Interventions Exam 2

What pts. are at greatest risk for pathologic fx during resistance exercise?

○ Known or suspected Osteoporosis, Osteopenia

Explain the DAPRE method of PRE program.

*Daily adjustable Progressive Resistive Exercise* - systematic approach to increasing weight in a PRE program. - if pt. is able to do more than 6 reps at a given weight on their third set, you add weight next set or next session - Drop weight from next set/session if they cannot achieve 6 reps on their 3rd set.

What are the key parameters of endurance training?

1. low-intensity muscle contractions 2. large number of repetitions 3. prolonged period of time

Describe the physiological adaptations that occur in the neural system with resistance exercise.

1. rapid gain in tension-generating capacity (increase EMG activity first 4-8 weeks) 2. increase recruitment in number of motor units firing 3. increase rate and synchronization of firing - decrease in inhibitory function of CNS 4. Decrease in sensitivity of GTOs

When is the general onset of DOMS?

12-24 hours after exercise

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

Overwork

What is meant by speed specific training?

Performing exercises at fast or slow speeds; training-induced strength gains are *only going to be gained at the speed of exercises performed*, with little to no overlap to other speeds

Explain the Delorme method of a PRE program.

Proposed & studied 3 sets at a percentage of 10-rep max. Warm-up included in protocol. example: 3x10 at 50% 10RM > 75% > 100%

How much time is needed for the body restore itself to a state that existed prior to exhaustive exercise? (recovery period)

Recovery from acute exercise takes *3-4 mins* - greatest proportion of recovery in first minute -oxygen and energy stores are replenished quickly - lactic acid removed from skeletal muscle and blood within ~1 hr after exercise

Adaptive changes in body systems ( increased strength, endurance) in response to resistance exercise programs are transient unless training-induced improvements are regularly used for functional activities.

Reversibility principle

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

Strength Training

T/F: A max concentric contraction produces less force than a max eccentric contraction.

TRUE

T/F: Eccentric training increases eccentric strength over the duration of a program more than concentric training increases concentric strength.

TRUE

T/F: Muscle strength has moderate cross-training effect on endurance but endurance does NOT have cross-training effect on muscle strength.

TRUE

T/F: At slow velocities with a maximum load, eccentric contraction generates greater tension than a concentric contraction.

True

When is multiple angle isometrics used?

When the goal of exercise is to improve strength throughout the ROM when joint motion is permissible but *dynamic resistance is painful or inadvisable*

Repeated bursts of less intense muscle activity.

aerobic power

What is the most common adaption to strength training?

an increase in maximum force-producing capacity of muscle (muscle strength)

Single burst of high-intensity activity.

anaerobic power

What is periodized training?

breaks up a training program into periods and builds systematic variation in exercise intensity and repetitions, sets, or frequency at regular intervals over a specified period of time

What are the disadvantages of closed kinetic chain exercises?

cannot be used when WB is restricted

Associated with repetitive, dynamic motor activities which involves use of large muscles of body (walking, cycling, swimming).

cardiorespiratory endurance (total body endurance)

Having a muscle contract and lift of lower a light load for many repetitions or sustain a muscle contraction for an extended period of time.

endurance training

Stabilization applied manually by the PT or sometimes patient with equipment such as belts, straps, or by a firm support surface (back of a chair or surface of table).

external stabilization

the ability of the NM system to produce, reduce, or control forces contemplated or imposed during functional activities in a smooth, coordinated manner

functional strength

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 strengthen firmly in place.

internal stabilization - abs during SLR

Defined as work produced by a muscle per unit of time.

muscle power

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

resistance exercise (resistance training)

What is the limiting problem with DCER?

the contracting muscles is *challenged maximally at only one point in the ROM* in which the maximum torque of the resistance matches the maximum torque output of the muscle.

Explain the oxford method of a PRE program.

uses *regressive loading* - reduce weight as sets continue and muscle fatigues. ○ Example: Warm up > 3x10 at 100% 10RM > 75% > 50% □ Both oxford and DeLorme use rest period between sets, and gradually increase resistance over time □ No significant difference found between techniques on improving quad strength in older adults after 9wks

What are the different classifications of velocity for isokinetic exercise?

○ *Isometric*- 0 deg/sec ○ *Slow*- 30-60 deg/sec ○ *Medium*- 60-180 or 240 deg/sec ○* Fast*- 180 or 240-360 deg/sec and above

What are the general guidelines for manual resistance exercises?

○ Body mechanics of the therapist ○ Application of manual resistance and stabilization ○ Verbal commands ○ Number of repetitions an sets/rest intervals

What are the causes of DOMS?

○ Contraction-induced, mechanical disruption (micro-trauma) of muscle fibers or CT in and around the muscle that results in degeneration of the tissue ○ Force production deficit due to damage at *Z bands* of the muscle fibers which directly affects its structural integrity

What are the disadvantages for mechanical resistance exercise?

○ Not appropriate when muscles are very weak or soft tissues in very early stages of healing, with the exception of some equipment that provides assistance/support/control against gravity ○ Equipment that provides constant external resistance maximally loads the muscle only at one point in ROM ○ No accommodation for painful arc (except with pneumatic/hydraulic/isokinetic equipment) ○ Expense for purchase/maintenance ○ With free weights and weight machines, gradation in resistance is dependent on manufacturer's increments of resistance

What are the general guidelines for mechanical resistance exercise?

○ Prior to resistance training, perform warm-up activities followed by flexibility exercises ○ Perform dynamic exercises thru full, available, and pain-free ROM and target the major muscle groups of the body (8-10 muscle groups of UE/LE and trunk) for total body muscular fitness ○ Balance flexion-dominant (pull) activities with extension-dominant (push) ○ Include concentric (lifting) and eccentric (lowering) exercises ○ Intensity: Moderate-intensity (60-80% 1RM), 8-12 repititions per set □ Increase intensity gradually (~5% increments) to progress program as strength/endurance improves ○ Sets: 2sets progressing to 4 ○ Rest: 2-3minutes between sets. Exercise another muscle group while resting one ○ Frequency: 2-3x/week ○ Use slow to moderate speeds of movement ○ Use rhythmic, controlled, non-ballistic movements ○ Exercises shouldn't impede normal breathing ○ Whenever possible, train with a partner for assistance/feedback ○ Cool down after completion After a layoff of more than 1-2weeks, reduce resistance and volume to reinitiate

How can the parameters of work and time be changed during exercise in order to increase power?

*1) increasing the work a muscle must perform during a specified period of time* *2) Reducing the time required to produce a given force* - the greater the intensity of the exercise and the shorter the time period taken to generate the force, the greater the muscle activity

Give examples of equipment that are used primarily or closed chain training.

*1. Body weight resistance: Multipurpose exercise systems* a. Ex: Total gym *2. Slide boards* a. Ex: The ProFitter *3. Balance board* a. Wobble board, BOSU, BAPS b. used for stabilization, proprioceptive and perturbation training *4. Mini trampolines*

Reflected by reduction in muscle performance, begins within a *week or two* after the cessation of resistance exercises and continues until training effects are lost.

*Detraining* - imperative to incorporate strength/endurance to daily activities

Explain the overload principle?

*If muscle performance is to improve, a load that exceeds the metabolic capacity of the muscle must be applied* 1. the muscle must be challenged to perform at a greater level than to which it is accustomed; if not, it can be maintained not increased 2. focuses on progressive loading of muscle by manipulating *intensity or volume*

How many reps and sets should be used?

*Improve muscle strength:* 1. One study says do 3 sets of 10 2. One study says you need 40-60% of max effort to get strength gains 3. One study says moderate exercise load (60-80% 1RM) that causes fatigue after 8-12 reps for 2-3sets *To improve muscle endurance:* 1. Involves performing many reps of an exercise against a submaximal load 2. 3-5 sets of 40-50 reps against a low amount of weight or light grade of elastic resistance 3. Can also do a sustained isometric muscle contraction for incrementally longer periods of time 4. Should be initiated early in a rehab program because it is used with low loads

The diminished response of muscle to a repeated stimulus reflected in a progressive decrement in amplitude in the amplitude of motor unit potentials.

*Muscle (local) fatigue* - normal and reversible - characterized by a gradual decline in the force-producing capacity of the NM system -> *temporary* state of exhaustion (failure), leading to decrease in muscle strength

Decline in physical performance in healthy indv participating in high intensity, high volume strength and endurance programs.

*Overtraining* ○ Individuals progressively fatigue more quickly and requires more time to recover from strenuous activity. ○ Caused by inadequate rest intervals between exercise sessions, rapid progression of exercises, inadequate diet and fluid intake

How can you prevent DOMS?

*Smoky the Weight-Bear - "Only YOU can prevent DOMS."* ○ Gradual progression of exercise intensity and volume ○ Low intensity warm up and cool down prior to exercise ○ Gentle stretching before and after exercise ○ "repeated-bout effect"- bout of concentric exercise protects muscle from damage from subsequent bouts of eccentric exercise

Diminished response of an individual as the result of prolonged physical activity, related to the body's ability to use oxygen efficiently.

*cardiopulmonary (general) fatigue* - factors associated with endurance training: 1. decreased *blood sugar* (glucose) levels 2. decreased *glycogen* stores in muscle and liver 3. decreased *potassium*, especially in elderly patient

Ability of muscle to contract repeatedly against load (resistance), generate & sustain tension, and resist fatigue over extended period of time.

*muscle endurance (local endurance)* -aerobic power used interchangeable with muscle endurance - maintenance of balance + proper alignment of body segments requires sustained control (endurance)

Explain the SAID principle.

*specific adaptation to imposed demands* - extension of Wolff's law - a framework of specificity is a necessary foundation on which exercise programs should be built; *whenever possible, the exercise should mimic function* -specificity of training should be considered with respect to *mode, velocity, joint angle*

How often should exercises be performed?

-Dependent on intensity, volume, patient goals, general health status, previous participation in resistance exercise program, and response to training *General guidelines:* 1. Early on, short sessions with low intensity and reps can be done daily early on, even several times per day 2. As intensity and volume increases, frequency of 2 to 3 times per week, every other day, or five days total a week is common 3. With prepubescent children or very elderly, frequency typically is limited to no more than 2 to 3 sessions per week 4. High intensity athletes may train at high intensity rate and volume up to 6 days per week

When is periodized training used?

1) Developed for highly trained athletes prior to a competitive event 2) Used on limited basis in clinical setting for injured athletes during advanced stage of rehab 3) Designed for optimal progression of training programs, prevent overtraining and psychological staleness prior to competition, and to optimize performance during competition

List the determinants of a resistance exercise program.

1) alignment 2) stabilization 3) intensity 4) volume 5) frequency 6) rest interval 7) duration 8) mode of exercise 9) velocity 10) periodization 11) integration of exercise into functional activities 12) Order of exercises

What are some factors that influence fatigue?

1) health status 2)diet 3) lifestyle 4) environmental factors (temp, air quality, altitude)

Describe the physiological adaptations that occur in body composition with resistance exercise.

1) increase in lean (fat-free body mass) 2) decrease in % body fat

What are the advantages of open kinetic chain exercises?

1) isolation of muscle groups; greater control of single joint motion 2) can be used when WB is contraindicated 3) used w/ soft tissue pain/swelling or restricted ROM

What are the disadvantages of open kinetic chain exercises?

1) less control of multi joint motion 2) less proprioceptive/kinesthetic feedback than CKC

What are some special considerations to take into account when performing DCER or variable resistance?

1) stabilizing muscles are also recruited to control arc and direction of limb movement 2) These exercises must be done at a *relatively slow velocity for safety* so that patient does not recruit other muscles or perform uncontrolled movements (typically 60°/sec); consequently, these strength gains may *not directly translate to higher velocities* in functional or sport activities

What are stabilization exercises used for?

1) to develop a sub maximal but sustained level of co-contraction *to improve postural stability or dynamic stability* -Body weight or manual resistance is typically source of resistance

What are the advantages of closed kinetic chain exercises?

1)greater control of multiple joint motion 2)joint approximation w/ axial loading increases congruency and stability 3) stimulation of joint and muscle mechanoreceptors, co-contraction of agonists/antagonists to promote dynamic stability 4) proprioceptive/kinesthetic feedback 5) improvement of balance and postural control in the upright position 6) partial WB

What are some limitations of isokinetic training?

1. *Limited number of studies* on relationship between isokinetic and improvement in performance of *functional skills* 2. *Velocities of limb movement* during daily living and sport related activities *exceeds the max velocity settings* of isokinetic equipment 3. Limb movements occur at *multiple velocities* NOT at *constant velocity in functional tasks* 4. Only isolates a *single muscle group, joint, is uniplanar and is NWB* 5. *Availability of equipment is limited to PT* 6. Appropriate set up and use of equipment can be difficult

Describe the physiological adaptations that occur in the skeletal muscle with resistance exercise.

1. *hypertrophy* - increase greatest in type IIb fibers - hypertrophy: increase in size of individual muscle fiber caused by increase in myofibrillar volume - greatest increase in protein syntheiss (hypertrophy) are associated with *high-volume, moderate resistance eccentric exercise* - stimulation of uptake of amino acids 2. *possible hyperplasia*- increase in number of muscle fibers 3. muscle fiber type adaptation: remodeling of type IIB to type IIA (no change in type I to type II)

What are the clinical signs and symptoms of muscle fatigue?

1. *uncomfortable sensation* in muscle, even pain and cramping 2. *tremulousness* in the contracting muscle 3. unintentional *slowing of movement* with successive repetitions of exercise 4. active movements: *jerky*, not smooth 5. *inability* to complete the movement pattern *through the full ROM* during dynamic exercise against same level of resistance 6. *use of substitute motions*—incorrect movement pattern—to complete movement 7. *inability* to continue *low-intensity* physical activity 8. *decline* in peak torque during *isokentic* testing

How can you avoid pathologic fxs?

1. Avoid High intensity, high volume weight training 2. Progress intensity and volume gradually 3. Weight lifting exercises 2-3 x's a wk 4. Use WB activities w/ resistance training that avoid high impact, high velocity, LE WB w/ torsional movement 5. Avoid loss of balance 6. in group exercise avoid high pt to instructor ratio

How much rest is needed between exercises?

1. Dependent on intensity and volume of exercise; the higher the intensity, the more rest is needed 2. *Moderate Intensity: 2-3 minute* rest period recommended 3. *High intensity: >3 minutes* -Particularly when strengthening multi-joint muscles such as the hamstrings 4. *Patients with pathological conditions that make them susceptible to fatigue, children, and elderly should rest at least 3 minutes* between sets by performing a non-resisted exercises i.e. cycling or exercise on opposite extremity -*active recovery is more efficient than passive recovery* 5. 48-hour rest interval between exercise sessions recommended for same muscle group

What are the advantages for mechanical resistance exercise?

1. Establishes a quantitative baseline measurement of muscle performance against which improvements can be judged 2. Most appropriate during intermediate and advances phases of rehab where muscle strength is 4/5 or greater OR when strength of pt exceeds strength of PT 3. Provides exercise loads far beyond what can be applied by PT manually to induce a training effect for already strong muscle groups 4.Provides quantitative documentation fo incremental increases in the amount of resistance □ Quantitative improvement is an effective source of motivation 5. Useful for improving dynamic or static muscular strength 6. Adds variety to resistance program 7. Practical for high-repetition training to improve endurance 8. Some equipment provides variable resistance through the ROM 9. High-velocity resistance training is possible and safe with some forms of mechanical resistance (elastics, hydraulic/pneumatic systems, isokinetic units) □ Potentially better carryover to functional activity than relatively slow-velocity manual resistance exercises □ Appropriate for independent exercise in a home program after careful patient education and supervision

What are the disadvantages for manual resistance exercise?

1. Exercise load is subjective 2. Resistance is limited to strength of therapist 3. Speed of movement is slow to moderate which may not carry over to functional activities 4. Cannot be performed independently by pt 5. Not useful in home program unless caregiver assistance available 6. Labor and time intensive for therapist 7. Impractical for improving muscle endurance, time consuming

Describe the physiological adaptations that occur in the vascular and metabolic with resistance exercise.

1. Increase ATP and PC storage 2. Increase myoglobin storage 3. Increase creatine phosphokinase 4. Increase myokinase 5. Decrease in capillary bed density (increase for endurance training) 6. Decrease mitochondrial density and volume (increase for endurance training)

Describe the physiological adaptations that occur in connective tissue with resistance exercise.

1. Increase tensile strength in tendons, ligaments, and bones 2. increase strength at MTJ 3. connective tissue thickens 4. Increase bone mineral density

What should the general order of exercises for resistance training be?

1. Large muscle groups before small muscle groups 2. Multi-joint exercises before single-joint exercises 3. After warm up, High intensity exercises before lower intensity exercises.

What are the advantages for manual resistance exercise?

1. Most effective during early stages of rehab when muscles are weak (4/5 or less) 2. Effective for transition from assisted to mechanically resisted movements 3. More finely graded resistance than mechanical 4. Resistance adjusted throughout ROM as therapist responds to pt's effort or painful arc 5. Muscle works maximally at all portions of ROM 6. Range of joint movement can be carefully controlled by therapist to protect healing tissues or prevent movement into unstable portion of range 7. Useful for dynamic or static strengthening 8. Direct manual stabilization prevents substitute motions 9. Can be performed in variety of pt positions 10. Placement of resistance easily adjusted 11. Direct interaction of therapist w/ pt to monitor pt's performance continually

What are the symptoms of DOMS?

1. Muscle soreness and aching 2. Tenderness w/ palpation throughout muscle belly/MT junction 3. Local edema/warmth 4. Increased soreness w/ passive lengthening/active contraction 5. Muscle stiffness w/ spontaneous muscle shortening before pain 6. Decreased ROM 7. Decreased muscle strength prior to onset of muscle soreness for 1-2 wks after soreness remitted

How long before a training effect is noticed?

1. Strength gains can be observed after 2-3weeks (neural adaptation) 2. Significant changes to occur in muscle, takes 6-12 weeks (hypertrophy or increased vascularization)

List the indications for isometric training.

1. To minimize *muscle atrophy* when joint *movement is not possible* owing to external immobilizations (casts, splints, skeletal traction) 2. To activate muscles (facilitate muscle firing) to begin *to re-establish neuromuscular control* but protect healing tissues when joint movement is not advisable after soft tissue injury or surgery 3. To develop *postural or joint stability* 4. To improve *muscle strength* when use of dynamic resistance exercise could *compromise joint integrity or cause joint pain* 5. To develop *static muscle strength* at particular points in the ROM consistent with *specific task-related needs*

What is muscle setting used for?

1. Used to decrease muscle pain and spasm, and to promote relaxation and circulation after injury to soft tissues during acute stage of healing i.e. quad sets, glute squeezes 2. Cannot increase strength except in very weak muscles; can be used to retard muscle atrophy and maintain mobility between muscle fibers

List the factors that influence the development of tension in normal skeletal muscle.

1. cross-section and size of muscle (muscle fiber number and size) 2. muscle architecture—fiber arrangement and length 3. fiber-type distribution of muscle (type I, type IIA, type IIB) 4. length-tension relationship of muscle at time of contraction 5. recruitment of motor units 6. frequency of firing of motor units 7. type of muscle contraction 8. speed of muscle contraction (force-velocity relationship) 9. energy stores available to muscle 10. influence of fatigue and recovery from exercise 11. persons age 12. persons gender psychological/cognitive status

What are the potential causes of muscle fatigue?

1. disturbances in contractile mechanism of muscle (energy store, insufficient oxygen, reduced sensitivity, availability of Ca, build up of H+) 2. reduced excitability at NM junction 3. inhibitory (protective) influences from CNS

What are the disadvantages of isokinetic equipment?

1. equipment is *large and expensive* to purchase and maintain 2. setup *time and assistance from personnel are necessary* if a patient is to exercise multiple muscle groups 3. most only allow *open-chain movement patterns, which do not simulate most lower extremity functions and some upper extremity* 4. most exercises are performed in a *single plane and at a constant velocity* (not functional) 5. Concentric training velocities don't always reach rapid limb *speed that are necessary for sports-related functions* a. Eccentric velocities only approach medium-range speeds, limiting functional goals

What are the advantages of isokinetic equipment?

1. if the patient puts *forth maximum effort, isokinetic equipment provides maximum resistance at all points* in the ROM as a muscle contracts 2. both *high and low velocity* training can be one *safely and effectively* 3. the equipment accommodates for a *painful arc of motion* 4. as a patient fatigues, exercise can still continue 5. Concentric and eccentric contractions of the same muscle group can be performed repeatedly, or reciprocal exercise of opposite muscle groups can be performed, allowing one muscle group to rest while its antangoist contracts (minimizes muscle ischemia)

List the indications for sub maximal loading.

1. in the early stages of *soft tissue healing* when injured tissues must be protected 2. after *prolonged immobilization* when the articular cartilage is not able to withstand large compressive forces or bone demineralization may have occurred (increase risk of pathological fracture) 3. when initially *learning an exercise* to emphasize the correct form 4. for most *children or older adults* 5. when the goals of exercise is to *improve muscle endurance* 6. *to warm-up and cool-down* prior to and after a session of exercise 7. during *slow-velocity isokinetic* training to minimize *compressive forces on joint*

What are the precautions for a 1-RM?

1. joint impairments 2. recovering from or who are at risk for soft tissue injury 3. patients with known or at risk for osteoporosis or CV pathology

What are the effects of age on muscle performance for young and middle adulthood?

1. muscle mass peaks in *women between 16 and 20 years* of age; muscle mass in *men peaks between 18 and 25 y/o* 2. *Decrease muscle mass* begin to occur as early as *25 years of age* 3. muscle continues to develop into *second decade*(especially men) 4. *muscle strength and endurance reach peak during second decade* 5. at 3rd decade strength: declines *1% per year, 8% per decade* (through 5th/6th decade) 6. strength and muscle endurance deteriorate *less rapidly in physically active* vs. sedentary 7. improvements in strength and endurance are possible with only most *a modest increase activity*

What are the effects of age on muscle performance for early childhood and preadolescence?

1. muscle performance *increases linearly with chronological age* in male and females from birth through early and middle childhood to puberty 2. *muscle endurance also increases linearly* 3. total number of *muscle fibers is established* prior to birth or early infancy 4. *rate of fiber growth* (PSCA) consistent from birth to puberty 5. *change in fiber type*distribution relatively complete by *age 1* - shift from predominance of type II fibers to more balanced distribution 6. *boys* have slightly *greater absolute/relative muscle mass* 7. training-induced strength gains in prepubescent children occur *primarily from neuromuscular adaptation*

What are the disadvantages of elastic resistance?

1. need to refer to table of figures for quantitative information about *level of resistance* for each color a. makes it difficult to know which grade to select initially and to what extent changing grades will change the resistance 2. *no source of stabilization* a. patient must use muscular stabilizers to ensure that the correct movement pattern occurs 3. should be *replaced on a routine basis* to ensure patients safety 4. some contain *latex*, eliminating use by pts. with an *allergy*

What are the advantages of elastic resistance?

1. products are *portable* and relatively inexpensive, making them ideal for *HEP* 2. because they are not significantly *gravity dependent*, they are extremely versatile a. allowing for many combinations of movement patterns in the extremities and trunk and in many positions 3. *safe to exercise at moderate to fast velocities* with elastic resistance because the patient does not have to overcome the inertia of a rapidly moving weight

What are the effects of puberty on muscle performance?

1. rapid acceleration in *muscle fiber size* and *muscle mass* (especially in boys) - muscle mass increases more than *30% per year during puberty* 2. rapid increase in *muscle strength* in both sexes 3. marked difference in strength levels develops in *boys and girls* - *in boys*: muscle mass and body height and weight peak before muscle strength - *in girls*: strength peaks before body weight 4. relative *strength gains* as the result of resistance training are *comparable between the sexes*, with significantly increased muscle hypotrophy in boys

What are the effects of age on muscle performance for late adulthood?

1. rate of decline in tension-generating capacity of muscle accelearates to *15%-20% per decade* during *6th/7th decades*, increases to *30%/decade after* 2. muscle fiber size (CSA), type I and type II fiber numbers, number of alpha motorneurons all decrease. Preferential atrophy of type II occurs 3. skeletal muscle *mass decreased by 50%* vs. peak muscle mass 4. decrease in *speed* of muscle contractions and *peak power output* 5. gradual but progressive decrease in *endurance and max. oxygen uptake* 6. *loss of flexibility* reduces the force-producing capacity of muscle 7. significant deterioration in *functional abilities by 8th decade*, with a decrease in endurance 8. Minimal decline in performance in functional abilities occurs during the *6th decade* 9. increase *connective tissue* in muscle 10. strength, power, endurance improvement is possible with training program

What are two main reasons for determining a repetition maximum?

1. to document a baseline measurement of dynamic strength of a muscle/muscle group against which exercise-induced improvements in strength can be compared 2. to identify initial exercise load to be used during exercise for specified # of times

How are exercise cycles used in resistance programs?

1. used to increase LE strength and endurance a. some provide resistance to UE 2. upright cycles require greater trunk control and balance than a recumbent cycle 3. Can be graded to challenge the patient progressively

List the indications of Near-Maximal or Maximal Loading

1. when the goal of exercise is to *increase muscle strength + power* and possibly increase muscle size 2. for otherwise *healthy adults in the advanced phase* of rehabilitation program after a msk injury in preparation for returning to high-demand occupational or recreational activities 3. in a *conditioning program* for individuals with *no known pathology* 4. for individuals training for competitive *weight lifting or body building*

What is the valsalva maneuver?

A deep inspiration is followed by closure of the glottis an contraction of the abdominal muscles, thus, increasing the intra-abdominal/intra-thoracic pressures, which produces a temporary increase in arterial BP

What are the precautions for isometrics?

Breath holding commonly occurs during isometric exercise, particularly when performed against substantial resistance; this can cause a rapid increase in BP; rhythmic breathing, emphasizing exhalation during contraction, should always be performed during isometrics

T/F: At high velocities, eccentric contraction tension rapidly decreases while concentric increases but then rapidly plateaus

False - eccentric increases - concentric decreases

T/F: Greater numbers of motor units are recruited with eccentric and thus less mechanical efficient and requires more effort by a patient to control the load.

False - greater for concentric

When is eccentric exercise considered essential in a rehab programs?

For musculoskeletal injury and in conditioning programs to reduce risk of injury associated with *high-intensity deceleration, quick changes of direction, or repetitive eccentric muscle contracitons*; also thought to improve sport related physical performance

What is a precaution to consider for eccentric exercises when compared to concentric?

Greater stress on CV system (increased HR and BP) during eccentric exercise; make sure they are rhythmically breathing

What are the contraindications for isometrics?

High-intensity isometric exercises may be contraindicated with patient with history of cardiac or vascular disorders

When should valsalva be exclusively avoided ?

In pts. with history of: • CAD • MI • CVD • HTN • Neurosurgery • Eye surgery •IVD pathology

the ability of contractile tissue to produce tension and a resultant force based on the demands placed on the muscle

Muscle strength