Therapeutic Exercises for Doctor of Physical therapy Students

1. Resistance lect:3
Dr. Abid Ullah PT

2. Surah An Noor: 24 Aya: 19

3. DETERMINANTS OF RESISTANCE EXERCISE
• Alignment and Stabilization
• Intensity
• Volume
• Exercise Order
• Frequency
• Duration
• Rest Interval (Recovery Period)
• Mode of Exercise
• Velocity of Exercise
• Periodization
• Integration of Function

4. Alignment and Stabilization
• Proper alignment is determined by the
direction of muscle fibers and the line of pull
of the muscle to be strengthened.
• For example, to strengthen the gluteus
medius, the hip must remain slightly
extended, not flexed; and the pelvis must be
rotated slightly forward as the patient abducts
the lower extremity against the applied
resistance.

5. Alignment and gravity
• The alignment or position of the patient or the limb
with respect to gravity may also be important during
some forms of resistance exercises, particularly if
body weight or free weights (dumbbells, barbells,
cuff weights) are the source of resistance.
• Example: strengthening the gluteus medius, if a cuff
weight is placed around the lower leg, the patient
must assume the side-lying position so abduction
occurs through the full ROM against gravity and the
additional resistance of the cuff weight.

6. Stabilization
• Stabilization refers to holding down a body segment or
holding the body steady.
• Exercising on a stable surface, such as a firm treatment
table, helps hold the body steady.
• Body weight may also provide a source of stability
during exercise, particularly in the horizontal position.
• It is most common to stabilize the proximal attachment
of the muscle being strengthened, but sometimes the
distal attachment is stabilized as the muscle contracts.
• Stabilization can be achieved externally or internally.

7. • For example: when performing a bilateral
straight leg raise, the abdominals contract to
stabilize the pelvis and lumbar spine as the hip
flexors raise the legs.

8. Intensity
• The intensity of exercise in a resistance training
program is the amount of resistance (weight)
imposed on the contracting muscle during each
repetition of an exercise.
• The amount of resistance is also referred to as the
exercise load (training load), that is, the extent to
which the muscle is loaded or how much weight is
lifted, lowered, or held.

9. • The intensity of exercise and the degree to
which the muscle is overloaded is also
dependent on the volume, frequency, and
order of exercise.

10. Submaximal loading
• Exercise at moderate to low intensitie is indicated:
• At the beginning of an exercise program to evaluate the
patient’s response to resistance exercise, especially after
extended periods of inactivity.
• After periods of immobilization when the articular cartilage
is not able to withstand large compressive forces or when
bone demineralization may have occurred, increasing the
risk of pathological fracture
• For most children or older adults
• When the goal of exercise is to improve muscle
• endurance
• To warm up and cool down prior to and after a session of
exercise

11. Near maximal or maximal loading
High-intensity exercise is indicated:
• When the goal of exercise is to increase muscle
strength and power and possibly increase muscle
size.
• For healthy adults in the advanced phase of a
rehabilitation program after a musculoskeletal injury
in preparation for returning to high-demand
occupational or recreational activities
• In a conditioning program for individuals with no
known pathology
• For individuals training for competitive weight lifting
or body building

12. Volume
• the summation of the total number of repetitions
and sets of a particular exercise during a single
exercise session multiplied by the resistance used.
• There is an inverse relationship between the
number of repetitions performed and the intensity
of the resistance.

13. Repetitions and Sets
• The number of repetitions in a dynamic exercise
program refers to the number of times a particular
movement is repeated.
• it is the number of muscle contractions performed to
move the limb through a series of continuous and
complete excursions against a specific exercise load.
• The number of repetitions selected depends on the
patient’s status and whether the goal of the exercise is
to improve muscle strength or endurance.

14. Sets
• A predetermined number of repetitions grouped
together is known as a set or bout.
• After each set of a specified number of repetitions,
there is a brief interval of rest.
• For example: during a single exercise session to
strengthen a particular muscle group, a patient might
be directed to lift a load 8 to 10 times, rest, and then
lift the load 8 to 10 more times. That would be two
sets of an 8 to 10 RM
• there is no optimal number of sets per exercise
session.

15. Exercise Order
• The sequence in which exercises are performed
during an exercise session.
• When multiple muscle groups are exercised in a
single session, as is often the case in rehabilitation
or conditioning programs
a) large muscle groups should be exercised before
small muscle groups
b) multi joint muscles before single-joint muscles

16. Frequency
• Frequency in a resistance exercise program refers
to the number of exercise sessions per day or per
week.
• frequency is dependent on other determinants,
such as intensity and volume as well as the
patient’s goals, general health status, previous
participation in a resistance exercise program, and
response to training.

17. • The greater the intensity and volume of
exercise, the more time is needed between
exercise sessions to recover from the
temporarily fatiguing effects of exercise.
• A common cause of a decline in performance
from overtraining is excessive frequency,
inadequate rest, and progressive fatigue.

18. • Therefore, rest intervals between exercise
sessions are longer and the frequency of
exercise is less.

19. Duration
• Exercise duration is the total number of weeks or
months during which a resistance exercise program
is carried out.
• Depending on the cause of an impairment in
muscle performance,
• For significant changes to occur in muscle, such as
hypertrophy or increased vascularization, at least 6
to 12 weeks of resistance training is required

20. Rest Interval (Recovery Period)
• Purpose of Rest Intervals
• Rest is a critical element of a resistance training
program and is necessary to allow time for the body
to recover from the acute effects of exercise
associated with muscle fatigue or to offset adverse
responses.
• Therefore, rest between sets of exercise and
between exercise sessions must be addressed.

21. Mode of Exercise
• The mode of exercise in a resistance exercise
program refers to the form of exercise, the type of
muscle contraction that occurs, and the manner in
which the exercise is carried out.
• For example, a patient may perform an exercise
dynamically or statically or in a weight-bearing or
non-weight-bearing position.

22. Type of Muscle Contraction
• Isometric (static) or dynamic muscle contractions
are two broad categories of exercise.
• Dynamic resistance exercises can be performed
using concentric (shortening) or eccentric
(lengthening) contractions, or both.

23. • Position for Exercise: Weight-Bearing or Non-
Weight-Bearing
• Manual resistance and mechanical resistance are
the two broad methods by which resistance can
be applied.
• A constant or variable load can be imposed using
mechanical resistance(e.g., free weights or weight
machines).
• Body weight or partial body weight is also a
source of resistance

24. Velocity of Exercise
• The velocity at which a muscle contracts
significantly affects the tension that the muscle
produces and subsequently affects muscular
strength and power.

25. Periodization
• Periodization, also known as periodized training, is
an approach to resistance training that builds
systematic variation in exercise intensity and
repetitions, sets, or frequency at regular intervals
over a specified period of time.
• This approach to training was developed for highly
trained athletes preparing for competitive weight-
lifting or powerliftingevents.

26. Integration of Function
• Balance of Stability and Active Mobility:
• Control of the body during functional movement
and the ability to perform functional tasks require
a balance of active movement.
• For example, a person must be able to hold the
trunk erect and stabilize the spine while lifting a
heavy object.

27. Balance of Strength, Power, and
Endurance
• Functional tasks related to daily living,
occupational, and recreational activities require
many combinations of muscle strength, power,
and endurance

28. Task-Specific Movement Patterns
During Resistance Exercise
• Applying resistance during exercise in anatomical
planes, diagonal patterns, and combined task-
specific movement patterns should be integral
components of a carefully progressed resistance
exercise program.
• Pushing, pulling, lifting, and holding activities, for
example, can first be done against a low level of
resistance for a limited number of repetitions.

29. Cont…
• The key to successful self-management is to teach
a patient how to judge the speed, level, and
duration of tension generation in muscle as well
as the appropriate timing that is necessary to
perform a motor task safely.