L23 - Exercise Therapy: Muscular Physiopatho Flashcards
Muscular physiopatho description
Muscular physiopathology
- Involves study of muscle diseases or dysfunctions (pathology) & impact on physiological
processes (how affect body functions)
WHO guidelines
=> 150-300 min of moderate intensity
=> 75-150 min of vigorous intensity physical activity or equivalent combination aerobic physical activity
should be undertaken per week
Skeletal muscle injuries:
- types of injuries
- description
Skeletal muscle injuries
Types of injuries
- Mechanical
- Ischemia
- Inflammatory
- Congenital
- Acquired atrophy
All involve disrupted connective tissues leading to:
- Loss of muscle mass
- Reduced motor unit discharge rate
- Impaired function
MAPK signaling in tissue regeneration
MAPK signaling in tissue regeneration
Exercise is not just about fitness: it’s about cellular repair & regeneration
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Muscle stem cell activation in aging vs youth
Muscle stem cell (MSC) activation in aging vs youth
Aged individuals: resistance training improves MSC proliferation through AKT pathway & rejuvenates MSCs by restoring cyclin D1 expression
Young individuals: exercise promotes MSC cycling via MAPK pathway & protects
MSCs from exhaustion by modulating AKT-mTOR activity & mitochondrial metabolism
Molecular mechanisms
- AKT pathway: drives MSC proliferation in aged individuals during long-term
exercise
- MAPK pathway: promotes cell cycling & self-renewal in younger individuals
Mitochondrial metabolism reprograming: reduces mitochondrial respiration, enhancing stemness
Guidelines American academy of sports medicine:
- endurance exercise
- resistance exercise
Endurance exercise
Walking, jogging, dancing, swimming & cycling
- Intensity lower than max
- Last for several minutes to several hours
- Endurance exercise training => FITT-VP principle of exercise prescription
- Intensity of exercise => heart rate, oxygen consumption & metabolic equivalent
Resistance exercise training
Barbell bench press, barbell overhead squat, dumbbell biceps curl or other strength exercises
- Optimal training load for strength training
- Single set of 6-12 rep, 70-85%, 1RM/2-3 times/week may produce sufficient training effect
HIIT vs MICT:
- intensity
- duration
- structure
- energy systems
- calorie burn
- adaptability
- primary benefits
Table
Exercise induced muscle regeneration:
- running exo
- endurance exo benefits
- resistant training
- HIIT benefits
EXERCISE-INDUCED MUSCLE REGENERATION
Running exercise
- Accelerate recovery muscle mass & cross-sectional area (CSA) in notexin-induced muscle
degeneration in rats
- Recovery faster than in sedentary groups
- Improves skeletal muscle mass recovery via contractile activity
Endurance exercise benefits:
- Mitochondrial biogenesis & capillary density
- Oxygen transport & utilization, delaying fatigue in aerobic activities
- Aids in maintaining muscle mass & recovery post-injury
Resistant training
- Improving muscle strength & power via neuromuscular adaptations
o Increased muscle CSA
o Enhanced connective tissue stiffness
HIIT benefits
Muscle regeneration
- Innervation
- Vascularization in volumetric muscle loss injuries
HIIT better & time-efficient strategy to improve vascular function than MICT
Benefits of exercise-induced tissue regeneration
- Heart
- Muscle
- CNS
- PNS
- Hematopoietic system
- Bone & cartilage
- Liver
Exercise CNS & brain health:
- interventions for brain health
- effects
Exercise, CNS and brain health
Interventions for brain health
- Progressive aerobic training for individuals with vascular
cognitive impairment (VCI) => 3 times/week for 6 months
- Aerobic endurance & balance training for stroke survivors => 3 times/week for 3 months
- Moderate-to-high intensity aerobic exercise for patients with Alzheimer’s disease => 3 times/week
for 16 weeks
Effects
- Improved cognitive performance
- Enhanced mobility & walking speed
- Maintenance if basic mobility & faster gait speed in Alzheimer’s patients
Exercise & bone health in aging:
- intervention of osteoporosis
- effects
- key points
Exercise & bone health in aging
Interventions of osteoporosis
- High-intensity resistance & impact training for older adults with osteoporosis (30 min/day, 2-3
times/week for 8 months)
- Low-intensity strength & balance exercises for postmenopausal women with osteoporosis (60
min/day, 3 times/week for 6 months)
- Home-based high-intensity resistance & impact training for postmenopausal women (30 min/day, 2 times/week for 8 months)
Effects
- Improved bone density & bone strength
- Enhanced static balance & muscle performance
Key points
- Exercise programs targeting bone health need to be high intensity & impact to strengthen bone density effectively
- Low-intensity exercises can enhance balance & prevent falls, which is critical for postmenopausal women
Muscle health & sarcopenia:
- intervention for sarcopenia
- effects
Muscle health & sarcopenia
Interventions for sarcopenia
- Bodyweight & resistance training for older women (60 min/session, 3 times/week for 16 weeks
- High-intensity resistance training for older men (2 times/week for 28 weeks)
Effects
- Increased grip strength, gait speed & isometric strength
- Enhanced muscle mass & peak torque in leg extension
- Improved overall functional strength
Role of different types of exercise in tissue regeneration:
- muscle regeneration
- brain regeneration
- heart regeneration
Muscle regeneration
- 4-week t/m running: activates muscle satellite cells via MAPK pathway
- 5-week t/m running: promotes muscle stem cells self-renewal through metabolic reprogramming
- 2-week t/m running: enhances fibro-adipogenic progenitors (FAP) activation & muscle regeneration
Brain regeneration
- Voluntary wheel running (4 to 7 days): enhances neural precursor cell proliferation via platelet factor 4
- 6-week t/m running: promotes oligodendrocyte precursor cell
proliferation. Increases hippocampal neurogenesis & specific neural stem cells (NSC) differentiation
Heart regeneration
- Swimming & t/m running cardiomyocyte proliferation & protects against ischemic injury
NICE guidelines on exercise for LBP & sciatica
Recommendation of exercise programs: include biomechanical, aerobic, mind-body or combination of approached. Tailored to individual’s specific needs, preferences & capabilities
Types of exercises: no specific types of exercise, depending in what suits patient best
Self-management & education: providing advice & information to help individuals self-manage LBP is crucial
Manual therapies: should not be offered in isolation but can be considered as part of treatment package including exercise
Invasive treatments: invasive treatments, such as spinal injections, generally not recommended for managing LBP without sciatica
LBP: MULTIDIMENSIONAL APPROACH & EXERCISE PRESCRIPTION
- High prevalence & recurrence
- Multidimensional nature
- Pathoanatomical (5-10%)
- Nonspecific LBP without pathoanatomical
diagnosis 85-90%
Exercise prescription (LBP):
- difficulty
- patient’s clinical profile
- exercise objective
Exercise prescription
Difficulty
- Demonstrated effectiveness in LBP
- Unclear dosage parameters
- Many types of exercise available, with ideal type still unclear
Patient’s clinical profile?
- Who is patient? (e.g., elderly, athlete, deconditioned?)
- What is dominant mechanism underlying the symptoms?
- What is patient’s profile? (Are cognitive, emotional, or other mechanisms present or absent?
Exercise objective
- Pain reduction?
- Increase in ROM? Increase in muscle strength or endurance?
- Reduction in movement-related fear?
