Week 3 Therapeutic Exercise - Resistance Exercise
Frequency usually reduced to
*2 times per week* for maintenance program
Endurance
*Many repetitions* against a *submaximal load*
Preparation:
1. Select and prescribe appropriate forms of resistance exercise. 2. Determine equipment needed. 3. Review the anticipated goals and functional outcomes with the patient. 4. Explain the exercise. 5. Demonstrate each exercise
Mechanical Resistance Exercise
Any form of exercise in which resistance is applied by some type of exercise equipment
Determinants: Stablization
Helps to maintain proper alignment, prevent substitute motions during resistance exercise. Externally - therapist, belts, straps. Internally - isometric contraction of adjacent muscle group, core activating to keep from rotating trunk while you isolate your hip
Volume
Training to improve *strength or endurance*
Examination & Evaluation: perform
a thorough history
Dynamic Exercise: eccentric exercise
physical lengthening of a muscle as it attempts to control a dynamic load
General Principles: do not initiate
resistance training at maximal level of resistance
anaerobic
single burst high intensity
Power can be expressed by a
single burst of high- intensity activity or repeated burst of less intense muscle activity
Integration of Function: A resistance exercise program must address
static and dynamic strength
Manual Resistance Exercise: Disadvantages - Little value for
strong muscle groups
General Principles: avoid
uncontrolled, ballistic movement
Strength
• 2-3 *sets* of 6-12 *reps*
Equipment for Resistance Training.
• Free weights and pulleys • Variable-resistance machines • Elastic resistance bands and tubing • Multipurpose exercise systems • Reciprocal exercise equipment • Equipment for dynamic stabilization training • Isokinetic equipment
Power training consists of
Plyometric training & Stretch shortening drills
Submaximal vs Maximal Exercise loads
Rehabilitation programs typically consist of *submaximal resistance* exercises. Example are the work hardening programs
Transfer of training contrasts
SAID principle
SAID principle
Specific. Adaptation. to Imposed. Demand.
Modes of Exercise: types of muscle contraction
Types of muscle contraction: • Concentric • Eccentric • Isometric
Isometric Exercise: improve strength at particular points in ROM for
a specific functional task
strength training
a systematic procedure of a muscle or muscle group lifting, lowering, or controlling heavy load for a relatively low number of repetitions or over a short period of time. Results in increase in muscle strength - neural adaptations and increase in muscle size
endurance
ability of a muscle to perform repeated contractions over a prolonged period
functional strength
ability of the neuromuscular system to produce, reduce, or control forces( have patient be able to sit down without falling into their seat) during functional activities, in a smooth coordinated manner
Manual Resistance Exercise: Advantages -resistance and ROM can be
adjusted as needed
Stretch shortening drills
an active stretch (eccentric) of a muscle followed by an immediate shortening (concentric) of that muscle
General Principles: do not apply resistance across
an unstable joint
Resistance exercise
any form of active exercise in which static or dynamic muscle contraction is resisted by an outside force
Periodization
approach to resistance training that builds systemic variability over a specified period of time
Mechanical Resistance Exercise: Advantages - heavy exercise loads
can be used
Isokinetic Exercise: functional
carryover
Mechanical Resistance Exercise: Disadvantages - equipment providing
constant resistance only maximally loads muscle at one point of ROM
Late Adulthood: Declines in muscle
contraction speed, muscle endurance, & ability for muscle to recover
strength
directly related to amount of force a muscle produces when contracting
Isometric Exercise: improve strength when
dynamic resistance is not advisable
Manual Resistance Exercise: Advantages - effective in
early stages
Manual Resistance Exercise: Disadvantages - impractical for
endurance training
Dynamic Exercise: Concentric and eccentric musclecontractions are
evident in many functional tasks
General Principles: avoid exercises that place
excessive, unintended secondary stress on the back
Open chain exercise
exercise in which the distal segment is free to move in space - non weight bearing setting
Closed chain exercise
exercise in which the distal segment remains in contact with a support surface
Plyometric Training
exercises in which muscles exert maximum force in short intervals of time, with the goal of increasing power
General Principles: avoid cumulative
fatigue
Application of overload principle
focuses on progressive loading by manipulating intensity or volume
Isokinetic Exercise:
form of dynamic exercise in which the angular velocity of the limb s held constant by an isokinetic dynamometer
If there is an impairment of muscle performance, strength, power, or endurance
functional limitations and disabilities are more likely to occur
Muscle strength specifically, the
greatest measurable force that can be exerted by a muscle or muscle group during a single maximum effort
Endurance training is characterized by
having muscle contracts to move light load for many repetitions or sustain a muscle contraction
Manual Resistance Exercise: Disadvantages - not useful for
home exercise plan
Mechanical Resistance Exercise: Advantages - practical for
improving muscle endurance
Manual Resistance Exercise: Advantages - can be performed
in a variety of patient positions
General Principles: prevent
incorrect or substitute motions
overloading the patient & decide to figure out to increase the resistance
increase the reps and sets FIRST before increasing the resistance
Early Childhood and Preadolescence: Muscle performance and endurance
increases linearly with age through early and middle childhood to puberty
Muscles adapt by
increasing oxidative and metabolic properties
Mechanical Resistance Exercise: Advantages - increases in resistance can be
incremental and documented
Mechanical Resistance Exercise: Advantages - appropriate during
intermediate and advanced phases of rehabilitation
examination and evaluations is
is key to resistance exercise
Examination & Evaluation: re-evaluate
just reevaluate at the end
aerobic
less intense muscle activity like go up a flight of steps
Mechanical Resistance Exercise: Disadvantages - gradation in resistance can be dependent upon
manufacturer
Manual Resistance Exercise: Advantages -muscle can work
maximally at all portions of range of motion
Frequency: initial exercise program
may be performed *several times on a daily basis*
Isometric Exercise: prevent or minimize
muscle atrophy when joint movement is not possible
Dynamic Exercise:concentric exercise
muscle loading where tension develops as muscle physically shortens to overcome an external force
to increase muscle power you need
muscle strength as a foundation
Isometric Exercise:
no mechanical work is done but tension and force are produced by the muscle
Examination & Evaluation: establish how resistance training will work with
other interventions to accomplish goals in plan of care
General Principles: Caution patient that
pain should not occur during exercise
Mechanical Resistance Exercise: Disadvantages - no accomodation for
painful arc
General Principles: discontinue exercises if
patient experiences pain, dizziness, shortness of breath
General Principles: be aware of medications
patient may be on the alter response to exercise
General Principles: have patient avoid
performing Valsalva maneuver
Isometric Exercise: develop
postural o rjoint stability
Volume: Sets
predetermined *number of repetitions grouped* together
Integration of Function: Task specific movement patterns can help to
progress patient back to functional activities (push, hold, etc.)
Open & closed chain exerciseshelp increase
proprioception, neuromuscular control, and balance
Mechanical Resistance Exercise: Advantages - established
quantitative baseline
Isometric Exercise: activate muscles to begin to
re-establish neuromuscular control but protect healing
Mechanical Resistance Exercise: Commonly used in
rehabilitation programs to eliminate or reduce muscular strength, power or endurance deficits
General Principles: avoid use of heavy resistance with
resistance with children, older adults, patients with osteoporosis
Mechanical Resistance Exercise: Disadvantages - not appropriate for
severely weak muscles, early stages of soft tissue healing
Manual Resistance Exercise: Disadvantages - speed of movement is
slower, less functional carryover
Specificity of training suggests the adaptive effects of training are
specific to training method employed. For example a swimmer will train the muscles used to swim, and it will be more effective than if they trained muscles used to run.
Isokinetic Exercise: training is largely
speed-specific
Manual Resistance Exercise: Advantages -useful for
static and dynamic strengthening
Reversibility Principle
strength and endurance gains must be incorporated into daily activities. These include maintenance programs
Examination & Evaluation: determine baseline
strength, muscular endurance, ROM, and overall function
Integration of Function: A resistance exercise program must incorporate
strength, power, and endurance
Manual Resistance Exercise: Disadvantages - amount of resistance is
subjective
Manual Resistance Exercise: Advantages - stabilization prevents
substitutions
American Academy of pediatrics and American College of Sports Medicine
support participation in properly designed and supervised resistance training programs
Specificity of training is
task specific training (goals to increase strength, power, endurance)
Manual Resistance Exercise: Advantages -more finely graded
than mechanical resistance
Muscle performance
the capacity of a muscle to do work
Manual Resistance Exercise: Disadvantages - labor and time consuming for
therapist
Frequency is reduced to
to *3-5 times per week* as intensity and volume of exercises increases
Manual Resistance Exercise: Disadvantages - amount of resistance is limited
to strength of therapist
Late adulthood Decline in strength accelerates
to ~15-20% per decade in 60s and 70s & 30% per decade thereafter
Mechanical Resistance Exercise: Advantages - high velocity
training is possible
High level athletes frequency
training up to *6 days per week*
Manual Resistance Exercise: Advantages -effective for
transition to mechanical resistance
Mechanical Resistance Exercise: Advantages - some equipment provides
variable resistance through ROM
Mechanical Resistance Exercise: Advantages -adds
variety to program
intensity is also dependent on
volume, frequency, exercise order, and rest periods
Factors to consider in resistance exercise
where muscle weakness occurs, degree of weakness, pathology, presence of other deficits, severity of impairment, age, overall fitness, ability to cooperate and learn
Examination & Evaluation: interpret findings to determine
whether resistance training is appropriate
power
work per unit of time
Force Velocity Relationship curve
y axis - muscle force. x axis - contractile velocity. concentric - as velocity increases the muscle force decreases. eccentric - initial increase in muscle force as velocity increases and then it levels off.
Modes of Exercise: forms of resistance
• Manual and mechanical resistance • Constant vs. variable load • Accommodating resistance • Body-weight exercises
Modes of Exercise: Positions for exercise
• Open-chain • Closed-chain
Clinical setting repetition maximum
# of reps on certain weight *before* the patient reaches fatigue
Frequency limited to
*2-3 sessions per week* for prepubescent children and the very elderly
Training Zones
*30-50% of 1 RM* for patients with *significant deficits in muscle strength*, or to *train for muscular endurance*
High intensity resistance training
*4-5 minute* rest period between sets
Muscular hypertrophy and increased vascularization require at least
*6-12 weeks* of resistance training
Rest is necessary in order to
*allow the body to recuperate* from acute effects of resistance exercise such as muscle fatigue & offset delayed onset muscle soreness
Neural adaptations are responsible for
*early strength gains* in the first 2-3 weeks
Repetition maximum (RM)
*greatest amount of weight* a muscle can move through the available ROM a *specific number of times*
Volume: Repetitions
*number of muscle contractions performed* to move the limb through a series of *continuous and complete excursions* against a specific exercise load
Late Adulthood: *resistance training* can have
*positive impact* on functional abilities
Determinants: Intensity
*the amount of resistance* imposed on the contracting muscle during each repetition
Duration
*total number of weeks or months* the resistance exercise program is carried out
*3 minutes* between sets for
*unresisted exercise* in patients with pathological conditions, young, and elderly
1 RM
1 rep max
Exercise order
1. *Large muscle groups* before small muscle groups. 2. *Multijoint muscles* before single-joint muscles. 3. *Higher intensity exercises* before lower intensity exercises.
Types of resistance Exercise
1. Manual and mechanical resistance exercise. 2. Isometric exercise. 3. Dynamic exercise. 4. Isokinetic exercise. 5. Open chain and closed chain exercise
Contraindications Resistance training
1. Pain. 2. Inflammation: inflammatory neuromuscular disease - like guillain barre. 3. Severe cardiopulmonary disease
Manual Resistance Exercise
1. Useful in *early* stages of an exercise program. 2. Range of joint movements can be carefully controlled. 3. Can be carried out in anatomical planes, diagonal patterns,or function movement patterns example: PNF patterns
Precautions of Resistance training
1. Valsalva. 2. Substitute motions. 3. Over-training and overwork. 4. Exercise- Induced Muscle Soreness
Application of exercise
1. Warm up 2. Placement of resistance 3. Direction of resistance 4. Stabilization 5. Intensity. 6. Volume 7. Verbal or written instructions 8. Monitor the patient 9. Cool down
Modes of exercise: energy systems
1. anaerobic -high intensity. 2. aerobic - low intensity repetitive
Modes of exercise: range of movement
1. short arc. 2. full arc
Adolescence
1.Rapid acceleration of muscle strength (mass and size) 2. Strength levels become markedly different in boys and girls (increases 5 fold in boys, and 3.5 fold in girls)
Moderate intensity resistance trainiing
2-3 minute rest period *between sets*. It is best to have 48 hours of rest *between sessions*
Isometric Exercise: holds
6-10 seconds, 2 second build up
Determinants: Alignment
Alignment and muscle action. Alignment and gravity (or any outside resistance) example: hip abduction sidelying has hip flexion compensation when they get tired; educate patient to maintain proper alignment
Mechanical Resistance Exercise: Advantages - appropriate for
Home exercise plan
Overload Principle
In order for muscle performance to improve, a load that exceeds the metabolic capacity of the muscle must be applied. The muscle must be challenged to perform at a level higher than it is accustomed to
Young & Middle Adulthood
Muscle mass peaks in women between 16-20 years old, and men between 18-25 years old. Strength then declines 1% per year until 50 years old.