L19 - FOUNDATION OF EXO THERAPY Flashcards
Additional stress factors for exercise prescription
- Work
- School
- Social life
- Heredity
- Environment
Biological stressors & stages of stress & examples of stressors
Exercise & physical training
Body reacts similarly to exercise as it does to other stressors
Stages of stress
- Alarm
- Resistance
- Exhaustion / sur compensation
Examples of stressors: exercise, food deprivation, hypothermia, hyperthermia,
psychological challenges & social challenges
General adaptation syndrome
Exercise as stress influencing body’s homeostasis
Body ability to adapt to stressor (if load is optimal)
Adaptation is dose-dependent:
- Optimal load → adaptation, increased ability level
- Insufficient load → decline in adaptation level
- Excessive load, not enough time to recovery → maladaptation & overtraining
Initial ability level goes down during alarm step
After exertion, body recovery to handle load and if enough time, body increase the
ability level
Sur-compensation stage = main concept for progress for athlete to progression / performance & for patients for recover after injury, adapt after load to return body back to the stage as before injury
Effects of exercise on CNS
- Exercise protects against chronic pain by strengthening body’s pain inhibition pathways & balancing chemicals in brain related to pain
- Inactive people have weaker pain-inhibition systems, which can lead to more intense & longlasting pain if they get injured
No regular physical active, pain receptor amplify and facilitate pain response. Less
chemical release in blood after injury. Pain-inhibition mechanism does not work if no
physical activity → create chronic pain, pain lasting more time
Effects of exercise on immune system
- Regular activity modulates immune system by increasing number of antiinflammatory M2 macrophages (anti-inflammatory cytokines), which reduces pain
sensitivity (analgesia)
Exercises recommended for MS: exercise, 5x/week, 1h/day
Health benefits of exercises & strength evidence
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Principles of exercise rehabilitation & training
- Physical stress theory
- Wolff’s law
- SAID principle (specificity)
- Overload
- Progression
- Individualization
- Adaptation
- Reversibility
- Basic exercise principles (FITT-VP)
Physical stress theory
- Factors affecting level of physical stress theory on tissues or adaptative response of tissues to
physical stress
Increased threshold, load more → risk injury
Decreased threshold, not enough load → muscle atrophy
During adaptation, modify threshold, tolerance goes up if good adaptation, goes down if bad adaptation
Wolff’s law
States that thickness, number & orientation of trabeculae will correspond to distribution of mechanical stresses on bone
Consequence of stress-induced bone remodeling is that strength of bone is greatest in direction in which loads are most imposed
Weightlifters often display increases in bone density in response to training
Astronauts often suffer reverse: being in microgravity environment they tend to lose bone density
SAID principles:
- acronym
- key points
- training specificity
SAID principle - “Specific Adaptation to Imposed Demand”
- Always applies
Key points:
1. Non-linear progression
2. Limits to adaptation
3. Misconception in injury management
4. Healing vs adaptation
5. Demand-adaptation cycle
Training should be specific
- Energy systems as used during competition / recovery
- Speed of movement
- Intensity / volume
- Muscle groups trained & involved
- ROM
Biological tissue adapts to demands, or lack of demand, imposed on it
Overload & progression principles
Overload & progression
1. Overload: gradually increasing intensity, duration, frequency or type of exercise to challenge body beyond current capacity, stimulating adaptation & improvement
2. Progression: systematic & incremental increase in workload over time to ensure continued improvement while avoiding overtraining or injury
Together principles help optimize recovery, build strength & improve performance
Individualization
Individualization
Each patient must be treated according to ability, potential, training age, sex-based difference & rate of
recovery
- Genetics & physical status
- Specific needs
- Health or injury concerns may limit exercises performed or exercise intensity
- Desired effort & motivation
- Time availability
- Available & preference of equipment
- Environment factors
- Diet & sleep
Adaptation concept: short term adaptation
- strength training adaptation
- stimuli for exo-induced adaptations
Strength training adaptation
- Increases in strength almost immediate for untrained person
- Muscle start showing signs of hypertrophy after 4 weeks, with significant change in size after 8-12 weeks
- Golgi tendon organ inhibition is overridden, allowing maximal agonist muscle recruitment
Stimuli for exercise-induced adaptations
Depend on:
- Type of muscle contraction
- Duration, frequency & intensity
- Recovery period
At cellular level:
- Load on muscle
- Metabolic stress
- Calcium flux
Endurance training adaptation
- Increased resistance to fatigue
- Increased VO2 max
- Increased plasma volume => increased cardiac output & stroke volume => decreased heart rate
- Increased capillary to muscle fiber ratio
- Increased mitochondria content => increased oxidative capacity
- More work can be done at same perception of effort
- More fat used as fuel & rate of glycogen utilization decreases during submaximal exercise after training
Reversibility concept
Use it or lose it
- Regularly & consistency of physical activity
- Decreased training removed or reduced
- Decreased detraining occurs
- Decreased performance decrements
- Decreased decline in strength & power
Consequences of articular cartilage loss in OA
Schema
FITT-VP acronym
- Frequency
- Intensity
- Time
- Type
- Total volume
- Progression
CORRECT acronym
CORRECT
- Combination of interventions
- Order of intervention
- Repetitions
- Rest period
- Exercise at home
- Cognitive domain
- Total dose & re-evaluation
Aerobic exo, resistance exo & physical activity:
- assess
- prescribe
- adjust
- re-assess
Schema
How find good intensity
HRmax & defining 5 zones
Rep max %
FITT-VP principle of exo recommendations in older adults:
- ACSM/AHA
- CDC
- NIH
- WHO
Table
Guidelines for resistance training
Table
Guideline for aerobic exercise in cardiac disease patients
Table
Tissue down, build tissue up, improve work capacity framework
Schema
Prescribing physical activity: clinical assessment
Prescribing physical activity: clinical assessment
- Clinical assessment in crucial before prescribing physical activity
Involves taking detailed history, conducting physical examination & potentially using
investigations
- Understanding patient’s sport or activity essential
Knowledge helps clinician identify potential injury causes & develop tailored rehabilitation
program - Assessing patient’s readiness for physical activity
Tools like Canadian Society for Exercise Physiology (CSEP) - Clinical should assess patient’s:
o Current levels of physical activity in all domains
o Current levels of sedentary behavior
o Risks & contraindications to physical activity
Written prescription
Writer prescription
- FITT-VP principle written physical activity prescription should be individualized & tailored to patient’s needs.
- Patient’s personal goals & preferences should be central to prescription.
- Prescription should consider different types of physical activity/exercises
- Clinician should discuss strategies to overcome potential barriers to physical activity.
- Referral to other healthcare professionals=>patients with high-risk conditions or those who require specialized support to engage in physical activity.
- Specific considerations apply to certain groups, such as individuals with diabetes, cardiovascular disease, or neurological conditions.
Processing appropriate therapeutic exercise
Change exercise challenge without directly increasing total exercise volume
Increase total exercise volume
Progressing appropriate therapeutic exercise: Biomechanical variables
Biomechanical
- Stability
o Size of BOS
o Height of COM
o Support surface
- External load
o Gravitational forces
o Length of lever arm - Other factors
o ROM
o Passive tension of muscles
o Open versus closed chain
o Starting position
Progressing appropriate therapeutic exercise: neuromuscular variables
Neuromuscular
- Sensory input
- Sensory facilitation of inhibition
- Number of segments involved
Progressing appropriate therapeutic exercise: psychological variables
Psychological
- Frequency
- Duration
- Speed
- Intensity of contraction / external load
- Volume
- Type of contraction
- Sequence of exercise
- Rest
Progressing appropriate therapeutic exercise: cognitive variables
Cognitive
- Frequency & duration of activity
- Initial information provided
- Accuracy provided
- Variability of environment demands
- Complexity of activity
Loading progression in therapeutic exercise
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Framework for exercise prescription
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PT & training periodization for athletes
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Periodization vs programming
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