Chapter 6 Therapeutic exercise

II B

ANEROBIC & Fatigue FAST

ankle, foot, hip, elbow, finger

Avulsion fx. common sites

cardiopulmonary lipid well-being

Benefits of balanced ex -Kids: Increased ___ fitness Decreased blood ___ levels Improved psychological ___

weights; light

Body ___ or ___ weights during preadolescence

injuries Ephiphyseal or avulsion

Concerns that kids who participate in resisted exercise risk for ___ ___ or ___ fractures

Threshold for FATIGUE

Level of exercise that cannot be sustained indefinitely

aerobic power

Often ___ used interchangeably with endurance

TYPE II FIBERS

Phasic Fast twitch Generate great amount of tension-within short period of time

injuries or improves sport performance

Resisted ex for pre-pubescent children now common—insufficient evidence to support structured resistance training program-when coupled with general sports conditioning reduces ___ or ___

work; time period time

To increase power: Either increase the ___ a muscle must perform during a specified ___ Or.... Reduce the amount of ___ required to produce work

Endurance

___ training -little to no cross training effect on mm. strength

greater ROM

long fibered muscles produced?

Neural Hypertrophy vs. Hyperplasia Vascular and Metabolic Connective Tissues

Physiological Adaptations to Resisted EX: ___ adaptations ___ vs ___ ___ and ___ Adaptations Adaptations of ___ Tendons, ligaments, and connective tissue is muscle Bone-

single burst of high intensity activity repeated bursts of less intense activity

Power can represent a ____ (such as lifting a heavy piece of luggage overhead or performing a high jump) or ___ (climbing a flight of stairs)

Depression attention; memory

Psychological and Cognitive Factors: ___ related to physical illness Impaired ___ or impaired ___ (age, head injury, meds side effects) all affect motor ability

15-20%

Rate of decline of tension-generating capacity of mm. accelerates to ___% to ___% per decade for men and women in their 60's and 70's

endurance

Refers to ability to perform repetitive or sustained activities over a prolonged period of time

velocity; patient or joint; movement Task specific

Specificity of Training: Must also incorporate optimal mode (type), ___ of exercise and ___ or ___ position, and the ___ patterns ___ practice must be focus

30; 20s 1%; 8% 50 active than sedentary

Strength peaks in men at age ___ in women during ___ After these peaks, strength declines approx. ___ per year or about __ a decade Strength declines minor until about age __ Slower decline if ___ than ___

Endurance Training

Systematic practice of using muscle force to raise, lower, or control a light external load for many reps over an extended period of time

Cardiopulmonary Fatigue

Systemic diminished response of an individual as a result of prolonged physical activity such as walking, jogging, cycling or repetitive work

avulsion fracture

Tendon or ligament pulls bone away at site of attachment.

contraction reps

Threshold for FATIGUE could be noted as the Length of time a mm ___ maintained Or number of ___ of ex. that can be performed

free play and organized

Toddler, preschooler, and during early elementary years- ___ and ___ age appropriate physical activities rather than resisted exercises

bone health

WB promotes?

strength endurance

What does activity require, ___ (high intensity over short period of time), power, or ___ (low intensity over prolonged period of time)?

oxidative and metabolic oxygen

With endurance training-mm. adapt by increasing ___ and ___ capacities which allows better delivery and use of ___

MM. strength and mm. endurance

___ and ___ increases linearly with chronological age in both boys and girls from birth-puberty

Resistance ex

___ in children-can increase mm. strength- before puberty results are due to neuromuscular adaptation (not increase in mm mass).

Muscle strengthening

___ program-transfers by moderately improving muscular endurance

endurance

___ used more often for older population

Muscle strength

____ is needed as foundation BEFORE developing power

Function Strength

ability of neuromuscular system to provide enough force during functional activities in a smooth coordinated manor.

IIA

aerobic

Wolff's Law

body systems adapt over time to the stresses placed on them

Mental status

can affect muscle performance

Psychological factors

can positively or negatively affect mm. performance

blood glucose glycogen potassium

cardiopulmonary fatigue associated with endurance training is probably caused by a combination of the following factors: 1: Decreased ___ levels 2: Decreased ___ stores in mm and liver 3: Depletion of ___ esp. in elderly patients

fatigue

complex phenomenon that affects performance and must be considered in a resistance ex program

tension

cross section and size of muscle (includes muscle fiber number and size) 1: the larger the muscle diameter, the greater its ___ producing capacity

detraining

decreased muscle performance begins 7-14 days after resistance ex. program stops and continues until training effects are lost

muscle fatigue

diminished response of muscle to a repeated stimulus

injury, disease, immobilization, disuse, and inactivity

factors such as ___, ___, ___, ___ and ___ may impair muscle performance, leading to weakness and muscle atrophy

activity limitation, participation restriction and dysfunction

if any one or more of the key elements of muscle performance is impaired ____ and ____ or increased risk of ___ may ensue

Specific adaptation to imposed demands (SAID) principle

improve muscle performance in a specific area must match resistance program Principle applies to all body systems and is extension of Wolff's Law

9-12

may take ___ to ___ months of exercise for detectable and significant increase in in bone mass to occur.

high force

muscle architecture-fiber arrangement and fiber length (also relates to cross sectional diameter of muscle) 2: short fibers with pennate and multipennate design are typical in ___ producing muscles (ex quad, gastroc, deltoid and biceps brachii)

amplitude statically or dynamically

muscle fatigue causes a progressive decrease in ___ of motor potentials. it occurs if muscle contracts ___ or ___ against imposed load

intensity and volume

muscle no longer fatigues means they have adapted to?

Insufficient rest

patient's performance plateaus or deteriorates (overwork or overtraining)

Anaerobic power vs aerobic power

power can be defined as ___ power vs ___ power

90-95% 3-4

recovery from ex, in which the force producing capacity of muscle returns to __-___% of the pre-ex capacity, usually takes ___ to ___ min with the greatest proportion of recovery occurring the first minute

resistance training

resistance ex, also called ____, is an essential element of rehab programs for persons with impaired function

health; well being performance; motor skills injury and disease

resistance is an integral component of conditioning programs for those who wish to promote of maintain ___ and physical ___, enhance ___ and ___ and reduce risk of ___ and ___

spinal fractures

resistance training-does not prevent ___ but---increases strength of trunk extensors which correlates to vertebral bone density

LOW LOADS AND REPS

resisted ex program may be of value if program performed at appropriate level----___ and ___, Includes sufficient rest and is closely supervised

greater force

short fibered muscle produce?

strength training

systematic practice of using muscle force to raise, lower or control heavy external loads for a relatively low number of reps or over a short period of time It is an integral component of most rehabilitation or conditioning programs

strength training program

the amount of external resistance applied to the muscle is incrementally and progressively increased

max force producing capacity of muscle

the most common adaptation to strength training is an increase in the?

intensity or volume

the overload principle focuses on progressively loading muscle by changing ___ or ___ of exercise

cardiopulmonary endurance

total body endurance associated with repetitive, dynamic motor activities, such as walking, cycling or UE ergometry, which involve the large muscles of the body

ecc, isometric, concentric

10: type of muscle contraction force output greatest to least- ___, ___, ___ muscle contraction

concentric ecc

11: speed of muscle contraction (force velocity relationship) ___ contraction: increased speed, decreased tension ___ contraction: increased speed and increased tension

shortening force

3: long fibers with parallel design are typical in muscles with fast ___ rates but lower ___ production (sartorius and lumbricals)

type 1

4: fiber type distribution of muscle type 1 (tonic slow twitch) and type 2A and 2B (phasic and fast twitch) high percentage of ___ fibers favors low force production, slow rate of max force and resistance to fatigue

type 2A and 2B

5: high percentage of ___ and ___ fibers favors rapid high force production and rapid fatigue

physiological resting length

6: length tension relationship of muscle at time of contraction muscle produces greatest tension when its near or at the ___ at the time of contraction

longer

7: moment arm between muscle force vector and axis of joint rotation greater tension is produced with ___ moment arm

force

8: recruitment of motor units the greater the number and synchronization of motor units firing, the greater ___ production

frequency; tension

9: rate of motor firing the higher the ___, the greater the ___

Resistance Exercise

Activity in which dynamic or static mm. contraction is resisted by outside force applied manually or mechanically

Reversibility Principle

Adaptive changes in response to resistance ex-are not permanent Unless training induced improvements are used regularly for functional activities or individual participates in resistance ex-maintenance program

Specificity of Training

Adaptive effects of training such as improvement of strength and power and endurance are specific to training method used Whenever possible-exercises should mimic anticipated function

pathology, age, tissue healing, response, goals, abilities adapt

Always consider patient ___, ___, stage of ___, patient ___, and overall ___ and ___ of patient. MM and related systems must be given time to ___ to increased intensity or volume

type I (slow twitch, tonic)

Are called tonic or slow twitch Generate low level of muscle tension but can sustain contraction for long period of time Geared toward aerobic metabolism More resistant to fatigue than type II A fibers Heavy distribution of ___ found in postural muscles

resistance joint reaction forces soft tissues comfortable

Benefits of Endurance Training: Uses lower level of ___ Minimizes potentially harmful ___ Produces less irritation to ___ More ___ for the patient than heavy resistance ex.

muscle performance connective tissue mineral density; demineralization joint soft tissue repair and healing; balance daily living, occupational, and recreational activities lean muscle; body fat feeling disability and quality of life

Benefits of Resistance Exercise: enhanced ___ through restoration, improvement or maintenance of muscle strength, power and endurance increased strength of ____: tendons, ligaments, and intramuscular connective tissue increased bone ___ and or less bone ___ decrease ___ stress during physical activity reduced risk of ___ injury during physical activity improved capacity for ___ and ___ of damaged soft tissues and for tissue remodeling improved ___ enhanced physical performance during ___, ___ and ___ positive changes in body composition: increase in ___ mass or decrease of ___ enhanced ___ of physical well being positive perception of ___ and ___

10%

Boys approx. ___ stronger than girls from early childhood -puberty

30% mass strength mass

Boys-rapid increase in mm. strength Strength in adolescent boys increases ___ per year between ages 10 and 16 Muscle ___ peaks before mm. strength Resistance training-results in significant ___ gains Muscle ___-increase 5x in boys and approx 3.5 x girls during adolescence

Muscle Strength

Broad term that refers to the contractile elements of muscle that produce force

Muscle Performance

Capacity of mm. to do work (force x distance)

oxygen efficiently

Cardiopulmonary fatigue is related to body's ability to use ___

transfer of training

Carryover of training effects from one variation of exercise or task to another—aka overflow, cross training or ___

MOTIVATION

Charting or graphing performance Incorporating gains in mm. performance into functional activities early on-makes movements meaningful Modifying exercise routine

Uncomfortable; pain and cramping Shaking or trembling slowing jerky or inconsistent full range of available motion substitute low-intensity isokinetic testing

Clinical Signs of MM. Fatigue: ___ sensation in muscle (___ and ___ possible) ___ or ___ of contracting mm An unintentional ___ of contraction velocity with successive repetitions of an exercise Active movements ___ or ___ Inability to complete movement pattern through the ___ during dynamic resistance during same level of resistance Use of ___ motions- to complete activity Inability to continue ___ physical activity Decline in peak torque during ___

70 physical activity greater inactivity and disuse

Decline increases to 30% each decade after age ___ Can be significantly less if both men and women maintain high level of ___ Loss of mm. strength may be due to ___ and ___

Muscle power

Defined as work (force x distance) produced by a muscle per unit of time (force x distance/time) Rate of performing work

low-intensity high number of reps time

Endurance Training: Key parameters: ___ muscle contractions, ___ , and a prolonged ___ period

function

Endurance training -In some patients improves ___ better than strength training

work demands; time

Ex: to increase muscle power the ex program should consist of interventions that increase ___ while decreasing the __ that work is accomplished

health status age Diet Lifestyle neuromuscular, cardiopulmonary, inflammatory, cancer, psychological fatigue MS

Factors that influence fatigue: Patient's ___ ___ ___ ___ (sedentary or active) If patient has ___, ___, ___, ___-relate or ___ disorders- Onset of ___ irregular ___ and fatigue

intensity power

Greater ___ of exercise and shorter time period taken to generate force= greater mm. ___— Ex : Plyometric drills or stretch shortening drills increase power

Intensity

How much external resistance is placed on muscle

light exercise

If ___ (active recovery) performed during recovery period; recovery occurs more rapidly than with total rest (passive recovery)

strength

If adequate ___ Contractile tissues generates enough force to meet physical and functional demands placed on muscle system

adapted increased

If external demands on mm. remain constant after mm. has ___, level of muscle performance can be maintained but not ___

Overload Principle

If muscle performance is to improve, a resistance load that exceeds metabolic capacity must be applied that is MM. must be challenged to perform at a GREATER LEVEL than its current status

single maximum effort

In Practice - Greatest measurable force that is exerted by the muscle or mm. group to overcome resistance during a??

Volume of ex

Includes repetitions, sets, or frequency or any combination that can be adjusted to increase demands on mm

strength, power, endurance

Key elements of muscle performance are

rate force and velocity

Key factors in power are ___ at which mm produces force and relationship between ___ and ___

power

Many motor tasks involve both strength and speed may be important priority in rehab

Acute; NORMAL; reversible force-producing capacity temporary

Muscle Fatigue: ___ physiological response to exercise that is ___ and ___ Characterized by gradual decline in ___ of neuromuscular system Decline is ___ that leads to a decrease in muscle strength

repeatedly; tension; fatigue

Muscle endurance -ability of mm. to contract ___ against external load, generate and sustain ___, and resist ___ over an extended period of time

strength and speed

Muscle power related to ___ and ___ of movement

mass (atrophy) I and II muscle fibers; connective tissue cross sectional II length-tension flexibility motor units

Neuromuscular Factors- late adulthood: Decreased muscle ___ Decreased #'s of type ___ and ___ and increase in ___ in muscle Decreased ___ size of mm Selective atrophy of type ___ fibers Change in ___ relationship Associated with more loss of ___ than deficits in motor unit activation and firing rate Number of ___ appears to decline after age 60

movement

Neuromuscular Factors-late adulthood: As rate of ___ declines-ability to generate muscle power during activities that require quick response declines EX: preventing fall, rising from low chair

mm. strength speed endurance fatigue advanced age torque relaxation

Neuromuscular Factors-late adulthood: Decrease in ___ Declines is ___ of muscle contraction, Declines in mm. ___, Declines in ability to recover from muscular ___ All occur with ___ Also increased time for same ___ output is longer in elderly and increased time necessary to achieve ___ after voluntary contraction

power; strength

Neuromuscular Factors-late adulthood: Stronger relationship with loss of mm. ___ with age to functional limitation and disability than mm. ___