Resistance Exercise

Muscle Performance and Resistance

Exercise
Muscle performance refers to the capacity of a muscle to do work

(force × distance).

Despite the simplicity of the definition, muscle performance is a complex component

of functional movement and is influenced by all of the body systems.

Muscle Performance and Resistance
Exercise
Factors that affect muscle performance include
the morphological qualities of muscle,
neurological,
biochemical, and biomechanical influences;
metabolic,
cardiovascular,
respiratory,
cognitive, and emotional function.
Muscle Performance and Resistance
Exercise
The key elements of muscle performance are strength, power,
and endurance.

If any one or more of these areas of muscle performance is impaired,

activity limitations (functional limitations) and participation restriction
(disability) or increased risk of dysfunction may ensue.
Muscle Performance and Resistance
Exercise
Many factors, such as injury, disease, immobilization, disuse, and inactivity, may
result in impaired muscle performance, leading to weakness and muscle atrophy.

When deficits in muscle performance place a person at risk for injury or hinder
function, the use of resistance exercise is an appropriate therapeutic intervention to
improve the integrated use of strength, power, and muscular endurance during
functional movements, to reduce the risk of injury or re-injury, and to enhance
physical performance.
Resistance Exercise
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.

Resistance exercise, also referred to as resistance training, is an essential element of

rehabilitation programs for persons with impaired function and an integral
component of conditioning programs for those who wish to promote or maintain
health and physical well-being, potentially enhance performance of motor skills, and
reduce the risk of injury and disease.
Strength
Muscle strength is a broad term that refers to the ability of contractile
tissue to produce tension and a resultant force based on the
demands placed on the muscle.

More specifically, muscle strength is the greatest measurable

force that can be exerted by a muscle or muscle group to overcome resistance
during a single maximum effort.
Strength
Functional strength relates to the ability of the neuromuscular system to
produce, reduce, or control forces, contemplated or imposed, during
functional activities, in a smooth, coordinated manner.

Insufficient muscular strength can contribute to major functional

losses of even the most basic activities of daily living.
Power
Muscle power, another aspect of muscle performance, is related to the
strength and speed of movement and is defined as the work
(force × distance) produced by a muscle per unit of time (force ×
distance/time).

In other words, it is the rate of performing work.

Endurance
Endurance is a broad term that refers to the ability to perform low-intensity,
repetitive, or sustained activities over a prolonged period of time.

Cardiopulmonary endurance (total body endurance) is associated with repetitive,

dynamic motor activities, such as walking, cycling, swimming, or upper extremity
ergometry, which involve use of the large muscles of the body.
Endurance
Muscle endurance(sometimes referred to as local endurance) is the
ability of a muscle to contract repeatedly against a
load (resistance), generate and sustain tension, and resist fatigue over
an extended period of time.

The term aerobic power sometimes is used interchangeably with muscle

endurance.
Overload Principle
Simply stated, if muscle performance is to improve, a
load that exceeds the metabolic capacity of the
muscle must be applied—that is, the muscle must be challenged
to perform at a level greater than that to which it is accustomed.

If the demands remain constant after the muscle has adapted, the level
of muscle performance can be maintained but not increased.
Overload Principle
■ In a strength training program, the amount of resistance applied to the
muscle is incrementally and progressively increased.

■ For endurance training, more emphasis is placed on increasing the

time a muscle contraction is sustained or the number of repetitions
performed than on increasing resistance.
Reversibility Principle
Adaptive changes in the body’s systems, such as increased strength or endurance, in
response to a resistance exercise program are transient unless training-induced
improvements are regularly used for functional activities or unless an individual
participates in a maintenance program of resistance exercises.

Detraining, reflected by a reduction in muscle performance, begins within a

week or two after the cessation of resistance exercises and
continues until training effects are lost.
Skeletal Muscle Function and Adaptation
to Resistance Exercise
Knowledge of the factors that influence the force-producing capacity of
normal muscle during an active contraction is fundamental to
understanding how the neuromuscular system adapts as the result of
resistance training.
Factors that Influence Tension
Generation in Normal Skeletal Muscle
Energy Stores and Blood Supply Recovery from Exercise
Fatigue
Age
oMuscle (local) fatigue

oCardiopulmonary (general)
fatigue
Determinants of Resistance Exercise
Alignment and Stabilization
Alignment

Alignment and muscle action

Proper alignment is determined by the direction of muscle fibers and the line of pull
of the muscle to be strengthened. The patient or a body segment must be positioned
so the direction of movement of a limb or segment of the body replicates the action
of the muscle or muscle groups to be strengthened.
Alignment and Stabilization
Alignment and gravity

The alignment or position of the patient or the limb with respect to gravity also may
be important during some forms of resistance exercises, particularly if body weight or
free weights (dumbbells, barbells, cuff weights) are the source of resistance.

The patient or limb should be positioned so the muscle being strengthened acts
against the resistance of gravity and the weight. This, of course, is contingent on the
comfort and mobility of the patient.
Alignment and Stabilization
Stabilization

Stabilization refers to holding down a body segment or holding the body

steady. To maintain appropriate alignment, ensure the correct muscle
action and movement pattern, and avoid unwanted substitute motions
during resistance exercise, effective stabilization is imperative.
Alignment and Stabilization
Stabilization can be achieved externally or internally.

External stabilization can be applied Internal stabilization is achieved by an

manually by the therapist or isometric contraction of an adjacent
sometimes by the patient with muscle group that does not enter into
equipment, such as belts and straps, or the movement pattern but holds the
by a firm support surface, such as the
body segment of the proximal
back of a chair or the surface of a
attachment of the muscle being
treatment table.
strengthened firmly in place.
Intensity
The intensity of exercise in a resistance training program is the amount of resistance
(weight) imposed on the contracting muscle during each repetition of an exercise.
The amount of resistance is also referred to as the exercise load (training load)—that
is, the extent to which the muscle is loaded or how much weight is lifted, lowered, or
held.
Initial Exercise Load (Amount of Resistance)
and Documentation of Training Effects
Repetition Maximum

A repetition maximum (RM) is defined as the greatest

amount of weight (load) a muscle can move through

the full, available ROM with control a specific number

of times before fatiguing.

Initial Exercise Load (Amount of Resistance)
and Documentation of Training Effects
Repetition Maximum
There are two main reasons for determining a repetition maximum:
(1) to document a baseline measurement of the dynamic strength of a
muscle or muscle group against which exercise-induced improvements in
strength can be compared; and
(2) to identify an initial exercise load (amount of weight) to be used
during exercise for a specified number of repetitions.
Alternative Methods of Determining
Baseline Strength or an Initial Exercise Load
Cable tensiometry and isokinetic or handheld dynamometry are
alternatives to a repetition maximum for establishing a baseline
measurement of dynamic or static strength.
Training Zone
After establishing the baseline RM, the amount of resistance (exercise load) to be used at the
initiation of resistance training often is calculated as a percentage of a 1-RM for a particular
muscle group.

At the beginning of an exercise program the percentage necessary to achieve training-

induced adaptations in strength is low (30% to 40%) for sedentary,
untrained individuals or very high (>80%) for those already highly
trained.
Training Zone
For healthy but untrained adults, a typical training zone usually falls
between 40% and 70% of the baseline RM.

The lower percentage of this range is safer at the beginning of a program

to enable an individual to focus on learning correct exercise form and
technique before progressing the exercise load to 60% to 70%.
Volume
In resistance training the volume of exercise is the summation of the total
number of repetitions and sets of a particular exercise during a single
exercise session times the intensity of the exercise.

The same combination of repetitions and sets is not and should not be
used for all muscle groups.
Volume
Repetitions; The number of repetitions in a dynamic exercise program refers to the
number of times a particular movement is repeated.

If the RM designation is used, the number of repetitions at a specific exercise load is

reflected in the designation.
Volume
The “average,” untrained adult, when exercising with a load that is
equivalent to 75% of the 1-RM, is able to complete approximately 10
repetitions before needing to rest.

 At 60% intensity about 15 repetitions are possible, and at 90% intensity

only 4 or 5 repetitions are usually possible.
Volume
Sets; a predetermined number of consecutive repetitions grouped
together is known as a set or bout of exercise.

There is no optimal number of sets per exercise session, but 2 to 4

sets is a common recommendation for adults.
Some common goals of resistance
training
Increases in muscle size, strength, power, speed, local muscular
endurance, balance, coordination, and flexibility, reductions in
body fat, improvements in general health (e.g., lower blood
pressure, strengthen connective tissue, reduce stress), and
rehabilitation from injury.
Training to Improve Strength or
Endurance
To Improve Muscle Strength
One resource suggests that a
threshold of 40% to 60% of
maximum effort is necessary
for adaptive strength gains to
occur in a healthy but
untrained individual.
However, other resources
recommend using a moderate
exercise load (60% to 80% of a
1-RM) that causes fatigue
after 8 to 12 repetitions for 2
or 3 sets.
To Improve Muscle Endurance
Training to improve muscle
(local) endurance involves
performing many repetitions of
an exercise against a submaximal
load.
For example, as many as three
to five sets of 40 to 50
repetitions against a low amount
of weight or a light grade of
elastic resistance might be used.
When increasing the number of
repetitions or sets becomes
inefficient, the load can be
increased slightly.
Exercise Order
The sequence in which exercises are performed during an exercise session has an
impact on muscle fatigue and adaptive training effects.
When several muscle groups are exercised in a single session, as is the case in most
rehabilitation or conditioning programs, large muscle groups should be
exercised before small muscle groups, and multi-joint
exercises should be performed before single-joint exercises.
In addition, after an appropriate warm-up, higher intensity exercises should be
performed before lower intensity exercises.
Frequency
Frequency in a resistance exercise program refers to the number of exercise sessions
per day or per week.

Frequency also may refer to the number of times per week specific muscle groups
are exercised or certain exercises are performed.

As the intensity and volume of exercise increases, a frequency of 2 to 3 times per
week, every other day, or up to five exercise sessions per week is common.
Duration
Exercise duration is the total number of weeks or months during which a
resistance exercise program is carried out.
Depending on the cause of impaired muscle performance, some patients
require only a month or two of training to return to the desired level of
function or activity, whereas others need to continue the exercise
program for a lifetime to maintain optimal function.
For significant changes to occur in muscle, such as hypertrophy or
increased vascularization, at least 6 to 12 weeks of
resistance training is required.
Rest Interval (Recovery Period)
Rest is a critical element of a resistance training program and is necessary to allow
time for the body to recuperate from the acute effects of exercise associated with
muscle fatigue or to offset adverse responses, such as exercise-induced, delayed-
onset muscle soreness.

Only with an appropriate balance of progressive loading and adequate rest intervals
can muscle performance improve. Therefore, rest between sets of exercise and
between exercise sessions must be addressed.
Resistance Exercise
Isokinetic Exercise
Isokinetic exercise is a form of dynamic exercise in which the velocity of
muscle shortening or lengthening and the angular limb velocity is
predetermined and held constant by a rate-limiting device known as an
isokinetic dynamometer.

The term isokinetic refers to movement that occurs at an

equal (constant) velocity.
https://youtu.be/AIIRLjqUbR8
Precautions for Resistance Exercise
Valsalva Maneuver (expiratory effort against a closed glottis, must be avoided during
resistance exercise)
Substitute Motions (If too much resistance is applied to a contracting muscle during
exercise, substitute motions can ocur)
Overtraining (a decline in physical performance in healthy individuals participating in
high-intensity, high-volume strength and endurance training programs)
Overwork (progressive deterioration of strength in muscles already weakened by
nonprogressive neuromuscular disease)
Exercise-Induced Muscle Soreness
Pathological Fracture (high risk for osteoporosis or osteopenia participicants)
Contraindications to Resistance Exercise
Pain (If a patient experiences severe joint or muscle pain during active-free
(unresisted) movements, dynamic resistance exercises should not be initiated.)

Inflammation (Dynamic and static resistance training is absolutely contraindicated in

the presence of inflammatory neuromuscular disease)

Severe Cardiopulmonary Disease (Severe cardiac or respiratory diseases or disorders

associated with acute symptoms contraindicate resistance training)
Manual Resistance Exercise
Upper Extremity
Shoulder Flexion
Hand Placement and Procedure
■ Apply resistance to the anterior aspect
of the distal arm or to the distal portion of
the forearm if the elbow is stable and
pain-free .
■ Stabilization of the scapula and trunk is
provided by the treatment table.
Upper Extremity
Shoulder Extension
Hand Placement and Procedure

■ Apply resistance to the posterior

aspect of the distal arm or the distal
portion of the forearm.

■ Stabilization of the scapula is

provided by the table.
Upper Extremity
Shoulder Abduction and Adduction
Hand Placement and Procedure
■ Apply resistance to the distal portion
of the arm with the patient’s elbow
flexed to 90˚. To resist abduction, apply
resistance to the lateral aspect of the
arm. To resist adduction, apply
resistance to the medial aspect of the
arm.
■ Stabilization is applied to the
superior aspect of the shoulder, if
necessary, to prevent the patient from
initiating abduction by shrugging the
shoulder (elevation of the scapula).
Upper Extremity
Elevation of the Arm in the Plane of the
Scapula (“Scaption”)
Hand Placement and Procedure
■ Same as previously described for
shoulder flexion.
■ Apply resistance as the patient
elevates the arm in the plane of the
scapula (30˚ to 40˚ anterior to the
frontal plane of the body).
Shoulder Internal and External Rotation
Hand Placement and Procedure
■ Flex the elbow to 90˚ and position
the shoulder in the plane of the
scapula.
■ Apply resistance to the distal portion
of the forearm during internal rotation
and external rotation.
■ Stabilize at the level of the clavicle
during internal rotation; the back and
scapula are stabilized by the table
during external rotation.
Upper Extremity
Shoulder Horizontal Abduction and Adduction
Hand Placement and Procedure
■ Abduct the shoulder and flex the elbow to 90˚ and place the shoulder in neutral
rotation.
■ Apply resistance to the distal portion of the arm just above the elbow during
horizontal adduction and abduction.
■ Stabilize the anterior aspect of the shoulder during horizontal adduction. The table
stabilizes the scapula and trunk during horizontal abduction.
■ To resist horizontal abduction from 0˚ to 45˚, the patient must be close to the edge
of the table while supine or be placed side-lying or prone.
Upper Extremity
Elevation of the Scapula
Hand Placement and Procedure
■ Have the patient assume a
supine, side-lying, or sitting
position.
■ Apply resistance along the
superior aspect of the shoulder
girdle just above the clavicle during
scapular elevation.
Upper Extremity
Elbow Flexion
Hand Placement and Procedure
■ To strengthen the elbow flexors, apply
resistance to the anterior aspect of the distal
forearm.
■ The forearm may be positioned in
supination, pronation, and neutral to resist
individual flexor muscles of the elbow.
Upper Extremity
Elbow Extension

Hand Placement and Procedure

■ To strengthen the elbow extensors, place

the patient prone or supine and apply
resistance to the distal aspect of the forearm.

■ Stabilize the upper portion of the humerus

during both motions.
Upper Extremity
Forearm Pronation and Supination

Hand Placement and Procedure

■ Apply resistance to the radius of

the distal forearm with the patient’s
elbow flexed to 90˚ to prevent
rotation of the humerus.
Upper Extremity
Wrist Flexion and Extension
Hand Placement and Procedure
■ Apply resistance to the volar and
dorsal aspects of the hand at the
level of the metacarpals to resist
flexion and extension, respectively.
■ Stabilize the volar or dorsal
aspect of the distal forearm.
Upper Extremity
Wrist Radial and Ulnar Deviation

Hand Placement and Procedure

■ Apply resistance to the second and fifth metacarpals alternately to

resist radial and ulnar deviation.

■ Stabilize the distal forearm.

Upper Extremity
Hand Placement and Procedure
■ Apply resistance just distal to the
joint that is moving. Resistance is
applied to one joint motion at a
time.
■ Stabilize the joints proximal and
distal to the moving joint.
Lower Extremity
Hip Flexion with Knee Flexion
Hand Placement and Procedure
■ Apply resistance to the anterior
portion of the distal thigh.
Simultaneous resistance to knee
flexion may be applied at the distal
and posterior aspect of the lower
leg, just above the ankle.
■ Stabilization of the pelvis and
lumbar spine is provided by
adequate strength of the
abdominal muscles.
Lower Extremity
Hip Extension
Hand Placement and Procedure
■ Apply resistance to the posterior
aspect of the distal thigh with one
hand and to the inferior and distal
aspect of the heel with the other
hand.
■ Stabilization of the pelvis and
lumbar spine is provided by the
table.
Lower Extremity
Hip Hyperextension
Patient position: prone.
Hand Placement and Procedure
■ With the patient in a prone position,
apply resistance to the posterior aspect of
the distal thigh.
■ Stabilize the posterior aspect of the
pelvis to avoid motion of the lumbar
spine.
Lower Extremity
Hip Abduction and Adduction
Hand Placement and Procedure
■ Apply resistance to the lateral and the
medial aspects of the distal thigh to resist
abduction and adduction, respectively, or
to the lateral and medial aspects of the
distal leg just above the malleoli if the knee
is stable and pain-free.
■ Stabilization is applied to the pelvis to
avoid hip-hiking from substitute action of
the quadratus lumborum and to keep the
thigh in neutral position to prevent
external rotation of the femur and
subsequent substitution by the iliopsoas.
Lower Extremity
Hip Internal and External Rotation
Patient position: supine with the hip and
knee flexed.
Hand Placement and Procedure
■ Apply resistance to the medial aspect of
the lower leg just above the malleolus during
external rotation and to the lateral aspect of
the lower leg during internal rotation.
■ Stabilize the anterior aspect of the pelvis
as the thigh is supported to keep the hip in
90˚ of flexion.
Lower Extremity
Patient position: prone, with the hip extended and
the knee flexed.

Hand Placement and Procedure

■ Apply resistance to the medial and lateral aspects

of the lower leg.

■ Stabilize the pelvis by applying pressure across the

buttocks.
Lower Extremity
Knee Flexion
■ Resistance to knee flexion may be
combined with resistance to hip flexion, as
described earlier with the patient supine.
Alternate patient position: prone with the
hips extended.
Hand Placement and Procedure
■ Apply resistance to the posterior aspect
of the lower leg just above the heel.
■ Stabilize the posterior pelvis across the
buttocks.
Lower Extremity
Knee Extension
Alternate Patient Positions
■ If the patient is lying supine on a table, the hip must be
abducted and the knee flexed so the lower leg is over the
side of the table. This position should not be used if the
rectus femoris or iliopsoas is tight because it causes an
anterior tilt of the pelvis and places stress on the low back.
■ If the patient is prone, place a rolled towel under the
anterior aspect of the distal thigh; this allows the patella to
glide normally during knee extension.
■ If the patient is sitting, place a rolled towel under the
posterior aspect of the distal thigh.
Hand Placement and Procedure
■ Apply resistance to the anterior aspect of the lower leg.
■ Stabilize the femur, pelvis, or trunk as necessary.
Lower Extremity
Ankle Dorsiflexion and
Plantarflexion
Hand Placement and Procedure
■ Apply resistance to the dorsum of
the foot just above the toes to
resist dorsiflexion and to the
plantar surface of the foot at the
metatarsals to resist plantarflexion.
■ Stabilize the lower leg.
Lower Extremity
Ankle Inversion and Eversion

Hand Placement and Procedure

■ Apply resistance to the medial aspect of the first metatarsal to resist inversion
and to the lateral aspect of the fifth metatarsal to resist eversion.

■ Stabilize the lower leg.

Lower Extremity
Flexion and Extension of the Toes

Hand Placement and Procedure

■ Apply resistance to the plantar and dorsal surfaces of the toes as the patient flexes
and extends the toes.

■ Stabilize the joints above and below the joint that is moving.
Mechanical Resistance Exercise
Mechanical resistance exercise is any form of exercise in which resistance
(the exercise load) is applied by means of some type of exercise
equipment.

Frequently used terms that denote the use of mechanical resistance are
resistance training, weight training, and strength training.
Progressive Resistance Exercise
PRE is a system of dynamic resistance training in which a constant
external load is applied to the contracting muscle by some mechanical
means (usually a free weight or weight machine) and incrementally
increased.

The RM is used as the basis for determining and progressing the

resistance.
Progressive Resistance Exercise
Delorme and Oxford Regimens
The concept of PRE was introduced by DeLorme, who originally used the
term heavy resistance training and later load-resisting exercise to
describe a new system of strength training.
DeLorme proposed and studied the use of three sets of a percentage of
a 10-RM with progressive loading during each set.
Other investigators developed a regimen, the Oxford technique, with
regressive loading in each set.
DeLorme Principle:
Thomas DeLorme’s work in the 1940 s proposes a progressive resistance exercise
(PRE) program based on 10 repetitions maximum (10RM) where subject begins sets
of training by performing

the first set at 50% 10RM,

the second at 75% 10RM and

the third (final) at 100% of the 10RM

Oxford Principle:
In opposite was created the ‘Oxford Technique’ as a regressive
loading in each set in which the full (100%) 10RM was the first
set and subsequent two sets were reduced to 75% and to 50% of
the 10RM.
Progressive Resistance Exercise
Progressive Resistance Exercise

Typical PRE programs produce training-induced

strength gains using 2 to 3 sets of 6 to 12 repetitions
Circuit Weight Training
Another system of training that employs mechanical resistance is circuit weight
training.

A pre-established sequence (circuit) of continuous exercises is performed in

succession at individual exercise stations that target a variety of major muscle
groups (usually 8 to 12) as an aspect of total body conditioning.
Circuit Weight Training
Each resistance exercise is performed at an exercise station for a specified number of
repetitions and sets.

Typically, repetitions are higher and intensity (resistance) is lower than in other forms
of weight training.
Circuit Weight Training
The program is progressed by increasing the number of sets or
repetitions, the resistance, the number of exercise stations, and the
number of circuit revolutions.
Exercise order is an important consideration when setting up a weight
training circuit. Exercises with free weights or weight machines should
alternate among upper extremity, lower extremity, and trunk
musculature and between muscle groups involved in pushing or pulling
actions.
This enables one muscle group to rest and recover from exercise while
exercising another group and therefore, minimizes muscle fatigue.
 6
1
7

4 8
2 9

3 5 10
Equipment for Resistance Training
Free Weights

Free weights are graduated weights that are handheld or applied to the upper and
lower extremities or trunk.

They include commercially available dumbbells, barbells, weighted balls, cuff weights,
weighted vests, and even sandbags.
Equipment for Dynamic Stabilization
Training
BodyBlade
The BodyBlade is a dynamic, reactive device that
produces oscillatory resistance proportional to the
force applied when the patient initiates the
oscillations with a few quick shakes of the blade.
While a patient drives the blade, rapidly alternating
contractions of agonist and antagonist muscle
groups occur in an attempt to control the instability
in three planes of motion dictated by movements of
the blade. The greater the amplitude or flex of the
blade, the greater the resistance. This provides
progressive resistance that the patient controls.
https://youtu.be/QZrfuol1SNw