MET - Medical Exercise Therapy

Medical Exercise Therapy (MET) – criteria

MET – Medical Exercise Therapy is a scientifically and evidenced based form of treatment that is underpinned by the biopsychosocial model of human function. Oddvar Holtens MET criteria became accepted by the Norwegian Health Insurance and National Insurance Administration in 1967. Since this time, MET has been nationally subsidized by the National Insurance Scheme (C32 – MTT) with allowance of up to 5 patients per group.
“A treatment form where the patient trains with specially adapted exercise equipment. The equipment is designed to optimally stimulate relevant functional qualities related to various body systems such as the neuromuscular, artrogeni , circulatory and respiratory systems. To achieve this effect, training occurs from specially adapted beginner positions where movement occurs through defined movement ranges, or parts thereof, with the appropriately prescribed dosage of load. For MET to have effect, a minimum of 1 hours training is expected (excluding showering or change of clothes). Before beginning MET treatment, a thorough assessment is conducted based on the following areas 1) muscle testing, 2) specific joint testing and 3) functional testing. The physical assessment and the patient’s history form the basis for an optimalized and tailored individual trainings program. Throughout the treatment period, the patient will receive retesting and on-going assessment that will ensure any adjustments or progressions needed to the program are timely met. A maximum of five patients per treatment group is allowed”, Oddvar Holten (1967)

MET – from 1967 to present day

MET was originally a biomedical treatment form with a focus on specific trainings stimuli that aimed to effect changes in various soft tissue structures. Additionally, emphasis was placed on the importance of pain free training and the importance of doing exercises correctly with proper technique. Over time, these focus areas have undergone change, especially the focus on changing tissue structure. Beginning in the 1990’s, Instead of attempting to change or effect soft tissue derangements like arthritis, partial or full thickness tendon tears, proplapse or other similar conditions, the concept of “functional training” was introduced. Functional training instead placed focus on what the patient could actually achieve and the patient’s belief in their own abilities. Focused treatment on what the patient can actually achieve, rather than structural changes in the body is today an important part of MET.

MET – a biopsychosocial treatment

Tom Arild Torstensen, clinincal director of the Holten Institute, has developed MET into a biopsychosocial treatment method. The focus of MET is based still on original concepts but more increasingly today focuses more on the patient`s beliefs and attitudes. A patient for example with constant pain, even at rest, cannot exercise pain free! In this situation, the patient must accept a level of pain associated with the MET treatment. The pain experience however must not be interpreted as dangerous or threatening, causing anxiety. An exercise may be defined as being performed correctly based on the patients pre-existing condition despite the fact that the exercise may initially appear uncoordinated. Working within a biopshychosocial framework, you meet the patient where they are now and on their level. Correctly prescribed MET training will help the patient to take responsibility for their own symptoms, body and health.

MET – Continuous communication and guidance

It is very important that the physiotherapist is close by and on hand, creating a safe environment for the patient to exercise in. Oddvar Holten described back in 1967: “The treatment happens without assistance, but with continuous guidance of the physiotherapist”. The thinking back then even, was that the physiotherapist be on-site to ensure that the exercises were completed correctly. This is still important today. However, more importantly is the feeling the patient gets of a “safe” environment created by the physiotherapist simply by being on-site in the pain modualtion/exercise room. Questions can be answered immediately, uncertainty disappears and the patient knows that the exercise therapy is done in the correct way. When uncertainty and anxiety is reduced, pain becomes less. The physiotherapist also has the opportunity to grade exercises such that the patient is always progressing in their therapy. It is easier and more motivating to exercise when we know we can be successful. In the painmodualtion/exercise room, the therapist becomes the coach and the motivator, a knowledge bank where the patient can use and find support in to improve their level of function. This often reduces patient’s symptoms.

MET – Global, semi-global and local exercises

METs focus today is largely on the dosage of exercise therapy/training. It is the dosage that gives the desired treatment effect, and not the choice of specific exercises for individual muscles or other soft tissue structures. An adequate trainings dose is achieved through a combination of GLOBAL (whole body exercise), SEMI-GLOBAL (exercise with one extremity or kinetic chain) and LOCAL (exercises with a part of the kinetic chain for example one joint) exercises. A combination of GLOBAL, SEMI-GLOBAL and LOCAL exercises gives the optimal exercise dose for the patient. We at the Holten Institute strongly believe that it is the DOSAGE of training that gives the treatment effect and not how specific an exercise is. In particular, use of GLOBAL exercises repeated several times in a session is an exciting way to increase the exercise dose. When the dosage of exercise is increased, we activate our descending pain inhibiting system and thus hinder nociceptive input to the central nervous system.