STRENGTH TRAINING

Thursday, November 18, 2010 10:59 AM

Motor Unit Nerve Supply to Muscle Slow Twitch (Type I) Fast Twitch (Type IIa) Fast Twitch (Type Iib)

Slow contraction Low force production Highly resistant to fatigue Lowest functional threshold

Fast contraction Influenced by type of training Fatigue resistant Higher thresholds

Fast contraction High force production Quick fatigue

Recruited in lighter, slower efforts Higher forces w/ greater velocity (endurance activities) Concepts of Strength Training Maximum tension in mid ROM, less tension in shortened or lengthened ROM. Muscle hypertrophy observed after at least 6-8 weeks of training. High intensity short duration exercises (<20 reps) --> fast twitch IIa fibers Ms contraction to 60% of its force-generating capacity causes blockage of blood flow to ms due to intramuscular pressure. Energy source is ANAEROBIC and DOES NOT improve w/ AEROBIC conditioning. Rhythmic activities Blood flow to exercising ms (milking action - contraction/relaxation); source is AEROBIC. Overwork/overtraining causes temporary or permanent loss of strength as a result of exercise. In normal individual, fatigue causes discomfort, so this does not occur. But in pxs w/ LMND (post polio syndrome), exercise intensity, duration, & progression should be progressed slowly. Errors in Resistance/Strength Training Valsalva's maneuver intrathoracic pressure, venous pressure & cardiac work HR and return of blood to the heart Inadequate rest after exercise 3-4 mins for ms to return to preexercise capacity Increasing progression quickly Substitute motion Local Fatigue
Normal response Depleted energy stores, insufficient oxygen, build up of lactic acid

Types of Resistance Training Isometric Contractions should be held for at least 6 seconds to obtain adaptive changes in muscles Strengthening of ms is developed at a point in the ROM, NOT over the entire length of the ms. Isotonic Use of weights Speed is variable Weight lifting machines are safer than free weights and used early in resistance exer or rehab program Isokinetic Resistance is accommodating and variable. Peak torque is inversely proportional to angular velocity Provides maximum resistance to all points of the ROM as the ms contracts Wt of body segment creates a torque output around the joint. Eccentric and Concentric Ecc>Con ECC - source of shock absorption during closed-chain functional activities ECC - consume less O2 & fewer energy stores against CON in similar load

Slow ECC > Fast ECC > Isometric > Slow CON > Fast CON Open Chain Closed Chain

Resistance exercises ONLY option Loads ms, bones, joints & noncontractile if WB is contraindicated tissues DOES NOT adequately prepare px Stimulates mechanoreceptors adding to joint for functional WB activities stability, balance, coordination & agility Specific Exercise Regimens PRE Uses RM (greatest amount of weight a ms can move through the ROM a specific # of times) DeLorme (3 sets of 10 reps of 50, 75, 100% RM w/ 1-2 min rest in between sets) Circuit Weight Training Sequence of exercises for total body conditioning Rest period of 30 secs to 1 min between each exercise Plyometric Training (Stretch shortening activity) Isotonic exercise (speed, strength & functional activities) Later stages of rehab Brief Repetitive Isometric Exercise (BRIME) Maximum 20 contractions held for 5-6 seconds daily 20-sec rest between each contractions to prevent increase in BP Strength gain in 6 weeks

General Fatigue
Affects whole body Low blood sugar, glycogen stores in ms & liver, potassium

Decline in peak torque & Ms pain w/ occasional spasm & AROM

Contraindications for Strength Training Inflammation Pain

Resistance Training Specificity Relative Loading

Light

Outcome
Muscular endurance

%1RM Repetition Range # of Sets Rest Between Sets

<70 12-20 1-3 20-30 secs

Moderate Heavy

Hypertrophy & strength 70-80 Max strength 80-100

8-12 1-8

1-6 1-5+

30-120 secs 2-5 mins

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ENDURANCE TRAINING
Thursday, November 18, 2010 11:34 PM

TRAINING STRATEGIES TO DEVELOP MUSCULAR ENDURANCE Exercise programs that increase strength also increase muscle endurance. Indicated after joint & soft tissue injuries. TRAINING STRATEGIES TO DEVELOP CARDIOVASCULAR ENDURANCE Overload principle used to enhance physiological improvement & bring about a training change. Specificity principle. Individual differences principle. Reversibility principle --> detraining after 2 weeks. FITT equation Frequency Intensity constant --> Benefit from 2 vs 4 vs 3 vs 5x/week is the same. Weight loss --> 5-7x/week increases caloric expenditure more than 2x/week. Less than 2x/week --> DOES NOT produce adequate changes in aerobic capacity. Intensity (Overload) Primary way to improve CV endurance Relative intensity --> percentage of max consumption (VO2 max or HR max) VO2 max --> Q (CaO2-CvO2), where Q is the cardiac output of the heart, CaO2 is the arterial oxygen content, and CvO 2 is the venous oxygen content. HR Max -->220-px age Can be measured by 3-min step, 12-min run, 1-mile walk test Target heart rate --> 70% HR max; athlete (75-85%); obese/sedentary (40-60%) Karvonen formula (HRR/THR) -->([HR max - RHR] X % of desired training intensity) +RHR Rating of Perceived Exertion

TRAINING STRATEGIES TO DEVELOP PULMONARY ENDURANCE Ventilation (Ve) = Breathing rate x TV (6 L) Exercise-induced asthma Reversible 5-15 mins after strenuous exercise When px does not breathe thru the nose Mouth breathes --> air is cold & dry --> bronchoconstriction Rare in short bursts of activity (baseball); more likely in endurance activities (soccer).

Modified
0 Nothing at all 0.5 Very, very weak 1 Very weak 2 Weak 3 Moderate 4 Somewhat strong 5 Strong 6 7 Very strong 8 9 10 Very, very strong

Original
6 - 20% effort 7 - 30% effort - Very, very light (Rest) 8 - 40% effort 9 - 50% effort - Very light - gentle walking 10 - 55% effort 11 - 60% effort - Fairly light 12 - 65% effort 13 - 70% effort - Somewhat hard - steady pace 14 - 75% effort 15 - 80% effort - Hard 16 - 85% effort 17 - 90% effort - Very hard 18 - 95% effort 19 - 100% effort - Very, very hard 20 - Exhaustion

AEROBIC TRAINING Positive effects Improve breathing volumes & increased VO2 max Increase heart weight & volume; cardiac hypertrophy is NORMAL w/ long-term aerobic training. Increase total Hb & O2 delivery capacity. Decrease resting & submaximal exercise HR Increase CO & SV Improve distribution of blood to working muscles & enhanced capacity of trained ms Reduce resting BP Continuous training at submax energy requirement can be prolonged for 20-60 mins w/o exhausting O2 transport system Healthy individuals --> continuous training is the MOST effective way to improve endurance. Circuit training Improves endurance & strength. Interval training Exercise followed by rest Less demanding than continuous Improves strength & power more than endurance. The longer the work interval, the more the aerobic system is stressed & the duration of the rest period is NOT important. Short work interval Work:recovery 1:1 to 1:5 is appropriate to stress the aerobic system Rest:work 1:1/2 allows exercise to begin before recovery is complete --> stresses the aerobic system The total amount of work completed w/ interval training is greater than the amount of work accomplished w/ continuous training. Warm-up and Cool-Down

Duration Increased when intensity is limited (environmental/medical conditions) 3-5 mins/day produces training effects in poorly conditioned pxs. Obese pxs should exercise at longer duration & lower intensity.

ERRORS W/ MUSCULAR, CARDIOVASCULAR & PULMONARY ENDURANCE TRAINING Lack of exercise tolerance testing (ETT) before exer Rx Starting at a level too high Increasing intensity too fast Exercising at a level too intense --> increases strength & power NOT endurance Insufficient warm-up and cool down Inconsistent training intensity

EXERCISE AT HIGH ALTITUDE

6000 feet (1829 m) --> drop in aerobic activities

EXERCISE IN HOT WEATHER

To decrease metabolic heat, blood is shunted to periphery (working ms deprived of O2)

PaO2 --> poor oxygenation of Hb

Hypoxia --> immediate compensatory hyperventilation (baroreceptors stimulated) & HR

Core temp & sweating --> replace fluids

Evaporative, cooling component even w/ profuse sweating. Excess fluid loss --> Compromise CV function

CO2 --> more alkaline body fluids

Fluid replacement Maintain plasma vol Colder fluids are emptied from stomach more rapidly than room temp fluids Concentrated carbohydrate drinks impair gastric emptying & slow fluid replacement Glucose-polymer drinks DO NOT impair physiologic functioning, may also resupply lost electrolytes
Repeated heat stress --> acclimatization in 10 days of exposure Exercise capacity CO better regulated Sweating more efficient Acclimitization to heat stress DOES NOT seriously deteriorate w/ age

Adjustments/acclimatization: Takes 2 weeks at 2300 m, additional week for every additional 600 m Plasma volume, Total RBCs & Hb Changes in local circulation may facilitate O2 transport Adjustments DO NOT fully compensate for altitude VO2 Max 2% every 300 m above 1500 m --> drop in performance of endurance activities Training in altitude DOES NOT provide any improvement in sea -level performance

Air is cool & dry. Body fluids lost thru evaporation --> dehydration

M=F in heat adaptation. Menstrual cycle is NOT a factor. Obesity is a major consideration when exercising in heat.

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MOBILITY & FLEXIBILITY TRAINING

Saturday, November 20, 2010 4:36 PM

Flexibility Dynamic - AROM Passive Stretching Manual passive Ballistic High-intensity, very short duration w/ bouncing stretch Contracting the opposite ms group Unsafe; SHOULD NOT be performed after injury or surgery. CONTRAINDICATED in spastic ms Prolonged mechanical Low-intensity external force (5-15 lb to 10% BW) applied over a prolonged period by positioning px w/ weighted pulley & traction system (dynamic splints, serial cast) 20-30 mins to several hours Dynamic splints 8-10 hours More effective than manual passive for flexion contractures Active Voluntary, assisted movement of px Strength & muscular contraction of prime mover to ACTIVELY stretch antagonist Force controlled by px, low intensity Low risk of injury 15-30 secs hold; limited by prime mover endurance Facilitated stretching (active inhibition) Hold-relax (HR) --> relaxation performed at the point of limited ROM in the agonist pattern Isometric of antagonist against slowly increasing resistance Voluntary relaxation PROM of the agonist Hold-relax-active (HRAC) Hold-relax AROM of the agonist Reciprocal inhibition --> ms is relaxed Contract-relax-active contraction Isotonic in rotation of antagonist Isometric hold of antagonist against slowly increasing resistance Voluntary relaxation AROM of agonist Contract-relax more painful if ms cocontraction is present

Neurophysiological Properties of Contractile Tissue Ms. Spindle monitors velocity & length changes in ms. Quick stretch facilitates alpha motoneuron & ms contraction via monosynaptic stretch reflex --> ms tension Tension --> GTO fires, inhibits alpha motoneuron, Tension Slow stretching at end range--> GTO fires & inhibits ms (autogenic inhibition), ms lengthens (stretch-protection reflex)
Neurophysiological Properties of NonContractile Tissue Low-magnitude loads over prolonged period better tolerated. 15-20 mins of low-intensity sustained stretch x 5 days = change in length of ms & connective tissue Intensive stretching is usually NOT done everyday

Overstretch - stretch beyond normal ROM --> hypermobility "stretch weakness" Contracture Myotactic contracture Usually in 2-joint muscles (hamstrings, rectus femoris, gastrocnemius) Irreversible contracture - tissue is replaced by nonextensible tissue (bone or fibrotic tissue) Relaxation of Muscles GTO sensitivity increased --> inhibits ms tension more Low-intensity active exercise --> increase circulation to soft tissue & warm the soft tissue to be stretched Heat w/o stretching has little to NO effect on long-term gains in tissue length than stretching alone Common Errors w/ Mobility & Flexibility Training Passively FORCING a joint beyond its normal ROM Aggressively stretching a px w/ newly united fx or osteoporosis --> fx High-intensity, short-duration (ballistic) stretching of ms & connective tissues that have been immobilized over a long time or recovering from injury or surgery Stretching ms around joints w/o using strengthening exercises to develop balance between flexibility & strength Overstretching of weak ms (esp postural ms) that support the body against gravity

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POSTURAL STABILITY TRAINING

Saturday, November 20, 2010 7:36 PM

COORDINATION & BALANCE TRAINING

Stability (Static postural control) Prolonged holding of core ms.

Training Strategies to Improve Coordination & Balance Motor learning strategies are important to assist the CNS in adaptation for movement control Dynamic Stabilization, Controlled Mobility Learning requires repetition, progression should be gradual. Movements occurs thru increments of range (small to large) Use sensory cues to enhance motor performance. Pxs w/ hyperkinetic movement disorder (ataxia) progressed from large to small range Feedback should address knowledge of results (KR) Feedback should address knowledge of performance (KP) movements & finally to holding steady (stability control) FB = improves initial performance Dynamic Stabilization, Static-Dynamic Control FB = improves retention of skill Use variety of activities & environment. Practice from closed to open Guidelines to Develop Postural Stability environment. Stability requires the recruitment of tonic, slow -twitch ms fibers for sustained periods of Px decision-making skills are promoted time. Remedial strategies --> use of involved body segment Chin tucking w/ axial extension of C-spine & pelvic tilting w/ ROM of lumbar spine. Control is first developed in isolated movement & progressed to more Teach neutral pelvis position first to ensure stable base. complex movement. Emphasis on strength & endurance of multifidi & oblique abdominals RATHER than Control is first achieved in holding (stability) to posture (stabilityerector spinae. dynamic control) & skill level (gait) Practice maintained holding in a variety of postures. Compensatory strategies to promote safety & early resumption of functional Alternating isometric contractions between antagonists can enhance stabilizing contractions skill --> may lead to learned non use & delay recovery & develop postural control. Safety is improved by substitution, altering postural strategies. Stabilizing reversals Isometric holding on 1 side of the joint Interventions to Improve Coordination Alternate holding of antagonist Functional training Rhythmic stabilization Initial focus on postural stability exercises Simultaneous isometric of both antagonist & agonist w/o relaxation WB positions (progression is to BOS & raising height of COM) Cocontraction of opposing ms groups To enhance stability --> stabilizing reversals & rhythmic Emphasizes rotational stability control stabilization Transitional stabilization - control of functional positions while moving from 1 position to Dynamic thru decreasing ROM w/ ataxic movements another Progress to controlled mobility Closed chain tasks - enhances postural stabilization Water exercises More complex patterns of movement can be added (PNF) Stabilization devices Incorporate stretching into the postural exercise program Environment (px w/ ataxia do better in a low-stimulus environment) Sensory training Errors with Postural Stability Training Patients w/ proprioceptive losses Inadequate stretching of tight muscles Visual compensation strategy (Frenkel's exercise) Inadequate control of core ms --> excessive stress of prox structures Light weights Progressing too quickly or starting at too high a level Patients w/ visual losses Exercising past the point of fatigue (inability of trunk or neck ms to stabilize spine in Cognitive training strategies functional position) Forcing a px in a gen neutral position INSTEAD of finding the proper & safe position for Interventions to Improve Balance each individual. Exercises to improve ROM, strength & synergistic responses Kitchen sink exercises Stability Ball Training (Swiss, Physio, Therapy Ball) Postural awareness training Benefits/Uses Weight shifts (postural sway) Promotes balance Training of change-of-support strategies Works ms in functional, synergistic patterns Functional training Sit to stand (STS) and sit-down (SIT) activities Proprioception & sensory perception, awareness of body moving in space Improves ROM, safe stretching Floor-to-standing rises Relaxation training Gait activities Safe, dynamic CV workout Elevation activities Dual-task training Strength Community activities Improves posture & concentration, calms hyperactive children Practice anticipatory timing activities Determining appropriate ball size Disturbed balance activities including manual pertuberations, moveable BOS Sitting on ball w/ feet flat, ball height should place hips & knees at 90 angles devices Supine, ball under knees --> equal the distance between the > trochanter & knees Sensory training Quadruped--> equal the distance between the shoulder & wrist Visual changes Precautions Somatosensory changes Obese, exceeding ball weight limits Vestibular changes Avoid sharp belt buckles, zippers when over the ball; check surface for sharp Introduce sensory conflict situations objects Safety/educational fall prevention Lack of foot traction, feet slipping --> use bare feet, rubber soled shoes, yoga sticky mat Interventions to Improve Aerobic Capacity & Muscular Endurance Requires adequate space Treadmill walking w/ focus on velocity control Watch for sensory overload: sympathetic signs (TBI) Ergometer pain w/mobility exercises & DJD Strength training Fatigue Stretching exercises Contraindications Dizziness/nausea associated w/ vestibular pathology Extreme anxiety or fear of being on the ball

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RELAXATION TRAINING
Sunday, November 21, 2010 6:13 PM

AQUATIC EXERCISE
Hydrostatic pressure - increased pressure counteracts effusion & edema & enhances peripheral blood flow. Increased water density at deeper level. Cooler temperatures --> High intensity exercise. Ambient air temperature should be close to H2O temperature (within 3C) >37C (98.6F) --> Increased CV demands at rest & during exercise. <25C (77F) --> difficulty maintaining core temp.

Training Strategies to Promote Relaxation Jacobson's progressive relaxation technique Reflex relaxation followed by active contraction of ms. The stronger the contraction, the greater the relaxation. Breathing control (diaphragmatic breathing - expiration thru the mouth) Cognitive strategies/guided imagery - visualize calmness & relaxation AROM (slow) Rhythmic rotation Slow, vestibular stimulation w/ gentle rocking Biofeedback Stress mx/lifestyle adaptation Errors w/ Relaxation Training Lack of awareness of the effects of the environment on an individual. Lack of awareness of stress factors affecting the px. Progressing too fast from one body segment to another. Lack of effective training of kinesthetic awareness.

Exercise Applications Movement horizontal to or upward toward the H2O surface (AAROM) is made easier due to buoyancy. Movement downward into the water is more difficult. Resistance is controlled by speed of movement Increased w/ increased velocity Ataxic movements are slowed & more controlled against resistance of H2O. Assists stretching exercises. The amount of WB on the LEs is determined by the height of the water of immersion The greater the depth, the less the weight/loading on extremities Enhanced LE reciprocal movements. Enhanced aerobic conditioning, progression to reduce H2O level.

Contraindications Bowel or bladder incontinence. Severe kidney disease. Severe epilepsy. Severe cardiac or respiratory dysfunction. Severe PVD. Large open wounds, skin infections, colostomy. Bleeding or hemorrhage. Water & airborne infections.

Precautions Fear of water, inability to swim Heat intolerance (MS) Use waterproof dressing on small open wounds/IV lines

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