Strengthening Exercises: Resistance Exercise Types

Goals of Strengthening Exercises

1. increase muscular strength

2. increase endurance

3. increase power

4. increase agility

Types of Strength Exercises

Static: Isometric

Dynamic: Isotonic, Isokinetic

Open kinetic chain and Close kinetic chain

Isometric Exercises

• safe rehab starting point→ pt controls amount of tension in muscle

• gentle contractions w/in p! free limits

• Recommended 2-3× 8-10rep/set→ hold 6-10 sec/rep, 30-60 sec rest b/t sets

Isometric: Setting Exercise

• almost any muscles

• just contracting

• avoid or minimize muscle atrophy

• often used right after surgery

• ex. quad set

Isometric: Static Exercise

Push against wall, no motion

Isometric: multiangle exercise

• increase strength through full ROM

• contract and move up to hold, go higher, contract, hold

Cautions for Isometric Exercises

• make sure pt is breathing

• avoid valsalva maneuver→ holding breath increases BP and increases risk of CV damage

• count time out loud to make them breath

Isotonic Exercises

• during repair stage of healing

• better to improve strength→ use when you regain some strength + ROM

• Concentric and eccentric

• can use equipment or body weight to add resistance

Concentric vs. Eccentric

Con: shortening

Ecc: lengthening

• eccentric can produce greater force than concentric

• speed ratio= Ecc:Con 2:1

Isotonic Exercises and Rehab

• subacute (repair) phase

• concentric first, and then eccentric

• caution: no overtraining!

Isokinetic Exercises

• machine provides constant velocity→ you can’t push harder to go faster

• use in late (remodel) phase of rehab to increase functional activity

Benefit of Isokinetic machine

• maximal resistance is provided throughout the ROM bc the resistance moves only at the constant speed, regardless of force applied to it.

• Improves beginning and end strength bc working through entire ROM with same resistance throughout

Overload principle

• increase strength with progressive resistance exercise (PRE)

How?

• increase resistance/weight

• increase # of reps/sets

• increase time to complete exercise

Cautions with Overload principle

Too passive:

• no increase strength

• no increase functional activity

• bored w/ rehab and quit

Too agressive:

• increase p!

• increase swelling

• increase tissue damage

Strengthening principle: SAID

Specific Adaptation to Imposed Demands

• you get what you train for

• know goals

• optimal functional outcomes→ design exercise according to goals

Strengthening principle: SNAP

Specific Exercises

No Pain

Attainable Goals

Progressive Overload

DeLorme Watkins Protocol

• 3 sets x 10 reps at _% of 10 RM (50, 75, 100)

• 2 min rest b/t sets to prevent muscle fatigue

• might be more beneficial if want to improve more strength

Oxford Protocol

• opposite of DeLorme

• 3 sets x 10 reps at __% of 10 RM (100, 75, 50)

• 2 min rest b/t sets

• may prevent fatigue

DAPRE (Daily Adjustable Progressive Resistance Exercise)

• 4 sets x various reps at _% of 6 RM

• best with free weight or machine

DAPRE adjusted working weight table

Calculation of 1 RM

Predicting nRM from 1RM

Strength vs Endurance RM and reps

Strength: 90% 1 RM, 3-9 reps

Endurance: 70% 1 RM, 15-20> reps

Strength and Endurance: 70-90% RM, 6-12 reps

* at least 66% 1 RM for strength gain

Precautions to strengthening

• overtraining

• CV concerns

• Fatigue

• muscle substitution

• muscle weakness

• muscle soreness

• osteoporosis

Contraindications of strengthening

• acute inflammation

• severe muscle or jt p!

• severe cv disease