RESISTANCE

EXERCISES
o By definition, muscular strength is the ability of a
muscle to generate force against some resistance.
Maintenance of normal level of strength in a given
muscle or muscle group is important for normal
healthy living.
o Muscle weakness or imbalance can result in
abnormal movement or gait and can impair normal
functional movement. Resistance training plays a
critical role in injury rehabilitation.

o Muscular performance is an essential component of

a person’s life. Every human activity from breathing
to walking to the bathroom to running a marathon
requires muscle activity.
o Physiologic, anatomic, psychologic, and
biomechanical factors affect muscle performance.
Pathology and disease affecting the cardiovascular,
endocrine, integumentary, musculoskeletal,
neuromuscular, or pulmonary systems can also affect
muscle performance; strength training can improve
the function of these systems.
o Muscle performance impairments can be considered
as impairments in muscle strength, power, or
endurance. These impairments must be related to an
activity limitation or participation restriction.

o A person with osteoarthritis of the knee and poor

quadriceps muscle performance requires quadriceps
 muscle training to prevent further knee joint
deterioration.

STRENGTH :
o Strength is defined as the “maximum force that a
muscle can develop during a single contraction, and
is the result of complex interactions of neurologic,
muscular, biomechanical, and cognitive systems”.
Strength can be assessed in terms of:
 Force,
 Torque,
 Work, and
 Power.
 o Force is tends to produce a change in the state of
rest or motion of an object.
Force= mass × acceleration
o Some of the factors influencing muscular force
production include:
 the neural input,
 mechanical arrangement of the muscle,
 cross sectional area,
 fiber-type composition,
 age, and
 gender.
TORQUE:
o All human motion involves rotation of body segments
about their joint axes. These actions are produced by
 the interaction of forces from external loads and
muscle activity. The ability of a force to produce
rotation is torque.
o Torque represents the rotational effect of a force with
respect to an axis:
Torque = force × moment arm
The moment arm:
o It is the perpendicular distance from the line of action
of the force - the axis of rotation.
o The metric unit of torque is the Newton-meter;
o Large amounts of torque are produced by the
musculoskeletal system during everyday functional
activities such as walking, lifting, and getting out of
bed.
 o Torque can be altered in biomechanics through three
strategies:
● changing the force magnitude
● changing the moment arm length
● changing the angle between the direction of force and
momentum

o In the human musculoskeletal system,

 changing the force magnitude (i.e., tension-
producing capability of muscle) can be altered by
training;
 the moment arm length can be decreased by
Positioning a load closer to the body, and
  The angle between the force and moment arm by
altering joint alignment through postural education.

Power and work:

o Power is the rate of performing work. Work is the
magnitude of force acting on an object multiplied by
the distance through which the force acts.
o work = force × distance
o The unit of power is the watt, which is equal to 1 J
per second.

o Power can be determined for:

 a single body movement,
 a series of movements, or for
 a large number of repetitive movements,
as in the case of aerobic exercise.
o Power is algebraically expressed as:
power = work/time

Power training –
 By increasing work of muscle for specific time
or reducing time for specific work of muscle.
 Greater the intensity & shorter the time period
taken to generate force – greater the muscle
power.
Endurance:
 Endurance is the ability of muscle to sustain
forces repeatedly or to generate forces over a
certain period. Endurance refers to the ability to
perform low intensity, repetitive or sustained
activities over a prolonged period of time.
 Muscle endurance is the ability to contract
repeatedly against a load, generate & sustain
tension & resist fatigue over an extended period of
time.
 Endurance training – low intensity muscle
contraction, large number of repetitions for
prolonged time period.
Muscle endurance is the ability of a muscle group to perform
repeated contractions against a load. This load can be
externally applied or as a result of posture, such as when
someone is working over a desk, counter, or work station all
day.
Muscle endurance can be examined by-- isometric
contractions, repeated dynamic contractions (isotonic), or
repeated contractions on an isokinetic dynamometer.
POTENTIAL BENEFITS OF RESISTANCE
EXERCISES
Enhance muscle performance
Increase strength of connective tissue
Greater BMD or reduces bone demineralization
Decrease stress on joints
Reduce risk of soft tissue injury
Improves capacity to repair or heal damaged soft tissues
Possible improvement in balance
Enhances physical performance during ADLs,
recreational activities & occupation
Improves body composition : increase lean muscle mass
& reduce body fat
Enhance feeling of physical well being & so QOL.
PRINCIPLES OF RESISTANCE EXERCISES:

1. Overload principle
2. SAID principle
3. Reversibility principle
OVERLOAD PRINCIPLE

 To improve muscle performance, a load that

exceeds the metabolic capacity of the muscle must
be applied.

 Progressiveloading of muscle can be done by

manipulating intensity or volume of exercises.
SAID PRINCIPLE
Specific adaptation to imposed demands
Exercise program should be built on specificity principle.
It’s a extension of Wolf’s law.
Specificity of exercise refers to the adaptive effects of
training like strength, power & endurance, are highly
specific to the training methods employed.
Considered relative to mode (type) & velocity of
exercise; joint angle; movement pattern during exercise.
Basis of specificity of training is related to morphological
& metabolic changes in muscles & neural adaptation to
the training stimulus with motor learning.
REVERSIBILITY PRINCIPLE
 Adaptive changes in body system (strength,
endurance) due to resistance exercises are
transient unless improvement is used for functional
activities or as a maintenance program.
 Detraining (reduced muscle performance), starts in
a week or two after exercise cessations & continues
until training effect are lost.
DETERMINANTS OF RESISTANCE EXERCISE:

 Many elements (variables) determine whether a

resistance exercise program is appropriate,
effective & safe.

 Allelements are interrelated & should be addressed

to improve one or more aspects of muscle
performance & achieve desired functional
outcomes.
 Alignment – of segments of body during exercise.
 Stabilization –of proximal or distal joint to
prevent substitution.
 Intensity – the exercise load (level of resistance).
 Volume – the total number of repetitions & sets
in the exercise sessions multiplied by the
resistance used.
 Exercise order – the sequence in which muscle
groups are exercised during the exercise session.
 Frequency – the number of exercise sessions
per day or per week.
 Rest interval – time allotted for
recuperation between sets & sessions of
exercise.
 Duration – total time frame of a resistance
training program.
 Mode of exercise – type of muscle contraction,
position of the patient, form of exercise, arc of
movement, or the energy system utilized primary.
 Velocity of exercise.
 Periodization – variation in intensity & volume
during specific period of resistance training.
 Integration of exercise into functional activities
– use of resistance exercise that approximate or
replicate functional demand.
 TYPES OF
RESISTANCE
EXERCISES
CONSIDERATIONS FOR SELECTION OF
MODES(type) OF RESISTANCE EXERCISE

 Cause & extent of primary & secondary

impairments
 Deficits in muscle performance

 Stage of tissue healing

 Condition of joints & their tolerance to compression

& movement
 General physical & cognitive ability of patient

 Availability of equipments

 Patient’s goal

 Intended functional outcomes of the program

MANUAL & MECHANICAL
RESISTANCE EXERCISE
Manual resistance exercise –
 Type of active resistive exercise where resistance
is applied manually by therapist, other professional
or self (by patient).
 Resistance cannot be measured quantitatively but
useful in early stage of exercise training.
 Also useful when joint ROM needs to be carefully
controlled.
 Amount of resistance is limited to therapist strength
Mechanical resistance exercises –

 Type of active resistive exercise where resistance

is applied through the use of equipments or
mechanical apparatus.
 Amount of resistance can be measured
quantitatively & increased progressively.
ISOMETRIC EXERCISES (STATIC)
 Static form of exercise in which muscle contracts &
produces force without appreciable change in
length of muscle & without visible joint motion.
 No mechanical work done but measurable amount
of tension & force are produced.
 Sources of resistance –
 Holding against force applied manually
 Holding weight in particular position
 Maintaining position against resistance of body weight
 Pushing or pulling immovable objects
RATIONAL & INDICATIONS

 To prevent or minimize muscle atrophy due to

external immobilization
 To activate muscle to begin to re-establish
neuromuscular control but protect healing tissues
when joint movement is not advisable (post
surgical)
 To develop postural or joint stability
 To improve muscle strength when dynamic activity
is not permissible
TYPES: there are three types of isometric exercises
 Muscle setting exs –
 Involve low intensity isometric contractions performed against
little or no resistance.
 To decrease muscle pain, promote relaxation & circulation
 Stabilization exs –
 Used to develop a sub-maximal but sustained level of
contraction to improve postural or dynamic stability of a joint by
means of mid-range isometric contraction against resistance in
antigravity & weight bearing position.
 Multiple angle isometrics –
 System of isometric exs where resistance is applied manually
or mechanically at multiple joint positions within available ROM.
CHARACTERISTICS & EFFECTS
 Intensity of muscle contraction –
 Amount of tension generation depends on joint position &
length of muscle fibers during contraction.
 60-80%
 Duration of muscle activation–
 Hold for 6-10secs, post 10secs fatigue.
 Sufficient time to develop peak tension & metabolic changes
 Repetitive contractions –
 Repetitive contractions hold for 6-10secs – decrease muscle
cramping & increase effectiveness of isometric regimen.
 Joint angle & mode specificity –
 Gain in muscle strength occur only at or closely adjacent to
the training angle.
 Precautions –
 Should be pain free
 Avoid breath holding

 Contraindications –
 High intensity isometrics should be avoided in cardiac
& vascular diseases.
DYNAMIC EXS – CONCENTRIC &
ECENTRIC
 A muscle causes joint movement and excursion of a body
segment through two unique contraction types—concentric or
eccentric.
 The term concentric exercise refers to a form of dynamic
muscle activation in which tension develops and physical
shortening of the muscle occurs as an external resistance is
overcome by internal force, as when lifting a weight.
 In contrast, eccentric exercise involves dynamic muscle
activation and tension production that is below the level of
external resistance so that physical lengthening of the muscle
occurs as it controls the load, as when lowering a weight.
 During concentric and eccentric exercise, resistance can be
applied in several ways:
constant resistance, ( body weight, a free weight, or a
simple weight-pulley system)
a weight machine or elastic bands (variable resistance) or
an isokinetic device that maintains the velocity of limb
movement.
RATIONALE
 Concentric contraction accelerate body segment
whereas eccentric contraction decelerate body
segment.
 Combined action is evident in countless daily
activities.
 Eccentric contraction –
 Acts as a source of shock absorption during high impact
activities.
 Essential component of rehabilitation & conditioning
program to reduce risk of muscle injury or re-injury.
 Plyometrics (stretch shortening drills)/ fast velocity,
eccentric isokinetic training – prepare patient for high
demands of activities.
DYNAMIC EXS – CONSTANT &
VARIBLE RESISTANCE
 The most common system of resistance training
used with dynamic exercise against constant or
variable resistance is progressive resistance exs.
(PRE)
 Dynamic constant external resistance exs (DCER)
–
 Resistance training where limb moves through a ROM
against constant external load, provided by free weights
like weight cuffs, Pulley system.
 Contracting muscle is challenged maximally at only one
point of ROM, where maximum torque of resistance
matches torque output of muscle.
 Variable resistance exercise –
 Specially designed resistance equipments imposes
varying levels of resistance to contracting muscle to
load the muscle more effectively at multiple points in
ROM. Eg with elastic tubes or bands.
 Performed against manual resistance, a skilled therapist
can vary the force applied to the contracting muscle
throughout the ROM.
ISOKINETIC EXERCISES
 It s a form of dynamic exs in which velocity of
muscle shortening or lengthening & the angular
limb velocity is predetermined & held constant by a
rate limiting device known as isokinetic
dynamometer.

 Characteristics –

 Constant velocity: Fundamental to the concept of isokinetic

exercise is that joint angular velocity is preset and controlled by the
unit and remains relatively constant throughout the ROM. Due to limb
inertia, there is usually a short period at the start and end ranges of
exercise motion where angular velocity is not constant.

 Range & selection of training velocity: Isokinetic

dynamometry affords a wide range of exercise velocities.Training
velocities are classified as slow, medium, and fast. This range
provides a mechanism by which a patient can prepare for the
demands of functional activities. The faster training velocities are
similar to the velocities of limb movements inherent in some
functional motor skills such as walking or lifting. The training velocities
 selected may also be based on the mode of exercise (concentric or
eccentric) to be performed.

 Reciprocal versus isolated muscle training: One advantage

of isokinetic dynamometry is the ability to provide resistance to
opposing muscle groups at a joint, referred to as reciprocal training.

 Specificity of training(speed specific): isokinetic exercise

tends to be velocity specific, patients typically exercise at several
velocities (between 90°and 360° per second) using a system of
training known as velocity spectrum rehabilitation.

 Compressive forces on joints: During concentric exercise

the compressive forces across the moving joint are lower at faster
angular velocities than they are at slower velocities.
 Accommodation to fatigue: the contracting muscle fatigues,
the patient is still able to perform additional repetitions at the constant
velocity even though the force output of the muscle is diminishing.

 Accommodation of painful arc: If a patient experiences

transient pain at some portion of the arc of motion during exercise
and uses less force to move through that arc, isokinetic training
accommodates by reducing the external resistance applied to the
limb. If the patient stops a resisted motion because of the sudden
onset of pain, the external resistance is eliminated as soon as the
patient stops pushing against the torque arm of the dynamometer.
 Training effects & carryover function –

 Improves one or more parameters of muscle

performance.
 Isolate single muscle or opposite muscle group
 Involves movement of single joint
 Uniplanar movement
 Does not involve weight bearing.
 Special considerations –

 Availability
of equipments
 Appropriate set up
 Accommodation to painful arc
OPEN CHAIN & CLOSED CHAIN EXS
 Functional activities & exs are commonly
categorized as having weight bearing or non weight
bearing characteristics.
 Also called as “open or closed kinetic chain” &
“open or closed kinematic chain”.
 Open kinetic chain refers to completely unrestricted
movement in space of a peripheral segment of the
body. (waving the hand, swinging the leg)
 Closed kinetic chain movements – peripheral
segment meets with the considerable external
resistance. One joint motion is always accompanied
by adjacent joint motions.
 OPEN CHAIN EXS CLOSED CHAIN EXS

Distal segment moves in space Distal surface fixed on stationary

support
Independent joint movement Interdependent joint movements

Movement of body segment distal to Movement of body segment distal &/or

the moving joint proximal to the moving joint
Muscle activation occurs in prime Muscle activation of multiple joint
Movers muscles
Performed in non weight bearing Performed in weight bearing position
position (typical) (typically but not always)
Resistance is applied to the moving Resistance is applied simultaneously to
distal segment multiple moving segments
Use of external rotary loading Use of axial loading

External stabilization usually required Internal stabilization by means of

muscle action, joint compression, etc.
GENERAL PRINCIPLES
OF
RESISTANCE TRAINING
EXAMINATION & EVALUATION
 Thorough examination of patients (history, system
review, selected tests & measurements)
 Determine qualitative & quantitative baseline
parameters (strength, endurance, ROM)
 Implement testing procedures (MMT, RM,
dynamometry, goniometry, level of disability)
 Interpret the findings

 Establish plan of care integrating resistance exs

 Periodical re-evaluation.
PREPARATION
 Select & prescribe form of resistance exs that are
appropriate & expected to be effective.
 If using mechanical resistance, determine what
equipment is needed & available.
 Review the anticipated goals & expected functional
outcomes
 Explain the exs plan & procedures.
 Let the patient were nonrestrictive clothing &
supportive shoes appropriate for exs.
 Select firm but comfortable support surface
 Demonstrate each exs & desired movement
pattern.
APPLICATION
 Warm up – (5-10mins, non resisted exs)
 Placement of resistance –
 Typicallyon distal end of segment
 May be applied across intermediate joint
 Revise placement if pressure is uncomfortable

 Direction of resistance –
 Concentric exs – opposite direction
 Eccentric exs – same direction

 Stabilization –
 Necessary to avoid unwanted or substitute motion
 Non weight bearing – proximal stabilization
 Weight bearing – muscle control
 Intensity of exs / amount of resistance –
 Initially minimal load; progress slowly
 Volume / no of reps & sets & rest intervals –
 Generally, 8-12reps with moderate load; followed by rest
 For progression initially increase no of reps & sets then
increase resistance
 Verbal / written instructions –
 Use simple instructions that are easy to understand
 Avoid medical terminologies
 Monitoring the patient –
 Before, during & after exs
 Cool down –
 Rhythmic, unresisted movements
PRECAUTIONS
 Select ambient room temperature
 Select clothing that facilitate heat dissipation
 Exs should be pain free
 Initiate with low loads/ avoid high intensity
 Do not apply pressure to unstable joint or distal to fracture site
 Avoid valsalva maneuver
 Avoid uncontrolled ballistic movements
 Prevent incorrect or substitute motion
 Avoid exercise that put excessive, unintended secondary
stress on body
 Be aware of medications a patient is using
 Avoid fatigue
 Discontinue exs if pt experience pain, dizziness or unusual
shortness of breath
 Prevent pathological fractures
CONT…
 Overtraining –
 Declined physical performance in healthy individuals
participating in high intensity, high volume strength
training program.
 Other terms are chronic fatigue, staleness, burnout
 Due to inadequate rest intervals, too rapid exs
progression, inadequate diet & fluid intake.
 Preventable, reversible phenomenon
 Overwork –
 Termed as overwork weakness
 Progressive deterioration of strength in muscles already
weakened by nonprogressive neuromuscular disease
 Prevention is better than cure
CONT…
Exs induced muscle soreness –
 Acute muscle soreness –
 During or directly after strenous exs
 Delayed onset muscle soreness (DOMS) –
 DOMS begins to develop 12-24hrs after the cessation
of strenuous activity; intensifies & peaks 24-48hrs later
 Can be prevented by gradual progression of intensity &
volume of resistance; warm up & cool down; slow
stretches before & after exs
CONTRAINDICATIONS
 Acute inflammation / acute disease
 Pain

 Severe cardiopulmonary disease

SKELETAL MUSCLE
FUNCTION
&
ADAPTATION TO
RESISTANCE
EXERCISE
 FACTORS INFLUENCING TENSION GENERATION IN
NORMAL SKELETAL MUSCLES

FACTOR INFLUENCE

Cross section & muscle Larger ms diameter – greater tension producing capacity
Size

Fiber length & •Short fibers (pinnate/multipinnate) – high force

arrangement producing capacity (quads, deltoid, gastrocnemius)
•Long parallel fibers –high rate of shortening; less force
production (sartorius)

Fiber type distribution •High % type I – low force production,fatigue resistant

•High % type II – rapid high force production & fatigue

Length tension Greater tension is produced near or at physiological

relationship resting position during contraction
CONT…

FACTOR INFLUENCE

Motor unit Greater no & synchronization of motor unit firing –

recruitment greater force production

Frequency of motor Higher frequency of firing – greater the tension

unit firing

Type of muscle Force output from greatest to least : eccentric,

contraction isometric, concentric muscle contraction

Speed of muscle Concentric contraction - ↑speed - ↓tension

contraction Eccentric contraction - ↑speed - ↑tension
ADDITIONAL FACTORS
 Energy store & blood supply –
 Adequate energy source is needed to contract, generate
tension & resist fatigue.
 3 main energy systems are :
 ATP-PC system
 Anaerobic/glycolytic/lactic acid system
 Aerobic system

 Fatigue – complex phenomenon affecting muscle

performance.
 Muscle (local) fatigue – the diminished response of muscle
to a repeated stimulus-is reflected in progressive decrement in
amplitude of motor unit potential.
 Cardiopulmonary (general) fatigue – diminished response
of an individual as a result of prolonged physical activity.`
CONT…
 Recovery from exs –

Adequate time of recovery from fatiguing exs must be
built

Both inter-session & intra-session
 Age –
 Muscle performance changes through out the life span.
 Psychological & cognitive factors –
Positive or negative influence
 Attention
Patient must focus on given task to perform it correctly
 Motivation & feedback-
PHYSIOLOGICAL ADAPTATIONS TO
RESISTANCE EXS

VARIABLE STRENGTH TRAINING ADAPTATION

Skeletal muscle •Hypertrophy of muscle fiber (more in type II)

structure •Hyperplasia of muscle fibers
•Fiber type composition: remodelling (type IIB to
IIA; no change in type I)
• Capillary bed density - ↓ or no change
•Mitochondrial density & volume: ↓
Neural system •Motor unit recruitment: ↑
•Rate of motor unit firing: ↑(↓twich contraction
time)
•Synchronization of firing: ↑
Metabolic system •ATP & CP storage: ↑
•Myoglobin storage: ↑
•Stored triglycerides: not known
 VARIABLE STRENGTH TRAINING ADAPTATION

Enzymes •Creatine phosphokinase: ↑

•Myokinase: ↑

Body composition •Lean body mass: ↑

•% body fat: ↓

Connective tissue •Tensile strength of tendons, ligaments &

connective tissue: ↑
•Bone: ↑BMD; no change or possible ↑ in bone
mass
 MANUAL
RESISTANCE
EXERCISES
DEFINITION

 Manual resistance exs is a form of active resistive

exs in which resistance force is applied by the
therapist to either a dynamic or static muscular
contraction.
ADVANTAGES
 Most effective during early stage of rehabilitation
 Effective during transition from assisted to
mechanically resisted movements
 More finely graded resistance

 Resistance can be adjusted throughout ROM

 Muscle works maximally at all portions of ROM

 Joint ROM can be carefully controlled

 Useful for dynamic & static strengthening

 Manual stabilization prevents substitute motions

 Can use variety of patient positions

 Placement of resistance can be easily adjusted

DISADVANTAGES
 Exs load is subjective; cannot be measured to
document
 Amount of resistance will be limited to the strength
of therapist
 Little value to strong muscle group

 Speed of movement is slow to moderate

 Cannot be performed independently by the patient

 Not useful in home program

 Labor- & time- intensive for therapist

 Impractical to improve muscle endurance

GUIDELINES
 Body mechanics of the therapist –
 Table/patient bed height
 Position close to patient
 Wide standing
 Application of manual resistance & stabilization
 Stabilize proximal attachment
 Vary resistance through out ROM
 verbal commands –

Coordinate timing of verbal commands with resistance
application

Simple, direct commands
 No of reps & sets; rest intervals –
 No depends on patient’s response & therapist strength
 Adequate rest interval after 8-12 reps
TECHNIQUE
 For eccentric contraction, direction of limb
movement would be opposite .
 Involves non weight bearing positions & isolate
individual muscle or muscle group
 Variation in therapist position, hand placement or
alternate patient position may be necessary
depending on size & strength of therapist & patient.
 Opposite motions are often alternately restricted
where strength & balanced neuromuscular control
in both agonist & antagonist are desired.
MECHANICAL
RESISTANCE
EXERCISE
 Mechanical resistance exercise is any form of
exercise in which the resistance is applied by
means of some form of exercise equipment.

 Integral
component of rehabilitation & conditioning
program.
ADVANTAGES
Establish quantitative baseline measurement– improvements
can be monitored.
Most appropriate in intermediate & advanced phases of
rehabilitation (muscle strength ≥4/5 or ≥therapist strength)
Increase in level of resistance can be incrementally
&quantitatively documented.
Quantitative improvement – effective source of motivation for
patient.
Useful for improving static & dynamic muscle strength.
Adds variety to resistance training program.
Some equipments provide variable resistance throughout the
ROM.
High velocity resistance training is possible & safe.
Appropriate for independent home exercise program.
DISADVANTAGES
 Not appropriate when muscles are very weak or
early stage of soft tissue healing (exception –
equipments that provide assistance, support or
control against gravity.)
 Equipment that provide constant external
resistance maximally loads the muscle at only one
point in ROM.
 No accommodation for painful arc (except with
hydraulic, pneumatic or isokinetic equipment).
 Expenses for purchase & maintenance of
equipment.
 With free weights & weighing machine, gradation
depends on manufacturer's increments of
resistance.
 Use in rehabilitation –
 To eliminate or reduce deficits in muscle strength,
power & endurance caused by an array of pathological
conditions.
 To restore or improve functional abilities.

 Use in conditioning –
 Important component of comprehensive conditioning
program to improve or maintain physical fitness &
health through out most of the lifespan.
GUIDELINES IN CONDITIONING PROGRAM FOR
HEALTHY ADULTS
Prior to training, warm up followed by flexibility exs
Perform dynamic muscle exs targeting major muscle
groups of body for total body fitness.
Balance flexion & extension dominant (pulling /
pushing)exs; concentric & eccentric (lowering / lifting)
exs.
Use full, available, pain free ROM.
Use moderate intensity (8-10reps; 1-3sets; 2-3min rest
interval.)
Use slow, moderate speed, rhythmic, controlled, non-
balliastic movements.
Exercise should not interfere normal breathing.
Frequency – 2-3times/wk
Increase intensity gradually
Cool down after completion of exercises.
CHILDREN & RESISTANCE TRAINING
Questionable….
Now evidence states that children do achieve health
related benefits & so can safely engage in supervised
weight training program.
Resistance by using body weight or equipments
designed specifically for children are safe.
Guidelines :-
 No training below 6-7 yrs age
 Start without weights then with light weights
 Close & continuous supervision
 Focus on proper form, technique & safety
 Emphasize low intensity, short duration, play oriented exs with
low exercise loads & frequency 2-3/wk
 Use warm up & cool down exs
 Initial progression by increasing reps & not resistance.
OLDER ADULTS & RESISTANCE TRAINING
 Major goal is to maintain or improve level of
functional independence & reduce risk of age
related diseases.
 Improves muscle strength, balance, speed of
walking, ability to rise in chair & minimize risk of fall.
 Guidelines :-
 Secure approval from physician
 Close supervision with vital parameters monitoring
 5-10 mins warm up
 Begin with low intensity, low repetitions exs
 Throughout avoid high resistance exs
 Frequency: 2-3 times/wk
SELECTED RESISTANCE
TRAINING PROGRAM
 PROGRESSIVE
RESISTANCE EXERCISE
 PRE is a system of dynamic resistance training with
constant external load to contracting muscle by
some mechanical means & incrementally
increased.
 RM (repetition maximum) – basis for determining &
progressing the resistance.
 Beneficial in variety of pathological conditions
(muscle injuries, osteoarthritis, osteoporosis,
hypertension, diabetes, COPD, etc)
 Various regimens are:-
 Delorme
 Oxford
 Macqueen
 DAPRE
DELORME REGIMEN
 Introduced around 1945
 Originally known as heavy resistance training &
later as load resisting exercise to describe system
of strength training.
 Uses 3sets of 10 RM with progressive loading
during each set.
 It builds a warm up period into the protocol
 Incorporate rest intervals between sets,
incrementally increase the resistance over time &
there is training induced strength gain over time.
SETS REPETITIONS AMOUNT OF RESISTANCE

1 10 50% of 10 RM

2 10 75% of 10 RM

3 10 100% of 10 RM
OXFORD REGIMEN
 Zinovieff regimen
 Regressive loading in each set

 Diminishes the resistance as the muscle fatigues

 Incorporate rest intervals between sets,

incrementally increase the resistance over time &
there is training induced strength gain over time.

AMOUNT OF
SETS REPETITIONS
RESISTANCE
1 10 100% of 10 RM

2 10 75% of 10 RM

3 10 50% of 10 RM
MAC QUEEN REGIMEN
AMOUNT OF
SETS REPETITIONS
RESISTANCE

1 10 100% of 10 RM

2 10 100% of 10 RM

3 10 100% of 10 RM

4 10 100% of 10 RM
DAPRE REGIMEN
 Dailyadjustable progressive resisted exercises
 More systematic & takes into account the different
rates at which individuals progress during
rehabilitation or conditioning program.
 Based on 6RM working weight

SETS REPETITIONS AMOUNT OF RESISTANCE

1 10 50% 6RM
2 6 75% 6RM
3 Max possible 100% 6RM
4 Max possible 100% of adjusted working weight
CIRCUIT WEIGHT TRAINING
Pre-established sequence(circuit) of continuous exercise
is performed in succession at individual exs stations that
target variety of major muscle groups for total body
conditioning.
Exs performed at an exs station for a specified no of
repetitions & sets (high reps, low intensity), minimum
amount of rest interval (15-20secs)
Progression is by increasing no of sets or reps, the
resistance, no of exs stations, or no of circuit revolution.
Exs order is important consideration; exs should
alternate among UL, LL, trunk to minimize fatigue.
Large muscle groups before small muscle groups;
multijoint exs before isolated muscle group.
Eg. Bench press→leg press/squats→sit ups →upright
rowing →hamstring curl →shoulder press →heel raise
→push ups →leg lifts or lowering.
PLYOMETRIC TRAINING
 “Plyometric training” / “stretch shortening drill” /
“stretch strengthening drill” is a system of high
velocity training characterized by rapid eccentric
contraction during which the muscle elongate
immediately followed by rapid reversal of
movement with a resisted shortening contraction of
same muscle.
 Amortization phase – period between stretch &
shortening cycle; should be brief.
 Integrated into advanced phases of rehabilitation
to train neuromuscular system to react quickly.
 Source of resistance –body weight/equipment.
 Eg. Catching & throwing ball, dribbling the ball,
jumping forward or sideways, etc.
NEUROLOGICAL & BIOMECHANICAL INFLUENCE

Spring like property of ms

Stretch – shortening cycle
tendon

Create elastic energy

Stimulates proprioceptors
during eccentric contraction

Releases energy during

↑excitability of NM receptors
concentric contraction

Improves reactivity of NM
Augment force production
system
 Effects –  Precautions –
 Enhance physical  Don’t include if high
performance stress, shock absorbing
 Enhance muscle’s activities are not
dynamic restraint permissible.
capabilities  For children or
 ↓ LL injury incidence elderly do not include
high impact heavy
 Contraindications – load activities
 Inflammation  Patient should have
 Pain adequate flexibility
 Joint instability & strength
 Progression –  Warm up & cool down
 Speed of drill  Teach safe techniques
 Intensity  Allow adequate time
of recovery (48-72hrs)
 Repetitions & frequency
 Stop if indicated
by patient
ISOKINETIC REGIMEN
 Should be performed at velocities that closely
match to velocity of specific movement of task.
 Generally medium or fast velocity

 Speed specific training

 Selection of velocity –
 Medium (60or90 -180 degrees)
 Fast (180-360degrees)

 Repetitions, sets & rest –

 1-2 sets of 8-10 or maximum 20 repetitions of agonist &
antagonist muscle groups at multiple velocities
 15-20sec rest between sets; 60sec rest in exs velocity

 Intensity –
 Warm up followed by submaximal efforts.
 EQUIPMENTS FOR
RESISTANCE TRAINING
 Limitless selection of exercise equipments
 Range from simple to complex; compact to space
consuming; inexpensive to expensive
 Most equipments are load resisting but few are load
assisting to improve strength of weak ms.
 Can be used for static or dynamic exs, concentric
or eccentric exs, open or closed chain exs
 To improve muscle strength, power or endurance;
neuromuscular stability or control & cardio
pulmonary endurance
 Choice of equipment depends on –
 Individuals needs, abilities & goals
 Availability
 Costof purchase & maintenance
 Ease of use
 Versatality
 Space requirement
FREE WEIGHTS & SIMPLE PULLEY SYSTEM
 Graduated weights or applied to extremities or trunk
 Dumbbells, barbells, weighted ball, cuff weights,
weighted vest, sand bags, simple weight pulleys
 Can be used for home exs program

 Can be used in various positions

 Can be used isometric/dynamic exs, weight bearing

& non weight bearing exs
VARIABLE RESISTANCE MACHINE
 Falls in 2 broad categories as :-
 Specially designed weight cables (weight pulley) –
same ms group contracts concentrically & eccentrically;
exs at slow velocity.
 Hydraulic &pneumatic units – concentric work of
agonist & antagonist; no eccentric work; safe at fast
velocities; allow to accommodate pain free arc.
 Advantages –
 Muscle is loaded maximally at multiple points
 Isolate & exs a specific muscle group
 Mostly allows single plane movements; new
machines dual axis movements
 Provides external stabilization to guide or
limit movements
 Disadvantages – initial expenses & maintenance
cost
ELASTIC RESISTANCE BANDS & TUBING
Use is widespread in rehabilitation; effective method of
providing resistance (variable resistance).
Two broad categories as elastic bands (available in
various grades & thickness) & tubes (in graduated
diameters & wall thickness)
Color coding denotes grade of resistance.
Selection should be based on thickness of material
(level of resistance)
Length should be sufficient to attach at both ends & not
taut at the beginning of exercise.
One end should be secured on firm surface & other end
grasped or tied to limb segment.
Progression - ↑ no of reps with same resistance or using
higher grade of elastic band or tubing.
 Advantages –
Portable
Relatively inexpensive
Resistance is not significantly gravity dependant
Safe to exs at moderate to fast velocities

 Disadvantages –
Difficult to determine which grade to start with & to what
extent changing grade of band or tubing changes level
of resistance.
No source of stabilization
 Effects of material fatigue are small, still should be
replaced on a routine basis to ensure patient safety.
Some products contains latex; eliminate use if allergy
to latex.
EQUIPMENTS FOR CLOSED CHAIN TRAINING
 Body weight resistance–multipurpose exs system
 Uses glide board that can be inclined at various angles
 Enables to perform unilateral or bilateral activities

 Balance boards (wobble board)–

 Proprioceptive training in UL & LL
 Slide boards –
 Moving platform that slides side to side
 Mini trampolines –
 Begin gentle, bilateral or unilateral bouncing activities on
resilient surface
RECIPROCAL EXERCISE EQUIPMENTS

 Strengthens multiple muscle groups at multiple

joints
 Appropriate for low intensity, high reps resistance
training to increase muscular endurance &
reciprocal coordination of UL, LL & improve
cardiopulmonary fitness.
 Often used in warm up & cool down.

 Variety of equipments are –

 Stationary exs cycle
 Portable resistive reciprocal exs unit
 Stair stepping machine
 Elliptical trainers
 Upper extremity ergometer
EQUIPMENTS FOR DYNAMIC STABILIZATION
TRAINING

 Swiss ball –
Usually 20-30inches in diameter
Used for variety of trunk & extremities stabilization

 Body blade –
Dynamic, reactive form of resistance exs that use
principle of inertia as the source of resistance to
produce dynamic stability.
ISOKINETIC TESTING & TRAINING EQUIPMENTS
Provides accommodating resistance during
dynamic exs of extremities or trunk.
 The equipment supplies resistance proportional to
the force generated by person using machine.
 Features –
 Computerized testing capability
 Passive & active modes that permit open chain,
concentric & eccentric testing & training
 Adjustable velocity settings
 Used even for CPM
 Allows limb movement in specific joint range
 Single joint uniplanar movements are common but
some multiplanar movements are possible.