Exam 1 Chapter 6: Resistance Exercise for Impaired Muscle Performance

Indications for Near Maximal / Maximal Loading

- Increase muscle strength and power - Healthy adults in advanced phase of rehab - Conditioning programs with no known pathology - Training for competitive weight lifting or body building

Muscle fiber types

- Type I (Slow twitch) - Slow to fatigue, slow force production - Type IIA ("Medium" twitch) - faster to fatigue, faster force production -Type IIB (Fast twitch) - Fast to fatigue, fast force production

Specificity of Training

Exercise should mimic function - Task specific Consider mode and velocity of exercise - Position of limb, joint angle - Movement pattern - Practice

Threshold Fatigue

Level of exercise that cannot be sustained indefinitely Time of contraction or number of repetitions max per set Allows baseline for measurement of improvement

tension generated by the musculature

When the weight is lowered (controlled by an eccentric contraction), fewer motor units are recruited, and thus less tension is generated, than when the weight is lifted (controlled by a concentric contraction)

Valsalva Maneuver

an expiratory effort against a closed glottis

Type I Fibers

low force, long time

You test the muscle strength of the middle deltoid and determine it to be 2/5. The goal of an exercise you are having a patient do is to increase muscular endurance of the middle deltoid. Of the exercises described, which is most appropriate to meet the goal at this point in the exercise program?

Place the patient in a supine position on a large mat. As you support the weight of the arm, have the patient abduct the arm through a full ROM as many times as possible against a minimal amount of manual resistance.

Power

Rate of performing work P = W/t (W = F x D) The greater the intensity, shorter time taken to generate force, the greater the power

Detraining

Reduction in muscle performance beginning 1-2 weeks after cessation of resistance exercise and continues until training effects are lost.

Muscle Performance

Refers to the capacity of a muscle to do work (force x distance)

Aerobic Power

Repetitive burst of less intense muscle activity i.e. stairs

Cardiopulmonary Endurance

Repetitive, dynamic, motor activities

BORG Scale

Scale that measures Rating of Perceived Exertion (RPE) - Used when 1RM or 10RM is inappropriate - How hard the pt feels they are working based on HR, breathing, sweat, and muscle fatigue. (Originally 6-20, Revised 0-10)

Exercise Order

Sequence in which muscle groups are exercised during a session: - Warm-Up - Large muscle groups before Small - Multi-Joint muscles before Single Joint - Higher Intensity before Lower Intensity - Cool Down

Fiber Arrangement and Fiber Length

Short, pennate, multi-pennate: high force production (gastroc, deltoid, quad) Long, parallel design: high rate of shortening, less force production (sartorius, lumbricals)

Anaerobic Power

Single burst of high intensity activity

SAID Principle

Specific Adaptation to Imposed Demands. Improvement in muscle performance is directly related to the design of the intervention.

Late Adulthood, Decrease in

Speed of contraction, Muscle endurance, Ability to recover

To selectively strengthen the flexor digitorum superficialis using manual resistance exercise, position the patient's forearm in supination and wrist in neutral on a table; then:

Stabilize the MCP and DIP joints in neutral, then apply resistance to the middle phalanx as the patient flexes the PIP joint.

Your patient is lying supine and you are strengthening the iliopsoas on the (R) using manual resistance. The main reason you would want to place the patient's (L) hip and knee in flexion (foot planted on the table) is to:

Stabilize the pelvis in a neutral to posteriorly rotated position to lessen the possibility of an anterior pelvic tilt occurring, placing stress on the low back.

Intensity: Exercise load (amount of resistance)

Submaximal vs. Maximal Loading RM: repetition maximum 1RM: greatest amount of weight that can be lifted through ROM one time 10RM: greatest amount of weight that can be lifted through ROM 10 times RM allows documentation of a baseline Identifying an initial exercise load

Strength training

Systematic procedure of a muscle or muscle group lifting, lowering, or controlling heavy loads for a relatively low number of repetitions or over a short period of time

RM Zone

Target # of reps performed for each exercise before a brief rest

Delorme Regimen

The RM is used as the basis for determining and progressing the resistance Determine 10RM -> 10 reps @ 50% 10RM -> 10 reps @ 75% 10RM -> 10 reps @ 100% 10RM

Functional Strength

The ability of the neuromuscular system to produce, reduce or control internal and external forces during functional activities in a smooth coordinated fashion.

Rest Interval (recovery period)

Time allotted for recuperation between sets and sessions of exercise Crucial for muscle performance improvements

Anaerobic training should be utilized for what type of muscle fiber?

Type IIb fibers, ATP-PC energy system

Signs and Symptoms of Muscle Fatigue

Uncomfortable sensations, pain, cramping, Trembling while muscle is contracting, Jerky movement, Change in ability to complete full ROM, Substitution, Inability to continue low intensity exercise, Decline in peak torque in isokinetic testing Active recovery > passive recovery for reducing fatigue

Volume: To improve strength

Use exercise load that causes fatigue after 6-12 reps for 2-3 sets (6-12 RM)

Volume: To improve endurance

Use many reps against a submaximal load; can be initiated early on in rehab w/min. risk to healing tissue(immobilization: Type I slow twitch fibers atrophy at faster rate) 3-5 sets of 40-50 reps or long isometric hold- 30-60 sec or > Type I muscles atrophy at a faster rate than Type II

Which of the following best describes cross-training or cross-exercise, a phenomenon that has been observed as a result of resistance training?

When resistance exercise is carried out by a muscle group on the right side of the body, small gains in strength occur in the same unexercised muscle on the opposite side of the body.

Young and Middle Adulthood

Women-Strength peaks in second decade Men-Strength peaks by age 30 Strength decline ~1%/yr or ~8%/decade

Alignment and Muscle Action

a body segment must be position so the direction of the movement of a limb or segment of the body replicates the action of the muscle or muscle groups to be strengthened

Isokinetic Exercise

a form of dynamic exercise in which the velocity of muscle shortening or lengthening and the angular limb velocity is predetermined and held constant by a rate-limiting device; velocity of limb movement, not the load, is manipulated

Dynamic Concentric Exercise

a form of dynamic muscle loading where tension in the muscle develops and physical shortening of the muscle occurs as an external force (resistance) is overcome, as when lifting a weight

Muscle-Setting Exercises

a form of isometric exercise; low-intensity isometric contraction performed against little to no resistance; can retard muscle atrophy and maintain mobility between muscle fibers when immobilization of a muscle is necessary

Dynamic Constant External Resistance (DCER) Exercise

a form of resistance training where a limb moves through a ROM against constant external load

Circuit Weight Training

a pre-established sequence of continuous exercise is performed in succession at individual exercise stations that target a variety of major muscle groups as an aspect of total body conditioning

Plyometric Training

a system of high velocity resistance training characterized by a rapid eccentric contraction during which the muscle elongates, immediately followed by a rapid reversal of movement with a resisted shortening contraction of the same muscle

Strength Training

a systematic procedure of a muscle or muscle group lifting, lowering or controlling heavy loads for a relatively low number of repetitions or over a short period of time

Internal Stabilization

achieved by an isometric contraction of an adjacent muscle group that does not enter into the movement pattern but holds the body segment of the proximal attachment of the muscle being strengthened firmly in place

Overtraining

aka chronic fatigue, staleness, burnout; a decline in physical performance in healthy individuals participating in high-intensity, high-volume strength and endurance training programs; fatigue occurs more quickly and requires longer recovery time; brought on by inadequate rest intervals. Too rapid of progression, and/or inadequate diet and fluid intake

Eccentric Muscle Contraction

as the velocity of active muscle lengthening increases, force production in the muscle initially increases, then levels off

Concentric Muscle Contraction

as the velocity of muscle shortening increases, the force the muscle can generate decreases

Neural Adaptations to Exercise

attributed to motor learning and improved coordination and include increased recruitment in the number of motor units firing as well as an increased rate and synchronization of firing

Cross-training

carryover of training effects from one variation of exercise to another; endurance training as no effect on strength; strength training has some effect on endurance

Dynamic Eccentric Exercise

dynamic loading of a muscle beyond its force producing capacity, causing physical lengthening of the muscle as it attempts to control the load, as when lowering a weight

Isometric (Static) Exercise

exercise in which a muscle contracts and produces force without an appreciable change in the length of the muscle and without visible joint motion

Pathological Fracture

fracture of a bone already weakened by disease that occurs as the result of minor stress to the skeletal system

Endurance Training

having a muscle contract and lift or lower a light load for many repetitions or sustain a muscle contraction for an extended period of time; muscles adapt to endurance training by increases in their oxidative and metabolic capacities, which allows for better delivery and use of oxygen

Type II Fibers

high force, short time

Open Chain

motions in which the distal segment (hand or foot) is free to move in space, without necessarily causing simultaneous motions at adjacent joints; limb movement only occurs distal to the moving joint and muscle activation occurs in the muscles that cross the moving joints

Delay-Onset Muscle Soreness (DOMS)

muscle soreness, which is noticeable in the muscle belly or at the myotendinous junction, that begins to develop approximately 12 to 24 hours after the cessation of exercise; possibly caused by contraction-induced, mechanical disruption (microtrauma) of muscle fibers and/or connective tissue in and around muscle that results in degeneration of the tissue

Recovery from fatigue occurs most efficiently if:

patient performs low-intensity, active exercise using the fatigued muscle. (Active recovery > passive recovery)

Short-Arc Exercise

resistance exercised executes through only a portion of the available range

Full-Arc Exercises

resistance exercised executes through the full available range of motion

Multiple-Angle Isometrics

resistance is applied at multiple joint positions within the available ROM

Acute Muscle Soreness

soreness which develops during or directly after strenuous exercise performed to the point of muscle exhaustion; occurs as a muscle becomes fatigued during acute exercise because of the lack of adequate blood flow and oxygen and a temporary buildup of metabolites

Intensity

the amount of resistance (weight) imposed on the contracting muscle during each repetition of an exercise

Alignment and Gravity

the body or limb should be positioned so the muscle being strengthened acts against the resistance of gravity and the weight

Muscle (local) Fatigue

the diminished response of a muscle to a repeated stimulus; reflective in a progressive decrement in the amplitude of motor unit potentials

Threshold for Fatigue

the level of exercise that cannot be sustain indefinitely

Overwork

the progressive deterioration of strength in muscles already weakened by non-progressive neuromuscular disease

Muscle Power

the work produced by a muscle per unit of time

the most effective way to improve muscle endurance?

train using dynamic exercise against submaximal loads over progressively longer time periods

Stabilization Exercises (Isometric)

used to develop submaximal but sustained levels of contraction to improve postural stability or dynamic stability by means of mid-range isometric contractions against resistance in antigravity positions

Frequency

- # of exercise sessions per day or per week 2-3 x/wk for prepubescent children to elderly Up to 6x/wk for highly trained/professional athlete - determined by recovery time needed (more in children/elderly) - dependent on frequency, intensity, volume, mode

Intensity: Training Zone

- % of 1RM for muscle group - Sedentary, untrained = 30-40% - Significant strength deficits/muscular endurance (children/elderly)= 30-50% - Typical, healthy but untrained = 40-70% - Highly trained (strength/power) = 80-95% - Safe and challenging - Typical training zone for healthy, untrained adults: 60-70-75%

Energy Systems

- ATP-PC system - anaerobic/glycolytic - lactic acid system, aerobic system

Physiological Adaptation to Resistance Exercise

- Body systems accommodate over time - Hypertrophy of muscle fibers - Motor unit recruitment - Increase tensile strength of tendons, ligaments, and connective tissue in muscle - Minimize or prevent bone loss (Wolffs law)

Alternatives to RM testing for baseline

- Cable tensiometry - Isokinetic or handheld dynamometry - Percentage of body weight

Acute recovery from exercise

- Force producing capacity returns to 90-95% - Takes 3-4 minutes - O2 stores are replenished - Energy stores are replenished - Lactic acid removed from muscle and blood - Glycogen replaced

Factors that influence ability to generate muscular tension

- Health status: Diet, Lifestyle, age - Time of day - Environment: temp, heat, humidity, Air quality, Altitude - Energy stores and blood supply - Fatigue/recovery from previous exercise bouts - Psychological and Cognitive factors

Anaerobic

- High intensity exercise for a few number of reps - Rapid muscle fatigue - Strengthening exercises

Rest between sets

- High intensity: >3 minutes - Mod-high intensity: 2-3 minutes - Low intensity: 30-90 sec - Active recovery > passive recovery for reducing fatigue - Note: This is an adaptation on the NSCA guidelines which are organized by exercise goal (Endurance 30 sec, hypertrophy 30-90 sec, power/strength 2-5 min)

Therapeutic interventions for resistance exercise are used to:

- Improve integrated use of strength, power, and muscular endurance - Reduce risk of injury or re-injury - Enhance physical performance - Promote/maintain health and well-being

Hyperplasia

- Increase in # of muscle fibers - Evidence is sparse - May be due to splitting of fibers due to large size and inefficiency

Hypertrophy

- Increased size of individual muscle fibers (increase in myofibrillar volume) - Moderate to high intensity training - As early as 2-3 wk, more commonly 4-8 wk - Increased actin/myosin synthesis combined with decreased protein degradation - High-volume / mod-resistance eccentric exercise most effective -Type IIB fibers most affected

Factors impacting muscle performance

- Injury - Disease - Immobilization - Disuse - Inactivity

Precautions for Near Maximal / Maximal Loading

- Intensity should never cause pain - As intensity reaches near maximal effort, cardiovascular risks increase - Maintain rhythmic breathing!

Aerobic

- Low intensity exercise for a high number of reps over an extended period of time - Increases muscular and cardiopulmonary endurance

Recommendations to improve muscular endurance

- Many reps against submaximal load (Local endurance) - 3-5 sets of 40-50 reps against low weight or light t-band - Increase load slightly when meet target - Can maintain isometric contraction for longer periods

Positive Impacts of Endurance

- Minimizes forces on joints - Less irritation to soft tissue - More comfortable

Key Elements of Endurance

- Muscle Contraction - Lift or lower load - Many repetitions or sustained contraction - Extended period of time

Acute response to muscle fatigue

- Normal and reversible - Gradual decline in capacity of neuromuscular system to produce forces - Temporary state of failure - Decrease in muscle strength - Decreased energy stores - Decreased O2 - Inhibition in CNS - Decreased impulse conduction

Power is affected by:

- Rate at which a muscle contracts and produces a force - Relationship of force and velocity

Resistance Exercise Contraindications

- Severe pain in jt or muscle during active movement with no load - Inflammation in joint, or any part of the neuromuscular chain to be used - Guillain-Barre, polymyositis, dermamyositis - Severe cardiopulmonary disease (unless cleared by doctor)

Key elements of muscle performance

- Strength - Power - Endurance

Volume

- Total # of reps times the intensity (load) - Same combo of reps and sets should not be used for all muscle groups - Inverse relationship - Higher the load the lower # of reps - Ex. Arm curls (3x10) x 30# = 900#

Fatigue signs and symptoms

- Uncomfortable sensation in muscle - Tremors in contracting muscle - Jerky active movements - Inability to complete movement pattern through available range - Use of substitute movements - Inability to continue low-intensity activity - Decline in peak torque during isokinetic test

Repetition Maximum (RM)

- Used when investigating progressive resistive exercise (PRE) - The greatest amount of weight a muscle can move through the available ROM a specific amount of times - Used to document baseline measurement - Identify load and reps

Mode of Exercise

-form of exercise -type of muscle contraction that occurs -how the exercise load is applied -manner in which the exercise is carried out -Static vs Dynamic -WB vs NWB -Manually or Mechanically

Determinants of Resistance Exercise Program

1. Alignment of body segments 2. Stabilization: of proximal or distal to prevent substitute motions 3. Intensity: exercise load/resistance 4. Volume: number of reps and sets 5. Exercise order 6. Frequency sessions/day or week 7. Rest interval 8. Duration: total time committed to a RET 9. Mode: type of contraction, resistance, arc of mvmnt, primary energy sys 10. Velocity rate at which mvmnt is performed 11. Periodization: varying intensity and volume during specific periods of RET (cycling) 12. Integration of exercise into functional activities

strength and resistance training through the life span

1. During the early and middle childhood years prior to puberty, muscle strength increases linearly and is reasonably similar (as little as a 10 difference) in boys and girls. 2. During puberty, although greater muscle hypertrophy occurs in boys than girls as the result of resistance training, relative training-induced strength gains are comparable between the sexes. 3. During late adulthood, muscle atrophy occurs to a greater extent in type II than type I muscle fibers.

Progressive loading of a muscle by manipulating

1. Intensity: weight 2. Volume: reps, sets, frequency Applies to both strength & endurance training

Recommendations to improve muscular strength

2-3 sets 8-12 reps resistance: 60-80% 1RM

Late Adulthood

60's->70's:Muscle tension generation declines 15-20%/decade in men and women > or = to 80's: 30% decline, decline minimized by exercise

Your goal is to improve lower extremity proprioception, balance, and strength. Which of the following closed-chain exercises is the most challenging? A. Have the patient stand on one foot on a piece of foam and maintain his balance. B. Have the patient kneel in an upright position on a piece of foam and shift his weight from side to side. C. Have the patient stand on the floor on one leg and maintain his balance. D. Have the patient stand on the floor with weight equally distributed on both feet and throw and catch a ball.

A. Have the patient stand on one foot on a piece of foam and maintain his balance.

Muscle Endurance

Ability of a muscle to contract repeatedly against a load, generate and sustain tension, and resist fatigue over extended period of time

Cardiovascular Endurance

Ability of cardiovascular system to perform repetitive dynamic motor activities

Strength

Ability of contractile muscle to produce tension & a resultant force, based on demands placed on the muscle Force generated during a single maximum effort

Muscle Strength

Ability of contractile tissue to produce tension and a resultant force - Based on demands placed on muscle - Greatest measurable force that can be exerted by a muscle or muscle group (overcoming resistance during a single max. effort)

Endurance

Ability to perform low intensity, repetitive, or sustained activities over prolonged period of time

Recovery Periods

After Exercise Bouts Replenish O2, energy stores Lactic acid removal within 1 hour Glycogen replaced over several days **Requires 3-4 min to return to 90-95% pre-activity force producing levels

Resistance Exercise

Any form of active exercise in which a dynamic or static muscle contraction is resisted by an outside force, applied either manually or mechanically

Resistance Exercise (aka Resistance Training)

Any form of active exercise in which dynamic or static muscle contraction is resisted by an outside force applied manually or mechanically

To strengthen the posterior tibialis using manual resistance, have the patient assume a long sitting position on a table or mat. Support and hold the lower leg with one hand and:

Apply resistance to the plantar and medial surfaces of the foot at the first metatarsal as the patient plantar flexes and inverts the ankle and foot.

Cardiopulmonary Fatigue

Associated with endurance training, Caused by: Decrease in blood glucose levels, muscle, liver glycogen stores, Depletion in K+(especially elderly)

If a patient, who is in a prone-lying position with a cuff weight around his ankle, flexes his knee from a fully extended (0°) position to a fully flexed (150°) position, what type(s) of contraction will occur in which muscle group(s)?

B. The knee flexors contract concentrically from 0° to 90°, and the knee extensors contract eccentrically from 90° to 150° of flexion.

Universal load as percentage of bodyweight (Box 6.5):

Bench press: 30% Leg Extension: 20% Leg Curl: 10-15% Leg Press: 50%

To improve upper extremity strength, stability, and proprioception, during which of the following variations of push-ups does body weight provide the greatest resistance?

Bilateral push-ups in a prone position, head down on an incline board with weight on hands and knees

Transfer of Training, Cross Training

Carryover of training effects from one variation of exercise or task to another

Duration

Complete time frame (weeks or months) of resistance program - 2-3 wks gains are primarily neural adaptation - 4-8 wks increased neural adaptation slows - as early as 2 but commonly 4-8 begin to see hypertrophy - 6-12 weeks begin to see significant hypertrophy, increased vascularization - after hypertrophy has plateaued neural adaptation is once again responsible for gain

Speed of muscle contraction

Concentric Contraction: higher speed -> lower tension Eccentric Contraction: higher speed -> greater tension

the following are an indication that muscle fatigue is occurring. A. Muscular tremor occurring during the exercise. B. The patient may not be able to complete the available ROM against the initial level of resistance applied. C. The patient may attempt to use a substitute motion and muscle group to perform the exercise. D. All of the above

D. All of the above

DAPRE Regimen

Daily Adjustable Progressive Resistance Exercise; used to calculate when and by how much to increase resistance; based on a 6 RM working weight, the adjusted working weight, which is based on the maximum number of repetitions possible using the working weight of set #3 of the regimen, determines the working weight for the nest exercise session

Late Adulthood, Time to contract and time to recover lengthen

Decreased ability to generate power and velocity of movement Limited ability to generate power vs strength has stronger affect on functional limitations and disability

Vascular & Metabolic adaptation to anaerobic training

Decreased mitochondrial density (decreased oxidative capacity of muscle) Decreased capillary density (due to increased # myofilaments)

Closed Chain

Distal segment fixed while proximal segment moves on it. Typically thought of as a weight-bearing position. Against similar exercise loads, it causes lower levels of shear force in the joint than open-chain exercise.

Type II fibers preferentially hypertrophy

Endurance Training: Type IIB->IIA Type II become more fatigue resistant but Type II DO NOT turn into Type I

Oxford Regimen

Exercise technique which diminishes resistance as muscle fatigues: Determine 10RM, 10 reps @ 100% 10RM -> 10 reps @ 75% 10RM -> 10 reps @ 50% 10RM

Psychological and Cognitive Factors

Fear, impaired cognition, memory or attention can limit muscle tension, Outlook also positively affect performance

Motivation and Feedback

Feedback can improve motivation Delivered at the right time and frequency for a patient's learning phase

Type of muscle contraction

Force output greatest to least: eccentric>isometric>concentric

Recruitment and frequency of firing of motor unit

Greater # firing -> greater force production Greater frequency -> greater tension

Power Training

Greater intensity of exercise in a shorter time - Plyometric training - Stretch-shortening drills

Length-Tension relationship

Greatest tension produced near physiologic resting length of muscle

Endurance training

Having a muscle contract and lift or lower a light load for many repetitions or sustain a muscle contraction for a long time

Factors Influencing Fatigue

Health status, Diet, Lifestyle - Neuromuscular - Cardiopulmonary - Oncologic - Inflammatory - Psychological - Air quality - Altitude

Adolescence

Hormone levels change-rapid acceleration in muscle strength 5 fold in boys in adolescence 3.5 fold in girls in adolescence

Skeletal Muscle

Hypertrophy Increased actin, myosin Decreased protein degradation Increased uptake in amino acids: After 4-8 weeks with moderate-high intensity resistance training

Overload Principle

In order for muscle performance to improve, must use load greater than what the muscle is accustomed to Progressive loading of muscle by: - Increasing intensity - Changing volume

Late Adulthood decline due to

Inactivity/disuse: decrease in Type I and Type II fibers -> decrease in muscle mass -> increase in connective tissue Change in length tension relationship due to decreased flexibility

Specificity of training

Incorporating resistance training that focuses on eccentric exercises of her quadriceps and gluteal muscles in weight-bearing positions (e.g., controlled squatting and partial lunges) represents what principle of therapeutic exercise?

Increase in Endurance

Increase in oxidative and metabolic capacities

Birth through prepubescence strength gains due primarily to:

Increase in strength is mostly by neuromuscular adaptation

Connective Tissue adaptations to RET

Increase tensile strength of tendons, ligaments, connective tissue in muscle Increased bone mineral density (BMD) Wolffs law: Hypertrophy occurs in noncontractile tissue as well as contractile tissue

repetitive setting exercises will not accomplish

Increase the strength in the muscle.

Explain how after only 1 week of beginning a resistance exercise program a pt is able to increase the level of resistance by using a heavier grade of elastic tubing:

Increased Recruitment of motor units

neural adaptation

Increased recruitment of motor units, Increased rate and synchronization of firing, Increased motor coordination: Initial rapid gain in tension generating capacity is due to neural responses, **1st 4-8wks of training

Reversibility Principle

Increased strength and endurance are transient - Must use in functional activities - Losses start within a week or 2 of training cessation - Use it or Lose it

Submaximal Loading

Indications for moderate to low intensity exercise: - Beginning of exercise program - Early stage of soft tissue healing - After immobilization - Most children and older adults - Goal is to improve muscle endurance - Warm up and cool down - During slow-velocity isokinetic training - To minimize compressive forces

isokinetic exercise

It accommodates for a painful arc. It provides maximal resistance throughout the available ROM. It accommodates for muscle fatigue.

Cross Sectional Area (CSA)/size of muscle effects on tension production

Larger diameter=more tension

Rest between sessions

Moderate-high intensity: 48 hour rest Low intensity: 12- 24 hours

A patient has mild joint swelling and pain during active ROM, but resisted tests of the muscles that cross the swollen joints do not cause pain. Your goal is to maintain or possibly increase strength through the available ROM. The most appropriate choice of exercise is:

Multiple-angle isometric exercise against resistance.

A patient had surgery on their L thenar eminence and is now 8 weeks into rehabilitation. The patient's L thenar eminence is now almost the same size as that of the R. Why?

Muscle Hypertrophy

Age and Muscle Tension Generation: Childhood and Preadolescence

Muscle performance and endurance increases linearly with chronological age from birth to puberty Fiber number determined at or just before birth Fiber type-completed by age one Boys-10% stronger; slightly more muscle mass than girls

Benefits of RET of healthy limb on pathological limb:

Muscular strength and endurance increase in the pathological limb Endurance training has minimal or no cross training effect on strength

Attention

Must be given to form, technique and outcome of a task Process relevant data and respond to internal cues

Transfer of Training (aka Overflow or Cross-Training)

Occurs on limited basis to the velocity and mode of exercise Strength can improve muscular endurance (but not vice versa)

Alignment

Of body segments during exercise; determined by line of pull of muscle and direction of muscle fibers

Stabilization

Of proximal or distal joint to prevent substitution External: manual, straps, surface Internal: isometric contractions of adjacent muscle groups (i.e. abs with (B) SLR)