Therapeutic Exercise & Manipulation Flashcards

1
Q

Work =

A

ATP + adp + Pi + energy

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2
Q

3 metabolic energy systems

High intensity (short)
High intensity (long)
Moderate intensity

A

High:
Creatine Phosphate System (5-25 sec)
Lactic Acid System/Rapid Glycolysis (2 min)

Mod: aerobic oxidation system (>2 min)

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3
Q

Cardiovascular exercise physiology

Resting heart rate:

Max heart rate

______increase with work

A

60-80

220-age

Linear increase

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4
Q

Stroke volume =

Ranges:
At rest:
Max:

______ increase with work

A

Esv-edv

Rest: 60-100ml/beat
Max: 100-120ml/beat

Curvilinear. Plateau around 50%

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5
Q

Stroke volume is greatest in which position?

Why?

A

Supine/prone. Less in standing or with static exercises due to increase in intrathoracic pressure

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6
Q

Cardiac output (Q) =

____ at rest
____ max

A

Q = HR x SV

4-5L/min at rest

20L/min max

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7
Q

______% of cardiac output is distributed to skeletal muscle at rest

______% is delivered to working muscle during exercise

A

15-20%

85-90%

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8
Q

Venous return during exercise occurs by what three things?

A
  1. Contracting skeletal muscle
  2. Venoconstriction by smooth muscle
  3. Diaphragmatic contraction lowering intrathoracic pressure facilitating blood flow to lower extremities.
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9
Q

SBP increases _______ with work.

Max around _____mmHg

A

Linearly with work

190-220mmhg

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10
Q

BP is related to ___ and ____ making it a good way to monitor ionotropic response during exercise.

______ & _____ are abnormal responses of BP to exercise

A

CO and PVR

Decrease in SBP with increase in work
Increase in DBP with increase in work

= severe exercise intolerance (pulm htn) or cardiac disease.

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11
Q

HR, SBP, DBP greater in arm or leg exercise?

A

Greater during arm work due to decrease total muscle mass requiring greater percentage of mass to perform work and decreased mech efficiency

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12
Q

Pulmonary ventilation: _____ in adults at rest
Can increase ____ fold with exercise.

A

6L/min at rest
15-25 fold increase with exercise

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13
Q

Define anaerobic threshold

A

Peak work rate and oxygen consumption at which energy demand exceeds circulatory ability

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14
Q

Average 70K human expends ______ kcal/min at rest.

Exercise can increase energy expenditure _____ times > resting values.

A

1.2 kcal/min at rest

15-25 times

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15
Q

What is the best index of physical work capacity or cardio respiratory fitness?

A

Max O2 consumption/VO2 max - highest rate of O2 transport at max physical exertion

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16
Q

Which of the following statements is false regarding the major energy sources?
The creatine phosphate system is responsible for providing energy for brief, high-intensity exercise lasting up to 5 seconds in duration.
Rapid glycolysis is responsible for fueling activities lasting up to 1-2 minutes in duration.
The aerobic oxidation system is capable of using carbohydrates, fat, and protein to produce energy.
During most activities, all energy systems may be active to some degree.

A

A

All energy-producing pathways are active during most exercises. However, different types of exercise place greater demands on different pathways. Shorter duration, high-intensity activities rely more on the anaerobic systems, whereas longer, lower intensity activities receive a greater contribution from the aerobic pathway. During high-intensity work, the first 5 seconds are energized by stored ATP. The next 25 seconds or so are supplied by the creatine phosphate system. Glycolysis predominates during activities lasting up to 1-2 minutes (long sprints or middle distance activities). Longer duration activities rely primarily on the aerobic oxidation system, including the Krebs cycle and electron transport chain, and are capable of using fats, carbohydrates, and even small amounts of protein to produce ATP.

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17
Q

Changes at Rest:
Heart rate: ____ (secondary to?)
Stroke volume _____ (secondary to?)
Cardiac output: ______
Oxygen consumption _______

A

Changes at Rest
Heart rate decreases, probably secondary to decreased sympathetic tone, increased parasympathetic tone, and a decreased intrinsic firing rate of the sinoatrial node.

Stroke volume increases secondary to increased myocardial contractility.

Cardiac output is unchanged at rest.

Oxygen consumption does not change at rest.

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18
Q

Changes at Submaximal Work:
Heart rate: _____ (secondary to?)
Stroke volume _____ (secondary to?)
Cardiac output _____ ( secondary to?)
Submaximal oxygen consumption ______ (secondary to)
Arteriovenous oxygen (avO2) difference _______
Lactate levels ______ ( secondary to?)

A

Changes at Submaximal Work*
Heart rate decreases, at any given workload, because of the increased stroke volume and decreased sympathetic drive.

Stroke volume increases because of increased myocardial contractility.

Cardiac output does not change significantly because the oxygen requirements for a fixed workload are similar. The same cardiac output is generated, however, with a lower heart rate and higher stroke volume.

Submaximal oxygen consumption does not change significantly because the oxygen requirement is similar for a fixed workload.

Arteriovenous oxygen (avO2) difference increases during submaximal work.

Lactate levels are decreased because of metabolic efficiency and increased lactate clearance rates.

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19
Q

Changes at Maximal Work
Maximal heart rate:
Stroke volume: 

Maximal cardiac output:
Maximal oxygen consumption (O2max):
Ability of the local mitochondria to use oxygen is ___

A

Changes at Maximal Work
Maximal heart rate does not change with exercise training.

Stroke volume increases because of increased contractility and/or increased heart size.

Maximal cardiac output increases because of increased stroke volume.

Maximal oxygen consumption (O2max) increases primarily because of increased stroke volume.

Ability of the local mitochondria to use oxygen is improved.

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20
Q

Physiologic changes with regular exercise:
Blood Pressure:
Blood Volume Changes:
Blood lipids:
Body Composition:
Biochemical changes:

A

Blood Pressure
In normotensive individuals, no significant effect.
In hypertensive individuals, there can be a modest reduction in resting blood pressure as a result of regular exercise.

Blood Volume Changes
Total blood volume increases because of an increased number of red blood cells and expansion of the plasma volume.

Blood Lipids
Total cholesterol can be decreased in individuals with hypercholesterolemia.

High-density lipoprotein cholesterol increases with exercise training.

Low-density lipoprotein cholesterol can remain the same or decrease with regular exercise.

Triglycerides can decrease in those with elevated triglycerides initially. This change is facilitated by weight loss.

Body Composition
Total body weight usually decreases with regular exercise.

Fat-free weight does not normally change.

Percent body fat declines

Biochemical Changes
Stored muscle glycogen increases.

The percentage of fast- and slow-twitch fibers does not change, but the cross-sectional area occupied by these fibers may change because of selective hypertrophy of either fast- or slow-twitch fibers.

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21
Q

Energy System Changes

Chronic anaerobic training using the ATP–creatine phosphate system results in increased ____ and ___ because of enhancement of enzyme activity and increases in the amount of ATP and creatine phosphate in the muscle.

Anaerobic glycolysis is improved if ________
Regular aerobic training improves _______. It increases muscle glycogen and triglyceride stores, as well as the rate at which carbohydrates and fat are metabolized.

A

Energy System Changes

Chronic anaerobic training using the ATP–creatine phosphate system results in improved capacity and power of this system because of enhancement of enzyme activity and increases in the amount of ATP and creatine phosphate in the muscle.

Anaerobic glycolysis is improved if the training program uses this system, resulting in increased stores of muscle glycogen and improved ability of enzymes in the system.

Regular aerobic training improves O2max. It increases muscle glycogen and triglyceride stores, as well as the rate at which carbohydrates and fat are metabolized.

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22
Q

Which of the following statements is true regarding blood pressure response to exercise?
Both systolic blood pressure and diastolic blood pressure normally rise linearly with increasing work intensity.
Only diastolic blood pressure rises during exercise.
Systolic blood pressure increases with exercise intensity; diastolic blood pressure typically remains unchanged or only slightly increases.
At similar oxygen uptakes, blood pressure is higher during leg work than during arm work.

A

C

Systolic blood pressure increases linearly with increasing work intensity, by approximately 8-12 mm Hg per metabolic equivalent. Diastolic blood pressure remains unchanged or only slightly increases with exercise. At similar oxygen consumptions, blood pressure is higher during arm work than during leg work.

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23
Q

8 signs of overtraining

A

Sudden decline in quality of work or exercise performance

Extreme fatigue

Elevated resting heart rate

Early onset of blood lactate accumulation

Altered mood states

Unexplained weight loss

Insomnia

Injuries related to overuse

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24
Q

five components of an exercise prescription

A
  1. Mode - Form or Type of Exercise
    2 Intensity - Difficulty level
    3 Duration - Time or length of session
  2. Frequency - Number of exercise sessions per day and per week
  3. Progression Increase activity over time
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25
Q

Describe the Borg scale of perceived exertion

A

Level Perceived Exertion
6 —
7 Very, very light
8
9 Fairly light
10
11
12
13 Somewhat hard
14
15 Hard
16
17 Very hard
18
19 Very, very hard
20

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26
Q

9 indications a patient needs exercise stress testing

A
  1. Pain and discomfort (or other anginal equivalent) in the chest, neck, jaw, arms, or other areas that may be ischemic in nature

  2. Shortness of breath at rest or with mild exertion

  3. Dizziness or syncope

  4. Orthopnea or paroxysmal nocturnal dyspnea

  5. Ankle edema

  6. Palpitations or tachycardia

  7. Intermittent claudication

  8. Known heart murmur

    9 Unusual fatigue or shortness of breath with usual activities
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27
Q

Type of muscle: Type 1 (slow oxidative)
Major source of ATP:
Mitochondria:
Myoglobin content:
Capillarity:
Muscle color:
Glycogen content:
Glycolytic enzyme activity:
Myosin ATPase activity:
Speed of contraction:
Rate of fatigue
Muscle fiber diameter

A

Oxidative phosphorylation
High
High
High
Red
Low
Low
Low
Slow
Slow
small

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28
Q

Type of muscle fiber: Type 2A (Fast oxidative glycolytic)
Major source of ATP:
Mitochondria:
Myoglobin content:
Capillarity:
Muscle color:
Glycogen content:
Glycolytic enzyme activity:
Myosin ATPase activity:
Speed of contraction:
Rate of fatigue
Muscle fiber diameter

A

Oxidative phosphorylation
High
HIgh
HIgh
Red
Intermediate
Intermediate
High
Fast
INtermediate
Intermediate

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29
Q

Type 2B (Fast Glycolytic)
Major source of ATP:
Mitochondria:
Myoglobin content:
Capillarity:
Muscle color:
Glycogen content:
Glycolytic enzyme activity:
Myosin ATPase activity:
Speed of contraction:
Rate of fatigue
Muscle fiber diameter

A

Glycolysis
Low
Low
Low
White
HIgh
HIgh
HIgh
Fast
Fast
Large

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30
Q

Muscle fiber orientation:
1 pectoralis major
2. Sartorius
3. Orbicularis Oris
4. Deltoid
5. Biceps brachii
6. Rectus femoris
7. Extensor digitorum longus

A
  1. Convergent
  2. Parallel
  3. Circular
  4. Multipennate
  5. Fusiform
  6. Bipennate
  7. UNipennate
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31
Q

Types of muscle contration:
1. Isometric
2. Concentric
3. Eccentric

A
  1. Muscle contracts but does not shorten
  2. Muscle shortens
  3. Muscle elongates
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32
Q

Determinants of Strength
Force is proportional
Pennate muscle are able to

Length-Tension Relationship
Max force of contraction occurs at
This is around
Efficiency occurs at around ___% velocity of max contraction (energy=work not heat)

A

Determinants of Strength
Force is proportional to cross-sectional area

Pennate muscle are able to generate more force

Length-Tension Relationship
Max force of contraction occurs at resting length
This is around midrange joint motion

Efficiency occurs at around 30% velocity of max contraction (energy=work not heat)

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33
Q

describe the torque-velocity relationship of muscle contractions:

from greatest to least

A

Torque-Velocity relationship

Force Generated by Contraction from greatest to least:

Fast eccentric (lengthening) > slow eccentric > isometric > slow concentric > fast concentric (shortening)

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34
Q

neural adaptations withe training:

  1. Will start to see how soon?
  2. Neuromuscular Recruitment becomes _______
  3. Most improvement of strength during rehab come from _____
  4. Muscle Hypertrophy is more common in more common _______ FIBERS, which occurs at ______, rare to have muscle hyperplasia (increase in number of fibers)
A

Neural Adaptations:
Seen in first few weeks of strength program
Neuromuscular Recruitment becomes more efficient
Most improvement of strength during rehab come from neural recruitment improvements
Muscle Hypertrophy:
More common in fast-twitch muscle FIBERS, occurs at 6-7wks, rare to have muscle hyperplasia (increase in number of fibers)

35
Q

progressive resistance exercise prescriptions

  1. Delorme Method:
  2. Oxford method
  3. Daily Adjusted Progressive Resistance Exercise (DAPRE)
A
  1. DeLorme Method - 3 sets of 10 reps at 50%, 75% then 100% 10RM
  2. Oxford Method - 3 sets at 100%, 75%, then 50% 10 RM
  3. Daily Adjusted Progressive Resistance Exercise (DAPRE)
    4 sets
    1st set, 10 reps: 50% 6RM
    2nd set, 6 reps: 75% 6RM
    3rd set, max out: 100% 6RM
    4th set, max out
    If 3rd set 5-7 reps  do same weight for set 4
    If 3rd set 7  increase wt by 5#
    Next day, use 4th set wt with adjustment
36
Q

ACSM guidelines for strength training:
1. mode:
2. Intensity:
3. Duration:
4. Frequency:

A
  1. Perform a minimum of 8-10 exercises that train the major muscle groups
  2. One set of 8-12 reps for strength/power, 15-20 for endurance, 10-15 for elderly, sedentary starting exercise; light or very light best for elderly or previously sedentary
  3. The entire program should last no more than 1 hour. Programs lasting > 1 hr are associated with a higher dropout rate
  4. atleast 2-3 days per week
37
Q

The greatest amount of force is generated by a muscle during
Fast eccentric contractions
Slow eccentric contractions
Fast concentric contractions
Slow concentric contractions

A

a
The greatest amount of force is generated by a muscle during fast eccentric (lengthening) contractions. The least amount of force is produced during fast concentric (shortening) contractions. The amount of force developed is summarized as follows: Fast eccentric > slow eccentric > isometric > slow concentric > fast concentric.

38
Q

_____ is the total achievable excursion (within limits of pain) of a body part through its range of motion.

A

flexibility

39
Q

Flexibility:

_____ variable
____ specific
Decreases with ____
No relationship to _____
CAN INCREASE WITH ________
F _____ M

A

Individually variable (gender, ethnic group)
Joint specific
Decreases with age
No relationship to body proportions
CAN INCREASE WITH TRAINING
F>M

40
Q

____ ia an activity that applies a deforming force along the rotational or translational planes of motion of a joint

A

Stretching: an activity that applies a deforming force along the rotational or translational planes of motion of a joint

41
Q

6 reasons being limber is important

A

Decreased injuries to an extent
Maintain Post-Operative mobilization
Decreased muscle soreness (athletes)
Skill enhancement (athletes)
Muscle relaxation (athletes)
Decreased back pain

42
Q

determinants of flexibility:
Static factors (4)
Dynamic factors (1)

A

Static Factors
Muscle-tendon unit length ratio 95:5%
Sarcomere changes with training
Temp (warm>cold)
Muscle>tendon

Dynamic Factors
Intrafusal fibers (muscle spindles)

43
Q

describe muscle spindle stretch apparatus

A

Muscle Spindle is stretched - spinal cord impulses that result in reflex muscle contraction - if stretch longer than 6 secs, golgi tendon fires causing relaxation.

44
Q

4 methods of stretching

A
  1. Ballistic: dynamic stretching/bouncing/jerking
  2. Passive: performed by someone else: trainer/therapist
  3. Static: Apply steady force for 15-60s
  4. Neuromuscular Facilitation: require assistance: contract-relax technique using isometric contraction with passive stretch with gradual progression.
45
Q

ACSM guidelines for flexibility training:
Mode:
Intensity:
Duration:
Frequency:
REpetitions:

A
  1. static, dynamic, and PNF stretching of major muscle groups including the low back and posterior thigh
  2. to a mild degree of tightness without discomfort
  3. Static stretches are held 15-60 seconds. A 6-second contraction followed by 10-30 seconds assisted stretch for PNF
  4. At least 2-3 days per week
  5. Four or more per muscle group
46
Q

Which of the following is true regarding flexibility?
Flexibility is closely related to body proportion and limb length.
Flexibility can be acquired through training.
Extensive evidence demonstrates the importance of flexibility in injury prevention.
All are true.

A

B

Flexibility can be defined as the total achievable excursion (within limits of pain) of a body part through its range of motion. The following generalizations can be made regarding flexibility: Flexibility is an individually variable, joint-specific, inherited characteristic that decreases with age, varies by gender and ethnic group, bears little relationship with body proportion or limb length, and can be acquired through training. There is considerable uncertainty regarding perhaps the two most important proposed benefits of flexibility training for athletes: Prevention of injury and improvement of performance. Although accepted teaching holds that stretching is a preventive measure for athletic injury, there is little conclusive epidemiologic evidence to support this idea.

47
Q

________ are brief, explosive moves with eccentric followed by concentric contraction (spring coiling)

4 benefits

A

Plyometrics

Store energy with eccentric phase
More powerful concentric phase
Promising results
Used to enhance athletic performance/skills

48
Q

_____ is the position and movement of body parts in relation to the central nervous system
Used in ______
Goal is to ______
Typically used after _____

A

Proprioceptive exercises

Used in injury prevention and rehabilitation
Goal is to improve joint/limb position sense
Typically used after an injury to a joint such as lateral ankle sprain

49
Q

3 neurofacilitation techniques

A

PNF
Use of specific spiral and diagonal movement patterns to facilitate weaker components of pattern

Brunnstrom
Use of primitive and resistive postural reactions to facilitate gross synergistic movement patterns

Bobath
Use reflex inhibitory movement patterns to inhibit increased tone

50
Q

Pregnancy and exercise:
1. encouraged?
2. If _______, may stay active as medically indicated
3. if Prev inactive and/or with medical/OB conditions need: _____
4. Physically active with h/o or risk of pre-term labor or fetal growth restriction:

A

No data or evidence supports limiting exercise during pregnancy
If already active, may stay active as medically indicated
Prev inactive and/or with medical/OB conditions need medical eval
Physically active with h/o or risk of pre-term labor or fetal growth restriction  reduce activity in 2nd and 3rd trimester.

51
Q

Contraindications to Aerobic Exercise During Pregnancy
Absolute Contraindications
(9)

A

Contraindications to Aerobic Exercise During Pregnancy
Absolute Contraindications
Hemodynamically significant heart disease
Restrictive lung disease
Incompetent cervix or cerclage
Multiple gestation at risk for premature labor
Persistent second- or third-trimester bleeding
Placenta previa after 26 weeks’ gestation
Premature labor during the current pregnancy
Ruptured membranes
Preeclampsia or pregnancy-induced hypertension

52
Q

Warning signs to terminate exercise while pregnant (10

A
  1. vaginal bleeding
  2. dyspnea prior to exertion
  3. dizziness
  4. headache
  5. chest pain
  6. muscle weakness
  7. calf pain or swelling (need to rule out thrombophlebitis)
  8. preterm labor
  9. decreased fetal movement
  10. amniotic fluid leakage
53
Q

During pregnancy, women should
Curtail all previous exercise programs
Limit sessions to three times per week
Avoid exercises in the supine position after the first trimester
Limit exercise to 30-minute sessions

A

c

Women active with exercise programs can usually continue mild to moderate exercise routines. Regular exercise (at least three times per week) is preferable to intermittent exercise. Thirty minutes or more of moderate exercise on most, if not all, days is recommended. Women should avoid exercise in the supine position because cardiac output will be preferentially distributed away from the splanchnic beds (including the uterus). See the references for additional, specific guidelines for exercise during pregnancy and the postpartum period.

54
Q

Aerobic exercise in the elderly:
Mode: 3
INtensity 5
Duration 2
Frequency 1

A
  1. Mode:
    - the modality should be one that does not impose significant ortho stress
    - the activity should be accessible, convenient, and enjoyable to the participant - al factors directly related to exercise adherence.
  2. intensity
    - must be sufficient to stress (overload) the cardiovascular, pulmonary, and musculoskeletal systems without overtaxing them.
    - high variability exists for maximal heart rates in persons older than 65 years. it is always better to use measured HR (max) rather than age-predicted HR (max) whenever possible
    - For similar reasons the HR reserve method is recommended for establishing a training HR in older individuals, rather than a straight percentage of HR(max)
    - The recommended intesnity for older adults is 50-70% of HR reserve
    - Because many older persons have a variety of medical conditions, a conservative approach to prescribing aerobic exercise is warranted
  3. Duration:
    - during the initial stages of an exercise program, some older adults can have difficulty sustaining aerobic exercise for 20 minutes. ONe viable option can be to perform the exercise in several 10 minute bouts throughout the day.
    - to avoid injury and ensure safety, older individuals should initially increase exercise duration rather than intensity
  4. Frequency - alternate between days that involve primarily weight-bearing and non-weight bearing exercise.
55
Q

Resistance exercise and the elderly:
Intensity:
Frequency:
Duration:

A

Intensity: Perform one set of 8-10 exercises that train all the major muscle groups (e.g., gluteals, quadriceps, hamstrings, pectorals, latissimus dorsi, deltoids, and abdominals). Each set should involve 8-12 repetitions that elicit a perceived exertion rating of 12-13 (somewhat hard).

Frequency:Resistance training should be performed at least twice a week, with at least 48 hours of rest between sessions.

Duration: Sessions lasting longer than 60 minutes can have a detrimental effect on exercise adherence. Following the above guidelines should permit individuals to complete total body resistance training sessions within 20-30 minutes.

56
Q

Children and strength training:
Frequency:
INtensity:
Time;
TYpes:

A
  1. At least 3-4 days per week, and preferably daily
  2. Moderate (physical activity that noticeably increases breathing, sweating, and HR) to vigorous (physical activity that substantially increases breathing, sweating, and HR) intensity
  3. 30min/day of moderate and 30 min/day of vigorous intensity to total 60 min/day of accumulated physical activity
  4. A variety of activities that are enjoyable and developmentally appropriate for the child or adolescent
57
Q

HTN and exercise:
Frequency:
INtensity:
Time:
Type:

A
  1. Aerobic exercise on most (preferably all days of the week; resistance exercise 2-3 days/wk)
  2. Moderate-intensity aerobic exercise (i.e., 40% to <60% Vo2R) supplemented by resistance training at 60%-80% 1-RM
  3. 30-60 min/day of continuous or intermittent aerobic exercise; if intermittent, use a minimum of 10-minute bouts.
  4. Emphasis should be placed on aerobic activities.
58
Q

Exercise and PVD:
Fequency:
INtensity:
Time:
TYpe:

A
  1. Weight-bearing aerobic exercise 3-5 days/wk; resistance exercise at least 2 days/wk
  2. Moderate intensity (i.e., 40% to <60% o2R) that allows patients to walk until they reaches a pain score of 3 (i.e., intense pain) on the 4-point pain scale.[122] Between bouts of activity, individuals should be given time to allow ischemic pain to subside before resuming exercise.[55,122]
  3. 30-60 min/day, but initially some patients may need to start with 10-minute bouts
  4. Weight-bearing aerobic exercise, such as walking, and non–weight-bearing activity, such as arm ergometry. Cycling may be used as a warmup, but should not be the primary type of activity. Resistance training is recommended to enhance and maintain muscular strength and endurance.
59
Q

Exercise and diabetes:
Frequency:
Intensity:
Time:
Type:

Resistance training in DM:
Frequency:
Intensity:
Time:

A
  1. 3-7 days per week
  2. 50%-80% Vo2R or HRR corresponding to an RPE of 12-16 on a scale from 6 to 20[24]
  3. 20-60 min/day continuous or accumulated in bouts of at least 10 minutes to total 150 min/wk of moderate physical activity, with additional benefits of increasing to 300 minutes or more of moderate-intensity physical activity
  4. Emphasize activities that use large muscle groups.

Resistance training should be encouraged for people with diabetes mellitus in the absence of contraindications, retinopathy, and recent laser treatments.
1. 2-3 days/wk with at least 48 hours separating the exercise sessions
2. 2-3 sets of 8-12 repetitions at 60%-80% 1-RM
3 8-10 multijoint exercises of all major muscle groups in the same session (whole body) or sessions split into selected muscle groups

60
Q

Which of the following is false regarding the effects of regular exercise on the cardiovascular system at rest?
Resting heart rate decreases
Stroke volume increases
Cardiac output increases
Oxygen consumption does not change at rest

A

C

Following a regular exercise program, certain cardiovascular features are commonly observed. Resting heart rate decreases, probably because of decreased sympathetic tone, increased parasympathetic tone, and a decreased intrinsic firing rate of the sinoatrial node. Stroke volume increases secondary to increased myocardial contractility. Cardiac output is unchanged at rest. Oxygen consumption does not change at rest.

61
Q

Define manipulation:

why used?

A

The use of the hands in the patient management process using instructions and maneuvers to maintain maximal, painless movement of the musculoskeletal system in postural balance.

Help maintain body mechanics and improve motion in restricted areas

62
Q

5 goals of manipulation

A

Restore/Improve Function
Decrease Nociception
Improve Circulation
Enhance Lymphatic Return
Decrease Gamma Gain

63
Q

Types of manipulation
1. direct
2. indirect

A

1 Direct Techniques:
HVLA (Thrust)
Articulatory
Muscle Energy
Myofascial Release

2 Indirect Techniques
Counterstrain
Balance Ligamentous Release
Indirect Myofascial Release
Craniosacral

64
Q

4 rationale for manual medicine

A
  1. Gamma SystemGamma motor neurons innervate intrafusal muscle fibers, increased activity results in increased alpha motor activity. Goal to decrease gamma gain activity to relax muscle.
  2. Golgi Tendon Reflex:Goal is to stimulate stretch to inhibit alpha motor neurons to decrease firing of motor units but golgi mechanism
  3. Muscle Stretch Reflexes
  4. Spinal Facilitation: inhibit nociceptive input to spinal cord from alpha motor neurons of similarly innervated muscular segment of viscera.
65
Q

_____ is a Impaired or altered function of related components of the somatic system; skeletal, arthrodial, and myofascial structures; and related vascular, lymphatic, and neural elements

A

somatic dysfunction

66
Q

What can be diagnosed with palpation 4

A

Diagnosed with palpation
TART Changes, Motion testing
Sympathetic Segmental innervation
Fascial Assessment

67
Q

describe the 5 direct manipulation techniques

A

Soft Tissue: Thoracolumbar Kneading
Articulatory (LVHA): SI Joint Articulatory, OB Roll
HVLA (Thrust): Cervical HVLA, “Kirksville Crunch”
Muscle Energy
Direct MFR

68
Q

limitations for manipulation: 2

A

Limited data with randomized studies to show long-term benefit
Effectiveness shown in some populations (Acute LBP)

69
Q

16 contraindications for HVLA

A

Unstable Fx
Severe osteoporosis
Multiple Myeloma
Osteomyelitis
Primary Bone Tumors
Paget Dz
Progressive Neuro deficit
Spinal Cord Tumors
Cauda Equina
Cervical Disk Herniation
Hypermobile Joints
RA
Inflammatory phase of Ankylosing Spondylitis
Psoriatic Arthritis
Reiter Syndrome
Anticoagulants or bleeding disorder

70
Q

What is the effect of increased gamma activity of muscle spindles?
Increased alpha motor neuron activity with resulting increase of muscle tension
Muscle relaxes and lengthens
The muscle becomes soft and flaccid
Motion in the joint(s) surrounding the muscle is increased

A

a

Increased gamma activity causes increased alpha motor neuron activity, which causes more motor units in a muscle to fire.

71
Q

______ is a technique used to stretch soft tissues and to separate joint surfaces or bone fragments by use of a pulling force
Dates back to _______
It has most commonly been used ________
Traction continues to be used in the treatment of _____

A

Traction
time of Hippocrates
to reduce fractures and dislocations
cervical and lumbar pain disorders

72
Q

Types of traction (3) based on

A

Manual, Mechanized, Motorized
Force = Continuous, Sustained, Intermittent
Cycle: 15-25 minutes with traction phase ranging from 5 to 15 secs
Surface resistance must be overcome and is approximately ½ the weight of the body segment

73
Q

Describe method of cervical traction:
optimal angle?
Lbs?

A

Uses head or chin sling, or supine posterior distraction unit
Optimal angle of pull 20-30 of Flexion with 25lbs of force required to reverse normal cervical lordosis

74
Q

Types of lumbar traction

A

VAX-D
DRX-9000
Limited Literature and declining use due to more active recovery programs

75
Q

The use of traction in ______ is controversial

A

Neck/LBP, Lumbar Radiculopathy

76
Q

traction recommendations most commonly recommended for:

A

Most Consensus recommendations for use is in Cervical Radiculopathy

77
Q

Effects of traction:
Muscle ligaments:
Posterior longitudinal ligament
INtervetebral space:
foramina:
facet joints:

A

n can stretch muscles and ligaments, tighten the posterior longitudinal ligament to exert a centripetal force on the annulus fibrosis, enlarge the intervertebral space, enlarge foramina, separate facet joint.

78
Q

absolute contraindications for traction include: 8

A

Absolute contraindications to traction include:
malignancy
infection such as osteomyelitis or diskitis
osteoporosis
inflammatory arthritis
fracture
pregnancy,
cord compression
uncontrolled hypertension or cardiovascular disease
in the setting of carotid or vertebral artery disease

79
Q

The optimal angle of pull used during cervical traction is
-20 degrees of extension
-20 degrees of flexion
20-30 degrees of flexion
20-30 degrees of extension

A

C

The optimal angle of pull is between 20 and 30 degrees of flexion.

80
Q

Massage
define:
goals: 5

A

Is the term used to describe certain manipulations of the soft tissue of the body
The goals of therapeutic massage are to produce relaxation, relieve muscle tension, reduce pain, increase mobility of soft tissues, and improve circulation

81
Q

Types of massage

A

Effleurage
Petrissage aka Kneading
Tapotement aka Percussion
Friction
Myofascial Release
Manual Lymphatic Drainage
Acupressure
Shiatsu aka finger pressure based on acupunture meridians
Reflexology: homuncular representations of the body on ears, feet, hands

82
Q

diseases for EBM use of massage 8

A

Anxiety and Depression
Fibromyalgia
Whiplash
Arthralgias
Lymphedema
LBP
Sport Injuries
Sleep disorders

83
Q

three contraindiations of massage

A
  1. Massage should not be performed over areas of malignancy, cellulitis, or lymphangitis
  2. Areas of trauma or recent bleeding should not be treated with deep tissue massage
  3. Massage should not be used over areas of known deep venous thrombosis or atherosclerotic plaques
84
Q

Tapotement massage is performed by which of the following?
Gently stroking the skin over the involved area
Alternating contact of varying pressure between the hands and body soft tissue
Rolling the tissues under the fingertips
Kneading the soft tissues

A

B