Lecture Exercise Prescription Flashcards
what 3 basic principles should be kept in mind to take optimal advantage of the said principle? (specific adaptation to imposed demand)
what are the 3 adaptations to exercise that can be targeted with exercise?
1) neurological adaptations
2) metabolic adaptations
3) morphological adaptations
describe neurological adaptations
describe metabolic adaptations
based primarily in changes to the metabolic processes that regulate the functioning of the cardiorespiratory system and of skeletal muscle
describe morphological adaptations
describe neuromotor exercise guidelines (6 principles)
1) frequent, structured training (typically low intensity, more usually better, min 2 days/week of 20-30 minutes/day)
2) variation (may have poorer performance during session, but better long-term skill retention)
3) mental imagery/cross education (not to be used as substitutes for actual task - ME is visualizing, CE is performing with other side)
4) distribution of training - should be based on capability and availability of patient (massed not ncessarily better than distributed)
5) continuous and discrete movements (movements that can be briken down can be practiced this way)
6) augmented feedback (coming from sources other than the patient - verbal, modeling/demonstration, manual guidance)
effects of a sedentary lifestyle
mechanism of adaptation for neuromotor exercise
neurological > morphological and metabolic
define balance, static balance, and dynamic balance
describe the requisites for balance
balance specific training guidelines
what are some balance specific training techniques?
- perturb COM (normal sway - ie just standing is enough, external perturbations -therapist push, internal perturbations - movement against resistance, reaching out of BOS)
- modify BOS (decrease external support, feet together etc)
- modify sensory feedback (vision, proprioception, vestibular - hard to modfy, but some VOR)
what is better - balance training and walking or just balance training?
- just balance training according to a study - likely due to relatively less balance-specific trianing
- evidence wrt resistance training in isolation is inconsistant
what are the areobic training guidelines (age, fitness level etc)
- the same guidelines for everyone!!
- should be in addition to ADLS, in bouts of at least 10 minutes, using large muscle groups
describe aerobic training maintenence
Stopping training
–2 weeks - significant ↓ in aerobic fitness
–4-12 weeks – loss of 50% of initial ↑ in V·O2max
–2.5 to 8 months – return to pre-training levels
–N.B. Following years of continuous training, benefits are kept for longer periods of detraining
Reduced training volume
–Up to 15 weeks if intensity is maintained (even with frequency and duration reduced by up to 2/3)
- V·O2max will ↓ if intensity is reduced by 1/3 or 2/3, even with frequency and duration constant
measures of intensity for cardiorespiratory exercise
1) metabolic equivalent task (MET): rate of energy consumtion relative to fixed O2 intake, 1 MET = 3.5 mL O2/kg/min
2) % of maximum oxygen uptake reserve (%VO2R): difference btw VO2 max and O2 uptake at rest
3) percentage HR reserve: diff btw max HR and HR at rest
4) ratio of perceived exertion (RPE): Borg scale (6-20, intended to mirror heart rate of middle aged man), OMNI scale (1-10) - both closely correlated
describe the borg and omni scale of exertions
describe FITT for cardiorespiratory exercise
Frequency: Moderate intensity (≥5 d/wk), High intensity (3-5 d/wk)
Intensity: deconditioned (Borg:9, omni:4, 55-65%max hr), other individuals (borg:12, omni:5, 55-65% max hr), to improve fitness (borg: 12-17, omni 5-8, 40-90%max hr)
Time: Moderate intensity (≥30 min), Higher intensity (≥20 min)
Type: must use large muscle group, sythmic (aerobic) in nature, can be maintained for at least 10 mins
Volume:
for novice/intermediate = Moderate intensity; 30-60 min/day; 5 days/wk, Vigorous intensity; 20-60 min/day; 3 days/wk, combination of above (≥500-1000 MET·min/wk)
f_or deconditioned_ = 3-5 days/week, light to moderarte, up to 20 mins/day
recomended aerobic training for hypertension
aerobic training recomendations for osteoarthritis
Increased physical activity Does not exacerbate joint symptoms and Confers significant benefits, including pain relief
aerobic trianing for chronic pain patients
A comprehensive physical activity program, including aerobic exercise, should be used for all patients
- recomendation as for healthy adults
recomended aerobic training for bone health
Volume: as for otherwise healthy adults
Mode: weight-bearing endurance activities and activities that involve jumping
maintaining effect for resistance training
resistance trianing for hypertension
Resistance training reduces BP–Follow ACSM guidelines
resistance trianing for osteoarthritis
-Strengthening exercise is associated with relief of pain in knee OA and hip OA
resistance training for chrinic pain patients
A comprehensive physical activity program, including RT, should be used for all patients
recomendations for resistance training - strength
*note recomended reps = 8-12 (novice/intermediate), 8-12 (advanced), 10-15 (older adults)
secondary variable for stregth training: muscle action
Concentric, Eccentric, and Isometric muscle actions should be included for clients of all experience levels (based on program goals)
secondary variable for strength training: exercise type
Emphasis on multiple-joint exercises
Unilateral and bilateral, single- and multiple-joint exercises may also be included
secondary variable for strength training: exercise order
Large muscle groups before small
Multiple-joint exercises before single-joint exercises
High-intensity exercises before lower-intensity
Alternate upper / lower body; agonist / antagonist;
secondary variable for strength: rest between sets
Core, multi-joint exercises: ≥2–3 min between sets
Other exercises: 1-2 min between sets (for endurance shorter rest, 1–2 min for high-repetition sets (≥15–20 reps), <1 min for moderate sets (10–15 reps))
Rest period between sessions: ≥48 hrs between sessions for the same muscle group
secondary variable for strength: movement velocity
For all experience levels, load should dictate tempo
- Concentric phase: the intent should be to maximally accelerate the load
- Eccentric phase: slower, controlled descent
Novice: slow (2:4) and moderate (1:2) velocities
Intermediate: moderate (1:2) velocity
Advanced: continuum of velocities corresponding to intensity
for endurance: Intentionally slow velocities for 10–15 repetitions, Moderate to fast velocities for ≥15–25 repetitions
for power: explosive velocity
what are the 3 key principles for strength training?
what is the 1 RM?
- person would be able to do one more rep at current weight but no more than that
training parameters for muscle power
Training for power is done concurrently with strength training
guidelines for strength training - muscle endurance
note that loads should be less than 50% 1RM, shorter rest periods, slow velocity for 10-15 reps, moderate to fast velocity for 15 + reps
what is isotonic ve isoinetic exercise vs isometric?
isotonic (inculde eccentric and concentric) = resistance dictates movement velocity (tension unchanged, muscle length changes) - tonic = muscle moving!! - eccentric training = more beneficial, but do not do in itself because increased risk of injury
isometric = no change in joint angle with resistance applied - little carry-over strength to other joint angles (MMT and RISOM = isometric!)
isokinetic = movement velocity dictates resistance - a constant rate of speed with a variable resistance force (measured by a dynamometer), which alters through the full distance stroke - requires a special machine!! *note largest training effects seen for trained velocities, requires expensive dynamometers
what is plyometric and ballistic training used for?
- to better promote muscle power (ie with goal not to stop at end of movement - up to 40% of concentric phase normally spent decellerating) - eg loaded jump squat
describe undulating periodization vs reverse periodization
undulating: strength gains optimised through variation of all 3 variables of strength training
reverse: training cycle begins with lower volumes (set and reps) and higher intensities, progressing towards higher volumes and lower intensities
describe flexibility training guidelines
- can be done as a session alone or part of a cool-down
- 2-3 days/week with maximum results daily
- static, ballistic, or pnf
static: hold each stretch 10-30s, 2-6 reps (60s total stretch)
pnf: produces best effect (better than static), 10-30s hold, 4 reps
what is the diff btw ROM and flexibility exercises?
ROM = intended to improve functional range of a joint movement - load ligaments or joint capsules
flexibility = intended to increase extensibility of muscle group (load muscle-tendon complex)
explain viscoelastic strain vs viscoplastic strain
viscoelastic: always fully reversed, accounts for most of the tissue deformation produced during flexibility/ROM, not for long-term adaptation
viscoplastic: implies micro-tearing has occured in tissue, allows for adaptation as damage is healed
what adaptations are made with ROM and flexibility exercises?
1) viscoplastic deformation (- followed by healing - morphological)
2) incrased stretch tolerence (tissue properties unaltered, but patient reports ledd discomfort with greater tissue stretch)
3) myofibrilogenesis (addition of sarcomeres in series, increases muscle resting length, alters length tension curve and therefore max force production occurs at longer length)
** note that decrease in stiffness of tissue not desired using these exercises and tissue stiffness is required for joint stability!!
pnf technique - hold relax
Hold-relax: the resisted contraction (step 2) is isometric (with the instruction “don’t let me move you”); the subsequent stretch (step 3) is passive (performed by the therapist).
pnf technique - contract relax
Contract-relax: the resisted contraction is concentric (over a 5-10o range, with the instruction “gently push into my hand”); the subsequent stretch is passive.
pnf technique - hold relax with agonist contract
Hold-relax with agonist contract: the resisted contraction is isometric; the subsequent stretch is active-assisted (contraction of the agonist muscle to move farther into the stretched position, with assistance from the therapist).
pnf technique - contract relax with agonist contract
Contract-relax with agonist contract: the resisted contraction is concentric; the subsequent stretch is active-assisted.
what are the 3 goals of ROM and flexibility exercises?
1) Maintain / increase ROM following acute injury or in a painful / irritable condition
2) ↑ ROM of a hypomobile joint
3) ↑ flexibility of a (relatively) short muscle
goal 1: how to increase ROM prescription
goal 2 parameters: ↑ ROM of a hypomobile joint
–Intensity: Moderate sensation of stretch (PROM or AAROM with OP)
–Duration: 10 - 30 sec
–Repetitions: 2 – 6 (total of 60s)
–Frequency: ≥2-3 / wk (2 / wk is absolute minimum to see long-term change, more is better*)
*leave enough time to rest btw bc microtearing
parameters of Goal 3: ↑ flexibility of a (relatively) short muscle
Intensity: Moderate sensation of stretch (Static (passive vs. active) Ballistic (sport-specific … rarely used in rehab))
Duration: 10 - 30 sec
Repetitions: 2 – 6 (total of 60s)
Frequency: ≥2-3 / wk (2 / wk is absolute minimum to see long-term change, more is better*)
describe the “more is better” rule for stretching
guideline to maintain flexibility
- at least 2 days a week, 10 minutes each time (absolute min!!)
describe reasoning behind foam roller massage techniques
describe flexibility exercise benefits
- does not reduce overall injury rates during exercise (but may reduce musculo tendon type injuries)
- stretch before or after exercise does not confer protection from D.O.M.S
- pre-exercise stretching = decreased stiffness of MT complex, Decreased force production & power, Decreased jump height, Improved running economy
- regular flexibility - Improved force production and velocity of contraction, No effect on economy of motion
- optimal flexibility determined by sport specific and individual factors, goal of program could be to balance flexibility (body moves through path of least resistance, therefor uneven flexibility affects movement)
describe the things contributing to compliance
how to motivate a patient
- Educate the pt on the condition
- Encourage active participation in the setting of goals and development of the HEP
- Ensure the pt’s understanding of the role of the HEP in reaching the mutually-assigned goals
- Determine pt willingness, and encourage pt to engage in activities that are appropriate for their condition
- Find creative ways to meet pt’s goals and motivate them to strive for the next level
- Be non judgmental
- Accommodate for different learning styles (visual, auditory, tactile)
how should a new exercise program be initiated?
how to screen for risk of new exercise program for a pt?
how to manage risks for any given exercise program
