exercise

Question 1

what is physical activity (PA)

Answer 1

> Any body movement which results in energy expenditure via skeletal muscle activity (NHS 2021)
Exercise and therapeutic exercise are subdivisions of PA
examples of low level PA:
-Housework
-Walking
-Dancing
-Gardening

Question 2

what is exercise

Answer 2

> Planned or structured physical activity (NHS 2021)
Aim to improve or maintain:
-Cardiorespiratory endurance
-Muscle strength
-Muscle endurance
-Flexibility
-Body composition

Question 3

what is therapeutic exercise (TE)

Answer 3

Systematic, planned exercise/activities/movements/postures with specific goals

-Remedying impairments
-Preventing impairments
-Enhancing function (local or systemic)
-Enhancing fitness or overall wellbeing

Question 4

Factors effecting exercise prescription

Answer 4

-Safety (always first)
-Treatment goals
-Adherence
-Stage of Rehabilitation

Question 5

why is safety important

Answer 5

physiotherapists need:
>Physiological, pathophysiological and psychological knowledge
>Baseline assessment
>Risk assessment (PARQ, Outcome/likelihood assessment)
>Measure of intensity
>BLS skills
>Progression/regression skills
>Demonstration/supervision

Question 6

what are the training principles

Answer 6

Overload
Specificity
Reversibility
Individuality

Question 7

what are warm up exercises

Answer 7

> Low intensity
Gradually build intensity
10 minutes optimal
Aim to redistribute blood to working muscles (including heart)

Question 8

what are cool down exercises

Answer 8

> Gradual reduction of intensity
Aims to redistribute blood to other systems
Missing this out can cause fainting/syncope

Question 9

what are (physical adaptations) aerobic exercises

Answer 9

Cardiovascular effects of training include a decrease in resting heart rate and heart rate response to submaximal exercise; an increase in resting and exercise stroke volume; an increase in maximal cardiac output; an increase in VO2max; and an increase in arteriovenous oxygen difference.

Question 10

what are (physical adaptations) strengthening exercises

Answer 10

The main adaptations found in-regards to muscle fibers are fiber type conversions, an increase in muscle cross-sectional area and an increase in muscle fiber peak power. Strength training promotes a fiber shift towards type IIA muscle fibers.

Question 11

types of strengthening exercises

Answer 11

-Free weights
-Weight machines
-Isokinetic machines (Biodex)
-Elastic Resistance
-Body weight exercises

Question 12

what are stretching exercises

Answer 12

As the sarcomere stretches, the area of overlap decreases, allowing the muscle fiber to elongate. Once the muscle fiber is at its maximum resting length (all the sarcomeres are fully stretched), additional stretching places force on the surrounding connective tissue. The collagen fibers in the connective tissue align themselves along the same line of force as the tension. When this occurs, it helps to realign any disorganized fibers in the direction of the tension. This realignment is what helps to rehabilitate scarred tissue back to health.

Question 13

what are the limiting factors of stretching exercises

Answer 13

-Joint articular surfaces
-Ligaments
-Muscle length
-Soft tissue opposition
>Aim to maintain or increase ROM

Question 14

what are the effects of bedrest on muscles

Answer 14

> Disuse of skeletal muscle rapidly leads to a loss of lean muscle mass (sarcopenia) as individual muscle groups atrophy.
Muscle Strength decreases at a rate around 12% a week or even up to 40% within the first week of immobility .
Lower limb muscles are usually first to atrophy as they resist gravity forces in the upright position.
There will be an overall reduction in size in both slow and fast twitch fibres with a slightly more rapid loss in the fast-twitch fibres

Question 15

what are the effects of bedrest on tendons

Answer 15

> Changes in their structure and functioning start to become apparent after 4-6 days of immobility and can remain even after normal activity has resumed. Most changes appear to the altered structure of collagen fibres.
20 days of bedrest reduces their stiffness and increases their viscosity.
This negatively affects the transmission of energy from muscle to bone and reduces ability to produce dynamic forces.

Question 16

what are the effects of bedrest on ligaments

Answer 16

Collagen structure changes into a mass of shortened, straighter and more densely packed fibres within one day. Within 2-3 weeks, this change can compound a joint contracture. After 2-3 months of immobility, contracture and stiffness may become so severe that surgical correction will be required to restore full range of movement.

Question 17

what are contractures

Answer 17

> A common problem associated with pro-longed bedrest and immobility is foot drop contractures. Which is a result in the inability to place the heel in its correct position on the ground when sitting or standing.
This is usually caused by entrapment of the common peroneal nerve at the neck of the fibula.
Foot drop contracture is compounded by a lack of passive exercise stretching the ankle joint both of which reduce tension on the Achilles tendon and lead to it’s shortening

Question 18

how to avoid contractures

Answer 18

The risk of contractures can be reduced through appropriate positioning and body alignment in bed. Mobilising each joint through its full range of motion at least once every eight hours.

Question 19

hoe does age affect muscles

Answer 19

> Muscle Mass decreases approximately 3-8% per decade after the age of 30 and this rate of decline is even higher after the age of 60

> The cause of sarcopenia is not clearly understood, but several mechanisms have been proposed.
At a cellular level, specific age-related alterations include a reduction in muscle cell number, muscle twitch time and twitch force, sarcoplasmic reticulum volume and calcium pumping capacity.
Sarcomere spacing become disorganized, muscle nuclei become centralized along the muscle fibers, the plasma membrane of muscle becomes less excitable.
Neuromuscular alterations include a decrease in the nervous firing rate to muscles, the number of motor neurons and the regenerative abilities of the nervous tissue.
Further aging is associated with changes in satellite cell number and recruitment, an indication and potential cause of reduce muscle growth

Question 20

what are the FITT principles

Answer 20

> Frequency- NHS England (2021) recommends. Strength training x2 a week. Remember to include rest days.

> Intensity- can vary between light, moderate and vigorous Intensity Activities, Intensity can be monitored by heart rate in most patients.

> Time- How long is the session going to be. NHS England (2021) recommend at least 150 mins of moderate-intensity exercise or at least 75 minutes of high-intensity exercises be week.

> Type- Is it Aerobic, Strength Training, Yoga etc.