
Comprehensive

Re-evaluate periodically
◦ document progress
◦ determine if and how the dosage of exercises and the types
of resistance exercise should be adjusted to continue to
challenge the patient.

Select the forms of resistance exercise
◦ Manual resistance exercises
◦ Mechanical resistance exercises.

With mechanical resistance exercise, determine what
equipment is needed and available.

Review the anticipated goals and expected functional
outcomes.

Explain the exercise plan and procedures.

Have the patient wear nonrestrictive clothing and supportive
shoes appropriate for exercise.
◦ If the patient is wearing a hospital gown, use a sheet to drape for
modesty.

select a firm but comfortable support surface for exercise.

Demonstrate each exercise and the desired movement pattern
to the patient.

Warm Up
◦ light, repetitive, dynamic, site-specific movements without
applying resistance.



Placement of Resistance
typically applied to the distal end of the segment in which
the muscle to be strengthened attaches.
May be applied across an intermediate joint if that joint is
stable and pain-free and if there is adequate muscle
strength supporting the joint
typical
possible

Direction of Resistance
◦ During concentric exercise resistance is applied in the
direction directly opposite to the desired motion
◦ during eccentric exercise resistance is applied in the same
direction as the desired motion

Stabilization
◦ Stabilization is necessary to avoid unwanted, substitute
motions.

Intensity of Exercise/Amount of Resistance
◦ Initially, have the patient practice the movement pattern
against a minimal load to learn the correct pattern and the
exercise technique.
◦ Have the patient exert a forceful but controlled and pain-free
effort.
◦ Adjust the alignment, stabilization, or the amount of
resistance if necessary

Keep the temperature of the room comfortable for vigorous
exercise.

Caution the patient that pain should not occur during
exercise.

Do not initiate resistance training at a maximal level of
resistance, particularly with eccentric exercise to minimize
delayed-onset muscle soreness (DOMS).

Avoid use of heavy resistance during exercise for children,
older adults, and patients with osteoporosis.

Do not apply resistance across an unstable joint or distal to a
fracture site that is not completely healed.

Avoid breath-holding during resisted exercises to prevent the
Valsalva maneuver; emphasize exhalation during exertion.

Avoid uncontrolled, ballistic movements as they compromise
safety and effectiveness.

Prevent substitution by adequate stabilization and an
appropriate level of resistance.

Avoid exercises that place excessive, unintended secondary
stress on the back.

Be aware of medications a patient is using that can alter
acute and chronic responses to exercise.

Incorporating adequate rest intervals between exercise
sessions to allow adequate time for recovery after exercise.

Discontinue exercises if the patient experiences pain,
dizziness, or unusual or precipitous shortness of breath.

An expiratory effort against a closed glottis that must
be avoided during resistance exercise
deep
inspiration
closure of the glottis
contraction of the
abdominal muscle
abrupt, temporary increase in
arterial blood pressure
increases intraabdominal and
intrathoracic
pressures
forcing blood
from the heart

At-Risk Patients
◦
◦
◦
◦
◦
◦
◦

Coronary artery disease
Myocardial infarction
Cerebrovascular disorders
Hypertension.
neurosurgery
eye surgery
intervertebral disc pathology.
High-risk patients must be monitored closely.




Caution the patient about breath-holding.
Ask the patient to breathe rhythmically, count, or talk
during exercise.
Have the patient exhale with each resisted effort.
Be certain that high-risk patients avoid high-intensity
resistance exercises.

DON’T DO
THIS!!!

attempt to carry out the desired movements that the
weak muscles normally perform by any means possible
◦
◦
◦
◦
◦


muscles weakness
Fatigue
Paralysis
Pain
Severe Cardiopulmonary Disease
an appropriate amount of resistance must be applied,
correct stabilization




Acute inflammation.
Acute diseases and disorders.
Pain
adverse effects from resistance training can be
avoided by:
◦ carefully selecting the appropriate mode of exercise
◦ keeping the initial intensity of the exercise at a very low to
moderate level

decline in physical performance in healthy individuals
participating in high-intensity, high-volume strength
and endurance training programs.

fatigue become more quickly and requires more time to
recover from strenuous exercise

Causes:
◦ inadequate rest intervals between exercise sessions
◦ too rapid progression of exercises
◦ Inadequate diet and fluid intake

It is a preventable, reversible phenomenon
◦ decreasing the volume and frequency of exercise
(periodization).

Progressive deterioration of strength in muscles already
weakened by nonprogressive neuromuscular disease.

Prevention:
Monitor patients closely
Progress slowly and cautiously
re-evaluate frequently
 Patients
should not exercise to exhaustion and should
be given longer and more frequent rest intervals during
and between exercise sessions.

Acute Muscle Soreness:

Delayed-Onset Muscle Soreness:

develops during or directly after strenuous exercise
performed to the point of muscle exhaustion.

Due to lack of adequate blood flow and oxygen and a
temporary buildup of metabolites

burning or aching pain in the muscle.
◦ transient and subsides quickly after exercise
◦ An appropriate cool-down period of low-intensity exercise can
facilitate this process.

Due vigorous and unaccustomed resistance training or
any form of muscular overexertion
◦ Noticeable in the muscle belly or at the myotendinous junction

begins to develop approximately 12 to 24 hours after
the cessation of exercise.

High-intensity eccentric muscle contractions
consistently cause the most severe DOMS symptoms.

the signs and symptoms, which can last up to 10 to 14
days, gradually dissipate.

Lactic acid theory:

The muscle spasm theory:

Current research suggest that DOMS is linked to some
form of contraction-induced, mechanical disruption
(micro-trauma) of muscle fibers and/or connective
tissue in and around muscle that results in degeneration
of the tissue.

beginning 12 to 24 hours after exercise and peaking at
48 to 72 hours

Tenderness with palpation throughout the involved
muscle belly or at the myotendinous junction

Increased with passive lengthening or active
contraction of the involved muscle

Local edema and warmth

Muscle stiffness: reflected by spontaneous muscle
shortening before the onset of pain

Decreased ROM

Decreased muscle strength: prior to onset of muscle
soreness that persists for up to 1 to 2 weeks after
soreness has remitted.

a regular routine of exercise, particularly eccentric exercise,
after an initial episode of DOMS has developed and remitted.

a definitive treatment has yet to be determined.







Continuation of a training program that has induced
DOMS
Light, high-speed (isokinetic), concentric exercise
Electrical stimulation
cryotherapy
post-exercise massage
compression sleeve
topical salicylate creams provide an analgesic effect