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  1. 1. Intro To Exercise Principles Kinesiotherapy Clinical Training Exercise Principles 1
  2. 2.     SAID Principle•  SAID principle (Specific Adaptation to Imposed Demands) – specific adaptations take place in the body in response to specific types of stimuli.; a certain exercise or type of training produces adaptations specific to the activity performed, and only in the structures that are stressed by the activity. •  The SAID principle is the key factor in determining the response that will occur as a result of an exercise application. •  Persons who train primarily by running long distances become more efficient distance runners, their bodies generally become leaner, aerobic metabolism is enhanced and slow twitch fibers are enhanced. •  Persons who train primarily by lifting heavy weights for low repetitions become stronger, their bodies becomes more muscular, and fast twitch muscle fibers are enhanced. Exercise Principles 2
  3. 3. Kinetic Chain Model•  Kinetic Chain - A biomechanical principle that means bones, joints, muscles, and ligaments work together (as in links in a chain) to accomplish functional movement. •  Weakness in one link of the chain can alter the function of the total movement pattern. •  Example – during the act of performing a squat, the torso, knee, and hip motion are all linked.•  Open Kinetic Chain Exercise – movement patterns in which the distal segment (hand or foot) is free to move in space. •  Movements occur distal to the moving joint and occur primarily in non-weight bearing positions. •  Examples – leg extension, leg curl, dumbbell curl or press, swing phase of gait Exercise Principles 3
  4. 4.   Kinetic Chain Model•  Closed Kinetic Chain Exercise – movement in which the distal segment (hand or foot) is fixed to a solid surface. •  Movements are performed primarily in weight bearing positions with the trunk and proximal segments moving over the fixed segment. •  Examples – push up, chin up, squat, lunge, climbing stairs, stance phase of gait•  During the early stage of rehabilitation when weight bearing is generally limited, open chain movements are the primary focus. •  Strengthening exercises during this phase are focused on the joints that are proximal to the injury. •  As stability and mobility are gradually restored, the emphasis shifts primarily to weight bearing activities which are closed chain.   Exercise Principles 4
  5. 5. Resistance  Exercise  •  Resistance  Exercise  -­‐  any  form  of  active  exercise  in  which  a  dynamic  or   static  muscle  contraction  is  resisted  by  an  outside  force.   •  The  resistance  can  be  applied:   •  Manually  (MR  exercise)  -­‐  a  type  of  active  exercise  in  which   resistance  is  provided  either  dynamically  or  statically  by   another  person.     •  Mechanically  -­‐  a  type  of  exercise  in  which  resistance  is   provided  by  an  external  apparatus  (ie.  barbells,  weight   machines,  elastic  resistance,  isokinetic  device).   •  Resistance  exercises  are  classiCied  as  either:     •  Isolated  (single  joint)  -­‐  exercises  that  recruit  smaller  muscle   areas  and  involve  only  one  primary  joint.   •  Barbell  curls  –  involve  the  elbow  joint  only.   •  Leg  curls  –  involve  the  knee  joint  only.     Exercise Principles 5
  6. 6. Resistance Exercise •  Compound (multi-joint) movements - exercises that recruit large muscle areas and involve 2 or more primary joints. •  Bench press – involves the shoulder and the elbow joint. •  Barbell squat – involves the hip and knee joint.•  Plyometric Exercise – an exercise activity in which a resisted eccentric muscle action is quickly followed by a rapid concentric muscle action. •  Jump off platform, land on floor, then quickly jump into the air.•  Isokinetic Resistance Exercise – the speed of the movement is controlled thus allowing accommodating resistance through the complete ROM. •  A special rate limiting device is required to perform isokinetic contractions. •  There is no eccentric resistance. •  Aquatic resistance movements are a form of isokinetic exercise. Exercise Principles 6  
  7. 7. Resistance Exercise•  Repetitions (reps) – the number of times a specific movement is repeated or the number of muscle contractions performed against a level of resistance.•  Sets – a given number of repetitions.•  Repetition Maximum (RM) – the maximum amount of weight a person can move through a range of motion for a given number of repetitions. •  Repetition Maximum (RM) examples: •  1 RM = max weight that can be lifted for 1 rep •  5 RM = max weight that can be lifted for 5 reps •  10 RM = max weight that can be lifted for 10 reps •  Training loads are often assigned as a percent of the 1RM (60%, 70%, 80%, etc.) with the individual completing the max reps possible with that assigned weight.   Exercise Principles 7
  8. 8. Resistance Exercise•  The RM selected for an exercise can range from 1-3 reps to 15 or more per set depending on the specific goal for the client/patient.•  The number of sets performed per exercise can range from 1 to 6 or higher •  Positive results can be achieved with one set for persons who are debilitated or unconditioned. •  As strength and adaptation occur, extra sets are added to elicit continued improvements.•  Training Goals/Focus: •  Muscle Strength - - resistance applied to a muscle is increased progressively. Exercise  Principles   8  
  9. 9. Resistance Exercise•  Training Goals/Focus:•  Muscular Hypertrophy - an increase in the size of a muscle’s mass due to an increase in the length and thickness of each muscle cell without any increase in the number of cells.•  Muscular Endurance - increase in length of time that a muscle contraction is sustained, or increase in total number of repetitions performed.•  Target training ranges:•  Strength = 4-6 reps (3-4 minutes rest between sets)•  Hypertrophy = 6-12 reps per set (30-60 seconds rest between sets)•  Muscular Endurance = 12 reps and higher per set (30-60 seconds rest between sets) Exercise  Principles   9  
  10. 10.   Progressive Resistive Exercise•  Progressive Resistive Exercise (PRE) – a systematic increase in resistance applied to a working muscle, to continually accommodate that muscle’s force production potential.•  Methods of PRE application include: •  Increasing the amount of weight lifted for a given RM. •  Increasing the number of reps that a weight can be lifted. •  Increasing the number of sets performed. •  Decreasing the time required to perform a given workload volume.•  To determine whether muscles are strengthened by a specific exercise: •  Determine the movement patterns that occur during the performance of the exercise. •  Determine the muscles that control the movement patterns that are occurring.   Exercise Principles 10
  11. 11.   Components of Exercise Prescription•  Intensity – the amount of resistance imposed on a contracting muscle during each repetition. •  A person who can bench press 10 reps with 100 pounds progresses to bench pressing 10 reps with 105 pounds•  Volume – the total of repetitions and sets of exercise performed during a single exercise session. •  An increase from performing 5 sets of 10 push ups during a workout session (50 total reps) to 5 sets of 12 (60 total reps).•  Frequency – the number of exercise sessions performed  over  a  given   period  of  time  (per  day  or  per  week,  etc.).     Exercise Principles 11
  12. 12. Components of Exercise Prescription•  Duration – the total number of weeks or months in which an exercise session is carried out.•  Mode – the form or type of exercise, or the manner in which the exercise is implemented.•  Progression – progressive overload can result from an increase in the frequency, volume, or intensity of an exercise. •  One or more of these variables may be manipulated at one time. •  Reducing rest intervals between sets of an exercise can also increase intensity. Exercise Principles 12
  13. 13. Overload Principle•  For muscle performance to improve in strength or endurance, the muscle must be challenged to perform at a level greater than that to which it is accustomed.•  There must be an increase in either resistance (work load), work volume, or intensity of effort.•  Methods of Overload Training: •  Numerous methods of overload training have proven to be effective. •  No specific method has emerged that is superior to the others. •  The therapist must determine the method that is most appropriate for the needs of the client/patient. Exercise  Principles   13  
  14. 14. Delorme Method•  A systematic method of applying progressive resistive exercise. •  Classified as a light to heavy approach. •  Originally referred to as the Delorme-Watkins method. •  Both Delorme and Watkins were orthopedic surgeons who used resistance training for faster recovery of their patients.•  Delorme Procedure: •  Determine the 10 RM for the client/patient. •  Perform 3 sets: •  1st set – 10 reps at 50% of the 10 RM •  2nd set – 10 reps at 75% of the 10 RM •  3rd set – 10 reps at 100% of the 10 RM •  When 10 reps are exceeded on the 3rd set, establish a new 10 RM. Exercise  Principles   14  
  15. 15. Oxford Method•  Developed in England as an alternative to the Delorme method. •  Involves a heavy to light approach. •  Designed to accommodate the cumulative fatigue of each set of maximal resistance.•  Oxford Procedure: •  Following a brief warm up, determine the 10 RM. •  Perform 3 sets: •  1ST set – 10 reps at 100% of 10 RM •  2nd set – 10 reps at 75% of 10 RM •  3rd set – 10 reps at 50& of 10 RM •  When 10 reps are exceeded on the 1st set, establish a new 10 RM. Exercise  Principles   15  
  16. 16.   Single Set System•  Consists of one set of several different exercises, each selected for a different muscle group. •  One or 2 warm up sets may be performed prior to the work set.•  Single set routines can meet the needs of persons on limited time schedules, or for athletes involved in high intensity practice sessions.•  Often used for untrained clients/patients who have never done resistance training; positive results can still be seen, at least initially.•  Several studies indicate that 1 set of 8 -12 reps (performed to voluntary muscular failure following a warm up), is sufficient to cause gains in muscular strength and hypertrophy. Exercise  Principles   16  
  17. 17.   Single Set System•  Further studies indicate that 1 training set per body part is effective during the first several months of training, but over time, multiple sets need to be introduced if gains are to continue. Multiple  Set  System    •  Historically, multiple set approaches consisted of 2 to 3 warm up sets followed by several sets at the same resistance level.•  Today, numerous adaptations of multiple set approaches have been developed.•  Numerous combinations of sets, repetitions, and resistance loads have been found to be effective.   Exercise  Principles   17  
  18. 18.   Multiple Set System•  One research study revealed that performing 3 sets of 10 repetitions without going to failure enhances strength gains better than one set of 8 – 12 reps to failure.•  Based on this premise, multiple set routines will increase muscular strength faster than the single set routines.•  Most current research indicates that multiple set routines are more effective than single set routines.   Exercise  Principles   18  
  19. 19.   Circuit Training System•  Consists of a series of resistance exercises, with one exercise following another, with minimal rest between sets (15-30 seconds max).•  A 10 to 15 RM workload is maintained for each exercise.•  Circuit training is time efficient and works well when large numbers of people must be trained in a minimum amount of time.•  The major premise of circuit training is that it can simultaneously improve muscular strength and aerobic endurance. However, circuit training : •  Does not result in aerobic conditioning equal to conventional aerobic training. •  Is not as effective in developing strength as conventional methods. Exercise  Principles   19  
  20. 20.   Circuit Training System •  Circuit training can be a viable alternative for those with limited time to exercise.•  Circuit Training program design •  Select a series of exercises that target all of the major muscle/joint movements of the body. •  Avoid consecutive exercises that target the same area. •  Example - Arm curl, chin up, up-right row •  Keep rest between each exercise to a minimum (15-30 sec. max). •  The circuit can be repeated for one or more series as conditioning improves. Exercise  Principles   20  
  21. 21. Elastic Resistance•  The use of rubber tubing, therabandTM , or other resistance modes that use an elastic resistance component. •  Can be very useful in the initial stages of therapeutic exercise. •  Advantages: •  Versatile •  Inexpensive •  Adaptable to a wide variety of angles of application •  Joint trauma is minimized   Exercise  Principles   21  
  22. 22.   Elastic Resistance•  Disadvantages: •  Quantitative measurement is difficult. •  Minimal resistance in the initial phase of the range. •  Elastic materials tend to denature and break down over time. •  Products are susceptible to tearing.•  Unique features: •  Resistance in the initial phase of the movement is minimal. •  Resistance increases progressively as the material is elongated. •  Resistance force is maximal when the material is angled 90 degrees from the moving bone. Exercise  Principles   22  
  23. 23. Aerobic Exercise•  Aerobic Exercise - sub-maximal, rhythmic, repetitive exercise of large muscle groups; the needed energy is supplied by inspired oxygen.•  Aerobic Endurance - improved by performing exercises that involve large muscle groups at a percentage of one’s maximal aerobic power.•  Cardiopulmonary (cardiorespiratory, cardiovascular) Endurance - the ability of the heart and lungs to take in and transport adequate amounts of oxygen to the working muscle, allowing activities that involve large muscle mass activity to be performed over long periods of time.•  Cardiopulmonary Conditioning – any rhythmic, continuous, large muscle activity that promotes a simultaneous increase in heart rate and return of blood to the heart. Exercise  Principles   23  
  24. 24. Aerobic  Exercise•  Maximal  Heart  Rate  -­‐  heart  rate  that  is  reached  at  the  maximum  level  of   physical  exertion.     •  The  common  standard  used  for  setting  intensity  for  aerobic   conditioning.   •  Exercise  prescriptions  will  range  on  average  from  60%  to  90%  of  max   heart  rate;  percentage  used  will  depend  on  the  client’s/patient’s   current  health  status  and  conditioning  level.  •  Age  Predicted  Maximal  Heart  Rate  Method       •  Subtract  the  person’s  age  from  220.   •  Assign  a  %  of  that  number  as  the  target  heart  rate  to  maintain  during   a  period  of  aerobic  training.   •  Example  –  client/patient  age  =  60  years   •  220-­‐60  =  160   •  70%  of  160  =  112   •  112  =  the  target  heart  rate  to  maintain   Exercise  Principles   24  
  25. 25. Aerobic Exercise•  Arm exercise is associated with max heart rate of approx. 90% of leg exercise. •  Therefore, when only upper body movements are used for aerobic exercise, the formula is: 200 minus age. •  Example – Spinal cord injury patients, bi-lateral amputees or those whose are restricted to a wheelchair.•  Karvonen Formula – a method of determining the target heart rate based on a percent of the difference between the individual’s maximal and resting heart rate or heart rate reserve. (APMH) Age Predicted Maximum Heart Rate = 220 – age (HRR) Heart Rate Reserve = APMHR – (RHR) Resting Heart Rate (THR) Target Heart Rate = (HRR x Exercise Intensity) + RHR BPM = Beats Per Minute   Exercise  Principles   25  
  26. 26.   Aerobic Exercise•  Karvonen example: APMHR = 220 – 30 = 190 HRR = 190 – 60 = 130 RHR = 60 THR = (130 X 70%) + 60 = 91 + 60 = 151 bpm•  Talk test – client/patient involved in an aerobic activity should be able to carry on a conversation during exercise. •  This is a relatively safe level of aerobic exertion. •  As conditioning occurs, the level of exercise intensity should increase, but conversation can be continued. Exercise  Principles   26  
  27. 27.   Aerobic Exercise•  Rate of Perceived Exertion (Borg Scale) - A subjective method of determining exercise intensity in which the client/patient is taught to estimate the work intensity level.•  Borg Scale – a numerical rank is assigned to various levels of perceived exertion. 10 – maximal effort 7 – very strong effort 5 – strong effort 3- moderate effort 2- weak effort 0 – no effort Exercise  Principles   27  
  28. 28.   Aerobic Exercise Application•  Volume – 15 to 60 minutes on average, depending on the level of intensity.•  Frequency – 3 to 5 days per week.•  Duration – minimum of 8 weeks on average for conditioning effects to occur.•  Mode – Walking, running, bicycling, rowing, or any activity that involves large muscle groups.•  Progression – as conditioning occurs, exercises of higher intensities will be required to maintain target heart rates. Exercise  Principles   28  
  29. 29. Aerobic Training Methods•  Continuous Training – maintaining a fixed level of aerobic exertion over an extended period of time. •  Example - maintaining a heart rate of 70% max during a 30 minute exercise session. •  As conditioning occurs, the person will be able to cover increasing distances while maintaining 70% heart rate for a 30 minute session.•  Interval Training –bouts of high intensity exertion are alternated with periods of low intensive effort. •  The key to interval training is that the high intensive bouts should drive the heart rate up to 90-95% of the maximal heart rate. •  During the lower intensity workout, the heart rate should recover to within 60-70% of max heart rate. •  Example: bouts of all out sprints are alternated with bouts of jogging. Exercise  Principles   29