Resisted Exercises: A Physiotherapy Module
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Resisted exercises, also known as resistance training, involve working muscles against an external force, leading to increased strength, muscle mass, and endurance. This can be achieved through various methods, including using free weights, weight machines, resistance bands, or even bodyweight.
Resisted Exercises: A Physiotherapy Module
- 1. RESISTED EXERCISES RESISTED EXERCISES Presenting Presenting by by Prof.Dr.Y.Shanthoshraja.PT Prof.Dr.Y.Shanthoshraja.PT IAP Reg No: L-31420 IAP Reg No: L-31420 Swamy Vivekanandha Physiotherapy College Swamy Vivekanandha Physiotherapy College Namakkal District Namakkal District
- 2. What is resisted exercise? What is resisted exercise? Any form of active exercise in which Any form of active exercise in which dynamic or static muscular contraction is dynamic or static muscular contraction is resisted by an outside force resisted by an outside force Force can be Force can be – Manual Manual – mechanical mechanical
- 3. Physiological changes Physiological changes Strength training Strength training Skeletal muscle – hypertrophy, Skeletal muscle – hypertrophy, hyperplasia hyperplasia Neural system – motor unit recruitment Neural system – motor unit recruitment rate of firing, synchronization rate of firing, synchronization metabolism – ATP, CP storage metabolism – ATP, CP storage Fat free mass increases body fat reduces Fat free mass increases body fat reduces Connective tissue strength increased Connective tissue strength increased
- 4. Exercise - Manual resistance Exercise - Manual resistance Type of active exercise in which resistance is Type of active exercise in which resistance is provided by a therapist provided by a therapist Patient can be taught to apply self resistance. Patient can be taught to apply self resistance. Amount of resistance cannot be measured Amount of resistance cannot be measured It is used in early stage of an exercise program It is used in early stage of an exercise program – when muscle is too weak when muscle is too weak – Can overcome only mild to moderate resistance Can overcome only mild to moderate resistance Amount of resistance is limited by the strength of Amount of resistance is limited by the strength of therapist. therapist.
- 5. Manual resistance exercise Manual resistance exercise 1. Before initiating exercise: 1. Before initiating exercise: Evaluation of patient’s ROM & strength Evaluation of patient’s ROM & strength using manual muscle testing will using manual muscle testing will – establish qualitative baseline to measure establish qualitative baseline to measure strength made during progress strength made during progress – Determine appropriate resistance to be Determine appropriate resistance to be applied applied2. 2. During manual resistance exercise: During manual resistance exercise: Site of application Site of application of resistance of resistance : At distal end of : At distal end of segment where muscle to be strengthened segment where muscle to be strengthened
- 6. Manual resistance exercise Manual resistance exercise Resistance applied is in Resistance applied is in direction direction opposite opposite to desired movement to desired movement Stabilization Stabilization must be provided to avoid must be provided to avoid substitute movements substitute movements Can use equipments like splints or belt or Can use equipments like splints or belt or therapist can do it manually therapist can do it manually Stabilization is generally at proximal Stabilization is generally at proximal attachment of muscle attachment of muscle
- 7. Manual resistance exercise Manual resistance exercise Apply appropriate Apply appropriate amount of resistance amount of resistance Desired response should be maximum Desired response should be maximum pain free effort by patient pain free effort by patient The motion should be smooth and not The motion should be smooth and not trembling trembling Resistance must be equal the ability of Resistance must be equal the ability of muscle at all points in ROM muscle at all points in ROM
- 8. Manual resistance exercise Manual resistance exercise Revise site of application or decrease Revise site of application or decrease amount if amount if – Patient is unable to complete full ROM Patient is unable to complete full ROM – Site of application is painful Site of application is painful – Muscle tremor develops Muscle tremor develops – Substitute motion occur Substitute motion occur
- 9. Goals and indications Goals and indications 1. 1. Increase strength Increase strength To increase strength muscle contraction must To increase strength muscle contraction must be loaded or resisted so that increasing levels be loaded or resisted so that increasing levels of tension will develop due to hypertrophy and of tension will develop due to hypertrophy and recruitment of muscle fibres recruitment of muscle fibres 2. Increase muscular endurance 2. Increase muscular endurance Endurance improves by performing exercise Endurance improves by performing exercise against mild resistance for many repetitions against mild resistance for many repetitions Most exercise programs designed to increase Most exercise programs designed to increase strength also increase endurance strength also increase endurance 3. Increase power 3. Increase power Power increases when exercise performed Power increases when exercise performed against resistance over a specified interval of against resistance over a specified interval of time time
- 10. High intensity exercise carried over a short High intensity exercise carried over a short interval of time is called interval of time is called anaerobic anaerobic power power Low intensity exercise sustained over a long Low intensity exercise sustained over a long period of time is period of time is aerobic aerobic power power – Type II muscle fibers generate great amount of Type II muscle fibers generate great amount of tension in a short period of time towards tension in a short period of time towards anaerobic activity and fatigue easily anaerobic activity and fatigue easily – Type I fibers generate low level of tension can Type I fibers generate low level of tension can sustain for long period of time, aerobic activity sustain for long period of time, aerobic activity and slow to fatigue and slow to fatigue
- 11. Precautions and contraindications Precautions and contraindications 1. 1. Cardiovascular precautions Cardiovascular precautions Vasalva procedure Vasalva procedure High risk patients High risk patients – past history of CVS problems past history of CVS problems – Geriatric patients Geriatric patients – Abdominal surgery Abdominal surgery PREVENTION PREVENTION – Do not hold breath Do not hold breath – Ask patient to exhale while performing a motion Ask patient to exhale while performing a motion – Ask patient to count or talk or breath rhythmically Ask patient to count or talk or breath rhythmically during exercise during exercise
- 12. Precautions and contraindications Precautions and contraindications 2. Fatigue 2. Fatigue A. Local muscle fatigue is diminished response A. Local muscle fatigue is diminished response to a repeated stimulus to a repeated stimulus can occur in dynamic or static exercise can occur in dynamic or static exercise Can happen due to factors Can happen due to factors – Disturbance in contractile mechanism of Disturbance in contractile mechanism of muscle as a result of decrease in stores of muscle as a result of decrease in stores of energy, insufficient oxygen, build up of lactic energy, insufficient oxygen, build up of lactic acid acid – Inhibitory influences from CNS Inhibitory influences from CNS – Decrease in conduction of impulses at Decrease in conduction of impulses at myoneural junctions in fast twitch fibres myoneural junctions in fast twitch fibres
- 13. Fatigue Fatigue B. Cardio pulmonary fatigue B. Cardio pulmonary fatigue -With very prolonged exercise with low -With very prolonged exercise with low intensity intensity – Decrease in blood sugar Decrease in blood sugar – glycogen stores glycogen stores – Depletion of potassium Depletion of potassium Factors influence fatigue – health status, diet, lifestyle, Factors influence fatigue – health status, diet, lifestyle, age, psychological, cognitive( attention, motivation), and age, psychological, cognitive( attention, motivation), and recovery from exercise. recovery from exercise.
- 14. 3. 3. Recovery from fatigue Recovery from fatigue Adequate time for recovery must be allocated in an Adequate time for recovery must be allocated in an exercise program exercise program Changes in muscle occur during recovery Changes in muscle occur during recovery – Energy stores are replenished Energy stores are replenished – Lactic acid is removed from skeletal muscle and blood Lactic acid is removed from skeletal muscle and blood after 1 hour of exercise after 1 hour of exercise – Oxygen stores are replenished in muscles Oxygen stores are replenished in muscles – Glycogen is replaced over several days Glycogen is replaced over several days Long term physical performance will improve if time is Long term physical performance will improve if time is allowed for recovery allowed for recovery Precautions and contraindications Precautions and contraindications
- 15. 4. Overwork 4. Overwork Exercise programs must be progressed with Exercise programs must be progressed with care for patients with neuromuscular diseases care for patients with neuromuscular diseases Overwork causes temporary or permanent Overwork causes temporary or permanent deterioration of strength as a result of exercise. deterioration of strength as a result of exercise. 5. Substitute motion 5. Substitute motion Application of too much resistance during Application of too much resistance during exercise can show substitute motions exercise can show substitute motions Weak muscles try to achieve the movement by Weak muscles try to achieve the movement by any means – deltoid weakness patient will use any means – deltoid weakness patient will use scapular movements scapular movements Therapist must ensure appropriate resistance Therapist must ensure appropriate resistance and correct stabilization and correct stabilization
- 16. 6 6. Osteoporosis . Osteoporosis Pathological fractures are common as due to Pathological fractures are common as due to prolonged immobilization there is bone loss, prolonged immobilization there is bone loss, narrowing of bone shaft and widening of narrowing of bone shaft and widening of medullary canal medullary canal Loss of normal muscle pull and loss of weight Loss of normal muscle pull and loss of weight bearing can cause bone atrophy in flaccid bearing can cause bone atrophy in flaccid paralysis paralysis Rheumatoid arthritis for many years and patients Rheumatoid arthritis for many years and patients using long term steriods using long term steriods Therapist must apply and progress resistance for such Therapist must apply and progress resistance for such patients with care to avoid pathological fractures patients with care to avoid pathological fractures
- 17. 7. Muscle soreness 7. Muscle soreness – Strenuous exercise to a point of fatigue can Strenuous exercise to a point of fatigue can cause muscle soreness cause muscle soreness – Due to lack of blood flow and oxygen (ischemia) Due to lack of blood flow and oxygen (ischemia) build up of metabolites build up of metabolites Acute – during or after sternous exercise, burning Acute – during or after sternous exercise, burning or aching pain, subsides quickly after exercise. or aching pain, subsides quickly after exercise. - Cool down period help to recover from this Cool down period help to recover from this - Delayed onset – After over exertion, DOMS is Delayed onset – After over exertion, DOMS is noticeable in the muscle belly or at myotendinous noticeable in the muscle belly or at myotendinous junction begins to develop 12 – 24 hrs after junction begins to develop 12 – 24 hrs after cessation of exercise. cessation of exercise.
- 18. Prevention Prevention Can decrease the delayed muscle Can decrease the delayed muscle soreness soreness – if light warm up activity with stretching is if light warm up activity with stretching is performed before the resisted exercise performed before the resisted exercise – Gradually increase the resistance Gradually increase the resistance
- 19. Contraindications Contraindications Inflammation - no resisted exercise should Inflammation - no resisted exercise should be given if joint or muscle is inflamed. be given if joint or muscle is inflamed. Resistance causes an increase in the Resistance causes an increase in the inflammation inflammation Resisted exercise should be terminated if Resisted exercise should be terminated if pain lasts for more than 24 hours after pain lasts for more than 24 hours after stopping exercise. stopping exercise. Severe cardio pulmonary diseases. Severe cardio pulmonary diseases.
- 20. Leg extension during strength Leg extension during strength training sequence training sequence
- 21. Progressive resistance exercise Progressive resistance exercise Load resisting and load assisting exercise Load resisting and load assisting exercise In PRE load is amount of weight used as In PRE load is amount of weight used as resistance resistance Load can be used to resist or assist Load can be used to resist or assist muscular contraction muscular contraction
- 22. Exercise load and number of Exercise load and number of repetitions repetitions 1. 1. Repetition maximum Repetition maximum ( RM) is the ( RM) is the greatest amount of weight a muscle can greatest amount of weight a muscle can move through ROM a specific number of move through ROM a specific number of times in a load resisting exercise routine times in a load resisting exercise routine Number of repetitions usually vary from 1 Number of repetitions usually vary from 1 – 10 in most PRE programs – 10 in most PRE programs This establishes a base line from which This establishes a base line from which strength and power can be measured strength and power can be measured
- 23. Specificity of exercise Specificity of exercise Variables are so many that comparison Variables are so many that comparison between all programs is difficult between all programs is difficult Design program to specific needs of patient Design program to specific needs of patient Muscle groups strengthened during program Muscle groups strengthened during program must be same group that are needed during must be same group that are needed during functional activity functional activity Speed and type have to be considered Speed and type have to be considered similarly similarly
- 24. Specific exercise regimens in Specific exercise regimens in PRE PRE Isotonic regimen Isotonic regimen – Delorme technique Delorme technique – Oxford technique Oxford technique – Brief maximal isotonic exercise Brief maximal isotonic exercise
- 25. Delorme technique – procedure Delorme technique – procedure Determine the 10 RM Determine the 10 RM Patient carries out Patient carries out – 10 repetitions at ½ of the 10 RM 10 repetitions at ½ of the 10 RM – 10 repetitions at 3/4 of the 10 RM 10 repetitions at 3/4 of the 10 RM – 10 repetitions at full 10 RM 10 repetitions at full 10 RM Patient performs all 3 at each exercise session Patient performs all 3 at each exercise session with brief rest between bouts with brief rest between bouts There is a warm up period as initially lifts ½ There is a warm up period as initially lifts ½ The 10 RM is increased weekly as strength The 10 RM is increased weekly as strength increases increases
- 26. Oxford technique Oxford technique Reverse of Delorme technique Reverse of Delorme technique Reduce resistance as exercise progresses as Reduce resistance as exercise progresses as fatigue sets in fatigue sets in Procedure Procedure – Determine the 10 RM Determine the 10 RM – Patient carries out Patient carries out 10 repetitions at full 10 RM 10 repetitions at full 10 RM 10 repetitions at 3/4 of the 10 RM 10 repetitions at 3/4 of the 10 RM 10 repetitions at ½ of the 10 RM 10 repetitions at ½ of the 10 RM This technique decreases effects of fatigue on This technique decreases effects of fatigue on muscle muscle Warm up period is separately added in Warm up period is separately added in
- 27. Principles for use of equipment Principles for use of equipment Equipments must be selected with care to Equipments must be selected with care to be able to use effectively and safely be able to use effectively and safely Evaluation of patient Evaluation of patient – Strength Strength – Range of motion Range of motion – Pain Pain – Joint deformity or stiffness Joint deformity or stiffness – Skin Skin
- 28. Principles for use of equipment Principles for use of equipment Type of exercise Type of exercise - decide which type is - decide which type is must advantageous must advantageous Safety measures Safety measures - make sure all straps - make sure all straps buckles are fastened properly before starting buckles are fastened properly before starting Apply padding over bony prominences for Apply padding over bony prominences for comfort comfort Stabilize or support parts that you do not Stabilize or support parts that you do not want movement and also prevent stress on want movement and also prevent stress on other parts of body other parts of body
- 29. Principles for use of equipment Principles for use of equipment Ensure that full range of motion is Ensure that full range of motion is obtained without substitute motions obtained without substitute motions When exercise is completed make sure When exercise is completed make sure remove equipment and put back ready for remove equipment and put back ready for next use checking that nothing is loose next use checking that nothing is loose broken or has come out broken or has come out Record, reevaluate, modify exercise Record, reevaluate, modify exercise program as needed program as needed
- 30. Free weights Free weights Barbells Barbells Dumbbells Dumbbells Cuff weights with Cuff weights with velcro straps velcro straps Sandbags Sandbags Weight boots Weight boots Elastic bands Elastic bands
- 33. Cuffs Cuffs
- 34. Weight boot, exercise bands, sand Weight boot, exercise bands, sand bags bags
- 35. Pulley systems Pulley systems Wall mounted Wall mounted pulley – weight pulley – weight system system Elgin exercise Elgin exercise unit – unit – interconnected interconnected cables and cables and weights and weights and pulleys pulleys
- 36. Resistive reciprocal exercise units Resistive reciprocal exercise units Pedal exerciser Pedal exerciser
- 37. isometric resisted exercise without isometric resisted exercise without equipments equipments
- 38. Different muscles with same Different muscles with same equipment equipment
- 39. Isometric resisted exercise Isometric resisted exercise