Ministry of higher education and scientific research

Erbil polytechnic university

Erbil health technical college
physiotherapy department
second stage
third semester
Subject: therapeutic exercise
study year 2020-2021

Progressive resistance
exercise

Prepared by: supervised by:

Shakar Mudrik Omer dr/Mahdi khalid qadir

Werde Jamel sadeq

Mehad omer naji

Contents page/NO

Introduction ………………………………………………………………..…………………………………………………….. 2
Why Is Progressive Resistance Needed?..................................................................................... 3
Methods of Progressive Resistance………………….………………………………………………………………. 3 -4
Precautions and contra-indication…………………………….……………………………………………………….. 4
Delorm Technique and Oxford Technique……………………..………………………………………………….. 5
types of progressive resistance exercise……………………………….…………………………………………….. 5-7
Progressive resistance exercise improves strength and physical performance
in people with mild to moderate Parkinson's disease …………………………………………………………. 8
effects of a progressive resistance and
balance exercise program in individuals with chronic stroke…………………………………………....8 -9
Progressive Resistance Exercise Improves Muscle Strength and May Improve Elements
of Performance of Daily Activities for People With
COPD……………………………………………………………………………………………………………………………………….. 9
Progressive resistance strength training for improving physical function in older
adults………………………………………………………………………………………………………………………………………. 1o
Summary……………………………………………………………………………………………………………………………………11
Reference………………………………………………………………………………………………………………………………….12

1
introduction

Progressive resistance exercise (PRE) is a method of increasing the ability of muscles to

generate force. The term "Progressive Resistance Exercise" means exercise performed against
Resistance \^d i is increased periodically as the exerciser ^ins strmgth. The American College of Sports
Medicine definesit as - "the proems by which muscle forces or torques are increased to overcome the
internal or external resistances imposed upon skeletal muscles". Progressive Resistance Exercise is
based on the overload principle and usually refersto weit lifting exercise. To achieve gains in muscle
strength and Itypertroplty, progressive resistance is essential to compensate for gains as the training
progresses. Without this, the body's adaptation to the stimulus is limited.

The principles of progressive resistance exercise (PRE) for increasing force production in muscles have
remained virtually unchanged since they were described by DeLorme and Watkins almost 60 years
ago. These principles are (1) to perform a small number of repetitions until fatigue, (2) to allow
sufficient rest between exercises for recovery, and (3) to increase the resistance as the ability to
generate force increases. These principles are detailed in the guidelines of the American College of
Sports Medicine (ACSM), where it is recommended that loads corresponding to an 8- to 12-repetition
maximum (RM) be lifted in 1 to 3 sets, training 2 or 3 days each week. An 8RM to 12RM load is the
amount of weight that can be lifted through the available range of motion 8 to 12 times before needing
a rest.

Traditionally, PRE has been used by young adults who are healthy to improve athletic performance.
However, recent reviews have emphasized the potential health benefits of including PRE as part of the
promotion of physical activity in the community. The potential health benefits of incorporating PRE
into an overall fitness program include helping to reduce risk factors associated with osteoporosis as
well as diseases such as cardiovascular disease and diabetes. The health benefits associated with PRE
also may make it a useful intervention in physical therapy. A reduced ability of muscles to generate
force, due to injury, pathology, or disuse, is a common impairment in clients seen by physical
therapists. If a lack of force generation by muscles is an impairment contributing to an inability to
perform everyday activities, then this provides a rationale for physical therapists to apply the
principles of PRE when designing treatment programs.

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Why Is Progressive Resistance Needed?

Your body adapts to exercise and needs to be constantly challenged in order to continue to see muscle
growth and improved levels of fitness. Doing the same thing day after day may maintain the muscle
and strength you have already built, but you may stop seeing improvements. If your goal is to lose
weight, it puts you at risk for a weight loss plateau, that frustrating time when your weight loss starts to
stall.

Methods of Progressive Resistance

There are many ways to achieve progressive resistance:

 Increase the weight you're lifting. Do the same number of reps and sets each week, but
increase the weights. You should only increase the weights by 2 percent to 10 percent of your
RM load at a time. The RM load is the maximum amount of weight you can lift one time. For
example, if you can lift 50 pounds once, you should only increase the weight you lift with each
rep by 2 to 5 pounds each week. You don't want to overdo the increase in the load.
 Increase the number of reps. Use the same weight for each workout, but increase the
reps each week.
 Decrease the number of reps. Intermediate to advanced trainers can lift heavier weights
for fewer reps, known as heavy loading. When doing heavy loading, you increased the rest time
between sets to three to five minutes.
 Increase the number of sets. A typical weight training workout for people with the goal
to lose weight will involve about two to four sets of each exercise. If you're a beginner, one set
may be enough to build strength and endurance but, as you get stronger, you'll want to
eventually work your way up to two to four sets, resting about 20 seconds to 60 seconds,
depending on how heavy you're lifting.
 Shorten the rest between the sets. If you're doing straight sets, e.g. three sets of squats
or three sets of pushups, you'll typically have a rest of about 10 seconds to 60 seconds between
sets. One way to challenge your body and increase intensity is to shorten the rest between sets.
If your form starts to suffer, increase the rest period or drop a little weight.

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  Lengthen the time under tension. This is how long your muscle fibers are under stress.
Use the same weight and reps, but slow down the exercise. For example, one count to lift the
weight, three counts to lower the weight.

Precautions and contra-indication

Precautions:

1 - Cardiovascular problems must be controled during exercises.

2- Avoid reaching to fatigue point.

3- Adequate time for recovery from fatigue.

4- Avoid over work to avoid excessive protein breakdown.

5- Osteoporosis: to avoid pathological fracture.

6- Muscle soreness: due to lack of blood flow and oxygen.

contra-indication:

1 – Inflammation which is leading to swelling.

2- Pain during the resistance exercises

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Delorm Technique

Describe a system approach by progressively increasing the resistance (weight lifted). The protocol
underwent a number of modifications but settled upon the following approach:

a-Once a week the 10 RM was determined for

each muscle or muscle group to be strengthened.

b-For each daily session 10 repetitions at 50% of

the 10 RM, 10 repetitions at 75% and 10 RM at

100% of the 10 RM.

Oxford Technique

This technique was designed to be used in beginning, intermediate, and advanced levels of
rehabilitation (it is the reverse of Delorm).

types of progressive resistance exercise.

Isotonic exercise is probably the type completed most often, which is when a muscle faces a
resistance that it is strong enough to overcome, so when the person uses their strength to resist the
weight, the muscle contracts and shortens and there is motion in the attached joint as it does so.
Isotonic exercises build muscular strength and endurance, but they aren’t too hard on the
cardiovascular system, so depending on the weight, your heart rate may or may not increase. Simply
lifting a bag of groceries is an example of isotonic exercise.

Isometric exercise, on the other hand, is when a muscle faces a resistance that it is not strong
enough to overcome, so
even when the person uses
all of their strength to resist
the weight, the muscle
contracts but doesn’t
shorten, and therefore the
attached joint doesn’t move
5
either.2 Think of the feeling when you do squats with the barbell loaded close to your maximum
weight, then you do a few and eventually you reach a point when you squat down, but it seems like no
matter how hard you push your feet into the floor and engage your legs, you just can’t stand back up
and that’s when your spotter steps in. The squats before that one were isotonic exercises, but the last
squat was an isometric exercise. If you were familiar with the feeling in that example, you’ll recognize
that while isotonic exercises don’t always raise the heart rate, isometric exercises definitely do raise the
heart rate, and are therefore more taxing for the cardiovascular system and cannot be done for as long
or as often as isotonic exercises.

Isokinetic Exercise

Isokinetic exercise, or
accommodating variable-
resistance exercise, is performed
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at a fixed speed with the resistance matching the muscle force at that speed of movement. As the
muscle force input changes, the resistance changes because the speed remains constant. Application of
the athlete's own muscular resistance is met with a proportional amount of resistance throughout a
range of motion. Isokinetic machines may be set to offer concentric-concentric, concentric-eccentric, or
eccentric-eccentric actions at various velocities

Benefits of Isokinetic Exercise

Because the variable resistance in these types of exercise equipment is so controlled, it helps to prevent
a lot of different kinds of injury for users. Isokinetic exercise also offers more direct response and
customization of challenges to a body's momentum. This kind of exercise and gear can be especially
helpful after injury, where participants want to take care not to strain muscles with excessive resistance.

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Progressive resistance exercise improves strength and physical performance in
people with mild to moderate Parkinson's disease:

Measures of muscle strength (maximum voluntary force production) - either continuous (force, torque,
work, EMG) or ordinal (manual muscle test) - and physical performance measures: sit-to-stand time,
fast and comfortable walking speeds, 6-min walk test, stair descent and ascent, the Activities-specific
Balance Confidence scale, Timed Up and Go test, and the Short Physical Performance Battery. Four
(quasi-) randomised trials were included, three of which reported data that could be pooled in a meta-
analysis. Progressive resistance exercise increased strength, with a standardised mean difference 0.50
(95% CI 0.05 to 0.95), and had a clinically worthwhile effect on walking capacity, with a mean
difference of 96 metres (95% CI 40 to 152) among people with mild to moderate Parkinson's disease.
However, most physical performance outcomes did not show clinically worthwhile improvement after
progressive resistance exercise. This review suggests that progressive resistance exercise can be
effective and worthwhile in people with mild to moderate Parkinson's disease, but carryover of benefit
does not occur for all measures of physical performance. The current evidence suggests that
progressive resistance training should be implemented in Parkinson's disease rehabilitation, particularly
when the aim is to improve walking capacity.

Short-term and long-term effects of a progressive resistance and balance exercise

program in individuals with chronic stroke: a randomized controlled trial.

In a randomized controlled trial with follow-up at 3, 6 and 15 months, 67 community-

living individuals (76% male; 65-85 years) with a stroke 1-3 years previously were
allocated to an intervention group (IG, n = 34; PRB exercises combined with
motivational group discussions twice weekly for 3 months) or a control group (CG, n =
33). The primary outcomes were balance (Berg Balance Scale, 0-56 points) and mobility
(Short Physical Performance Battery, 0-12 points) at 3 months. The secondary outcomes
were 10 m comfortable walking speed, physical activity levels, health-related quality of
life, depression and fall-related self-efficacy.

At 3 months, the IG exhibited significant improvements in balance (MD 2.5 versus 0

points; effect size [ES], 0.72; p < 0.01) and comfortable walking speed (MD 0.04 versus

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-0.05 m/s; ES, 0.68; p = 0.01) relative to the CG. A faster walking speed persisted at 6
months. No differences were found for the other outcomes. In chronic stroke patients, 3
months of PRB exercises and motivational discussions induced improvements in balance
at 3 months and in walking speed at 3 and 6 months. Implications for Rehabilitation A
progressive resistance and balance exercise program supported by motivational group
discussions and one home-based exercise appears to be an effective means of improving
the short-term balance and the walking speed in individuals with chronic stroke. People
with poor balance and motor function discontinued the study more often and may
require additional support. There is a need for powerful and cost-effective strategies that
target changes in behavior to obtain long-term changes in physical function after
exercising.

Progressive Resistance Exercise Improves Muscle Strength and May Improve

Elements of Performance of Daily Activities for People With COPD: 

Skeletal muscle weakness and its impact on exercise tolerance in many people with COPD provide a
rationale for the intervention of progressive resistance exercise during pulmonary rehabilitation. To
optimize rehabilitation outcomes, clinicians prescribing resistance programs require up-to-date
information on effectiveness, safety, and feasibility. Therefore, the review aimed to update the current
evidence for progressive resistance exercise for people with COPD. Eighteen controlled trials
(including 10 trials published in the last 5 years) demonstrated moderate effects for increases in muscle
strength after short-term progressive resistance exercise. Despite effects favoring progressive resistance
exercise for cycling tests when compared with no intervention, and daily tasks such as sit-to-stand and
stair climbing, trials reporting these outcomes had a higher risk of bias. Short-term progressive
resistance exercise can lead to appreciable increases in muscle strength for people with COPD, which
may carry over to the performance of some daily activities. Future research should place emphasis on
activity and participation level outcomes, and focus on determining the longer term outcomes and
optimal methods for maintaining outcomes in this population.

9
Progressive resistance strength training for improving physical function in older
adults.

One hundred and twenty one trials with 6700 participants were included. In most trials, PRT was
performed two to three times per week and at a high intensity. PRT resulted in a small but significant
improvement in physical ability (33 trials, 2172 participants; SMD 0.14, 95% CI 0.05 to 0.22).
Functional limitation measures also showed improvements: e.g. there was a modest improvement in
gait speed (24 trials, 1179 participants, MD 0.08 m/s, 95% CI 0.04 to 0.12); and a moderate to large
effect for getting out of a chair (11 trials, 384 participants, SMD -0.94, 95% CI -1.49 to -0.38). PRT
had a large positive effect on muscle strength (73 trials, 3059 participants, SMD 0.84, 95% CI 0.67 to
1.00). Participants with osteoarthritis reported a reduction in pain following PRT(6 trials, 503
participants, SMD -0.30, 95% CI -0.48 to -0.13). There was no evidence from 10 other trials (587
participants) that PRT had an effect on bodily pain. Adverse events were poorly recorded but adverse
events related to musculoskeletal complaints, such as joint pain and muscle soreness, were reported in
many of the studies that prospectively defined and monitored these events. Serious adverse events were
rare, and no serious events were reported to be directly related to the exercise programme. This review
provides evidence that PRT is an effective intervention for improving physical functioning in older
people, including improving strength and the performance of some simple and complex activities.
However, some caution is needed with transferring these exercises for use with clinical populations
because adverse events are not adequately reported.

10
Summary

Progressive resistance exercise (PRE) is a method of increasing the ability of muscles to generate force.
The term "Progressive Resistance Exercise" means exercise performed against Resistance \^d i is
increased periodically as the exerciser ^ins strmgth. The American College of Sports Medicine
definesit as - "the proems by which muscle forces or torques are increased to overcome the internal or
external resistances imposed upon skeletal muscles". Progressive Resistance Exercise is based on the
overload principle and usually refersto wei^t lifting exercise. To achieve gains in muscle strength and
Itypertroplty, progressive resistance is essential to compensate for gains as the training progresses.
Without this, the body's adaptation to the stimulus is limited.

Your body adapts to exercise and needs to be constantly challenged in order to continue to see muscle
growth and improved levels of fitness. Doing the same thing day after day may maintain the muscle
and strength you have already built, but you may stop seeing improvements. If your goal is to lose
weight, it puts you at risk for a weight loss plateau, that frustrating time when your weight loss starts to
stall.

11
Reference

1. https://pubmed.ncbi.nlm.nih.gov/16253049/
2. https://academic.oup.com/ptj/article/85/11/1208/2805087
3. https://core.ac.uk/download/pdf/77018594.pdf
4. https://www.verywellfit.com/progressive-resistance-1229835
5. https://pubmed.ncbi.nlm.nih.gov/23419910/
6. https://pubmed.ncbi.nlm.nih.gov/27415645/
7. https://www.sciencedirect.com/science/article/abs/pii/S0012369209606838
8. https://pubmed.ncbi.nlm.nih.gov/19588334/
9. https://healthyheels.org/2014/10/01/workout-wednesday-isotonic-vs-
isometric-exercise-whats-the-difference/
10. https://www.sciencedirect.com/topics/medicine-and-dentistry/isokinetic-
exercise#:~:text=Isokinetic%20exercise%2C%20or%20accommodating
%20variable,because%20the%20speed%20remains%20constant.
11. https://www.fitday.com/fitness-articles/fitness/exercises/what-is-isokinetic-
exercise.html
12. https://fihsmultan.files.wordpress.com/2014/01/progressive-resisted-
exercises.ppt

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