Lecture Exercise Prescription

Question 1

what 3 basic principles should be kept in mind to take optimal advantage of the said principle? (specific adaptation to imposed demand)

Answer 1

Question 2

what are the 3 adaptations to exercise that can be targeted with exercise?

Answer 2

1) neurological adaptations
2) metabolic adaptations
3) morphological adaptations

Question 3

describe neurological adaptations

Answer 3

Question 4

describe metabolic adaptations

Answer 4

based primarily in changes to the metabolic processes that regulate the functioning of the cardiorespiratory system and of skeletal muscle

Question 5

describe morphological adaptations

Answer 5

Question 6

describe neuromotor exercise guidelines (6 principles)

Answer 6

1) frequent, structured training (typically low intensity, more usually better, min 2 days/week of 20-30 minutes/day)
2) variation (may have poorer performance during session, but better long-term skill retention)
3) mental imagery/cross education (not to be used as substitutes for actual task - ME is visualizing, CE is performing with other side)
4) distribution of training - should be based on capability and availability of patient (massed not ncessarily better than distributed)
5) continuous and discrete movements (movements that can be briken down can be practiced this way)
6) augmented feedback (coming from sources other than the patient - verbal, modeling/demonstration, manual guidance)

Question 7

effects of a sedentary lifestyle

Answer 7

Question 8

mechanism of adaptation for neuromotor exercise

Answer 8

neurological > morphological and metabolic

Question 9

define balance, static balance, and dynamic balance

Answer 9

Question 10

describe the requisites for balance

Answer 10

Question 11

balance specific training guidelines

Answer 11

Question 12

what are some balance specific training techniques?

Answer 12

• perturb COM (normal sway - ie just standing is enough, external perturbations -therapist push, internal perturbations - movement against resistance, reaching out of BOS)
• modify BOS (decrease external support, feet together etc)
• modify sensory feedback (vision, proprioception, vestibular - hard to modfy, but some VOR)

Question 13

what is better - balance training and walking or just balance training?

Answer 13

• just balance training according to a study - likely due to relatively less balance-specific trianing
• evidence wrt resistance training in isolation is inconsistant

Question 14

what are the areobic training guidelines (age, fitness level etc)

Answer 14

• the same guidelines for everyone!!
• should be in addition to ADLS, in bouts of at least 10 minutes, using large muscle groups

Question 15

describe aerobic training maintenence

Answer 15

Stopping training

–2 weeks - significant ↓ in aerobic fitness

–4-12 weeks – loss of 50% of initial ↑ in V·O2max

–2.5 to 8 months – return to pre-training levels

–N.B. Following years of continuous training, benefits are kept for longer periods of detraining

Reduced training volume

–Up to 15 weeks if intensity is maintained (even with frequency and duration reduced by up to 2/3)

• V·O2max will ↓ if intensity is reduced by 1/3 or 2/3, even with frequency and duration constant

Question 16

measures of intensity for cardiorespiratory exercise

Answer 16

1) metabolic equivalent task (MET): rate of energy consumtion relative to fixed O2 intake, 1 MET = 3.5 mL O2/kg/min
2) % of maximum oxygen uptake reserve (%VO2R): difference btw VO2 max and O2 uptake at rest
3) percentage HR reserve: diff btw max HR and HR at rest
4) ratio of perceived exertion (RPE): Borg scale (6-20, intended to mirror heart rate of middle aged man), OMNI scale (1-10) - both closely correlated

Question 17

describe the borg and omni scale of exertions

Answer 17

Question 18

describe FITT for cardiorespiratory exercise

Answer 18

Frequency: Moderate intensity (≥5 d/wk), High intensity (3-5 d/wk)

Intensity: deconditioned (Borg:9, omni:4, 55-65%max hr), other individuals (borg:12, omni:5, 55-65% max hr), to improve fitness (borg: 12-17, omni 5-8, 40-90%max hr)

Time: Moderate intensity (≥30 min), Higher intensity (≥20 min)

Type: must use large muscle group, sythmic (aerobic) in nature, can be maintained for at least 10 mins

Volume:

for novice/intermediate = Moderate intensity; 30-60 min/day; 5 days/wk, Vigorous intensity; 20-60 min/day; 3 days/wk, combination of above (≥500-1000 MET·min/wk)

f_or deconditioned_ = 3-5 days/week, light to moderarte, up to 20 mins/day

Question 19

recomended aerobic training for hypertension

Answer 19

Question 20

aerobic training recomendations for osteoarthritis

Answer 20

Increased physical activity Does not exacerbate joint symptoms and Confers significant benefits, including pain relief

Question 21

aerobic trianing for chronic pain patients

Answer 21

A comprehensive physical activity program, including aerobic exercise, should be used for all patients

• recomendation as for healthy adults

Question 22

recomended aerobic training for bone health

Answer 22

Volume: as for otherwise healthy adults

Mode: weight-bearing endurance activities and activities that involve jumping

Question 23

maintaining effect for resistance training

Answer 23

Question 24

resistance trianing for hypertension

Answer 24

Resistance training reduces BP–Follow ACSM guidelines

Question 25

resistance trianing for osteoarthritis

Answer 25

-Strengthening exercise is associated with relief of pain in knee OA and hip OA

Question 26

resistance training for chrinic pain patients

Answer 26

A comprehensive physical activity program, including RT, should be used for all patients

Question 27

recomendations for resistance training - strength

Answer 27

\*note recomended reps = 8-12 (novice/intermediate), 8-12 (advanced), 10-15 (older adults)

Question 28

secondary variable for stregth training: muscle action

Answer 28

Concentric, Eccentric, and Isometric muscle actions should be included for clients of all experience levels (based on program goals)

Question 29

secondary variable for strength training: exercise type

Answer 29

Emphasis on multiple-joint exercises Unilateral and bilateral, single- and multiple-joint exercises may also be included

Question 30

secondary variable for strength training: exercise order

Answer 30

Large muscle groups before small Multiple-joint exercises before single-joint exercises High-intensity exercises before lower-intensity Alternate upper / lower body; agonist / antagonist;

Question 31

secondary variable for strength: rest between sets

Answer 31

Core, multi-joint exercises: ≥2–3 min between sets Other exercises: 1-2 min between sets (for endurance shorter rest, 1–2 min for high-repetition sets (≥15–20 reps), \<1 min for moderate sets (10–15 reps)) Rest period between sessions: ≥48 hrs between sessions for the same muscle group

Question 32

secondary variable for strength: movement velocity

Answer 32

For all experience levels, load should dictate tempo - Concentric phase: the intent should be to maximally accelerate the load - Eccentric phase: slower, controlled descent Novice: slow (2:4) and moderate (1:2) velocities Intermediate: moderate (1:2) velocity Advanced: continuum of velocities corresponding to intensity _for endurance_: Intentionally slow velocities for 10–15 repetitions, Moderate to fast velocities for ≥15–25 repetitions _for power:_ explosive velocity

Question 33

what are the 3 key principles for strength training?

Answer 33

Question 34

what is the 1 RM?

Answer 34

- person would be able to do one more rep at current weight but no more than that

Question 35

training parameters for muscle power

Answer 35

Training for power is done concurrently with strength training

Question 36

guidelines for strength training - muscle endurance

Answer 36

note that loads should be less than 50% 1RM, shorter rest periods, slow velocity for 10-15 reps, moderate to fast velocity for 15 + reps

Question 37

what is isotonic ve isoinetic exercise vs isometric?

Answer 37

isotonic (inculde eccentric and concentric) = resistance dictates movement velocity (tension unchanged, muscle length changes) - tonic = muscle moving!! - eccentric training = more beneficial, but do not do in itself because increased risk of injury isometric = no change in joint angle with resistance applied - little carry-over strength to other joint angles (MMT and RISOM = isometric!) isokinetic = movement velocity dictates resistance - a constant rate of speed with a variable resistance force (measured by a dynamometer), which alters through the full distance stroke - requires a special machine!! \*note largest training effects seen for trained velocities, requires expensive dynamometers

Question 38

what is plyometric and ballistic training used for?

Answer 38

- to better promote muscle power (ie with goal not to stop at end of movement - up to 40% of concentric phase normally spent decellerating) - eg loaded jump squat

Question 39

describe undulating periodization vs reverse periodization

Answer 39

undulating: strength gains optimised through variation of all 3 variables of strength training reverse: training cycle begins with lower volumes (set and reps) and higher intensities, progressing towards higher volumes and lower intensities

Question 40

describe flexibility training guidelines

Answer 40

- can be done as a session alone or part of a cool-down - 2-3 days/week with maximum results daily - static, ballistic, or pnf static: hold each stretch 10-30s, 2-6 reps (60s total stretch) pnf: produces best effect (better than static), 10-30s hold, 4 reps

Question 41

what is the diff btw ROM and flexibility exercises?

Answer 41

ROM = intended to improve functional range of a joint movement - load ligaments or joint capsules flexibility = intended to increase extensibility of muscle group (load muscle-tendon complex)

Question 42

explain viscoelastic strain vs viscoplastic strain

Answer 42

viscoelastic: always fully reversed, accounts for most of the tissue deformation produced during flexibility/ROM, not for long-term adaptation viscoplastic: implies micro-tearing has occured in tissue, allows for adaptation as damage is healed

Question 43

what adaptations are made with ROM and flexibility exercises?

Answer 43

1) viscoplastic deformation (- followed by healing - morphological) 2) incrased stretch tolerence (tissue properties unaltered, but patient reports ledd discomfort with greater tissue stretch) 3) myofibrilogenesis (addition of sarcomeres in series, increases muscle resting length, alters length tension curve and therefore max force production occurs at longer length) \*\* note that decrease in stiffness of tissue not desired using these exercises and tissue stiffness is required for joint stability!!

Question 44

pnf technique - hold relax

Answer 44

Hold-relax: the resisted contraction (step 2) is isometric (with the instruction “don’t let me move you”); the subsequent stretch (step 3) is passive (performed by the therapist).

Question 45

pnf technique - contract relax

Answer 45

Contract-relax: the resisted contraction is concentric (over a 5-10o range, with the instruction “gently push into my hand”); the subsequent stretch is passive.

Question 46

pnf technique - hold relax with agonist contract

Answer 46

Hold-relax with agonist contract: the resisted contraction is isometric; the subsequent stretch is active-assisted (contraction of the agonist muscle to move farther into the stretched position, with assistance from the therapist).

Question 47

pnf technique - contract relax with agonist contract

Answer 47

Contract-relax with agonist contract: the resisted contraction is concentric; the subsequent stretch is active-assisted.

Question 48

what are the 3 goals of ROM and flexibility exercises?

Answer 48

1) Maintain / increase ROM following acute injury or in a painful / irritable condition 2) ↑ ROM of a hypomobile joint 3) ↑ flexibility of a (relatively) short muscle

Question 49

goal 1: how to increase ROM prescription

Answer 49

Question 50

goal 2 parameters: ↑ ROM of a hypomobile joint

Answer 50

–Intensity: Moderate sensation of stretch (PROM or AAROM with OP) –Duration: 10 - 30 sec –Repetitions: 2 – 6 (total of 60s) –Frequency: ≥2-3 / wk (2 / wk is absolute minimum to see long-term change, more is better\*) \*leave enough time to rest btw bc microtearing

Question 51

parameters of Goal 3: ↑ flexibility of a (relatively) short muscle

Answer 51

Intensity: Moderate sensation of stretch (Static (passive vs. active) Ballistic (sport-specific … rarely used in rehab)) Duration: 10 - 30 sec Repetitions: 2 – 6 (total of 60s) Frequency: ≥2-3 / wk (2 / wk is absolute minimum to see long-term change, more is better\*)

Question 52

describe the "more is better" rule for stretching

Answer 52

Question 53

guideline to maintain flexibility

Answer 53

- at least 2 days a week, 10 minutes each time (absolute min!!)

Question 54

describe reasoning behind foam roller massage techniques

Answer 54

Question 55

describe flexibility exercise benefits

Answer 55

- does not reduce overall injury rates during exercise (but may reduce musculo tendon type injuries) - stretch before or after exercise does not confer protection from D.O.M.S - pre-exercise stretching = decreased stiffness of MT complex, Decreased force production & power, Decreased jump height, Improved running economy - regular flexibility - Improved force production and velocity of contraction, No effect on economy of motion - optimal flexibility determined by sport specific and individual factors, goal of program could be to balance flexibility (body moves through path of least resistance, therefor uneven flexibility affects movement)

Question 56

describe the things contributing to compliance

Answer 56

Question 57

how to motivate a patient

Answer 57

1. Educate the pt on the condition 2. Encourage active participation in the setting of goals and development of the HEP 3. Ensure the pt’s understanding of the role of the HEP in reaching the mutually-assigned goals 4. Determine pt willingness, and encourage pt to engage in activities that are appropriate for their condition 5. Find creative ways to meet pt’s goals and motivate them to strive for the next level 6. Be non judgmental 7. Accommodate for different learning styles (visual, auditory, tactile)

Question 58

how should a new exercise program be initiated?

Answer 58

Question 59

how to screen for risk of new exercise program for a pt?

Answer 59

Question 60

how to manage risks for any given exercise program

Answer 60