GAF FPP, Wk13, Lect.1, Principles and Physiology of Exercise 2023-24.pptx

Principles and Physiology of Exercise Lecture Week 13 2023-24 UH FPP 2023-24 Learning Outcomes By the end of the session and independent study you should: • Understand the scope of exercise used in physiotherapy practice • Identify the different energy systems • Begin to understand basic exercise...

Principles and Physiology of Exercise Lecture Week 13 2023-24 UH FPP 2023-24 Learning Outcomes By the end of the session and independent study you should: • Understand the scope of exercise used in physiotherapy practice • Identify the different energy systems • Begin to understand basic exercise physiology and the effect on the different body systems • Understand the principles underpinning therapeutic exercise UH FPP 2023-24 Definition of therapeutic exercise Prescription of a physical activity programme that involves the client undertaking voluntary muscle contraction and/or body movement with the aim of relieving symptoms, improving function or improving, retaining or slowing deterioration of health. Taylor, Dodd, Shields & Bruder (2007) UH FPP 2023-24 Therapeutic Exercise • Prevent disabilities. • Rehabilitate disabilities. • Improve or restore physical function so that activities of daily living (ADL’s) are no longer a challenge. • Improve overall health and fitness. • Reduce risk factors. UH • Rehabilitation Cycle Functional fitness and rehabilitation Early to middle management FPP 2023-24 Which patient groups would benefit from therapeutic exercise? UH FPP 2023-24 This Photo by Unknown Author is licensed under CC Which patients groups benefit from therapeutic exercise? • Cardiac patients • Orthopaedic patients • Amputees • General surgical • Neurological • Elderly • Learning disabilities • Psychiatric • Palliative care • Respiratory • Paediatric • Rheumatology • Musculo-skeletal • Occupational • Spinal injuries • Obstetrics • Gynacological • Burns and plastics UH FPP 2023-24 Exercise for the prevention of disease • Relationship between a sedentary lifestyle and chronic degenerative disorders • More than 20 disorders related to inactivity • 50 years of research • Seminal research bus conductors • Physical activity retards the decline in functional capacity associated with ageing and disuse • Physiotherapists have a role to play in health promotion UH FPP 2023-24 Morris & Crawford 1958 General Principles of Training To be an Olympic calibre performer, you must choose your parents wisely’ (Astrand 1960’s) Sanchis-Gomar, Fabian & Pareja-Galeano, Helios & Rodriguez-Marroyo, Jose & de Koning, Jos & Lucia, Alejandro & Foster, Carl. (2016). Olympic Genes on the Podium?. International Journal of Sports Physiology and Performance. 11. 1-8. 10.1123/ijspp.2016-0421. UH FPP 2023-24 General Principles of Training • Overload • Specificity • SAID – specific adaptations to imposed demands • Reversibility • Detraining • Individuality • Differences in response to training tend to be the ‘norm’ • Diminishing returns • Objective assessments UH FPP 2023-24 Overload *A system must be trained at a level beyond its current capabilities. *Variables of training; -Intensity. -Duration. -Frequency of exercise. *Give the muscle enough time to recover before applying the next session. UH FPP 2023-24 Specificity Coffey et al 2017 • Any exercise will train the muscle for the particular task performed. • E.g., strengthening exercise will train the muscle in the range and mode of exercise. UH FPP 2023-24 Specificity Single joint vs multi-joint exercises Stein et al 2020 Need to consider what the goal is UH FPP 2023-24 Endurance v Strength Training UH FPP 2023-24 Adaptability of the cardiovascular system (CVS) Reversibility Principle • Cardiorespiratory changes in response to deconditioning and reconditioning • The beneficial effects of training are lost as soon as training stops. UH FPP 2023-24 Adaptability of the cardiovascular system (CVS) Reversibility Principle • Cardiorespiratory changes in response to deconditioning and reconditioning Component Deconditioned Reconditioned Stroke volume Decreased Increased Resting heart rate Increased Decreased Resting blood pressure Increased Decreased Oxygen delivery Reduced Improved Gas exchange Less efficient More efficient Capillary density Decreased in myocardium Increased in myocardium Fatty deposits Collection in vessels Cleared from vessels UH FPP 2023-24 Individuality: • People respond differently to the same training programme. • Due to; • Initial fitness level: individuals with lower fitness respond more quickly. • Health status: patients may not be able to perform the same intensity as healthy and take longer to achieve the goals. • Genetic makeup. UH FPP 2023-24 Overview of Exercise Physiology • If you have covered the physiology of exercise consider how pathology of the different systems may affect an individuals ability to exercise. UH FPP 2021-22 Energy Systems: • Energy systems are metabolic systems involving a series of biochemical reactions resulting in the formation of adenosine triphosphate (ATP), carbon dioxide, and water. • The cell uses the energy produced from the conversion of ATP to adenosine diphosphate (ADP) and phosphate (P) to perform metabolic activities. • Muscle cells use this energy for actin-myosin cross-bridge formation when contracting. UH FPP 2023-24 Energy Systems There are 3 distinct, yet closely integrated, processes that operate together to satisfy the energy requirements of muscle. The intensity and duration of activity determine when and to what extent each metabolic system contributes. The anaerobic energy system Immediate Energy : ATP-PCr System Short-Term Energy: Lactic Acid System. The aerobic energy system Long-Term Energy: The Aerobic System UH FPP 2023-24 Immediate Energy: • In high intensity exercise immediate energy is needed 4-8 times faster than aerobic metabolism. • The source of this energy can be found within the muscle in the form of highenergy phosphate/phosphagen sources: Adenosine triphosphate (ATP) and Phosphocreatine (PCr). • No oxygen is required (it is anaerobic metabolism). • ATP-PC is replenished when the muscle rest. • It has small energy capacity (max: 0.7 mol ATP). • It provides energy for short, quick bursts of activity. • It is the major source of energy during the first 30 seconds of intense exercise. UH FPP 2023-24 GLYCOGEN Total Glycogen Stored Muscle Energy • Main source of carbohydrate energy for active muscles during exercise. • What food sources provide carbohydrate energy? • Glycogen stores provide a relatively short-lived store of energy and need replacing on a daily basis UH FPP 2023-24 Plasma glucose 3g Liver glycogen 100g Muscle glycogen 400g Short-Term Energy: Lactic Acid System • During exercise stored muscle glycogen provides the energy source to phosphorylate ADP, providing a rapid formation of ATP called GLYCOLYSIS. • This is the non-aerobic process – without oxygen (anaerobic). • This breakdown of carbohydrate forms lactic acid. • This anaerobic energy for ATP resynthesis can be viewed as reserve fuel • As you accelerate at the start of exercise • During last few hundred yards of a mile run • When performing all out from start to finish in a 400 metre run McArdle, Katch & Katch (2010) UH FPP 2023-24 Short-Term Energy: Lactic Acid System • It has intermediate energy capacity (max: 1.2 mol ATP). • The systems provide energy for activity of moderate intensity and short duration. • It is the major source of energy from 30-90 seconds of training. UH FPP 2023-24 LONG-TERM ENERGY: THE AEROBIC SYSTEM • Once intense exercise continues beyond a few minutes aerobic metabolism (using oxygen) is needed to provide enough ATP. • During the first few minutes of exercise you have a rapid rise in oxygen consumption. • After 2-4 minutes a steady rate develops where there is a balance between the muscles needing energy and the production of ATP in aerobic metabolism to supply them. • Glycogen, fats, and proteins are utilized as fuel sources according to their availability and the intensity of the exercise. • ATP is resynthesized in the mitochondria of the muscle cell. • The ability to metabolize oxygen and other substrates is related to the number and concentration of the mitochondria and cells. • It has great energy capacity (max: 90.0 mol ATP). • The system predominates over the other energy systems after the second minute of exercise. UH FPP 2023-24 UH FPP 2023-24 Changes in the anaerobic and aerobic systems are very dependent on the training stimulus, changes in one system does not occur with concomitant changes in the other. The effect of exercise on metaboli sm Specific training can lead to the following changes: Anaerobic Increase in levels of energy substrates Increase in blood lactate levels and ability to tolerate these Aerobic Increase in size & no. of mitochondria in muscle Changes in enzyme levels Improved ability to oxidise fats UH FPP 2023-24 The effect of exercise on the central nervous system • The strength of the central nervous system connections are maintained by repeated use of them • Allows parts of the brain to ‘talk’ more easily to each other • Form a record of past memory stored in their brain – a motor programme • Improvement in motor skill initially • Increase in synchronization and recruitment of motor units UH FPP 2023-24 The cardiovascular response to Cardiorespiratory (aerobic) exercise •Longer term – adaptations • Heart – Larger • Increase in plasma volume • Increase in stroke volume • Increase in cardiac output • Improved oxygen extraction UH FPP 2023-24 The body’s response to Cardiorespiratory exercise Short Term – Long Term during exercise – effect of regular exercise HR BP RR UH FPP 2023-24 The body’s response to Cardiorespiratory exercise Short Term – during exercise Long Term – effect of regular exercise HR BP RR May be slightly rate Tidal volume UH FPP 2021-22 Tidal volume Heart Rate response to Exercise (McArdle, Katch and Katch 1994) UH FPP 2023-24 The effect of exercise on the musculoskeletal system • Endurance training • improved uptake and usage of oxygen by the muscle • increase capillary network • Increase in mitochondria • Strength training • cross sectional area of the muscle fibres increases • Increase in motor unit recruitment and synchronisation UH FPP 2023-24 The effect of Exercise on the endocrine system Pituitary Gland Releases human growth hormone, which tells the body to increase bone, muscle and tissue production. Releases Antidiuretic hormone (ADH) Thyroid Gland thyroxine and calcitonin, start of exercise regulate the body’s temperature, heart rate and blood pressure, regulates the alertness Adrenal Gland cortisol control blood pressure, glucose and acts as an antiinflammatory agent. aldosterone, regulates hydration levels, the speed of the heart and the strength of contractions. It also turns stored carbohydrates into energy. Pancreas Insulin regulates glucose, by transporting it to the muscles and tissue for energy. UH FPP 2023-24 Body systems, pathology and exercise • Consider how pathology of the different systems we have covered may affect an individuals ability to exercise. • • • • Central nervous system Cardiovascular system Musculoskeletal system Endocrine system UH FPP 2023-24 Summary • Exercise prescription is a core skill for physiotherapists • Underpinned by physiological and patho-physiological processes • Requires a good understanding of exercise physiology and the principles of training UH FPP 2023-24 References • Bird P, Tarpenning KM and Marino FE (2005). Designing Resistance Training Programmes to Enhance Muscular Fitness. Sports Med: 35 (10): 841-851. • Coffey, V.G. and Hawley, J.A. (2017), Concurrent exercise training: do opposites distract?. J Physiol, 595: 2883-2896. • Garber, CE; Blissmer, B; Deschenes, M; Franklin, BA.; Lamonte, MJ; Lee, I-M; Nieman, D; Swain, D. • American College of Sports Medicine (ACSM) Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise (2011) Medicine & Science in Sports & Exercise: 43 ( 7); 1334-1359. • http://europepmc.org/abstract/MED/21694556 • Glynn, A & Fidler, H (2009). The Physiotherapists Pocket Guide to Exercise Assessment, Prescription and Training. Churchill Livingstone Elsevier. • Hall C, Thein Brody L (2011). Therapeutic exercise: Moving toward function. (3rd ed.) Philidelphia, Lippincott Williams & Wilkins • MORRIS JN and CRAWFORD MD (1958). Coronary heart disease and physical activity of work; evidence of a national necropsy survey. Br Med J. Dec 20;2(5111):1485-96. doi: 10.1136/bmj.2.5111.1485. PMID: 13608027; PMCID: PMC2027542 • Morrissey MC, Harman EA, Johnson MJ. (1995) Resistance training modes: specificity and effectiveness. Medicine and Science in Sports and Exercise. 27(5):648-660. • Stien N, Pedersen H, Ravnøy AH, Andersen V, Saeterbakken AH (2020) Training specificity performing single-joint vs. multi-joint resistance exercises among physically active females: A randomized controlled trial. PLOS ONE 15(5): e0233540. UH FPP 2023-24