9/13 - Resistance Exercise for Impaired Muscle Performance Flashcards by Jenn Cantilli

strength

ability of contractile tissue to produce tension

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power

work produced by ms over time
(f x d/t)

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endurance

ability to perform low intensity, sustained activity over a prolonged time

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overload principle

progressive loading (strength)
progressive reps (endurance)

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SAID principle

Specific Adaptation to Imposed Demands
- exercise prescribed specific to function
- what is the deficit and how do we address this

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transfer of training

carryover of effects from one type of exercise to another
- ex: strength program also improve endurance

only limited evidence, greater support for specificity of training

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reversibility principle / detraining

if you don’t use it you lose it
- detraining can happen more rapidly than building up the muscle

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what influences the amt of tension able to be generated

energy stores and blood supply
fatigue
recovery from exercise

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muscle (local) fatigue

diminished response of muscle

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CP (general) fatigue

diminished response of person

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threshold for fatigue

level of sustainable activity

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what are other factors which influence fatigue

overall health
diet
sleep

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what are general factors of fatigue that can impact the possible tension to be generated

muscle/local fatigue
CP/general fatigue
threshold of fatigue
other factors

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how does age impact tension generation in normal skeletal muscle

childhood - linear inc in strength to puberty

adolescence - strength levels significantly differ b/w sexes

adulthood - women reach peak strength at younger age than men

late adulthood - decline of 15% or greater each year >60yo

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what are psychological and cognitive factors which influence tension generation

attention
motivation
feedback

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where do you see physiological adaptations to resistance exercise

neural adaptations
skeletal muscle adaptations
vascular & metabolic adaptations
adaptations of connective tissues

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what neural adaptations are seen to resistance exercise

inc EMG without hypertrophy
- motor learning & improved coordination

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what skeletal muscle adaptations are seen to resistance exercise

hypertrophy - inc size of ms fiber
- inc protein (actin & myosin) synthesis

hyperplasia - inc number of ms fibers
- limited evidence

muscle fiber type adaptation
- IIB converted to IIA

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what vascular and metabolic adaptations are seen to resistance exercise

muscle hypertrophy
- dec capillary bed density as myofilaments inc

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what adaptations of connective tissues are seen to resistance exercise

tendons, ligaments, connective tissue in ms
- tendon/ligament tensile strength inc w resistance training

bone
- ms strength correlated w bone density

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how is alignment different from stabilization

alignment of muscle fibers
- changes the primary mover
alignment of gravity

stabilization in that position

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describe how the position of the hip affects the alignment of the muscle fibers

if flexed&raquo_space; more TFL
if extended&raquo_space; more glut med

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how can intensity vary and what determines this

submaximal vs maximal exercise loads
- considered desired goal of program

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what about the initial level of resistance (load) should be documented to assess training effects

repetition maximum
- provides baseline to measure progress
- trial & error

training zone
- % of RM
- initially low for untrained patients

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what components of volume are determinants of resistance exercise

reps and sets - consider goals of exercise activity & individual patient

describe the impact of exercise load and reps on desired muscles

improve ms strength = high load/low reps improve ms endurance = low load/high reps

what does the exercise order have an impact on

fatigue - large ms groups before small - multi-joint exercises before single joint

what should be considered when prescribing frequency of exercise

inc intensity and volume = inc recovery time

what program duration is needed for neural adaptations

2-3 weeks

what program duration is needed for hypertrophy

6-12weeks

what are components for the mode of exercise that should be considered (6)

type of ms contraction position for exercise forms of resistance energy systems range of movement patient & outcome specific

what types of ms contractions are considered for the mode of exercise

concentric eccentric isometric

what about the position for exercise should be considered for mode of exercise

WB non- WB

what about forms of resistance should be considered for the mode of exercise

manual mechanical body weight

what about energy systems should be considered for the mode of exercise

aerobic anaerobic

what about range of motion could be considered for mode of exercise

short arc full arc

what about the velocity of exercise is important for determining resistance exercise

function specific force-velocity relationship - concentric - eccentric

what is periodization

variability of training for specific goal

how can you integrate function into an exercise program

balance of stability and active mobility balance of strength, power, endurance task specific movement patterns during resistance exercise

what are 6 types of resistance exercise

manual and mechanical isometric dynamic - concentric/eccentric dynamic - constant / variable isokinetic open chain / closed chain

what is manual resistance exercise and what are the pros of this

provided by therapist gives you real time feedback can feel when start to fatigue can adjust amt of force - more in mid range, less in end range

what is mechanical resistance exercise

provided by equipment

what is the rationale for using isometric exercise

stability

what are types of isometric exercise (3)

muscle setting exercises stabilization exercises multiple angle isometrics

what is an example of a muscle setting isometric exercise

quad set

what is an example of a stabilization isometric exercise

PNF alternating isometrics

what is an example of multiple angle isometrics

4-6 points in ROM - PNF, engage ms at different angles

what is another word for isometric in terms of exercise

static

intensity of isometric training

60% of MVC

duration of muscle activation

6-10sec

why does isometric training have repetitive contractions

dec cramping

isometric training joint angle and mode specificity

individualized to activity

rationale for using concentric vs eccentric exercise

concentric - accelerate eccentric - decelerate

exercise load and concentric vs eccentric

inc loads are better controlled w eccentric

energy expenditure with concentric vs eccentric exercise

eccentric more efficient

mode specificity w concentric vs eccentric exercise

eccentric more mode specific than concentric

what is the cross-training effect with concentric and eccentric exercise

opposite side (L vs R) may be stabilizing

exercise-induced ms soreness with concentric vs eccentric exercise

inc DOMS w eccentric - (delayed onset muscle soreness)

constant vs variable resistance w dynamic exercise

dynamic constant external resistance exercise (DCER) - max challenge occurs at only one point of ROM variable-resistance exercise - challenges ms throughout ROM - cybex equip and/or tubing

what are special considerations for DCER and variable resistance exercise

arc of motion by patient controlled pace

where are isokinetic machines typically seen

more research than clinical practice

what is the role of velocity in isokinetic training

constant velocity of ms shortening / lengthening

what is the range and selection of isokinetic training velocities

0-500 degrees / sec

how can muscle groups be activated in isokinetic exercises

reciprocal movements with isolated muscles activated

how is isokinetic exercise specified

velocity specific

what is the role of compressive forces on joints and isokinetic exercise

dec at a faster velocity

how does isokinetic training accommodate for fatigue and/or a painful arc

dec the force = dec resistance

isokinetic training effects and carryover to function

there is limited carryover to function - single ms or segment is isolated

what are special considerations for isokinetic training

availability of equipment appropriate setup

open chain exercise

distal segment moves independent joint movement; unpredictable pattern segments moving are distal to moving joint typically NWB ex: sitting and ext knee

closed chain exercise

distal segment stationary interdependent joint movements predictable patterns distal & proximal segments moving typically WBing ex: standing and squats

OKC or CKC: isolation of ms groups

OKC

OKC or CKC: control of movements

OKC

OKC or CKC: joint approximation

OKC & CKC

OKC or CKC: more functional

CKC

OKC or CKC: co-activation and dynamic stabilization

CKC ?

OKC or CKC: proprioception, kinesthesia, NM control, and balance

CKC

OKC or CKC: carry over to function and injury prevention

OKC and CKC

how can you progress closed chain exercises (7)

% body weight (partial -> full) BOS (wide -> narrow) support surface (stable -> unstable) balance - (+) support -> (-) support - EO -> EC limb movement (short -> full arc) plane of movement (uni-> multiplanar) speed of movement (slow -> fast)

why is placement of resistance important

dictates how challenging it is

when is direction of resistance important

manual load - careful of hand placement bc can impact how they activate their ms

why do you stabilize w resistance exercises

prevent substitution

how do you decide if verbal or written instructions are best for the patient

depends on their learning style

what is a val salva maneuver

expiration w closed glottis

what can the valsalva maneuver cause in at risk patients

inc BP

how do you prevent valsalva maneuver during resistance exercise

avoid holding breath exhale on lift

what are precautions for resistance exercise

valsalva maneuver substitute motions overtraining and overwork exercise-induced ms soreness pathological fx

what can encourage substitute motions which should be avoided

applying too much resistance

overtraining vs overwork

overtraining - decline in performance overwork - decline in strength

what does overtraining and overwork put the patient at inc risk for

injury

types of exercise induced muscle soreness

acute ms soreness delayed onset ms soreness (DOMS)

acute ms soreness

during or directly after exercise

delayed onset ms soreness (DOMS)

12-24hrs post exercise

how to prevent DOMS

gradual progression warm up / cool down

what patients are at inc risk for a pathological fx

osteoporosis osteopenia

what are contraindications to resistance exercise

pain inflammation severe CP dz

appropriate exercise for a patient in pain

AROM w/o resistance

appropriate exercise for patient w inflammation

isometric exercise

appropriate exercise for patient w severe CP dz

assess parameters of activity & impact on cardiac / respiratory systems

what are 4 advantages of manual resistance exercise

1. resistance adjusted throughout ROM 2. ms works max throughout ROM bc resistance is adjusted 3. control ROM to protect healing tissues - can minimize how hard they are working in certain areas 4. manual stabilization prevents substitution

what are 3 disadvantages for manual resistance exercise

1. resistance is subjective 2. patient can't perform independently 3. labor and time intensive for PT

resistance training guidelines for healthy adults (<50-60yo) --- (8)

1. begin w warmup followed by flexibility 2. perform thru full, pain free ROM 3. balance flex / ext exercises 4. utilize concentric / eccentric 5. mod intensity (60-80% 1RM) 6. rhythmic controlled motions 7. maintain normal breathing 8. cool down after exercise

resistance training guidelines for children

no formal resistance training under 6yo - focus on play and body weight activity wt training introduced in pre-pubescent years

wt training guidelines in pre-pubescent years (5)

1. close supervision w attention to proper form 2. low loads & intensity 3. limit frequency to 2x/wk 4. caution w eccentric exercise 5. ensure equipment is appropriate for child's size

what do you need to do resistance training in older adults (>60-65yo)

MD clearance

what should be avoided with regards to resistance training in older adults & why

high load resistance - tissues potentially more susceptible to overloading flexion dominant exercise that could create postural dysfunction - more ext bias >> tend to be tight and weak

what are 4 other guidelines for resistance training in older adults

begin w 5-10min of warm up monitor vital signs 40-60% 1RM intensity 48hr rest interval b/w sessions

what role does an individualized prescription play a role in

better outcomes and engagement

what specific demands of the patient should be considered

ADL work sport goals