Beyond biomechanics: advancing physical therapy through bioenergetic integration in clinical practice

Physical therapists are considered movement experts, yet many physical therapists lack the knowledge, training, and confidence to incorporate bioenergetic considerations when prescribing aerobic exercise and resistance training interventions. Additionally, clinical practice guidelines (CPGs) omit bioenergetic considerations reflecting a fundamental gap in how the profession conceptualizes rehabilitation, one that individual clinicians cannot be expected to bridge when CPGs themselves exclude the bioenergetic dimensions of health conditions. As this perspective outlines, bioenergetics are essential for propelling human movement and should inform physical therapist interventions. A bioenergetically informed approach to physical therapist interventions empowers physical therapists to design interventions that integrate physiologic systems critical to bioenergetic capacities more fully, optimizing both the mechanical components and fuel systems that power movement. This perspective uses recovery as a model framework to emphasize the benefits of a bioenergetically informed approach, and importantly, it serves as a component of rehabilitation that can be immediately acted on by clinicians, recognizing that optimal therapeutic outcomes require adequate bioenergetic capacity to support the intended applications. While physical therapists have traditionally excelled as biomechanical practitioners who address the structural and mechanical aspects of human movement, the integration of comprehensive bioenergetic principles represents a transformative opportunity to elevate clinical practice by understanding not only the machinery, but also the metabolic systems that fuel optimal performance.