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Download MBBS Physical Medicine and Rehabilitation Presentations 16 Therapeutic Exercises Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Physical Medicine and Rehabilitation 16 Therapeutic Exercises PPT-Powerpoint Presentations and lecture notes

This post was last modified on 08 April 2022

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Overview

Introduction

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Energy system for muscular contraction

Health benefits of exercise

Types of exercises

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Exercise prescription


Introduction

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`Therapeutic' relates to the treatment of disease/physical
disorder

`Exercise' refers to bodily exertion for the sake of

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training/improvement of health.

? Use of activities requiring physical exertion in the

prevention/treatment/rehabilitation of il ness and disabling

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conditions.

Energy Systems

Al three energy systems supply energy at all times but

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one energy system may predominate during a particular

activity.

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Energy Systems

q ATP in skeletal muscles lasts approximately 5 to 10 seconds of

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high-intensity work

q Creatine phosphate system lasts for approximately 25 seconds of

high-intensity work.

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This provides energy for activities such as sprinting and weightlifting.

q Rapid Glycolysis starts along with high-intensity exercise and

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dominates for approximately 1.5 to 2 minutes.

Energy Systems

Aerobic Oxidation System:

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Unlimited ability to regenerate ATP depending upon amount of

fuel and oxygen available to the cell.

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Maximal oxygen consumption (VO2max) is a measures power

of the aerobic energy system and the best indicator of aerobic
fitness.

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Prolonged exercise ( >30 minutes) of low to moderate intensity

shifts substrate utilization from carbohydrate toward fat.


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Health benefits of exercise

? Primary and Secondary Prevention of Cardiovascular Disease
? Blood Pressure Regulation
? Weight Control

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? Type 2 Diabetes Mellitus Prevention
? Improved Psychological Well-being
? Maintenance of Bone Density
? Increased Fibrinolytic Activity
? Decreased Inflammatory Marker

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? Improved Endothelial Function
? Improved Sleep
? Reduced Cancer Risk


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The activity pyramid

Types of exercise

q Cardiovascular Exercise (Aerobic exercise)

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q Strengthening exercise

q Flexibility

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q Proprioception


Cardiovascular Exercise

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Pulmonary Ventilation (Ve)

q Volume of air exchanged per minute.

? At rest Approximately 6 L/min in an average sedentary

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adult man.

? At maximal exercise, increases 15- to 25-fold over

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resting values.

? Increases in Ve are directly proportional to an increase

in oxygen consumption (VO2) and carbon dioxide

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produced (VCO2).
Anaerobic (ventilatory) threshold

The anaerobic threshold signifies the peak work rate or oxygen

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consumption at which the energy demands exceed the
circulatory ability to sustain aerobic metabolism.

At critical exercise intensity Ve increases disproportionately

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relative to the VO2 (paralleling an abrupt increase in serum
lactate and VCO2).

Determined by

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? serial measurements of blood lactate

? assessment of expired gases during exercise testing, specifical y Ve

and carbon dioxide production (VCO2).

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Maximal Oxygen Consumption

? VO2max defined physiologically as the highest rate of oxygen

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transport and use, that can be achieved at maximal physical
exertion.

? The resting oxygen consumption (250 mL/min) divided by

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body weight (70 kg) gives the resting energy requirement, 1
MET (approximately 3.5 mL/ kg per minute).

? METs is considered the best index of physical work capacity

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or cardiorespiratory fitness.
Symptoms of Overtraining Syndrome

? Sudden decline in quality of work or exercise performance

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? Extreme fatigue

? Elevated resting heart rate

? Early onset of blood lactate accumulation

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? Altered mood states

? Unexplained weight loss

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? Insomnia

? Injuries related to overuse

Physical Activity Readiness

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Questionnaire

1.

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Has your doctor ever said that you have a heart condition and that you should only do physical
activity recommended by a doctor?

2.

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Do you feel pain in your chest when you do physical activity?

3.

In the past month, have you had chest pain when you were not doing physical activity?

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4.

Do you lose your balance because of dizziness or do you ever lose consciousness?

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5.

Do you have a bone or joint problem that could be made worse by a change in your physical
activity?

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6.

Is your doctor currently prescribing drugs (e.g., water pil s) for your blood pressure or heart
condition?

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7.

Do you know of any other reason why you should not do physical activity?

A "yes" answer to any of the questions indicates a pre-exercise

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evaluation before the individual begins or increases physical activity
Major Symptoms or Signs Suggestive of

Cardiopulmonary Disease

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? Pain and discomfort in the chest, neck, jaw, arms, or other areas that may be

ischemic in nature

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? Shortness of breath at rest or with mild exertion

? Dizziness or syncope

? Orthopnea or paroxysmal nocturnal dyspnea

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? Ankle edema

? Palpitations or tachycardia

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? Intermittent claudication

? Known heart murmur

? Unusual fatigue or shortness of breath with usual activities

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Components of an Exercise Prescription

? Mode is the particular form or type of exercise.

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? Intensity is the relative physiologic dif iculty of the exercise.

Intensity and duration of exercise interact and are inversely
related.

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? Duration or time is the length of an exercise session.

? Frequency refers to the number of exercise sessions per

day and per week.

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? Progression (overload) is the increase in activity during

exercise training, which, over time, stimulates adaptation

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ACSM Recommendations for

Cardiorespiratory Endurance Training

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Mode: large muscle groups are engaged in rhythmic aerobic
activity.

? Activities includes walking, jogging, cycling, rowing, stair

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climbing, aerobic dance ("aerobics"), water exercise, and cross
-country skiing etc.

Intensity: minimal exercise of moderate intensity (i.e., 40% to
60% of VO2max that increases HR and breathing).

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? A combination of moderate and vigorous exercise (60% of

VO2max results in increases in HR and breathing) is ideal for
improvements in health and fitness.

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Intensity Calculation

q Heart Rate Methods
v MAXIMUM HEART RATE METHOD:

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? HRmax = 220 - age (with a standard deviation of 10 beats/min)
? Using 70% to 85% of an individual's HRmax provides the stimulus

needed to improve or maintain cardiorespiratory fitness.

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v HEART RATE RESERVE METHOD:

q Rating of Perceived Exertion:

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? The RPE is a subjective grading of how hard individuals feel they

are exercising. The most commonly used scale of perceived

exertion is the Borg Scale.

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ACSM Recommendations for

Cardiorespiratory Endurance Training

q Duration

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? Physical activity may be continuous or intermittently

accumulated during a day through one or more sessions of

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activity lasting greater than 10 minutes.

? The ACSM recommends physical activity for healthy adults: 1000

kcal/ week (or approximately 150 min/wk or 30 min/day).

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q Frequency

? The ACSM recommends exercise 3 to 5 days per week.
? Less conditioned people can benefit from lower intensity, shorter

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duration exercise performed at higher frequency.

q Progression

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? The ACSM notes a 5- to 10-minute increase every 1 to 2 weeks

over the first 4 to 6 weeks.

Types of Muscle Contraction

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Isometric contractions are contractions in which there is no

change in the length of the muscle. No joint or limb motion

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occurs.

Isotonic contractions occur when the muscle changes length,

producing limb motion.

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Concentric contractions occur when the muscle shortens.
Eccentric contractions occur when the muscle lengthens.

More fast-twitch fibers are recruited during eccentric

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contractions.

Isokinetic contractions occur when muscle contraction is

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performed at a constant velocity. This can be done only with

the assistance of a preset rate-limiting device.


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Resistance Exercise

Training program include increasing the amount of weight lifted,

increasing repetitions, or increasing the velocity of training.

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One-repetition maximum (1-RM) is maximum amount of weight that

a person can possibly lift for one repetition.

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q Progressive resistance exercise

? DeLorme method: The weight for the first set is 50% of the 10-RM;

the second set, 75% of the 10-RM; and the third set, 100% of the

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10-RM.

q Regressive resistive exercise

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? Oxford technique: an individual starts with 10 repetitions at 100%

of the 10-RM, then 10 repetitions at 75% of the 10-RM, then a third

set of 10 repetitions at 50% of the 10-RM.

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Recommended Guidelines for Strength

Training
Flexibility

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"The total achievable excursion (within limits of pain) of a body part
through its range of motion."

? Even smal reductions in range may result in biomechanical

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accommodations that place abnormal stress on tissues elsewhere in
the body.

? Benefits from stretching:

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I. Prevention of musculoskeletal injuries
I . Improved performance in sports
I I. Reduced post-exercise muscle soreness
IV. Improved general wel -being

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Factors affecting range of motion

? Tightness of soft-tissue structures such as muscle, tendon, ligament,

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and joint capsule.

? Involuntary muscle contraction i.e. spasm

? Bony contour of the joint

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? Abnormal bone growth around a joint

? Intra-articular loose bodies (e.g., bone or cartilage)

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? Excessive fluid
Stretching techniques

1) Bal istic: repetitious bouncing movements, where the momentum of a

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moving body segment is used to generate forces producing a rapid
stretch.

v Greater risk for injury

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2) Static: a slowly applied stretch that is held for several seconds

v Easy to perform

v Can be done voluntarily or received passively

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v Little associated risk of injury

3) PNF (proprioceptive neuromuscular facilitation): The concept is to

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enhance relaxation of the muscle to be stretched through reciprocal
inhibition and the stretch reflex.

Proprioception

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q It denotes the process by which information about the

position and movement of body parts is related to the
central nervous system.

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? Proprioceptive organs: including muscle (particularly

intrafusal spindle fibers), skin, ligaments, and joint capsules

? Proprioceptive exercises used after an injury to a joint

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resulting in a deficit in proprioception.

e.g. Tilt or wobble board training, carioca (sideways
running) and backward walking or running.

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Thank you