
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.

For example, to strengthen the gluteus medius, the hip
must remain slightly extended, not flexed; and the pelvis
must be rotated slightly forward as the patient abducts the
lower extremity against the applied resistance.

Alignment and gravity. The patient or limb should be
positioned so the muscle being strengthened acts against
the resistance of gravity and the weight.
Goals:
 To maintain appropriate alignment.
 ensure the correct muscle action and movement pattern.
 Avoid unwanted substitute motions during resistance
exercise.
Types of stabilization:
 External: by therapist or patient’s hand or by equipment such
as belt.
 Internal: is achieved by an isometric contraction of an
adjacent muscle group that does not enter into the movement
pattern.
This form of stabilization is effective only if the
fixating muscle group is strong enough or not
fatigued.

The amount of resistance (weight) imposed on
the contracting muscle during each repetition
of an exercise.
◦ also referred to as the exercise load (training load)
Submaximal loading. Exercise at moderate to low intensities
is indicated:
 At the beginning of an exercise program.
 In the early stages of soft tissue healing.
 After periods of immobilization.
 For most children or older adults
 When the goal of exercise is to improve muscle endurance
 To warm up and cool down prior to and after a session of
exercise
 During slow-velocity isokinetic training to minimize
compressive forces on joints
Near maximal or maximal loading. High-intensity exercise
is indicated:
 When the goal of exercise is to increase muscle strength
and power and possibly increase muscle size.
 in the advanced phase of a rehabilitation program.
 In a conditioning program for individuals with no known
pathology
 For individuals training for competitive weight lifting or
body building

With manual resistance exercise the decision is entirely
subjective, based on the therapist’s judgment during
exercise.

In an exercise program using mechanical resistance the
determination can be made quantitatively.
Greatest amount of weight a muscle can move through
the available ROM a specific number of times
Reasons of use of RM
◦ to document a baseline measurement of the dynamic
strength of a muscle

◦ to identify an exercise load (amount of weight) to be
used during exercise for a specified number of
repetitions.

1 RM: the greatest amount of weight a subject can lift
through the available ROM just one time.
◦ baseline measurement of a subject's maximum effort

10 RM: the amount of weight that could be lifted and
lowered exactly 10 times during training.

Select a specific amount of resistance and document how
many repetitions can be completed through the full range
before the muscle begins to fatigue.
◦ Remember, a sign of fatigue is the inability to complete the
available ROM against the applied resistance

Cable tensiometry and isokinetic or handheld
dynamometries

The sequence in which exercises are performed during
an exercise session has an impact on muscle fatigue
and the adaptive training effects.

large muscle groups should be exercised before small
muscle groups and multijoint muscles before singlejoint muscles.

higher intensity exercises should be performed before
lower intensity exercises.


Number of exercise sessions per day or per week.
The greater the intensity, the more time is needed between
exercise sessions to recover

A common cause of a decline in performance from
overtraining is excessive frequency, inadequate rest, and
progressive fatigue.

Some forms of exercise should be performed less
frequently than others because they require greater
recovery time.

as the intensity and number of repetitions are low, short sessions
of exercises several times per day (postsurgical immobilized
patients)

As the intensity and volume of exercise increases, every other
day or up to five exercise sessions per week

for a maintenance program, two times per week.

With prepubescent children and the very elderly, frequency is
usually limited to two to three sessions per week.

Highly trained athletes train at a high intensity and volume up to
6 days per week.

total number of weeks or months during which a
resistance exercise program is carried out.

strength gains, (after 2 to 3 weeks) are the result of
neural adaptation.
For hypertrophy or increased vascularization, at least 6
to 12 weeks of resistance training is required.


Purpose
◦ allow time for the body to recuperate from the acute effects of
exercise associated with muscle fatigue or to offset adverse
responses, such as DOMS.

Only with an appropriate balance of progressive
loading and adequate rest intervals can muscle
performance improve.

The higher the intensity of exercise the longer the rest
interval.
◦ 4 to 5 minutes with high-intensity resistance training, large,
multijoint muscles, such as the hamstrings
◦ 2-3min rest period after each set with moderate-intensity resistance
training
◦ A shorter rest interval is adequate after low-intensity exercise

While the muscle group that was just exercised is resting,
resistance exercises can be performed by another group

In patients more susceptible to fatigue, children and
elderly, should rest at least 3 min by
◦ performing an unresisted exercise low-intensity cycling
◦ performing the same exercise with the opposite extremity.

When strength training is initiated at moderate
intensities a 48-hour rest interval between exercise
sessions allows the patient adequate time for recovery.

The form of exercise, the type of muscle contraction that
occurs and the manner in which the exercise is carried out.
◦
◦
◦
◦
Type of Muscle Contraction
Position for Exercise
Energy Systems
Range of Movement



30% to 40% of 1RM for sedentary untrained individuals
60% to 70% of 1RM For healthy but untrained adults
80% to 95% of 1RM for those already highly trained.
◦ Exercising at a low to moderate percentage of the established
RM is also recommended for children and the elderly.
◦ For patients with significant deficits in muscle strength or to
train for muscular endurance, using a low load, possibly at the
30% to 50% level, is safe yet challenging.

The summation of the total number of repetitions and sets
of a particular exercise during a single exercise session
multiplied by the resistance used
◦ rep.x set x r

The same combination of repetitions and sets should not be
used for all muscle groups.

There is an inverse relationship between the number of
repetitions performed and the intensity of the resistance.

The number of times a particular movement is repeated.

If a 1 RM has been established as a baseline level of
strength, a percentage of the 1 RM used as the exercise
load influences the number of repetitions a patient is able
to perform.
◦ The untrained adult 75% of the 1 RM 10 rep before rest
◦ At 60% intensity  15 repetitions
◦ at 90% intensity  only 4 or 5 repetitions




For practical reasons, the target number of repetitions
performed for each exercise is often within a range rather
than an exact number of repetitions RM zone
E.g. between 8 and 10 repetitions against a specified load
it gives the patient a goal but builds in some flexibility.
No optimal number for strength training or endurance
training has been identified. Training effects (greater
strength) have been reported employing 2 to 3 RM to 15
RM.





A predetermined number of repetitions grouped together
After each there is a brief interval of rest.
E.g. during exercise session to strengthen a particular
muscle group, a patient might be directed to lift a load 8 to
10 times, rest, and then lift the load 8 to 10 more times.
That would be two sets of an 8 to 10 RM
Single-set exercises at low intensities in the early phases of
a resistance exercise program or in maintenance program.
Multiple-set exercises are used to progress the program





The question is: Is the goal to improve strength,
muscular endurance, or both?
To Improve Muscle Strength
DeLorme's studies 3 sets of a 10 RM performed for 10
repetitions over the training period led to gains in
strength.
Current recommendations (6 to 12 RM). are for 2-3 sets
When fatigue no longer occurs after target number of
repetitions has been completed, the level of resistance
is increased to once again overload the muscle.




To Improve Muscle Endurance
many repetitions of an exercise against a submaximal
load.
three to five sets of 40 to 50 or more repetitions against
a low amount of weight or a light grade of elastic
resistance
When increasing the number of repetitions or sets
becomes inefficient, the load can be increased slightly.
The DeLorme technique builds a warm-up period into
the protocol
 the Oxford technique diminishes the resistance as the
muscle fatigues.


Both regimens incorporate a rest interval between sets;
both incrementally increase the resistance over time;
and both have been shown to result in training-induced
strength gains over time.


In general, training-induced strength gains occur with 2
to 3 sets of 6 to 12 repetitions of a 6 to 12 RM.
This gives a therapist wide latitude when designing an
effective weight-training program