Transcript Exercise Regimens

PT 153: Therapeutic Exercise 2
AILA NICA J. BANDONG, PTRP
Instructor
Department of Physical Therapy
UP-College of Allied Medical Professions
At the end of the lecture, the students should be able
to:
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identify the factors affecting tension generation in muscles.
discuss the principles of resistance exercise aimed at
increasing strength.
discuss the determinants of resistance exercise.
differentiate the various forms of resistance exercise.
identify guidelines to providing resistance exercise for
various age groups.
discuss considerations for designing resistance exercise for
children.
enumerate precautions and contraindications to treatment
using resistance exercise.
Power
Strength
Endurance
MUSCLE PERFORMANCE
 Ability
of contractile tissue to
produce tension and a resultant
force based on the demands
placed upon it
 Greatest measureable force
that can be exerted to
overcome resistance in one
maximum effort
A
systematic procedure of a muscle or muscle
group lifting, lowering, or controlling
resistance for a particular number of
repetitions or over a short period of time
Overload
SAID
Reversibility
 If
improvements in muscle performance is
desired, the muscle must be challenged to
perform at a level greater than that to which
it is accustomed to
 Progressive loading of muscle through
increasing intensity or volume
S pecific
A daptation to
I mposed
D emands
A
framework of specificity is a necessary
foundation on which exercise programs should
be built
 Unless
training-induced improvements are
regularly used or resistance exercises are
maintained, adaptive changes are only
temporary
 Detraining begins at one to two weeks after
cessation of exercise
Increase in the maximum force-producing
capacity of muscle due to physiological
adaptations of the body to resistance exercise
 Alignment
 Stabilization
 Intensity
 Volume
 Exercise
order
 Frequency
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•
Rest interval
Duration
Mode of exercise
Velocity
Periodization
Integration to
functional
activities
 Muscle

Action
The direction of movement of a limb or segment
of the body replicates the action of the muscle or
muscle group being strengthened
 Gravity

Muscle being strengthened should act against the
resistance of gravity and additional force provided
by a device/equipment
 Refers
to holding down a body segment or
keeping the segment/body steady during
performance of exercise


External
Internal
 aka
training load, exercise load
 Amount of resistance imposed on the
contracting during each repetition
 Should follow the overload principle

Intensity is greater than the usual load carried and
progressively and gradually increased
Indications
 At
the beginning of exercise
 During early stage of soft tissue healing
 After immobilization
 Children and older adults
 Improvement of muscular endurance
 During warm up and cool down
 During slow-velocity isokinetic training
Indications
 Goal
to increase strength and power and
muscle size
 Healthy individuals in the advanced phase
of a rehab program
 Conditioning program for the well
population
 Training for competitive weight lifting and
body building
 Repetition
Maximum
 Other methods
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Cable tensiometry
Dynamometry (hand-held, isokinetic)
Percentage body weight
 As
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
a factor of repetition maximum
Sedentary individuals/untrained
individuals/children/elderly:
30% to 40% of 1RM
Patients with significant strength impairments:
30% to 50% of 1RM
Highly trained individuals:
80% to 95% of 1RM
 As
a factor of body weight (percentage)

Universal bench press: 30% body weight

Universal leg extension: 20% body weight

Universal leg curl: 10-15% body weight

Universal leg press:
50% body weight
 Summation
of the total number of repetitions
and sets of a particular exercise during a
single session
 Inverse relationship between intensity and
volume of resistance exercise
 Repetitions vs. Sets
 Exercise
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protocols
De Lorme
Oxford
DAPRE
 Use
an exercise load that cause fatigue after 6
to 12 repetitions for two to three sets; if
fatigue no longer occurs, increase level of
resistance
 Refers
to the sequence in which muscle groups
are exercised during a session
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Large muscle groups before small, isolated muscles
Multi-joint muscles before single-joint muscles
Higher intensity exercise before lower intensity
(following an appropriate warm up)
 Number
of sessions performed in a day or in a
week
 Dependent on the following factors:
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Intensity
Volume
Patient’s goals
Health status
Previous participation in resistance exercise
Response to training
 Low
intensity, low volume: short sessions
performed daily or several times daily
 As intensity and volume increases: frequency
decreases to every other day or up to five
sessions weekly
 Frequency of two times weekly for
maintenance programs
 Prepubescent
children and very old:
frequency is two to three times/sessions
weekly
 Highly-trained athletes: high intensity and
high volume performed 6 days per week
 aka
recovery period
 Rest between sets and exercise sessions
 Dependent on the intensity and volume of
exercise as well as status
 Active recovery is more efficient than passive
recovery to neutralize effects of fatigue
 Decreasing rest interval between bouts and
sessions as strategy to increase dosage
 Total
number of weeks or months that the
resistance exercise program is performed


For hypertrophy or increase in vascularization to
occur, at least 6 to 12 weeks of resistance training
is needed
Depending on the nature of impairment, the
training program may last from about a month or
two to lifetime training to maintain optimal
function
 The
form or type of exercise or the manner in
which the exercise is carried out
 Classification:
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Forms of exercise
Type of muscle contraction
Weight bearing vs Non-weight bearing
Energy system used
Short arc vs Full arc exercise
 Manual
and mechanical resistance
 Constant or variable load through free
weights/weigh machines
 Accommodating resistance using isokinetic
dynamometer
 Body weight as resistance
 Isometric

or dynamic muscle contraction
Dynamic can be performed either CONCENTRICALLY
or ECCENTRICALLY
 Isokinetic
contraction: speed of limb
movement is held constant by a
device/equipment (controlled dynamic
contraction)
 Nonweight-bearing
with distal extremity
moving: open-chain exercise
 Weight bearing with body moving over a fixed
distal segment/extremity: closed-chain
exercise
 Anaerobic
exercise: high-intensity exercise
carried out for a limited number of repetitions
and utilized as part of a strengthening exercise
program
 Full-arc:
develop strength throughout the
entire range of motion
 Short-arc: utilized to avoid painful motion or a
part of the range where the joint is unstable
and to protect healing tissues following injury
 Refers
to the speed with
which an exercise is
performed
 Varies with concentric
and eccentric muscle
contraction
 With
free weights, slow to medium
speed/velocity of movement is safer and more
effective as patient can maintain control of
movement
 Speed-specific training
 Plyometric training
 Isokinetic training
 aka
periodized training
 A method of designing a systematic variation
in exercise intensity and volume at regular
intervals over a specified period of time
 Used to limit overtraining and psychologic
staleness
 Designed for preparing athletes for
competition
 Balance

of stability and active mobility
Exercise program should address both static and
dynamic strength of the trunk and extremitites
 Balance
of strength, power, and endurance
 Progression of movement patterns

Isolated strengthening, combined patterns, taskoriented movement patterns
A
form of active-resistive exercise in which
resistance is applied by the therapist to a
dynamic or a static muscle contraction
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Throughout the available ROM
Various planes of motion
Isolated muscle contraction or group of muscles
 aka
weight training, load-resisting exercise
 Any form of exercise in which the resistance is
applied by an equipment
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Free weights
Elastic resistance
Weight-pulley system
Closed-chain training equipments
Reciprocal exercise equipment
Isokinetic training equipment
 Progressive
Resistive Exercise
 Circuit Weight Training
 Plyometric Training
 Isokinetic Regimens
 Dynamic
resistance training in which a
constant external load is applied to the
contracting muscle and incrementally
increased
 Use of RM as basis for determining and
progressing resistance
DeLorme
Oxford
Determination
of 10 RM
Determination
of 10 RM
10 reps @ 50% of
10 RM
10 reps @100%
of 10 RM
10 reps @ 75% of
10 RM
10 reps @ 75% of
10 RM
10 reps @ 100% of
10 RM
10 reps @ 50% of
10 RM
SETS
REPETITIONS
AMOUNT OF
RESISTANCE
1
2
10
6
50% of 6 RM
3
Maximum
possible
Maximum
possible
100% 0f 6 RM
4
75% of 6 RM
100% of adjusted
working weight
Repetitions
in Set 3
Set 4
Next Exercise
Session
0-2
5-10 lbs
5-10 lbs
3-4
0-5 lbs
5-6
Same weight
Same
weight
5-10 lbs
7-10
5-10 lbs
5-15 lbs
11 or more
10-15 lbs
10-20 lbs

Pre-established sequence of continuous exercises are
performed in succession at individual exercise stations
that target a variety of major muscle groups (8-12) as
an aspect of total body conditioning


Minimum amount of rest interval between stations (15-20
seconds)
Alternate among upper/lower extremity and trunk
musculature
Exercise Regimens:
Circuit Weight Training
 Bench
press
 Leg press or squats
 Sit-ups
 Upright rowing
 Hamstring curls
• Trunk
extension
• Shoulder press
• Heel raises
• Push-ups
• Leg lifts or
lowering
 aka
plyometrics, stretch-shortening drills,
reactive neuromuscular training
 A system of high-velocity resistance training
characterized by a rapid eccentric
contraction followed by a rapid shortening
contraction of the same muscle
 Three
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phases
Stretch cycle: eccentric loading phase
Amortization phase: period of time between
stretch and shortening cycles
Shortening cycle : concentric phase
 Sources
load
of resistance: body weight, external
 Appropriate
only in the later stages of
rehabilitation of active individuals requiring
high level of physical performance in highdemand activities
 CRITEARIA for Plyometric Training:
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
80 to 85% level of strength
90 to 95% ROM
 Velocity

Spectrum Rehabilitation
Performance of exercises at various velocities
 Limb
is accelerated at the predetermined
speed/velocity then resistance is applied by the
torque arm of the dynamometer through a
small portion of the ROM
 Performed without pain
 Training
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velocities
Medium angular velocity: 60/90-180 degrees/sec
Fast angular velocity: 180-360 degrees/sec
Increments of 30 degrees/sec
 Sub-maximal
intensity/effort for a brief warmup period  maximal intensity
 One
or two sets of 8-10 upto 20 repetitions of
concentric contractions of antagonist muscle
groups at multiple velocities
 Rest of 15-20 seconds between sets and 60
seconds rest period between exercise speeds
 Maximum frequency of 3x/week
 Progression
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Submaximal  maximal
Intermediate and slow speed  fast
Short arc  full arc exercises
Concentric  eccentric

Eccentric performed to further challenge the individual
muscle groups when strength deficits persist
Eccentric Isokinetic Training
 aka
static exercise
 Muscle contracts and produces force without
change in length of the muscle and without
visible joint motion
 Sources of resistance:

Manually, weights, maintaining a position against
body weight, pushing/pulling an immovable
object
Prevent or minimize muscle atrophy when joint
motion is not possible due to external
immobilization
 Activate muscles to begin to re-establish control
and protect healing tissues following soft tissue
injury or surgery
 Develop postural or joint stability
 Improve muscle strength if dynamic exercise
could cause joint pain and compromise joint
integrity
 Develop static muscle strength st particular
points in the ROM needed for specific taskrelated needs

 Muscle-setting
exercise
 Stabilization exercise
 Multiple-angle isometrics
 Low
intensity isometric exercise performed
against little to no resistance
 Benefits:
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Promotes relaxation and circulation
Decrease muscle pain and spasm after injury to
soft tissues during acute stage of healing
Maintains mobility between muscle fibers during
healing
Retard atrophy during immobilization
 Benefits:
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
Develop sub-maximal but sustained level of cocontraction
Reduce instabililty
Enhance joint or postural stabililty
 Variations:
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Rhythmic stabilization
Alternating isometrics
Dynamic stabilization
A
system of isometric exercise where
resistance is applied manually or mechanically
at multiple joint positions within the available
ROM
 Goals:

Improve strength throughout ROM but dynamic
resistive exercise causes pain or not advised
 Intensity:
dependent on joint position
 Duration: held for 6-10 seconds to allow for
peak tension to develop and for metabolic
changes to occur
 Repetitive Contractions: decreases muscle
cramping and increases effectiveness of the
regimen
 Joint Angle: resistance at 4-6 points in the
available ROM
 Improvements
occur only at or closely
adjacent to the training angle
 Little or no carry-over of strength gains to
dynamic exercise
 Not as effective for developing muscle
endurance as resisted dynamic exercise
 Perform
warm-up activities followed by
flexibility exercises prior to resistance
training
 For total body muscular fitness: perform
dynamic exercises that target approx 8-10
muscle groups of the U/LE
 Balance flexion-dominant (pulling) with
extension-dominant (pushing) exercises
 Move through the full, available, and painfree ROM
 Include both concentric (lifting) and
eccentric(lowering) muscle actions
 Use
moderate-intensity exercises at least 812 repetitions per set
 Perform 1-3 sets of each exercise
 Include rest periods of 30-60 seconds
between sets
 Frequency of 2-3 times per week
 Use slow to moderate speeds of movement
 Use rhythmic, controlled, non-ballistic
movements
 Cool down after the completion of exercise
 Exercises
should not interfere with
breathing: avoid valsalva maneuver
 Increase intensity gradually (5%
increments) as progression
 Train with a partner for feedback and
assistance, if possible
 When re-initiating weight training after a
period of exercise cessation (>1-2 weeks),
reduce resistance and volume of exercise
 Perform
at least 5-10 minutes of warm-up
activities before each session of resistance
exercises
 Low to moderate levels at 10-12 repetitions
for 6-8 weeks
 Perform resistance training 2-3x weekly,
allowing 48-hour rest periods between
sessions
 Avoid flexion-dominant resistance training
that could emphasize postural changes
 Low
intensity exercise to minimize
excessive stress on the joints
 Resistance training should be initiated with
close supervision and minimal resistance
 Maintain functional ROM
 Monitor vital signs, especially when the
program is progressed
 After a 1 to 2-week layoff, reduce the
intensity of weight training by 50%
 Pre-adolescence:
period between pre- and
early puberty until 11 y/o (girls) and 13 y/o
(boys)
 Remained to be a debatable issue among the
lay and scientific community
 Positive correlation of strength gains and
resistance training can not be generalized due
to methodological flaws and limited literature
VARIABLES
TRAINING
DETRAINING
Max voluntary strength
Definite increase
Likely decrease
Evoked twitch force
Likely increase
Unknown
Muscle cross-sectional area Likely no change
Probable no change
(uncertain)
Neuromuscular adaptation
Definite increase
Probable decrease (uncertain)
Motor coordination
Probable increase (uncertain)
Unknown
Body mass
Definite no change
Unknown
Lean body mass
Probable no change (uncertain)
Unknown
Body fat
Likely no change
Unknown
Stature
Likely no change
Unknown
Potential Benefits and Risks
VARIABLES
EFFECTS
Sports Performance
Improvements in performance
Prevention of Injury
Diminished susceptibility in injuries
Recommended for girls as part of osteoporosis
prevention
Rehabilitation from Injury
Accelerated rehabilitation after injury
Injury Risk (weightlifting)
Moderate: unsupervised conditions and
during competitive lifting
Low: supervised and properly prescribed
programmes
Cardiorespiratory Illness
No effect or possible improvement depending on the
nature of the training programme
Weightlifting Blackout
Not likely in properly-instructed, supervised and
prescribed programmes
Resting Blood Pressure
No proven detrimental effect
Maintain
activity
Enjoy movement
Develop lifelong
activity habits
 No
formal resistance training for children
less than 6 to 7 years old
 At age 6 to 7, introduce the concept of
exercise initially without weights  using
light weights
 Maintain close and continuous supervision
by a trained personnel or a parent who has
received instructions
 Focus on proper form, exercise technique,
and safety: alignment, stabilization, and
controlled motion
Guidelines: Children and Adolescents
 Perform
warm-up and cool down for 5 to10 mins
 Low exercise loads of at least 8 to 12 or 12-15
repetitions
 Perform 1 to 2 sets of each exercise allowing
rest periods of about 3 minutes between sets
 Frequency limited to 2 exercise sessions per
week
 Initial progression through increasing
repetitions, not resistance; or increasing the
total number of exercise  increase resistance
by 5% at a time
 Gradually progress activities
Guidelines: Children and Adolescents
 Provide
a variety of activities that target
larger muscle groups, multi-joint, combined
exercises
 Focus on active, creative, enjoyable play in
very young children
 Encourage children >6 yrs to accumulate a
minimum of 30 minutes of at least moderateintensity activity in most, if not all, days of
the week
 Encourage older children to participate in 2030 minutes of higher intensity activity at least
3x a week
Specific Guidelines
 Encourage
resistance training as only one of a
variety of normal recreational and sport
activities
 Encourage using a variety of different training
modalities (free weights, body weight, etc)
 Discourage inter-individual competition, and
stress the importance of personal
improvement
Specific Guidelines
 Discourage
extremely high intensity (loading)
efforts
 Avoid isolated eccentric training
 Encourage a circuit system approach to
capitalize on possible cardiorespiratory
benefits
 Ensure
safety as children are anatomically,
physiologically, and psychologically immature

Use appropriate equipment, match activity to
maturation or skill level, provide adequate skill
preparation
 Children
are less tolerant to high heat load and
increased susceptibility to hypothermia in a cold
environment

Limit strenuous prolonged exercise, provide good
hydration, and use appropriate clothing
_____ x ______ x _____ x ______, ______
type intensity # of reps # of sets
frequency
mode or
of
form of
the
resistance
exercise
amount of
number
load that
of times
will be
used
the ex
in a day
will be
performed
performed
number
of bouts
number
times
exercise
to be
in a week
Example 1
Resistance exercise of the right upper extremity
muscles using free weights (dumbbell) x 10 lbs
x 10 repetitions x 2 sets, thrice a week
Example 2
Manual resistance exercise of the left hip
flexors x 8 repetitions x 2 sets, thrice a week
Example 3
Multiple angle isometrics of the right knee
extensors x 7 seconds hold x 5 repetitions x 1
set, daily
Muscle setting exercise of both quadriceps x 10
seconds hold x 5 repetitions x 1 set, daily
Example 4
Resistance exercise of both lower-extremity
muscles using elastic band (may specify initial
color to use) x 10 repetitions x 3 sets, three
times a week
Example 5
Progressive resistive exercise of both elbow
flexors using De Lorme protocol x 3 sets,
twice a week
American College of Sports Medicine (1998).
Guidelines for exercise testing and prescription
(3rd ed). Baltimore: Williams and Wilkins.
Blimkie, C. J. R. (1993). Resistance training during
preadolescence: Issues and controversies. Sports
Medicine, 15(6), 389-407.
Kisner, C., Colby, L. (2007). Therapeutic exercise:
Foundations and techniques (4th ed).
Philadelphia: F. A. Davis Company.
Matos, N. and Winsley, R. J. (2007). Trainability of
young athletes and overtraining. Journal of
Sports Science and Medicine 6,353-367.