INTRODUCTION &

CLASSIFICATION OF
THERAPEUTIC EXERCISE

Dr.TAMILVANAN MANI
ASIMS&R LUDHIANA

CONTENTS
CORE SKILLS
INTRODUCTION
THERAPEUTIC EXERCISE - BENEFITS
GROUPS BENEFITS FROM THERAPEUTIC EXERCISE
AIMS OF THERAPEUTIC EXERCISE
DESIGNING EXERCISE PROGRAMMES
CLASSIFICATION / TYPES OF EXERCISES
PRINCIPLES OF TRAINING
PRESCRIPTION VARIABLES
MUSCLE FIBER TYPES
EXERCISE PRISCRIPTION

Learning Outcomes
By the end of the session and independent study you should;
UNDERSTAND THE SCOPE OF EXERCISE USED IN PHYSIOTHERAPY PRACTICE
UNDERSTAND THE PRINCIPLES OF TRAINING
UNDERSTAND THE CONCEPT OF TRAINING VARIABLES

Core Skills - Physiotherapy

MOVEMENT ANALYSIS
MANUAL THERAPY
ELECTROTHERAPY
EXERCISE THERAPY EXERCISE PRESCRIPTION

INTRODUCTION - Exercise for the

prevention of disease
RELATIONSHIP BETWEEN A
SEDENTARY LIFESTYLE AND
CHRONIC DEGENERATIVE
DISORDERS
MORE THAN 20 DISORDERS
RELATED TO INACTIVITY
1980S PARFENBARGER16 YEAR
SURVEY OF ALL CAUSES CHF
50 YEARS OF RESEARCH
PHYSIOTHERAPISTS HAVE A ROLE
TO PLAY IN HEALTH PROMOTION
Morris & Crawford 1958

THERAPEUTIC EXERCISE - Benefits

PREVENT OR REHABILITATE
Rehabilitation Cycle
DISABILITIES
IMPROVE OR RESTORE PHYSICAL
FUNCTION SO
THAT ADLS ARE NO LONGER A Functional fitness
and rehabilitation
CHALLENGE
IMPROVE OVERALL HEALTH AND
Early to middle
FITNESS
management
REDUCE RISK FACTORS

Which patients groups benefit from

therapeutic exercise?
CARDIAC PATIENTS
ORTHOPAEDIC PATIENTS
AMPUTEES
GENERAL SURGICAL
NEUROLOGICAL
ELDERLY
LEARNING DISABILITIES
PSYCHIATRIC
PALLIATIVE CARE

RESPIRATORY
PAEDIATRIC
MUSCULO-SKELETAL
OCCUPATIONAL
SPINAL INJURIES
OBSTETRICS
GYNACOLOGICAL
BURNS AND PLASTICS

Aims of Therapeutic Exercise

ENABLE AMBULATION
RELEASE CONTRACTED
SOFT TISSUES
MOBILISE JOINTS
IMPROVE CIRCULATION
IMPROVE RESPIRATORY
CAPACITY
DECREASE STIFFNESS

AIMS OF THERAPEUTIC EXERCISE

Improve muscle
strength
Improve endurance
Improve coordination
Promote confidence
and wellbeing
Improve balance
Promote relaxation

OVERARCHING GOAL
TO TRY WHENEVER POSSIBLE TO
RESTORE FULL FUNCTION AND
ACHIEVE AN OPTIMAL LEVEL OF
PHYSICAL FITNESS.
ACHIEVE THIS BY SETTING
SHARED REALISTIC GOALS AND
IDENTIFYING HOW FIT THE
CLIENT NEEDS TO BE.
MOTIVATION
ADHERENCE, COMPLIANCE AND
CONCORDANCE

DESIGNING EXERCISE
PROGRAMMES
WHEN DESIGNING AN EXERCISE
PROGRAMME CONSIDER;
PATHOLOGY
PERSON (AGE, PERSONALITY
PSYCHOLOGY)
NEEDS - ASPIRATIONS
ENVIRONMENT
PHYSIOLOGICAL PROCESSES
PRINCIPLES OF TRAINING

CLASSIFICATION / TYPES OF
EXERCISES
RANGE OF MOVEMENT
/MOBILITY EXERCISES
STRETCHING
STRENGTHENING EXERCISES
ENDURANCE EXERCISES
PROPRIOCEPTIVE OR BALANCE
TRAINING
CARDIO-VASACULAR TRAINING

PRINCIPLES OF TRAINING
READINESS
OVERLOAD
SPECIFICITY
MOTIVATION
LEARNING
REVERSIBILITY

PRESCRIPTION VARIABLES
5 KEY COMPONENTS
FREQUENCY
DURATION
INTENSITY
TYPE OF EXERCISE
PROGRESSION

MOBILITY
EXERCISES
PASSIVE MOVEMENTS
MOVEMENTS PERFORMED BY EXTERNAL
FORCE

ACTIVE ASSISTED
USUALLY USED AS INTERIM MEASURE
MOVING FROM PASSIVE TO ACTIVE, ALSO
WHEN JOINT PAIN LIMITS FREE ACTIVE
MOVEMENT

FREE ACTIVE
KNOWLEDGE OF AGING AND PATHOLOGIES
REQUIRED TO PREVENT UNDESIRABLE
MOVEMENTS E.G. TRUNK FLEXION
EXERCISES IN OSTEOPOROSIS

STRETCHING
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

STRENGTHENING EXERCISE
STRENGTH TRAINING IS A TYPE OF PHYSICAL EXERCISE SPECIALIZING
IN THE USE OF RESISTANCE TO INDUCE MUSCULAR CONTRACTION
WHICH BUILDS THE STRENGTH, ANAEROBIC ENDURANCE, AND SIZE
OF SKELETAL MUSCLES.

STRENTHENING EXERCISES
CONSIDER WHY WE MIGHT
CHOOSE THESE DIFFERENT
TYPES OF EXERCISES?
ARE THERE ANY RISKS?
ISOMETRIC
CONCENTRIC
ECCENTRIC
ISOKINETIC
CLOSED AND OPEN CHAIN
EXERCISES

ENDURANCE EXERCISE
THE ABILITY OF AN ORGANISM TO EXERT ITSELF AND
REMAIN ACTIVE FOR A LONG PERIOD OF TIME.
HE TERM ENDURANCE TRAINING GENERALLY REFERS TO
TRAINING THE AEROBIC SYSTEM AS OPPOSED TO
ANAEROBIC.
ENDURANCE TRAINING IS ESSENTIAL FOR A VARIETY OF
ENDURANCE SPORTS. A NOTABLE EXAMPLE IS DISTANCE
RUNNING EVENTS (800 METERS UPWARDS TO
MARATHON

REALIZATION OF TRAINING
GOALS

SETS OF ONE TO FIVE REPETITIONS PRIMARILY DEVELOP

STRENGTH, WITH MORE IMPACT ON MUSCLE SIZE AND
NONE ON ENDURANCE.
SETS OF SIX TO TWELVE REPETITIONS DEVELOP A
BALANCE OF STRENGTH, MUSCLE SIZE AND ANAEROBIC
ENDURANCE.
SETS OF THIRTEEN TO TWENTY REPETITIONS DEVELOP
ANAEROBIC ENDURANCE, WITH SOME INCREASES TO
MUSCLE SIZE AND LIMITED IMPACT ON STRENGTH.

CARDIO-RESPIRATORY EXERCISE
AEROBIC EXERCISE POSITIVE INFLUENCE ON RISK FACTORS
IN CVD, DIABETES, WEIGHT CONTROL AND CANCER.
REHABILITATION PROGRAMMES FOR CARDIAC AND
PULMONARY PATIENTS
INCREMENTAL MONITORED PROGRESSION OF EXERCISE
EARLY ON: EXERCISE NOT MORE THAN 20BPM ABOVE
RESTING LEVEL AND NOT MORE THAN 11-12 ON RPE (40%
VO2 MAX)
40-80% MHR DEPENDING ON FITNESS (MHR =220-AGE)
ISOMETRIC EXERCISES FOR VULNERABLE PATIENTS ADVISE
ISOMETRIC CONTRACTION 6 SECS EACH

Borg Scale

MUSCLE FIBRE TYPES

SKELETAL MUSCLE FIBERS ARE CLASSIFIED INTO TWO MAJOR
CATEGORIES; SLOW-TWITCH (TYPE 1) AND FAST-TWITCH
FIBERS (TYPE II).
THE DIFFERENCE BETWEEN THE TWO FIBERS CAN BE
DISTINGUISHED BY;
METABOLISM
CONTRACTILE VELOCITY
NEUROMUSCULAR DIFFERENCES
GLYCOGEN STORES
CAPILLARY DENSITY OF THE MUSCLE
AND THE ACTUAL RESPONSE TO HYPERTROPHY

FIBRE TYPE
SLOW TWITCH TYPE 1

RICH IN HAEMAGLOBIN
MITOCHONDRIA
RICH IN BLOOD VESSELS
RED
COMMON POSTURAL MUSCLES.

SLOW TWITCH TYPE II

TYPE II A - FAST OXIDATIVE FATIGUE RESISTANT FAST
OXIDATIVE FIBRES
TYPE II (B)X - FAST GLYCOLYTIC
FIBRES - SPLIT ATP AT A FAST
RATE AND HAVE A FAST
CONTRACTION VELOCITY.

EXERCISE PRESCRIPTION
EXERCISE PRESCRIPTION IS BASED ON PHYSIOLOGICAL PRINCIPLES
AND LAWS OF TRAINING AND MODIFIED BY CLINICAL FINDINGS.
PAIN
UNDERLYING MEDICAL CONDITIONS DIABETES, CARDIOVASCULAR DISEASE,
DIABETES, PSYCHOLOGICAL FACTORS ETC.
SAFETY

EXERCISE PRESCRIPTION
REQUIRES A DETAILED
KNOWLEDGE OF;
MOTOR LEARNING
ANATOMY
BIOMECHANICS/PATHOMECHANICS
KINESIOLOGY
PATHOLOGY
EXERCISE PHYSIOLOGY

References
Hanandez Kravitz (2006)
http://www.unm.edu/~lkravitz/Article%20folder/hypertrophy.h
tml
Robergs, R. A. and S. O. Roberts(1997) Exercise Physiology:
Exercise, Performance, and Clinical Applications. Boston,
WCB McGraw-Hill
National Institute on Aging (2005)
www.niapublications.org/exercisebook/chapter4.htm .
Skinner JS (2005) Exercise Testing and Exercise Prescription for
Special Cases. Philadelphia, Lippincott, Williams & Wilkins
Woolf-May K (2006) Exercise Prescription physiological
foundations. Churchill Livingstone