Resistance Exercises

By M.Paul Raj

Definition of resistance exercise

Resistance exercise is a form of active exercise

in which a dynamic or static muscular contraction is resisted by an outside force. The external force may be applied manually or mechanically.

MUSCLE STRUCTURE

MUSCLE STRUCTURE

CROSS-BRIDGE CYCLE
Interaction between the thick and thin filaments of the

sarcomere leading to muscle contraction is initiated by the arrival of a nerve impulse at the motor end plate, which evokes an electric impulse, or action potential, that travels along the muscle fiber.
The action potential initiates the release of calcium

ions, and the calcium ions cause troponin to reposition the tropomyosin molecules so that receptor sites on the actin are free and the head groups of the myosin can bind with actin. This bonding of filaments is called a cross-bridge.
Tension is generated with the inclusion of the

hydrolysis of adenosine triphosphate (ATP) and the release of adenosine diphosphate (ADP) from the myosin head.

TYPES OF MUSCLE CONTRACTION

Isometric contraction with no change in

length In this contraction, the length of the muscle fiber is constant.

Concentric or shortening muscle contraction In this contraction, the thin myofilaments are pulled toward the thick myofilaments, and cross-bridges are formed, broken, and re-formed.

Eccentric or lengthening muscle contraction

In this contraction, the thin myofilaments are pulled away from the thick myofilaments, and cross-bridges are broken, re-formed, and broken.

TYPES OF RESISTED EXERCISES

Resistance Exercise

Isometric
Isotonic

Isokinetic

ISOMETRIC RESISTED EXERCISE

Isometric resisted exercise is a static contraction of muscle

against external resistance without appreciable change in its length or joint motion. Advantage: Isometric exercise is valuable when joint motion is uncomfortable or contraindicated, during immobilization. Isometric exercise is effective when weakness exist at a specific point in the ROM. Easy to understand. Disadvantage: Isometric strength is specific to the joint angle (joint angle dependent).

ISOTONIC RESISTED EXERCISE

Isotonic resisted exercise is dynamic exercise that is

carried out against resistance as a muscle lengthens or shortens through the available range of motion.
CONCENTRIC CONTRACTION occurs when active

muscle undergoes shortening while overcoming external resistance. ECCENTRIC CONTRACTION occurs when active muscle undergoes lengthening while being overcome by an external resistance. Eccentric contraction performed against supramaximal resistance generates greater force production than concentric contraction.

ISOKINETIC RESISTIVE EXERCISE

Isokinetic exercise is a form of active exercise in

which a muscle or group of muscles contracts against a controlled accommodating resistance which is moving at a constant angular velocity.
The isokinetic exercise are performed with a

specialized apparatus that provides variable resistance to a movement, so that no matter how much effort is exerted, the movement takes place at a constant speed. The isokinetic device are computerized training and testing device that provide maximum resistance through the entire ROM. The device provide multi-angle isometric resistance, resisted concentric and eccentric exercise.

ISOKINETIC RESISTIVE EXERCISE

Advantages: Ability to fully activate more muscle fiber for longer period because

the machine accommodate the resistance according to the changing ability throughout the ROM. Allow training at a variety of speeds Provide objective documentation The isokinetic device provides many strengthening protocols to chose from according to the patient condition and the goal of exercise. For example (isometric conditioning, isokinetic conditioning, eccentric & eccentric conditioning and open & closed chain conditioning)
Disadvantages: The device is expensive

Require trained personnel for setting up the patient training program.

MODES OF RESISTANCE
1. Manual Resistance Exercise
2. Mechanical Resistance Exercise

1. Manual Resistance Exercise

Manual resistance exercise is active resisted exercise in which the

resistance force is applied by the therapist to either a dynamic or isometric contraction. Advantages: The resistance can be varied with changes in strength production throughout the range. When joint motion is allowed, manual resisted exercise offer an easy inexpensive method of strengthening muscle. Specific or individual muscle could be strengthened. Disadvantage The amount of resistance depend on the therapist condition. The resistance can not be measures so the treatment results can not be documented. Effort and time consuming as the therapist can treat only one patient at a time.

2. Mechanical Resistance Exercise

Mechanical resisted exercise is active resisted exercise in which the

resistance provided by equipments to either a isotonic or isometric muscle contraction.

A variety of mechanical equipment are available ranging from simple to complex, small to large, and expensive to inexpensive. The choice between them depend on the patients need and ability, goal of the exercise and availability of the apparatus.

Free weights Weight machine Exercise bicycle Pulley system

Goals and Indications of Resistance Exercise

The overall purpose of resistance exercise is to

improve physical function. The specific goals are to: A. Increase Muscular Strength
B. Increase Muscular Endurance C. Increase Muscular Power

A. Increase Muscular Strength

1. Strength refers to the force output of a contracting

muscle and is directly related to the amount of tension a contracting muscle can produce. 2. In order to increase the strength of a muscle, contraction must be loaded or resisted so that increasing levels of tension will develop due to hypertrophy and recruitment of muscle fibers.

B. Increase Muscular Endurance

1. Endurance is the ability to perform low-intensity repetitive exercise over a

prolonged period of time. 2. Muscular endurance is improved by performing exercise against mild resistance for many repetitions. 3. It has been shown that in most exercise programs designed to increase strength, muscular endurance also increases. 4. In certain clinical situations it may be more appropriate to implement a resistance exercise program that will increase a patients muscular endurance rather than his strength. For example, it has been shown that after many acute or chronic knee injuries, dynamic exercises, carried out for a high number of repetitions against light resistance, are more comfortable and create less joint irritation than dynamic exercises performed against heavy resistance. 5. Total body endurance also can be improved with prolonged low-intensity exercise.

C. Increase Muscular Power

1. Power is also a measure of muscular performance and is

defined as work per unit of time (force X distance/time). Force times velocity is an equivalent definition. 2. The rate at which a muscle contracts and develops force throughout the range of motion and the relationship of speed and force are both factors that affect power. 3. When exercise is performed dynamically against resistance over a specified interval of time, power will increase. 4. Resistance exercise programs can be designed to selectively recruit different fiber types in muscles by controlling the intensity and speed of exercise.

PRINCIPLES OF RESISTANCE EXERCISE

Overload Principle:
the foundation of training to increase muscular strength and endurance is the overload principle which states that In order to increase strength or endurance a load that exceeds the metabolic capacity of the muscle must be used to induce adaptive changes in muscle that lead to increasing strength and endurance The SAID principle (specific adaptation to imposed demands) suggests that a framework of specificity is a necessary foundation on which exercise programs should be built. This principle applies to all body systems and is an extension of Wolffs law (body systems adapt over time to the stresses placed on them). *Specificity of Training *Transfer of Training

Said Principle:

Reversibility Principle:

Adaptive changes in the bodys systems, such as increased strength or endurance, in response to a resistance exercise program are transient unless training-induced improvements are regularly used for functional activities or unless an individual participates in a maintenance program of resistance exercises.

RESISTANCE TO FATIGUE
Muscle (local) fatiguethe diminished response of muscle to a repeated stimulus
is reflected in a progressive decrement in the amplitude of motor unit potentials

PHYSIOLOGICAL ADAPTATIONS TO RESISTANCE EXERCISE

Specific Resistance Exercise Regimens

A. Isotonic Regimens
1. The DeLorme technique a. It is also known as Progressive Resistive Exercise (PRE) b. Procedure (1) Determine the 10 Repetition Maximum (RM). (2) The patient then performs: (a) 10 repetitions at 1/2 of the 10 RM. (b) 10 repetitions at 3/4 of the 10 RM. (c) 10 repetitions at the full 10 RM. d) The patient performs all 3 bouts at each exercise session with a brief rest between bouts. (3) The approach builds in a warm-up period because the patient initially lifts only 1/2 and 3/4 of the 10 RM. (4) The 10 RM is increased weekly as strength increases.

2. The Oxford technique a. It is the reverse of the 3-bout DeLorme system. It was designed to diminish resistance as muscle fatigue develops. b. Procedure (1) Determine the 10 RM. (2) The patient then performs: (a) 10 repetitions at the full 10 RM. (b) 10 repetitions at 3/4 of the 10 RM. (c) 10 repetitions at 1/2 of the 10 RM. (3) This technique attempts to decrease the detrimental effects of fatigue. (4) A general, nonspecific warm-up period of active exercise is advocated prior to beginning the bouts of resistance exercise.

Daily adjustable progressive resistance exercisethe DAPRE a. The DAPRE technique was developed by Knight to more objectively determine when to increase resistance and how much to increase the resistance in an exercise program. b. Procedure (1) Determine an initial working weight (Knight suggests a 6 RM). (2) The patient then performs: a) Set No. 1: 10 repetitions of 1/2 the working weight. b)Set No. 2: 6 repetitions of 3/4 the working weight. c) Set No. 3: as many repetitions as possible of the full working weight. d) Set No. 4: as many repetitions as possible of the adjusted working weight. i) The adjusted working weight is based on the number of repetitions of the full working weight performed during Set No. 3. ii) The number of repetitions done in Set No. 4 is used to determine the working weight for the next day.

 (3) Guidelines for adjustment of the working weight Repetitions Performed During Set No. 3 0-2 3-4 5-6 7-10

Set No. 4 Decrease 0-5 lb and repeat set Decrease 5-10 lb Keep weight the same Increase 5-10 lb

Next Day Decrease 5-10 lb Same weight Increase 5-10 lb Increase 5-15 lb

(4) Knight suggests that the "ideal" maximum number of repetitions

(when the patient is asked to perform as many repetitions as possible) is 5 to 7 repetitions. (5) The DAPRE system eliminates the arbitrary determination of how much weight should be added in a resistance exercise program on a day-to-day basis. (6) This system can be used with free weights or weight machines.

4. Circuit weight training a. Another approach to isotonic resistance exercise is circuit weight training. b. Resistance exercises are carried out in a specific sequence using a variety of exercises for total body conditioning. Exercises can be performed using free weights or weight training units such as the Universal, Nautilus, or Eagle systems. c. Exercises could include 8 to 10 RMs of: (1) bench press (2) leg press (3) sit-ups (4) shoulder press (5) squats (6) curls d. A rest period (usually 30 seconds to 1 minute) is taken between each bout of exercise. e. Many examples of circuit weight training regimens can be found in the athletic training and sports medicine literature.

B. Isometric Regimens
1. In the 1950s, Hettinger and Muller studied and advocated isometric exercise

as an optimal means for increasing muscle strength. 2. Involves brief, maximal isometric exercise. 3. Procedure a. The patient performs a single isometric contraction of the muscle to be strengthened against a fixed resistance. The contraction is held for 5 to 6 seconds. b. This procedure is performed once a day, 5 to 6 times per week. 4. Brief repetitive isometric exercise (BRIME) a. This is a refinement of the earlier isometric regimens. b. Five to ten brief but maximum isometric contractions are performed against resistance 5 days per week. c. This repetitive approach was found to be more effective and maintained the subject's level of motivation better than using a single maximum contraction.

 5. Current use of isometrics in rehabilitation and conditioning

a. Early studies documented that isometric resistance exercise can be an effective means of improving muscle strength. b. Although isometric exercise can improve muscular endurance, the effect is minimal. Dynamic (isotonic and isokinetic) exercises are a more effective means of increasing muscle endurance. (1) Multiple angle isometrics (a) Necessary if the goal of exercise is to improve strength throughout the range of motion. (b) Gains in strength will only occur at or closely adjacent to the training angle. (c) Physiologic overflow only occurs a total of 20 degrees from the training angle (10 degrees in either direction). (d) Resistance should be applied at least every 20 degrees through the range. (e) Davies's suggests 10 sets of 10 repetitions of 10-second contractions every 10 degrees in the range of motion. (A 10second contraction may be preferable to a 6-second contraction, if your patient counts quickly!).

C. Isokinetic Regimens
1. Velocity spectrum rehabilitation
a.

Most isokinetic exercise programs designed to develop strength, endurance, or power involve performing exercises on an isokinetic unit at slow, medium, and fast velocities. b. A minimum of 3 contractile velocities is usually chosen for a training program. c. A common exercise bout might include training at 60, 120, and 180 degrees/second or 60, 150, and 240 degrees/second. d. The effects of training may only carry over 15 degrees/second from the training velocity. Therefore, some clinicians may choose to set up programs with as many as 8 to 10 training velocities.

PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION

DEFINITION
Proprioceptive neuromuscular facilitation

is hastening (quickening) the response of the neuromuscular mechanism through stimulation of the proprioceptors; could result in either facilitation or inhibition.

AIM OF PNF
To promote functional movement of paralyzed

limb through facilitation, inhibition, strengthening, and relaxation of muscle groups.

In intact persons it is used in training and in

rehabilitation as a set of specific movement patterns.

MECHANISM OF PNF
Autogenic inhibition: inhibitory signals (from

GTOs) override excitatory impulses (from muscles spindles) causing gradual relaxation. Reciprocal inhibition: contraction of agonist muscle elicits relaxation of antagonist. Stretch Reflex: sudden stretch of muscle spindle causes agonist to contract and antagonist to relax (ie., patellar tap reflex)

PRINCIPLES OF PNF
Patterns of facilitation
Manual contact The stretch stimulus and the stretch reflex Traction and approximation Commands to the patient

Normal timing
Maximal resistance Re-inforcement

PNF Strengthening Diagonal Patterns

PNF Strengthening Diagonal Patterns

D1 Flexion Upper Extremity Joint Specific Movements

Shoulder Flexion External Rotation Adduction
Forearm Wrist Fingers Supination Radial Deviation Flexion

PNF Strengthening Diagonal Patterns

D1 Extension Upper Extremity

D1 Extension Upper Extremity Joint Specific Movements

Shoulder Extension Internal Rotation Abduction
Forearm Wrist Fingers Pronation Ulnar Deviation Extension

PNF Strengthening Diagonal Patterns

D2 Flexion Upper

Extremity

D2 Flexion Upper Extremity Joint Specific Movements

Shoulder Flexion External Rotation Abduction
Forearm Wrist Fingers Supination Radial Deviation Extension

PNF Strengthening Diagonal Patterns

D2 Extension Upper

Extremity

D2 Extension Upper Extremity Joint Specific Movements

Shoulder Extension Internal Rotation Adduction
Forearm Pronation

Wrist Fingers

Ulnar Deviation Flexion

PNF Strengthening Diagonal Patterns

D1 Flexion Lower

Extremity

D1 Flexion Lower Extremity Joint Specific Movements

Hip Flexion Adduction External Rotation
Ankle Dorsiflexion Inversion Toes Extension

PNF Strengthening Diagonal Patterns

D1 Extension Lower

Extremity

D1 Extension Lower Extremity Joint Specific Movements

Hip Extension Abduction Internal Rotation
Ankle Planar Flexion

Eversion Toes Flexion

PNF Strengthening Diagonal Patterns

D2 Flexion Lower

Extremity

D2 Flexion Lower Extremity Joint Specific Movements

Hip Flexion Abduction Internal Rotation
Ankle Dorsiflexion

Eversion Toes Extension

PNF Strengthening Diagonal Patterns

D2 Extension Lower

Extremity

D2 Extension Lower Extremity Joint Specific Movements

Hip Extension Adduction External Rotation
Ankle Plantar Flexion Inversion Toes Flexion

NECK PATTERNS

Neck flexion with rotation to right Neck extension with rotation to left

TRUNK PATTERNS
UPPER TRUNK Flexion with rotation to the left Extension with rotation to the right
LOWER TRUNK Flexion with rotation to the left Extension with rotation to the right

PNF TECHNIQUES
Strengthening techniques rhythmic initiation rhythmic stabilization repeated contraction Slow reversal Stretching techniques hold relax contract relax

RHYTHMIC INITIATION
This is a relaxation technique for specific

application to the rigidity of Parkinsons disease Initially passive then active assisted then it is progressed to active movement through the agonist pattern. Further progressed to resisted movement. Rhythm must not be changed.

RHYTHMIC STABILISATION
An isometric contraction of the agonist

followed by an isometric contraction of the antagonist. Stability is maintained against resistance by a co contraction of antagonistic muscles. The patient is instructed to HOLD while the physiotherapist applies maximal resistance alternating rhythmically from one direction to the other.

REPEATED CONTRACTION
The contraction of specific weak muscles or

weaker components of a pattern is repeated in this technique while they are being reinforced by maximal isotonic or isometric contraction of stronger allied muscles.

SLOW REVERSAL
This technique is based on Sherringtons

principle of successive induction i.e., that immediately after the flexor reflex is elicited the excitability of extensor reflex is increased. Isotonic contraction of the agonist followed immediately by an isotonic contraction of the antagonist

ELASTIC RESISTANCE

THERABAND & TUBE

What is it?
Resistance bands and tubing are low-cost,

portable and versatile. Made of natural rubber latex, they are easily recognized by the trademark colors yellow, red, green, blue, black and silver, as well as other colors of tan and gold. It has been proven to increase strength, mobility function as well as reduce joint pain

Why Elastic band?

Inexpensive
Portable Versatile means of exercise Effective Home based exercise

Non-reliance on Gravity

In short Tuck a gym in your pocket

PROGRESSIVE RESISTANCE LEVELS

Resistance in Kilograms Based on Percent Elongation

Practical Exercise Tips

With all exercises, posture and body alignment is critical. Keep

the shoulders and hips aligned, tighten the abdominals, and relax the knees. Be sure to practice the safest posture possible by maintaining a natural spinal curve Include proper warm-up and cool-down activities with your elastic resistance training program. Perform all exercises in a slow and controlled manner. At no time should you feel out of control; remember to control the band or tubing rather than allowing it to control you. Do not allow the band or tubing to snap back. Avoid hyper extending or over-flexing joints when exercising. Dont lock the joints.

Continue
Breathe evenly while performing these exercises. Exhale during

the more difficult phase of the repetition. Dont hold breath. For beginners, perform the exercises without the band or tubing until the subject are comfortable, then add resistance. Begin with 8 to 10 exercises that target major muscle groups. Exercise with the color band that was prescribed to complete 2 to 3 sets of 10 to 15 repetitions. Progress to the next color band when you are able to easily complete the 3 sets of 10 to 15 repetitions.

Outcomes
Clinical research has proven that elastic resistive exercise, including

Increases Strength

Increases Power Improves Balance and Proprioception Prevents Falls Improves Posture Decreases Pain Improves Gait Increases Grip Strength Improves Cardiovascular Fitness Decreases Blood Pressure Decreases Disability and Improves Function

Database contains over 500 articles and studies on elastic resistance

including nearly 100 randomized clinical trials using elastic resistance.

Plyometrics

TERMINALOGY
Plyometrics (also known as "plyos") is a type of

exercise training designed to produce fast, powerful movements, and improve the functions of the nervous system, generally for the purpose of improving performance in sports. It utilize the stretch shortening cycle to produce an enhanced concentric contraction It is used to increase the speed or force of muscular contractions, providing explosiveness for a variety of sport-specific activities.

PROCEDURE
A plyometric contraction involves first a rapid muscle lengthening

movement (eccentric phase), followed by a short resting phase (amortization phase), then an explosive muscle shortening movement (concentric phase), which enables muscles to work together in doing the particular motion. Some of the research has shown that combining both resistance training and plyometric training will have better effects on training. While doing plyometrics, it assists in rapid force development (power), weight training assists in maximal force output (strength). Power refers to the combined factors of speed and strength.

Reviews for bone mineral density (Osteoporosis)

A number of recent studies have demonstrated that resistance

training has a positive effect on bone mineral density (Swezey et al., 2000; Taaffe and Marcus, 2000; Kelley et al., 2001). Kelley et al., 2001). A review of such literature suggests that mechanical strains of resisted muscle contraction stimulates an osteogenic response in the spine in particular, but also in the femur and radius, particularly in post-menopausal women. Strength training at 70% 1 RM is recommended as safe and effective at maintaining bone mass (Hartard et al., 1996). Swezey et al. (2000) recommend resisted isometric exercises for ten minutes daily as being adequate to strengthen muscles and enhance bone formation.

 The study by Engardt et al. (1995) compared the effects of eccentric and concentric training of the paretic leg in two groups, each consisting of ten stroke patients.

Training involved generating isokinetic maximal voluntary knee

extension motions, through a range of angular velocities, and was performed twice a week for six weeks for each group. Post-training results showed that knee extensor strength had increased in eccentric and concentric actions in both groups (p < 0.05). The increases in the eccentric and concentric strength in the paretic leg relative to the non-paretic leg showed statistical significance in the eccentric training group(p < 0.05) but were not significant in the concentric training group. The eccentric group demonstrated significant improvement (p < 0.01) in symmetry of lower limb weight distribution in the action of standing up from sitting, while the concentric group demonstrated significant increases in walking speed (p < 0.05). It was also reported in this study that results of EMG activity indicated that increases in strength were related to enhanced activation of the agonists.