Therapeutic Exercise

Question 1

What are the 6 components of patient management?

Answer 1

Examination, evaluation, diagnosis, prognosis, intervention, outcomes

Question 2

Therapeutic exercise includes a variety of activities. Name 5.

Answer 2

Stretching, strengthening, balance, coordination, and fine motor skills

Question 3

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.

Answer 3

Roger that

Question 4

In general, therapeutic exercise can improve overall health and wellness and prevents/helps manage many diseases including CAD, HTN, Depression/Anxiety, Obesity, and others.

Answer 4

Roger that

Question 5

(Strength/Endurance) - Ability to produce tension (the stronger the muscle, the more tension).

Answer 5

Strength

Question 6

(Strength/Endurance) - Low intensity, repetitive or sustained activities over a prolonged period of time

Answer 6

Endurance

Question 7

Deficiencies in strength or endurance can (create/prevent) limitations

Answer 7

create

Question 8

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.

Answer 8

endurance

Question 9

What are the factors to manipulate when thinking of muscle performance?

Answer 9

FITT - F(frequency), I(intensity), T(time)(duration), T(type)(mode)

Question 10

From the FITT principle, what is how often exercise is performed? The number of exercise sessions per day or sessions per week.

Answer 10

Frequency

Question 11

(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.

Answer 11

Healthy; Injured

Question 12

From the FITT principle, what is how hard you are working?

Answer 12

Intensity

Question 13

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.

Answer 13

Roger that

Question 14

What are two ways to manipulate intensity?

Answer 14

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.

Question 15

From the FITT principle, what is the number of days, weeks, or months that you have been performing this exercise program consistently?

Answer 15

Time (duration)

Question 16

If a patient has been running 2 miles for 6 weeks, how long is the duration based on the FITT principle?

Answer 16

6 weeks

Question 17

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

Answer 17

Got it

Question 18

The longer the duration is equal to the (smaller/greater) the gains as long as the intensity is correct.

Answer 18

greater

Question 19

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.

Answer 19

Type (Mode)

Question 20

__ principle - We need to make the muscle work harder to get it to become stronger. We want to increase the ____ to improve strength.

Answer 20

Overload; overload

Question 21

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.

Answer 21

endurance

Question 22

___ 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.

Answer 22

Angular

Question 23

____ 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.

Answer 23

Speed

Question 24

___ 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.

Answer 24

Contraction

Question 25

___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.

Answer 25

Training

Question 26

(concentric/isometric) - internal force = external force

Answer 26

isometric

Question 27

(concentric/eccentric) - internal force > external force

Answer 27

concentric

Question 28

(concentric/eccentric) - overall muscle length decreases

Answer 28

concentric

Question 29

(concentric/eccentric) - internal force < external force

Answer 29

eccentric

Question 30

(concentric/eccentric) - overall muscle length increases

Answer 30

eccentric

Question 31

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.

Answer 31

Got it

Question 32

For frequency, what does the ACSM recommend for cardiorespiratory exercise in terms of minutes per week?

Answer 32

150 minutes per week

Question 33

For frequency, what does the ACSM recommend for moderate cardiorespiratory exercise?

Answer 33

30-60 minutes for 5 days per week

Question 34

For frequency, what does the ACSM recommend for vigorous cardiorespiratory exercise?

Answer 34

20-60 minutes, 3 days per week

Question 35

For frequency, what does the ACSM recommend for resistance exercise?

Answer 35

All major muscle groups 2-3x per week

Question 36

For frequency, what does the ACSM recommend for flexibility exercise?

Answer 36

2-3x per week

Question 37

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.

Answer 37

Got it

Question 38

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.

Answer 38

60-70

Question 39

What is the range for minimal intensity for gains in terms of VO2 max for cardiovascular?

Answer 39

60-80%

Question 40

What is the range for the recommended amount of repetitions for strength training?

Answer 40

3-10

Question 41

What is the range for the recommended amount of sets for strength training?

Answer 41

2-3

Question 42

For endurance training, do you increase the number of sets and reps?

Answer 42

Yes

Question 43

(Increase/Lower) the number of reps for strength exercises, (increase/lower) the number of reps and sets for endurance type of exercises.

Answer 43

Lower; increase

Question 44

Doing _ sets of _at a PT clinic is a rule of thumb that has been passed down and that sort of thing.

Answer 44

3; 10

Question 45

What is the range of weeks needed before you get true strength changes?

Answer 45

6-12

Question 46

(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.

Answer 46

Hypertrophy

Question 47

Before 6-12 weeks, any strength change you get is due to (hypertrophy/neural adaptations).

Answer 47

neural adaptations

Question 48

(Hypertrophy/Neural adaptations) - Better recruitment of motor units and associated fibers and better synchronization of muscles

Answer 48

Neural adaptations

Question 49

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).

Answer 49

Got it

Question 50

In patients with osteoarthritis or conditions where you do not want them to apply compressive forces, you should do (closed/open) chain exercises.

Answer 50

open

Question 51

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).

Answer 51

isometric

Question 52

If you are going to do isometric exercises you have to work at what range as far as percent of your max volumetric contraction?

Answer 52

60-70%

Question 53

How long do you have to hold isometric exercises to get physiological changes?

Answer 53

6 seconds

Question 54

How many repetitions per day do you have to do for isometric exercises?

Answer 54

5-10

Question 55

(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.

Answer 55

Dynamic

Question 56

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.

Answer 56

Got it

Question 57

___ 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

Answer 57

Valsalva

Question 58

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.

Answer 58

Got it

Question 59

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.

Answer 59

Weight bearing

Question 60

Pain is a cardinal sign of ____.

Answer 60

inflammation

Question 61

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.

Answer 61

Got it

Question 62

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.

Answer 62

6;6

Question 63

(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).

Answer 63

Acute muscle soreness

Question 64

(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.

Answer 64

DOMS

Question 65

You get more sore from doing (eccentric/concentric) exercises

Answer 65

eccentric

Question 66

(Acute muscle soreness/ DOMS) - Tenderness to palpation, increased pain with stretching of the muscle, increased pain with contraction of the muscle, edema (increased warmth).

Answer 66

DOMS

Question 67

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.

Answer 67

DOMS

Question 68

There has been shown to be no treatment for DOMS except for rest and letting the muscle heal

Answer 68

got it