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Resistance exs

Resistance exercises enhance muscle performance through strength, power, and endurance, adapting based on principles like overload, specificity, and reversibility. Benefits include improved muscle strength, connective tissue health, bone density, joint stress reduction, and overall physical performance. A detailed examination and tailored program are crucial for effective resistance training, considering factors like intensity, volume, and exercise mode.

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RESISTANCE EXERCISES DR. MEGHAN PHUTANE (PT) CARDIORESPIRATORY PHYSIOTHERAPIST
MUSCLE PERFORMANCE & RESISTANCE EXERCISES  3 elements of muscle performance – strength, power & endurance – can be enhanced by some form of resistance exercises.  Alteration in each element depends on -  How principles of resistance training are applied &  How factors like intensity, frequency & duration are manipulated.
POTENTIAL BENEFITS OF RESISTANCE EXERCISES  Enhance muscle performance  Increase strength of connective tissue  Greater BMD or reduces bone demineralization  Decrease stress on joints  Reduce risk of soft tissue injury  Improves capacity to repair or heal damaged soft tissues  Possible improvement in balance  Enhances physical performance during ADLs, recreational activities & occupation  Improves body composition : increase lean muscle mass & reduce body fat  Enhance feeling of physical well being & so QOL.
STRENGTH  Ability of a contractile tissue to produce tension & resultant force based on demands placed on the muscles / Greatest measurable force exerted by muscle or group of muscles to overcome resistance during a single maximum effort.  Functional strength – ability of a neuromuscular system to produce, reduce or control forces imposed during functional activity in a smooth coordinated manner.  Strength training – systemic procedure of a muscle or muscle group of lifting, lowering or controlling heavy loads (resistance) for a relatively lower number of repetitions or a short period of time.  Increases maximum force producing capacity of muscle & muscle fiber size (neural adaptation).
POWER  Muscle power is related to strength & speed of movement & is defined as work produced by muscle per unit time. (force×distance/time).  Power training –  By increasing work of muscle for specific time or reducing time for specific work of muscle.  Greater the intensity & shorter the time period taken to generate force – greater the muscle power.
ENDURANCE  Endurance refers to the ability to perform low intensity, repetitive or sustained activities over a prolonged period of time.  Muscle endurance is the ability to contract repeatedly against a load, generate & sustain tension & resist fatigue over an extended period of time.  Endurance training – low intensity muscle contraction, large number of repetitions for prolonged time period.
PRINCIPLES 1. Overload principle 2. SAID principle 3. Reversibility principle
OVERLOAD PRINCIPLE  To improve muscle performance, a load that exceeds the metabolic capacity of the muscle must be applied.  Progressive loading of muscle can be done by manipulating intensity or volume of exercises.
SAID PRINCIPLE  Specific adaptation to imposed demands  Exercise program should be built on specificity principle.  It’s a extension of Wolf’s law.  Specificity of exercise refers to the adaptive effects of training like strength, power & endurance, are highly specific to the training methods employed.  Considered relative to mode & velocity of exercise; joint angle; movement pattern during exercise.  Basis of specificity of training is related to morphological & metabolic changes in muscles & neural adaptation to the training stimulus with motor learning.
REVERSIBILITY PRINCIPLE  Adaptive changes in body system (strength, endurance) due to resistance exercises are transient unless improvement is used for functional activities or as a maintenance program.  Detraining (reduced muscle performance), starts in a week or two after exercise cessations & continues until training effect are lost.
DETERMINANTS OF RESISTANCE EXERCISE  Many elements (variables) determine whether a resistance exercise program is appropriate, effective & safe.  All elements are interrelated & should be addressed to improve one or more aspects of muscle performance & achieve desired functional outcomes.
 Alignment – of segments of body during exercise.  Stabilization –of proximal or distal joint to prevent substitution.  Intensity – the exercise load (level of resistance).  Volume – the total number of repetitions & sets in the exercise sessions multiplied by the resistance used.  Exercise order – the sequence in which muscle groups are exercised during the exercise session.  Frequency – the number of exercise sessions per day or per week.  Rest interval – time allotted for recuperation between sets & sessions of exercise.
 Duration – total time frame of a resistance training program.  Mode of exercise – type of muscle contraction, position of the patient, form of exercise, arc of movement, or the energy system utilized primary.  Velocity of exercise.  Periodization – variation in intensity & volume during specific period of resistance training.  Integration of exercise into functional activities – use of resistance exercise that approximate or replicate functional demands.
TYPES OF RESISTANCE EXERCISES
CONSIDERATIONS FOR SELECTION OF MODES OF RESISTANCE EXERCISE  Cause & extent of primary & secondary impairments  Deficits in muscle performance  Stage of tissue healing  Condition of joints & their tolerance to compression & movement  General physical & cognitive ability of patient  Availability of equipments  Patient’s goal  Intended functional outcomes of the program
MANUAL & MECHANICAL RESISTANCE EXERCISE Manual resistance exercise –  Type of active resistive exercise where resistance is applied manually by therapist, other professional or self (by patient).  Resistance cannot be measured quantitatively but useful in early stage of exercise training.  Also useful when joint ROM needs to be carefully controlled.  Amount of resistance is limited to therapist strength
CONT… Mechanical resistance exercises –  Type of active resistive exercise where resistance is applied through the use of equipments or mechanical apparatus.  Amount of resistance can be measured quantitatively & increased progressively .
ISOMETRIC EXERCISES (STATIC)  Static form of exercise in which muscle contracts & produces force without appreciable change in length of muscle & without visible joint motion.  No mechanical work done but measurable amount of tension & force are produced.  Sources of resistance –  Holding against force applied manually  Holding weight in particular position  Maintaining position against resistance of body weight  Pushing or pulling immovable objects
RATIONAL & INDICATIONS  To prevent or minimize muscle atrophy due to external immobilization  To activate muscle to begin to res-establish neuromuscular control but protect healing tissues when joint movement is not advisable (post surgical)  To develop postural or joint stability  To improve muscle strength when dynamic activity is not permissible
TYPES  Muscle setting exs –  Involve low intensity isometric contractions performed against little or no resistance.  To decrease muscle pain, promote relaxation & circulation  Stabilization exs –  Used to develop a sub-maximal but sustained level of contraction to improve postural or dynamic stability of a joint by means of mid-range isometric contraction against resistance in antigravity & weight bearing position.  Multiple angle isometrics –  System of isometric exs where resistance is applied manually or mechanically at multiple joint positions within available ROM.
CHARACTERISTICS & EFFECTS  Intensity of muscle contraction –  Amount of tension generation depends on joint position & length of muscle fibers during contraction.  60-80%  Duration of muscle activation–  Hold for 6-10secs, post 10secs fatigue.  Sufficient time to develop peak tension & metabolic changes  Repetitive contractions –  Repetitive contractions hold for 6-10secs – decrease muscle cramping & increase effectiveness of isometric regimen.  Joint angle & mode specificity –  gain in muscle strength occur only at or closely adjacent to the training angle.
 Precautions –  Should be pain free  Avoid breath holding  Contraindications –  High intensity isometrics should be avoided in cardiac & vascular diseases.
DYNAMIC EXS – CONCENTRIC & ECENTRIC  Causes joint movement & excursion of body segment as muscle contracts under tension.  Concentric exs – form of dynamic muscle loading where tension develops in muscle & physical shortening of muscle occurs as resistance overcomes. (lifting weight)  Ecentric exs – dynamic loading of muscle beyond its force producing capacity, causing physical lengthening of muscle as it attempts to control the load. (lowering the weight)  Resistance can be applied by –  Constant resistance (body wt/simple wt/ wt pulley)  Weight machine (variable resistance)  Isokinetic device (controls velocity)
RATIONALE  Concentric contraction accelerate body segment whereas eccentric contraction decelerate body segment.  Combined action is evident in countless daily activities.  Eccentric contraction –  Acts as a source of shock absorption during high impact activities.  Essential component of rehabilitation & conditioning program to reduce risk of muscle injury or re-injury.  Plyometrics (stretch shortening drills)/ fast velocity, eccentric isokinetic training – prepare patient for high demands of activities.
DYNAMIC EXS – CONSTANT & VARIBLE RESISTANCE  The most common system of resistance training used with dynamic exercise against constant or variable resistance is progressive resistance exs.(PRE)  Dynamic constant external resistance exs (DCER) –  Resistance training where limb moves through a ROM against constant external load, provided by free weights like weight cuffs, Pulley system.  Contracting muscle is challenged maximally at only one point of ROM, where maximum torque of resistance matches torque output of muscle.
 Variable resistance exercise –  Specially designed resistance equipments imposes varying levels of resistance to contracting muscle to load the muscle more effectively at multiple points in ROM. Eg with elastic tubes or bands.  Performed against manual resistance, a skilled therapist can vary the force applied to the contracting muscle throughout the ROM.
ISOKINETIC EXERCISES  Its a form of dynamic exs in which velocity of muscle shortening or lengthening & the angular limb velocity is predetermined & held constant by a rate limiting device known as isokinetic dynamometer.
 Characteristics –  Constant velocity  Range & selection of training velocity  Reciprocal versus isolated muscle training  Specificity of training(speed specific)  Compressive forces on joints  Accommodation to fatigue  Accommodation of painful arc
 Training effects & carryover function –  Improves one or more parameters of muscle performance.  Isolate single muscle or opposite muscle group  Involves movement of single joint  Uniplanar movement  Does not involve weight bearing.
 Special considerations –  Availability of equipments  Appropriate set up  Accommodation to painful arc
OPEN CHAIN & CLOSED CHAIN EXS  Functional activities & exs are commonly categorized as having weight bearing or non weight bearing characteristics.  Also called as “open or closed kinetic chain” & “open or closed kinematic chain”.  Open kinetic chain refers to completely unrestricted movement in space of a peripheral segment of the body. (waving the hand, swinging the leg)  Closed kinetic chain movements – peripheral segment meets with the considerable external resistance. One joint motion is always accompanied by adjacent joint motions.
OPEN CHAIN EXS CLOSED CHAIN EXS Distal segment moves in space Distal surface fixed on stationary support Independent joint movement Interdependent joint movements Movement of body segment distal to the moving joint Movement of body segment distal &/or proximal to the moving joint Muscle activation occurs in prime movers Muscle activation of multiple joint muscles Performed in non weight bearing position (typical) Performed in weight bearing position (typically but not always) Resistance is applied to the moving distal segment Resistance is applied simultaneously to multiple moving segments Use of external rotary loading Use of axial loading External stabilization usually required Internal stabilization by means of muscle action, joint compression, etc.
GENERAL PRINCIPLES OF RESISTANCE TRAINING
EXAMINATION & EVALUATION  Thorough examination of patients (history, system review, selected tests & measurements)  Determine qualitative & quantitative baseline parameters (strength, endurance, ROM)  Implement testing procedures (MMT, RM, dynamometry, goniometry, level of disability)  Interpret the findings  Establish plan of care integrating resistance exs  Periodical re-evaluation.
PREPARATION  Select & prescribe form of resistance exs that are appropriate & expected to be effective.  If using mechanical resistance, determine what equipment is needed & available.  Review the anticipated goals & expected functional outcomes  Explain the exs plan & procedures.  Let the patient were nonrestrictive clothing & supportive shoes appropriate for exs.  Select firm but comfortable support surface  Demonstrate each exs & desired movement pattern.
APPLICATION  Warm up – (5-10mins, non resisted exs)  Placement of resistance –  Typically on distal end of segment  May be applied across intermediate joint  Revise placement if pressure is uncomfortable  Direction of resistance –  Concentric exs – opposite direction  Eccentric exs – same direction  Stabilization –  Necessary to avoid unwanted or substitute motion  Non weight bearing – proximal stabilization  Weight bearing – muscle control
 Intensity of exs / amount of resistance –  Initially minimal load; progress slowly  Volume / no of reps & sets & rest intervals –  Generally, 8-12reps with moderate load; followed by rest  For progression initially increase no of reps & sets then increase resistance  Verbal / written instructions –  Use simple instructions that are easy to understand  Avoid medical terminologies  Monitoring the patient –  Before, during & after exs  Cool down –  Rhythmic, unresisted movements
PRECAUTIONS  Select ambient room temperature  Select clothing that facilitate heat dissipation  Exs should be pain free  Initiate with low loads/ avoid high intensity  Do not apply pressure to unstable joint or distal to fracture site  Avoid valsalva maneuver  Avoid uncontrolled ballistic movements  Prevent incorrect or substitute motion  Avoid exercise that put excessive, unintended secondary stress on body  Be aware of medications a patient is using  Avoid fatigue  Discontinue exs if pt experience pain, dizziness or unusual shortness of breath  Prevent pathological fractures
CONT…  Overtraining –  Declined physical performance in healthy individuals participating in high intensity, high volume strength training program.  Other terms are chronic fatigue, staleness, burnout  Due to inadequate rest intervals, too rapid exs progression, inadequate diet & fluid intake.  Preventable, reversible phenomenon  Overwork –  Termed as overwork weakness  Progressive deterioration of strength in muscles already weakened by nonprogressive neuromuscular disease  Prevention is better than cure
CONT… Exs induced muscle soreness –  Acute muscle soreness –  During or directly after strenous exs  Delayed onset muscle soreness (DOMS) –  DOMS begins to develop 12-24hrs after the cessation of strenuous activity; intensifies & peaks 24-48hrs later  Can be prevented by gradual progression of intensity & volume of resistance; warm up & cool down; slow stretches before & after exs
CONTRAINDICATIONS  Acute inflammation / acute disease  Pain  Severe cardiopulmonary disease
SKELETAL MUSCLE FUNCTION & ADAPTATION TO RESISTANCE EXERCISE
FACTORS INFLUENCING TENSION GENERATION IN NORMAL SKELETAL MUSCLES FACTOR INFLUENCE Cross section & muscle size Larger ms diameter – greater tension producing capacity Fiber length & arrangement •Short fibers (pinnate/multipinnate) – high force producing capacity (quads, deltoid, gastrocnemius) •Long parallel fibers –high rate of shortening; less force production (sartorius) Fiber type distribution •High % type I – low force production,fatigue resistant •High % type II – rapid high force production & fatigue Length tension relationship Greater tension is produced near or at physiological resting position during contraction
CONT… FACTOR INFLUENCE Motor unit recruitment Greater no & synchronization of motor unit firing – greater force production Frequency of motor unit firing Higher frequency of firing – greater the tension Type of muscle contraction Force output from greatest to least : eccentric, isometric, concentric muscle contraction Speed of muscle contraction Concentric contraction - ↑speed - ↓tension Eccentric contraction - ↑speed - ↑tension
ADDITIONAL FACTORS  Energy store & blood supply –  Adequate energy source is needed to contract, generate tension & resist fatigue.  3 main energy systems are :  ATP-PC system  Anaerobic/glycolytic/lactic acid system  Aerobic system  Fatigue – complex phenomenon affecting muscle performance.  Muscle (local) fatigue – the diminished response of muscle to a repeated stimulus-is reflected in progressive decrement in amplitude of motor unit potential.  Cardiopulmonary (general) fatigue – diminished response of an individual as a result of prolonged physical activity.`
CONT…  Recovery from exs –  Adequate time of recovery from fatiguing exs must be built  Both inter-session & intra-session  Age –  Muscle performance changes through out the life span.  Psychological & cognitive factors –  Positive or negative influence  Attention  Patient must focus on given task to perform it correctly  Motivation & feedback-
PHYSIOLOGICAL ADAPTATIONS TO RESISTANCE EXS VARIABLE STRENGTH TRAINING ADAPTATION Skeletal muscle structure •Hypertrophy of muscle fiber (more in type II) •Hyperplasia of muscle fibers •Fiber type composition: remodelling (type IIB to IIA; no change in type I) • Capillary bed density - ↓ or no change •Mitochondrial density & volume: ↓ Neural system •Motor unit recruitment: ↑ •Rate of motor unit firing: ↑(↓twich contraction time) •Synchronization of firing: ↑ Metabolic system •ATP & CP storage: ↑ •Myoglobin storage: ↑ •Stored triglycerides: not known
VARIABLE STRENGTH TRAINING ADAPTATION Enzymes •Creatine phosphokinase: ↑ •Myokinase: ↑ Body composition •Lean body mass: ↑ •% body fat: ↓ Connective tissue •Tensile strength of tendons, ligaments & connective tissue: ↑ •Bone: ↑BMD; no change or possible ↑ in bone mass
MANUAL RESISTANCE EXERCISES
DEFINITION  Manual resistance exs is a form of active resistive exs in which resistance force is applied by the therapist to either a dynamic or static muscular contraction.
ADVANTAGES  Most effective during early stage of rehabilitation  Effective during transition from assisted to mechanically resisted movements  More finely graded resistance  Resistance can be adjusted throughout ROM  Muscle works maximally at all portions of ROM  Joint ROM can be carefully controlled  Useful for dynamic & static strengthening  Manual stabilization prevents substitute motions  Can use variety of patient positions  Placement of resistance can be easily adjusted
DISADVANTAGES  Exs load is subjective; cannot be measured to document  Amount of resistance will be limited to the strength of therapist  Little value to strong muscle group  Speed of movement is slow to moderate  Cannot be performed independently by the patient  Not useful in home program  Labor- & time- intensive for therapist  Impractical to improve muscle endurance
GUIDELINES  Body mechanics of the therapist –  Table/patient bed height  Position close to patient  Wide standing  Application of manual resistance & stabilization  Stabilize proximal attachment  Vary resistance through out ROM  verbal commands –  Coordinate timing of verbal commands with resistance application  Simple, direct commands  No of reps & sets; rest intervals –  No depends on patient’s response & therapist strength  Adequate rest interval after 8-12 reps
TECHNIQUE  For eccentric contraction, direction of limb movement would be opposite .  Involves non weight bearing positions & isolate individual muscle or muscle group  Variation in therapist position, hand placement or alternate patient position may be necessary depending on size & strength of therapist & patient.  Opposite motions are often alternately restricted where strength & balanced neuromuscular control in both agonist & antagonist are desired.
MECHANICAL RESISTANCE EXERCISE
 Mechanical resistance exercise is any form of exercise in which the resistance is applied by means of some form of exercise equipment.  Integral component of rehabilitation & conditioning program.
ADVANTAGES  Establish quantitative baseline measurement– improvements can be monitored.  Most appropriate in intermediate & advanced phases of rehabilitation (muscle strength ≥4/5 or ≥therapist strength)  Increase in level of resistance can be incrementally &quantitatively documented.  Quantitative improvement – effective source of motivation for patient.  Useful for improving static & dynamic muscle strength.  Adds variety to resistance training program.  Some equipments provide variable resistance throughout the ROM.  High velocity resistance training is possible & safe.  Appropriate for independent home exercise program.
DISADVANTAGES  Not appropriate when muscles are very weak or early stage of soft tissue healing (exception – equipments that provide assistance, support or control against gravity.)  Equipment that provide constant external resistance maximally loads the muscle at only one point in ROM.  No accommodation for painful arc (except with hydraulic, pneumatic or isokinetic equipment).  Expenses for purchase & maintenance of equipment.  With free weights & weighing machine, gradation depends on manufacturer's increments of resistance.
 Use in rehabilitation –  To eliminate or reduce deficits in muscle strength, power & endurance caused by an array of pathological conditions.  To restore or improve functional abilities.  Use in conditioning –  Important component of comprehensive conditioning program to improve or maintain physical fitness & health through out most of the lifespan.
GUIDELINES IN CONDITIONING PROGRAM FOR HEALTHY ADULTS  Prior to training, warm up followed by flexibility exs  Perform dynamic muscle exs targeting major muscle groups of body for total body fitness.  Balance flexion & extension dominant (pulling / pushing)exs; concentric & eccentric (lowering / lifting) exs.  Use full, available, pain free ROM.  Use moderate intensity (8-10reps; 1-3sets; 2-3min rest interval.)  Use slow, moderate speed, rhythmic, controlled, non- balliastic movements.  Exercise should not interfere normal breathing.  Frequency – 2-3times/wk  Increase intensity gradually  Cool down after completion of exercises.
CHILDREN & RESISTANCE TRAINING  Questionable….  Now evidence states that children do achieve health related benefits & so can safely engage in supervised weight training program.  Resistance by using body weight or equipments designed specifically for children are safe.  Guidelines :-  No training below 6-7 yrs age  Start without weights then with light weights  Close & continuous supervision  Focus on proper form, technique & safety  Emphasize low intensity, short duration, play oriented exs with low exercise loads & frequency 2-3/wk  Use warm up & cool down exs  Initial progression by increasing reps & not resistance.
OLDER ADULTS & RESISTANCE TRAINING  Major goal is to maintain or improve level of functional independence & reduce risk of age related diseases.  Improves muscle strength, balance, speed of walking, ability to rise in chair & minimize risk of fall.  Guidelines :-  Secure approval from physician  Close supervision with vital parameters monitoring  5-10 mins warm up  Begin with low intensity, low repetitions exs  Throughout avoid high resistance exs  Frequency: 2-3 times/wk
SELECTED RESISTANCE TRAINING PROGRAM
PROGRESSIVE RESISTANCE EXERCISE
 PRE is a system of dynamic resistance training with constant external load to contracting muscle by some mechanical means & incrementally increased.  RM (repetition maximum) – basis for determining & progressing the resistance.  Beneficial in variety of pathological conditions (muscle injuries, osteoarthritis, osteoporosis, hypertension, diabetes, COPD, etc)  Various regimens are:-  Delorme  Oxford  Macqueen  DAPRE
DELORME REGIMEN  Introduced around 1945  Originally known as heavy resistance training & later as load resisting exercise to describe system of strength training.  Uses 3sets of 10 RM with progressive loading during each set.  It builds a warm up period into the protocol  Incorporate rest intervals between sets, incrementally increase the resistance over time & there is training induced strength gain over time.
SETS REPETITIONS AMOUNT OF RESISTANCE 1 10 50% of 10 RM 2 10 75% of 10 RM 3 10 100% of 10 RM
OXFORD REGIMEN  Zinovieff regimen  Regressive loading in each set  Diminishes the resistance as the muscle fatigues  Incorporate rest intervals between sets, incrementally increase the resistance over time & there is training induced strength gain over time. SETS REPETITIONS AMOUNT OF RESISTANCE 1 10 100% of 10 RM 2 10 75% of 10 RM 3 10 50% of 10 RM
MAC QUEEN REGIMEN SETS REPETITIONS AMOUNT OF RESISTANCE 1 10 100% of 10 RM 2 10 100% of 10 RM 3 10 100% of 10 RM 4 10 100% of 10 RM
DAPRE REGIMEN  Daily adjustable progressive resisted exercises  More systematic & takes into account the different rates at which individuals progress during rehabilitation or conditioning program.  Based on 6RM working weight SETS REPETITIONS AMOUNT OF RESISTANCE 1 10 50% 6RM 2 6 75% 6RM 3 Max possible 100% 6RM 4 Max possible 100% of adjusted working weight
CIRCUIT WEIGHT TRAINING
 Pre-established sequence(circuit) of continuous exercise is performed in succession at individual exs stations that target variety of major muscle groups for total body conditioning.  Exs performed at an exs station for a specified no of repetitions & sets (high reps, low intensity), minimum amount of rest interval (15-20secs)  Progression is by increasing no of sets or reps, the resistance, no of exs stations, or no of circuit revolution.  Exs order is important consideration; exs should alternate among UL, LL, trunk to minimize fatigue.  Large muscle groups before small muscle groups; multijoint exs before isolated muscle group.  Eg. Bench press→leg press/squats→sit ups →upright rowing →hamstring curl →shoulder press →heel raise →push ups →leg lifts or lowering.
PLYOMETRIC TRAINING
 “Plyometric training” / “stretch shortening drill” / “stretch strengthening drill” is a system of high velocity training characterized by rapid eccentric contraction during which the muscle elongate immediately followed by rapid reversal of movement with a resisted shortening contraction of same muscle.  Amortization phase – period between stretch & shortening cycle; should be brief.  Integrated into advanced phases of rehabilitation to train neuromuscular system to react quickly.  Source of resistance –body weight/equipment.  Eg. Catching & throwing ball, dribbling the ball, jumping forward or sideways, etc.
NEUROLOGICAL & BIOMECHANICAL INFLUENCE Augment force production Releases energy during concentric contraction Create elastic energy during eccentric contraction Spring like property of ms tendon Improves reactivity of NM system ↑excitability of NM receptors Stimulates proprioceptors Stretch – shortening cycle
 Effects –  Enhance physical performance  Enhance muscle’s dynamic restraint capabilities  ↓ LL injury incidence  Contraindications –  Inflammation  Pain  Joint instability  Progression –  Speed of drill  Intensity  Repetitions & frequency  Precautions –  Don’t include if high stress, shock absorbing activities are not permissible.  For children or elderly do not include high impact heavy load activities  Patient should have adequate flexibility & strength  Warm up & cool down  Teach safe techniques  Allow adequate time of recovery (48-72hrs)  Stop if indicated by patient
ISOKINETIC REGIMEN
 Should be performed at velocities that closely match to velocity of specific movement of task.  Generally medium or fast velocity  Speed specific training  Selection of velocity –  Medium (60or90 -180 degrees)  Fast (180-360degrees)  Repetitions, sets & rest –  1-2 sets of 8-10 or maximum 20 repetitions of agonist & antagonist muscle groups at multiple velocities  15-20sec rest between sets; 60sec rest in exs velocity  Intensity –  Warm up followed by submaximal efforts.
EQUIPMENTS FOR RESISTANCE TRAINING
 Limitless selection of exercise equipments  Range from simple to complex; compact to space consuming; inexpensive to expensive  Most equipments are load resisting but few are load assisting to improve strength of weak ms.  Can be used for static or dynamic exs, concentric or eccentric exs, open or closed chain exs  To improve muscle strength, power or endurance; neuromuscular stability or control & cardio pulmonary endurance  Choice of equipment depends on –  Individuals needs, abilities & goals  Availability  Cost of purchase & maintenance  Ease of use  Versatality  Space requirement
FREE WEIGHTS & SIMPLE PULLEY SYSTEM  Graduated weights or applied to extremities or trunk  Dumbbells, barbells, weighted ball, cuff weights, weighted vest, sand bags, simple weight pulleys  Can be used for home exs program  Can be used in various positions  Can be used isometric/dynamic exs, weight bearing & non weight bearing exs
VARIABLE RESISTANCE MACHINE  Falls in 2 broad categories as :-  Specially designed weight cables (weight pulley) – same ms group contracts concentrically & eccentrically; exs at slow velocity.  Hydraulic &pneumatic units – concentric work of agonist & antagonist; no eccentric work; safe at fast velocities; allow to accommodate pain free arc.  Advantages –  Muscle is loaded maximally at multiple points  Isolate & exs a specific muscle group  Mostly allows single plane movements; new machines dual axis movements  Provides external stabilization to guide or limit movements  Disadvantages – initial expenses & maintenance cost
ELASTIC RESISTANCE BANDS & TUBING  Use is widespread in rehabilitation; effective method of providing resistance (variable resistance).  Two broad categories as elastic bands (available in various grades & thickness) & tubes (in graduated diameters & wall thickness)  Color coding denotes grade of resistance.  Selection should be based on thickness of material (level of resistance)  Length should be sufficient to attach at both ends & not taut at the beginning of exercise.  One end should be secured on firm surface & other end grasped or tied to limb segment.  Progression - ↑ no of reps with same resistance or using higher grade of elastic band or tubing.
 Advantages –  Portable  Relatively inexpensive  Resistance is not significantly gravity dependant  Safe to exs at moderate to fast velocities  Disadvantages –  Difficult to determine which grade to start with & to what extent changing grade of band or tubing changes level of resistance.  No source of stabilization  Effects of material fatigue are small, still should be replaced on a routine basis to ensure patient safety.  Some products contains latex; eliminate use if allergy to latex.
EQUIPMENTS FOR CLOSED CHAIN TRAINING  Body weight resistance–multipurpose exs system  Uses glide board that can be inclined at various angles  Enables to perform unilateral or bilateral activities  Balance boards (wobble board)–  Proprioceptive training in UL & LL  Slide boards –  Moving platform that slides side to side  Mini trampolines –  Begin gentle, bilateral or unilateral bouncing activities on resilient surface
RECIPROCAL EXERCISE EQUIPMENTS  Strengthens multiple muscle groups at multiple joints  Appropriate for low intensity, high reps resistance training to increase muscular endurance & reciprocal coordination of UL, LL & improve cardiopulmonary fitness.  Often used in warm up & cool down.  Variety of equipments are –  Stationary exs cycle  Portable resistive reciprocal exs unit  Stair stepping machine  Elliptical trainers  Upper extremity ergometer
EQUIPMENTS FOR DYNAMIC STABILIZATION TRAINING  Swiss ball –  Usually 20-30inches in diameter  Used for variety of trunk & extremities stabilization  Body blade –  Dynamic, reactive form of resistance exs that use principle of inertia as the source of resistance to produce dynamic stability.
ISOKINETIC TESTING & TRAINING EQUIPMENTS  Provides accommodating resistance during dynamic exs of extremities or trunk.  The equipment supplies resistance proportional to the force generated by person using machine.  Features –  Computerized testing capability  Passive & active modes that permit open chain, concentric & eccentric testing & training  Adjustable velocity settings  Used even for CPM  Allows limb movement in specific joint range  Single joint uniplanar movements are common but some multiplanar movements are possible.
Resistance exs
Resistance exs

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Resistance exs

  • 1.
    RESISTANCE EXERCISES DR. MEGHAN PHUTANE(PT) CARDIORESPIRATORY PHYSIOTHERAPIST
  • 2.
    MUSCLE PERFORMANCE &RESISTANCE EXERCISES  3 elements of muscle performance – strength, power & endurance – can be enhanced by some form of resistance exercises.  Alteration in each element depends on -  How principles of resistance training are applied &  How factors like intensity, frequency & duration are manipulated.
  • 3.
    POTENTIAL BENEFITS OFRESISTANCE EXERCISES  Enhance muscle performance  Increase strength of connective tissue  Greater BMD or reduces bone demineralization  Decrease stress on joints  Reduce risk of soft tissue injury  Improves capacity to repair or heal damaged soft tissues  Possible improvement in balance  Enhances physical performance during ADLs, recreational activities & occupation  Improves body composition : increase lean muscle mass & reduce body fat  Enhance feeling of physical well being & so QOL.
  • 4.
    STRENGTH  Ability ofa contractile tissue to produce tension & resultant force based on demands placed on the muscles / Greatest measurable force exerted by muscle or group of muscles to overcome resistance during a single maximum effort.  Functional strength – ability of a neuromuscular system to produce, reduce or control forces imposed during functional activity in a smooth coordinated manner.  Strength training – systemic procedure of a muscle or muscle group of lifting, lowering or controlling heavy loads (resistance) for a relatively lower number of repetitions or a short period of time.  Increases maximum force producing capacity of muscle & muscle fiber size (neural adaptation).
  • 5.
    POWER  Muscle poweris related to strength & speed of movement & is defined as work produced by muscle per unit time. (force×distance/time).  Power training –  By increasing work of muscle for specific time or reducing time for specific work of muscle.  Greater the intensity & shorter the time period taken to generate force – greater the muscle power.
  • 6.
    ENDURANCE  Endurance refersto the ability to perform low intensity, repetitive or sustained activities over a prolonged period of time.  Muscle endurance is the ability to contract repeatedly against a load, generate & sustain tension & resist fatigue over an extended period of time.  Endurance training – low intensity muscle contraction, large number of repetitions for prolonged time period.
  • 7.
    PRINCIPLES 1. Overload principle 2.SAID principle 3. Reversibility principle
  • 8.
    OVERLOAD PRINCIPLE  Toimprove muscle performance, a load that exceeds the metabolic capacity of the muscle must be applied.  Progressive loading of muscle can be done by manipulating intensity or volume of exercises.
  • 9.
    SAID PRINCIPLE  Specificadaptation to imposed demands  Exercise program should be built on specificity principle.  It’s a extension of Wolf’s law.  Specificity of exercise refers to the adaptive effects of training like strength, power & endurance, are highly specific to the training methods employed.  Considered relative to mode & velocity of exercise; joint angle; movement pattern during exercise.  Basis of specificity of training is related to morphological & metabolic changes in muscles & neural adaptation to the training stimulus with motor learning.
  • 10.
    REVERSIBILITY PRINCIPLE  Adaptivechanges in body system (strength, endurance) due to resistance exercises are transient unless improvement is used for functional activities or as a maintenance program.  Detraining (reduced muscle performance), starts in a week or two after exercise cessations & continues until training effect are lost.
  • 11.
    DETERMINANTS OF RESISTANCEEXERCISE  Many elements (variables) determine whether a resistance exercise program is appropriate, effective & safe.  All elements are interrelated & should be addressed to improve one or more aspects of muscle performance & achieve desired functional outcomes.
  • 12.
     Alignment –of segments of body during exercise.  Stabilization –of proximal or distal joint to prevent substitution.  Intensity – the exercise load (level of resistance).  Volume – the total number of repetitions & sets in the exercise sessions multiplied by the resistance used.  Exercise order – the sequence in which muscle groups are exercised during the exercise session.  Frequency – the number of exercise sessions per day or per week.  Rest interval – time allotted for recuperation between sets & sessions of exercise.
  • 13.
     Duration –total time frame of a resistance training program.  Mode of exercise – type of muscle contraction, position of the patient, form of exercise, arc of movement, or the energy system utilized primary.  Velocity of exercise.  Periodization – variation in intensity & volume during specific period of resistance training.  Integration of exercise into functional activities – use of resistance exercise that approximate or replicate functional demands.
  • 14.
  • 15.
    CONSIDERATIONS FOR SELECTIONOF MODES OF RESISTANCE EXERCISE  Cause & extent of primary & secondary impairments  Deficits in muscle performance  Stage of tissue healing  Condition of joints & their tolerance to compression & movement  General physical & cognitive ability of patient  Availability of equipments  Patient’s goal  Intended functional outcomes of the program
  • 16.
    MANUAL & MECHANICALRESISTANCE EXERCISE Manual resistance exercise –  Type of active resistive exercise where resistance is applied manually by therapist, other professional or self (by patient).  Resistance cannot be measured quantitatively but useful in early stage of exercise training.  Also useful when joint ROM needs to be carefully controlled.  Amount of resistance is limited to therapist strength
  • 17.
    CONT… Mechanical resistance exercises–  Type of active resistive exercise where resistance is applied through the use of equipments or mechanical apparatus.  Amount of resistance can be measured quantitatively & increased progressively .
  • 18.
    ISOMETRIC EXERCISES (STATIC) Static form of exercise in which muscle contracts & produces force without appreciable change in length of muscle & without visible joint motion.  No mechanical work done but measurable amount of tension & force are produced.  Sources of resistance –  Holding against force applied manually  Holding weight in particular position  Maintaining position against resistance of body weight  Pushing or pulling immovable objects
  • 19.
    RATIONAL & INDICATIONS To prevent or minimize muscle atrophy due to external immobilization  To activate muscle to begin to res-establish neuromuscular control but protect healing tissues when joint movement is not advisable (post surgical)  To develop postural or joint stability  To improve muscle strength when dynamic activity is not permissible
  • 20.
    TYPES  Muscle settingexs –  Involve low intensity isometric contractions performed against little or no resistance.  To decrease muscle pain, promote relaxation & circulation  Stabilization exs –  Used to develop a sub-maximal but sustained level of contraction to improve postural or dynamic stability of a joint by means of mid-range isometric contraction against resistance in antigravity & weight bearing position.  Multiple angle isometrics –  System of isometric exs where resistance is applied manually or mechanically at multiple joint positions within available ROM.
  • 21.
    CHARACTERISTICS & EFFECTS Intensity of muscle contraction –  Amount of tension generation depends on joint position & length of muscle fibers during contraction.  60-80%  Duration of muscle activation–  Hold for 6-10secs, post 10secs fatigue.  Sufficient time to develop peak tension & metabolic changes  Repetitive contractions –  Repetitive contractions hold for 6-10secs – decrease muscle cramping & increase effectiveness of isometric regimen.  Joint angle & mode specificity –  gain in muscle strength occur only at or closely adjacent to the training angle.
  • 22.
     Precautions – Should be pain free  Avoid breath holding  Contraindications –  High intensity isometrics should be avoided in cardiac & vascular diseases.
  • 23.
    DYNAMIC EXS –CONCENTRIC & ECENTRIC  Causes joint movement & excursion of body segment as muscle contracts under tension.  Concentric exs – form of dynamic muscle loading where tension develops in muscle & physical shortening of muscle occurs as resistance overcomes. (lifting weight)  Ecentric exs – dynamic loading of muscle beyond its force producing capacity, causing physical lengthening of muscle as it attempts to control the load. (lowering the weight)  Resistance can be applied by –  Constant resistance (body wt/simple wt/ wt pulley)  Weight machine (variable resistance)  Isokinetic device (controls velocity)
  • 24.
    RATIONALE  Concentric contractionaccelerate body segment whereas eccentric contraction decelerate body segment.  Combined action is evident in countless daily activities.  Eccentric contraction –  Acts as a source of shock absorption during high impact activities.  Essential component of rehabilitation & conditioning program to reduce risk of muscle injury or re-injury.  Plyometrics (stretch shortening drills)/ fast velocity, eccentric isokinetic training – prepare patient for high demands of activities.
  • 25.
    DYNAMIC EXS –CONSTANT & VARIBLE RESISTANCE  The most common system of resistance training used with dynamic exercise against constant or variable resistance is progressive resistance exs.(PRE)  Dynamic constant external resistance exs (DCER) –  Resistance training where limb moves through a ROM against constant external load, provided by free weights like weight cuffs, Pulley system.  Contracting muscle is challenged maximally at only one point of ROM, where maximum torque of resistance matches torque output of muscle.
  • 26.
     Variable resistanceexercise –  Specially designed resistance equipments imposes varying levels of resistance to contracting muscle to load the muscle more effectively at multiple points in ROM. Eg with elastic tubes or bands.  Performed against manual resistance, a skilled therapist can vary the force applied to the contracting muscle throughout the ROM.
  • 27.
    ISOKINETIC EXERCISES  Itsa form of dynamic exs in which velocity of muscle shortening or lengthening & the angular limb velocity is predetermined & held constant by a rate limiting device known as isokinetic dynamometer.
  • 28.
     Characteristics – Constant velocity  Range & selection of training velocity  Reciprocal versus isolated muscle training  Specificity of training(speed specific)  Compressive forces on joints  Accommodation to fatigue  Accommodation of painful arc
  • 29.
     Training effects& carryover function –  Improves one or more parameters of muscle performance.  Isolate single muscle or opposite muscle group  Involves movement of single joint  Uniplanar movement  Does not involve weight bearing.
  • 30.
     Special considerations–  Availability of equipments  Appropriate set up  Accommodation to painful arc
  • 31.
    OPEN CHAIN &CLOSED CHAIN EXS  Functional activities & exs are commonly categorized as having weight bearing or non weight bearing characteristics.  Also called as “open or closed kinetic chain” & “open or closed kinematic chain”.  Open kinetic chain refers to completely unrestricted movement in space of a peripheral segment of the body. (waving the hand, swinging the leg)  Closed kinetic chain movements – peripheral segment meets with the considerable external resistance. One joint motion is always accompanied by adjacent joint motions.
  • 32.
    OPEN CHAIN EXSCLOSED CHAIN EXS Distal segment moves in space Distal surface fixed on stationary support Independent joint movement Interdependent joint movements Movement of body segment distal to the moving joint Movement of body segment distal &/or proximal to the moving joint Muscle activation occurs in prime movers Muscle activation of multiple joint muscles Performed in non weight bearing position (typical) Performed in weight bearing position (typically but not always) Resistance is applied to the moving distal segment Resistance is applied simultaneously to multiple moving segments Use of external rotary loading Use of axial loading External stabilization usually required Internal stabilization by means of muscle action, joint compression, etc.
  • 33.
  • 34.
    EXAMINATION & EVALUATION Thorough examination of patients (history, system review, selected tests & measurements)  Determine qualitative & quantitative baseline parameters (strength, endurance, ROM)  Implement testing procedures (MMT, RM, dynamometry, goniometry, level of disability)  Interpret the findings  Establish plan of care integrating resistance exs  Periodical re-evaluation.
  • 35.
    PREPARATION  Select &prescribe form of resistance exs that are appropriate & expected to be effective.  If using mechanical resistance, determine what equipment is needed & available.  Review the anticipated goals & expected functional outcomes  Explain the exs plan & procedures.  Let the patient were nonrestrictive clothing & supportive shoes appropriate for exs.  Select firm but comfortable support surface  Demonstrate each exs & desired movement pattern.
  • 36.
    APPLICATION  Warm up– (5-10mins, non resisted exs)  Placement of resistance –  Typically on distal end of segment  May be applied across intermediate joint  Revise placement if pressure is uncomfortable  Direction of resistance –  Concentric exs – opposite direction  Eccentric exs – same direction  Stabilization –  Necessary to avoid unwanted or substitute motion  Non weight bearing – proximal stabilization  Weight bearing – muscle control
  • 37.
     Intensity ofexs / amount of resistance –  Initially minimal load; progress slowly  Volume / no of reps & sets & rest intervals –  Generally, 8-12reps with moderate load; followed by rest  For progression initially increase no of reps & sets then increase resistance  Verbal / written instructions –  Use simple instructions that are easy to understand  Avoid medical terminologies  Monitoring the patient –  Before, during & after exs  Cool down –  Rhythmic, unresisted movements
  • 38.
    PRECAUTIONS  Select ambientroom temperature  Select clothing that facilitate heat dissipation  Exs should be pain free  Initiate with low loads/ avoid high intensity  Do not apply pressure to unstable joint or distal to fracture site  Avoid valsalva maneuver  Avoid uncontrolled ballistic movements  Prevent incorrect or substitute motion  Avoid exercise that put excessive, unintended secondary stress on body  Be aware of medications a patient is using  Avoid fatigue  Discontinue exs if pt experience pain, dizziness or unusual shortness of breath  Prevent pathological fractures
  • 39.
    CONT…  Overtraining – Declined physical performance in healthy individuals participating in high intensity, high volume strength training program.  Other terms are chronic fatigue, staleness, burnout  Due to inadequate rest intervals, too rapid exs progression, inadequate diet & fluid intake.  Preventable, reversible phenomenon  Overwork –  Termed as overwork weakness  Progressive deterioration of strength in muscles already weakened by nonprogressive neuromuscular disease  Prevention is better than cure
  • 40.
    CONT… Exs induced musclesoreness –  Acute muscle soreness –  During or directly after strenous exs  Delayed onset muscle soreness (DOMS) –  DOMS begins to develop 12-24hrs after the cessation of strenuous activity; intensifies & peaks 24-48hrs later  Can be prevented by gradual progression of intensity & volume of resistance; warm up & cool down; slow stretches before & after exs
  • 41.
    CONTRAINDICATIONS  Acute inflammation/ acute disease  Pain  Severe cardiopulmonary disease
  • 42.
  • 43.
    FACTORS INFLUENCING TENSIONGENERATION IN NORMAL SKELETAL MUSCLES FACTOR INFLUENCE Cross section & muscle size Larger ms diameter – greater tension producing capacity Fiber length & arrangement •Short fibers (pinnate/multipinnate) – high force producing capacity (quads, deltoid, gastrocnemius) •Long parallel fibers –high rate of shortening; less force production (sartorius) Fiber type distribution •High % type I – low force production,fatigue resistant •High % type II – rapid high force production & fatigue Length tension relationship Greater tension is produced near or at physiological resting position during contraction
  • 44.
    CONT… FACTOR INFLUENCE Motor unit recruitment Greaterno & synchronization of motor unit firing – greater force production Frequency of motor unit firing Higher frequency of firing – greater the tension Type of muscle contraction Force output from greatest to least : eccentric, isometric, concentric muscle contraction Speed of muscle contraction Concentric contraction - ↑speed - ↓tension Eccentric contraction - ↑speed - ↑tension
  • 45.
    ADDITIONAL FACTORS  Energystore & blood supply –  Adequate energy source is needed to contract, generate tension & resist fatigue.  3 main energy systems are :  ATP-PC system  Anaerobic/glycolytic/lactic acid system  Aerobic system  Fatigue – complex phenomenon affecting muscle performance.  Muscle (local) fatigue – the diminished response of muscle to a repeated stimulus-is reflected in progressive decrement in amplitude of motor unit potential.  Cardiopulmonary (general) fatigue – diminished response of an individual as a result of prolonged physical activity.`
  • 46.
    CONT…  Recovery fromexs –  Adequate time of recovery from fatiguing exs must be built  Both inter-session & intra-session  Age –  Muscle performance changes through out the life span.  Psychological & cognitive factors –  Positive or negative influence  Attention  Patient must focus on given task to perform it correctly  Motivation & feedback-
  • 47.
    PHYSIOLOGICAL ADAPTATIONS TORESISTANCE EXS VARIABLE STRENGTH TRAINING ADAPTATION Skeletal muscle structure •Hypertrophy of muscle fiber (more in type II) •Hyperplasia of muscle fibers •Fiber type composition: remodelling (type IIB to IIA; no change in type I) • Capillary bed density - ↓ or no change •Mitochondrial density & volume: ↓ Neural system •Motor unit recruitment: ↑ •Rate of motor unit firing: ↑(↓twich contraction time) •Synchronization of firing: ↑ Metabolic system •ATP & CP storage: ↑ •Myoglobin storage: ↑ •Stored triglycerides: not known
  • 48.
    VARIABLE STRENGTH TRAININGADAPTATION Enzymes •Creatine phosphokinase: ↑ •Myokinase: ↑ Body composition •Lean body mass: ↑ •% body fat: ↓ Connective tissue •Tensile strength of tendons, ligaments & connective tissue: ↑ •Bone: ↑BMD; no change or possible ↑ in bone mass
  • 50.
  • 51.
    DEFINITION  Manual resistanceexs is a form of active resistive exs in which resistance force is applied by the therapist to either a dynamic or static muscular contraction.
  • 52.
    ADVANTAGES  Most effectiveduring early stage of rehabilitation  Effective during transition from assisted to mechanically resisted movements  More finely graded resistance  Resistance can be adjusted throughout ROM  Muscle works maximally at all portions of ROM  Joint ROM can be carefully controlled  Useful for dynamic & static strengthening  Manual stabilization prevents substitute motions  Can use variety of patient positions  Placement of resistance can be easily adjusted
  • 53.
    DISADVANTAGES  Exs loadis subjective; cannot be measured to document  Amount of resistance will be limited to the strength of therapist  Little value to strong muscle group  Speed of movement is slow to moderate  Cannot be performed independently by the patient  Not useful in home program  Labor- & time- intensive for therapist  Impractical to improve muscle endurance
  • 54.
    GUIDELINES  Body mechanicsof the therapist –  Table/patient bed height  Position close to patient  Wide standing  Application of manual resistance & stabilization  Stabilize proximal attachment  Vary resistance through out ROM  verbal commands –  Coordinate timing of verbal commands with resistance application  Simple, direct commands  No of reps & sets; rest intervals –  No depends on patient’s response & therapist strength  Adequate rest interval after 8-12 reps
  • 55.
    TECHNIQUE  For eccentriccontraction, direction of limb movement would be opposite .  Involves non weight bearing positions & isolate individual muscle or muscle group  Variation in therapist position, hand placement or alternate patient position may be necessary depending on size & strength of therapist & patient.  Opposite motions are often alternately restricted where strength & balanced neuromuscular control in both agonist & antagonist are desired.
  • 56.
  • 57.
     Mechanical resistanceexercise is any form of exercise in which the resistance is applied by means of some form of exercise equipment.  Integral component of rehabilitation & conditioning program.
  • 58.
    ADVANTAGES  Establish quantitativebaseline measurement– improvements can be monitored.  Most appropriate in intermediate & advanced phases of rehabilitation (muscle strength ≥4/5 or ≥therapist strength)  Increase in level of resistance can be incrementally &quantitatively documented.  Quantitative improvement – effective source of motivation for patient.  Useful for improving static & dynamic muscle strength.  Adds variety to resistance training program.  Some equipments provide variable resistance throughout the ROM.  High velocity resistance training is possible & safe.  Appropriate for independent home exercise program.
  • 59.
    DISADVANTAGES  Not appropriatewhen muscles are very weak or early stage of soft tissue healing (exception – equipments that provide assistance, support or control against gravity.)  Equipment that provide constant external resistance maximally loads the muscle at only one point in ROM.  No accommodation for painful arc (except with hydraulic, pneumatic or isokinetic equipment).  Expenses for purchase & maintenance of equipment.  With free weights & weighing machine, gradation depends on manufacturer's increments of resistance.
  • 60.
     Use inrehabilitation –  To eliminate or reduce deficits in muscle strength, power & endurance caused by an array of pathological conditions.  To restore or improve functional abilities.  Use in conditioning –  Important component of comprehensive conditioning program to improve or maintain physical fitness & health through out most of the lifespan.
  • 61.
    GUIDELINES IN CONDITIONINGPROGRAM FOR HEALTHY ADULTS  Prior to training, warm up followed by flexibility exs  Perform dynamic muscle exs targeting major muscle groups of body for total body fitness.  Balance flexion & extension dominant (pulling / pushing)exs; concentric & eccentric (lowering / lifting) exs.  Use full, available, pain free ROM.  Use moderate intensity (8-10reps; 1-3sets; 2-3min rest interval.)  Use slow, moderate speed, rhythmic, controlled, non- balliastic movements.  Exercise should not interfere normal breathing.  Frequency – 2-3times/wk  Increase intensity gradually  Cool down after completion of exercises.
  • 62.
    CHILDREN & RESISTANCETRAINING  Questionable….  Now evidence states that children do achieve health related benefits & so can safely engage in supervised weight training program.  Resistance by using body weight or equipments designed specifically for children are safe.  Guidelines :-  No training below 6-7 yrs age  Start without weights then with light weights  Close & continuous supervision  Focus on proper form, technique & safety  Emphasize low intensity, short duration, play oriented exs with low exercise loads & frequency 2-3/wk  Use warm up & cool down exs  Initial progression by increasing reps & not resistance.
  • 63.
    OLDER ADULTS &RESISTANCE TRAINING  Major goal is to maintain or improve level of functional independence & reduce risk of age related diseases.  Improves muscle strength, balance, speed of walking, ability to rise in chair & minimize risk of fall.  Guidelines :-  Secure approval from physician  Close supervision with vital parameters monitoring  5-10 mins warm up  Begin with low intensity, low repetitions exs  Throughout avoid high resistance exs  Frequency: 2-3 times/wk
  • 64.
  • 65.
  • 66.
     PRE isa system of dynamic resistance training with constant external load to contracting muscle by some mechanical means & incrementally increased.  RM (repetition maximum) – basis for determining & progressing the resistance.  Beneficial in variety of pathological conditions (muscle injuries, osteoarthritis, osteoporosis, hypertension, diabetes, COPD, etc)  Various regimens are:-  Delorme  Oxford  Macqueen  DAPRE
  • 67.
    DELORME REGIMEN  Introducedaround 1945  Originally known as heavy resistance training & later as load resisting exercise to describe system of strength training.  Uses 3sets of 10 RM with progressive loading during each set.  It builds a warm up period into the protocol  Incorporate rest intervals between sets, incrementally increase the resistance over time & there is training induced strength gain over time.
  • 68.
    SETS REPETITIONS AMOUNTOF RESISTANCE 1 10 50% of 10 RM 2 10 75% of 10 RM 3 10 100% of 10 RM
  • 69.
    OXFORD REGIMEN  Zinovieffregimen  Regressive loading in each set  Diminishes the resistance as the muscle fatigues  Incorporate rest intervals between sets, incrementally increase the resistance over time & there is training induced strength gain over time. SETS REPETITIONS AMOUNT OF RESISTANCE 1 10 100% of 10 RM 2 10 75% of 10 RM 3 10 50% of 10 RM
  • 70.
    MAC QUEEN REGIMEN SETSREPETITIONS AMOUNT OF RESISTANCE 1 10 100% of 10 RM 2 10 100% of 10 RM 3 10 100% of 10 RM 4 10 100% of 10 RM
  • 71.
    DAPRE REGIMEN  Dailyadjustable progressive resisted exercises  More systematic & takes into account the different rates at which individuals progress during rehabilitation or conditioning program.  Based on 6RM working weight SETS REPETITIONS AMOUNT OF RESISTANCE 1 10 50% 6RM 2 6 75% 6RM 3 Max possible 100% 6RM 4 Max possible 100% of adjusted working weight
  • 72.
  • 73.
     Pre-established sequence(circuit)of continuous exercise is performed in succession at individual exs stations that target variety of major muscle groups for total body conditioning.  Exs performed at an exs station for a specified no of repetitions & sets (high reps, low intensity), minimum amount of rest interval (15-20secs)  Progression is by increasing no of sets or reps, the resistance, no of exs stations, or no of circuit revolution.  Exs order is important consideration; exs should alternate among UL, LL, trunk to minimize fatigue.  Large muscle groups before small muscle groups; multijoint exs before isolated muscle group.  Eg. Bench press→leg press/squats→sit ups →upright rowing →hamstring curl →shoulder press →heel raise →push ups →leg lifts or lowering.
  • 74.
  • 75.
     “Plyometric training”/ “stretch shortening drill” / “stretch strengthening drill” is a system of high velocity training characterized by rapid eccentric contraction during which the muscle elongate immediately followed by rapid reversal of movement with a resisted shortening contraction of same muscle.  Amortization phase – period between stretch & shortening cycle; should be brief.  Integrated into advanced phases of rehabilitation to train neuromuscular system to react quickly.  Source of resistance –body weight/equipment.  Eg. Catching & throwing ball, dribbling the ball, jumping forward or sideways, etc.
  • 76.
    NEUROLOGICAL & BIOMECHANICALINFLUENCE Augment force production Releases energy during concentric contraction Create elastic energy during eccentric contraction Spring like property of ms tendon Improves reactivity of NM system ↑excitability of NM receptors Stimulates proprioceptors Stretch – shortening cycle
  • 77.
     Effects – Enhance physical performance  Enhance muscle’s dynamic restraint capabilities  ↓ LL injury incidence  Contraindications –  Inflammation  Pain  Joint instability  Progression –  Speed of drill  Intensity  Repetitions & frequency  Precautions –  Don’t include if high stress, shock absorbing activities are not permissible.  For children or elderly do not include high impact heavy load activities  Patient should have adequate flexibility & strength  Warm up & cool down  Teach safe techniques  Allow adequate time of recovery (48-72hrs)  Stop if indicated by patient
  • 78.
  • 79.
     Should beperformed at velocities that closely match to velocity of specific movement of task.  Generally medium or fast velocity  Speed specific training  Selection of velocity –  Medium (60or90 -180 degrees)  Fast (180-360degrees)  Repetitions, sets & rest –  1-2 sets of 8-10 or maximum 20 repetitions of agonist & antagonist muscle groups at multiple velocities  15-20sec rest between sets; 60sec rest in exs velocity  Intensity –  Warm up followed by submaximal efforts.
  • 80.
  • 81.
     Limitless selectionof exercise equipments  Range from simple to complex; compact to space consuming; inexpensive to expensive  Most equipments are load resisting but few are load assisting to improve strength of weak ms.  Can be used for static or dynamic exs, concentric or eccentric exs, open or closed chain exs  To improve muscle strength, power or endurance; neuromuscular stability or control & cardio pulmonary endurance  Choice of equipment depends on –  Individuals needs, abilities & goals  Availability  Cost of purchase & maintenance  Ease of use  Versatality  Space requirement
  • 82.
    FREE WEIGHTS &SIMPLE PULLEY SYSTEM  Graduated weights or applied to extremities or trunk  Dumbbells, barbells, weighted ball, cuff weights, weighted vest, sand bags, simple weight pulleys  Can be used for home exs program  Can be used in various positions  Can be used isometric/dynamic exs, weight bearing & non weight bearing exs
  • 84.
    VARIABLE RESISTANCE MACHINE Falls in 2 broad categories as :-  Specially designed weight cables (weight pulley) – same ms group contracts concentrically & eccentrically; exs at slow velocity.  Hydraulic &pneumatic units – concentric work of agonist & antagonist; no eccentric work; safe at fast velocities; allow to accommodate pain free arc.  Advantages –  Muscle is loaded maximally at multiple points  Isolate & exs a specific muscle group  Mostly allows single plane movements; new machines dual axis movements  Provides external stabilization to guide or limit movements  Disadvantages – initial expenses & maintenance cost
  • 85.
    ELASTIC RESISTANCE BANDS& TUBING  Use is widespread in rehabilitation; effective method of providing resistance (variable resistance).  Two broad categories as elastic bands (available in various grades & thickness) & tubes (in graduated diameters & wall thickness)  Color coding denotes grade of resistance.  Selection should be based on thickness of material (level of resistance)  Length should be sufficient to attach at both ends & not taut at the beginning of exercise.  One end should be secured on firm surface & other end grasped or tied to limb segment.  Progression - ↑ no of reps with same resistance or using higher grade of elastic band or tubing.
  • 86.
     Advantages – Portable  Relatively inexpensive  Resistance is not significantly gravity dependant  Safe to exs at moderate to fast velocities  Disadvantages –  Difficult to determine which grade to start with & to what extent changing grade of band or tubing changes level of resistance.  No source of stabilization  Effects of material fatigue are small, still should be replaced on a routine basis to ensure patient safety.  Some products contains latex; eliminate use if allergy to latex.
  • 88.
    EQUIPMENTS FOR CLOSEDCHAIN TRAINING  Body weight resistance–multipurpose exs system  Uses glide board that can be inclined at various angles  Enables to perform unilateral or bilateral activities  Balance boards (wobble board)–  Proprioceptive training in UL & LL  Slide boards –  Moving platform that slides side to side  Mini trampolines –  Begin gentle, bilateral or unilateral bouncing activities on resilient surface
  • 90.
    RECIPROCAL EXERCISE EQUIPMENTS Strengthens multiple muscle groups at multiple joints  Appropriate for low intensity, high reps resistance training to increase muscular endurance & reciprocal coordination of UL, LL & improve cardiopulmonary fitness.  Often used in warm up & cool down.  Variety of equipments are –  Stationary exs cycle  Portable resistive reciprocal exs unit  Stair stepping machine  Elliptical trainers  Upper extremity ergometer
  • 92.
    EQUIPMENTS FOR DYNAMICSTABILIZATION TRAINING  Swiss ball –  Usually 20-30inches in diameter  Used for variety of trunk & extremities stabilization  Body blade –  Dynamic, reactive form of resistance exs that use principle of inertia as the source of resistance to produce dynamic stability.
  • 94.
    ISOKINETIC TESTING &TRAINING EQUIPMENTS  Provides accommodating resistance during dynamic exs of extremities or trunk.  The equipment supplies resistance proportional to the force generated by person using machine.  Features –  Computerized testing capability  Passive & active modes that permit open chain, concentric & eccentric testing & training  Adjustable velocity settings  Used even for CPM  Allows limb movement in specific joint range  Single joint uniplanar movements are common but some multiplanar movements are possible.