Therapeutic Exercise Flashcards
What are the 6 components of patient management?
Examination, evaluation, diagnosis, prognosis, intervention, outcomes
Therapeutic exercise includes a variety of activities. Name 5.
Stretching, strengthening, balance, coordination, and fine motor skills
Therapeutic exercise should be able to correct impairments related to body structure and function and by correcting those impairments that can help alleviate the activity or participation limitations we have.
Roger that
In general, therapeutic exercise can improve overall health and wellness and prevents/helps manage many diseases including CAD, HTN, Depression/Anxiety, Obesity, and others.
Roger that
(Strength/Endurance) - Ability to produce tension (the stronger the muscle, the more tension).
Strength
(Strength/Endurance) - Low intensity, repetitive or sustained activities over a prolonged period of time
Endurance
Deficiencies in strength or endurance can (create/prevent) limitations
create
Often times for people with lower back pain when we think muscle performance is an issue, we will try to improve the muscle performance of the core and lower back muscles in an (strength/endurance_ type fashion because that is how those muscles work.
endurance
What are the factors to manipulate when thinking of muscle performance?
FITT - F(frequency), I(intensity), T(time)(duration), T(type)(mode)
From the FITT principle, what is how often exercise is performed? The number of exercise sessions per day or sessions per week.
Frequency
(Healthy/injured) populations usually go per week in terms of frequency. (Healthy/Injured) populations normally do multiple sessions per day because they require that level of activity to really rehabilitate an injury.
Healthy; Injured
From the FITT principle, what is how hard you are working?
Intensity
Intensity is a key factor to improve muscle performance overall. If people aren’t working to the right intensity they wont improve their strength or endurance.
Roger that
What are two ways to manipulate intensity?
Increase the amount of resistance – Weight, incline on a treadmill, resistance on a bike.
Increase the volume of resistance – number of repetitions, number of miles biked.
From the FITT principle, what is the number of days, weeks, or months that you have been performing this exercise program consistently?
Time (duration)
If a patient has been running 2 miles for 6 weeks, how long is the duration based on the FITT principle?
6 weeks
In general for our terms we think of duration as the longer period of time, but sometimes you will see duration being the duration of each training session being increased
Got it
The longer the duration is equal to the (smaller/greater) the gains as long as the intensity is correct.
greater
From the FITT principle, what is the form or type of exercise performed? Examples:
Squats versus leg extensions, manual versus mechanical (machines) resistance, and type of contractions (isometric, concentric, and eccentric) performed.
Type (Mode)
__ principle - We need to make the muscle work harder to get it to become stronger. We want to increase the ____ to improve strength.
Overload; overload
If you want to improve the endurance of the abdominals and low back muscles of our core because someone has low back pain, we have to employ training that activates those muscles in an (strength/endurance) type fashion for those muscles to get better.
endurance
___ specificity – If you work at a particular angle, the gains that you will get are most pronounced at that angle. (Ex – If only doing bicep curls from 0 degrees of bicep extension to 30 degrees of flexion, the strength gains will be most pronounced in that particular angle.) Basically picking up strength gains in different ranges.
Angular
____ specificity – The thought was you could train people at higher speeds that would replicate what they are actually trying to do. Whatever speed you exercise at, you’ll get the most gains there. More applicable example is distance runners training for long distances and sprinters sprinting for sprints.
Speed
___ specificity – However you work the muscle (isometrically, concentrically, eccentrically) dictates how you get your gains.
There are certain times where you want to really work the eccentric phase in certain conditions to stress the musculotendinous unit because research shows if you do that it causes remodeling of the tissue. Examples are using two hands for the concentric phase of the bicep curl and then struggle with one hand in the eccentric phase. If a person has a problem going down the stairs (going down the stairs is an eccentric contraction where they are trying to control their body weight going down) so focusing on the eccentric lowering piece would be very beneficial for them.
Contraction
___specificity – If you want to train a muscle that works primarily in an endurance type fashion, then you want to train it with endurance type principles, and same thing for strength.
Think of planks because those are postural muscles.
Training
(concentric/isometric) - internal force = external force
isometric
(concentric/eccentric) - internal force > external force
concentric
(concentric/eccentric) - overall muscle length decreases
concentric
(concentric/eccentric) - internal force < external force
eccentric
(concentric/eccentric) - overall muscle length increases
eccentric
When making a presecription for a patient in terms of frequency, consider the patient (injury/age), the patient’s goals, and type of exercise they will perform (intensity/ eccenctric vs concentric). Everyone has different circumstances.. Some people want to return to professional athletics, high level recreational activities, or just want to return to be able to do activities of daily living.
Got it
For frequency, what does the ACSM recommend for cardiorespiratory exercise in terms of minutes per week?
150 minutes per week
For frequency, what does the ACSM recommend for moderate cardiorespiratory exercise?
30-60 minutes for 5 days per week
For frequency, what does the ACSM recommend for vigorous cardiorespiratory exercise?
20-60 minutes, 3 days per week
For frequency, what does the ACSM recommend for resistance exercise?
All major muscle groups 2-3x per week
For frequency, what does the ACSM recommend for flexibility exercise?
2-3x per week
For a lot of people that are coming in injured into physical therapy or have some condition that is going on, I worry about putting them in a 1 rep max or even a 10 rep max because I worry that they are going to get hurt. Their tissue is already compromised and if I try and maximally stress that tissue, do I just set themselves up for reinjuring themselves or injuring something else, but at the same time you want to try and tie our intensity to some sort of objective measure. For most of our patients we prescribe a set intensity using a particular a number of sets and reps based on an educated guess. MMT (manual muscle testing) is used universally between physical therapists and other health care providers to try and quantify how much strength a person has. That information will help dictate to us a little bit about their intensity of exercise that they may be able to do and it is better than just guessing.
Got it
Need to work the patients hard enough to create physiological changes in the body to “progress” them (creating overload in the body). You have to keep advancing people so that they are working at their -% of their 1RM.
60-70
What is the range for minimal intensity for gains in terms of VO2 max for cardiovascular?
60-80%
What is the range for the recommended amount of repetitions for strength training?
3-10
What is the range for the recommended amount of sets for strength training?
2-3
For endurance training, do you increase the number of sets and reps?
Yes
(Increase/Lower) the number of reps for strength exercises, (increase/lower) the number of reps and sets for endurance type of exercises.
Lower; increase
Doing _ sets of _at a PT clinic is a rule of thumb that has been passed down and that sort of thing.
3; 10
What is the range of weeks needed before you get true strength changes?
6-12
(Hypertrophy/Neural adaptation) - Increased cross sectional area of fibers due to increased proteins and is directly related to the ability of the muscle to produce tension.
Hypertrophy
Before 6-12 weeks, any strength change you get is due to (hypertrophy/neural adaptations).
neural adaptations
(Hypertrophy/Neural adaptations) - Better recruitment of motor units and associated fibers and better synchronization of muscles
Neural adaptations
When determining the mode for an exercise prescription, it is determined from examination/evaluation and functional limitations that the patient demonstrates as well as how the muscles work (strength vs endurance and isometric vs concentric vs eccentric).
Got it
In patients with osteoarthritis or conditions where you do not want them to apply compressive forces, you should do (closed/open) chain exercises.
open
When to use (isometric/isotonic) exercises:
An isometric contraction might be beneficial for patients that are postoperative and can’t move the joint through its full range of motion because it might put stress on structures that were repaired, but performing isometric contractions of the surrounding musculature or musculature that is proximal or distal to the area that has been surgically repaired might be okay.
Performing isometric contractions might be beneficial for people who have immobilized joints, people in a brace or cast or post surgical, people who have painful conditions, people who need to get taught muscle activation (trying to get people to recruit muscles), muscles that contract and stabilize a joint (trying to mimic how the muscle works), and muscles that have a grade of 3/5.
Sometimes people who have knee surgery have swelling and their quad does not work very well so post surgery often times you are just trying to get them to activate that muscle again (think of quad sets).
isometric
If you are going to do isometric exercises you have to work at what range as far as percent of your max volumetric contraction?
60-70%
How long do you have to hold isometric exercises to get physiological changes?
6 seconds
How many repetitions per day do you have to do for isometric exercises?
5-10
(Isometric/Dynamic) variable resistance is good for most patient populations and is the most prescribed type of exercise involving healthy and nonhealthy populations. The person must be able to move t/o (through) ROM to be able to do these exercises.
Dynamic
Most places if they have isokinetic machines are used for high level strength testing as opposed to general strengthening. In general you can use these machines for any patient that you do dynamic variable resistance with.
Got it
___ maneuver – basically holding your breath while you are trying to exercise.
Not a good idea because it puts a lot more stress on your cardiopulmonary system while exercising.
Asking people to count out loud is a good way to make sure that they are breathing
Valsalva
People who are very weak or deconditioned do not recover as quickly as people who are not deconditioned so if you work them too hard it takes them way too long to recover and overall it slows down your progress with them.
Got it
Post menopausal woman is the group that has the largest percentage of osteoporosis diagnosis. (Weight bearing/Nonweight bearing) exercises are good for people who have osteoporosis. You do not want to load them too much or load them in positions where there is a ton of stress on the bone because of the increased risk of fractures.
Weight bearing
Pain is a cardinal sign of ____.
inflammation
Try letting your patient know when they should expect some pain or let them know that an exercise might feel a little uncomfortable, things like that so they are on the same page as you and that expectation really helps.
Got it
It takes around _ weeks for soft tissue / bone to heal (pretty good rule of thumb). At that _ week mark, normally the tissue / bone is normally strong enough to put some stress on it .
A little bit of stress on the tissue after it has healed is good for tissue and makes it stronger.
6;6
(Acute muscle soreness/Delayed onset muscle soreness) - Occurs during or immediately after exercise and is due to fatigue (lack of oxygen and increase in lactic acid). Burning and aching. Subsides quickly with rest (restoration of oxygen, elimination of lactic acid).
Acute muscle soreness
(Acute muscle soreness/Delayed onset muscle soreness) - Develops 12-24 hours after exercise; peaks at 48-72 hours. Can last 10-14 days, but 2-3 days for most people.
DOMS
You get more sore from doing (eccentric/concentric) exercises
eccentric
(Acute muscle soreness/ DOMS) - Tenderness to palpation, increased pain with stretching of the muscle, increased pain with contraction of the muscle, edema (increased warmth).
DOMS
Cause of (Acute muscle soreness/DOMS) is due to microtears in the muscle. You can mitigate this by not going crazy in your first workout if you haven’t worked out in a long time.
DOMS
There has been shown to be no treatment for DOMS except for rest and letting the muscle heal
got it
