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S3 - Clinical Practice 2 > Week 6- Resistance Training: Developing a Program, Types of Resistance, Blood Flow Restriction Therapy > Flashcards

Week 6- Resistance Training: Developing a Program, Types of Resistance, Blood Flow Restriction Therapy Flashcards

1
Q

RESISTANCE TRAINING: PROGRAM DEVELOPMENT

A

RESISTANCE TRAINING: PROGRAM DEVELOPMENT

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2
Q

What does the FITT Principle stand for?

A
  • Frequency
  • Intensity
  • Time
  • Type
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3
Q

What is frequency?

A

Number of exercise sessions (per day or week)

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4
Q

Frequency:

  • Frequency is dependent on other determinants such as _______ and _______ as well as patient ___________ and ______.
  • Recommended frequency will vary with type of exercise. What is an example of this?
  • Shorter sessions can be performed more frequently and is often seen initially in _________ care with isometrics or with endurance training.
  • Most maintenance programs fall more in the _-_x/week.
A
  • intensity and volume
  • characteristics and goals
  • Eccentric frequency will be < concentric due to increased tissue micro-trauma and higher incidence of DOMS.
  • post-op
  • 2-3x
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5
Q

Frequency:

  • Frequency is _______ dependent.
  • Can range from a few weeks to a lifetime recommended “__________ program”
  • Strength gains may occur as quickly as __-__ weeks, however hypertrophy and increased vascularization may take up to ___ weeks.
A
  • goal
  • maintenance
  • 2-3 weeks, 12 weeks
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6
Q

What is intensity?

A

How hard you exercise.

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7
Q

With intensity it is important to remember the __________ principle. What is this principle influenced by?

A
  • overload principle

- amount of resistance, volume, frequency, order of exercises, length of rest periods

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8
Q

When possible we want to establish a _____ or __________ for intensity.

A
  • 1RM

- Multiple RM

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9
Q

What are the 2 ways we can determine the 1RM?

A
  • Manually

- Oddvar Holten Diagram

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10
Q
  • What can we do if it is not safe or we can’t perform a 1RM?
  • How do we do this?
  • If we ask the patient to do 3x10 for strength and they do 30 in a row, are we applying the overload principle?
A
  • Take an educated guess on where to start and then illicit patient feedback.
  • Ask if they felt fatigued after the last rep.
  • No, we are NOT working resistance.
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11
Q

For intensity,it is desirable to establish a __________ _____ for your clients.

A

TRAINING ZONE

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12
Q

In regards to Training Zones:
-To achieve muscular adaptation for those who are sedentary/untrained, percentage of 1 RM necessary to work is ___ (__%- __%) initially
For those who are highly trained and desire improvements in muscle adaptation, may need to train in a zone of __% or higher of 1 RM
For healthy adults who are not accustomed to participating in strengthening exercises, Training Zone typically falls between __% - __% of 1 RM
Exercising on lower end of the % values is safer in the _________ of a program

A
  • low, 30-40%
  • 80%
  • 60-80%
  • beginning
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13
Q

For intensity, when is submaximal vs. maximal intensity used?

A

Submaximal

  • early stage of soft tissue healing
  • after prolonged immobilization
  • when initially learning exercise
  • when goal is muscle endurance
  • during warm up and cool down

Maximal

  • when goal is increased strength and power
  • for conditioning program for people with no pathology
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14
Q
  • Volume is the total number of _______ and _____ of an exercise * the ________ at which it’s performed.
  • The average adult can do 10 reps at __% of their 1RM before fatiguing.
A
  • repititions and sets, intensity

- 75%

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15
Q

What would the reps and sets look like for muscle strength vs muscle endurance?

A

Muscle Strength
-3 sets of 10 reps

Muscle Endurance

  • 3-5 sets of 40-50 reps
  • isometric contractions for longer periods of time
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16
Q

Is muscle strength or endurance initiated early in the rehab program?

A

Muscular endurance due to its decreased risk of injury to healing tissues.

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17
Q

_______ recovery leads to more rapid recovery than _________.

A
  • active

- passive

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18
Q

What are the general recommendations for recovery/rest times in high intensity, moderate intensity, and low intensity exercise.

A
  • High Intensity = >3m
  • Moderate Intensity = 2-3m
  • Low Intensity = <2m
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19
Q

What is time?

A

Time of day and how long.

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20
Q

Time is going to fluctuate based off the patients ______ and their ___________.

A

goals and motivation

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21
Q

What is type?

A

What kind of exercise are you doing.

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22
Q

What are the considerations to take into account when looking at the type of exercise?

A
  • dynamic vs. static
  • WB vs. NWB
  • manual vs. mechanical resistance
  • Which types of muscle contractions are you trying to elicit and for what purpose?
  • What is available to you in your setting?
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23
Q

Isometric (static)

  • What is isometric exercise?
  • There is a need for ______ strength with most daily activities.
  • Muscular endurance may play more of a role than strength when it comes to “________” strength. We lose this type of “_______” strength very quickly (-% a day) with immobilization.
  • Research suggests that static exercise has an ________ effect.
A
  • “Holding” against manual resistance
  • static
  • “postural”, “postural”, 5-8%
  • analgesic
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24
Q

Isometric (static) holds should be completed for between __-__ seconds at a minimum to achieve adaptive muscular changes. The use of repetitive contractions is more effective than one long hold due to decreases in muscle cramping and improving the quality of each contraction.

A

-6-10s

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25
Q

When are isometrics (static) appropriate and encouraged?

A
  • when goal is to minimize atrophy
  • after acute soft tissue injury
  • developing postural stability
  • when dynamic resistance exercises causes pain or if it is unsafe
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26
Q

What is the main precaution with isometric (static) holds? Why?

A

Ensure patient does not hold their breath (Valsalva maneuver) because it can lead to a rapid increase in BP and fainting.

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27
Q

Dynamic (eccentric or concentric):

  • Resistance exercises performed using ________ or _________ contractions, or both
  • Application of resistance can be constant with use of body weight, free weight, or pulley system or variable such as performing active resistance exercise with bands
  • Both concentric and eccentric strength training are essential for daily life and should be incorporated
A

concentric or eccentric

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28
Q

With muscles that have <3/5 muscle grade, are eccentric muscle contractions against gravity better than performing active concentric exercises? Why or why not?

A

Yes, eccentric load is controlled by both the contractile unit of the muscle AND surrounding supportive tissue. Concentric is primarily the contractile muscle that is loaded.

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29
Q

Do we get DOMS more so with eccentric or concentric contractions?

A

eccentric

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30
Q

What are the precautions for eccentric exercises?

A

Greater stresses occur on CV system during eccentric; ensure proper breathing and discourage valsalva

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31
Q

What are 2 things to think about when talking about form of resistance training?

A

Alignment
-ensure body segments are lined in a way to optimize the appropriate action of the muscles
Stabilization
-“steadiness” of the body, necessary to maintain alignment and appropriate movement patterns

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32
Q

What are the 2 types of stabilization?

A
  • external

- internal

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33
Q

PROGRAM DEVELOPMENT

A

PROGRAM DEVELOPMENT

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34
Q

What are the 5 stages of rehabilitation?

A
  1. ) Tissue healing phase
  2. ) Mobility phase
  3. ) Performance initiation/stabilization and motor control phase
  4. ) Performance improvement phase
  5. ) Advanced skill, agility, coordination
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35
Q
  1. ) Tissue Healing Phase:
    - ______ and _________ are most beneficial exercises in this phase
    - Controlled and progressive mobility is indicated to remodel tissues along the lines of tensile strength
    - The timeframe at which tissue healingoccurs depends on the ______ of tissue and _______ of the damage
A
  • ROM and isometrics

- type, extent

36
Q

What are the 3 stages of tissue healing?

A
  1. ) Inflammatory
  2. ) Proliferative
  3. ) Repair and Remodel
37
Q

In the inflammatory phase of tissue healing we want to apply __________ increase in stress on tissues. Our goal is to control inflammation through muscle contraction is a ____-____ ROM to help minimize ROM loss.

A
  • gradual

- pain-free

38
Q

In the proliferative phase of tissue healing we want to monitor our ROM and strengthening exercises for aggravation of _________ or symptoms of ___________ or ______________.

A
  • signs

- regression or inflammation

39
Q

In the Repair/Remodel phase of tissue healing we will integrate more agressive active ROM and strengthening exercises to facilitate tissue ___________ and _________ along the lines of stress.

A

remodeling and realignment

40
Q
  1. ) Mobility Phase:
    - If signs of inflammation have disappeared, are showing signs of decreasing, or are not worsened with the mobility activities for greater than __ hours, patients can progress to this phase.
    - Can patients skip straight to this phase? How?
    - Determining which ROM exercise to use is dependent on patient _________ and what type of ________ impairment is present.
A
  • 24 hours
  • Yes, if signs of inflammation are not present and proliferation appears to have begun
  • irritability, mobility
41
Q

If mobility is an issue it should be determined if it is due to a ______________ limitation or an ____________ limitation. How are these 2 treated differently?

A

Arthrokinematics
-generally treated with a joint mobilization)
Osteokinematic
-generally treated using ROM/stretching exercises)

42
Q
  1. ) Performance Initiation/Stabilization and Motor Control Phase:
    - Can patients skip to this phase? How?
    - Patients should be in the ___________ or __________ stages of healing.
    - Is full mobility required to begin this stage?
A
  • Yes, if signs of inflammation are absent, decreasing, or are not worsened with the introduction of these exercises for greater than 24 hours.
  • proliferative or remodeling
  • No, but pain-free range is essential
43
Q
  • Are concentric exercises the only ones we can use in the Performance Initiation/Stabilization and Motor Control Phase?
  • In this phase, our focus should be on ________ not _________ as well as optimal dynamic control.
  • To decide the most appropriate muscle action, apply the ______ principle
A
  • No, we can use concentric, eccentric, and isometric
  • quality not quantity
  • SAID
44
Q

Proximal __________=Distal __________

A

Proximal Stability = Distal Mobility

45
Q
  1. ) Performance Improvement Phase:
    - Can patients skip to this phase? How?
    - Patients should be in the ___________ or __________ stages of healing.
    - Is full mobility required to begin this stage?
A
  • Yes, if signs of inflammation are absent, decreasing, or are not worsened with the introduction of these exercises for greater than 24 hours.
  • proliferative or remodeling
  • No, but pain-free range is essential
46
Q
  • In the Performance Improvement Phase, are we applying the SAID principle?
  • Once the training goals component has been identified, the muscle action (concentric, eccentric or isometric), load, reps & sets, positioning, order, rest periods, velocity and frequency parameters are ______ and ________
A
  • Yes

- decided and adjusted

47
Q
  1. ) Advanced Skill, Agility, Coordination Phase:
    - What is this phase?
    - Is this stage solely for those returning to competition or sports?
A
  • Once patients have progressed through rehabilitation and have approached near normal muscle performance without signs of tissue injury or mobility issues.
  • No
48
Q

If an impairment has been linked to activity limitations, what should we consider?

A
  • Is the impairment amenable by physiotherapy?
  • What are the potential negative effects of the exercise for that impairment?
  • What is the cost:benefit ratio of the exercise for that impairment?
  • Can it lead to future impairment if left untreated?
49
Q

What are some considerations to acknowledge when creating an initial program?

A
  • Which muscle groups require training, which other muscles work with it,and which contraction typeis needed for functional activities?
  • What range or position does the muscle have to function? At what speed?
  • What type of training is required? i.e. strength, endurance, power, motor control, a combination
  • What is the patient’s training history/current status?
  • What is the most appropriate way to load tissues for this patient given their history/current status?
  • What precautions are present?
  • What stage of healing are they most likely in?
50
Q

Resistance training in any rehabilitative setting should be related to __________.

A

function

51
Q

It is important to educate the patient that there is a required balance of __________ with active ________ for optimal performance or goal achievement.

A
  • stability

- mobility

52
Q

TYPES OF RESISTANCE

A

TYPES OF RESISTANCE

53
Q

What are the 3 main categories for Forms of Resistance?

A
  • Constant vs. Variable
  • Open vs. Closed Chain
  • Manual vs. Mechanical
54
Q

What is a constant resistance exercise?

A 
Dynamic exercise (isotonic) against constant external resistance (DCER)
-example is curling a dumbbell
55
Q

What is the limitation of constant resistance exercises?

A

Limitation of DCER is that the working muscle is only maximally challenged at one point during the arc of motion.

56
Q

What is a variable resistance?

A

Involves variable levels of resistance using a pulley and weight system
-example is an elastic band

57
Q

What is isokinetic training?

A

Velocity of resistance is kept constant throughout the entire joint’s ROM.

58
Q

What are the positives of isokinetic training?

A
  • can exercise at a wide range of velocities
  • specific velocities of training that correlate to specific tasks and function
  • concentric and/or eccentric contraction
  • the resistance applied = the force being applied the the extremity, this may allow for patient to perform increased number of reps as fatigue begins to set in
  • accomodate exercise to pain, less resistance through the painful arc, but still allowing for reps to occur
59
Q

What are the negatives of isokinetic training?

A
  • limited evidence of how this training carries over to function
  • isolation of a single muscle and is uniplanar
  • does not involve weight bearing
  • patient cannot typically carry over isokinetic programs
60
Q
  • What is open chain?

- What is closed chain?

A

Open Chain
-Distal segments are free to move in space without necessitating simultaneous motions at other joints
Closed Chain
-Motions where body moves on distal segments that is fixed or stabilized on a support surface; typically performed in weight bearing positions

61
Q

Weight bearing is typically though of as ______ chain and non weight bearing is typically thought of as _______ chain.

A
  • closed

- open

62
Q

For each of the following statements, indicate whether it is open chain or closed chain:

  1. ) Joint approximation in weight bearing and axial loading is associated with less shear force than open chain activity, leading to increased stability of the joint
  2. ) Weight bearing positions stimulate mechanoreceptors and proprioceptors → activates both agonists and antagonists → better stability
  3. ) May be superior in isolating one muscle group
  4. ) May have better outcomes for those working to improve balance
  5. ) Greater level of control can be achieved with a single moving joint; may be advantageous in early stages of rehabilitation
  6. ) Option for those who have limited weight bearing status
  7. ) Better for those who have soft tissue inflammation or pain
  8. ) Increased likelihood for substitution due to multiple joints moving
  9. ) Necessitates the functional challenge of multiple muscles being activated for postural support; may have improved carry over for those who have postural weakness
  10. ) At times can be more easily replicated for initial exercise program
A
  1. ) closed chain
  2. ) closed chain
  3. ) open chain
  4. ) closed chain
  5. ) open chain
  6. ) open chain
  7. ) open chain
  8. ) closed chain
  9. ) closed chain
  10. ) open chain
63
Q

What are 5 parameters used for the progression of closed chain exercises?

A
  1. ) % body weight
  2. ) Base of support
  3. ) Balance
  4. ) Plane of movement
  5. ) Speed
64
Q

Difference between manual and mechanical resistance?

A

1

65
Q

General Guidelines for Manual Resistance:

  • Ensure appropriate body ________ for yourself as treating therapist
  • Keep patient’s limb _______ to you for optimization of control
  • Use a gradual, graded technique when _______ or ________ resistance
  • Employing ________ commands is very helpful; be sure to coordinate the timing of your commands with the applied resistance to elicit the contraction and response you desire
A
  • mechanics
  • close
  • applying or releasing
  • verbal commands
66
Q

What are the advantages of manual resistance?

A
  • Effective in early rehabilitation; good way to transition to mechanical resistance
  • Therapist can perform more “fine tuning” in grading resistance
  • Able to challenge the muscle to work at it’s maximum potential through entire ROM
  • Can utilize statically or dynamically
  • Easily adjust resistance or patient position
  • Requires/ allows for more direct contact with the patient
67
Q

What are the disadvantages of manual resistance?

A
  • Exercise load applied is subjective, cannot be measured
  • Resistance applied is limited to strength of the therapist
  • Cannot be safely performed at higher speeds
  • Not useful for transition into home program unless caregiver is trained consistently and adequately
  • Labor and time intensive for therapist
  • Not practical for improving muscular endurance
68
Q

What is some common equipment used for mechanical resistance training?

A
  • free weights
  • pulley systems
  • variable resistance units
  • elastic bands
  • dynamic stabilization equipment
  • closed chain related equipment
69
Q

What are the advantages of mechanical resistance?

A
  • Obj. measure resistance and repeat, progress easily
  • Appropriate for patients in the intermediate/ advanced stages of rehabilitation or when the patient’s strength is greater than the therapist’s ability to apply force
  • Appropriate for building muscular endurance allowing for a high number of repetitions
  • Certain pneumatic machines allow for variable resistance/ velocities
  • Can be carried over into HEP with training and initial supervision
70
Q

What are the disadvantages of mechanical resistance?

A
  • Not appropriate with very weak muscles or soft tissues in early stages of healing
  • Only maximally challenges muscle at one point during the range of motion
  • Cable weight and pneumatic systems can be expensive
  • Machines, elastic bands and free weights are manufacturer specific
71
Q

With free weights, we need to consider the _______ and joint angles at which the muscle is going to be maximally loaded.

A

levers

72
Q

What are the advantages to free and pulley weight training?

A

-Positions easily varied; more muscle groups accessible
Stabilizing muscles required!*
-Multiple movement patterns are feasible*
-Depending on equipment availability, resistance can be graduated by small increments
-Easily incorporating into HEP (potentially depending on availability of equipment)

73
Q

What are the disadvantages to free and pulley weight training?

A
  • Due to the requirement of appropriate stabilization, may take longer for proper form and correct alignment to be achieved
  • Must ensure controlled movement to minimize unsafe acceleration and deceleration and end range movements; risk for joint damage
  • By necessitating slow/controlled movements may have less direct functional carry over for quicker activities
  • Spotter/ assistance necessary when utilizing heavier free weights/ bar bells
74
Q

Elastic resistance exercise provides __________ resistance through properties of elongation.

A

variable

75
Q

What are the advantages of elastic exercise?

A
  • Portable
  • Inexpensive
  • Easy to set up for home programs
  • Safe to exercise at higher velocities
  • Able to exercise in multiple planes of movement
  • No external stabilization, adds postural challenge*
76
Q

What are the disadvantages of elastic exercise?

A
  • Needs replaced (especially ones used frequently in the clinic) on a routine basis
  • Material fatigue: occurs most significantly in first 20-50 stretch cycles; however after this studies support bands do not have a substantial loss in elastic tension until more than 5000 cycles of stretch occur!
  • LATEX ALLERGY PRECAUTIONS!
  • Lack of “standardized” resistance; company dependent; may be more difficult to document progress
77
Q

BLOOD FLOW RESTRICTION THERAPY

A

BLOOD FLOW RESTRICTION THERAPY

78
Q

What is blood flow restriction therapy?

A
  • Training method involving applying a tourniquet system to the most proximal region of the UE/LE.
  • This partially restricts arterial flow and fully restricts venous flow in muscle that is being exercised.
  • This results in inadequate O2 supply in the muscle tissue.
  • Compression of venous outflow results in blood pooling in capillaries.
  • When muscle contractions are performed, there is an increase in intramuscular pressure which further disturbs blood flow.
79
Q

When can BFR be applied?

A
  • voluntary resistance exercise
  • aerobic exercise
  • passively without exercise
80
Q

What is the goal of low load resistance exercise with BFR?

A

Mimic the effects of high intensity exercise by creating a hypoxic environment while performing low intensity exercises

81
Q

Is high load resistance exercise or BFR superior in enhancing muscle strength and hypertrophy?

A

High load resistance

82
Q

If high load resistance is better than BFR, then why would we use BFR?

A

BFR is still better than low load resistance exercises and can be used when high load resistance exercise is not appropriate.

83
Q
  • BFR training with aerobic exercise usually occurs with _______ or _______.
  • Can this lead to significant improvement in aerobic capacity?
  • Intensity used during BFR-AE are generally ____ in nature (__% HR reserve or __% VO2 max)
A
  • walking or cycling
  • yes, but not always
  • low, 45%, 40%
84
Q

What can BFR without exercise be helpful?

A

-could provide benefits for patients following surgeries, prescribed bed rest, or in intensive care unit if not contraindicated

85
Q

What is the main concern of BFR?

A

formation of venous thromboembolism (DVT and pulmonary embolism) and muscle damage

86
Q

What are the contraindications for BFR therapy?

A
  • venous thromboembolism
  • peripheral vascular compromise
  • sickle cell anemia
  • extremity infection
  • lymphadenectomy
  • cancer or tumor
  • extremity w/ dialysis access
  • increased intracranial pressure
  • vascular grafts
  • medications known to increase clotting risk

S3 - Clinical Practice 2 (13 decks)

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