Exercise Prescription (MSK) Flashcards
How long do patients need to perform each stretch for increased ROM or flexibility?
20-30secs
How do we challenge balance?
- Reduce BOS (stand on 1 leg)
- Remove a balance system (vision - close eyes)
- Increase instability (add uneven / unstable surface)
- Add a movement (turn head / move arm / leg)
- Add a distraction (pass / throw / kick a ball)
- Add cognitive challenge (count back in 7s)
(Little and often – it is hard and can be painful)
What are the benefits of strength training?
- Muscle strength and tone to( protect joints from injury)
- Enhanced performance of everyday tasks
- Weight management & increased muscle-to-fat ratio (as you gain muscle, your body burns more kilojoules at rest)
- Reduce or prevent cognitive decline in older people
- Increased stamina (as you grow stronger, you won’t get tired as easily)
- Improved sleep
- Pain management
- Increased bone density & reduced risk ofosteoporosis
- Improved sense of wellbeing (boost self-confidence, improve body image & mood)
- Increased self-esteem
- Prevention or control of chronic conditions (e.g.: diabetes,heart disease,arthritis,back pain,depressionandobesity)
What are the core principles for exercise prescription for it to be effective?
- Specific to patient needs + ability
- Overload the muscles (so physiological effects take place to increase muscle strength)
- Constantly progress to maintain specificity, interest + effective optimise efficacy
What are the general strength training aims (in a healthy person)?
- 2-3 resistance sessions per week on each major muscle group
- Trained individuals can tolerate higher volumes of training.
- These are based on a 70% maximum effort load (12RM load)
What needs to be considered when deciding the type of exercise prescribed to a patient?
- Current level of strength
- Equipment available
- Aims of your exercise
- Activity you are aiming to improve
What are some of the types of exercise decisions?
- Active assisted / Active / Resisted
- Isometric / Concentric / Eccentric
- Specific / functional
What are some types of resistance used in exercise prescription?
- Gravity, friction
- Manual resistance
- Resistance bands (portable & adaptable to most workouts, different strengths)
- Suspension equipment (training tool using gravity + user’s body weight)
- Body weight (e.g. squats, jumps, push-ups and chin-ups)
- Free weights (e.g. dumbbells, barbells and kettlebells)
- Medicine balls or sand-bags
- Weight/resistance machines (adjustable increments through weights or hydraulics)
What needs to be thought about when planning exercises?
- Do they need any ROM first / alongside?
- What muscle group(s) need strengthening?
- What type of strengthening do they need (strength, power, endurance)?
- How is it best to train for this (eccentric, concentric, isometric)?
- What dose will you prescribe (resistance, frequency, intensity, rest FITTVP)?
- What can your patient achieve (consider pain, fitness, time)?
What steps must be taken to create an exercise plan?
- Assessment & Problem list formation
- Collaborative SMART Goal setting
- Problem lists
- Plan your exercise programme
(Remember specificity of each patient)
What are the (3) core principles of strengthening?
- Specificity
- Overload
- Progression
How do we know when to progress exercises?
- Subjective info
- Objective info
Why do we need to progress our patient?
- Maintain specificity
- Maintain patient interest + avoid frustration + reduce compliance
- Optimise efficacy + recovery
How can we progress exercises?
- Change the exercise
- Increase complexity / include kinetic chain
- Increase the load
- Change the lever
- Increase resistance / reduce friction
- Reduce stability
- Increase time under tension
How can we regress our exercise suggestions?
- Reduce resistance (friction)
- Reduce load
- Reduce reps / sets / frequency
- Change the lever
- Reduce complexity
How can over-training affect a patient?
- Reduce compliance and adherence to the exercise regimen.
- Reduce intensity of effort (due to local muscle, or total-body fatigue or psychological responses).
- Have negative effects on immune response.
What may affect the reps + sets you prescribe for your patient?
- Form
- Pain / Tolerance
- Age
- Other fitness constraints
- Goals / needs of the patient
What are the 3 principles of strengthening?
- Specificity
- Overload
- Progression
In a needs analysis what must you consider?
- How much time the patient has for their exercises
- Which muscle groups need strengthening
- What the patient’s goals are
- Their SIN factor
When considering frequency of exercises. If you have a patient who, due to their pain, is only able to manage working at 40% of their maximum perceived effort. How frequently would you advise they complete their exercise programme?
- 1x a day
OR - More than once a day if time allows
When considering exercise intensity, time and volume (reps and sets) in a therapeutic strengthening programme, what advice would you give to your patients?
- Aim for muscle fatigue when doing exercises
- Reduce your exercise range or volume if you have increasing pain
- A small amount of pain or discomfort is ok, as long as it settles quickly
True or false…
Isometric exercises have been associated with analgesic effects.
True
Are concentric or eccentric exercises linked to greater results in tendinopathy management?
Eccentric
What can be used as a means to progress exercises?
- Increased time under tension
- Reduce stability
- Increase resistance
- Increase repetitions
What can be used to regress an exercise?
- Reduce the resistance of the Theraband
- Remove additional weights
- Shorten the lever
What effect can over-training have on a patient?
- Negative effects on immune system
- Increase their symptoms
- More likely when patients are given insufficient education with their exercise programmes
- Associated with a ‘no pain, no gain’ mentality
- Reduce compliance
What has effective exercise prescription been shown to do?
- Reduce pain in patients with PFPS
- Reduce pain in patients with persistent lower back pain
- Increase patient confidence post injury
- Improve functional outcomes
- Increase patient motivation
- Reduce the risk of re-injury in patients post ankle inversion injury
- Improve patient outcomes
What are the FITT-VP parameters for prescribing exercise?
- Frequency
- Intensity
- Time
- Type
- Total volume
- Progression
What principle is strength training based on?
Overload principle
- Muscles will work to overcome a resistance force when they are required to do so.
- When resistance training repeatedly and consistently, muscles become stronger & larger (hypertrophy).
- They may/not, have increased anaerobic endurance
What is muscle hypertrophy?
- Myogenic stem cells (satellite cells) become active when sufficient mechanical stimulus placed on muscle
- Contractile elements enlarge
- Extracellular matrix expands
- Hyperplasia (increase in fibre numbers)
When does muscle hypertrophy occur?
When muscle protein synthesis exceeds muscle protein breakdown
Describe frequency aims in FITT-VP when strength training.
- 2-3 resistance sessions per week on each major muscle group
- Trained individuals can tolerate higher volumes of training.
BUT
(These are based on a 70% maximum effort load (12RM load)) - Consider how your patient can achieve this if they are in pain or can’t access a gym.
- Strengthening can be achieved at lower loads with higher volumes.
What colour thera-band equates to what strength?
Beginner –> Advanced
- Tan
- Yellow
- Red
- Green
- Blue
- Black
- Silver
- Gold
What does time in FITT-VP depend on?
- Aims (Strength, power, endurance0
- Available intensity
- Patient (their needs + ability)
What is Borg’s Rating of Perceived Exertion?
0 = At rest
1 = Very easy
2 = Somewhat easy
3 = Moderate
4 = Somewhat hard
5 = Hard
6 = …
7 = Really hard
8 = …
9 = Really, really hard
10 = Maximal effort
How do you roughly calculate a patient’s rep max %?
- Ask how an exercise feels.
- Compare to Borg’s Rating of Perceived Exertion.
- If under 70% (7 = Really hard), then need to increase the frequency, intensity, time, type and/or volume.
When in recovery is isometric exercise used & why?
Early phase of rehab
- Minimise muscle atrophy when movement is limited or when severity + irritability prevent resistance through movement
What are the benefits of eccentric exercises in rehab?
- Greater muscle force compared to concentric & isometric
- Greater effect on muscle development, resulting in extra recruitment of motor units
- Muscle strength & length
(More effective in treating tendinopathies)
What is a negative of eccentric exercises?
Can induce more damage to muscles when overloaded resulting in DOMS, so potentially worse patient compliance / adherence.
What will a higher volume of sets result in?
Increased hypertrophy
(4 sets = maximal, or multiple exercises for a particular muscle group)
Which system do low reps (<5) stress?
Phosphocreatine system
Which system do moderate reps (6-15) stress?
- Anaerobic glycolysis
- Maximal hormonal responses + cellular hydration
What % of 1 rep max are you aiming for when increasing endurance?
50%
How many reps are recommended to improve muscular endurance?
15-20
How many sets are recommended to improve muscular endurance?
≤2
What is important with rest periods between sets?
Minimise rest periods between sets
What % of 1 rep max is recommended for optimal power training in adults?
30-60%
What % of 1 rep max is recommended for optimal power training in older adults?
20-50%
How many reps & sets are recommended to improve power in most adults?
8-12 reps
2-4 sets
(dependant on patient)
What may affect the reps & sets you prescribe for your patient when aiming to increase power?
- Form
- Pain / Tolerance
- Age
- Other fitness constraints
- Goals / needs of the patient
What is a popular method used when power training?
Plyometric training.
