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STRENGTHENING EXERCISE

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1 STRENGTHENING EXERCISE
PT 153: Therapeutic Exercise 2 STRENGTHENING EXERCISE AILA NICA J. BANDONG, PTRP Instructor Department of Physical Therapy UP-College of Allied Medical Professions

2 Learning Objectives At the end of the lecture, the students should be able to: identify the factors affecting tension generation in muscles. discuss the principles of resistance exercise aimed at increasing strength. discuss the determinants of resistance exercise. differentiate the various forms of resistance exercise. identify guidelines to providing resistance exercise for various age groups. discuss considerations for designing resistance exercise for children. enumerate precautions and contraindications to treatment using resistance exercise.

3 Strength Power Endurance MUSCLE PERFORMANCE

4 STRENGTH Ability of contractile tissue to produce tension and a resultant force based on the demands placed upon it Greatest measureable force that can be exerted to overcome resistance in one maximum effort

5

6 STRENGTH TRAINING A systematic procedure of a muscle or muscle group lifting, lowering, or controlling resistance for a particular number of repetitions or over a short period of time

7 Principles of Resistance Exercise
Overload SAID Reversibility

8 Overload Principle If improvements in muscle performance is desired, the muscle must be challenged to perform at a level greater than that to which it is accustomed to Progressive loading of muscle through increasing intensity or volume

9 SAID Principle S pecific A daptation to I mposed D emands
A framework of specificity is a necessary foundation on which exercise programs should be built

10 Reversibility Principle
Unless training-induced improvements are regularly used or resistance exercises are maintained, adaptive changes are only temporary Detraining begins at one to two weeks after cessation of exercise

11 Effect of Strength Training
Increase in the maximum force-producing capacity of muscle due to physiological adaptations of the body to resistance exercise

12

13 Determinants of Resistance Exercise
Alignment Stabilization Intensity Volume Exercise order Frequency Rest interval Duration Mode of exercise Velocity Periodization Integration to functional activities

14 Alignment Muscle Action Gravity
The direction of movement of a limb or segment of the body replicates the action of the muscle or muscle group being strengthened Gravity Muscle being strengthened should act against the resistance of gravity and additional force provided by a device/equipment

15 Stabilization Refers to holding down a body segment or keeping the segment/body steady during performance of exercise External Internal

16 Intensity aka training load, exercise load
Amount of resistance imposed on the contracting during each repetition Should follow the overload principle Intensity is greater than the usual load carried and progressively and gradually increased

17 Intensity: Sub-maximal Loading
Indications At the beginning of exercise During early stage of soft tissue healing After immobilization Children and older adults Improvement of muscular endurance During warm up and cool down During slow-velocity isokinetic training

18 Intensity: Maximal Loading
Indications Goal to increase strength and power and muscle size Healthy individuals in the advanced phase of a rehab program Conditioning program for the well population Training for competitive weight lifting and body building

19 Intensity: Determining the Amount of Load
Repetition Maximum Other methods Cable tensiometry Dynamometry (hand-held, isokinetic) Percentage body weight

20 Intensity: Calculating Initial Load
As a factor of repetition maximum Sedentary individuals/untrained individuals/children/elderly: 30% to 40% of 1RM Patients with significant strength impairments: 30% to 50% of 1RM Highly trained individuals: 80% to 95% of 1RM

21 Intensity: Calculating Initial Load
As a factor of body weight (percentage) Universal bench press: 30% body weight Universal leg extension: 20% body weight Universal leg curl: 10-15% body weight Universal leg press: 50% body weight

22 Volume Summation of the total number of repetitions and sets of a particular exercise during a single session Inverse relationship between intensity and volume of resistance exercise Repetitions vs. Sets

23 Volume: Training to Improve Strength
Exercise protocols De Lorme Oxford DAPRE Use an exercise load that cause fatigue after 6 to 12 repetitions for two to three sets; if fatigue no longer occurs, increase level of resistance

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25 Exercise Order Refers to the sequence in which muscle groups are exercised during a session Large muscle groups before small, isolated muscles Multi-joint muscles before single-joint muscles Higher intensity exercise before lower intensity (following an appropriate warm up)

26 Frequency Number of sessions performed in a day or in a week
Dependent on the following factors: Intensity Volume Patient’s goals Health status Previous participation in resistance exercise Response to training

27 Frequency: Guidelines
Low intensity, low volume: short sessions performed daily or several times daily As intensity and volume increases: frequency decreases to every other day or up to five sessions weekly Frequency of two times weekly for maintenance programs

28 Frequency: Guidelines
Prepubescent children and very old: frequency is two to three times/sessions weekly Highly-trained athletes: high intensity and high volume performed 6 days per week

29 Rest Interval aka recovery period
Rest between sets and exercise sessions Dependent on the intensity and volume of exercise as well as status Active recovery is more efficient than passive recovery to neutralize effects of fatigue Decreasing rest interval between bouts and sessions as strategy to increase dosage

30 Duration Total number of weeks or months that the resistance exercise program is performed For hypertrophy or increase in vascularization to occur, at least 6 to 12 weeks of resistance training is needed Depending on the nature of impairment, the training program may last from about a month or two to lifetime training to maintain optimal function

31 Mode of Exercise The form or type of exercise or the manner in which the exercise is carried out Classification: Forms of exercise Type of muscle contraction Weight bearing vs Non-weight bearing Energy system used Short arc vs Full arc exercise

32 Mode of Exercise: Forms of Exercise
Manual and mechanical resistance Constant or variable load through free weights/weigh machines Accommodating resistance using isokinetic dynamometer Body weight as resistance

33 Mode of Exercise: Type of Muscle Contraction
Isometric or dynamic muscle contraction Dynamic can be performed either CONCENTRICALLY or ECCENTRICALLY Isokinetic contraction: speed of limb movement is held constant by a device/equipment (controlled dynamic contraction)

34 Mode of Exercise: Weight-bearing vs Nonweight-bearing
Nonweight-bearing with distal extremity moving: open-chain exercise Weight bearing with body moving over a fixed distal segment/extremity: closed-chain exercise

35 Mode of Exercise: Energy Systems
Anaerobic exercise: high-intensity exercise carried out for a limited number of repetitions and utilized as part of a strengthening exercise program

36 Mode of Exercise: Short-arc vs Full-arc
Full-arc: develop strength throughout the entire range of motion Short-arc: utilized to avoid painful motion or a part of the range where the joint is unstable and to protect healing tissues following injury

37 Velocity Refers to the speed with which an exercise is performed
Varies with concentric and eccentric muscle contraction

38 Velocity: Implication to Resistance Training
With free weights, slow to medium speed/velocity of movement is safer and more effective as patient can maintain control of movement Speed-specific training Plyometric training Isokinetic training

39 Periodization aka periodized training
A method of designing a systematic variation in exercise intensity and volume at regular intervals over a specified period of time Used to limit overtraining and psychologic staleness Designed for preparing athletes for competition

40 Integration to Function
Balance of stability and active mobility Exercise program should address both static and dynamic strength of the trunk and extremitites Balance of strength, power, and endurance Progression of movement patterns Isolated strengthening, combined patterns, task-oriented movement patterns

41 Manual Resistance Exercise
A form of active-resistive exercise in which resistance is applied by the therapist to a dynamic or a static muscle contraction Throughout the available ROM Various planes of motion Isolated muscle contraction or group of muscles

42 Mechanical Resistance Exercise
aka weight training, load-resisting exercise Any form of exercise in which the resistance is applied by an equipment

43 Equipments Used Free weights Elastic resistance Weight-pulley system
Closed-chain training equipments Reciprocal exercise equipment Isokinetic training equipment

44 Exercise Regimens Progressive Resistive Exercise
Circuit Weight Training Plyometric Training Isokinetic Regimens

45 Exercise Regimens: Progressive Resistive Exercise
Dynamic resistance training in which a constant external load is applied to the contracting muscle and incrementally increased Use of RM as basis for determining and progressing resistance

46 DeLorme Oxford Determination of 10 RM 10 reps @ 50% of 10 RM

47 100% of adjusted working weight
SETS REPETITIONS AMOUNT OF RESISTANCE 1 10 50% of 6 RM 2 6 75% of 6 RM 3 Maximum possible 100% 0f 6 RM 4 100% of adjusted working weight

48 Adjusted working weight (DAPRE)
Repetitions in Set 3 Set 4 Next Exercise Session 0-2 5-10 lbs 3-4 0-5 lbs Same weight 5-6 Same weight 7-10 5-15 lbs 11 or more 10-15 lbs 10-20 lbs

49 Exercise Regimens: Circuit Weight Training
Pre-established sequence of continuous exercises are performed in succession at individual exercise stations that target a variety of major muscle groups (8-12) as an aspect of total body conditioning Minimum amount of rest interval between stations (15-20 seconds) Alternate among upper/lower extremity and trunk musculature

50 Exercise Regimens: Circuit Weight Training
Bench press Leg press or squats Sit-ups Upright rowing Hamstring curls Trunk extension Shoulder press Heel raises Push-ups Leg lifts or lowering

51 Exercise Regimens: Plyometric Training
aka plyometrics, stretch-shortening drills, reactive neuromuscular training A system of high-velocity resistance training characterized by a rapid eccentric contraction followed by a rapid shortening contraction of the same muscle

52 Exercise Regimens: Plyometric Training
Three phases Stretch cycle: eccentric loading phase Amortization phase: period of time between stretch and shortening cycles Shortening cycle : concentric phase Sources of resistance: body weight, external load

53 Exercise Regimens: Plyometric Training
Appropriate only in the later stages of rehabilitation of active individuals requiring high level of physical performance in high-demand activities CRITEARIA for Plyometric Training: 80 to 85% level of strength 90 to 95% ROM

54 Exercise Regimens: Isokinetic Regimens
Velocity Spectrum Rehabilitation Performance of exercises at various velocities Limb is accelerated at the predetermined speed/velocity then resistance is applied by the torque arm of the dynamometer through a small portion of the ROM Performed without pain

55 Exercise Regimens: Isokinetic Regimens
Training velocities Medium angular velocity: 60/ degrees/sec Fast angular velocity: degrees/sec Increments of 30 degrees/sec Sub-maximal intensity/effort for a brief warm-up period  maximal intensity

56 Exercise Regimens: Isokinetic Regimens
One or two sets of 8-10 upto 20 repetitions of concentric contractions of antagonist muscle groups at multiple velocities Rest of seconds between sets and 60 seconds rest period between exercise speeds Maximum frequency of 3x/week

57 Exercise Regimens: Isokinetic Regimens
Progression Submaximal  maximal Intermediate and slow speed  fast Short arc  full arc exercises Concentric  eccentric Eccentric performed to further challenge the individual muscle groups when strength deficits persist

58 Exercise Regimens: Isokinetic Regimens
Eccentric Isokinetic Training

59 Isometric Exercise aka static exercise
Muscle contracts and produces force without change in length of the muscle and without visible joint motion Sources of resistance: Manually, weights, maintaining a position against body weight, pushing/pulling an immovable object

60 Rationale and Indications
Prevent or minimize muscle atrophy when joint motion is not possible due to external immobilization Activate muscles to begin to re-establish control and protect healing tissues following soft tissue injury or surgery Develop postural or joint stability Improve muscle strength if dynamic exercise could cause joint pain and compromise joint integrity Develop static muscle strength st particular points in the ROM needed for specific task-related needs

61 Types of Isometric Exercise
Muscle-setting exercise Stabilization exercise Multiple-angle isometrics

62 Muscle-setting Exercise
Low intensity isometric exercise performed against little to no resistance Benefits: Promotes relaxation and circulation Decrease muscle pain and spasm after injury to soft tissues during acute stage of healing Maintains mobility between muscle fibers during healing Retard atrophy during immobilization

63 Stabilization Exercise
Benefits: Develop sub-maximal but sustained level of co-contraction Reduce instabililty Enhance joint or postural stabililty Variations: Rhythmic stabilization Alternating isometrics Dynamic stabilization

64 Multiple-angle Isometrics
A system of isometric exercise where resistance is applied manually or mechanically at multiple joint positions within the available ROM Goals: Improve strength throughout ROM but dynamic resistive exercise causes pain or not advised

65 Considerations Intensity: dependent on joint position
Duration: held for 6-10 seconds to allow for peak tension to develop and for metabolic changes to occur Repetitive Contractions: decreases muscle cramping and increases effectiveness of the regimen Joint Angle: resistance at 4-6 points in the available ROM

66 Limitations Improvements occur only at or closely adjacent to the training angle Little or no carry-over of strength gains to dynamic exercise Not as effective for developing muscle endurance as resisted dynamic exercise

67 Guidelines: Healthy Adults (<60 y/o)
Perform warm-up activities followed by flexibility exercises prior to resistance training For total body muscular fitness: perform dynamic exercises that target approx 8-10 muscle groups of the U/LE Balance flexion-dominant (pulling) with extension-dominant (pushing) exercises Move through the full, available, and pain-free ROM Include both concentric (lifting) and eccentric(lowering) muscle actions

68 Guidelines: Healthy Adults (<60 y/o)
Use moderate-intensity exercises at least 8-12 repetitions per set Perform 1-3 sets of each exercise Include rest periods of seconds between sets Frequency of 2-3 times per week Use slow to moderate speeds of movement Use rhythmic, controlled, non-ballistic movements Cool down after the completion of exercise

69 Guidelines: Healthy Adults (<60 y/o)
Exercises should not interfere with breathing: avoid valsalva maneuver Increase intensity gradually (5% increments) as progression Train with a partner for feedback and assistance, if possible When re-initiating weight training after a period of exercise cessation (>1-2 weeks), reduce resistance and volume of exercise

70 Guidelines: Older Adults (>60 y/o)
Perform at least 5-10 minutes of warm-up activities before each session of resistance exercises Low to moderate levels at repetitions for 6-8 weeks Perform resistance training 2-3x weekly, allowing 48-hour rest periods between sessions Avoid flexion-dominant resistance training that could emphasize postural changes

71 Guidelines: Older Adults (>60 y/o)
Low intensity exercise to minimize excessive stress on the joints Resistance training should be initiated with close supervision and minimal resistance Maintain functional ROM Monitor vital signs, especially when the program is progressed After a 1 to 2-week layoff, reduce the intensity of weight training by 50%

72 Resistance Exercise Among Pre-adolescents (Blimkie, C., 1993)
Pre-adolescence: period between pre- and early puberty until 11 y/o (girls) and 13 y/o (boys) Remained to be a debatable issue among the lay and scientific community Positive correlation of strength gains and resistance training can not be generalized due to methodological flaws and limited literature

73 Physiologic Adaptations
VARIABLES TRAINING DETRAINING Max voluntary strength Definite increase Likely decrease Evoked twitch force Likely increase Unknown Muscle cross-sectional area Likely no change Probable no change (uncertain) Neuromuscular adaptation Probable decrease (uncertain) Motor coordination Probable increase (uncertain) Body mass Definite no change Lean body mass Body fat Stature

74 Potential Benefits and Risks
VARIABLES EFFECTS Sports Performance Improvements in performance Prevention of Injury Diminished susceptibility in injuries Recommended for girls as part of osteoporosis prevention Rehabilitation from Injury Accelerated rehabilitation after injury Injury Risk (weightlifting) Moderate: unsupervised conditions and during competitive lifting Low: supervised and properly prescribed programmes Cardiorespiratory Illness No effect or possible improvement depending on the nature of the training programme Weightlifting Blackout Not likely in properly-instructed, supervised and prescribed programmes Resting Blood Pressure No proven detrimental effect

75 Goals Maintain activity Enjoy movement Develop lifelong
activity habits

76 Guidelines: Children and Adolescents
No formal resistance training for children less than 6 to 7 years old At age 6 to 7, introduce the concept of exercise initially without weights  using light weights Maintain close and continuous supervision by a trained personnel or a parent who has received instructions Focus on proper form, exercise technique, and safety: alignment, stabilization, and controlled motion

77 Guidelines: Children and Adolescents
Perform warm-up and cool down for 5 to10 mins Low exercise loads of at least 8 to 12 or repetitions Perform 1 to 2 sets of each exercise allowing rest periods of about 3 minutes between sets Frequency limited to 2 exercise sessions per week Initial progression through increasing repetitions, not resistance; or increasing the total number of exercise  increase resistance by 5% at a time Gradually progress activities

78 Guidelines: Children and Adolescents
Provide a variety of activities that target larger muscle groups, multi-joint, combined exercises Focus on active, creative, enjoyable play in very young children Encourage children >6 yrs to accumulate a minimum of 30 minutes of at least moderate-intensity activity in most, if not all, days of the week Encourage older children to participate in minutes of higher intensity activity at least 3x a week

79 Specific Guidelines Encourage resistance training as only one of a variety of normal recreational and sport activities Encourage using a variety of different training modalities (free weights, body weight, etc) Discourage inter-individual competition, and stress the importance of personal improvement

80 Specific Guidelines Discourage extremely high intensity (loading) efforts Avoid isolated eccentric training Encourage a circuit system approach to capitalize on possible cardiorespiratory benefits

81 Precautions: Children and Adolescents
Ensure safety as children are anatomically, physiologically, and psychologically immature Use appropriate equipment, match activity to maturation or skill level, provide adequate skill preparation Children are less tolerant to high heat load and increased susceptibility to hypothermia in a cold environment Limit strenuous prolonged exercise, provide good hydration, and use appropriate clothing

82 Documentation _____ x ______ x _____ x ______, ______
type intensity # of reps # of sets frequency mode or amount of number number number of form of load that of times of bouts times the resistance will be the ex in a day exercise exercise used will be to be performed performed in a week

83 Documentation Example 1 Resistance exercise of the right upper extremity muscles using free weights (dumbbell) x 10 lbs x 10 repetitions x 2 sets, thrice a week

84 Documentation Example 2 Manual resistance exercise of the left hip flexors x 8 repetitions x 2 sets, thrice a week

85 Documentation Example 3 Multiple angle isometrics of the right knee extensors x 7 seconds hold x 5 repetitions x 1 set, daily Muscle setting exercise of both quadriceps x 10 seconds hold x 5 repetitions x 1 set, daily

86 Documentation Example 4 Resistance exercise of both lower-extremity muscles using elastic band (may specify initial color to use) x 10 repetitions x 3 sets, three times a week

87 Documentation Example 5 Progressive resistive exercise of both elbow flexors using De Lorme protocol x 3 sets, twice a week

88       THANK YOU FOR LISTENING!      

89 References American College of Sports Medicine (1998). Guidelines for exercise testing and prescription (3rd ed). Baltimore: Williams and Wilkins. Blimkie, C. J. R. (1993). Resistance training during preadolescence: Issues and controversies. Sports Medicine, 15(6), Kisner, C., Colby, L. (2007). Therapeutic exercise: Foundations and techniques (4th ed). Philadelphia: F. A. Davis Company. Matos, N. and Winsley, R. J. (2007). Trainability of young athletes and overtraining. Journal of Sports Science and Medicine 6,


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