Organising equipment-based exercise therapy: Space and flow

In equipment-based exercise therapy, instruction, supervision and documentation all have to be organised within a clearly structured process. What matters is therefore not only which pieces of equipment are available, but also how floor space, scheduling and the division of tasks work together. A well-planned training area makes therapeutic supervision easier and keeps processes clear even when utilisation is high.

Floor planning: Routes, sightlines and zones

Before you start talking about individual pieces of equipment, it is worth taking a look at the room. What counts is not just the available square metres, but also how the space is laid out and organised.

Three factors in particular determine how easy the training floor is to oversee:

• Sightlines: Active training areas should be as visible as possible to the therapist. Tall equipment, partition walls or awkwardly placed elements can make it harder to keep an overview.
• Circulation routes: Patients move between training stations while the therapist switches between instruction, supervision and documentation. Routes should therefore stay as clear as possible and offer enough space for patients using walking aids or with limited mobility.
• Zoning: Dividing the space into areas for warm-up and mobilisation, equipment training, functional training and instruction or short debriefs can help structure the process.

Alongside the actual footprint of the equipment, plan for enough space to move and access each station. Storage options for rollators, aids and personal belongings should also be considered from the outset so that circulation routes remain clear.

How many stations does a training area need?

The number of usable training stations should match your treatment concept, the size of the room and the maximum number of patients supervised at the same time. Additional simple exercise areas – for functional exercises or mobilisation, for example – can help avoid waiting times between individual pieces of equipment.

What matters is less the highest possible number of stations than a sensible layout: the therapist should be able to see at any time where direct instruction is needed and which exercises can already be performed safely and independently.

Station logic and scheduling: The process carries the supervision

An open-ended format in which every patient works through their training plan in any order can make supervision more difficult. Several new or technically demanding exercises may then take place at the same time and compete for the therapist's attention.

One option is therefore a staggered start. Rather than all beginning the same training phase at once, patients start at different times. This spreads instruction, direct supervision and already familiar exercises more evenly across the session.

In Germany, specific requirements apply to equipment-based exercise therapy under statutory health insurance. The service is designed as parallel individual treatment with a maximum of three patients. The standard treatment time is 60 minutes per patient. Instruction, supervision and monitoring are provided directly by the treating therapist. The individual treatments do not have to start at the same time.

A possible staggered schedule could be organised as follows, for example:

Time slot	Patient A	Patient B	Patient C
0–15 min	Instruction and start of training	–	–
15–30 min	Familiar exercise sequence	Instruction and start of training	–
30–45 min	Further training stations	Familiar exercise sequence	Instruction and start of training
45–60 min	Closing phase and review	Further training stations	Familiar exercise sequence
60–75 min	–	Closing phase and review	Further training stations
75–90 min	–	–	Closing phase and review

The table is intended as an organisational example. The actual schedule depends on the individual treatment plan, the patient's capacity and the equipment being used.

New or technically more demanding exercises should ideally fall into time slots in which direct therapeutic instruction and supervision are guaranteed. Exercises that are already familiar and performed safely can then be integrated into the rest of the session.

How scheduling and appointment planning can be structured outside the training area as well is described in the article Reducing waiting times in physiotherapy: Planning instead of pace.

Instruction, handovers and safety routines

Parallel treatment only works if instruction, ongoing supervision and independently performed parts of the session are clearly distinguished from one another. In equipment-based exercise therapy, direct instruction, supervision and monitoring by the therapist remain a central part of the service.

Before training begins, equipment settings, range of movement, load and relevant safety criteria should therefore be clearly defined and documented. That way the key information is also available if another therapist takes over the treatment.

Three pieces of information can be particularly helpful for handovers between therapists:

1. Current exercises and settings: equipment used, starting positions, resistances and other load specifications.
2. Observations from the last session: quality of execution, perceived exertion, complaints, anything unusual or exercises that were stopped.
3. Next planned step: which exercise, load or movement should be adjusted in the coming session.

Safety routines should also be designed to be as clear and simple as possible. These include, for example, a brief assessment of current symptoms and daily form before training begins, defined criteria for breaks or stopping, and regular checks during the session.

After use, equipment settings should either be documented or returned to a defined starting position, so that the next patient does not unintentionally begin with unsuitable settings.

Which observations are actually relevant for traceable progress documentation is described in the article Training documentation in physiotherapy: What really counts?.

Digital training support in the training area

Digital systems can complement equipment-based exercise therapy and other training services in day-to-day practice, but they do not replace the therapeutic instruction, supervision and monitoring prescribed for KG-Gerät (equipment-based exercise therapy under German statutory health insurance).

The Pixformance Station is a digital training and therapy device with an integrated camera system and virtual trainer. Exercises are demonstrated on the display while movement execution is captured and immediately accompanied by visual and written cues. Training parameters are documented automatically and can be viewed via the online platform.

For the training area, this means that recurring elements such as exercise prescription, movement feedback and the recording of training data can be supported technically. The decision about which exercises are used, how the load is dosed and when an adjustment is needed remains with the therapist.

The automated recording of training data can also reduce the manual documentation workload. How much this changes your processes, however, depends on your particular practice concept and on how it is integrated into your existing documentation.

Pixformance has been examined in various clinical and scientific projects. The results of such investigations should always be considered in the context of study design, target group and specific field of application.

Criterion	Digital training support with Pixformance	Conventional strength equipment	1:1 supervision by a therapist	Conventional group training
Feedback during execution	automated visual and written feedback	depends on therapeutic supervision and equipment	individual feedback from the therapist	depends on group size and supervision
Exercise instruction	via virtual trainer and the stored training plan	by the therapist or following instruction	directly by the therapist	by the supervising therapist or trainer
Training documentation	training data is recorded automatically	depends on equipment and practice process	therapeutic documentation required	depends on the respective concept
Individual adaptation	training plan can be adjusted therapeutically	resistance and settings individually adjustable	possible immediately and individually	possible within the group concept
Manual and tactile support	not provided	possible by the therapist	immediately possible	depends on the supervision concept
Field of application	structured, digitally supported movement training	equipment-based strength and functional training	assessment and individual therapeutic care	standardised training formats

The various training formats serve different purposes and can complement each other in everyday practice. With complex findings, unclear load tolerance or situations in which manual or tactile support is required, direct personal supervision remains central.

Digital training systems, by contrast, can provide support where defined exercises are performed repeatedly, movements are accompanied and training data is to be recorded in a traceable way. They should be understood as an addition to the therapeutic concept and not as a substitute for the requirements of equipment-based exercise therapy.

Implementation in four steps

If you want to restructure your training area, you can start with just a few organisational changes:

1. Take stock: Draw the room with its equipment, circulation routes and sightlines. Mark the areas where the overview is regularly limited or where patients have to wait for each other.
2. Define zones: Arrange the different training formats sensibly within the space and make sure that access points and circulation routes stay clear.
3. Define the schedule: Determine how patients can start at staggered times and at which points direct instruction or supervision is required. For KG-Gerät, the applicable requirements on treatment duration, patient numbers and direct instruction, supervision and monitoring must be taken into account.
4. Put routines in writing: Equipment settings, handovers, safety rules and relevant progress information should be documented so that the process remains traceable even when a different therapist takes over.

After a few weeks, review at which stations waiting times regularly occur, where direct therapeutic support is needed particularly often and where unnecessary walking routes arise. These observations give you concrete pointers on how to adapt the training area further.

Which metrics are also useful for assessing therapeutic progress is described in the article Digital movement therapy: Which metrics really hold up.