Chapter 10 Therapeutic Exercise Flashcards
MUSCLE FIBER CHARACTERISTICS
Type I muscle fibers are “_______-twitch,” highly fatigue-_______, grossly _______ fibers (“_______ meat”) that appear light on myosin ATPase (at pH 9.4) or PAS staining. Type II fibers comprise the “_______ meat” but are _______ histologically with these stains (see Table 10-1 for characteristics of each type/subtype).
MUSCLE FIBER CHARACTERISTICS
Type I muscle fibers are “slow-twitch,” highly fatigue-resistant, grossly dark fibers (“dark meat”) that appear light on myosin ATPase (at pH 9.4) or PAS staining. Type II fibers comprise the “white meat” but are dark histologically with these stains (see Table 10-1 for characteristics of each type/subtype).
All fibers in a given motor unit are of the same type. According to the _______ size principle, smaller motor units are recruited first and then progressively larger units are sequentially recruited as the strength of contraction increases.
All fibers in a given motor unit are of the same type. According to the Henneman size principle, smaller motor units are recruited first and then progressively larger units are sequentially recruited as the strength of contraction increases.
EMG predominately records type I fiber activity. FES preferentially recruits type _______ fibers but may turn type IIs into type Is after long-term use. Steroids predominately cause type _______ fiber atrophy. Both types decrease with _______.
EMG predominately records type I fiber activity. FES preferentially recruits type II fibers but may turn type IIs into type Is after long-term use. Steroids predominately cause type IIb fiber atrophy. Both types decrease with aging.
STRENGTH TRAINING
Isometric Strengthening – Tension is generated without visible joint _______ or appreciable change in muscle _______ (e.g., pushing against a wall). This is most efficient when the exertion occurs at the _______ length of the muscle and most useful when joint motion is contraindicated (e.g., s/p tendon repair) or in the setting of pain or inflammation (e.g., rheumatoid arthritis). Chance of injury is minimized. Isometric exercise should be avoided in the _______ and in patients with _______ due to its tendency to elevate _______.
Isotonic Strengthening – This is characterized by constant external resistance, but variable speed of movement. Examples include free weights, weight machines (e.g., Nautilus), calisthenics (e.g., pull-ups, push-ups, and sit-ups), and TheraBand. The equipment is readily available, but there is potential for injury with this type of exercise (Fig. 10-1).
STRENGTH TRAINING
Isometric Strengthening – Tension is generated without visible joint motion or appreciable change in muscle length (e.g., pushing against a wall). This is most efficient when the exertion occurs at the resting length of the muscle and most useful when joint motion is contraindicated (e.g., s/p tendon repair) or in the setting of pain or inflammation (e.g., rheumatoid arthritis). Chance of injury is minimized. Isometric exercise should be avoided in the elderly and in patients with HTN due to its tendency to elevate BP.
Isotonic Strengthening – This is characterized by constant external resistance, but variable speed of movement. Examples include free weights, weight machines (e.g., Nautilus), calisthenics (e.g., pull-ups, push-ups, and sit-ups), and TheraBand. The equipment is readily available, but there is potential for injury with this type of exercise (Fig. 10-1).
STRENGTH TRAINING
Isokinetic Strengthening – This is characterized by a relatively constant _______ joint speed, but _______ external resistance. (Special equipment is required, e.g., Cybex and Biodex.) If the user pushes harder, the speed of the manipulated piece of equipment will not increase, but the resistance supplied by the machine will. This maximizes _______ throughout the _______–tension curve of the exercised muscles and is beneficial in the early phases of rehabilitation. The chance of injury is relatively low (Fig. 10-2).
STRENGTH TRAINING
Isokinetic Strengthening – This is characterized by a relatively constant angular joint speed, but variable external resistance. (Special equipment is required, e.g., Cybex and Biodex.) If the user pushes harder, the speed of the manipulated piece of equipment will not increase, but the resistance supplied by the machine will. This maximizes resistance throughout the length–tension curve of the exercised muscles and is beneficial in the early phases of rehabilitation. The chance of injury is relatively low (Fig. 10-2).
Progressive Resistive Exercise – In the DeLorme method, a _______-repetition maximum (RM) is first determined. Ten reps of the exercise are performed in sets of _______%, _______%, and _______% of the _______ RM. The sessions are performed ≈3 to 5×/week and the 10 RM is redetermined ≈qwk. In the Oxford technique, the order of the sets is reversed, so that 10 reps at 100% of the 10 RM are performed first, followed by sets of 75% and 50%.
Progressive Resistive Exercise – In the DeLorme method, a 10-repetition maximum (RM) is first determined. Ten reps of the exercise are performed in sets of 50%, 75%, and 100% of the 10 RM. The sessions are performed ≈3 to 5×/week and the 10 RM is redetermined ≈qwk. In the Oxford technique, the order of the sets is reversed, so that 10 reps at 100% of the 10 RM are performed first, followed by sets of 75% and 50%.
The DeLorme axiom:
The DeLorme axiom posits that high-resistance, low-rep exercise builds _______, while low-resistance, high-rep exercise improves _______. deLateur later demonstrated that for the most part, strength and endurance gains are equivalent for the two types of exercise as long as muscles are exercised to fatigue. High-resistance, low-rep exercise, however, achieves its results more efficiently (fewer reps/less time).
Moritani and de-Vries demonstrated that gains in the first few weeks of strength training were mostly due to neural factors (e.g., improved coordination of muscle firing) and not muscle hypertrophy.
The DeLorme axiom:
The DeLorme axiom posits that high-resistance, low-rep exercise builds strength, while low-resistance, high-rep exercise improves endurance. deLateur later demonstrated that for the most part, strength and endurance gains are equivalent for the two types of exercise as long as muscles are exercised to fatigue. High-resistance, low-rep exercise, however, achieves its results more efficiently (fewer reps/less time).
Moritani and de-Vries demonstrated that gains in the first few weeks of strength training were mostly due to neural factors (e.g., improved coordination of muscle firing) and not muscle hypertrophy.
AEROBIC EXERCISE
Regular aerobic exercise increases _______ and decreases resting _______, whereas strength training does not have an effect on either of these. Other long-term cardiovascular adaptations/benefits of aerobic exercise include increased stroke volume (SV), cardiac output (CO), work capacity, and HDL; and decreased resting HR, HR response to submaximal workloads, and triglyceride levels. Diabetic patients benefit from reduced obesity and insulin requirements. Improvements in mood, sleep, immune function, and bone density, among others, are also reported in the literature (Table 10-2).
AEROBIC EXERCISE
Regular aerobic exercise increases Vo2max and decreases resting BP, whereas strength training does not have an effect on either of these. Other long-term cardiovascular adaptations/benefits of aerobic exercise include increased stroke volume (SV), cardiac output (CO), work capacity, and HDL; and decreased resting HR, HR response to submaximal workloads, and triglyceride levels. Diabetic patients benefit from reduced obesity and insulin requirements. Improvements in mood, sleep, immune function, and bone density, among others, are also reported in the literature (Table 10-2).
AEROBIC EXERCISE
Anaerobic threshold signifies the onset of metabolic _______ during exercise, traditionally determined by serial measurements of blood lactate. It is noninvasively determined by assessment of expired gases during exercise testing, specifically _______ _______ (VE) and _______ _______ production (Vco2). The anaerobic threshold signifies the peak work rate or oxygen consumption at which energy demands exceed circulatory ability to sustain aerobic metabolism.
AEROBIC EXERCISE
Anaerobic threshold signifies the onset of metabolic acidosis during exercise, traditionally determined by serial measurements of blood lactate. It is noninvasively determined by assessment of expired gases during exercise testing, specifically pulmonary ventilation (VE) and carbon dioxide production (Vco2). The anaerobic threshold signifies the peak work rate or oxygen consumption at which energy demands exceed circulatory ability to sustain aerobic metabolism.
THE EXERCISE PRESCRIPTION
Preexercise Evaluation – Physician evaluation should be comprehensive and include key elements of patient history, such as current and previous _______ patterns, _______/_______ to exercise, discussion of risks/benefits of exercise, preferred types of activity, social support, and time and scheduling considerations. Special attention must be given to _______ limitations, current and past medical problems, current medications, history of exercise-induced symptoms (shortness of breath, asthma, hives, and chest pain), and a thorough review of heart disease risk factors. These include family history of heart disease before age 50 years, DM, HTN, smoking, hyperlipidemia, sedentary lifestyle, and obesity. Identify those in need of exercise stress testing as per AHA/ACSM guidelines.
THE EXERCISE PRESCRIPTION
Preexercise Evaluation – Physician evaluation should be comprehensive and include key elements of patient history, such as current and previous exercise patterns, motivations/barriers to exercise, discussion of risks/benefits of exercise, preferred types of activity, social support, and time and scheduling considerations. Special attention must be given to physical limitations, current and past medical problems, current medications, history of exercise-induced symptoms (shortness of breath, asthma, hives, and chest pain), and a thorough review of heart disease risk factors. These include family history of heart disease before age 50 years, DM, HTN, smoking, hyperlipidemia, sedentary lifestyle, and obesity. Identify those in need of exercise stress testing as per AHA/ACSM guidelines.
Components of an Exercise Prescription – There are _______ essential components apply when developing exercise prescriptions for persons of all ages and fitness levels. Careful consideration should be given to the individual’s health status, medications, risk factors, behavioral characteristics, personal goals, and exercise preferences.
Components of an Exercise Prescription – There are five essential components apply when developing exercise prescriptions for persons of all ages and fitness levels. Careful consideration should be given to the individual’s health status, medications, risk factors, behavioral characteristics, personal goals, and exercise preferences.
Components of an Exercise Prescription
_______ is the particular form or type of exercise. The selection of mode should be based on the desired outcomes, focusing on exercises that are most likely to sustain participation and enjoyment.
_______ is the relative physiologic difficulty of the exercise. _______ and duration of exercise interact and are inversely related.
Duration (time) is the length of an exercise session.
_______ refers to the number of exercise sessions per day and per week.
_______ (overload) is the increase in activity during exercise training, which, over time, stimulates adaptation.
Components of an Exercise Prescription
Mode is the particular form or type of exercise. The selection of mode should be based on the desired outcomes, focusing on exercises that are most likely to sustain participation and enjoyment.
Intensity is the relative physiologic difficulty of the exercise. Intensity and duration of exercise interact and are inversely related.
Duration (time) is the length of an exercise session.
Frequency refers to the number of exercise sessions per day and per week.
Progression (overload) is the increase in activity during exercise training, which, over time, stimulates adaptation.
