Intro to Therapeutic Exercise Finals

■ energy stores and blood supply ■ fatigue ■ recovery from exercise/fatigue ■ age ■ psychological and cognitive factors

Factors That Influence Tension Generation in Normal Skeletal Muscle

Valsalva maneuver

Precaution for Isometric exercise

Short arc or full arc exercise(both have resistance)

Range of Movement

External resistance

directly dictates how many repetitions and sets are possible

Aerobic exercise

low intensity; long duration exercise

Type 2 fibers

phasic(more powerful), fast twitch

Overwork

refers to progressive deterioration of strength in muscles already weakened by nonprogressive neuromuscular disease

-Buoyancy -Hydrostatic Pressure -Viscosity -Surface Tension

Physical Properties of Water

Increased heart rate and blood pressure

Precaution for Dynamic exercise

-Valsalva Maneuver -Substitute Motions -Overtraining and Overwork -Exercise-Induced Muscle Soreness -Pathological Fracture

Precautions for Resistance Exercise

-Fear of Water -Neurological Disorders -Respiratory Disorders -Cardiac Dysfunction -Small, Open Wounds and Lines

Precautions to Aquatic Exercise

- DeLorme Regimen - Oxford Regimen - Daily Adjustable Progressive Resistive Exercise (DAPRE) Regimen

Progressive Resistance Exercise (PRE) types

inverse relationship; the higher the intensity, the lower the number of repetitions and sets; the lower the external resistance, the greater the number of repetitions and sets

Relationship between the sets and repetitions of an exercise and the intensity of the resistance(volume)

■ An uncomfortable sensation in the muscle, with pain and cramping possible ■ Shaking or trembling of the contracting muscle ■ An unintentional slowing of contraction velocity with successive repetitions of an exercise ■ Active movements are jerky or inconsistent ■ Inability to complete the movement pattern through the full range of available motion during dynamic exercise against the same level of resistance ■ Use of substitute motions—that is, incorrect movement patterns—to complete the activity ■ Inability to continue low-intensity physical activity ■ Decline in peak torque during isokinetic testing

Signs and Symptoms of Muscle Fatigue

-Hypertrophy -Hyperplasia -Muscle fiber type adaptation

Skeletal Muscle Adaptations

-Mobility -Stability -Controlled mobility -Skill

Stages of motor control (integration of function)

(30% to 40%) for sedentary, untrained (>80%) for highly trained individuals (40% to 70%) for healthy but untrained adults (30% to 50%) for muscular endurance, for patients with significant weakness

Training Zone

1. Muscle-setting exercise 2. Stabilization exercise 3. Multiple-angle isometrics

Types of Isometric Exercise

1. Manual and Mechanical 2. Isometric (static) 3. Dynamic (concentric and eccentric) 4. Dynamic (constant and variable)

Types of Resistance Exercise

isometric, concentric, eccentric

Types of muscle contraction

(1) to identify an initial exercise load (amount of weight) (2) to document a baseline measurement

Use of RM

Motivation and Feedback

Using meaningful activities that are perceived as having potential usefulness or periodically modifying an exercise routine help maintain a patient's interest in resistance training

Endurance

a broad term that refers to the ability to perform repetitive or sustained activities over a prolonged period of time

kilocalorie (kcal)

a measure expressing the energy value of food; the amount of heat necessary to raise 1 kilogram (kg) of water 1°C

Daily Adjustable Progressive Resistive Exercise (DAPRE) Regimen

a more systematic and objective system that takes into account the different rates at which individuals progress during rehabilitation or conditioning programs; based on a 6-RM working weight

Circuit Weight Training

a pre-established sequence or circuit of exercises targeting major muscle groups is performed in succession at individual exercise stations; add cardiovascular system conditioning

Overload Principle

a resistance load that exceeds the metabolic capacity of the muscle must be applied—that is, the muscle must be challenged to perform at a level greater than that to which it is accustomed

Multiple-angle isometrics

a system of isometric exercise in which resistance is applied at multiple joint positions within the available ROM; by angle mag provide ng resistance

Endurance (aerobics)

ability to work for prolonged periods of time and the ability to resist fatigue

Resistance exercise

an activity in which dynamic or static muscle contraction is resisted by an outside force applied manually or mechanically.

Hyperplasia

an increased number of muscle fibers

Type 2B fibers

anaerobic activity; quickly fatigue

Physical Activity (aerobics)

any bodily movement produced by the contraction of skeletal muscles

Exercise (aerobics)

any planned and structured physical activity designed to improve or maintain physical fitness

Substitute motions

are compensatory movement patterns caused by muscle action of a stronger adjacent agonist or a muscle group that normally serves as a stabilizer

Cardiopulmonary endurance (total body endurance)

associated with repetitive, dynamic motor activities, such as walking, cycling, swimming, or upper extremity ergometry, which involve use of the large muscles of the body

Aerobic Exercise Training (Cardiorespiratory Endurance)

augmentation of the energy utilization of the muscle by means of an exercise program; Training is dependent on exercise of sufficient frequency, intensity, and time; Training produces cardiovascular and/or muscular adaptation; Training for a particular sport or event is dependent on the specificity principle

Wolff's Law

bones grow/remodel/adapt in response to stress or demands placed on it

DeLorme Regimen

builds a warm-up period; increasing

External stabilization

can be applied manually by the therapist or the patient with equipment such as belts and straps or by using gravity to hold the body against a firm support surface

Isokinetic contraction

can be concentric or eccentric; occurs under controlled condition

6-12 weeks

can observe hypertrophy after (part of duration)

2-3 weeks

can observe strength gains after (part of duration)

Transfer of Training (overflow or a cross-training effect)

can occur from an exercised limb to a nonexercised, contralateral limb

Angina

chest pain; persons who have coronary occlusion may not present with any type of chest pain/symptoms (angina) until they need to exert themselves

Dynamic contraction

concentric (muscle shortening) or eccentric (muscle lengthening)

Oxford Regimen

decreasing the resistance as the muscle fatigues

Delayed Onset Muscle Soreness (DOMS)

develops approximately 12 to 24 hours after the exercise session; noticeable in the muscle belly or at the myotendinous junction

Acute Muscle Soreness

develops during or directly after strenuous exercise is performed; feeling of burning or aching in the muscle

Valsalva Maneuver

expiratory effort against a closed glottis; hold breath

Maximal loading

for high-intensity exercise

Submaximal loading

for moderate to low-intensity exercise

Viscosity

friction occurring between molecules of liquid resulting in resistance to flow

Type 2A fibers

great amount of tension, short time

Muscle strength

greatest measurable force that is exerted by a muscle or muscle group to overcome resistance during a single maximum effort; the extent that the contractile elements of muscle produce force

Specific Adaptation to Imposed Demands (SAID) Principle

guides therapists to determine the exercise parameters that will create specific training effects to best meet the patient's functional needs and goals; body will adapt to specific demands placed upon it

Anaerobic exercise

high intensity; short duration exercise

Volume

includes variables such as repetitions, sets, or frequency

Attention

involves the ability to process relevant data while screening out irrelevant information from the environment; patient must be able to focus on a given task to learn how to perform it correctly

Light activity

is 2.0 to 2.9 METs or 3.5 to 10.15 mL/kg per minute

Moderate activity

is 3.0 to 5.9 METs or 10.5 to 10.65 mL/kg per minute

Vigorous activity

is 6 to 8.8 METs or 21 to 30.8 mL/kg per minute

Fatigue

is a complex phenomenon that affects muscle performance

Isometric exercise

is a static form of exercise in which a muscle contracts and produces force without an appreciable change in the length of the muscle and without visible joint motion (for stroke patients)

Internal stabilization

is achieved by an isometric contraction of an adjacent muscle group that does not impact the desired movement pattern but holds the proximal body segment of the muscle being strengthened firmly in place

Hypertrophy

is an increase in the size of an individual muscle fiber caused by increased myofibrillar volume

Muscle power

is related to the strength and speed of movement and is defined as the work (force × distance) produced by a muscle per unit of time (force × distance/time)

Endurance training

is the systematic practice of using muscle force to raise, lower, or control a light external load for many repetitions over an extended period of time; light load, many reps, longer time; emphasis is placed on increasing the time a muscle contraction is sustained or the number of repetitions performed rather than the amount of external resistance

Strength training

is the systematic practice of using muscle force to raise, lower, or control heavy external loads for a relatively low number of repetitions or over a short period of time; the amount of external resistance applied to the muscle is incrementally and progressively increased; no time factor; load is the main variable

Static contraction

isometric contraction(no change in length); internal; unmovable external resistance

Atrophy

it also starts to develop along with detraining (after 1-2 weeks of cessation)

Physical Fitness (aerobics)

it describes the ability to perform physical work

Weight-bearing position

joint approximation increases joint congruency and contributes to stability

strength, power, and endurance

key elements of muscle performance

Muscle-setting exercise

low-intensity isometric contractions performed against little to no resistance; it does NOT improve muscle strength except in very weak muscles

Training To Improve Muscle Endurance

many repetitions of an exercise against a submaximal load; 3 to 5 sets of 40 to 50 reps

Maximum Oxygen Consumption (VO2 max) (aerobics)

measure of the body's capacity to use oxygen; the maximum amount of oxygen consumed per minute when the individual has reached maximum effort

Myocardial Oxygen Consumption

measure of the oxygen consumed by the myocardial muscle

Training To Improve Muscle Power

modifying the intensity and speed; 20% to 70% of 1-RM, rate of exercises should be explosive or ballistic; 3 to 4 sessions per week

Nonweight-bearing position

more effective with isolation of muscle groups; if there is a specific target muscle

Purpose of rest intervals

necessary to allow time for the body to recuperate from muscle fatigue

Deconditioning

occurs with prolonged bed rest, and its effects are frequently seen in the patient who has had an extended, acute illness or long-term chronic condition

Eccentric exercise

physical lengthening of the muscle occurs; should be a controlled movement; prevents ballistic

Repetition Maximum (DeLorme)

progressive resistive exercise (PRE); the greatest amount of weight or load that can be moved with control through the full, available range of motion (ROM) a specific number of times before fatiguing

Detraining

reductions in muscle performance, begins 1-2 weeks after the cessation of resistance exercises and continues until training effects are lost

Intensity

refers to how much external resistance is imposed on the muscle

Mode

refers to the form of exercise, the type of muscle contraction that occurs, and the manner in which the exercise is carried out

Frequency

refers to the number of exercise sessions per day or per week

Repetitions

refers to the number of times a particular movement is performed consecutively

Functional strength

relates to the ability of the neuromuscular system to produce the appropriate amount of force, during functional activities in a smooth and coordinated manner.

Short-arc exercise

resistance exercises are executed through only a portion of the available range

Integration of rest into exercise

rest intervals for each exercising muscle group are dependent on the intensity and volume of exercise

> 3 mins

rest required if there is higher intensity

2-3 mins

rest required if there is lower intensity

Adaptation

results in increased efficiency of the cardiovascular system and the active muscles; dependent on the ability of the organism to change and the training stimulus threshold; significant changes measured at 10-12 weeks; the higher the initial level of fitness, the greater the intensity of exercise needed to elicit a significant change

Surface Tension

surface of a fluid acts as a membrane under tension; resistance is higher in surface

Muscle endurance

the ability of a muscle to contract repeatedly against an external load, generate and sustain tension, and resist fatigue over an extended period of time

Muscular endurance (aerobics)

the ability of an isolated muscle group to perform repeated contractions over a period of time

Cardiovascular Endurance (aerobics)

the ability to perform large muscle dynamic exercise, such as walking, swimming, and/or biking for long periods of time

Specificity of Training

the adaptive effects of training, such as improvement of strength, power, and endurance, are highly specific to the training method employed; task-specific practice always must be emphasized

1-RM

the baseline measurement of a subject's maximum effort but used a multiple RM, specifically a 10-RM

Closed-chain exercise/ Weight-bearing position

the body moves over a fixed distal segment

Muscle performance

the capacity of a muscle to do work

Muscle (local) fatigue

the diminished response of muscle to a repeated stimulus; an acute physiological response to exercise that is normal and reversible; temporary decline that leads to a decrease in muscle strength

Open-chain exercise/ Nonweight-bearing position

the distal segment (foot or hand) moves freely during exercise

Neural Adaptations

the initial, rapid gain in the tension-generating capacity of skeletal muscle from a resistance training program is attributed largely to neural responses, not adaptive changes in muscle itself

Threshold for fatigue

the level of exercise that cannot be sustained indefinitely; the length of time a contraction is maintained or the number of repetitions of an exercise that initially can be performed; baseline for adaptive changes

Increase in coronary blood flow

the myocardial muscle extracts 70% to 80% of the oxygen from the blood during rest, its main source of supply during exercise is through an

MET

the oxygen consumed (milliliters) per kilogram of body weight per minute (mL/kg); approximately 3.5 mL/kg per minute

Hydrostatic Pressure

the pressure exerted by the water on immersed objects.

Cardiopulmonary (general) fatigue

the systemic diminished response of an individual to a stimulus as the result of prolonged physical activity; is related to the body's ability to use oxygen efficiently

Volume

the total number of repetitions and sets of a particular exercise during a single exercise session

Duration

the total number of weeks or months

Buoyancy

the upward force that works opposite to gravity

Aquatic exercise

the use of water that facilitates the application of established therapeutic interventions, including stretching, strengthening, joint mobilization, balance and gait training, and endurance training

Overtraining

to describe a decline in physical performance in healthy individuals participating in high-intensity, high-volume strength and endurance training programs

Stabilization exercise

to improve postural stability or dynamic joint stability; isometric contractions against resistance in antigravity or weight-bearing positions

Type 1 fibers

tonic(postural), slow twitch; low level muscle tension; more resistant to fatigue

Substitute Motions

when the external resistance is too great for the target muscle to manage during exercise(recruit other muscles or use alternate movements)

Eccentric Versus Concentric Exercise: Summary of Characteristics

■ Greater external loads can be controlled with eccentric exercise. ■ Training-induced gains in muscle strength and mass are greater with maximum-effort eccentric training than with maximum-effort concentric training. ■ Adaptations associated with eccentric training are more mode and velocity specific than are adaptations from concentric training. ■ Eccentric muscle contractions are more efficient metabolically and generate less fatigue than concentric contractions. ■ Following unaccustomed, high-intensity eccentric exercise, there is greater incidence and severity of delayed-onset muscle soreness than there is after concentric exercise.

Isometric Exercise: Summary of Rationale and Indications

■ To minimize muscle atrophy when joint movement is restricted by external immobilization (casts, orthotics, or skeletal traction) ■ To begin re-establishing neuromuscular control of healing tissues when joint movement is not advisable after soft tissue injury or surgery ■ To develop postural or joint stability ■ To improve muscle strength when use of dynamic resistance exercise could compromise joint integrity or cause joint pain ■ To develop static muscle strength at particular points in the ROM consistent with specific task-related needs

Rest Interval (Recovery Period)

-Purpose of rest intervals -Integration of rest into exercise

Adaptations of Connective Tissues

-Tendons, Ligaments, and Connective Tissue in Muscle -Bone

static and dynamic

2 broad categories of contraction

Frequency for children and older adults

2-3x weekly

Training To Improve Muscle Strength

3 sets of a 10-RM performed for 10 reps

Frequency for highly trained athletes

6x weekly

Sets

A predetermined number of consecutive repetitions grouped together

Reversibility Principle

Adaptive changes in the body's systems in response to a resistance exercise program are transient unless training-induced improvements are regularly used for functional activities or unless an individual participates in a maintenance program of resistance exercises

■ Enhanced muscle performance through restoration, improvement or maintenance of muscle strength, power, and endurance ■ Increased strength of connective tissues: tendons, ligaments, and intramuscular connective tissue ■ Increased bone mineral density and/or less bone demineralization ■ Decreased joint stress during physical activity ■ Reduced risk of soft tissue injury during physical activity ■ Improved capacity for repair and healing of damaged soft tissues and for tissue remodeling ■ Improved balance ■ Enhanced physical performance during daily living, occupational, and recreational activities ■ Positive changes in body composition: ↑ lean muscle mass or ↓ body fat ■ Enhanced feeling of physical well-being ■ Positive perception of disability and quality of life

Benefits of Resistance Exercise

-Light activity -Moderate activity -Vigorous activity

Classification of Activities

-history of cardiac or vascular disorders; example: myocardial infarction

Contraindication for Isometric exercise

-Acute Pain -Acute Inflammation -Acute diseases and disorders

Contraindications to Resistance Exercise

■ Incipient cardiac failure and unstable angina ■ Respiratory dysfunction, vital capacity of less than 1 liter ■ Severe peripheral vascular disease ■ Danger of bleeding or hemorrhage ■ Severe kidney disease (patients are unable to adjust to fluid loss during immersion) ■ Open wounds without occlusive dressings, colostomy, and skin infections, such as tinea pedis and ringworm ■ Uncontrolled bowel or bladder (bowel accidents require pool evacuation, chemical treatment, and possibly drainage) ■ Menstruation without internal protection ■ Water and airborne infections or diseases (examples include influenza, gastrointestinal infections, typhoid, cholera, and poliomyelitis) ■ Uncontrolled seizures during the last year (they create a safety issue for both clinician and patient if immediate removal from the pool is necessary)

Contraindications to Aquatic Exercise

↓ Muscle mass ↓ Strength ↓ Cardiovascular function ↓ Total blood volume ↓ Plasma volume ↓ Heart volume ↓ Orthostatic tolerance ↓ Exercise tolerance ↓ Bone mineral density

Deconditioning Effects Associated With Bed Rest

■ Alignment of body segments during each unique exercise ■ Stabilization of proximal or distal joints to prevent substitute motions ■ Intensity: the exercise load or level of resistance ■ Volume: the total number of repetitions and sets in an exercise session ■ Exercise order: the sequence in which muscle groups are exercised during a session ■ Frequency: the number of exercise sessions per day or per week ■ Rest interval: the time allotted for recuperation between exercise sets and sessions ■ Duration: total time committed to a resistance training program ■ Mode: the type of muscle contraction, type of resistance, arc of movement used, and primary energy system utilized during exercise ■ Velocity: the rate at which each exercise is performed ■ Periodization: the variation of intensity and volume during specific periods of resistance training ■ Integration of exercises into functional activities: exercises that approximate or replicate functional demands

Determinants of a Resistance Exercise Program

MET ■1.0-2.9: Sitting, standing, self-care, making the bed, food shopping, walking less than 2.5 mph ■3.0-5.9: Walking downstairs, walking 2.5 mph to less than 3.5 mph, mowing the lawn (walking) with a power mower, playing golf ■6.0-8.8: Walking faster than 3.5 mph, swimming laps (moderate effort), jogging, running at 5.0 mph, shoveling snow

Energy Expenditure of Daily Tasks

1-RM= (weight x reps x 0.0333) + weight lifted

Epley's Equation

-larger muscles before smaller muscles -multi joint before single joint

Exercise order

Full-arc Exercise

External resistance through the full joint range of movement

patient's health status, diet, or lifestyle (and environmental factors)

Factors that influence fatigue

■ Manual resistance and mechanical resistance(two broad methods ) ■ Constant or variable(free weights) ■ Accommodating resistance(dynamometer) ■ Body weight or partial body weight(antigravity position)

Forms of Resistance

■ Facilitate range of motion (ROM) exercise ■ Initiate resistance training ■ Facilitate weight-bearing activities ■ Enhance delivery of manual techniques ■ Provide three-dimensional access to the patient ■ Facilitate cardiovascular exercise ■ Initiate functional activity replication ■ Minimize risk of injury or re-injury during rehabilitation ■ Enhance patient relaxation

Goals and Indications for Aquatic Exercise

Power training

Many motor tasks are somewhat ballistic movements that involve both strength and speed; greater intensity, short time