Treatments - Exercise

Question 1

Benefits of Exercise

Answer 1

> Increased well-being and confidence
Increased cardio + respiratory function
Increased muscle strength/power/tone
Increased balance + co-ordination
Decreased body fat
Decreased likelihood of cardiovascular disease
Decreased risk of osteoporosis
Decreased stress (increased relaxation)

Question 2

Function Requires

Answer 2

> Muscle performance
> cardiorespiratory fitness
> neuromuscular control
> stability/balance/posture
> mobility/flexibility

Question 3

Before exercise consider:

Answer 3

> Patient
- cognitive abilities
- cardiorespiratory status 
- RoM 
- Strength 
- Power
- Endurance 
- Co-ordination 
- Diagnosis + Prognosis (Realistic)
- Expectations + perception of needs (Patient-centred)
> Current treatments
> agreed expectations
> contraindications/ co-morbidities (when not to exercise)
> markers/ outcome measures - how will we assess + measure progress

Question 4

Oxford Scale

Answer 4

> 0 - no contraction
1 - flicker
2 - movement with gravity counterbalanced
3 - movement vs. gravity
4 - movement vs small resistance
5 - movement vs. large resistance/ equal to unaffected side
*2-5 = through range

Question 5

limitations to oxford scale

Answer 5

> lack of functional relevance
not linear pattern ie difference between 1 -2 is not the same as 2-3
patient will vary over time
subjective to assessor
only concentric measurement
difficult to apply to all cases
*dynamometer may be better to use for levels 4+5

Question 6

Passive Exercises - what are they

Answer 6

> 0 on oxford scale 
> 3 types:
- manually assisted
- auto relaxed - patient moves themselves passively
- mechanical reactive - by machine

Question 7

Passive Exercises - effects

Answer 7

> Maintain RoM
Prevent contractures
Increase synovial fluid production + circulation
maintain soft tissue integrity
increase kinaesthetic awareness (awareness of movement of body parts - stimulates joint receptors)
maintain functional movement patterns
Reduce pain

Question 8

Passive Exercises - Contraindications

Answer 8

> Post injury
- area = inflamed
- fracture could be displaced
- could cause further damage (tears/sprains/strains)
> Pain 
- beyond tolerance
- sharp or burning pain especially 
> Hypermobility 
> Circulation could be damaged

Question 9

Passive Exercises - Application

Answer 9

> 5-10 reps

> slow speed - don’t stimulate muscle spindle fibres

Question 10

Active Assisted exercise - what is it

Answer 10

> 1-2 on oxford scale
prime movers aren’t strong enough to perform full RoM
Assistance is provided - manual/auto/mechanical
*Position to eliminate gravity + provide help as required within available RoM
*mechanical = slide board/pole/band/gym ball/static bike

Question 11

Active Assisted exercise - effects

Answer 11

> Maintain physiological elasticity + contractility of participating muscles
Sensory feedback for contracting muscles
Stimulus for bone/joint tissue integrity
Increase circulation (prevent thrombus)
Develop co-ordination/motor skills (aid function down the line)

Question 12

Active Assisted exercise - Contraindications

Answer 12

> Disruptive to healing
- tears/fractures/surgery
*may decrease adhesions, thrombus risk, pain and recover time though
If causes increased pain/inflammation
Upper limb after chest surgery (MI/breast surgery/CABG/coronary angioplasty)
+ skin/nerve/tendon grafts - don’t want to stretch these

Question 13

Active Exercise - What is it

Answer 13

> 3 on oxford
muscle can contract actively and move segment through range without assistance
not vs. resistance though

Question 14

Active exercise - limitations

Answer 14

> strong muscles - won’t maintain/increase strength

> only develops skill/co-ordination in pattern used

Question 15

Active exercise - types

Answer 15

> Rhythmical 
> Pendular
> Single patterned
> open/closed chain
> short/long lever

Question 16

Active exercise - effects

Answer 16

> Maintain/Increase:
- RoM
+ boost nutrition to joint surfaces
- Protein synthesis (actin + myosin) - boosts muscle strength + length
- Cardiorespiratory fitness
- strength of connective tissues (greater stability/control)
Encourages relaxation of surrounding tissues
facilitates neuromuscular patterns
decreases pain
increases confidence

Question 17

Positioning for exercise

Answer 17

> Most appropriate position

• Stable
• maximise benefit
• resistance
• long/ short levers

> Lying (supine/side/prone)
sitting
kneeling/on all fours
standing

Question 18

PNF strengthening

Answer 18

> Repeated contractions
- concentric and eccentric (targeting same muscle group)

> Slow reversals
- concentric of both agonist and antagonist (ie push one one and pull back in)