GAF FPP, Wk14, Lect 1, Theory of Exercise Prescription 2023.24.pptx

The Theory of Exercise Prescription Foundations for Physiotherapy Practice Lecture 2023-24 UH. FPP 2023-24 Learning Outcomes By the end of the session and independent study you should: • Understand the aims of therapeutic exercise • Understand the concept of prescription variables • Describe th...

The Theory of Exercise Prescription Foundations for Physiotherapy Practice Lecture 2023-24 UH. FPP 2023-24 Learning Outcomes By the end of the session and independent study you should: • Understand the aims of therapeutic exercise • Understand the concept of prescription variables • Describe the documents guiding exercise prescription • Begin to consider how to progress/regress an exercise UH. FPP 2023-24 What is therapeutic exercise? Therapeutic exercise has been defined as: “The prescription of a physical activity program 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 What is the aim of therapeutic exercise? General: To try whenever possible to restore full function and achieve an optimal level of physical fitness. So…if the aim was to enable someone to go up and down stairs safely, what therapeutic exercises could you prescribe them? To prescribe exercise effectively we need to understand the components of physical fitness UH. FPP 2023-24 What is the aim of therapeutic exercise? To try whenever possible to restore full function and achieve an optimal level of physical fitness. Maintain or improve: mobility range of movement flexibility balance and coordination muscle strength and endurance muscle endurance respiratory capacity cardiac function and circulation confidence, self esteem and well being Social network Reduce anxiety and depression UH. FPP 2023-24 So…if the aim was to enable someone to go up and down stairs safely, To prescribe exercise effectively we need to understand the components of physical fitness Maintain or Improve range of movement (ROM) • Passive • Active assisted • Usually used as interim measure moving from passive to active, also when joint pain limits free active movement • Free active • Knowledge of ageing and pathologies required to prevent undesirable movements UH. FPP 2023-24 Maintain or Improve flexibility • Passive or active • Stretching to retain range e.g. joint pathology • Stretching to increase normal range e.g. sport and dance • Stretching to lengthen contracted, fibrosed, shortened tissue e.g. congenital conditions, postsurgery/immobilisation/injury • What medical conditions might have reduced joint range of movement and therefore might benefit from flexibility exercises? UH. FPP 2023-24 Maintain or Improve respiratory capacity and cardiac function • Rehabilitation programmes for cardiac and pulmonary patients • Breathing exercises • All exercises potentially improve cardiovascular fitness • What ADLs do you need Cardiorespitatory fitness for? UH. FPP 2023-24 Maintain or Improve muscle strength and endurance • Active exercises • Resisted exercises • Exercises using body weight • Exercises using equipment Can you give an example of each for the lower limb UH. FPP 2023-24 Maintain or Improve confidence and self-esteem • Increase confidence, self esteem and well being • Group classes • Reduce anxiety and depression • Mental health and wellbeing Some experiences related to mental health and exercise • https://www.mind.org.uk/information-support/you r-stories/?tag=7098 Getting started • https://www.mind.org.uk/information-support/you r-stories/physical-activity-tips-on-getting-started/ UH. FPP 2023-24 This Photo by Unknown Author is licensed under CC BY Maintain or Improve social network • Cardiac rehabilitation class • Exercise classes "The evidence surrounding the relationship between SS, or loneliness, and PA in older adults suggests that people with greater SS for PA are more likely to do LTPA", https://ijbnpa.biomedcentral.com/articles/10.1186/s1296 6-017-0509-8 SS – social support PA-Physical activity LTPA –Long term physical activity UH. This Photo by Unknown Author is licensed under CC BY-SA-NC FPP 2023-24 Time to get up - Dr Michael Mosley: Take the balance challenge to help you live longer • A good test of your balance is to see how long you can stand on one leg, first with your eyes open and then closed. Take your shoes off, put your hands on your hips and stand on one leg. See how long you last. The test is over as soon as you shift your planted foot or put your raised foot down on the ground. Best of three. • Under 40: 45 seconds with eyes open, 15 seconds with eyes closed. • Aged 40-49: 42 seconds open, 13 seconds closed. • Aged 50-59: 41 seconds open, 8 seconds closed. • Aged 60-69: 32 seconds open, 4 seconds closed. • Aged 70-79: 22 seconds open, 3 seconds closed. • https://www.sciencefocus.com/the-human-body/dr-michaelmosley-standing-on-one-leg/ UH. FPP 2022-23 Take the balance challenge to help you live longer “How much does it matter? In a study published in the BMJ in 2014, researchers tested 2,760 men and women who, at that time of testing, were all 53 years old. They measured grip strength, how quickly they could stand upright from sitting and how long they could stand on one leg with their eyes closed”. “When the researchers returned 13 years later, they found that the tests had all, independently, predicted the chance that someone would die over that period, but the onelegged standing test was the best. Those individuals who lasted less than two seconds were three times more likely to have died than those who held it for 10 seconds or more”. • https://www.sciencefocus.com/the-human-body/dr-michael-mosley-standing-on-one-leg/ • Cooper R, Strand B H, Hardy R, Patel K V, Kuh D. Physical capability in mid-life and survival over 13 years of follow-up: British birth cohort study BMJ 2014; 348 :g2219 doi:10.1136/bmj.g2219 UH. FPP 2023-24 Maintain or Improve balance and coordination is important • Essential post-injury especially lower limb • Examples - Retraining for amputees and neuro patients • Why is balance training important as you age? UH. This Photo by Unknown Author is licensed under CC BY-SA FPP 2023-24 Let’s revise the guidelines related to: Cardiorespiratory exercise Muscular fitness - strength - endurance UH. FPP 2023-24 UK Chief Medical Officers' physical activity guidelines Department of Health and Social Care, September 2019 Cardiorespiratory exercise • For good physical and mental health, adults should aim to be physically active everyday. Any activity is better than none, and more is better still. • Each week, adults should accumulate at least 150 minutes (2 1/2 hours) of moderate intensity activity (such as brisk walking or cycling); or 75 minutes of vigorous intensity activity (such as running); or even shorter durations of very vigorous intensity activity (such as sprinting or stair climbing); or a combination of moderate, vigorous and very vigorous intensity activity. UH. FPP 2023-24 Physical Activity guidelines for UK 2019 UH. FPP 2022-23 Physical activity guidelines for Americans 2018 UH. FPP 2022-23 Muscular Fitness • Strength • Ability of a muscle to produce force • Maximum strength • Force generated in a single maximum voluntary muscle action • Strength endurance • Force generated for sustained or repeated muscle actions against a sub-maximal resistance • Power • Force x velocity UH. FPP 2023-24 UK Chief Medical Officers' physical activity guidelines Department of Health and Social Care, September 2019 Muscle strengthening exercise • Adults should do activities to develop or maintain strength in the major muscle groups. These could include heavy gardening, carrying heavy shopping, or resistance exercise. Muscle strengthening activities should be done on at least two days a week, but any strengthening activity is better than none. • What are the major muscle groups? • Why two days a week and not every day? UH. FPP 2023-24 Muscle strengthening Resistance Exercises • Consider why we might choose these different types of exercises? • Are there any risks? Isometric Concentric Eccentric Isokinetic Closed and open chain exercises Remember exercises can use more than one of the above UH. This Photo by Unknown Author is licensed under CC BY FPP 2023-24 What is the difference? Muscle Strength, Power and Endurance Load (resistance) Repetitions Sets Frequency Consider muscle fibre type UH. FPP 2023-24 Reps 15 – 25 per set Muscular endurance (ACSM 2011, Department of Health and Human Services 2018) Sets not to exceed 2 Intensity Light to moderate ie <50% 1RM Rest 48 hrs (min) between sessions UH. FPP 2023-24 Adults should also undertake physical activity to improve muscle strength For all of the major muscle groups: Muscular strength (ACSM 2011, Department of Health and Human Services 2018) Reps - 8 - 12 per set Sets : one set is effective, 2 or 3 is more effective per muscle group Freq – 2-3 times per week Intensity moderate- hard ie 60 -70% 1RM hard – very hard > 80% 1RM Rest 48 hrs (min) between sessions UH. FPP 2023-24 Flexibility (ACSM 2011) UH. FPP 2023-24 Prescription Variables • When planning an exercise programme must consider the following variables. What do the letters stand for? • • • • F– I– T– T–  UH. FPP 2023-24 If the aim was to enable Therapeutic exercise someone to go up and down stairs safely, Exercise - Stepping up For the exercise given here and down on a step give an example of a  What would tell you that progression and a you need to regress this regression exercise. How would you regress?  What would tell you that you need to progress this exercise. How would you progress, what parameters might you UH. FPP 2023-24 change and why?  Progressing or Regressing an Exercise • Overload • Motivation • Strength • Endurance • Power • Cardiorespiratory factors • Complexity of task • Functional UH. • Need to reason why and how you would regress and progress • Clear aims and goals are needed, why? FPP 2023-24 Lets return to therapeutic exercise – think through what you have learned in this session To try whenever possible to restore full function and achieve an optimal level of physical fitness. You are treating a person not a condition • What are some of the key points that you take away from this lecture? To prescribe exercise effectively we need to understand the components of physical fitness and be able to justify what we do UH. FPP 2023-24 The Theory of Exercise Prescription • Any Questions? UH. FPP 2023-.24 References • 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. Retrieved from http://europepmc.org/abstract/MED/21694556 • Bird P, Tarpenning KM and Marino FE (2005). Designing Resistance Training Programmes to Enhance Muscular Fitness. Sports Med: 35 (10): 841-851. • Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Retrieved from https://health.gov/paguidelines/second-edition/ • Department of Health and Social Care (2019) Retrieved from UK Chief Medical Officers' physical activity guidelines • Garber, CE; Blissmer, B; Deschenes, M; Franklin, BA.; Lamonte, MJ; Lee, I-M; Nieman, D; Swain, D. • 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 UH. FPP 2022-23 References • Kisner C, Colby LA (2012). Therapeutic exercise: Foundations and techniques. (5th ed.) Philadelphia, FA Davis Company. Available as an e book. • McArdle WD, Katch FI and Katch VL (2016) Essentials of Exercise Physiology . Philadelphia: Wolters Kluwer. • Scott, A. (Ed.), Gidlow, C. (Ed.). (2016). Clinical Exercise Science. London: Routledge • Taylor, NF., Dodd, KJ., Shields, N. & Bruder, A.(2007). Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002–2005. Australian Journal of Physiotherapy 53: 7–16 UH. FPP 2022-23