1. Therapeutic Exercise I Chapter 6
Resistance Exercise For Impaired Muscle Performance

2. What is Resistance Exercise? (Resistance Training)
It is any form of active exercise in
which dynamic or static muscle
contractions is resisted by an outside
force applied manually or
Mechanically
Resisted exercises are good for injury
prevention, reduce injury or disease, being
healthy, and for impaired function

3. Benefits of Resistance Exercise -see box 6.1 pg. 159
Enhanced muscle performance
Increased strength of connective tissue
Greater Bone Mineral density
Decrease stress on joints
Reduced Risk of Soft tissue injury

4. Benefits of Resistance Exercise -continued
Possible improvement in capacity for tissue repair
Possible improvement in balance
Enhanced physical performance
Positive changes in body image
Enhanced feeling of physical well-being
Possible improvement in perception of disability & quality of life

5. Muscle Performance and Resistance Exercises-Definitions
Strength-Muscle strength, functional strength, strength training
Power-Muscle power, anaerobic versus aerobic power, power training
Endurance-Cardiopulmonary endurance, muscle endurance, endurance training
Overload Principle
SAID Principle/Specificity of Training
Transfer of Training
Reversibility Principle

6. Factors that Influence Tension Generation in Skeletal Muscle
See Table 6.1 pg. 161
Cross section & size
Muscle architecture
Fiber Type – I, IIA, IIB
Length-Tension
Recruitment of motor units
Frequency of firing of motor units
Type of contraction
Speed of contraction

7. Fatigue Muscle fatigue Signs and symptoms of muscle fatigue
Cardiopulmonary Fatigue
Thresholds for fatigue
Factors that influence fatigue
Recovery from exercise

8. Age Related Changes in Muscle Performance
See Box 6.3 pg. 164
Psychological & Cognitive Factors

9. Physiological Adaptations to Resistance Exercise
See Table 6.3 pg. 168
Skeletal Muscle Structure
Neural System
Metabolic System & Enzymatic Activity
Body Composition
Connective Tissue

10. Determinants of Resistance Exercises
Alignment
Stabilization are basic elements of any exercise
Intensity
Volume
Exercise Order
Frequency
Rest Interval
Duration
Mode of Exercise
Velocity of exercise
Periodization
Integration of function

11. Intensity Submaximal loading --Exercise low/moderate intensities
--Exercise at high intensities
Intensity of exercise should never be so great to cause
pain….A patient must be reminded on correct breathing
techniques to avoid increase cardiovascular risks

12. Volume
The summation of the total # of reps and sets of a particular exercise during a single exercise session multiplied by the resistance used
Remember: the reps/load will depend on of the goal is for increase strength or endurance or both
Muscle strength- 6 to 12 reps for 2-3 sets
Muscle endurance- 3-5 sets of reps

13. Frequency Refers to the # of exercise sessions per day or per week
Remember: Frequency will vary and will be patient specific pending other factors (NEED TO AVIOD OVERTRAINING)
For Children and older adults 2-3 x weekly and for highly trained athletes up to 6x weekly

14. Duration
Is the total 3 of weeks or months during which a resistance exercise program is carried out
Time required for significant changes past the neural adaptations, is between 6-12 weeks

15. Rest Interval (Recovery Period)
Purpose
Integration of rest into Exercise

16. Mode of Exercise Type of Contraction Position for Exercise: WB or NWB
Forms of Resistance
Energy Systems
Range of Movement
Mode of Exercise & application to function

17. Velocity of Exercise
See figure 6.6 pg. 176
Concentric vs. Eccentric

18. Periodization
See Table 6.5 pg. 177
Evidence is limited

19. Integration of Function
Pg. 177
Stability – Mobility – Controlled Mobility - Skill

20. Types of Muscle Contractions:
Isometrics-Muscle contraction without visible joint movement (Muscle setting, stabilization)
Isotonic-Muscle contraction with visible joint movement
-- Concentric-Muscle contraction that
results in muscle shortening
-- Eccentric-Muscle contraction that
results in muscle lengthening
Isokinetic-The application of force at a constant speed against an equal force (BIODEX)

21. Isometric Contraction
Intensity of muscle contraction (60-80% of a muscle force)
Duration of muscle activation (6-10 second hold…this will allow a 2 second rise time, 6 second hold time, and a 2 second fall time)
Repetitive Contractions (6-10 second hold)
Joint Angle and Mode Specific (4-6 points is usually recommended)
BE CAREFUL OF THE PATIENT BREATH-HOLDING WITH ISOMETRICS

22. Concentric/Eccentric Contractions
Concentric Contraction-accelerates body segments, less mechanical efficiency (requires more motor units for control of the load) than eccentric contractions, cross training occurs
Eccentric Contraction-Decelerate body segments, acts as a shock absorbent for high impact activities and quick change in direction activities, requires fewer motor units of control the load than concentric contraction, consumes less energy and oxygen than concentric contractions-therefore fatigues slower, cross training occurs, high incident of muscle soreness than concentric contractions (DOMS-delayed onset muscle soreness
Remember: Have the patient maintain normal breathing pattern
when performing an exercise program and base the program on
functional activities

23. Isokinetic Contraction (Accommodating)
Is a form of dynamic exercise in which the velocity
of muscle shortening or lengthening and the
angular limb velocity is predetermined and held
constant by a rate-limiting device known as an
isokinetic dynamometer-equal (constant) velocity
Remember: make sure the patient maintains
normal breathing pattern during exercise
performance

24. Examples of Muscle Contractions (Biceps):
a) Isometric
b) Isotonic Concentric
c) Isotonic Eccentric
Isokinetics
(Which we will not be focusing on today)

25. Open Chain and Closed Chain Exercises:
Open Chain-involves motions in which the distal segment is free to move in space (typically performed in non-weight bearing positions)
Closed Chain-involves in which the body moves on a distal segment that is fixed or stabilized on a support surface (typically performed in weight bearing positions)

26. Rationale for use of open/closed chain exercises
Both: help to reduce deficits in muscle performance, improve muscle strength-power-endurance (need to be function based to have the greatest benefit)
Open: more effective with isolation of muscle groups, has greater level of control
Closed: joint approximation-increases joint congruency and contributes to stability, gives greater feedback-stimulates mechanoreceptors, engaging several muscle groups through co-activation and dynamic stabilization

27. Examples of Open Chain and Closed Chain Exercises:
Open Chain (leg extension)
Closed Chain (squat)

28. Videos:
Muscle Basic Video
Ultrasound
Manual resistance

29. Lets Practice!!!!!!!!!!

30. How did you do????? 1.) Concentric; open chain
2.) Isometric; closed chain
3.) Eccentric; open chain
4.) Concentric; open chain
5.) Isometric; open chain
6.) Eccentric; closed chain

31. Precautions for Resistance Exercise
Valsalva Maneuver
Substitute Motions
Overtraining and Overwork
Exercise Induced Muscle Soreness
Pathological Fractures

32. Valsalva Maneuver
An expiratory effort against a closed glottis, must be avoided during resisted exercises. If it occurs, this will increase intra-abdominal and intra-thoracic pressure, which in turn forces blood from the heart, causing an abrupt, temporary increase in arterial blood pressure
Ways to prevent valsalva maneuver:
--Caution the patient about breath-holding
--suggest patient to breathe rhythmically, count of talk
during exercise
--Exhale on the resisted effort
--high risk patients should avoid high-intensity resistance
exercise

33. Contraindications to Resisted Exercises
Acute Inflammation
Acute Pain
Acute disease and disorder
Remember: the patient must be cleared by the supervising PT and the MD prior to implementing resisted exercises; you must review the POC and if there is a discrepancy or something that is unknown to you….you must clarify the information with the PT

34. Proprioceptive Neuromuscular Facilitation (PNF) Principles
Is an approach the therapeutic exercise that combines functionally based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improve neuromuscular control and function
Can be used to facilitate: muscle strength, stability, endurance, mobility, neuromuscular control, coordinate movements, and lay a foundation for the restoration of function
Is a combination of multi-joint, multi-planar, diagonal, and rotational movements of the extremities, trunk, and neck

35. (If time permits may review LE’s)
Break for Lab with Lecture on UE Manual Resistance Exercises, Mechanical Resisted Exercises, Selected Resistance Training Regimens, Equipment for Resisted Training
Resistance Techniques in Anatomical Planes of Motion/Diagonals of the UE’s
(If time permits may review LE’s)