Rehab Exercise Science

Why is understanding the underpinning science important for rehabilitation exercise programming?

To provide effective, individualized conditioning programs and exercises.

What is the mortality improvement seen with Cardiorespiratory (CR) training?

400% improvement.

What is the mortality improvement seen with Resistance Training (RT)?

250% improvement.

How much VO2max is lost per day without training?

1%.

What is the maximum possible increase in VO2max?

25%.

What is the primary energy currency for muscular work?

ATP (Adenosine Triphosphate).

How much ATP is typically stored in a muscle?

Around 85g.

How is ATP rebuilt after depletion?

Using energy from food to rebuild ADP (Adenosine Diphosphate) to ATP.

How can mental fatigue or shift work impact a patient's willingness to complete their Home Exercise Program (HEP)?

It can decrease glucose stores, which reduces their desire to complete the HEP.

Name the three main energy systems.

Alactic (ATP-PCR/ATP CRP), Lactic (Anaerobic Glycolytic), and Aerobic (Oxidative).

What is the primary fuel source for the Alactic (ATP-PCR/ATP CRP) energy system?

Phosphocreatine.

What is the typical duration of activity supported by the Alactic energy system?

0-6 seconds.

How long does it take to recover 50% of Alactic (ATP-PCR) stores?

30 seconds.

How long does it take to recover 100% of Alactic (ATP-PCR) stores?

3-5 minutes.

What enzyme is involved in breaking down phosphocreatine to help rebuild ATP?

Creatine kinase.

What is a potential benefit of creatine supplementation related to the brain?

It can increase brain health.

What is the primary fuel source for the Lactic (Anaerobic Glycolytic) energy system?

Carbohydrates (glucose).

What causes the "burning sensation" in muscles during intense exercise?

Increased hydrogen ions in the muscles, which also increases lactate.

How is lactate measured in the body?

By blood testing.

What is considered the anaerobic threshold in terms of lactate levels?

Anything between 2-4 mM of lactate.

What is the typical duration of activity supported by the Lactic energy system when going "full out"?

30-60 seconds.

How long does it typically take for the body to recover from the effects of the Lactic energy system (flush out hydrogen ions)?

45-60 minutes.

What is EPOC, and how does it relate to the Lactic system?

EPOC (Excess Post-exercise Oxygen Consumption) involves an increased heart rate and pumping to remove excess hydrogen by converting it into water, aiding recovery from lactic acid buildup.

What happens if a person goes lactic too early during training?

It will cause the next 45-60 minutes of training to be in a hydrogen deficit, decreasing performance/training.

What are the primary fuel sources for the Aerobic (Oxidative) energy system?

Fats (free fatty acids) and proteins (amino acids).

How much ATP is typically produced by the Aerobic energy system?

36-39 ATP.

Name two key processes involved in the Aerobic (Oxidative) energy system.

Kreb's cycle and the Electron Transport Chain (ETC).

What happens in the Kreb's cycle?

Carbon, hydrogen, and oxygen are stripped, and CO2 output increases.

Where is energy primarily produced in the Aerobic system?

In the Electron Transport Chain (ETC).

Why do fats require a lower intensity to be used as fuel compared to carbohydrates?

Fats have less oxygen per carbon, meaning you have to work at a lower intensity to use them for fuel.

When is the most fat typically burned?

At resting (Basal Metabolic Rate - BMR).

Describe the Beta Oxidative system.

It's the system that processes fat for energy; fat has a lot of energy but is metabolized the slowest because this system is the slowest and longest.

What are the characteristics of Type Ia muscle fibers?

They are endurance muscles, suited for constant load and high reps, oxidative, burn fat and glucose, and are more energy efficient.

What are the characteristics of Type IIx muscle fibers?

They are anaerobic glycolytic, providing high power but having low energy stores.

What type of muscle fiber is considered "intermediate"?

Type IIa.

Which muscle fiber type can change its characteristics to match the training type?

Type IIax, though it will revert to its original characteristics if there is no stimulus.

What is a motor unit?

A single motor unit innervates its muscle fibers, and all fibers within that unit are of the same type.

Explain the "All or None" theory in relation to motor units.

If the neural potential is sufficient to activate a motor unit, then all the muscle fibers within that unit are activated.

What is Henneman's size principle?

It describes motor unit recruitment, stating that smaller motor units are recruited first, followed by larger ones.

What does a Myofascial Unit include?

Motor units, associated connective tissue, nerves (for muscular contraction input and movement perception), and blood and lymphatic vessels supplying the area involved.

Name the contractile elements of muscle.

Actin and myosin.

What are the series elements of muscle, and what do they include?

Tendons, specifically the Z discs of myofibrils.

What are the parallel elements of muscle?

Myofascia.

Name three types of muscle contractions classified by length change.

Concentric, Eccentric, and Isometric.

Name two types of muscle contractions classified by force.

Isokinetic and Isotonic.

Which type of muscle contraction produces the most force?

Eccentric.

Which type of muscle contraction produces the least force?

Concentric.

How does speed training affect the force-velocity curve?

It shifts the curve to the right.

How does strength training affect the force-velocity curve?

It shifts the curve upwards.

What are eccentrics important for in rehabilitation?

Shock absorbing/weight accepting functions, training overuse injuries, MMT Grade progression (2-3), and limb deceleration (e.g., gait).

What is a primary function of isometric contractions?

Stabilization functions.

What is a potential physiological effect of isometric contractions?

Increases Blood Pressure (BP).

What is a benefit of isokinetic contractions?

They can control velocity and limit the need for deceleration.

Define "Strength" in resistance training.

The maximal amount of force that can be developed in a single voluntary contraction.

Name four key terms related to resistance training outcomes.

Power, Muscle endurance, Hypertrophy (chronic & transient), and Strength (relative vs absolute).

What are the typical rep and rest ranges for training for "Strength"?

1-6 reps, with 3-6 minutes rest.

Why is a 3-6 minute rest period recommended for strength training?

To allow for recovery of the ATP-PCR energy system and the neural system.

What is the recommended recovery time after heavy strength training?

72+ hours.

What are the typical rep and rest ranges for training for "Power" with resistance?

1-5 reps with resistance, with 3-10 minutes rest.

When should one stop power training?

The second speed decreases.

What are the typical rep and rest ranges for training for "Endurance"?

12+ reps, with 30 seconds to 2 minutes rest.

Why are shorter rest periods used for endurance training?

To work primarily in the anaerobic glycolytic system and prevent the ATP-PCR system from being used.

What are the typical rep and rest ranges for training for "Hypertrophy"?

6-12 reps, with 30 seconds to 3 minutes rest.

What is the typical recovery time for Power, Endurance, and Hypertrophy training?

48-72 hours.

What is "Reps in Reserve" (RIR)?

A submaximal training approach where the goal is to achieve the same hypertrophic gains as training to failure, often used when training to failure is dangerous.

What is the benefit of Blood Flow Restriction (BFR) training?

BFR with light loads can produce hypertrophy gains similar to heavy resistance training without BFR, specifically for Type 1 muscle fibers.

How many sets are generally recommended for a beginner in resistance training?

1-2 sets.

How many sets are generally recommended for an intermediate lifter in resistance training?

6-12 sets.

What range of sets is considered optimal for resistance training?

Between 4-8 sets.

How is recovery typically considered in resistance training, and what else needs to be considered?

Typically per muscle group, but chronic training dose and weekly load also need to be considered.

What is the recommended training frequency for a beginner?

3-4 times per week.

What is the recommended training frequency for an intermediate lifter?

5-6 times per week.

What is the recommended training frequency for an advanced lifter?

7 times per week.

When can technical training be performed daily?

If it's not to failure and fatigue is low.

What is "Long Slow Distance" (LSD) training?

Performing an activity at a continuous slow pace for a long period, aiming to improve the efficiency of the oxidative system and limit the buildup of metabolic limiting products.

What is the basis of all metabolic conditioning?

Long Slow Distance (LSD) training.

Describe "Fartlek" training.

Also called "surging," it involves increases in intensity followed by periods of active recovery, with intensity determined by how the person feels.

What are "Intervals" in metabolic training?

Set distances covered in set times with calculated rest periods.

What is the typical work-rest ratio for intervals up to 200m?

1:3.

How does active recovery during intervals affect energy system usage?

It limits ATP-PCR recovery, shifting the work more towards the lactic/anaerobic glycolytic system.

What is High Intensity Intermittent Training (HIIT)?

It's an increased intensity form of interval training achieved by maximizing effort and decreasing rest periods.

Give an example of a common HIIT protocol.

Tabata: 20 seconds on, 10 seconds off, repeated 8 times.

How does Moderate Continuous Interval Training (MCIT) compare to HIIT?

MCIT takes longer than HIIT, but HIIT is more intense.

How is intensity measured using the RPE (Borg scale) for a layman?

On a scale of 1-10.

How is intensity measured using the RPE (Borg scale) when based on max HR?

On a scale of 6-20.

Describe the "Talk Test" for light intensity.

The individual can talk comfortably.

Describe the "Talk Test" for moderate to hard intensity.

The individual can answer questions but does not wish to hold a prolonged conversation.

Describe the "Talk Test" for very hard intensity.

The individual cannot answer questions and is out of breath.

How is Target Heart Rate (THR) calculated using the percentage of Predicted Max Heart Rate (PMHR) method?

THR = PMHR x Intensity (e.g., (220 - age) x Intensity%).

How is Target Heart Rate (THR) calculated using the Heart Rate Reserve (HRR) or Karvonen method?

THR = (PMHR - RHR) x Intensity + RHR (where RHR is Resting Heart Rate).