EXERCISE PRESCRIPTION P.241 Flashcards
Basic principles of conditioning
overload specificity progression consistency assessment and screening
Overload
implies that adaptions of some unit or system of the body (ex: muscular system for walking) will occur if it is repeatedly stressed to a level beyond which it is normally accustomed.
Overload is defined by which 4 variables?
SAME AS FITT
Frequency - how often
Intensity - to what degree
Duration - period of time
Mode - type of activity
In general, gains in muscle strength o end require a min of _____ to _____ days of resist training (one day of recovery between days of training to prevent overwork… alternate muscle grow).
2-3
For those who are frail, have arthritis, or fibromyalgia, etc, what kind of frequency do they?
they could prob only do light loads
so shorter training sessions may be appropriate for people with extreme weakness or fatigue
when should exercise be reocmmended at home?
1) conditions involving periods of flare up (like MS)
2) adapted transport
Reps for optimal strength gains
3-7 reps
keep in mind thi might be hard for some conditions, who would benefit more from less reps and higher load
Reps for musc endurance
12-20 reps
more reps = lower load
Exercise load can be determined by the amount of resistance that cuases a slight __________________________ and/or by local muscular fatigue
slight burning sensation in the muscle
Each set of reps should result in…
muscle fatigue
If the load is too high, what will tend to happen?
the use of substitute motions (like trunk movement during knee extension)
low load is recommended for which people?
join instability weakness muscle spasms at risk of high BP symptoms of pain or fatigue
Stroke = ISOM contractions for longer than ____ seconds which increases BP.
6 sec
Is the overload principle always appropriate?
no
Who should avoid exercising until fatigued?
people with progressive diseases
joint instability
chronic pain with movement
or likelihood to develop disabling fatigue
Arthritis: if joint is affected but not painful
STRENGTH: 5-10 reps with low load (with 3 sets)
Arthritis: if joint is slightly swollen and mildly painful
STRENGTH: cut the reps in half
7-15 reps (3x)
Arthritis: if joint is hot and swollen and painful
STRENGTH: avoid strengthening in general
BUT! ROM exercises should be performed daily. Reps depends on pain and swelling
Recovery of ___ to ____ minutes should be used for general strengthening routines
2-4
To stress the glycolytic system, rests of ________ should be prescribed.
a min or less
Work:Rest ratio
compares time required to perform a set of repetitions to the rest period
(Longer/shorter) rest periods are optimal for pure strength training
Longer
as high as 1:12
USUALLY 1:6 TO 1:12
(Longer/shorter) rest periods are optimal for muscular endurance
ratios as low as 1:1
USUALLY 1:1 TO 1:2
need to adapt per person tho!
Recommended work to rest ratios for conditions involving fatigue, pain or muscle weakness?
HIGH ratios like 1:6 to 1:12
What can stretching benefit?
maintains ROM
decreases or controls spasticity
may prevent muscle atrophy (gradual decline in effectiveness)
How long should warm ups be?
6 to 12 second for warm up
Flexibility duration?
10-30s
What is a contracture?
shortening and hardening of muscles and connective tissue, tendons, other tissues often leading to deformity and rigidity of joints. decreased ROM
What causes contracture?
inactivity and scarring from an injury or burn
muscles involved in contractures / hand paralysis?
flexor pollicis longus, thumb flexors
what causes contracture longterm?
spasticity and prolonged loss of joint mobility (absence of movement)
what happens to muscle with contracture
muscle fibers remodel themselves
more fibrous tissue
types of contractures
dynamic - occur during movement
fixed - present at all times
Increased stretch = ________ sarcomeres = _______ muscle atrophy = normal ROM
increased sarcomeres, decreased muscle atrophy
when muscle is immobilised in a shortened position, there isa reduction in muscle fiber length due to _______ sarcomeres. This leads to _______ muscle stiffness. = _________ ROM and _________ pain.
decreased
increased
decreased
incresed
Article for stretch on sarcomere tested what kind of stretch?
intermittent stretch
What happened in the sarcomere article?
no movement of ankle in plantar flexion = reduction of sarcomere of 19%
HALF HOUR STRETCHING is best:
maintains normal DF
prevents sarcomere loss
increase in serial sarcomere of as much as 10% within 2 hours
doesnt cause as much weight loss as the other stretching times!
Immobilisation is the loss of sarcomeres leading to reduction in…
muscle fiber length
When a muscle is immobilised in a shortened position there is both a reduction in muscle fiber length due to loss of serial sarcomere AND remodelling of _______________________________, and replacement of ______ tissue with ______ fibrous tissue. Which leads to muscle stiffness
intramuscular connective tissue
replacement of soft tissue to dense fibrous tissue
Contracture: paralysis/weakness cause is for…
SCI, TBI, MS
Contracture: spasticity cause is for…
SCI, TBI, MS
Contracture: pain cause is for…
arthritis, neuropathic
How to immobilize contracture?
casting or splinting
How to adjust frequency (where to start)?
start with SOAP
Modifying overload with aerobic training
p.256!!!!!!! didnt write questions on it
upper body ex calculation
(200-age)*%HRmax=target HR
Borg RPE scale most commonly used for?
used for tests of perceived exertion
Advantage of borg RPE scale?
given ratings grow linearly with exercise intensity, HR and VO2
As intensity increases, HR and VO2 increase, so ratings will _________
increase
Specificity
adaption to ex training is specific o the nature of the exercise activity and the physiologic systems that are stressed
Specificity article research paper explained
Hemiparetic participants of secondary stroke.
Treatment group: 12-week high intensity (70% of the 1 RM) resistance training (bilateral leg press, knee extension, ankle dorsiflexion, plantarflexion). Frequency = 3 x per week Control group: 12-week upper extremity stretching
Results of specificity research paper
Significant improvement in muscle strength in the treatment group but
no change in the control group
No significant change in any functional measures in both groups
Clinical message for specificity
Clinical Message (in your notes: see rectangle at the bottom of the page)
- Training effect is specific to the exercise mode: ↑ knee extensors did not ↑ functional test results.
- If the goal is to ↑ functions (walking, stair climbing, standing up from chair, etc.) then design functional exercises (ex: stepping up and down; walking, chair rise, etc)
Progression
Progression is the requirement that exercise training progressively increases the overload stimulus to elicit continual improvements in fitness (or functional level).
EX: ↑ treadmill speed to increase cardiovascular capacity in participants with MS
Progression may not always be achieved with the following disorders/conditions:
- progressive disorders (ex ALS MS MD)
- abnormal fatigue (chronic fatigue syndrome)
- chronic pain syndromes (fibromyalgia)
- conditions involving flare up
(ex: Complex Regional Pain Syndrome, Multiple Sclerosis, etc.)
5. Others? (Chronic conditions)
Goal for chronic disease and disability participants
maintain
to avoid functional decline
Consistency
the principle of consistency states that training must occur on a continual and regular basis to produce or maintain training adaptations
With aerobic training, detraining occurs with more than ___ days of rest between exercise sessions.
3
potential barriers to exercise for those who are impaired or disabled
transport flare ups (increased pain and fatigue, decreased function) depression busy schedule lack of time
objective for waterbased execises on healthy older women p.263
to evaluate effects of short term ex detraining on the FUNCTIONAL FITNESS of older women after a 12 week water based exercise WE program
method for waterbased execises on healthy older women p.263
12 weeks of trainin after 4 and weeks of detraining
results for waterbased execises on healthy older women p.263
no changes found in control
inproved aerobic capacity, neuromuscular fitness and Q of L for the ones who did. Ater 6 weeks of detraining, upper, low body strength, agility, flexibility, body balance returned to UN levels.
What is fitness testing for?
Fitnesstestingshouldbeconductedtoestablishbaselinelevelsinallparameters of fitness before setting program goals
When testing for muscular fitness with conditions that have asymmetrical effects (ex: stroke TBI MS SCI) be sure to….
conduct tests on both sides of body
what will fitness tsting help you with?
The testing will not only highlight needs for equipment modifications, but also direct your choice of exercise (ex: arm vs. leg muscles) and conditioning
variables (ex: strength, endurance, flexibility etc.)… It depends on where improvements are needed (ex: what you found in your SFT testing)
fitness tesing:
1-Motor control or coordination:
identify the extent and nature of any impairment (e.g., paralysis, spasticity, athetosis, restriction in joint mvt due to pain or swelling, etc.).
identify initial levels of spasticity + pain + restriction in joint mvt, and note if it increases or decreases with specific exercises
STROKE IMPAIRMENT ASSESSMENT SCALE: Testing of:
MOTOR FUNCTION in hemiparetic participants
STROKE IMPAIRMENT ASSESSMENT SCALE: validated in
Strokepopulation.Couldfitother neuro conditions (ex. CP, MS, TBI, ALS) but no validation studies yet
STROKE IMPAIRMENT ASSESSMENT SCALE: items presented in this scale:
CanbeusedasEXERCISESto improve motor control in neuro conditions
STROKE IMPAIRMENT ASSESSMENT SCALE Pros and Cons:
Easyandquick(p)
Provideinfoonspecific impairments observed in stroke patients (p)
Sometimesdifficulttoscore between 2 numbers (c)
Balance fitness testing
test general stability with exercise from a standing or
Berg Balance Scale or Step test
sitting position
fullerton scale
ROM fitness testing
identify muscle imbalances, joint instability, effects of exercise on postexercise ROM, or needs for additional stretching during the warm-up or cool-down (active vs. passive)
Pain fitness testing
determine if any types of exercise or movements cause or increase pain (how?) _M_c_G_il_l _P_a_in\_\_Q_u_e_st_io_n_n_a_i_re\_\_+_V_A\_\_S\_\_
Fatigue fitness testing
identify individuals prone to excessive fatigue due to
extreme deconditioning, limited muscle function, or other conditions
associated with the specific disability (such as MS or fibro + chronic
fatigue syndrome)
+ How to measure it: VAS
McGill Plan Questionnaire
INSTRUCTIONS:
For each row, place an “X” next to the one word that best describes your pain. Choose no more than one word in each row. If no words in a row describe your pain, then do not choose any words in that row.
whats the most common scale used to assess pain in the medical/rehab community?
McGill Pain Questionnaire
For each row in the mcgill questionnaire, words are placed in (ascending/descending) order.
ascending
Muscle function fitness testing
identify functional muscles that can be trained; identify needs for adapting equipment for stability (overhead harness on treadmill, wall bar) and hand gripping;
- Identify muscle groups with weakness and distinguish between weakness due to deconditioning, progressive or neuromuscular disorders
Sensation fitness testing
identify muscle groups where sensation is lacking
light touch =
feather
pin prick =
needle
ASIA scale has which 2 components
motor and sensory
