MTT OCH HOLTEN INSTITUTE
(1921-1995), founder of Medical Exercise Therapy (MET) and the Holten Institute is the Norwegian and Nordic physiotherapy pioneer.
As a speed skater Holten was already early in his life interested in movement and he started his professional career in physical education. He was also involved teaching ergonomics to forest workers. Medical Exercise Therapy (MET) developed by Holten reflects his passion for physical activity and his background as an active athelete and later as a coach for the national skating team.
Oddvar Holten became a physiotherapist at Oslo’s orthopedic institute in 1951 and later became a leading member in the group of physiotherapists who developed the Norwegian model for Manual Therapy. Holtens position in the group was to develop and integrate graded exercise therapy with manual therapy. Holten had a theory: Patients should be able to exercise like athletes do, but the loading of the exercises had to be adjusted to the patient conditions. For patients to be able to do that Holten together with Kjell Steen at Steens Industrier in Oslo developed the MET exercise equipment. This exercise equipment is today known as Steens Physical.
Oddvar Holten’s philosophy about how to treat or assist patients with pain problems was extremely significant for his time and laid the foundations of modern therapeutic methods. Despite the fact that the theoretical basis for MET at this time was not fully understood, the method worked very well clinically, using exercise dosages lasting at least 60 minutes for a treatment performed 2-3 times a week. Because patients with a pain experience is not able to do strength training, Holten introduced a concept called circulatory training using many repetitions in sets. A model is performing 3 sets of 30 repetitions of an exercise with 30-60 seconds rest between each set. The total number of repetitions of one exercise is 90 repetitions. During one treatment of 60 minutes a patient perform 7-9 exercises. With an initial warm up the total number of repetitions during one single treatment is close to a 1000 repetitions. Strength training with a few repetitions was used when patients became symptom free or close to symptom free. Developing MET, Holten used well know training principles from the field of exercise physiology. The design of the MET exercise equipment made it possible for Holten to develop exercise banks for all parts of the body where the golden standard was to grade the exercise so that the patient performance was pain free or close to pain free.
During the last 20 years since Holten passed away, new knowledge has emerged why it is important to grade exercises. Especially our knowledge about pain makes it easier to understand why we should be careful not pushing into pain. Holten said; ”Why exercise with pain when simple easy grading makes the exercise comfortable close to pain free or even pain free”. At that time, Holten did of course not have the knowledge we have to day from the pain sciences. However, from the experince of working with patients, he understood that it was important to grade exercises making the therapy comfortable for the patient.
Holten made MET a clinical effective and efficient method organizing the working place and working day using exercise therapy in bouts of 60 minutes having 4-5 patients at the same time in a group setting. What is significant with MET, is that each patient in the group has an individual graded exercise program designed specifically for his/her problem. A MET group can consist of patients from all age groups with different types of diagnosis from musculoskeletal pain problems, to neurological disease to cardiovascular problems. And the therapist must be present in the execise room supporting and regrading exercises making the patients exercise dosage optimal.
Holten designed MET so it can be used to treat professional athletes, workers suffering from the negative effects of static or repetitive work, or elderly suffering from old age and lack of movement. MET is used to treat patients at all age groups ranging from children to the very old person.
Holten combined MET with manual therapy. If patients were not proceeding as expected using MET only, other approriate modalities were applied. A few treatments using hands on techniques ususally made it easier for the patient to exercise. Performing manual therapy, mobilsing and manipulating joint(s), stretching and mobilising soft tissue structures, Holten argued that after the manual therapy it was of the utmost importance to activate the patient. Working all muscles in motor patterns involving the stiff joint(s) and the soft tissues in question.
Experiencing and learning how graded exercise therapy can decrease symptoms and increase function, the patient better understands how to deal with similar problems in the future. And probably most important of all, has a fairly good idea of how this can be done practically.
Holten’s model has survived because it is fundamental to our physiological function, how we think and how we work with patients. An ever growing pool of evidence shows that MET effectively reduces pain, improves function and does so in a cost effective manner. Starting in 1960s, and continuing throughout the last 50 years, has Holten’s theory and the MET method continued on through courses and seminars. Establishing first in the Nordic region and later spreading throughout the rest of Europe, North America, Japan and Korea. Courses today are held all over the world. Oddvar Holten retired in 1999 and his successor, Tom Arild Torstensen continues his legacy and great work of the Holten Institute and MET today.