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.