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Ther-ex Ch 6

DPT 729 Resistance Exercise

QuestionAnswer
Resistance Exercise Any form of active exercise involving muscle contraction resisted by external force
Benefits of Resistance Exercise Increased strength of connective tissuesPositive impact on tissue remodelingGreater bone mineral densityEnhanced feeling of well-being
Muscle strength refers to ability of contractile tissue to produce tension and a resultant force based on demands placed on that muscle.
Functional strength relates to the ability of neuromuscular system to produce, reduce, or control forces, contemplated or imposed, during functional activities.
Muscle power is related to strength AND speed of movement and is defined as the work (F x d) produced by a muscle per unit of time (F x d / t).
Endurance refers to the ability to perform low-intensity, repetitive, or sustained activities over a long period of time.
2 Types of Endurance: Cardiopulmonary and muscle
Overload principle – loads must exceed metabolic capacity of the muscle being used - Systems must be given time to adapt - Wolff’s Law
SAID (Specific Adaptation to Imposed Demands) principle – training exercises need to be specific to desired outcome. - strength, endurance, mode, velocity, etc.
Describe what SAID does... Transfer of training is very limited with respect to velocity and modeStrength training programs have been shown to improve muscular enduranceEndurance training has little to no cross-training effect on strength
Reversibility Principle demonstrates that adaptive changes in response to resistance training are transient unless maintained.
Detraining begins within - a week or two after cessation of resistance exercises and continues until training effects are lost- Incorporate gains into daily routines
What contributes to force-generating capacity? Dif in sarcomere alignment & length affect force & per generating capacity of mPennation allows for a large # of fibers to pack into a small x sectional areaLarge x-section and size = greater tension-producing capacityIncreased # and synchronization
Muscle Fiber AlignmentPennate Have less ROM than fusiform fibersGenerate greater force & power than fusiform muscles b/c a greater number of sarcomeres contribute to the action of the muscle
Muscle Fiber AlignmentFusiform run parallel to the muscle’s long axisFiber length = muscle lengthForce generation transmits directly to the tendonFacilitates rapid muscle shortening
Energy Stores ATP-CP, glycolytic or anaerobic (fast & slow), aerobicATP production based primarily on intensity of muscular activity and secondarily on duration
Muscle Fiber Types Type I, Type IIA and IIBRelates to fatigability, Table 6.2Muscle  Motor unit  muscle fibers  sarcomere  myofibril
Force = mass x acceleration
Work = Force x distance
Torque = Force x Moment arm
Power = Work/time
Muscle fatigue – diminished response of muscle to a repeated stimulus
Muscle fatigue – What does is do? Decrease in energy stores, protective responses, decreased conduction of myoneural impulsesDecrease or stop exercise once signs/symptoms of fatigue are present
Cardiopulmonary fatigue is diminished response of an individual to prolonged physical activity
Fatigue Threshold – important for establishing baselines and goal-setting
Fatigue affects: Health statusDietLifestyleEnvironmentDiseasesMedications
Recovery Oxygen and energy stores replenished in musclesLactic acid removed from skeletal muscle within approximately 1 hour after exerciseGlycogen replaced after several days
Is passice or acitive recovery more eficient? Active recovery more efficient than passive recovery, likely due to neural and circulatory influences.
Age, Early childhood: growth and development; emphasis on recreationAdolescence: hormone levelsYoung/Middle Adulthood: peaks, active vs sedentaryLate Adulthood: rate of decline 15-20%/decade, capable of incr strength,power & endurance; strength train:fun
2 types of fatigue: Muscle and Cardiopulmonary
Physiological AdaptationsNeural: motor learning, increased recruitment, increased rate and synchronization = initial gains seen as early as one session and can last through late phases of programs
Physiological AdaptationsHypertrophy: Hypertrophy:Hyperplasia:
Hypertrophy: increase in size of individual muscle fiber caused by increase in myofibrillar volume; increases in actin and myosin synthesis, 4-8wks
Hyperplasia: increase number of fibers;???Fiber type adaptation: IIB  IIA, animal studies I  II
Physiological Adaptations VascularMetabolicConnective tissues:
Physiological AdaptationsVascular decreases in capillary bed density
Physiological AdaptationsMetabolic decreases in mitochondrial density
Physiological AdaptationsConnective tissues: increases in tendon/ligament tensile strength, incr with eccentric train;increased bone density
Variables of Resistance Training AlignmentStabilizationIntensityVolumeExercise orderFrequencyRest intervalDurationModVelocityPeriodizationIntegration into functional activity
Intensity Submax loadingNear max or Max loading
Submax loading Beginners, early healing, after immobilization, most kids/elderly, muscle endurance, warm-up/cool down, slow velocity isokinetic testing
Near max or Max loading Muscle strength & power, advanced stage of rehab, conditioning in healthy, competition
Intensity Initial LoadIsokinetic, dynamometry, %BW1RM – DeLorme
1RM – DeLorme Document baselinesDetermine working loadMaximum effortTraining zone: sedentary, untrained 30-70%, highly trained 80-95%
Volume RepetitionsSets
Repetitions # of muscle contractions performed“average” 75% of 1RM = 10reps, 60% = 15repsSafer alternatives to begin rehab programRM zoneDependent on goals – strength vs endurance
Sets # of Repetitions
Physiological AdaptationsNeural: motor learning, increased recruitment, increased rate and synchronization = initial gains seen as early as one session and can last through late phases of programs
Physiological AdaptationsHypertrophy: Hypertrophy:Hyperplasia:
Hypertrophy: increase in size of individual muscle fiber caused by increase in myofibrillar volume; increases in actin and myosin synthesis, 4-8wks
Hyperplasia: increase number of fibers;???Fiber type adaptation: IIB  IIA, animal studies I  II
Physiological Adaptations VascularMetabolicConnective tissues:
Physiological AdaptationsVascular decreases in capillary bed density
Physiological AdaptationsMetabolic decreases in mitochondrial density
Physiological AdaptationsConnective tissues: increases in tendon/ligament tensile strength, incr with eccentric train;increased bone density
Variables of Resistance Training AlignmentStabilizationIntensityVolumeExercise orderFrequencyRest intervalDurationModVelocityPeriodizationIntegration into functional activity
Rest Interval (Recovery)Need appropriate balance What are your (your patient’s) goals?Higher intensity requires longer rest… why?Consider health statusHigh-intensity, eccentric exercise is associated w/ greater microtrauma to soft tissue and higher incidence of DOMS
Intensity Submax loadingNear max or Max loading
Submax loading Beginners, early healing, after immobilization, most kids/elderly, muscle endurance, warm-up/cool down, slow velocity isokinetic testing
Near max or Max loading Muscle strength & power, advanced stage of rehab, conditioning in healthy, competition
Intensity Initial LoadIsokinetic, dynamometry, %BW1RM – DeLorme
1RM – DeLorme Document baselinesDetermine working loadMaximum effortTraining zone: sedentary, untrained 30-70%, highly trained 80-95%
Volume RepetitionsSets
Repetitions # of muscle contractions performed“average” 75% of 1RM = 10reps, 60% = 15repsSafer alternatives to begin rehab programRM zoneDependent on goals – strength vs endurance
Types of muscle contraction IsometricDynamicIsokinetic
Sets # of Repetitions
Current RecommendationsStrength gains: 6-12 reps x 2-3 setsShould encounter fatigueIncrease rest between reps/sets
Mode of Exercise types: OKC vs CKCManual vs mechanicalConstant vs variableAccommodatingBody weightAnaerobic vs aerobicSpecificity of Training is the Key!
Current RecommendationsEndurance: high reps, submax loadsIncrease contraction time within reps, setsImportant in early phase of rehab due to quicker loss of Type I fibers in injured, immobilized muscle
Exercise order Large  small, multi  single, intensity 
Frequency dependent on intensity, volume, health status, initial responseNo consensus for gains, 2-3x/wk for maintenance
Duration: at least 6-12 wks for hypertrophy and vascularization
Review: General Principles of Rehabilitation Know prior activity level, health status and patient goalsUnderstand physiology of healing and exerciseSpecificity of training and integration of function
Rest Interval (Recovery)Need appropriate balance What are your (your patient’s) goals?Higher intensity requires longer rest… why?Consider health statusHigh-intensity, eccentric exercise is associated w/ greater microtrauma to soft tissue and higher incidence of DOMS
Mode of Exercise refers to form of exercise, type of contraction or manner in which it is carried out
Types of muscle contraction IsometricDynamicIsokinetic
Mode of Exercise types: OKC vs CKCManual vs mechanicalConstant vs variableAccommodatingBody weightAnaerobic vs aerobicSpecificity of Training is the Key!
Periodization Systematic variation in exercise intensity, reps, sets and frequencies.Designed to prevent over training and psychological stalenessLimited evidence supporting efficacy.
Review: General Principles of Rehabilitation Know prior activity level, health status and patient goalsUnderstand physiology of healing and exerciseSpecificity of training and integration of function
Types of Resistance Exercise Specificity of training guides decisionWhat does the clinical exam/eval tell you about your patient?Manual and Mechanical ResistanceStatic and Dynamic ResistanceOpen-Chain and Closed-chain
Static Resistance ExerciseIsometric: Function, endurance, N-M control, stability, dynamic exercise is contraindicatedExamples: muscle setting, stabilization exercises, multi-angleL-T curve, 6-10 sec repetitive contractionsMinimal physiologic overflow (<10° either direction)
Dynamic Exercise consists of: ConcentricEccentric
Dynamic ExerciseConcentric: tension develops and shortening occurs as resistance is overcome – accelerate body segments
Dynamic ExerciseEccentric: physical lengthening of a muscle as it attempt to control the load – decelerate, shock absorptionLoad can be applied with Constant resistance (DCER)Variable resistanceConstant velocity
Dynamic Resistance components Load/Intensity: Velocity:Energy: Mode: X-train Effect: Exercise-induced muscle sorenessIsokinetic
Dynamic ExerciseLoad/Intensity: max concentric contraction produces less force than max eccentric contraction under the same conditions…
Dynamic ExerciseVelocity: at slow velocities w/ max load, eccentric contraction = increased tension vs concentric contract
Dynamic ExerciseEnergy: b
Dynamic ExerciseMode: transfer of training is limited
Dynamic ExerciseX-train Effect: slight increase in contralateral limb strength, no evidence on impact of function
Dynamic ExerciseExercise-induced muscle soreness ecc = greater association w/ DOMS
Isokinetic Refers to: refers to movement that occurs at a constant velocity
Isokintic does what? Accommodating resistance – strength, fatigue, painTraining velocities and specificity of training – LE during walking 230°/secReciprocal vs isolatedJoint compression lower at faster speeds w/ concentric exercise
Isokinetic Resistance studies: Studies are positive for improving set parameters of muscle performanceLimited research on functional performance effectTypically done in later stages of rehabAvailability, cost, set-up
Open-chain: Distal segment is not fixated; movement only occuring distal to moving joint. Ex: kicking a ball
Closed-chain: Body moves on stabilized distal segment; chain reaction of movement up proximal joints. Ex: push-upIncludes weight-bearing activities in which distal segment moves, but remains in contact w/ surface (leg press, pull-up)
Benefits Open-chain: Improved isolation of individual muscleImproved control at single jointMay be less painful, stressful to healing tissue
Benefits Close-chain: Increased joint approximationCo-activation = increased dynamic stabilityIncreased proprioceptive feedback?
Implementation - Factors Underlying pathologyExtent of muscle impairmentsPresence of other deficitsStage of tissue healingAgeOverall fitness levelAbility to learnPrecautions/contraindicationsGoals
Application Warm-up 5-10 minPlacement of resistanceIntensity – forceful, but controlledWhat is the goal?Stabilization – avoid substitutionsHow much control does your patient have? How much control do you want your patient to attain?InstructionMonitor
Substitution why is your patient choosing to do an activity a particular way?
Overtraining: decline in physical performance in healthy individuals; temporary, “burnout”
Overwork: progressive deterioration of strength in muscles already weakened by nonprogressive neuromuscular disorder; may be permanent, but is preventable
Exercise-Induced Muscle SorenessAcute: During or immediately after exercise“burning”Ischemia and inadequate blood flowBuild-up of metabolitesActive recovery
Exercise-Induced Muscle SorenessDelayed (DOMS)Delayed (DOMS) Begins 12-24 hrs post exerciseResult of microtrauma?Characterized by independent courses of pain and decreased strength
PrecautionsPathologic fracture: fracture of bone already weakened by disease that occurs as the result of minor stress to skeletal system
Contraindications (resistance training) Pain – “No pain, no gain???”InflammationSevere Cardiopulmonary Disease
Manual Resistance Exercise Resistance force applied by therapist to either a dynamic or static contractionBody mechanics IMPORTANT!Verbal commandsPlacement and StabilizationGrade and vary throughout ROMSmooth movementsUse your body to stabilize
PNF exercices combine...... Combines functionally-based diagonal patterns w/ techniques of neuromuscular facilitation via sensory cues to evoke motor responsesUseful throughout continuum of rehabD1 and D2 flexion and extension
PNF Basics Interaction between patient and therapist is key- Manual contacts- Max resistance
PNF Basics Manual contacts Placed over agonistTactile cue
PNF Basics Max resistance - Smooth movement- Pain free- Complete range
PNF Basics Therapist position and movement - PT remains aligned along plane of movement, facing the limb.- Resist movement through body weight.
PNF Basics Streth: - “wind up” tissue to increase excitability of muscles- Stretch reflex – rapid overpressure- Not used in early stage after injury/surgery
PNF Basics- NOrmal timing Distal -> proximal; specificity of training
PNF Basics- Traction- slight separation of joints - Inhibits pain- Facilitates movement
PNF Baisics- Approximation - Stimulates co-contraction- Increases dynamic stability
PNF Basics: Verbal Commands maintain attention, assist in movement
PNF Basics- Visual cues follow limb throughout ROM
PNF D1 Flexion UE Grasp pt’s hand w/ same PT hand (R and R)PT opposite hand (L) placed into direction of mvmt to cueStay in diagonalStart distallyPatient should maintain eye contact w/ hand
PNF D1 Extension UE Grasp pt’s hand w/ opp PT hand (lumbrical grip) on post surface of pt hand to facilitate extPT’s other hand supinated on post aspect of upper armOK to switch hands to maintain in diagonal, but maintain contact on appropriate surface
PNF D2 Flexion UE Cradle pt’s arm w/ opp hand on dorsal surface (lumbrical grip) PT other hand on post surface of forearm near elbow
PNF D2 Extension UE Index and middle fingers of same hand in pt’s palmPT other hand on volar (ant) surface of distal upper arm
PNF D1 Flexion LE Get in proper position to resist the force – use body weightGrasp pt’s dorsum of foot w/ same PT hand (R and R)Other hand supports and guides at distal thigh from ant/med to cue movementKeep your body in the diagonal (pivot and step)
PNF D1 Extension LE Place your same hand on plantar aspect of pt’s footPT other hand at post aspect of knee at popliteal fossa
PNF D2 Flexion LE Place same hand on pt’s dorsal/lateral footOpposite hand on anterolateral of thigh, proximal to knee, fingers point distally to aid cues
PNF D2 Extension LE Place same hand on plantar/medial surface of foot at base of toesOther hand at posteromedial thigh, proximal to knee
PNF Techniques - Rhythmic Initation- Repeated Contraction- Reversal of Antagonists
PNF Techniques- Rhythimic Initiation PROM at appropriate rate
PNF Techniques- Repeated Contraction dynamic contractions after quick stretch, followed by resistance
PNF Techniques-Reversal of Antagonists first resist antagonist to facilitate weaker agonist, reverse just before pattern is completed- slow reversal- Slow reversal hold
PNF Techniques-Reversal of Antagonists: Slow reversal dynamic concentric agonist followed immediately by dynamic concentric antagonist; no relaxation between
PNF Techniques-Reversal of Antagonists: Slow Reversal Hold adds isometric to ends of each contraction; no relaxation between
PNF Techniques- Alternating Isometrics: resistance alternately applied to agonist isometric followed by antagonist isometric; no joint movement should occurManual contact is maintained
PNF Techniques- Rhythmic Stabilization: progression; multidirectional resistance by placing manual contacts on opposite sides of the body and applying resistance simultaneouslyEmphasis on the rotators
Mechanical Resistance- Pros QuantitativeDynamic, static, accommodating, isokineticVarietyIndependenceHeavier loadsIncr training effectStrong muscle groups
Mechanical Resistance- Cons Not appropriate for weak muscles or early stage of rehabMinimal accommodationPain, weaknessConstant loadExpensiveLimited increments
(Mechanical resistance)Special Populations: Older People: have a higher incidence of ___ DOMS
(Mechanical resistance)Special Populations: KIDS No formal resistance training for <6-7 year-oldsClose and continuous supervisionShort-duration, play-oriented activitiesLow loads, mid-range repsIncrease rest periodsLimit frequency to 2x/wkProperly fitted equipment
Training Regimines - 3 techniques w/ PREs DeLorme, Oxford, DAPRE
DeLorme Training Regimine - - goal is hypertrophyHeavy resistance 10RM
Oxford Training Regimine - increase strength w/ min fatigueHeavy -> light
DAPRE (Daily Adjustable Progressive Resistance Exercise)Training Regimine - 6RM
DeLorme Examples 10 reps @ ½ 10 RM (50%)10 reps @ ¾ 10 RM (75%)10 reps at Full 10 RM (100%)
Oxford Examples 10 lbs x 10 RM7.5 lbs x 10 RM5 lbs x 10 RM
DAPRE = 6RM is working weightExample 10 reps @ 50% 6RM6 reps @ 75% 6RMMax reps @ 100% 6RMMax reps @ adjusted working weightAdjusted working weight based on set 3 (6RM is goal)
Circuit Training: explain what it is and describe Pre-established sequence of continuous exerciseGoal is to increase strength and enduranceHigh reps, lower intensityMinimum rest between sets, stationsExercise order is importantAlternate groups to incorporate restLarge groups -> Small groups
What is Plyometric Training High-intensity, high-velocityGoal is increased power and coordination“Stretch-shortening drills”
What are Plyometric High-intensity,“Stretch-shortening drills” Rapid, eccentric contraction (quick stretch) immediately followed by concentric [] (shortening)Amortization phase (time between ecc and concentric contractions) is kept briefStimulates activation of monosynaptic stretch reflex/muscle spindles
Plyometrics- Neurological Effects Stimulates proprioceptorsIncrease excitability of N-M receptorsImprove reactivity of N-M system
Plyometrics- Musculoskeletal Effects Enhance muscle’s dynamic restraint capabilities (resists stretch)Decreased incidence of LE injuryImproved physical performance???
Plyometrics - Application Initiated in later stages of rehabEmphasis on technique and “soft” landingPerform plyos early in sessionKids and growth plates – limit high-intensity plyosGeneral: should have 80-85% strength and 90-95% ROM before beginning plyo
PlyometricsSpecificityProgression Speed – reduce contact timeIntensity – wts, unilateral, depthReps and frequency – PROPER FORM is vital; 48-72hr recovery is recommended
Plyometrics Contraindications – pain, inflammation significant joint instability
Created by: NicoleB