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Therapeutic Exercise 2
Resistance Exercise-1
Dr. Dania Qutishat
Muscle performance
• Definition: “the capacity of the muscle to do work”.
• Factors that affect muscle performance: morphology
of the muscle, neurological, biomechanical,
biochemical factors, cardiovascular, respiratory,
metabolic, cognitive and emotional function”.
• Important for functional movement.
Why it is important?
• To be to able to carry out the activities of daily living
in a safe and efficient manner.
• The muscles has to produce, sustain ans regulate
tension to carry out these functions.
Benefits of resistance Ex.
• Enhanced muscle performance.
• Increased strength of connective tissue.
• Increased mineral density of the bone.
• Decreased stress on joints during physical activity.
• Reduced risk of soft tissue injury during physical
activity.
• Positive impact on tissue remodelling.
Benefits of resistance Ex.- Cont.
• Possible improvement in balance.
• Enhanced physical performance.
• Positive changes in body composition (less fat
and more muscles).
• Enhanced feeling of physical wellbeing.
• Possible improvement of disability and quality
of life.
Strength
• Strength : “the greatest measurable force
that can be exerted by a muscle or a muscle
group to overcome resistance during a
single maximum effort”.
• Functional strength: the ability of the
neuromuscular system to produce, reduce
and control forces during functional activities
in a smooth and coordinated manner”.
Power
• Def. : “the rate at which the muscle
contracts and produces a resultant
force”.
• Single burst of high intensity.
• Repeated bursts of less intensity of
muscle activity.
Endurance
• Endurance: “the ability of the muscle to contract
repeatedly against a load, generate and sustain
tension and resist fatigue over an extended period of
time”.
• Cardiopulmonary (total body) Endurance refers to
repeated and dynamic activities.
• Aerobic power might be used interchangeably with
muscle endurance.
• A strong muscle does not necessarily mean that it has
endurance.
Strengthening Exercise
Systematic procedure of a muscle or
group of muscles lifting, lowering or
controlling heavy loads for low number of
repetitions over a short period of time.
Power Exercise
• Exercises that increase the work
performed by the muscle in a specified
period of time OR reduce the amount of
time needed to produce a given force.
Endurance Exercise
• Lifting or lowering light loads for many
repetitions or sustain a muscle
contraction for extended period of
time.
• How does Strengthening ex. and
endurance ex. affect the muscle
performance positively?
Overload principle
• The resistance must be greater than the
metabolic capacity of the muscle.
How to apply the overload principle in
strengthening and endurance ex.?
SAID principle
• Specific adaptations to imposed demands.
• Specificity of the ex.: the exercise has to
mimic the anticipated function.
How to make the resistance exercise
specific?
Reversibility principle
• Adaptive changes in muscle performance
following a resistance exercise are transient
unless practiced regularly in functional
activities or maintenance program of
resistance exercises.
• Detraining starts within a week or two after
cessation of the resistance exercise.
Determinants of resistance Ex.
1. Alignment: Positioning.
 Muscle action
 Gravity
2. Stabilisation: holding the body segment steady
 Internal stabilisation
 External stabilisation
To prevent substitute motions.
Substitute motions
• “Compensatory movement patterns caused by
muscle action of a stronger adjacent agonist or a
muscle group that normally serve as a stabilizer
(fixator)”.
Determinants of resistance Ex.
3. Intensity: amount of resistance (load).
 Submaximal loading
 Maximal loading
 Initial ex. loading
 Repetition maximum
 Alternative methods
 Training zone
4. Volume
 Repetitions
number of muscle contractions performed to move
the limb through a series of continuous excursion
against a specific load.
 Training to increase strength
Fatigue Ex causing (6-12 Repetitions for two or
three sets).
 Training to increase endurance
(40, 50 or more Repetitions for 3-5 sets)
 Sets
predetermined number of repetitions grouped
together.
Rest after each set.
Determinants of resistance Ex.- Cont.
4. Ex order: the sequence in which exercises are
being performed.
- Large muscles before small
- Multi joint before single joint
- Warm up, higher intensity then lower intensity ex.
Determinants of resistance Ex
 5. Frequency: number of ex sessions per
day or per week.
- Low intensity, Short sessions Daily basis,
(several times per day).
- Increased intensity (every other day up to 5
days/week).
- Maintenance program (2 days/week)
- Highly trained athletes high intensity
(6 days/ week)
Determinants of resistance Ex
6. Duration: is the total number of weeks or
months during which a resistance ex are being
performed.
 2-3 weeks- neural adaptation
 6-12 weeks- hypertrophy and increased
vascularisation.
Determinants of resistance Ex
6. Mode of Ex.: the form of ex.,, the manner in which the
ex is carried out.
 Type of muscle contraction
- Isometric, Concentric, Eccentric
 Position for Ex.
- Weight bearing, Non-weight bearing
 Forms of resistance
- Manual, mechanical/ Constant, variable load/
Accommodating resistance/ Body weight or partial
body weight)
 Energy systems
-Aerobic/Anaerobic
 Range of movement
- Short arc/ Full arc
 Application to function.
Strengthening Exercise
7. Velocity
 Force-velocity relationship
Concentric vs. eccentric contraction.
8. Rest interval (recovery period):
 Moderate intensity (2-3 minutes after each set).
 High intensity (4-5 minutes after each set).
 Pathological conditions, children and elderly (at
least 3 minutes performing unresisted ex)
Factors that influence tension
generation in normal skeletal muscle
1- Energy stores and blood supply
2- Fatigue
3- Recovery from exercise
4- Age
5- Physiological and cognitive factors
Energy stores and blood supply
• Energy stores and blood supply
Muscle needs energy to contract, generate tension
and resist fatigue.
• Energy systems:
- ATP-PC system
- Anaerobic/ glycolytic/ lactic acid system
- Aerobic system
Fatigue
• Muscle (local) fatigue
• Cardiopulmonary (general) fatigue
Definitions of fatigue are based on the type of fatigue.
Muscle (local) fatigue
• Definition :” Diminished response of muscle to
a repeated stimulus”.
• It is an acute and reversible physiological
response to exercise.
• Temporary state of exhaustion (failure) that
result in decreased muscle strength.
Why it happens?
• Decrease in the energy stores, insufficient
oxygen and build up of H+.
• Inhibitory influences from the central nervous
system.
• Decrease in the conduction of
impulses at the myoneural junction.
Types of muscle fibre
• Type I (tonic slow-twitch)
Generates low level of tension that could be
sustained for long period of time.
• Type II (phasic fast-twitch)- type IIA and IIB
Generates great amount of tension in short
period of time.
• Different muscle are composed of varying
proportions of tonic and phasic fibres.
• High proportion of type I fibres- e.g. Postural
muscles
• High proportion of type IIB fibres- e.g. muscles
responsible for lifting heavy loads.
Cardiopulmonary (general) fatigue
• Definition: “Diminished response of the
entire body as a result of prolonged physical
activity”.
• Why it happens?
- Decrease in the blood sugar (glucose) levels
- Decrease in glycogen stores in the muscle
and liver
- Depletion of potassuim
Threshold for fatigue
• Definition: “ the level of exercise that cannot
be sustained indefinitely”.
• Determined by:
- Length of the muscle contraction
- Number of repititions
Factors that influence fatigue
• Patients' health status.
• Diet.
• Lifestyle (active or sedentary).
• Patients with neuromuscular, cardiopulmonary,
oncologic, inflammatory or psychological
disorders- have abnormal onset of fatigue.
Recovery from exercise
– Intrasession and intersession recovery.
– Changes during recovery:
Restore oxygen in muscles
Restore energy
Removal of lactic acid from skeletal muscle
blood within 1 hour after exercise.
Replacement of glycogen over several days
Age
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Infancy, early childhood and preadolescence
Puberty
Young and middle adulthood
Late adulthood
Psychological and cognitive factors
• Attention
Ability to focus and learn
• Motivation and feedback
Effort and adherence over time
Different types of feedback to enhance
performance
Physiological adaptation to resistance
exercise
1- Neural adaptation
2- Skeletal muscle adaptation
3- Vascular and metabolic adaptation
4- Connective tissue adaptation
Neural adaptation
• First and rapid gain in the strength.
• Motor learning and improved coordination.
• Increased recruitment in the number of motor units
firing.
• Increased rate and synchronization of firing.
• Decrease in the inhibitory function of the CNS.
Skeletal muscle adaptation
• Hypertrophy.
- Increase in the size of the individual muscle fibre.
- Occurs after moderate to high intensity resistance
training (4-8 wks)/ 2-3 wks very high intensity
resistance.
- Increase in the protein (myosin and actin) synthesis
and decrease in protein degeneration.
Skeletal muscle adaptation
- High synthesis- moderate resistance, high
volume, eccentric contraction.
- Muscle fibre type IIB- highest increase in size.
Skeletal muscle adaptation
• Hyperplasia
- increase in the number of muscle fibres
- Splitting fibres
• Muscle fibre type adaptation
- type II- hypertrophy
- Transformation of IIB to IIA with endurance ex.
Vascular and metabolic adaptation
• High intensity and low volume.
• Less capillary bed density because of the
increased number of myofilaments per fibre.
• Decrease in the mitochondrial density.
• Reduced oxidative capacity of the muscle.
Connective tissue adaptation
• Tendons, ligaments and connective tissue in
muscles.
- Increased strength of the tendons and
ligaments which make them less prone to injury.
- Increased thickness of the connective tissue
around the muscle fibers to support their
increased size.
• Bone
- High correlation between muscle
strength and physical activity.
- ex performed from weight bearing
positions to prevent or minimise bone
loss
Types of resistance exercise
• Manual and mechanical resistance exercise.
• Isometric (static) exercise
• Dynamic (concentric and eccentric) exercise
• Dynamic exercise (constant and variable
resistance)
• Isokinetic resistance
• Open-chain and closed chain exercise
Isometric resistance ex.
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Definition?
Why? (rationale)
Types?
Characteristics?
Precaution and contraindication?
Concentric and eccentric ex.
• Definition?
• Why? (rationale)
• Characteristics?
- Ex. load
- Velocity
- Energy expenditure
- Mode specificity
- Cross training effect
- Ex. Induced muscle soreness
General principles of resistance training
• Examination and evaluation (Health history,
systems review, selected test and
measurements)
- Determine a baselines of muscle performance
(strength, endurance, ROM, functional activities).
Why?
- Implement selected tests (examples?).
• Interpret the findings
• Integrate the resistance ex. with the
rehabilitation program.
Preparation for resistance ex.
• Select the form of resistance ex.
• Explain to the patient (understand and
consent).
• The pt. should wear non restrictive
clothing and a supportive shoes if
needed.
• The supporting surface is firm but
comfortable.
• Demonstrate each ex.
Application
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Warm up
Placement of resistance
Direction of resistance
Stabilisation
Amount of resistance
Volume
Instructions (verbal/written)
Monitoring the pt
Cool down
Precaution
• Valsalva maneuver
• Substitute motions
• Over training and over work
• Exercise induced muscle soreness
• Pathological fracture
Contraindication
• Pain
• Inflammation
• Severe cardiopulmonary disease
Advantages
• Quantitative baseline measurement of muscle
strength.
• Appropriate in moderate and advanced phases
of rehabilitation (4/5).
• Training for already strong muscles.
• Increase in the level of resistance
incrementally and quantitatively
Advantages
• Some equipment provide variable resistance.
• Some equipment provide high velocity exercise.
• Could be applied independently.
Disadvantages
• Not appropriate for early stage in rehabilitation
or weak muscles.
• Could not accommodate painful arc in ROM.
• Expense of purchase and maintenance.
• Gradation in resistance depends on the
manufacturers increments of weight.
Equipment for resistance training
• Wide range of equipment for resistance
training.
• Free weights
• Elastic resistance.
Priniciples for selection of equipment
Selection of the equipment should be
based on the individual needs, abilities
and goals, cost, space requirements,
ease of use.
Principles for the use of equipment
• Determine when to use, modify and stop.
• Determine if the equipment could be used
independently.
• Stabilise body parts as appropriate.
• Teach the appropriate exercise before adding
resistance.
• Set up a regular maintenance, check up and
replacement.
Free weights
• Types
Graduated weights that could be applied to the
upper and lower extremities and trunk.
e.g. Dumbbells, weighted balls, weighted vests.
• Characteristics
Provide constant load,
Advantages & Disadvantages
• Exercises could be done in different positions.
• Used for dynamic and isometric resistance exercise.
• Does not provide external stabilisation so the
individual take time to learn the appropriate
movement.
• Increase in the resistance depends on the
graduated weights available.
Elastic resistance bands
• Elastic bands and elastic tubing.
• Color-coding denotes the level of resistance.
Properties of elastic resistance
• Effect of elongation of elastic material.
• Determination and quantification of resistance.
• Fatigue characteristics.
Application of elastic resistance
• Selecting the appropriate grade of the
material.
• Selecting the appropriate length.
• Securing bands or tubing.
• Setting up an exercise.
• Progressing exercise.
Reference
• Kisner C. and Colby L. (2007). Therapeutic exercise
foundations and techniques. 5th edition.