Therapeutic Exercise Intervention

Question 1

Rehabilitation program =

Answer 1

primary emphasis is restoration of muscular strength, endurance, flexibility

Question 2

Physical Fitness =

Answer 2

improvement, CV fitness, body composition

Question 3

risk factors for chronic disease

Answer 3

physical inactivity and sedentary behaviour 
smoking
nutrition
high blood cholesterol 
overweight and obesity
alcohol
high BP

Question 4

health risks of obesity

Answer 4

low self esteem
social isolation 
depression
heat intolerance
SOBOE
fatigue 

Heart disease and stroke
abnormal blood lipids & metabolic syndrome 
hypertension
diabetes
cancer
gallbladder disease & gall stones 
OA & gout
Respiratory conditions
infertility, incontinence, PCOS

Question 5

Physical inactivity

Answer 5

associated with poor health outcomes and increased mortality
increased risk of diabetes, CV disease, cancer
Regular physical activity and high CV fitness decrease mortality

Question 6

Benefits of regular physical activity

Answer 6

reduces risk of premature mortality
reduces risk of death from CV disease
reduces risk of stroke
reduces risk of developing diabetes
reduces risk of developing bowel cancer 
helps to control weight
helps to build and maintain healthy bones, muscles, joints
decreased risk of falls, improved mobility (elderly) 
Reduces depression/anxiety/stress levels
promotes psychological wellbeing
reduces cognitive decline & dementia

Question 7

Immediate short term goals

Answer 7

1. provide first aid + mgmt - swelling
2. reduce or minimise pain
3. restore full ROM
4. establish core stability
5. reestablish neuromuscular control
6. improve postural stability and balance
7. restore or increase muscular strength/endurance/power
8. maintain cardiorespiratory fitness
9. Incorporate functional progressions

Question 8

Functional progression

Answer 8

graduated progressive activities to prepare return to specific activity or function
skills are broken down into components
advance if no additional pain or swelling

Question 9

Stage 1 : stabilisation

Answer 9

muscle, joint, nerve, postural control and stability deficits addressed 
correct imbalances 
recondition injured structures 
prepare tissues for physical demands
prevent tissue overload 
improve work capacity 
improve stabilisation strength

progress from isometric to incorporating movement
Improve neuromuscular efficiency, core stability, functional strength, functional flexibility

Question 10

Stage 2: strength

Answer 10

enhance stabilisation strength and endurance
high volume resistance exercises
goal is to achieve adaptive changes by challenging NM system
- increase in muscle size
- increase fatigue resistance
-increased stabilisation strength to control joint translation

Question 11

Stage 3 : power

Answer 11

important for return to high level activity
30-45% of max strength, accelerating through ROM
Goal : enhance NM efficiency and power production by increasing motor neurone excitability and speed strength throughout ROM

Question 12

Consider healing factors

Answer 12

Injury extent - response is determined by extent 
effusion  and or oedema
haemorrhage 
poor vascular supply
separation of tissue 
muscle spasm 
atrophy 
steroid use 
keloid or hypertrophic scars 
infection 
health/age/nutrition 
wound healing conditions

Question 13

Establishing core stability

Answer 13

stabilises entire kinetic chain during FXN
maintains normal length - tension relationship of agonists + antagonists
normal force couple relationships in lumbo-pelvic -hip
Allows for optimal lumbo-pelvic-hip complex during functional kinetic chain movements
proximal stability - efficiency in limb movements

Question 14

Revise core anatomy

Answer 14

42

Question 15

Range of motion and stretching

Answer 15

Flexibility = movement through full, unrestricted painfree ROM

Question 16

Open chain =

Answer 16

distal segment is mobile, hand or foot not fixed or in contact with the ground/surface

Question 17

Closed chain =

Answer 17

Distal segment fixed, hand or foot is weightbearing

Question 18

Closed chain

Answer 18

safer, less stress and force to healing joints
co-contraction of agonist-antagonist decreases shear forces on joint
enhances joint stability

Question 19

Open chain

Answer 19

isolated to single joint
strength and ROM
Useful when closed chain is not possible

Question 20

Neuromuscular control

Answer 20

Reestablishing brains interpretation of proprioceptive and kinaesthetic info
retrain conscious control of specific movement
successful repetition - automatic
functional strengthening, closed chain kinetic
critical during early stages to prevent re-injury

Question 21

Four crucial elements of neuromuscular control

Answer 21

1. proprioceptive and kinaesthetic sensation
2. dynamic joint stabilisation
3. reactive neuromuscular control
4. functional activity

Open and closed chain activities, balance training, eccentric + high rep/low load strengthening, reflex facilitation, plyometrics, biofeedback

Question 22

Postural control and balance

Answer 22

ability to maintain stability and balance 
requires proprioception and kinesthesia 
decreased?
- poor neuromuscular control 
-muscular weakness
-ROM limitations
-Vestibular, visual deficits 

poor postural control - risk of re-injury
combination of open and closed chain

Question 23

Postural control and balance

Answer 23

safety first
train in multiple planes of motion 
consider multisensory 
progress
- static, bilateral, stable surface > dynamic, unilateral, unstable surface 
progress towards sports specific

Question 24

Strength, power, endurance

Answer 24

goal - work in full pain-free ROM 
Multiplanar : concentric, isometric, eccentric 
consistent, increasing effort against progressively increasing resistance 
isometic 
-early stage of rehab
- limitation in ROM 
-Minimise atrophy
-decrease swelling

Question 25

progressive strengthening

Answer 25

progress: isometric - concentric/eccentric
aim to incorporate both into rehab program
ideal ratio of contraction?
-Conc: 1 Ecc 2

Isokinetics? Resistance dependant on speed
plyometrics
- later stages of rehab
-quick eccentric stretch to facilitate subsequent concentric contraction
-restore/develop dynamic movements associated with muscular power
- sports performance

Question 26

Cardiovascular fitness

Answer 26

don’t forget to incorporate
start early in the program to maintain existing levels
cycling, swimming, water walking, walking, trainer, rowing machine, arm erg

Question 27

compliance & adherence

Answer 27

compliance = obedience in following instructions
adherence = voluntary long term behavioural change
1/3 - 1/3 - 1/3 rule
30-60% dropout rate in first 3 months of exercise programs
pain tolerance, motivation, external support, positive attitude
educate about reasoning/healing/goals - written instructions
collaborative goal setting process, encouragement & positive reinforcement
clear guidelines
don’t forget about pain
consider amount, make it interesting and patient focused/specific

Question 28

Full return to function

Answer 28

patient and injury specific 
monitor during rehab, outcome measures
reassessment of function and goals during rehab process
ability to perform functional tasks
full return of deficits
low risk of re-injury
self management

Question 29

Worst in australia

Answer 29

darling downs

SE region SA

Question 30

best in australia

Answer 30

sydney east

melbourne inner

Question 31

over the next 20 years

Answer 31

hospitalisations expected to double
2.7x diabetes
4x renal failure

Question 32

obesity rates atm

Answer 32

1 in 4 Aussies (30%) BMI >30
7% are children
1 in 3 are overweight
Indigenous are 1.9x more likely to be obese

Question 33

Orrow (2012)

Answer 33

significant increase in self reported exercise in 12 months

Question 34

Lin (2010)

Answer 34

mod to intensive counseling - small improvements in secondary outcome, large changes to level of activity

Question 35

Oglivie (2007)

Answer 35

tailored motivational counseling - incr. walking 30-60min/week

Question 36

Hillsdon(2005)

Answer 36

interventions had moderate impact on self reported activity levels

Question 37

summary

Answer 37

intense, individualised counseling with personalised exercise prescription

Question 38

Witvrouw (2004) on stretching to improve flexibility

Answer 38

important for sports with high intensity stretch shorten cycle like soccer, football, sprinting
not so important for sports with less stretch- shorten cycle- cycling, swimming, jogging

Question 39

Page (2012) on stretching to improve flexibility

Answer 39

dynamic /ballistic before exercise (warm up)
static before exercise is potentially detrimental to performance
after exercise can be beneficial for injury prevention

Question 40

Sherry and Best (2004) on stretching to improve flexibility

Answer 40

1. Faster to full ROM and improved effectiveness of
   rehab program
   • 2. Progressive agility and trunk stability exercises (PATS)
   with static stretching and isolated hamstring resistance
   exercise (STST) demonstrated:
   – Nil difference in time until return to sport
   – Significant reduction in re-injury 2/52 and 1 year post return
   to sport with PATS

Question 41

Katalinic (2011) contractures in neurological patients

Answer 41

no evidence to demonstrate clinically important changes

Question 42

Injury prevention such as stretching, warm up cool down

Answer 42

conflicting evidence for stretching to prevent injury and does not reduce DOMS

Cool down may facilitate lactate removal
slow return form vasodilation, return blood to CC
increase in cardiac vagal tone, reduction in resting HR
Slow walking, stretching exercises, calisthenics