504

how we prescribe exercise

information from the patient, about the injury/condition, and goals of exercise

>10%

weekly increases in workload of ___ associated with increased injury risk

exercise progressions

increase volume, resistance/load, speed, ROM of motion

decrease ROM of motion

add leverage, displacement, multiple systems

change BOS

multidirectional

exercise regressions

decrease volume, resistance/load, ROM, speed, displacement

increase speed, ROM, BOS

begin 1 system at a time

unidirectional

compliance

therapist led, numbers are more important than intent, used in research settings

adherence

long term behaviour change, intent more important than numbers, collaborative, real world setting

WHO 5 dimensions of adherence

condition, patient, intervention, therapist, societal factors

condition factors

pain, level of disability, symptom variability (change day to day), specificity of exercise

patient factors

confidence with exercise, motivation, and understanding

intervention factors

time, equipment, location, enjoyment (habit stacking)

therapist factors

therapeutic relationship, empathy, trust, availability, touch

societal factors

privilege, access, economics, diversity

<10 seconds

creatine phosphate: stored within cell, 1:1 trade off of ATP that fuels for _______

<90 seconds

Anaerobic glycolysis: glucose/glycogen > pyruvate > lactate and H+ = 2-3 ATP

>1-2 minutes

oxidative system: krebs cycle, electron transport chain; occurs in mitochondria and needs O2 = 36 ATP

obesity, myopathy, detraining

conditions that affect aerobic metabolism at the muscle level

occlusive, autonomic, dysfunction

conditions that affect aerobic metabolism at the peripheral circulation

CAD, heart failure, other HD, anemia

conditions that affect aerobic metabolism at the heart and blood

PPH, thrombo-embolic, 1st and 2nd PVD

conditions that affect aerobic metabolism at the pulmonary circulation

obstructions, restrictions, infiltrative, chest wall

conditions that affect aerobic metabolism at the lungs

increase in myocardial contractility, SV and CO

acute CV response during max aerobic exercise

lactate threshold

intensity of exercise at which lactate begins to accumulate in the blood faster than it can be removed

ventilatory threshold

intensity of exercise at which ventilation starts to increase at a faster rate than VO2

anaerobic threshold

point during exercise that your aerobic metabolism no longer meets the body’s energy demand and begins to rely on anaerobic metabolism (lactate/ventilatory threshold)

CV response to dynamic vs static exercise

dynamic = more heart related changes (CO, HR, SV)

static = more vascular related changes (peripheral resistance, SBP, DBP, MAP)

valsalva maneuver

loads greater than 80% 1RM; increased intra-thoracic pressure helps stabilize the spine; exaggerates blood pressure response

cerebrovascular disease, CV disease, hernias

avoid the valsalva maneuver with these populations

>160/90

shouldn’t start exercise if BP is higher than

>250/115mmHg, >10mmHg

should stop exercise if BP is higher than ___, or SBP drops ___

CV changes associated with bed rest

reduced plasma volume, RBC mass, peripheral O2 diffusing capacity, blunted vasodilation function, and cardiac atrophy

higher

bed rest study found that subjects with a ____ pre-study VO2 max level had a bigger decrease in VO2

low cardiorespiratory fitness

independent predictor of increased risk of CV event and elevated risk of all cause mortality

postural hypotension

form of low blood pressure that occurs when individual goes from sitting/lying to standing

• problem when the body doesn’t correct

  • bed ridden patients see diminished mechanisms to counteract

20 hours

changes in mechanisms that counteract postural hypotension are seen in as little as _________ of bed rest

virchow’s triad

venous stasis/pooling, hypercoagulability-clotting factors, blood vessel damage

1.5-2.0% or 10-20%

muscle mass decreases by _____ per day or ____ per week during the first 3-5 weeks of bed rest

joint contractures

mostly affect 2 joint muscles, fibres and tissues are maintained in shortened position and tissues adapt to shortened length

PT related ways to mimize effects of bed rest

early mobilization/ambulation, deep breathing and coughing, active, passive ROM and strengthening exercises

when we don’t want to mobilize early

patients aren’t alert/are sedated, instable respiratory, hemodynamically unstable, brain injury, severe delirium, terminal diagnosis, spine or limb injury, CPR on admission, pre-existing severe physical disability

how to reduce contractures

AROM/PROM, stretching, splinting and casting, surgical interventions

how to reduce skin ulcers

special mattress, sheep’s skin, foam, boots, exercise (^blood flow and muscle to be able to self adjust)

metabolic equivalents

index of energy expenditure; ratio of the rate of energy during an activity to the rate or energy expended at rest

• 1 MET = energy expenditure at rest (3.5mLxkgxmin)

threshold for independence

the point at which a person needs help doing daily activities

class 1 (NYHA)

no limitations with ordinary activities (>6-7 MET, >6 min on Bruce, VO2 >20ml/kg/min)

class 2 (NYHA)

slight limitations w/ ordinary activity (5-7 METs, 3-6 min on Bruce, VO2 14-20ml/kg/min)

class 3 (NYHA)

marked limitations w/ less than ordinary activities (2-5 METs, <3min on Bruce, VO2 10-14ml/kg/min)

class 4 (NYHA)

symptomatic at rest or w/ minimal exertion (<2METs, VO2 <10ml/kg/min)

>401m

class 1 for 6 min walk test

301-400m

class 2 for 6 min walk test

201-300m

class 3 for 6 min walk test

<200m

class 4 for 6 min walk test

25-50 meters

minimal clinical significance for the 6 min walk test in most chronic conditions

>500-1000 MET

guideline is to get at least ______ MET minutes per week

indications for stretching/mobility exercises

ROM is decreased, pain managment, facilitate tissue healing, correct muscle imbalances, improve posture, improve physical performance capability, injury prevention, muscle relaxation, address post-exercise muscle soreness

what can cause decreased ROM/tight structures?

injuries or conditions, muscle weakness, pain-protective mechanism, inflammation, aging and degeneration

joint ROM

amount of motion available at a specific joint, typically in a single plane of movement

passive accessory motion

synovial joint ROM that can only be passively obtained by the examiner

• must be restored before a patient can regain functional voluntary movement

mobility

the general ability to go through the movement

flexibility

the ability to go through the movement but it is tissue related

plastic deformation

need to see some ______ to actually see a difference in flexibility

20 seconds

how long do you need to hold a static-passive strech to ensure stress relaxation?

4 reps

Evidence shows little gains for past _______ for hold-relax stretch techniques (contraction 6secs, holding 20-30secs)

reciprocal inhibition

contraction of one muscle will cause a reflex relaxation in the antagonist muscle

autogenic inhibition

activation of the GTO in stretched tendon causes an inhibition (relaxation) of the same muscle

functional rehab

dynamic stretching is a common pre-activity and as part of a ______

end-stage rehab

ballistic stretching is applied with caution in a rehab environment but used more as part of _______, return to sport/activity

pre-treatment considerations for L3D

no end range pain, tissue stretch or capsular end feel (not spasm), patient can control range up to restriction

low load (2-3lbs)

The difference between L3D and capsular stretching is that L3D uses a ____ and capsular stretching doesn’t

2 min hold, 5 reps, 1x/day

dosage for capsular stretching

10+min hold

dosage for L3D

4 weeks

All stretching types showed ROM improvements after at least _____

static stretching

Higher gains in ROM were found in ____ compared to other stretching types

stretch tolerance

acute bouts or short-term stretching sessions up to 3 weeks appear to promote ____ _____

biomechanical/physiological properties

long term stretching sessions over 3 weeks act on _______ ______ of muscles, tendons and the nervous system

stretch weakness

when a muscle remains in an elongated position beyond its normal resting position for prolonged periods of time

entire MSK system

AROM that restores the joint mechanics targets the ____

bone/joint

PROM that restores the joint mechanics targets the _____

elastic deformation

dynamic stretching, static stretching (held not that long) and hold-relax mechanisms all see ______

plastic deformation

static stretching (held for longer), L3D, and capsular stretching all see ______

Wolf’s law

Specific adaptations to imposed demands but relative to bones

Davis’ law

specific adaptations to imposed demands but relative to soft tissue

Mechanotransduction

processes whereby cells convert physiological mechanical stimuli (load) into biochemical responses

• creates a paracrine and endocrine effect

part 1 of mechanotransduction

mechano-coupling; mechanical trigger or catalyst is applied (shear, compression, tensile)

part 2 of mechanotransduction

cell to cell communication through the tissue to distribute the loading message

part 3 of mechanotransduction

effector response at the cellular level that produces and assembles the necessary materials in the correct orientation

slow-twitch oxidative

used almost constantly to stand, maintain postures, walk

relies on oxidative phosphorylation for energy (ATP)

fast-twitch oxidative-glycotic

used for quick movements such as playing piano and typing. single twitch lasts 7.5 milliseconds

fast-twitch glycotic

relies purely on glycotic energy chain which makes the muscle fibre quick to produce force. quickly fatiguable b/c hydrogen ions

volitional activation

muscle setting; little to no resistance and low intensity with the goal to reduce or prevent atrophy, improve circulation and reverse muscle inhibition

neurological strength

early stages of an exercise program, strength increases are normally due to ______

• rise in whole muscle specific tension

3-6 weeks

cross education changes are seen in as little as _____

afferent nociceptive

homeostatic mechanisms maintain pH until very end of max exertion (VO2max), so the ‘burn’ you feel is from _____ response to inflammatory markers present during fatiguing exercise

3-5 minutes

ATP/Creatine system is used for quick burst activity (6-10 seconds) and recovers 85% in _____

1:6 ratio

glycogen replenishment is highly dependent on level of depletion. A ____ is used for recovery

1:1 up to 1:3 ratio

oxidative restoration needs a ____ for recovery

cytokines

small proteins involved in cellular signalling and apoptosis. regulate inflammation, muscular injury and repair after exercise

• tumor necrosis factor, interleukin 6

active recovery

only way to modify cytokines/inflammatory markers post exercise

osteocytes

mechanosensor cells that signal osteoblasts and osteoclasts to maintain homeostasis

• found in interstitial fluid within calcified bone matrix

pro-inflammatory cytokines (crohn’s disease, RA)

_____ promote apoptosis of osteocytes which directly influence bone mineral density

myoblasts

muscle fibres form through _______ to form multi-nucleated fibres called myotubes

• also need satellite cells