Resistance Exercise For Impaired

Muscle Performance
Chapter No 6
Part 1
 INTRODUCTION
• Muscle performance refers to the capacity of a
muscle to do work (force distance)

• The key elements of muscle performance are

strength, power, and endurance

• Resistance exercise is any form of active exercise in

which dynamic or static muscle contraction is
resisted by an outside force applied manually or
mechanically
 FACTORS AFFECTING RESISTANCE
TRAINING
• Underlying pathology, • A patient’s or client’s age
• The extent and severity of
muscle performance • Overall level of fitness
impairments
• The ability to cooperate and
• T he presence of other learn all must be considered
deficits

• The stage of tissue healing

after injury or surgery
• The three elements of muscle performance—
• Strength
• Power
• Endurance—can be enhanced by some form of
resistance exercise.
 Potential Benefits of Resistance
Exercise
• Enhanced muscle performance:
restoration, improvement or
maintenance of muscle strength,
power, and endurance
• Increased strength of connective tissues:
• Enhanced physical performance
tendons, ligaments, intramuscular during daily living, occupational,
connective tissue and recreational activities
• Greater bone mineral density or less • Positive changes in body
bone demineralization composition: ↑ lean muscle
• Decreased stress on joints during mass or ↓ body fat
physical activity • Enhanced feeling of physical well-
• Reduced risk of soft tissue injury during being
physical activity • Possible improvement in
• Possible improvement in capacity to perception of disability and
repair and heal damaged soft tissues quality of life
due to positive impact on tissue
 STRENGTH
• Muscle strength is a broad term Strength training.
that refers to the ability of • Strength training
contractile tissue to produce
(strengthening exercise) is
tension and a resultant force
based on the demands placed defined as a systematic
on the muscle procedure of a muscle or
• Functional strength relates to muscle group lifting,
the ability of the neuromuscular lowering, or controlling
system to produce, reduce, or heavy loads (resistance) for
control forces, contemplated or a relatively low number of
imposed, during functional repetitions or over a short
activities, in a smooth, period of time.
coordinated manner
 STRENGTH
The most common adaptation to heavy resistance
exercise is an increase in the maximum force-
producing capacity of muscle, that is,
•An increase in muscle strength,
•Primarily as the result of neural adaptations and an
increase in muscle fiber
 POWER
• Power can be expressed
• Muscle power by either a
• It is related to the strength • Single Burst of high-
and speed of movement intensity activity (such as
• It is defined as the work lifting a heavy piece of
(force distance) produced luggage onto an
by a muscle per unit of overhead rack or
time (force distance/time). performing a high jump)
• The rate of performing anaerobic power
work • Repeated Bursts of less
intense muscle activity
(such as climbing a flight
of stairs). aerobic power
 POWER
Power Training
•Power can be enhanced by either increasing the work a
muscle must perform during a specified period of time or
reducing the amount of time required to produce a given
force

•The greater the intensity of the exercise and the shorter

the time period taken to generate force, the greater is the
muscle power

e.g plyometric training or stretch-shortening drills

 ENDURANCE
• Muscle endurance (sometimes
• Endurance is a broad term
referred to as local endurance) is
that refers to the ability to
the ability of a muscle to contract
perform low-intensity,
repeatedly against a load
repetitive, or sustained (resistance), generate and sustain
activities over a prolonged tension, and resist fatigue over an
period of time extended period of time
• Cardiopulmonary endurance • The term aerobic power is
(total body endurance) is sometimes use interchangeably
associated with repetitive, with muscle endurance
dynamic motor activities such • Maintenance of balance and
as walking, cycling, swimming, proper alignment of the body
or upper extremity ergometry, segments requires sustained
which involve use of the large control (endurance) by the
muscles of the body postural muscles.
 ENDURANCE
The key elements of endurance training
• Low-intensity muscle contractions
• A large number of repetitions
• A prolonged time period.
Endurance training increases in oxidative and metabolic
capacities, of the muscles which allows better delivery
and use of oxygen.
 OVERLOAD PRINCIPLE
• Application of the Overload
• If muscle performance is to Principle
improve, a load that exceeds • The overload principle focuses on
the metabolic capacity of the the progressive loading
muscle must be applied; that of muscle by manipulating,
is, the muscle must be
• For example, the intensity or
challenged to perform at a
level greater than that to volume of exercise
which it is accustomed • Intensity of resistance exercise
• If the demands remain refers to how much weight
(resistance) is imposed on the
constant after the muscle has
muscle
adapted, the level of muscle
performance can be • volume encompasses variables
maintained but not increase such as repetitions, sets, or
frequency of exercise,
 OVERLOAD PRINCIPLE
• In a strength training PRECAUTION
program
• To ensure safety, the extent and
the amount of resistance progression of overload must always
applied to the muscle is be applied in the context
incrementally and of the underlying pathology, age of
progressively increased. the patient, stage of tissue
• For endurance training, more healing, fatigue, and the overall
abilities and goals of the patient.
emphasis is placed on
increasing the time a muscle
• The muscle and related body systems
contraction is sustained or must be given time to adapt to the
the number of repetitions demands of an increased load or
performed than on increasing repetitions before the load or number
of repetitions is again increased
 SAID PRINCIPLE
• The SAID principle (specific • The SAID principle helps
adaptation to imposed therapists determine
demands) suggests that a the exercise
framework of specificity is a prescription and which
necessary foundation on parameters of exercise
which exercise programs should be selected to
should be built
create specific training
• This principle applies to all effects that best meet
body systems and is an specific functional
extension of Wolff’s law
needs and goals.
(body systems adapt over
time to the stresses placed on
 SAID PRINCIPLE
• Specificity of Training • Specificity of training should
• Specificity of training, also also be considered relative to
mode (type) and velocity of
referred to as specificity of
exercise as well as patient or
exercise, is a widely limb position (joint angle) and
accepted concept suggesting the movement pattern during
that the adaptive effects of exercise
training, such as • EXAMPLE, if the desired
improvement of strength, functional outcome is the ability
power, and endurance, are to ascend and descend stairs,
highly specific to the training exercise should be performed
eccentrically and concentrically
method employed
in a weight-bearing pattern and
progressed to the desired speed
 SAID PRINCIPLE
• It has been suggested that Transfer of Training
the basis of specificity of • In contrast to the SAID
training is related to principle, carryover of
morphological and training effects from one
metabolic changes in variation of exercise or task
muscle as well as neural to another has also been
adaptations to the training reported. This
stimulus associated with phenomenon is called
motor learning. transfer of training,
overflow, or cross-training
• Transfer of training has been • A program of exercises
reported to occur on a very designed to develop
limited basis with respect to muscle strength has also
the velocity of training and been shown to improve
the type or mode of muscular endurance at
exercise least moderately.
• It has also been suggested • In contrast, endurance
that a cross training effect training has little to no
can occur from an exercised cross-training effect on
limb to a non exercised, strength
contralateral limb in a
resistance training program
 Reversibility Principle
• Adaptive changes in the • Detraining, reflected by a
reduction in muscle
body’s systems, such as
performance, begins within a
increased strength or week or two after the cessation
endurance, in response to a of resistance exercises and
resistance exercise program continues until training effects
are lost.
are transient unless
• It is imperative that gains in
training-induced
strength and endurance are
improvements are regularly incorporated into daily activities
used for functional as early as possible in a
activities or unless an rehabilitation program.
individual participates in a • It is also advisable for patients to
participate in a maintenance
maintenance program of
program of resistance exercises
resistance exercises as an integral component of a
Factors that Influence Tension Generation in Normal
Skeletal Muscle
• Factor Influence
• Cross-section and size of the
muscle (includes muscle fiber • The larger the muscle diameter, the
number and size) greater its tension producing
capacity

• Fiber arrangement and fiber

• Short fibers with pinnate and
length
multipinnate design in high
force producing muscles (ex.
quadriceps, gastrocnemius, deltoid,
biceps brachii)
• Long parallel design in muscles with
high rate of shortening but less force
production (ex. Sartorius, lumbricals
 Factors that Influence Tension Generation in
Normal Skeletal Muscle
• Factor • Influence
• High percentage of type I
• Fiber-type distribution of fibers: low force production,
muscle: type I (tonic, slow slow rate of maximum force
twitch) and type IIA & IIB development, resistant to
(phasic, fast-twitch fatigue
• High percentage of type IIA
and IIB fibers: rapid high
force production; rapid
fatigue
 Factors that Influence Tension Generation in
Normal Skeletal Muscle
• Factor • Influence
• Length-tension relationship of• Muscle produces greatest tension
muscle at time of contraction when it is near or at the
physiological resting position at
the time of contraction

• The greater the number and

• Recruitment of motor units synchronization of motor units
firing, the greater the force
production

• Frequency of firing of motor • The higher the frequency of firing,

units the greater the tension
 Factors that Influence Tension Generation in
Normal Skeletal Muscle
• Factor • Influence

• Type of muscle • Force output from greatest

contraction to least: eccentric,
isometric, concentric
muscle contraction

• Speed of muscle • Concentric contraction

contraction ↑ speed → ↓ tension.
• (force-velocity • Eccentric contraction:
relationship) • ↑ speed → ↑ tension
• Energy Stores and Blood Supply • The three main energy
• Muscle needs adequate sources systems (ATP-PC
of energy (fuel) to contract, system,
generate tension, and resist
fatigue
anaerobic/glycolytic/
• The predominant fiber type lactic acid system,
found in the muscle and the aerobic system)
adequacy of blood supply, which
transports oxygen and nutrients
to muscle and removes waste
• Fatigue
products, affect the tension-
producing
capacity of a muscle and its
resistance to fatigue
 Muscle Fiber Types and Resistance to Fatigue
Characteristics Type I Type IIA Type IIB
Resistance High Intermediate Low
to fatigue
Capillary density High High Low
Energy system Aerobic Aerobic Anerobic
Diameter Small Intermediate Large
Twitch rate Slow Fast Fast
Maximum muscle Slow Fast Fast
shortening
velocity
• Muscle (local) fatigue • This acute physiological
• Most relevant to resistance response to exercise is
exercise is the phenomenon normal and reversible
of skeletal muscle fatigue • A gradual decline in the
• Muscle (local) fatigue—the force-producing capacity of
diminished response of the neuromuscular system,
muscle to a repeated that is, a temporary state of
stimulus—is reflected in a exhaustion (failure), leading
progressive decrement in to a decrease in muscle
the amplitude of motor strength
unit potentials.
 • TYPES OF MUSCLE FIBERS
• The diminished response of the
• Type I (tonic, slow-twitch)
muscle is caused by a combination
• Type I muscle fibers generate a low
of factors, which include:
level of muscle tension but can
• Disturbances in the contractile sustain the contraction for a long
mechanism of the muscle time
itself because of a decrease in • Type II (phasic, fast-twitch)
energy stores, insufficient  Types IIA
oxygen, and a build-up of H  Type IIB
• Inhibitory (protective) influences • Type II fibers generate a great
from the central nervous system amount of tension within a short
• Possibly a decrease in the period of time
conduction of impulses at the • IIB being geared toward anaerobic
myoneural junction, particularly in metabolic activity and having a
tendency to fatigue more quickly
fast-twitch fibers
than type IIA fibers.
• Type IIA fibers are geared toward
aerobic metabolism
• Type I fibers are more resistant to • Muscles with a large
fatigue than type IIA.
• Proportions of tonic and phasic
distribution of type IIB
fibers, in muscles their function (phasic) fibers, such as the
becomes specialized gastronomies or biceps
• Example : brachii, produce a great
• Type I (tonic) fibers in found in burst of tension to enable a
postural muscles, which allows
muscles such as the soleus to person to lift the entire body
sustain a low level of tension for weight or to lift, lower, push,
extended periods of time to hold or pull a heavy load but
the body erect against gravity or
stabilize against repetitive loads
fatigue quickly.
 Signs and Symptoms of Muscle
Fatigue
• An uncomfortable sensation • Use of substitute motions
in the muscle, even pain and —that is, incorrect
cramping movement patterns—to
• Tremulousness in the complete the movement
contracting muscle pattern
• Active movements jerky, not • Inability to continue low-
smooth intensity physical activity
• Inability to complete the
• Decline in peak torque
movement pattern through the
full range of available motion during isokinetic testing
during dynamic exercise
against the same level of
Cardiopulmonary (general) fatigue
• This type of fatigue is the • Threshold for fatigue
diminished response of an • Threshold for fatigue is the
individual (the entire body) as the
level
result of prolonged physical activity,
such as walking, jogging, cycling, or of exercise that cannot be
repetitive lifting or digging sustained indefinitely
Factors of Cardiopulmonary fatigue • A patient’s threshold for
• Decrease in blood sugar (glucose)
fatigue could be noted as the
levels
• Decrease in glycogen stores in
length of time a contraction
muscle and liver is maintained or the number
• Depletion of potassium, especially of repetitions of an exercise
in the elderly patient that initially can be
• Factors that influence fatigue • In multiple sclerosis, the patient usually
• A patient’s health status, diet, awakens rested and functions well
during the early morning. By mid-
or lifestyle (sedentary or
afternoon, however, the patient
active) all influence fatigue reaches a peak of fatigue and becomes
• A patient’s health status, diet, notably weak. Then by early evening
or lifestyle (sedentary or the fatigue diminishes, and strength
active) all influence fatigue returns
• A therapist to become familiar • Patients with cardiac, peripheral
vascular, and pulmonary diseases, as
with the patterns of fatigue well as patients with cancer undergoing
associated with different chemotherapy or radiation therapy, all
diseases and medications. have deficits that compromise the
oxygen transport system. Therefore,
these patients fatigue more readily and
require a longer period of time for
recovery from exercise
 • Recovery from Exercise
• Environmental factors, such
• Adequate time for recovery
as outside or room
from fatiguing exercise must
temperature, air quality,
and altitude, also influence be built into every resistance
how quickly the onset of training program. This applies
fatigue occurs and how to both intrasession and
much time is required for intersession recovery. After
recovery from exercise vigorous exercise, the body
must be given time to restore
itself to a state that existed
prior to the exhaustive
exercise
• Recovery from acute Changes that occur in muscle
exercise, where the force- during recovery are
producing capacity of • Oxygen stores are
muscle returns to 90% to replenished in muscles.
95% of the preexercise • Energy stores are replenished
capacity, usually takes 3 to
• Lactic acid is removed from
4 minutes, with the
skeletal muscle and blood
greatest proportion of
recovery occurring in the within approximately 1 hour
first minute after exercise.
• Glycogen is replaced over
several days.
 Focus on Evidence
If light exercise is performed during the recovery
period (active recovery), recovery from exercise
occurs more rapidly than with total rest (passive
recovery). Faster recovery with light exercise is
probably the result of neural as well as circulatory
influences.
 AGE
• Muscle performance
changes throughout the life
span.
 Age-Related Changes in Muscle and Muscle
Performance
Infancy, Early Childhood, and
Muscle strength and muscle
Preadolescence endurance increase linearly with
• At birth, muscle accounts for chronological age in boys and
about 25% of body weight. girls throughout childhood until
• Total number of muscle fibers is puberty.
established prior to or early • Muscle mass (absolute and
during infancy. relative) and muscle strength is
• Postnatal changes in distribution just slightly greater
of type I and type II fibers in (approximately 10%) in boys than
muscle are relatively complete by girls from early childhood to
the end of the first year of life. puberty.
• Muscle fiber size and muscle • Training-induced strength gains
mass increase linearly from occur equally in both sexes during
infancy to puberty childhood without evidence of
 Age-Related Changes in Muscle and
Muscle Performance
Puberty • In boys, muscle mass and
• Rapid acceleration in muscle body height and weight
fiber size and muscle mass, peak before muscle
especially in boys. During strength; in girls, strength
puberty, muscle mass peaks before body
increases more than 30% per weight.
year. • Relative strength gains as
• Rapid increase in muscle the result of resistance
strength in both sexes. training are comparable
• Marked difference in strength between the sexes, with
levels develops in boys and significantly greater
girls muscle hypertrophy in
boys.
 Age-Related Changes in Muscle and
Muscle Performance
Young and Middle Adulthood
• Muscle strength and endurance
• Muscle mass peaks in women
reach a peak during the second
between 16 and 20 years of
decade, earlier for women than
age; muscle mass in men peaks men.
between 18 and 25 years • By sometime in the third decade,
of age. strength declines between 8% and
• Decreases in muscle mass occur as 10% per decade through the fifth
early as 25 years of age. or sixth decade.
• Muscle mass constitutes • Strength and muscle endurance
approximately 40% of total body deteriorate less rapidly in
physically active versus sedentary
weight during early adulthood, with
adults.
men having slightly more muscle
• Improvements in strength and
mass than women
endurance are possible with
• Strength continues to develop into
only a modest increase in physical
the second decade, especially in men
 Age-Related Changes in Muscle and
Muscle Performance
Late Adulthood • Gradual but progressive decrease in
Rate of decline of muscle strength endurance and maximum oxygen uptake.
accelerates to 15% to 20% per decade • Loss of flexibility reduces the force-
during the sixth and seventh decades producing capacity of muscle.
and increases to 30% per decade • Minimal decline in performance of
thereafter. functional skills during the sixth decade.
• Loss of muscle mass continues; by the • Significant deterioration in functional
eighth decade, skeletal muscle mass abilities by the eighth decade associated
has decreased by 50% compared to with a decline in muscular endurance.
peak muscle mass during young • With a resistance training program, a
adulthood. significant improvement in muscle
• Muscle fiber size (cross-sectional area), strength, power, and endurance is possible
type I and type II fiber numbers, and during late adulthood.
the number of alpha motoneurons all • Evidence of the impact of resistance training
decrease. Preferential atrophy of type on the level of performance of functional
II muscle fibers occurs. motor skills is mixed but promising.
• Decrease in the speed of muscle
 Age-Related Changes in Muscle and
Muscle Performance
• Resistance training, if initiated
during the preadolescent years,
should be performed using
body weight or light weights
and carefully supervised
 Age-Related Changes in Muscle and
Muscle Performance

Conditioning and fitness programs for active young and middle-age adults include resistance
training with a balance of (A) upper extremity and (B) lower extremity strengthening
exercises.
 Age-Related Changes in Muscle and
Muscle Performance
• Incorporating resistance
training into a fitness
program has many
benefits for older adult
 Psychological and Cognitive Factors
Fear of pain, injury, or reinjury, • Attention
depression related to physical • Motivation and
illness, or impaired attention Feedback
or memory as the result of
age, head injury, or the side
effects of medication can
adversely affect the ability to
develop or sustain sufficient
muscle tension for execution
or acquisition of functional
motor tasks