The exercises that Kuhn provided can be viewed as a partial list of exercises that might be appropriate for treating an individual with RCIS. We offer modifications to 3 of the proposed exercises and discuss factors used by athletic trainers and physical therapists to establish initial exercise selection, intensity, and periodic modification of an exercise program that were not discussed by Kuhn. Based on current evidence, the anterior shoulder stretch in the proposed protocol might not be the most effective way to stretch the pectoral muscles. When performing the stretch as described in the protocol, the individual is instructed to place his or her hands at shoulder level on either side of a door or corner and to lean forward. This might be a preferred position to initiate pectoral muscle stretch if the individual is unable to perform stretching with the arm elevated as a result of pain; however, evidence3 indicates that changing the position of the upper extremity so that the individual's hand is above the head with the shoulder in 90° of abduction and 90° of external rotation likely provides a more effective stretch.
One of the rotator cuff strengthening exercises proposed by Kuhn is scaption performed with the thumb down or up. Clinically, this exercise is called the empty-can (thumb-down) or full-can (thumb-up) exercise. When prescribing this strengthening exercise, one should consider the effect that upper extremity position has on the tissues located in the subacromial space. Yanai et al4 showed that impingement forces on the rotator cuff tendons under the coracoacromial ligament were greater with the empty-can exercise than with the full-can exercise. Therefore, the full-can exercise is more appropriate for this patient population.
It is well known that exercise in the older population may prevent several diseases [1–4]. Reduced physical activity impairs the quality of life in elderly people with Alzheimer's Disease , Parkinson's Disease , and Depressive Disorders . Moreover, musculoskeletal, cardiopulmonary, and cerebrovascular decline are associated with poor physical fitness because of the cumulative effects of illness, multiple drug intake, fatigue, and bed rest [7, 8]. The effects of physical activity and exercise programs on fitness and health-related quality of life (HRQOL) in elderly adults have been widely studied by several authors [9–11]. De Vries et al.  conducted a meta-analysis focusing on elderly patients with mobility problems and/or multimorbidity. Eighteen articles describing a wide variety of actions were analyzed. Most used a multicomponent training program focusing on the combination of strength, balance, and endurance training. In 9 of the 18 studies included, interventions were supervised by a physical therapist. Intensity of the intervention was not reported and the duration of the intervention varied from 5 weeks to 18 months. This meta-analysis concluded that, considering quality of life, the exercise versus no-exercise studies found no significant effects. High-intensity exercise appears to be somewhat more effective in improving physical functioning than low-intensity exercise. These positive effects are of great value in the patient population but the most effective type of intervention remains unclear. Brovold et al.  recently examined the effects of high-intensity training versus home-based exercise programs using the Norwegian Ullevaal Model  on a group of over-65-year-olds after discharge from hospital. These authors based their study on the Swedish Friskis-Svettis model  which was designed by Johan Holmsater for patients with coronaropathy to promote their return to work and everyday activities and improve their prognoses. This model includes three intervals of high intensity and two intervals of moderate intensity, each one lasting for 5 to 10 minutes. Included in each is coordination. Exercises consist of simple aerobic dance movements and involve the use of both upper and lower extremities to challenge postural control . Exercise intensity was adjusted using the Borg Rating of Perceived Exertion (RPE) Scale. Moderate intensity was set between 11 and 13, and high intensity was set between 15 and 17 on the Borg Scale.