbells, ball, Theraband etc.).
The exercises should be selected in such a way that no “known pain” occurs for the individual participant during and after the exercise and that a balanced load is achieved. The functional exercises are carried out calmly, evenly and combined for breathing. The starting positions are adapted to the possibilities of the participants and the exercise focus and goals.
The exercises should not be unrelated to everyday or professional activities, so that the participants develop a better understanding of the effectiveness of rehabilitation sports and the benefits for their everyday life. Training principles: Target-oriented training must be designed to improve the individual motor skills of the participants, which are, however, distributed and developed differently for each participant. For example, good trunk strength does not necessarily include good leg strength, or does not mean that the more power-oriented participant has sufficient mobility, coordination or endurance for the demands of everyday life.
The training of motor skills takes place in different adaptation phases. For example, strength: strength can be maintained, it can increase or decrease (unfortunately, the latter happens without our help due to everyday life without physical activity, aging or phases of injury or illness). In order to build muscle strength, the training stimulus must be so highly dosed during the strength exertion and repeated over and over again that training effects are achieved in the long run.
However, the recovery phases are just as important as the training stimulus so that the muscles can replenish their energy reserves.Training effects in the sense of improved muscular coordination or increased strength occur when the new training stimulus begins in the recovery or regeneration phase of the muscles and the training stimulus begins several times a week. The organism adapts to the increased load by making energy reserves available more and faster. In rehabilitation sports, the main focus is on improving strength endurance, because this is the main stress in everyday life.
To achieve this goal, there are different training methods. A possible method to improve strength endurance in rehabilitation sports is training with medium strength intensity, frequent repetitions (10 – 15 repetitions/exercise and 3-4 series) and recovery breaks. Since the participants’ prerequisites in the area of strength vary greatly and since everyone in the group should achieve a training effect, the course instructor can work with the individual feeling of exertion rather than with exact repetition guidelines in very inhomogeneous groups.
If the participants feel that their muscles are so tired that they cannot manage a single repetition, they should “add on” 2-3 more repetitions to get into the training area. Always provided that existing pain neither occurs during the exercise nor increases afterwards. This means that the number of repetitions and series, as well as the recovery phases in the group can vary in length.
In rehabilitation sports, however, the training success is limited by limiting factors. These can be: current form on the day, pain or restrictions due to disease patterns and/or disabilities. Also, many participants do not reach the required training units/week to achieve truly sustainable training effects.
Cooling down or warming up serves to gently return the organism to the state it was in before the sports activity. The regeneration of muscles and joints is accelerated by warming down, metabolic products can be removed. The warming down is based on the contents of the respective functional part, thus aims at loosening and relaxing the previously stressed body systems.
The participants should go home with a good body feeling. The contents are moderate running out, loosening exercises and passive stretching with low intensity. Playful exercises, body awareness training and relaxation exercises such as relaxation exercises according to Jacobsen, Feldenkrais, body travel and trigger point massages are also suitable for the end of the class.
- Medical information about health connections
- Functional gymnastics including pelvic floor gymnastics and breathing training – with and without small devices for all age groups
- Strength and endurance training for all ages
- Mobilization exercises/stretches for all age groups
- Coordination and balance exercises for all age groups
- Cardiovascular endurance training, (Nordic) walking, hiking, orienteering for all ages
- Relaxation and body awareness exercises for all ages Feldenkrais, Yoga, relaxation training according to Jacobsen, autogenic training
- Non-competitive sports games for all ages
- Water gymnastics for all ages
- Music, rhythm, dance for all ages
- Gear training
- Memory training and reaction training for all ages
- Especially in senior sports: moving brain training, memory and coordination training, body perception, breathing therapy, support by challenging (going to the individual limits)
- In particular in the handicapped sport sport sport plays, assistance for the compensation of the Handycaps A Rehab sport hour consists of a warming up part, a function or main part, a cool down, information about medical background or health-oriented way of life, homework and each quantity fun. The warm-up part is about bringing the body and head to operating temperature by running exercises, rhythmic exercises to music at different tempos, light endurance training, mobilization, coordination exercises and sports games. The heart volume and the circulating blood volume increase and the breathing is deepened by the moderate load.
The muscles and ligaments become more elastic as a result of the movement and more synovial fluid is formed in the joints.By warming up and loosening up before increased sporting activity, injuries to the musculo-skeletal locomotor system can be prevented. In addition to the physical warming up, the lesson also focuses on the “social warming up” of the participants among themselves and the integration of new “fellow athletes”. The contents of the warm-up program should be adapted to the following athletic strain.
If it is cold, the warm-up will be longer. As a self-control of the load, the participants can measure their pulse and/or breathing rate. In the main part or functional part, participants are offered functional exercises or endurance training according to the current training goal of the hour.
Depending on the symptoms, the handycaps, the age and the performance of the participants, a different focus is set in each hour. Information on medical contexts and the effectiveness of the exercises support the compliance (motivation/cooperation) of the participants. Exercise and training goals are the improvement of motor skills, including strength, coordination, balance, endurance, flexibility, body awareness, integration and fun.
The functional exercises (strength training, coordination exercises, endurance exercises through running, walking, sports games, loosening exercises, stretching) can be performed as individual partner or group exercises with or without small equipment (dumbbells, ball, Theraband etc.). The exercises should be selected in such a way that no “known pain” occurs for the individual participant during and after the exercise and that a balanced load is achieved. The functional exercises are carried out calmly, evenly and combined for breathing.
The starting positions are adapted to the possibilities of the participants and the exercise focus and goals. The exercises should not be unrelated to everyday or professional activities, so that the participants develop a better understanding of the effectiveness of rehabilitation sports and the benefits for their everyday life. Training principles: Target-oriented training must be designed to improve the individual motor skills of the participants, which are, however, distributed and developed differently for each participant.
For example, good trunk strength does not necessarily include good leg strength, or does not mean that the more power-oriented participant has sufficient mobility, coordination or endurance for the demands of everyday life. The training of motor skills takes place in different adaptation phases. For example, strength: strength can be maintained, it can increase or decrease (unfortunately, the latter happens without our help due to everyday life without physical activity, aging or phases of injury or illness).
In order to build up muscle strength, the training stimulus must be so highly dosed during the strength exertion and repeated over and over again that training effects are achieved in the long run. However, the recovery phases are just as important as the training stimulus so that the muscles can replenish their energy reserves. Training effects in the sense of improved muscular coordination or increased strength occur when the new training stimulus begins in the recovery or regeneration phase of the muscles and the training stimulus begins several times a week.
The organism adapts to the increased load by making energy reserves available more and faster. In rehabilitation sports, the main focus is on improving strength endurance, because this is the main stress in everyday life. To achieve this goal, there are different training methods.
A possible method to improve strength endurance in rehabilitation sports is training with medium strength intensity, frequent repetitions (10 – 15 repetitions/exercise and 3-4 series) and recovery breaks. Since the participants’ prerequisites in the area of strength vary greatly and since everyone in the group should achieve a training effect, the course instructor can work with the individual feeling of exertion rather than with exact repetition guidelines in very inhomogeneous groups. If the participants feel that their muscles are so tired that they cannot manage a single repetition, they should “add on” 2-3 more repetitions to get into the training area.
Always provided that existing pain neither occurs during the exercise nor increases afterwards. This means that the number of repetitions and series, as well as the recovery phases in the group can vary in length.In rehabilitation sports, however, training success is limited by limiting factors. These can be: current daily form, pain or restrictions due to disease patterns and/or disabilities.
Also, many participants do not reach the required training units/week to achieve truly sustainable training effects. Cooling down or warming up serves to gently return the organism to the state it was in before the sports activity. The regeneration of muscles and joints is accelerated by warming down, metabolic products can be removed.
The warming down is based on the contents of the respective functional part, thus aims at loosening and relaxing the previously stressed body systems. The participants should go home with a good body feeling. The contents are moderate running out, loosening exercises and passive stretching with low intensity.
Playful exercises, body awareness training and relaxation exercises such as relaxation exercises according to Jacobsen, Feldenkrais, body travel and trigger point massages are also suitable for the end of the class.
The professional trainers should have a well-established personality and professional competence. They must be able to motivate a group, have physical fitness and sufficient experience of movement, be sociable, sensitive and humorous. Before the upcoming rehabilitation sport unit, the trainer plans the lesson under certain aspects.
At the beginning of the lesson, the OC asks the participants about their daily form and possible (positive/negative) reactions to the last lesson. Goals and contents of the following lesson are briefly presented. The subject trainers will instruct the exercises as individual/partner or group exercises and will check and correct their correct execution.
They also provide information on the effectiveness and everyday relevance of the exercises. They observe the individual participants for their reactions to the offered program and, if necessary, modify exercises or ” prescribe” a break. In order to improve the participants’ body awareness, the trainers repeatedly give hints to “feel” which reactions the exercises trigger in the body.
These hints can relate, for example, to which muscles are being addressed in terms of strength, stretching or relaxation or how breathing changes during the exercises. This reflection in relation to the effects can be done individually or in dialogue with a partner. Reflection within the entire group is also possible.
In addition, the O.D. will ask about the current feeling of exertion or whether pain or other problems occur due to the exercises. With increasing body awareness, the participants can feel how the exercises should be performed, how many repetitions, how evasive movements can be avoided and which exercise selection or endurance units are particularly good for them personally.
It is important that known pain during and after the lesson is not forced! The contents of the lessons are adapted to the individual health and performance of the participants, but since it is a group sport and not individual supervision, problems with the execution of the exercises can occur with individual participants. If a participant is unable to perform an exercise, endurance unit or sports game due to pain, overexertion or other impairments, the instructors will modify the exercises for the participant so that they can be performed.
Of immense importance is working with positive reinforcement. Praise is at least as important as professional correction and supports motivation. Positively formulated exercise instructions challenge the participants to face the challenge and try it out, even if the exercise does not yet work out.
Rehab sport offers an excellent supplement to or after the individual physiotherapy. Often the individual treatment lays the foundation for group sports. Without appropriate pre-treatment, many participants who come with acute problems, such as pain or injuries, are not able to participate in group training.
Sometimes it is necessary to take pain medication to participate in sports, because with certain health problems it is better to move with the medication than not to move at all.
- Didactics/What are the goals and focal points of the following lesson?
- What are the contents of the upcoming rehabilitation sports lesson/planned exercises, training or game forms?
- Which organizational and social forms/individual/partner/group exercises do I choose for the following hour?
- Methodology/Which materials/mat, small devices… are used?
- What differentiation possibilities do I have with regard to the planned lesson contents/starting position, safety, modification of individual exercises
- What medical information is included in the lesson content, what is the everyday relevance of the planned exercises?
- What are the possibilities of communicating the sports offer?
Contraindications: In case of absolute contraindications, participation in rehabilitation sports is generally prohibited. There are few absolute contraindications against any kind of athletic strain.
Sport is forbidden in the acute stage of inflammatory diseases (including mildly feverish colds), in acute or chronic cardiovascular diseases that can no longer cope with sporting stress, acute thromboses, unadjusted blood pressure or diabetes, fresh vaccinations or acute inflammatory rheumatic attacks. Relative contraindications do not prohibit sport in general, but rather the ability to cope with sporting stress is limited. The restriction may relate to certain types of sport or frequently to dosage recommendations.
By issuing a prescription for rehabilitation sports, the physician certifies the prerequisite for sporting strain. If participants participate on a private basis, it is recommended to obtain a medical sports permit (also as a safeguard for the club and the exercise instructors).
- Rehabilitation sports in orthopedics/ surgery
- Rehabilitation sports in internal medicine/cardiology
- Rehabilitation sports in neurology, for congenital or acquired physical or mental disabilities
- Rehabilitation sports in the aftercare of cancer
- Rehabilitation sports for seniors
- Rehabilitation sport for people with hearing, speech or visual impairments
- Rehabilitation sports for mental/psychosomatic illnesses and people with limited self-confidence
