Exercise Prescription PDF

FITT - frequency, intensity, type, time Intensity -> monitored by target heart rate (don’t use if they are on medications like B-blockers which can blunt HR response)/RPE/talk and sing test Measure HRmax = 220-age Target HR = HRmax x % intensity desired HRR = HRmax - HR rest SAID - specific...

FITT - frequency, intensity, type, time Intensity -> monitored by target heart rate (don’t use if they are on medications like B-blockers which can blunt HR response)/RPE/talk and sing test Measure HRmax = 220-age Target HR = HRmax x % intensity desired HRR = HRmax - HR rest SAID - specific adaptation to imposed demands PAR-Q (the screening test for exercise participation) - Do you have any health conditions that might preclude you from participating in exercise/PA? - Then explain the experimental procedure to the patient - MENTION: if you want to stop the experiment @ any time, you are free to do so - Do you understand the instructions? - Are you happy to continue? (obtain informed consent) BALANCE PRE-SCREENING -> get to know the patient’s risk profile + test their blood pressure and ask if they have BP problems (hypotension) - STATIC - To maintain a stable antigravity position while @ rest, such as when standing/sitting - TESTS: - Rhomberg test - Stand with feet parallel and together with eyes open and then closed for 30s - Single-leg balance stance test - Predict falls in the elderly and ankle sprains in athletes  - Stand on one leg, without shoes and without the legs touching each other, and place arms across the chest. Perform 5 30s trials for each leg w max of 150s on each leg - TRAINING: - Do it on firm surfaces (standing with feet together/standing still and catching a ball) -> using a safety belt - PROGRESSION: practice in tandem/single-leg stance or in lunge and squat position - PROGRESSION: working on softer surfaces/moving arms/closing eyes - DYNAMIC - To control and stabilise the body when the support surface is moving or when the body is moving on a stable surface. Eg: - STS transfers - Walking - Standing on a bus that accelerates forward - TESTS: - 5 STS - While sitting on a chair, have the arms across the chest and stand up and sit down as quickly as possible for 5 times consecutively - Should be < 15s - TRAINING: - For older patients: tandem walking w arms out - PROGRESSION: turning head in different direction while walking - Maintain equal weight distribution and upright trunk while on moving surfaces (therapeutic ball/standing on wobble board) - PROGRESSION: varying the position of the arms (from putting on their side to putting it above on their head) - REGRESSION: forward-backwards and lateral weight shifting - ANTICIPATORY (voluntary) - Involves the activation of postural muscles in advance of performing skilled movements (aims to keep COG controlled with little effort) - Eg. Activating the posterior leg + back extensor muscles prior to a person pulling on a handle when standing - IF have problem with this = cannot do timed up and go, sit to stand, gait - People tend to flex their hips and knees more and shift their weight back more when lifting a heavier load BUT if they overestimate the weight = too much momentum is generated and the body tends to topple backwards - TESTS: - Star Excursion test (test the lower extremity and detect deficits in people with chronic ankle instability) - Standing barefoot, with hands on the hips. Reach as far as possible with one leg in each of the 8 prescribed directions (4 strips of tape placed on the floor with a 45  degree diff from each one) while maintaining balance on the contralateral leg - Cannot put leg back at midpoint and cannot touch the tape heavily - Functional reach test - Reach in different directions as far as possible without changing BOS - TRAINING: - Reach in all directions to touch or grasp objects - Catching/kicking a ball in all directions - Lifting objects of different weights - REACTIVE (involuntary) - The body reacts by adjusting to disturbances of balance factors that have no voluntary control - Often patients who report having falls due to slower reaction time - TESTS: (patient’s response to external perturbations) **ALWAYS stand behind the patient to ensure safety - Pushes - Different pushes (small, large, slow or rapid, anticipated and unanticipated) applied in different directions to the sternum and posterior trunk or pelvis - Pull test - Putting a hand on their shoulder from behind and doing a sudden backward pull them suddenly (ask them to maintain their balance as much as possible (taking steps is also ok)) - Doing it 4 ways (normal relaxed -> eyes open and closed, standing on foam mat -> eyes open and closed) - TRAINING: - Dodgeball - Playing dodgeball in an unpredictable environment can help to improve their reaction times - SENSORY ORGANISATION (need to target the WEAK sense) - TESTS: - Foam and dome test  - POSITIONING: stand with feet parallel and arms @ side or hands on hips (each station to be done minimally for 30s) - Stand on a firm surface with eyes open, then do it with eyes closed, then do it by wearing a dome/eyemask - Next, stand on a foam cushion with eyes open, then do it with eyes closed, then again with the dome - TRAINING: - To reduce visual support -> close eyes/wear prism glasses - To reduce somatosensory cues -> narrow BOS/stand on foam/march on the trampoline - FUNCTIONAL TESTS - Determines activity and participation limitations and restrictions - TESTS: - Timed Up and Go - Mark out a 3m course and place a chair and cone on each end of the 3m. The patient will get up from the chair, walk around the cone and sit back on the chair as quickly as possible. Time is recorded with a stopwatch - Berg Balance Scale - Four Square Step Test - Completing a circuit (going in clockwise and backwards in anticlockwise) as quickly as possible - Dual tasking activities - Standing on 1 leg and counting backwards - Marching on the spot and naming objects in a category (eg. fruits, animals) - Help with fear of falling - Steps-ups - Lunges  - Done multi-directionally/can also add twists - Marching and catching a ball People who are aged/have diabetes have reduced somatosensation in their lower extremities = have increased fall risk and rely more heavily on hip strategy to maintain balance People who have viral infections/TBI/experience vertigo -> leads to bilateral loss of vestibular function and are unable to use hip strategies even when standing BUT ankle strategies are unaffected MUSCLE PERFORMANCE + RESISTANCE TRAINING - MUSCLE PERFORMANCE - Strength - Ability of the contractile tissues to produce tension + resultant force - Controlling loads for a low number of repetitions/for a short period of time - FOCUS: increasing the amount of resistance applied to a muscle - Power - Related to the strength and speed of movement by the muscle -> the rate of performing work - By increasing the work a muscle performs during a period of time OR reducing the time to produce a given force - Endurance - Ability to perform low-intensity, repetitive/sustained activities over a prolonged period of time -> ability to contract repeatedly against a load and resist fatigue over a period of time - FOCUS: increasing period of sustained contraction/number of repetitions performed - RESISTANCE TRAINING - Involves dynamic/static muscle contraction being resisted by manual/mechanical resistance AEROBIC EXERCISE - ALWAYS do pre-screening (undertakes regular exercise, no underlying CV/metabolic disease) - WARM-UP - Light intensity for 5 minutes @ light resistance - MONITORING - Onset of chest pain - Decrease of systolic BP > 10mmHg - Excessive increase in BP -> SBO > 250, DBP > 115 - Shortness of breath, wheezing, leg cramps, lightheadedness, nausea - Physical/verbal signs of severe fatigue FLEXIBILITY/STRETCHING (elongates muscle and increases ROM -> done @ low intensities and stretch should just feel like pulling and NOT painful) - CONTRAINDICATION - Recent injury/fracture (and it is not completely healed yet) - Acute inflammation (heat + swelling) - Sharp acute pain - Hypermobility - Spasticity - STATIC (PROM) - Improves flexibility and increases ROM - The tissue is elongated just past tissue resistance and the position is held in the lengthened position over a period of time (each rep >10s) - 15 min a DAY -> maintains flexibility and prevents contractures - PROGRESSIVE: the shortened tissue is held @ a comfortable lengthened position UNTIL a degree of relaxation is felt - CYCLIC/INTERMITTENT (AROM) - Short-duration END-RANGE stretch that is applied repeatedly @ LOW velocities in a controlled manner (each cycle 5s-10s) - Low velocity = less likely to increase tensile stress on connective tissues/to activate stretch reflex - PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF) (AROM) - CAN NOT be used on patients with paralysis/spasticity issues - Improves flexibility and increases ROM - Integrates active muscle contraction into stretching (each cycle is of 10s holds -> doing 3-4 sets) - PRECAUTION: increased breath holding + BP - TYPES - Hold-relax/contract-relax - Target muscle is lengthened to the point of tissue resistance - Performs an end-range isometric contraction ~5s followed by voluntary relaxation before moving the limb into new range - Agonist contraction - Concentric contraction of the muscle opposite to the affected muscle and hold the end-range position for a few sec in a slow and controlled manner (this allows the affected muscle to relax + lengthen more readily) - Hold-relax with agonist contraction - Move tissue of the affected muscle to the point of resistance - The patient then performs an end-range isometric contraction followed by a voluntary relaxation and an immediate concentric contraction of the muscle opposite to the affected muscle - BALLISTIC (done mainly ONLY in young + healthy conditioned subjects AND @ end-stage rehab) (AROM)  - Rapid, forceful intermittent stretch @ HIGH velocity and intensity -> quick, bouncing movements creating momentum to bring segment through ROM OPEN KINETIC CHAIN + CLOSED KINETIC CHAIN OPEN KINETIC = NON-WEIGHTBEARING - The distal segment is free to move in space without causing simultaneous motion @ adjacent joints - The exercise focuses on motion in a single joint CLOSED KINETIC = WEIGHTBEARING - The distal segment remains fixed or in contact with support surface - Focuses on joint compression and are more functional exercises - Eg. Squats, leg presses, lunges, heel raises, press-ups from a chair, wall push-offs EXERCISE PRESCRIPTION FOLLOWING INJURY - De-sensitisation + reducing overall load = considered during the acute phase of the injury and it can be done by: - Informed reassurance + education (saying: for acute injuries, pain is normal BUT will be gone soon so don’t need to worry) - Pain management - In the stabilisation phase, use the pain + activity traffic light to monitor expectations of pain during exercise - Mild pain during activity is fine providing it settles within 24h - GREEN (safe zone) = 0-3 - YELLOW (acceptable range) = 4-5 - RED (excessive/stop zone) = 6-10 - EXERCISE PRESCRIPTION FOR OA PATIENTS - For hip OA - Isometric quadriceps contraction - Dorsiflex the foot and ask the patient to push downwards towards the bed (maintaining the contraction for ~5s and doing 10 repetitions of that) - Bridges - **ensure that the exercise is working the muscle to fatigue for actual strengthening of the muscle to occur - PROGRESSION: bringing one leg up and elevating it (holding it for a few sec) before bringing it back down - PROGRESSION: putting a ball under the leg that is resting on the bed and carrying out the exercise - Squats - Ensuring the back is straight and that the knee goes over the toes EXERCISE TYPE HIP HIP HIP HIP FLEXION EXTENSION ABDUCTOR ADDUCTORS GRADE 2 While lying While lying While lying While lying STRENGTH supine, use a supine, use a supine, use a supine, use a polished board polished board polished board polished board w knees bent + w knees bent + + a rolled towel + a rolled towel a rolled towel a rolled towel under the heel under the heel under the heel under the heel and move the and move the and move the and move the board from side board from side board from board from to side to side towards the towards away buttocks GRADE 3 STRENGTH STRETCHES STATIC = lying supine and having 1 leg leaning against the wall, push the leg into the wall for 30s KNEE KNEE KNEE KNEE FLEXION = EXTENSION = ABDUCTOR ADDUCTORS HAMSTRINGS QUADRICEPS GRADE 2 STRENGTH GRADE 3 Leg curls in prone Sit to stand STRENGTH Squats Seated heel-toe raises Lunges Step-ups Seated marches Seated leg  extensions ISOMETRIC - Wall sits EXERCISES While seated, place a towel under the knee with the heel still on the bed and squeeze the quads for 5s before releasing (the physio can place their hand on it to see if it is squeezing) PROGRESS, when there is no pain/exercise, is done with ease STRETCHES STATIC = lying STATIC = lying supine and supine and wrapping a towel having 1 leg under the arch of leaning against the foot, pull on the wall, push the towel for 10s the leg into the wall for 30s PROGRESSION: cyclic/dynamic CYCLIC = lying leg swings (only prone, lift the leg when pain is towards the butt completely gone) as much as possible for a 5s CYCLIC = in before relaxing tandem, the knee in front should PROGRESSION be straightened : putting a pillow and back knee under the knee should be slightly bent and bend REGRESSION: upper body putting a pillow holding it for 5s under the pelvis  BALLISTIC = doing the same as cyclic but doing it rapidly by pulsing downards with NO holds SHOULDER SHOULDER SHOULDER SHOULDER FLEXION EXTENSION ABDUCTOR ADDUCTORS GRADE 2 STRENGTH GRADE 3 Placing a slider Sitting STRENGTH under the sideways, affected arm, try place the to move the affected arm on hand AWAY the surface with from the body a slider and use the underneath and unaffected arm slide it further to pull it further out towards the side, letting the While sitting, unaffected arm the patient guide the actively lifts movement their arm and the physio will While sitting, provide the patient will assistance to actively abduct elevate their their arm and arm and slowly the physio will lower them provide assistance to move the arm outwards STRETCHES ELBOW ELBOW ELBOW ELBOW FLEXION = EXTENSION ABDUCTOR ADDUCTORS biceps GRADE 2  STRENGTH GRADE 3 STRENGTH STRETCHES BALLISTIC = cross-body arm swings Standing hip-width apart, extend the arms outwards and swing both arms across the body rapidly touching the opposite shoulder SQUATS - IF the knees buck inwards - = make the BOS narrower - REGRESSION (especially if they have poor ankle mobility/cannot maintain an upright posture) - place small plates under the heel [reduces the need to dorsiflex] and also promotes a vertical torso = reducing tendency to lean forward FACILITATING TRUNK AWARENESS - EARLY PHASE - Learning neutral positions and those of bias + those causing the MOST symptoms - HEAD/UPPER NECK - Cervical retraction/protraction - The patient can also gently flex, extend, side flex and rotate the head and neck to find the position of bias (position of most relief) - RETRACTION = tuck chin in and make a double-chin - LOWER NECK/UPPER BACK - Stand against a wall/flat surface and look @ their posture (where their head and shoulder is) to identify dysfunction - LOWER BACK - Pelvic tilts - ANTERIOR = extension of lumbar / POSTERIOR = flexion - IF unable to do it actively = do passive positioning of spine  - In supine, lying with knees bent = flexes lumbar spine BUT with the leg extended = extends lumbar spine - In prone, a pillow under the abdomen flexes the lumbar spine and NO pillow extends lumbar spine EXERCISES - IF pain in lumbar flexion (early stage) = stop when unable to control position - IF pain in lumbar extension (early stage) = do 4-point kneeling extension SHOULDER FLEXORS - OPEN = front raises (lift the arm from the side to shoulder height)/overhead presses - CLOSE = push-ups of any variation SHOULDER EXTENSORS - OPEN = lats pulldown (starts from overhead and to chest), rear delt fly - CLOSE = pull-ups/shoulder dips SHOULDER ABDUCTORS - OPEN = lateral raises - CLOSE = side-plank with arm abduction/wall slides/chest-fly SHOULDER EXTERNAL ROTATORS - OPEN = resisted/dumbbell external rotation/kettlebell windmill - CLOSE = ELBOW FLEXORS (biceps) - OPEN = bicep curl/hammer curl (like bicep curl but the dumbbell is vertical) - CLOSE = pull-ups ELBOW EXTENSORS (triceps) - OPEN = triceps pulldown (starts from chest to the hips)/overhead triceps extension - CLOSE = push-ups KNEE FLEXORS (hamstrings) - OPEN = nordic hamstring curls, hamstring curls - CLOSE = squats/step-ups/lunges/wall sits KNEE EXTENSORS (quadriceps) - OPEN = straight leg raises/isometric quad contractions - CLOSE = squats/step-ups/lunges/wall sits