{
  "resourceType": "ActivityDefinition",
  "id": "schroth-three-dimensional-exercises",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/schroth-three-dimensional-exercises",
  "version": "1",
  "name": "SchrothThreeDimensionalExercises",
  "title": "Schroth-Based Three-Dimensional Exercises",
  "status": "draft",
  "experimental": true,
  "description": "Functional exercises addressing postural kyphosis through three-dimensional corrective movements. Combines elongation, deflection, derotation, and facilitated breathing. Demonstrates large effect sizes for improving thoracic kyphosis (mean reduction of 14.76°), lumbar lordosis, balance, and quality of life.",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: intermediate"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "schroth-three-dimensional-exercises",
          "display": "Schroth-Based Three-Dimensional Exercises"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "thoracic-spine",
          "display": "Thoracic Spine"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "5261000",
          "display": "Structure of thoracic intervertebral disc"
        }
      ],
      "text": "Thoracic Spine"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "2x/week for 8 weeks under supervision; ≤3 months program"
    }
  ],
  "usage": "Evidence: moderate. Kyphosis reduction -14.76° (large effect size) [Özdemir 2023]",
  "note": [
    {
      "text": "Long spine, lifted breastbone, soft jaw",
      "authorString": "focus:internal"
    },
    {
      "text": "Reach the crown of the head toward the ceiling",
      "authorString": "focus:external"
    },
    {
      "text": "Breathe into the collapsed side of the ribcage",
      "authorString": "focus:external"
    },
    {
      "text": "A string lifts the sternum away from the hips",
      "authorString": "focus:imagery"
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "label": "kisner-therapeutic-2017",
      "citation": "Kisner C, Colby LA, Borstad J. (2017). Therapeutic Exercise: Foundations and Techniques"
    },
    {
      "type": "citation",
      "label": "acsm-guidelines-2021",
      "citation": "American College of Sports Medicine. (2021). ACSM's Guidelines for Exercise Testing and Prescription",
      "document": {
        "url": "https://doi.org/10.4135/9781412994149.n165"
      }
    },
    {
      "type": "citation",
      "label": "ozdemir-schroth-2023",
      "citation": "Özdemir Görgü S, Algun ZC. (2023). A Randomized Controlled Study of the Effect of Functional Exercises on Postural Kyphosis: Schroth-Based Three-Dimensional Exercises Versus Postural Corrective Exercises",
      "document": {
        "url": "https://doi.org/10.1080/09638288.2022.2083244"
      }
    },
    {
      "type": "citation",
      "label": "jenkins-thoracic-kyphosis-2021",
      "citation": "Jenkins HJ, Downie AS, Fernandez M, Hancock MJ. (2021). Treatments for Decreasing Thoracic Hyperkyphosis: Systematic Review",
      "document": {
        "url": "https://doi.org/10.1016/j.spinee.2021.12.011"
      }
    },
    {
      "type": "citation",
      "label": "katzman-spine-strengthening-kyphosis-2017",
      "citation": "Katzman WB, Vittinghoff E, Lin F, et al.. (2017). Targeted Spine Strengthening for Hyperkyphosis: SHEAF RCT",
      "document": {
        "url": "https://doi.org/10.1007/s00198-017-4109-x"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Erector Spinae Group"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "44947003"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Multifidus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "5709001"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Lower Trapezius"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "31764008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Diaphragm"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "5798000"
          }
        }
      ]
    }
  ]
}