Determinants of a Resistance

Exercise Program
• ALIGNMENT: • STABILIZATION:
- strengthen a specific muscle -correct muscle action & movement
or muscle group effectively pattern,
-avoid unwanted substitute motions
-avoid substitute motions
Stabilization can give in two ways:
• Alignment and muscle
External stabilization -by
action.ex: strengthen the
therapist,patient, equipment like
gluteus medius- hip flexed belt,strape etc
,abducts(tensor fascialatae), Internal stabilization-by abdominal
instead of hip slightly muscle –for B/L SLR
extended, pelvis rotated OR lumbar spine for one side hip
slightly forwarda,bducts flexion
• Alignment and gravity.
 Intensity
• The intensity of exercise in a resistance training
program is the amount of resistance (weight) imposed
on the contracting muscle during each repetition of
an exercise. The amount of resistance is also
referred to as the exercise load(training load).
• The intensity of exercise is also dependent on the
 volume,
 frequency, and
 order of exercise/the length of rest intervals.
 Sub maximal Vs Maximal Exercise
Loads(intensity)
Many factors, including:
 the goals and
 expected functional outcomes of the exercise program,
 the cause of deficits in muscle performance,
 the extent of impairment,
 the stage of healing of injured tissues,
 the patient’s age,
 general health,and
 fitness level, and other factors
determine whether the exercise is carried out against submaximal or
maximal muscle loading.
Submaximal loading.(moderate to low intensities) is indicated:

 At the beginning of an exercise program

 evaluate the patient’s response to resistance exercise,( periods of
inactivity)
 In the early stages of soft tissue healing when injured tissues must
be protected
 After periods of immobilization when the articular cartilage is not
able to withstand large compressive forces or when bone
demineralization may have occurred, increasing the risk of
pathological fracture
 For most children or older adults
 When the goal of exercise is to improve muscle endurance
 To warm up and cool down prior to and after a session of exercise
 During slow-velocity isokinetic training to minimize compressive
forces on joints
 Near maximal/maximal loading.
(High-intensity exercise) is indicated:

• To increase muscle strength and power and

possibly increase muscle size,
• Advanced phase of a Rehabilitation program
after a musculoskeletal injury in preparation for
returning to high-demand occupational or
recreational activities
• Individuals with no known pathology
• For individuals training for competitive weight
lifting or body building
 Exercise Order
• When multiple muscle groups are exercised in
a single session, in rehabilitation programs,
large muscle groups should be exercised
before small muscle groups and multi-joint
muscles before single-joint muscles.
• In addition, after an appropriate warm-up,
higher intensity exercises should be
performed before lower intensityexercises.
 Frequency
• Frequency refers to the number of exercise sessions per day or per week.
• Frequency is dependent on other determinants, such as:
 intensity and volume
 the patient’s goals,
 general health status,
 previous participation in a resistance exercise program, and
 response to training.
• The greater the intensity and volume of exercise, the more time is needed
between exercise sessions to recover from the temporarily fatiguing.
• A common cause of a decline in performance from overtraining is excessive
frequency, inadequate rest, and progressive fatigue.
• Some forms of exercise should be performed less frequently than others because
they require greater recovery time.
• High intensity eccentric exercise, for example, is associated with greater
microtrauma to soft tissues and a higher incidence of DOMS than other modes of
exercise.
• Therefore, rest intervals between exercise sessions are longer and the frequency
of exercise is less than with other forms of exercise
• Initially in an exercise program, the intensity and
number of repetitions are low, short sessions of
exercises sometimes can be performed on a daily basis
several times per day.
• This frequency is often indicated for early postsurgical
patients when the operated limb is immobilized and
the extent of exercise is limited to low-intensity
isometric (setting) exercises to prevent or minimize
atrophy.
• Highly trained athletes involved in body building,
power lifting, and weight lifting who know their own
response to exercise often train at a high intensity and
volume up to 6 days per week.
 Duration
• Exercise duration is the total number of weeks or
months during which a resistance exercise program is
carried out.
• Depending on the cause of an impairment in muscle
performance, some patients require only a month,
whereas others need to continue the exercise program
for a lifetime to maintain optimal function.
• For significant changes to occur in muscle, such as
hypertrophy or increased vascularization, at least 6 to
12 weeks of resistance training is required
 Rest Interval (Recovery Period)
Purpose of Rest Intervals
• It is necessary to allow time for the body to
recuperate from the acute effects of exercise
associated with muscle fatigue or to offset adverse
responses, such as DOMS.
• Only with an appropriate balance of progressive
loading and adequate rest intervals can muscle
performance improve. Therefore, rest between sets
of exercise and between exercise sessions must be
addressed.
Integration of Rest into Exercise:
• Rest intervals for each exercising muscle group are
dependent on the intensity and volume of exercise.
• In general, the higher the intensity of exercise the
longer the rest interval. For moderate-intensity
resistance training, a 2- to 3-minute rest period after
each set is recommended.
• A shorter rest interval is adequate after low-intensity
exercise;
• longer rest intervals (4 to 5 minutes) are appropriate
with high-intensity resistance training, particularly
when exercising large, multijoint muscles, such as the
hamstrings, which tend to fatigue rapidly.
• Rest is directly proportional to intensity
 Mode of Exercise
• The mode of exercise is refers to the form of
exercise, the type of muscle contraction that occurs,
and the manner in which the exercise is carried out.
• For example, a patient may perform an exercise
dynamically or statically or in a weight-bearing or
non-weight-bearing position.
• Mode of exercise also encompasses the form of
resistance, that is, how the exercise load is applied.
Resistance can be applied manually or mechanically.
Type of Muscle Contraction
Position for Exercise:
Weight-Bearing or Non-Weight-Bearing
Forms of Resistance:
• Manual resistance and mechanical resistance.
• A constant or variable load
• Accommodating resistance
• Body weight or partial body
Energy Systems:
 Anaerobic exercise involves high-intensity (near-maximal) exercise
carried out for a very few number of repetitions because muscles
rapidly fatigue. Strengthening exercises fall into this category.
 Aerobic exercise is associated with low-intensity, repetitive exercise
of large muscle groups performed over an extended period of time.
This mode of exercise primarily increases muscular and
cardiopulmonary endurance
Range of Movement: Short-Arc or Full-Arc Exercise
• Resistance through the full, (full-arc exercise)is necessary
to develop strength through the ROM. .
• short-arc exercise is used to avoid a painful arc of motion
or a portion of the range where the joint is unstable or to
protect healing tissues after injury or surgery.
Mode of Exercise and Application to Function
• Mode-specific training is essential if a resistance training
• program is to have a positive impact on function. When
tissue healing allows, the type of muscle contractions
performed or the position in which an exercise is carried
out should mimic the desired functional activity
 Velocity of Exercise
The velocity at which a muscle contracts
significantly affects the tension that the muscle
produces and subsequently affects muscular
strength and power.
The velocity of exercise is frequently manipulated in
a resistance training program to prepare the patient
for a variety of functional activities that occur
across a range of slow to fast velocities
Force-Velocity Relationship:
• The force-velocity relationship is different during concentric
and eccentric muscle contractions
Concentric Muscle Contraction
As the velocity of muscle shortening increases, the force
the muscle can generate decreases.
EMG activity and torque decrease as a muscle shortens at
faster contractile velocities, possibly because the muscle
may not have sufficient time to develop peak tension.
Eccentric Muscle Contraction
Findings are less consistent for eccentric than concentric
muscle actions. During an eccentric contraction, as the
velocity of active muscle lengthening increases, force
production in the muscle initially also increases but then
quickly levels off.
 Periodization
• Periodization is the gradual cycling of specificity, intensity,
and volume of training to achieve optimal development of
performance capacities; it consists of periodic changes of the
objectives, tasks, and content of training.
• Periodization is a high-level concept, most commonly used in
training athletes. Although used primarily with athletes, the
concept of changing volume and intensity can be used for all
patients.
• Periodization can be explained as the division of the training
yea(Preparation Phase, Competition Phase, Transition Phase)
to meet specific objectives. The objectives make up a year-
long program for optimal improvement in performance and
preparation for a definitive climax to a competitive season. .
 Integration of Function
• Balance of Stability and Active Mobility
• Balance of Strength, Power, and Endurance
• Task-Specific Movement Patterns During
Resistance Exercise
 Balance of Stability and Active Mobility

• Functional movements and tasks require a balance of

active movement of neuromuscular control.
• Stability is also necessary to control quick changes of
direction during functional movements.
• Stability is achieved through proper agonist and
antagonist muscle activation at individual joints, while
mobility requires the correct activation sequencing and
intensity across multiple muscle groups.
• For example, a person must be able to hold the trunk
erect and stabilize the spine to grasp, lift, and transport a
heavy object. A resistance exercise program must address
both the static and dynamic strength of the trunk and
extremities.
 Balance of Strength, Power, and Endurance

• Functional tasks encompass many

combinations of muscle strength, power, and
endurance, requiring motor capabilities that
produce slow and controlled movements, rapid
movements, repeated movements, and long-
term positioning.
• Analysis of the tasks a patient would like to be
able to do provides the framework for a task-
specific resistance exercise program
 Task-Specific Movement Patterns
With Resistance Exercise

• To prepare the patient for the demands of

their regular functional activities, resistance
should be incorporated into task specific
movement patterns.
• Applying resistance during exercise in
anatomical planes, diagonal patterns, and
combined task-specific movement patterns is
an important strategy in a carefully progressed
resistance exercise program.
• Pushing, pulling, lifting, and holding activities can
initially be done against a low level of resistance
for a low number of repetitions.
• Over time, the intensity and dose of the resistance
is progressed until the patient returns to using the
same movements during functional activities in an
unsupervised work or home setting.
• The key to successful self-management is to teach
a patient how to judge the speed, level, and
duration of muscle force in combination with the
appropriate timing necessary to perform a motor
task safely and efficiently.