Intro to resisted exercise testing + prescription in rehab

Benefits of resisted exercise

Hlth benefits do not require heavy lifting.

• Glucose homeostasis

• Body composition

• Cardioresp fxn

• Cognition

• Mm strength

• Mitigate decline in mm mass

• Mobility

Helps manage hlth conditions/injuries

Components of muscular fitness

1. Endurance

2. Strength

3. Power

Developed thru resisted exercise

Physiological Adaptations from resisted exercise

• ↑ BMR, bone mineral density, insulin sensitivity, lean mass, mood

• ↓ CV risk factors, cholesterol, cognitive decline

1st line, best practise rx for MSK/pain?

EXERCISE!

• ↑ strength, fx

• Less pain

DeLorme Protocol

Find 10RM

Do 3 × 10 reps

• 1st: 50% 10RM

• 2nd: 75% 10RM

• 3rd: 100% 10RM

Once can do > 10 reps on 3rd set, ↑ load

Used for WW2 soldiers

Disuse Mm Atrohpy

Episodes of inactivity/mm disuse after sick/injured = mm size loss

• MM atrophy

• Recover quickly if young and already do strengthening exercises

Initially fast, then decreases over time

DIFFERS btwn mm groups

ICU - Most mm loss

Rapid mm wasting due to…

Critical illness

Sepsis

Burn

End stage renal disease

Chronic mm wasting conditions

Rheumatoid arthritis

Renal failure

T2DM

COPD

CVD

Age related mm loss

Sarcopenia

What can mitigate disuse mm atrophy strength & fxn loss?

Resisted exercise when implemented before, during and after episodes of disuse

Repetition Continuum Theory

Resisted exercise producing fatigue in specific rep ranges elicits specific characteristics

• Low rep ranges= strength

• Mod rep ranges = hypertrophy [↑ size of mm]

• High rep ranges = endurance

Revised repetition continuum theory

Current evidence in most healthy adults supports

• low rep ranges = strength

Low, mod, high rep ranges = hypertrophy

• NOT LOAD-DEPENDENT!

High rep ranges= endurance

*Don’t have to use strength prescription to elicit hypertrophy

FITT-VP Principle

Frequency prescription for adaptations

Newbies: >1x/wk is enough. Need recovery for adaptations; interdependence of FITVP

Experienced: 2-3x/wk. When weekly volume is =, no diff in mm fitness seen.

Intensity prescription for adaptations

Objective: RM, RM Range

Subjective: RPE, RIR

Clinically include both objective + subjective when prescribe.

Rep Max

Max load for 1 rep while maintaining standardized technique.

1 RM Test or predict thru Multiple RM test

1RM Pros/cons

P: valid, reliable, good for healthy

C: training needed, high motivation, risk of injury, account for daily changes, most responsive to training @ low rep ranges

Multiple RM Pros/cons

P: low injury risk, less motivation, ideal for compromised ppl

C: risk overestimation, most responsive to train @ multiple rep ranges

Rep Max Ranges

Max load lift within specific ranges or reps w/ standardized technique

• Endurance: 12-20 RM range

• Strength: 8-12 RM range

• Power: > 12 RM range

Fatigue within this range

RPE

Familiarize patient w/ scale sensation w/anchoring

10/10 RPE = can’t complete another rep w/ good technique

RIR

• Estimate remaining reps be4 failure

• Client must be familiar w/ failure.

Failure

Temporarily cannot continue resisted exericse w/ standardized technique

Induces neuromsk fatigue, mm damage, discomfort

Discontinue resisted exercise be4 failure = GREATER improvements in strength, hypertrophy, power.

• 1-2 RIR good for healthy ppl

• 3 RIR for inexperienced ppl

Single vs Multi-joint Exercises → Type

Single joint: OKC, few mm activation, simple neuromotor control

Multiple joint: CKC, many mm activated, complex neuromotor control

Consider order of exercises: do multi be4 simple

Volume prescription recommendations

Newbies: > 1 set is enough!

Experienced: graded dose-response relationship btwn # weekly sets and mm fitness (hypertrophy)

Amount of rest btwn sets

More intense exercise, MORE REST

Periodization

Planned manipulation of exercise prescription variables

• i.e. intensity, volume to maximize physiologic adaptations

Greater effect on strength vs. non-periodized programs

Linear periodization progresses from high vol/low intensity to low volume/high intensity

Unilateral Resisted exercise

Increases contralateral strength by up to 8%

Centrally mediated neuromuscular mechanism

@ what age does significant strength loss occur?

50 (5%/yr)

Fxn AT strength limits > 1RM living

To minimize strength loss, start resisted exercise early and keep at it

Key factors to consider when prescribe exercise

Client

Goals: endurance, strength, power