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

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

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

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

  5. Principles of Resistance Exercise

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  40. Exercise Regimens • Progressive Resistive Exercise • Circuit Weight Training • Plyometric Training • Isokinetic Regimens

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

  42. Adjusted working weight (DAPRE)

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

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

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