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.