Resistance Exercise
Preparation
- Select exercises - Explain and demonstrate - Firm/comfortable surface
Energy systems
Aerobic Anaerobic
At risk patients for resistance training
CAD, MI, CVA, HTN Neurosurgery, eye surgery Intervertebral disk pathology
Forms of resistance
Manual or mechanical Constant or variable Accommodating (isokinetic) Body weight
For many patients with impaired muscle performance
endurance training has a more positive impact on improving function than strength training
Delayed onset muscle soreness (DOMS) prevention:
p. 197
may be result of overwork
Polio first observed, GB, Post-polio
Stabilization
Purpose: avoid substitute motions Usually at proximal attachment Internal stabilization for multi-joint movements
B/c work can be produced over a very brief or extended period of time, power can be expressed by a:
Short: single burst of high intensity activity (such as lifting a heavy piece of luggage onto an overhead rack or performing a high jump) Anaerobic power Extended: by repeated bursts of less intense muscle activity (such as climbing a flight of stairs) Aerobic power
Strength training
Systematic procedure of a muscle (or muscle group) lifting, lowering, or controlling heavy loads. Low Reps, short period of time.
Increases with resistance training
Tensile strength of tendons, ligaments, and bone
Endurance
The ability to perform low-intensity, repetitive, or sustained activities over a prolonged period of time
The greater is the muscle power:
The greater the intensity of the exercise and the shorter the time period tale the generate force
Position
The patient's body position or the position of a limit in NWB or WB positions
Power
The rate of performing work Force x distance/time Ex: Plyometric training, stretch-shortening drills
Exercise order
The sequence in which exercises are performed during an exercise session has an impact on muscle fatigue and training effects Large muscle groups should be exercised before small muscle groups Multi-joint exercises should be performed before single-joint exercises After warm up, high intensity exercise should be performed before lower intensity exercises
Duration
Total number of weeks/months a resistance exercise program is carried out 6-12 required for hypertrophy and increased vascularization
Precautions for Resistance Training --> Osteoporosis
Type 1 --> Postmenopausal women Type 2 --> Prolonged immobilization or disuse, NWB, Cortiosteoroid or immunosuppresents for extended time
To improve muscle strength:
Variable recommendations 40-60% 1 RM 60-80% 1 RM with 8-12 reps and 2-3 sets
Cardiopulmonary endurance (total body endurance)
associated with repetitive, dynamic motor activities, such as walking, cycling, swimming, or UE ergometry
For significant changes to occur in muscle
at least 6-12 weeks of resistance training is required
1 Rep max
baseline measurement of dynamic strength
decrease in muscle mass
begin to occur as early as 25 years of age
Muscle Mass Peak In women
between 16-20 years of age
Muscle mass Peaks in Men
between 18-35 years of age
When muscles hypertrophy with high-intensity, low-volume training
capillary bed density actually decreases because of an increase in the number of myofilaments per fiber
Endurance training
characterized by 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 Low weight, high reps Minimizes irritation on joints and soft tissues More comfortable than heavy resistance exercise
As velocity increases
concentric contractions get weaker & eccentric contractions get stronger
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d
Increased intensity
decreased frequency
Strength ≠
endurance
Mode-specific training
essential if a resistance training program is to have a positive impact on function.
10 Rep max
for training
Pathologic fracture:
fracture of bone already weakened by disease; result of minor stress to skeletal system
Stabilization
holding down a body segment or holding the body steady External: can be applied manually Internal: achieved by an isometric contraction of an adjacent muscle group that does not enter into the movement pattern (ex: when performing a bilateral SLR, the abdominals contract to stabilize the pelvis and lumbar spine as the hip flexors raise the legs)
Tendon and ligament tensile strength
increases in response to resistance training to support the adaptive strength and size changes in muscle connective tissue also thickens, giving more support to the enlarged fibers
Non contractile soft tissue strength
may develop more rapidly with eccentric resistance training than with other types of resistance exercieses
Exercise frequency is prepubescent and very elderly
no more than 2-3/week
Dynamic
performed using concentric (shortening) or eccentric (lengthening) contractions, or both
strength =
power
Strength gains observed early in a resistance training program (2-3 weeks)
primarily are the result of neural gains
Neuromuscular, systemic, metabolic, inflammatory disease:
progressive slowly, greater rests, monitor closely
Necessary to develop strength through the ROM
resistance through the full, available ROM (full-arc exercise)
Muscle Endurance (local endurance):
the ability of the muscle to contract repeatedly against a load (resistance), generate and sustain tension, and resist fatigue over an extended period of time --> aerobic power --> postural muscles
Functional strength:
the ability of the neuromuscular system to produce, reduce, or control forces, contemplated or imposed, during functional activities, in a smooth, coordinated manner
Intensity
the amount of resistance (weight) imposed on the contracting muscle during each repetition of an exercise AKA: the extent to which the muscle is loaded or how much weight is lifted, lowered, or held
Mode
the form of exercise, type of muscle contraction, manner in which exercise executed ex: a patient may perform an exercise dynamically or statically or in a WB or NWB position.
Isokinetic
when the velocity of limb movement is held consisted by a rate-controlling device
Type II muscle fibers hypertrophy
with heavy resistance training
Overwork
"Progressive deterioration of strength in muscles already weakened by nonprogressive neuromuscular disease" (KC ref)
Characteristics of isokinetic training
- Constant velocity - Range and selection of training velocity - Reciprocal versus isolated muscle training - Specificity of training - Accommodation to fatigue and painful arc
Exam and evaluation
- Current stage of healing - Swelling - pain
Characteristics and effects of isometric training
- Intensity of muscle contraction - Duration of muscle activation - Repetitive contractions - Joint angle and mode specificity - Sources of resistance
Isometric exercise Ratoionale:
- Minimize muscle atrophy when joint movement is not possible - Activate muscles - Develop postural or joint stability - Improve muscle strength
Types of Isometric Exercise
- Muscle-setting exercises - Stabilization exercises - Multiple-angle isometrics
Open - and Closed chain exercises Rationale for use
-Isolation of muscle groups - Control of movements - Joint approximation - Co-activation and dynamic stabilization - Carryover to function and injury prevention - Proprioceptive, kinesthetic and neuromuscular impact
Delayed onset muscle soreness (DOMS)
12-24 hours afterward High intensity eccentric
Rest interval (recovery between sets)
2-3 min. for moderate training > 3 for high level training Can perform alternate group while resting one group Children/elderly at least at least 3 minutes Active recovery combats muscle fatigue better than passive recovery
Exercise frequency in adult:
2-3/week up to 5/week
resistance training for High risk cardiovascular patients
30-40% intensity for UE 50-60% intensity for LE AFTER CLEARANCE
Intensity Dosage -- Training zone (% of 1 RM)
30-40% sedentary 40-70% healthy, untrained adult >80% highly trained
To improve muscle endurance:
40-50 reps, 3-5 sets (KC ref) holding isometric contractions for longer periods of time
Untrained adult when exercising with a load that is equivalent to:
60% intensity about ~ 15 reps 75% intensity about ~ 10 reps 90% intensity about ~ 4-5 reps
Dosage
8-12 reps for most adults Usually reaches muscular fatigue; adaptive gains in strength
SAID principle
A framework of specificity is a necessary foundation on which exercise programs should be built. Applies to all body systems and is an extension of Wolff's law (body systems adapt over tim to the stresses placed on them) Specific adaptation to imposed demands
Transfer of training
Aka cross training effect Muscle strength training moderately improves muscular endurance Endurance training ≠ strength improvements
Periodization of Training
Breaks up a training program into periods and builds systematic variation in exercise intensity and repetitions/sets/frequency over a specific period of time
Overtraining
Decline in physical performance in healthy individuals Chronic fatigue, burnout, staleness
Alignment
Determined by direction of muscle fibers and line of pull --> Avoid substitute motions --> Muscle action Ex: gluteus medius --> Gravity Anti-gravity
Placement and direction of resistance
Distal end of segment to be strengthened Opposite desired motion (concentric) Same as desired motion (eccentric)
Acute muscle soreness
During or directly after strenuous exercise
Intensity - General principle for resistance training
First, pt practice with AAROM, PROM, minimal load Motion should be smooth, nonballistic or tremulous Effort from pt should be forceful, controlled and painfree
Periodization of Training Developed for:
Highly trained athletes in preparation for competition Prevents over-training, psychological staleness Can extend over an entire year Limited research supports efficacy
Skeletal Muscle Adaptations
Hypertrophy (increase in the size of an individual muscle fiber caused by an increased in myofibrillar volume) Hyperplasia (in increase in the number of muscle fibers) Muscle fiber type adaptation
Overload principle
If muscle performance is to improve, a load that exceeds metabolic capacity of the muscle must be applied --> the muscle must be challenged to perform at a level greater than that to which it is accustomed Progressive loading of the muscle
Reversibility principle
If you don't use it you lose it --> Detraining (reduction in muscle performance, begins within a week or 2 after the cessation of resistance exercises and continues until training effects are lost)
Overtraining caused by
Inadequate rests, too rapid progressions, inadequate diet/fluids
Power can be enhanced by:
Increasing the work --> Heavier loads Decreasing the time --> Faster
Type of muscle contraction
Isometric (static) Dynamic Isokinetic Dynamic contraction under controlled conditions
Application of the Overload Principle:
Loading the muscle through manipulation of intensity (resistance) and/or volume of exercise (sets, reps, frequency)
Alternatives to 1 Rep Max
Multi-rep max as baseline Dynamometers Isokinetic machines % body weight
Reps:
No optimal # for strength or endurance Greater strength reported with 2-3 RM vs. 15 RM ( KC ref.)
Frequency
No optimal frequency determined Eccentric = longer rests Early postsurgical isometrics = several times/day
Sets
No optimal number per exercise session, but 2-4 sets is a common recommendation for adults. 1 set at lower intensities are most common in the very early phases of a resistance exercise program.