Pocket_Guide_to_Exercise_Assessment

101, IIII' l'I'V·\",oIIII·'.'III'.I··. 1',\" 1,,'1 (;II11h, 10 Exercise I\" ,·.111t ,\" •d.\\( I Ilenls 10 he considered as it may be appropriate to use 1:',IVlly ,dolle ,IS the training stimulus or to position an individual iII such a way that they do not have to lift their limb against gravity (cf. previous example). Range of exercises A strength training programme may target a particular muscle or muscle group or several muscle groups. It is important to think about the needs of the individual when designing a strength training programme, particularly in terms of incorporating functional activity into a training programme in its latter stages. Rest intervals To avoid training a fatigued muscle, adequate rest time is needed betweell training sessions. For strength training 24-48 hours are recommended between sessions training the same muscle group. In general, the higher the intensity of the training, the longer the rest period required between sessions. Il: Safety Safety factors which are especially important to consider when pre­ :ou=.J. Il: scribing and supervising strength training programmes are: W f­ «0­ Cardiovascular stress. When a person is lifting a weight, their I u blood pressure will increase in proportion to the effort involved in lifting the weight. As the effort intensity is highest as the person reaches fatigue, people with increased cardiovascular risk should ,lvoid high-intensity training. Breathing. To avoid breath holding or Valsalva manoeuvre, It IS recommended that the person carrying out a resistance training programme should breathe out during the concentric phase of the weight lift. Injury. If individuals are using large weights, they should work with a training partner or a supervisor particularly if using tech­ niques where there is a risk of dropping the weight on themselves. Certain patient populations, for example those who are frail, may also need constant assistance and supervision. If weights have not been properly secured to a limb there is also the risk of these drop­ ping onto feet. Muscle strains may occur if a weight is too heavy for all individual or if they are using a poor movement technique. Delayed-onset muscle soreness. This usually occurs 24-48 hours after excessive unaccustomed physical activity and is thought to be due to damage to the connective tissue supporting the muscle.

Exercise to Increase Muscle Strength 67 There is a higher risk of delayed-onset muscle soreness with eccen· tric training. This may discourage people from continuing with their training programme. Progressive training regimes should min­ imize this problem. EQUIPMENT Il: One of the main differences in equipment used for weight training :ou=.J. is that it can provide a constant or variable resistance. Il: Constant resistance equipment W This provides a resistance which does not change through range of f­ motion. Examples of constant resistance equipment are free weights ,md the Westminster Pulley System. «0­ Variable resistance equipment I This allows the muscle to work maximally through its entire range by varying the resistance offered to the muscle and so accommo­ u dates to muscle strength through range. Variable resistance machines are designed to isolate muscle work and are associated with a lower risk of injury than free weights because they control body position and speed of movement. They can be expensive and take up a lot of space. Examples of variable resistance equipment include isokilletic machines and Nautilus equipment. At the opposite end of the spec­ trum elastic resistance bands offer variable resistance and have the advantages of being cheap and portable. Not everyone will have access to or need the complete range of different strength training equipment. Cost, available space or the situation in which somebody works is more likely to dictate the type of equipment available. It is important to be able to adapt a strength training programme to different situations. Equipment which is more commonly available to physiotherapists is discussed below. Free weights This is probably one of the commonest methods used in clinical practice to strengthen muscle. Free weights can easily be used in many settings such as the ward, the gym and the home. To be able to carry out resistance training programmes effectively, a variety of different weights are needed as well as different methods of attach­ ing them to the body. Commonly used weights include dumbbells, barbells and wrist and ankle weights, which are all most useful when adjustable. The appropriate training load can then be applied and increased gradually (see Figure 4.1). If there is not an adequate range of weights available the training programme may become ineffective or dangerous.

68 The Physiotherapist's Pocket Guide to Exercise A range of different free weight equipment Using free weights is a very effective way of increasing muscle strength but the muscle being exercised needs to be relatively strong 0::: to benefit from this kind of training, i.e. able to work against gravity with a resistance. The person carrying out the exercise also needs o:::> LL 0::: to be able to safely lift and attach the weight they are going to use. W I­ :«0r.:. There is a higher risk of possible injury with this type of activity u than with some other kinds of resistance training. The added benefit of using free weights is that other muscles are recruited during the programme to stabilize the body and maintain posture. The activity of all'lChing a weight will generate a training stimulus for the other l11uscles which assist in this. The type of muscle work carried out using fi\"ee weights will be a hyhrid concentric/eccentric programme. The muscle will shorten as il works Lo lift the weight against gravity and then lengthen as the weighl is lowered in a controlled manner. Figure 4.2 shows a dumb­ bell being used to strengthen the elbow flexors. Westminster Pulley System This is a wall-mounted frame with a weight carrier and more thall one pulley in circuit to allow loading of muscle to occur. Muscle loading can occur in different muscle ranges and planes of movement whilst the person exercising is lifting a known weight which is often visible. It is a much neglected piece of therapeutic equipment, probably because it takes a little time to develop the skill necessary to set up the pulley system quickly and effectively. 10 be able to use a pulley system for resistance training, a set of different weights which fit on the weight holder are needed along with devices to attach the pulley system to