Treatment - Exercise

Question 1

Benefits of exercise

Answer 1

> Increased Cardiorespiratory function
> Increased muscle tone/flexibility/posture
> Increased balance + co-ordination
> Increased well-being + confidence
> Decreased risk of osteoporosis
> Decreased risk of CVD
> Decreased body fat 
> Reduced stress + relaxation

Question 2

What are we targeting

Answer 2

> Strength
Muscle length
RoM (could be a mix of above)
Power (ability to produce force at speed)
Endurance
Graded exposure - analgesia + reduced fear avoidance
* Try not to go above 5/10 on NPRS (balance RPE vs. NPRS)
* Pain shouldn’t be increased 60 mins post exercise or next day

Question 3

Muscle strength depends on:

Answer 3

> Type of contraction
> speed of contraction
> firing of motor units (+number of motor units)
> neurological factors
> psychological factors
> angle of pull/muscle length/lever arm
> Age + fitness of person
> genetic factors
> connective tissue 
Ie. dependent on lots of things

Question 4

Principles of strength training

Answer 4

> Overload (continual progression or else plateau)
Specificity (function/range/strength/power/endurance etc.)
Motivation (education is key + don’t do too much/little)
Learning
Reversibility (lose gains with no training)
Diminishing returns (less increase as we go)
age + gender may affect excitation of cells (reduced with age + less testosterone)

Question 5

Effects of strength training

Answer 5

> 6-8 weeks = motor learning (strength is constant but get more efficient at pattern)
10-12 weeks = Increase in muscle strength without increase in size
12 weeks + = true hypertrophy - muscle size increase + strength increase

Question 6

Mechanotherapy

Answer 6

1. Loading of tissue
2. Stimulates cellular response
3. Tissue adapts
4. Tissue improves structure
5. Better able to maintain homeostasis

Question 7

Exercise - goals

Answer 7

> Goals

• maintain elasticity + contractility
• sensory feedback
• stimulus for bone + joint integrity
• increase circulation + prevent thrombus formation
• develop co-ordination + motor skills (aid functional activity later)

Question 8

Exercise - Contraindications

Answer 8

> disruptive to healing process (acute tears/fractures/surgery - ‘optimal loading’)
if it causes increased pain/inflammation
UL exercise post chest surgery ( CABG/MI/Breast surgery)

Question 9

Active assisted exercise

Answer 9

> grade 1+2

- assistance = provided manually or mechanically (+automatically) to aid prime movers complete motion

Question 10

Active exercise

Answer 10

> muscle contracts actively + moves segment through range without assistance (oxford 3+)

Question 11

Effects + limitations of active exercise

Answer 11

> effects

• muscles gain strength
• repetition facilitates neuromuscular pathways
• increases patient confidence
• may increase joint RoM

> Limitations

• strong muscles need resistance to maintain/increase strength
• only develops co-ordination in pattern practiced in

Question 12

Programming

Answer 12

> Strength

• 60-80% of 1RM
• 8-12 reps
• 1-4 sets
• 2-3 mins rest

> Endurance

• 50% 1RM
• 15-25 reps
• 30-90 seconds rest

> Power 
- 0-60% 1RM
- 3-6 reps 
- 3-6 sets 
- 3 - 5 mins rest 
-

Question 13

Recording

Answer 13

> Have to record + re-evaluate exercise programs

• re-evaluation = based on
• physical (fitness/body fat etc)
• lifestyle (smoking, diet, activity levels)
• health behaviours (medication, other treatments etc)
• psychosocial elements (anxiety, mood, social networks)