1. Exercise Therapy

2. Objectives • Define basic exercise and physical fitness terminology • Explain the 9 components of physical fitness • Describe and apply the 5 principles of fitness • Describe and apply the difference types of range of motion (ROM) exercises • Describe the 3 types of resistance training • Review the use of the Oxford scale to evaluate strength

3. Objectives Continued . . . • Describe the basic progression of exercise therapy • Given an exercise treatment plan, be able to: • Select the appropriate exercise • Utilize the required exercise equipment • Demonstrate the exercise to the patient • Monitor the patient during exercise therapy • Evaluate the patient’s performance, and • Provide feedback to the patient

4. Terminology • Activity: • The execution of a task or action by an individual • Physical Activity: • Defined as any bodily movement produced by skeletal muscles that requires energy expenditure • Activities of daily living (ADL): • Daily self-care activities required to function in the home and/or outdoor environment

5. Terminology Continued . . . • Repetition: is one performance of single exercise • Set: a number of exercises performed without stopping • Load: the amount of weight or resistance for a given exercise • Frequency: How many times per a given time period to perform an exercise • Example: 3 x10@5lbs x 3/day • 3 sets of 10 repetitions at 5lbs 3 times per day

6. Exercise • A subcategory of physical activity that is planned, structured, repetitive, and purposeful, with the objective of improving or maintaining one or more components of physical fitness • Physical activity includes exercise as well as other activities which involve bodily movement, and are done as part of playing, working, active transportation, house chores and recreational activities

7. Physical Fitness • The ability to carry out daily tasks with vigor and alertness, without undue fatigue, and with ample energy remaining to enjoy leisure-time and respond to emergencies. • Components include: • Cardio-respiratory endurance (aerobic power) • Muscle endurance • Muscle strength • Muscle power • Flexibility • Balance • Speed of movement • Reaction time • Body composition

8. Components of Fitness • Cardio-respiratory endurance: • The ability of the body to perform prolonged, large-muscle, dynamic exercise at moderate-to-high levels of intensity • Muscular endurance: • The ability of a muscle or group of muscles to sustain repeated contractions against a resistance for an extended period of time. • Muscular strength: • The ability of a muscle or muscle group to exert force

9. Continued . . . • Muscular power: • The maximum force that a muscle or muscle group can generate in a minimum time • Flexibility: • The ability of an individual to move his or her joints through a full range of motions • Balance: • The ability to stay upright or stay in control of body movement

10. Continued . . . • Speed: • The ability to move quickly across the ground or move limbs rapidly to grab or throw • Reaction time: • The ability to respond quickly to a stimulus • Body composition: • The distribution of muscle and fat in the body

11. 5 Principles of Fitness 1.) The Overload Principle 2.) The FITT Principle 3.) The Specificity Principle 4.) The Rest and Recovery Principle 5.) The Use or Lose Principle

12. The Overload Principle • The body will adapt to the workload placed upon it • The more you do, the more you will be capable of doing • Explains how fitness improvements occur when exercising and training: • The body will react to stress by causing physiological changes in order to be better able to handle that stress the next time it occurs • To determine how to increase the workload of a workout you need to understanding the FITT principle

13. The FITT Principle • Frequency: • How often you will exercise. Determining the frequency of exercise is important in order to find a balance that provides enough stress for the body to adapt and also allows enough rest time for healing • Intensity: • The amount of effort or work that must be completed in a specific exercise. Requires a good balance to ensure that the intensity is hard enough to overload the body but not so difficult that it results in over training, injury or burnout • Time: • How long each individual session should last. This will vary based on the intensity and type • Type: • What type of exercise will you be doing? Will an exercise session be primarily cardiovascular, resistance training or a combination of both? And, what specific exercises will you perform?

14. Combining Overload and FITT

15. Specificity • Exercise should be specific to the desired goals • Examples: • If your main goal is simply health, fitness and weight management you should focus on total body strength, cardio and a healthy diet • If you're trying to improve your racing times, you should focus on speed workouts

16. Rest and Recovery • Rest and recovery are also essential for reaching your fitness goals • Should have at least a day of rest between strength training workouts • During strength workouts, micro-tears to the muscle fiber being trained occur • Rest allows the healing of the micro-tears and consequently increases the power of that muscle when trained consistently

17. Use or Lose Principle • When it comes to fitness, you "use it or lose it“ • Your muscles build strength (hypertrophy) with use and lose strength (atrophy) with lack of use • Explains why we lose fitness when we stop exercising

18. Range of Motion Training

19. Range of Motion (ROM) • The capacity for movement of a given joint in a specific direction • The anatomy of a joint dictates the normal limits of its range of motion • Assess joint movement with two types of range-of-motion testing: • Active-movement achieved under the patient’s own power • Passive-movement possible when the examiner moves the joint for a patient

20. ROM Exercises • Joints maintain their normal range of motion by being moved • ROM exercises are done to preserve flexibility and mobility of joints • Reduce stiffness and slow down the freezing of joints

21. Factors Leading to ↓ ROM • Surgery • Trauma • Inactivity • Immobilization • Joint Neurological Disease • Muscular Disease

22. Indications for ROM Exercises • Acute or inflamed tissue where active motion may disrupt the normal healing process • Patients who are unable to move or are not allowed to move such as when comatose, paralyzed, or on complete bed rest • For assessment purposes • When teaching a patient movement • To prepare a patient for stretching

23. Passive ROM (PROM) Exercises • Goals: • Maintain Integrity • Maintain elasticity of muscles • Assist circulation • Enhance synovial movement • Decrease pain • Assist healing process • Demonstrate desired movement • Prepare for stretching • Reassessment • Minimize effects of contractures

24. PROM Will Not . . . • Prevent atrophy • Increase strength or endurance • Is not as effective at assisting in circulation as active, voluntary muscle contractions

25. Active ROM (AROM) Exercises • Movements produced by muscle contraction • Same goals as PROM, with added benefit of muscle contraction • Maintains elasticity and contractility of muscles • Sensory feedback from contracting muscles • Stimulus for bone & joint tissue integrity

26. AROM Continued . . . • Increase circulation and prevent thrombus formation • Coordination and motor skills development • Only in specific movement pattern • Will not maintain or increase strength in strong muscles

27. Active Assisted ROM (AAROM) • A sub-category of AROM • Assistance is provided by an outside force (manual or mechanical), as the prime mover muscles is unable to complete the motion • Goals: • Maintain elasticity and contractility of muscles • Provide sensory feedback from the contracting muscles • Provide a stimulus for bone and joint tissue integrity • Increase circulation and prevent thrombus formation • Develop coordination and motor skills for functional activities

28. AAROM Will Not . . . • Maintain or increase strength of already strong muscles • Develop skill or coordination except in the movement patterns used

29. Precautions and Contraindications • Stay within range, speed, and tolerance of individual • ROM ≠ Stretching • Should not disrupt the healing process • Excessive movement/wrong performance of movement leads to increased pain and inflammation • Should not be done if response will be life-threatening to the patient

30. Application of ROM Exercises • Patient Prep: • Communicate the plan of intervention and the method to be used • Remove all restrictive clothing, linen, splints, and dressings; drape appropriately • Position the patient comfortably maintaining proper alignment and stabilization while allowing the required movement of the joint • Maintain proper biomechanics (therapist)

31. Application of Techniques • Grasp the extremity around the joint, providing the support needed for control • Support areas of poor structural integrity • Move the joint throughout its pain-free range to point of tissue resistance • Perform the movements smoothly and rhythmically for 5 to 10 reps • Depends on the objectives of the program, and patient’s general condition and response to the exercise

32. Application of Passive ROM • Movement is being provided by an external force • No active resistance or assistance is provided by the muscles that cross the joint • Perform the motion within the available range • There should be no pain or forced motion elicited

33. Application of Active ROM • Demonstrate the desired motion through PROM • Ask the patient to perform the movement independently • Be ready to provide assistance or guidance when necessary • To complete movement smoothly • In the presence of weakness (may be required at the beginning or end of ROM, or when torque is greatest) • Perform the motion within the available range

34. Exercise Prescription • Identify the appropriate ROM exercise for the case with due consideration of: • Baseline function of the patient • Available resources • Identify the joints that require mobilization • Identify motions required • State the number of repetitions, sets, and the frequency with which the exercise is to be performed

35. Resistance Training

36. Resistance Training • Any type of physical activity in which you use your muscles against resistance • Resistance can be provided in many forms such as: • Resistance bands (Theraband) • Free weights (dumb bells) • Machines • Body weight • Pool

37. Types of Resistance Training • Isotonic: The force generated by a muscle while contracting, when the muscle lengthens and shortens and the force remains constant • Helps to isolate certain muscle groups • Example: dumbbell curls, squats, lunges

38. Continued . . . • Isometric: Muscle contraction without the muscle or joints moving • Does not significantly build strength but can maintain strength, therefore used in rehab setting • Example: Pushing against something that is immovable, plank

39. Continued . . . • Isokinetic: A dynamic contraction but the speed of the entire movement is controlled by the machine • Helps build strength in people who have limited used of their muscles • Example: Exercise bike set for 110 revolutions per minute

40. Oxford Scale • A rating system used for the assessment and recording of muscle power • Knowledge of muscle anatomy is vital so that the joint can be positioned correctly, and the tendon and muscle palpated for contractions

41. Oxford Scale

42. Exercise Progression • Must continually increase the magnitude of the training stimulus or intensity • This ensures that results will continue to improve over time • 6 Different ways to progress an exercise

43. 6 Ways to Progress Exercise • Increase poundage: • Increasing the weight lifted is the most common method of progression • Increase training density: • Doing more work in less time by shortening rest periods • Increase time under tension: • Lower the weight slowly, while maximally contracting the muscles the entire way down and eliminating pauses between reps

44. Continued . . . • Increase training volume: • Add more sets or reps to a training session • Use more challenging exercises: • Changing exercises is often enough to provide a progressive overload • Increase intensity: • Base weight increases using % of 1RM* • *1RM = the maximum weight one can lift in a single rep for a given exercise. Used as an upper limit to determine the desired "load" for an exercise

45. Exercise Equipment • Common exercise equipment includes: • Treadmill • Elliptical • Stationary bike • Stepper • Resistance bands/tubes • Mats • Universal machine • Dumbbells/Ankle weights

46. Cardio Equipment

47. Resistance Equipment

49. Exercise Prescription • Based on the assessment of the patient and: • The diagnosis • The problem list • The patient’s function level • The goals of the PT tech • The goals of the patient • The resources available (time, equipment, staff, etc.)

50. Contraindications to Exercise • Recent acute myocardial infarction • Unstable angina • Ventricular tachycardia and other dangerous arrhythmias • Dissecting aortic aneurysm • Congestive heart failure • Severe aortic stenosis • Active or suspected myocarditis or pericarditis • Thrombophlebitis or intracardiac thrombi • Recent systemic or pulmonary embolus • Acute infection