Exercise Therapy
Third Edition
1015 Mark Avenue • Carpinteria, CA 93013
1.800.892.4772 • 1.805.745.8111 (international)
ISSAonline.com
Course Textbook for SPECIALIST IN EXERCISE THERAPY
International Sports Sciences Association
800.892.4772 • ISSAonline.com
Exercise Therapy
Karl G. Knopf, EdD
Third Edition
Course Textbook for SPECIALIST IN EXERCISE THERAPY
Exercise Therapy
INTRODUCTION
Exercise Therapy
Karl Knopf, EdD
With contributions by:
Barbara McCarthy
Joan Worley
Content Editors:
Steve & Kim Downs
Lori McCormick
Mary Ann Wilson
Patricia Davoren
Editor and Typists:
Anna Billings
Toni Di Vittorio
Exercise Therapy (Edition 3)
Official course text for: International Sports Sciences Association’s Specialist in Exercise Therapy Program
10 9 8 7 6 5 4 3
Copyright © 2019 International Sports Sciences Association.
Published by the International Sports Sciences Association, Carpinteria, CA 93013.
All rights reserved. No part of this work may be reproduced or transmitted in any form or by any electronic, mechanical, or other means, now known
or hereafter invented, including xerography, photocopying, and recording, or in any information storage and retrieval system without the written
permission of the publisher.
Direct copyright, permissions, reproduction, and publishing inquiries to:
International Sports Sciences Association, 1015 Mark Avenue, Carpinteria, CA 93013
1.800.892.4772 • 1.805.745.8111 (local) • 1.805.745.8119 (fax)
Disclaimer of Warranty
This text is informational only. The data and information contained herein are based upon information from various published and unpublished
sources that represents training, health, and nutrition literature and practice summarized by the author and publisher. The publisher of this text
makes no warranties, expressed or implied, regarding the currency, completeness, or scientific accuracy of this information, nor does it warrant
the fitness of the information for any particular purpose. The information is not intended for use in connection with the sale of any product. Any
claims or presentations regarding any specific products or brand names are strictly the responsibility of the product owners or manufacturers.
This summary of information from unpublished sources, books, research journals, and articles is not intended to replace the advice or attention
of health care professionals. It is not intended to direct their behavior or replace their independent professional judgment. If you have a problem
or concern with your health, or before you embark on any health, fitness, or sports training programs, seek clearance and guidance from a qualified health care professional.
Exercise Therapy
TABLE OF CONTENTS
Part 1
Fundamentals of Exercise Therapy
Part 2
Health Conditions
Part 3
Adaptive Programming
Part 4
Exercise Therapy Support Materials
iii
Exercise Therapy
TABLE OF CONTENTS
TABLE OF CONTENTS
PART 1: Fundamentals of Exercise Therapy
1. Therapeutic Exercise, 2
History, 3
2. Understanding the Disabled, 6
Evolution of Adaptive Physical Education for Adults with Disabilities, 7
Changing Attitudes Towards Disabled Persons, 8
Role of Exercise for the Disabled, 11
3. Exercise as Therapy, 12
Proper Exercise Is Therapeutic, 13
Designed for Action, 14
Fitness as Medicine, 17
Use It or Lose It, 17
Exercise and Disease, 19
4. Functional Fitness, 20
Summary, 23
5. Fundamentals of Exercise Therapy, 24
Benefits of Exercise Therapy Programs, 25
Designing an Exercise Therapy Program, 26
Exercise Participation Flowchart, 30
Fundamental Terminology for the Specialist in Exercise Therapy, 31
Proper Body Mechanics for the Instructor, 32
Effective Teaching Considerations, 34
Effective Communication Skills, 38
6. Muscles and Movement, 42
Anatomy for the Exercise Therapy Educator, 43
Exercise Therapy Kinesiology, 48
How Muscles Work Together, 59
iv
Exercise Therapy
TABLE OF CONTENTS
7. Contraindicated Exercises, 62
Doing It Right, 63
Facts and Myths about Exercise, 63
Risks vs. Benefits, 64
Beyond the Core, 65
Exercises to Avoid, 68
Exercise Therapy Exercise Considerations, 71
PART 2: Exercise Therapy for Chronic Conditions, 73
8. Overview of Chronic Conditions, 74
Exercise Is for Everyone, 75
Common Physical Health Problems Seen Among Older Adults, 76
Thoughts to Share with Clients, 77
9. Cardiorespiratory Conditions, 80
High Blood Pressure, 81
Low Blood Pressure, 82
Heart Disease, 82
Chronic Obstructive Pulmonary Disease, 83
Asthma, 86
10. Metabolic Conditions, 88
Diabetes, 89
Obesity, 91
11. Neurological Conditions, 94
Acquired Brain Injury, 95
Cerebral Vascular Accident, 96
Epilepsy, 100
Peripheral Vascular Disease, 103
Spinal Cord Injury, 104
Learning Disabilities, 106
Multiple Sclerosis, 107
Parkinson’s Disease, 109
v
Exercise Therapy
TABLE OF CONTENTS
12. Orthopedic Conditions, 110
Arthritis, 111
Fibromyalgia Syndrome, 114
Neck Problems, 115
Low Back Problems, 116
Shoulder Problems, 118
Hip Problems, 120
Knee Problems, 120
Ankle Problems, 121
Osteoporosis, 122
Amputations, 123
13. Sensory Impairments, 126
Auditory Disorders, 127
Visual Impairments, 127
14. Other Health Conditions 130
HIV/AIDS, 131
Cancer, 132
Pregnancy, 133
PART 3: Adaptive Programming
15. Programming for Ambulation, 136
Transfers and Ambulation Aids, 137
Progressive Mobilization, 142
Ambulation Aids, 143
Gait Training, 147
16. Programming for Aquatics, 154
Water Exercise for Special Population, 155
Fitness Aquatics: Hydrogymnastics, 157
Assessment of Aquatic Skills, 159
17. Programming for Balance and Perceptual Motor Skills, 166
Balance Progressions, 169
Perceptual Motor Skills, 172
Fine Motor Tasks, 173
vi
Exercise Therapy
TABLE OF CONTENTS
18. Programming for Cardiovascular Fitness, 176
Cardiovascular Exercises, 177
Karvonen’s Formulas, 179
How to Take a Pulse, 180
Determining Target Heart Rate, 181
19. Programming for Flexibility and Range of Motion, 182
Flexibility, 183
Range of Motion, 183
Programming for Flexibility, 184
Range-of-Motion Exercises, 186
Active Range of Motion Worksheet, 189
20. Program for Muscular Strength and Endurance, 190
General Progressive Resistance Guidelines, 191
Strength Training, 191
Terminology, 192
General Guidelines for Adaptive Weight Training, 196
Sample Strength Training Program and Exercises, 198
21. Programming for Posture, 206
Assessment of Posture, 207
Procedures for Spinal Screening, 210
Posture Exercises, 211
PART 4: Exercise Therapy Support Materials
Appendix, 215
Abbreviations, 217
Support Materials, 218
Forms, 221
Glossary, 231
Index, 251
vii
Exercise Therapy
FROM THE AUTHOR
This edition of Exercise Therapy is designed for personal trainers, adaptive
fitness instructors, club owners and physical therapy aides. The material contained within this book is the result of twenty-five years of working with this
population. This new and improved book has been modified from previous
editions of Adapted Exercises for the Disabled Adult, co-authored with Dr.
Lasko, to better meet the needs of Specialists in Exercise Therapy.
The goal of this book is to provide you with practical information in a
straight-forth style. All the material was written to best reflect the most
current theories regarding exercise therapy. The book is organized in a
manner to take the reader through the logical sequence needed to develop a
therapeutic program.
As you enter the profession, I hope you will find the fulfillment and satisfaction that this career has provided me. I trust that this profession of serving
the under-served members of our society brings you the same rewards.
Lastly, go out and find a profession that you enjoy and you’ll never work a
day in your life.
Love what you do and
do what you love.
Therapeutic
Exercise
Sports Medicine
AA
PT
H
PE
TR
E R1 5
PC CHA
R
T
THERAPEUTIC EXERCISE
1
UNDERSTANDING THE DISABLED
Evolution of Exercise Therapy Education
for Adults with Disabilities
Changing Attitudes Towards Disabled Persons
Role of Exercise for the Disabled
EXERCISE AS THERAPY
Proper Exercise Is Therapeutic
Designed for Action
Fitness as Medicine
Use It or Lose It
Exercise and Disease
FUNCTIONAL FITNESS
FUNDAMENTALS OF EXERCISE THERAPY
Benefits of Exercise Therapy Program
Designing an Exercise Therapy Program
Proper Body Mechanics for the Instructor
Effective Teaching Considerations
Effective Communication Skills
MUSCLES AND MOVEMENT
Anatomy for the Exercise Therapy Educator
Exercise Therapy Kinesiology
How Muscles Work Together
CONTRAINDICATED EXERCISES
Risks vs. Benefits
Facts and Myths About Exercise
Common Questions
Exercises to Avoid
Exercise Therapy Exercise Considerations
Fundamentals of
Exercise Therapy
1
Chapter
1
THERAPEUTIC EXERCISE
To p i c s c o v e r e d i n t h i s c h a p t e r
HISTORY
Therapeutic Exercise
CHAPTER 1
HISTORY
Therapeutic exercise is motion of the body or its
parts to relieve symptoms and improve function.
The roots of therapeutic exercise goes back to
ancient times, whether it was Cong Fou who prescribed particular postures and breathing exercises
for the priests for the relief pain or Hippocrates
(460 B.C.) who recognized the value in strengthening weak muscles to hasten convalescence and
improve mental outlook.
restore an athlete to peak performance. The application of therapeutic exercise will vary in its purpose
based on the goals of the client. In order for the
client to obtain the best outcomes it is essential that
before an exercise program is designed the client
should receive a comprehensive assessment. An
exercise program designed without a competent
medical evaluation may not only be inadequate but
detrimental to the client.
Before World War II physical therapy generally consisted of heat, massage or electricity. If exercise was
prescribed, it was only referred to in a vague
manner. During WWII, many VA Hospitals
employed physical medicine physicians to employ
corrective exercise to rehabilitate injured soldiers.
This was the advent of pro-active treatments
opposed to the passive days of a therapist “working
on” or “doing for” the client.
After an assessment by a trained medical professional, the next step is to establish goals and appropriate treatment plans. The treatment plan should be
designed based on clients goals, medical professionals
realistic expectations along with the following:
We now know that a properly designed exercise program can have a positive impact on the outcome of
most conditions.
Therapeutic exercise can vary from very specific
selected activities designed for particular muscle or
condition, to general and vigorous movements to
•
Functional limitations
•
Prognosis of condition
•
Psychological status
•
Socioeconomic support
•
Cultural reactions and expectations
•
Physical and emotional environment
•
Client/employers vocational plans
•
Ethical choices
3
Therapeutic Exercise
CHAPTER 1
from the front lines and were given a “cap” to hold
in their hand to beg. Thus the word handicapped is
a word and a mind set that we want to eliminate.
The role of a therapeutic exercise program should
include the prevention of further dysfunction and
should thrive to foster improvement, restoration or
even maintenance of:
•
Muscular strength and endurance
•
Cardiovascular and cardio respiratory
fitness
•
Mobility, flexibility and range of motion
•
Balance and stability
•
Coordination
•
Functional skills
•
Activities of daily living
When designing a comprehensive program consider:
While in everyday conversations the words disability, handicap, and functional limitation are used
interchangeably. However, for the purpose of this
text lets define some terms.
•
Goals and kinds of exercises
•
Safety and appropriateness
•
Clients age
Disability—refers to the restriction of or inability to
perform normal activities of daily living.
•
Previous conditions
•
Deformities
Functional Limitations—are disabilities that are not
as truly disabling yet become symptomatic when
performing a specific activity. The term functional
limitation may be more useful than the word “disability” because it is more descriptive and less
imposing. Thus the focus is on ability rather than
disability. Your role as Specialist in Exercise Therapy
is to minimize the ‘Dis’ in disability.
•
Potential risks
DisABILITY—where the focus is on ability or differently labeled
Handicap—is a social disadvantage that results from
an impairment/disability that prevents a person
from engaging in a vocationally, socially and physically “normal” life.
The word handicap had it’s origins after World War
II when injured British soldiers returned home
4
When working in the field of exercise therapy, it is
critical that the practitioner be at the top of the
profession. There is no place in exercise therapy
for people who are well intentioned yet ill-prepared. The Specialist in Exercise Therapy must
rely on sound scientific knowledge rather than
antidotal information. If you plan to operate in
the shadows of the profession, then exercise
therapy is not where you belong. A Specialist in
Exercise Therapy must know proper biomechanics, safe movement, sound nutrition, up-todate exercise science and most importantly adhere
to a strong code of ethics. No one is more vulnerable than someone who desires to be healthy
again. The client will believe in you, don’t betray
their trust in you by selling misinformation.
Therapeutic Exercise
CHAPTER 1
Most importantly, the exercise therapy arena is not
a place where a “fake it until you make it” practice
has any place. If you have any questions or concerns
err on the side of caution and refer out. Your client
will appreciate it and your credibility will increase
within the medical community. Always check your
sources—what is correct today can change
tomorrow. Stay current!
When working with able-bodied clients, an incorrect move may not cripple a person—however
with a client who has entrusted you with their
recovery, a mistake can have serious ramifications.
Train your client in a smart not hard fashion.
Remind them to be patient, it took their body a long
time to get into the shape they are in and it will take
a while to get it to where they want it to be.
Remember, haste makes waste. They may have spent
a great deal of time and money to have the doctor
and therapist fix them; you as the fitness professional do not want to be responsible for undoing all
they have done.
5
Chapter
2
UNDERSTANDING THE
DISABLED
To p i c s c o v e r e d i n t h i s c h a p t e r
EVOLUTION OF EXERCISE THERAPY EDUCATION
FOR ADULTS WITH DISABILITIES
Benefits of Increased Physical Activity
Key Points
CHANGING ATTITUDES TOWARDS DISABLED PERSONS
Taking the ‘Dis’ out of Disability
ROLE OF EXERCISE FOR THE DISABLED
Understanding the Disabled
CHAPTER 2
“A teacher who makes little or no allowance for individual differences in the classroom
is an individual who makes little or no difference in the lives of his/her students.”
-William A. Ward
EVOLUTION OF EXERCISE THERAPY EDUCATION
FOR ADULTS WITH DISABILITIES
True physical education implies the full involvement of the student’s mind and body in concert.
From time to time the idea arises that one can educate the mind and ignore the body. Dr. Claudine
Sherrill stated, “To develop the mind and neglect
the body is analogous to developing a powerful jet
engine without a fuselage to carry it.” Yet, many
times, well-meaning rehabilitation counselors and
special education teachers tell the disabled to
develop their cerebral qualities at the expense of
their physical potential. By neglecting the body the
deleterious effects of a sedentary lifestyle will manifest themselves.
Education through the “physical” has become a
principle of both education and rehabilitation.
One of the many encouraging developments of
recent years has been the realization that physical
activity for the disabled can make a major contribution to the quality of their lives. Being physically
competent enhances a person’s self-image and
confidence, which are critical to social and intellectual growth. Julian Stein said about the disabled,
“Give me pride; give me substance; give me a life of
my own and I’ll stop feeding off of yours.”
Prior to the late 20th century the attitude towards
the disabled was that of pity or sympathy. Today,
fortunately, attitudes towards the disabled are
improving. As one of my students said: “I can
think of ways to deal with architectural barriers,
but attitudinal barriers are far more difficult.” As
teachers who work with the disabled, we must
remember that such a person first is a unique individual, and second, happens to have a disability.
The 20th century saw much progress in attaining
rights for the disabled. Within the past thirty years
vast improvements have been made in enhancing
the services and programs for the disabled within
our society. Many laws have been enacted to assist
the disabled. Some of this legislation provides the
impetus for the physical educator and special educator to work together to assure quality education
for the disabled. The general theme of these and
other laws is that education for the disabled should
be free and appropriate.
Exercise therapy is a diversified psychomotor and
educational approach in which teaching styles and
activities are modified to ensure success for each
individual. In addition, it should provide the opportunity for interactions that develop appropriate
social skills. Exercise therapy differs from typical
physical fitness in that it features individualized
programs of instruction. Exercise therapy may
range from clinical programs to post-rehabilitation.
Exercise therapy should focus on developing and
maintaining muscular strength and endurance, cardiovascular fitness, flexibility, posture, balance, and
motor skills. Exercise therapy programs should
always be designed in conjunction with medical
consultation and recommendations from physical
therapists and physicians.
Exercise therapy professionals work with, not on,
disabled individuals. Typically, clients involved in
an exercise therapy program at the post-rehab level
have acquired disabilities such as post-stroke,
spinal cord injuries, visual impairment, and neuromuscular diseases. The focus of an exercise therapy
program for these types of individuals should be to
develop and maintain fitness and posture, along
with continuing the skills they acquired in therapy.
Exercise therapy is designed to be therapeutic as
well as educational. Exercise therapy uses many of
the tools of physical medicine in an educational
environment. The focus of exercise therapy is to
increase the psychomotor skills of disabled individuals and allow them the opportunity to achieve
their greatest overall potential.
7
Understanding the Disabled
CHAPTER 2
Benefits of Increased Physical Activity
Disuse Syndrome: Cessation
of use, practice, or exercise;
inusitation; desuetude; as, the
limbs lose their strength by
disuse
Activities of Daily Living
(ADLs): Self-care activities,
including dressing, bathing,
eating, getting in and out of
bed, using a wheelchair, and
ambulating short distances
•
Maintains optimal health and decreases incidence of secondary
health problems related to disuse syndrome
•
Increases muscular strength and endurance
•
Increases flexibility
•
Improves cardiovascular function and blood-lipid management
•
Reduces risk factors responsible for cardiovascular disease
•
Reduces obesity and glucose intolerance
•
Lessens or eliminates depression
•
Improves sleep
•
Enhances self-esteem and a feeling of control
•
Improves basic motor skills
•
Makes activities of daily living (ADLs) easier
•
Turns handicaps into disabilities
Key Points
A sound exercise therapy program should address the major components of
physical and motor fitness. These components are:
•
Agility
•
Balance
•
Body composition
•
Cardiovascular endurance
•
Flexibility
•
Muscular endurance
•
Muscular strength
•
Neuromuscular coordination
•
Power
•
Speed
CHANGING ATTITUDES TOWARDS
DISABLED PERSONS
Attitudes towards persons with disabilities are often reflected in the labels used
to identify and group them. Medical labels do have some benefit, but incorrect
or improper use of labels can stigmatize individuals and groups. Stigmatization generates sympathy or fear towards persons with disabilities, and of
course is not desirable.
8
Understanding the Disabled
CHAPTER 2
Another problem with labels is that they tend to
segregate people. Stigmatization and stereotyping
may lead to prejudice and discrimination in social,
educational, and vocational settings. Persons with
disabilities are often externally limited much more
by society’s attitudes regarding the disability than
by the actual disability itself. The familiar socialpsychological axiom states that, “What you think
of me, I will think of me, and what I think of me, I
will become.”
Terms that influence attitudes, and therefore warrant differentiation from each other, are handicap
and disability. These terms are not synonymous.
Handicap is generally defined as anything that prevents the attainment of one’s goals (Sherrill, 5th ed.
1998). A person is handicapped if he/she encounters
impediments or disadvantages that limit success in
a given situation. Thus, being handicapped is situation-specific; i.e., a person may be handicapped in
one situation but not in others. In contrast, the term
disability refers to the presence of a medical condi-
tion. Participants in an exercise therapy program
may have either congenital or acquired disabilities.
A person may have a disability because of a spinal
cord injury to the thoracic vertebra, leaving the
individual disabled or paralyzed in the leg muscles.
This person is handicapped if stairs are the only
means to get to the second floor. If an elevator is
provided, however, then no handicap exists because
the individual is able to accomplish the objective of
getting to the second floor. This same person may
not be handicapped at all in regards, say, to archery,
if upper-body strength was not affected by the disability. Unfortunately, the word handicapped is still
used interchangeably with disability in many legislative, educational, and administrative circles.
Even federal legislation—e.g., Public Law 93-112,
Public Law 94-142 (the Americans with Disabilities
Act)—has utilized words such as handicapped and
disabled synonymously.
Professionals who work in exercise therapy programs must remember that the participants are
9
Understanding the Disabled
CHAPTER 2
Taking the ‘Dis’ out of
Disability
There is virtually no chronic condition that cannot
be positively influenced by proper exercise and a
caring instructor. If you desire to be an effective
teacher of the physically limited, you must be
willing to adapt, modify, and create until your client
is successful.
individuals first and disabled second. It is less desirable to use the term epileptic than the phrase,
person with epilepsy. The former defines the
person in terms of his/her limitations while the
latter places individuality first. It is valid to assume
that, taken as a total human being, a person with
a disability can do more than he/she cannot do.
Terms currently in vogue in reference to persons
with physical disabilities are physically challenged
and differently abled. The bottom line is to be sensitive to word choices that have negative connotations (which include cripple, victim, invalid,
abnormal, wheelchair-bound or -confined, and
gimp). These words have negative connotations
because they define the individual in reference to
his/her limitations. Our purpose and goal is to take
the ‘dis’ out of disability until we find only ability!
10
The way a society cares for its less fortunate is a
reflection of the level of that society. As our society
ages, more and more individuals are acquiring disabling conditions. Demographics show that soon a
large percentage of the population will manifest
some type of chronic condition. Unfortunately,
many fitness professionals are unprepared to effectively train this important segment of the population. With the adoption of the Americans with
Disabilities Act, all public facilities must be accessible to persons with disabilities. Without properly
trained instructors to implement exercise programs,
persons with disabilities will be programmatically
excluded from gyms and health clubs. It is imperative that fitness professionals be trained to work
with this important segment of the population and
work with management to remove attitudinal and
physical barriers to make the gym accessible to all!
Individualizing an exercise program for a person
with special needs can be extremely challenging for
even the most seasoned professional. To be a
respected member of the disabled person’s treatment team it is critical to always solicit input from
your client’s physician and therapist regarding exercise protocols. Improper exercise programs can be
just as harmful as no exercise at all. The current evidence suggests that people with a disability can benefit from a sensible exercise routine. More than four
out of five people over the age of 65 have at least one
chronic condition. A recent study revealed that the
six most prevalent chronic conditions seen in older
people are: arthritis, hypertension, hearing impairments, heart disease, vision loss, and assorted
orthopedic conditions.
Understanding the Disabled
CHAPTER 2
ROLE OF EXERCISE FOR THE DISABLED
The role of an exercise intervention for chronic conditions is to increase functional fitness without
exacerbating existing conditions. Exercise is especially appropriate for clients with disabling conditions for a myriad of reasons. Today it is common to
see healthcare professionals recommending exercise
for rehabilitative purposes. An adaptive program is
designed to provide a disabled client the opportunity to participate in fitness activities that are not
otherwise easily performed. The goal of an exercise
therapy session for a client with a disability is
improved fitness, mobility, and self-efficacy.
appropriate for people with orthopedic and joint
dysfunctions. Persons with obesity, ambulatory limitations, and low-back syndrome conditions do
extremely well within an adaptive aquatic setting. In
fact, there are only a few conditions where the
implementation of an exercise program would be
contraindicated. (These are summarized in an Exercise Participation Flowchart included in Chapter 5
of this guide, and, of course, it is always prudent to
have the client’s physician give approval before the
client undertakes an exercise program or engages in
a new activity.)
The exercise therapy program can be enjoyed by virtually anyone with a disability, but it is especially
Physical activity for all is our goal!
11
C h a p t e r
3
EXERCISE AS THERAPY
To p i c s c o v e r e d i n t h i s c h a p t e r
PROPER EXERCISE IS THERAPEUTIC
DESIGNED FOR ACTION
EXERCISE AS MEDICINE
USE IT OR LOSE IT
EXERCISE AND DISEASE
Exercise
Therapy
Exercise
as as
Therapy
CCHHAAPPTT E R 33
IF IT IS PHYSICAL, THEN IT SHOULD BE THERAPEUTIC
The traditional model of medicine was if something
went wrong the doctor would fix it. It was not to
long before we realized that was not always possible.
As time progressed we saw a growth in preventive
medicine. Unfortunately, still people had heart
attacks, strokes, broken hips and developed arthritis.
Before managed health care, patients were able to
attend physical therapy until they were restored.
Unfortunately for most of us, that paradigm no
longer exists. That is why ISSA has developed an
Exercise Therapy course to assist the trainer to work
as part of a “rehab team” to assist the patient/client
back to optimum function.
Historically, physical therapists were trained to
rehab acute injuries, not manage chronic conditions. Today the need for trained professionals to
manage chronic longterm health problems is ever
expanding. The key is to do this with the most cost
Prevention
Treatment or
Control
effective method possible. A Specialist in Exercise
Therapy can play a major role in achieving this goal.
Proper Exercise Is
Therapeutic
Most of the things that cause disease and/or accelerate aging can be positively influenced with the
proper dose of therapeutic exercise whether as a preventive measure or as a restorative tool. Hipppocrates knew this in 370 BC, he is known to have
said, “Generally speaking all parts of the body that
have function, if used in moderation and exercised
in labors to which each is accustomed become
healthy and well developed and age slowly. But if
unused and left idle become liable to disease, defective in growth and age quickly.” Said another way
“Use it or lose it!” Most of us agree with those statements. Unfortunately, it only took 2000 years for the
scientific community to prove it.
Rehabilitation
Restoration
Orthodox Health Care
e.g., Western Medicine
Prevention of
Reoccurrence
Orthodox
Health Care
Alternative Health Care
e.g., Chiropractic Medicine
Naturopathic Health Care and Medicine
“Fitness” applications such as diet and exercise
Fitness Management, Feb. 2002, pg. 36
13
DESIGNED FOR ACTION
The health benefits of regular physical activity. The table is based on a total physical fitness program
that includes physical activity designed to improve both aerobic and musculoskeletal fitness.
**** Strong consensus, with little or no conflicting data.
***
Most data are supportive, but more research is needed for clarification
**
Some data are supportive, but much more research is needed
*
Little or no data support
PHYSICAL ACTIVITY BENEFIT
SURITY
PHYSICAL ACTIVITY BENEFIT
SURITY
Nutrition and Diet Quality
Fitness of Body
Improves heart and lung fitness
****
Improvement in diet quality
**
Improves muscular strength/size
****
Increase in total energy intake
****
Weight Management
Cardiovascular Disease
Coronary heart disease prevention
****
Prevention of weight gain
****
Regression of atherosclerosis
**
Treatment of obesity
**
Treatment of heart disease
***
Helps maintain weight loss
***
Prevention of stroke
**
Children and Youth
Cancer
Prevention of obesity
***
Prevention of colon cancer
****
Controls disease risk factors
***
Prevention of breast cancer
**
Reduction of unhealthy habits
**
Prevention of uterine cancer
**
Improves odds of adult activity
**
Prevention of prostate cancer
**
Elderly and the Aging Process
Prevention of other cancers
*
Improvement in physical fitness
****
Treatment of cancer
*
Counters loss in heart/lung fitness
**
Counters loss of muscle
***
Osteoporosis
Helps build up bone density
****
Counters gain in fat
***
Prevention of osteoporosis
***
Improvement in life expectancy
****
Treatment of osteoporosis
**
Improvement in life quality
****
Cigarette Smoking
Blood Cholesterol/Lipoproteins
Lowers blood total cholesterol
*
Improves success in quitting
Lowers LDL-cholesterol
*
Diabetes
Lowers triglycerides
***
Prevention of type 2
****
Raises HDL – cholesterol
***
Treatment of type 2
***
Treatment of type 1
*
Improvement in diabetic life quality
***
Low Back Pain
Prevention of low back pain
**
Treatment of low back pain
**
**
DESIGNED FOR ACTION CONTINUED
PHYSICAL ACTIVITY BENEFIT
SURITY
Infection and Immunity
PHYSICAL ACTIVITY BENEFIT
SURITY
Sleep
Prevention of the common cold
**
Improvement in sleep quality
Improves overall immunity
**
Psychological Well-Being
Slows progression of HIV to AIDS
*
Elevation in mood
****
Improves life quality of HIV-infected
****
Buffers effects of mental stress
***
Alleviates/prevents depression
****
Arthritis
***
Prevention of arthritis
*
Anxiety reduction
****
Treatment/cure of arthritis
*
Improves self-esteem
****
Improvement life quality/fitness
****
Special Issues for Women
High Blood Pressure
Improves total body fitness
****
Prevention of high blood pressure
****
Improves fitness while pregnant
****
Treatment of high blood pressure
****
Improves birthing experience
**
Improves health of fetus
**
Improves health during menopause
***
Asthma
Prevention/treatment of asthma
*
Improvement in life quality
***
Today there is promising evidence that regular
physical activity positively influences the following:
1) Mental activity—whether by decreasing
depression or improving mental acuity
2) Immune function—mild to moderate
exercise improves T cell production
where as vigorous exercise decreases
immune function
3) Cardiorespiratory function—heart and
lung function has been well documented to improve with proper training
4) Cardiovascular function—the vascular
system can develop collateral circulation to make this system more efficient
5) Bone density—can maintain or increase
with adequate stimulation. Wolfe’s Law
say’s the robustness of the bone is in
direct relation to the forces applied to it
6) Liver function—the ability to store liver
glycogen is improved with cardiovascular conditioning
7) Body composition—proper exercise
along proper caloric consumption can
improve lean body mass quotients
8) Gastrointestinal function—physical
activity may decrease colon cancer
because physical movement decreases
the time food is in the colon and rectum
9) Metabolism—physical activity increases
the body’s metabolism, strength
training increases muscle mass which
elevates metabolism as well
10) Musculoskeletal system—most sedentary older adults have lost a large
amount of strength and muscle mass by
age 70. This loss of muscle is responsible for many older adults losing their
ability to maintain their independence
It appears that regular exercise benefits everything
from the head to the toe and from the inside out. It
now appears that exercise/physical activity can be
used to prevent or control a condition or rehab or
restore a condition. Therapists and rehab specialists
15
Exercise as Therapy
CHAPTER 3
have known for years that the proper dose of exercise
is useful to restore numerous chronic conditions.
Said in a simpler way, “everything gets worse with
age and disability if positive steps are not taken to
remediate, rehabilitate or restore. The normal course
of most diseases is downward. Research now suggests that almost all diseases and chronic conditions
can be positively influenced with regular, sensible
and systematic exercise.
Research has well documented that a prudent and
well-designed fitness program will keep us healthy
and/or make us healthier. A review of the literature
shows that proper exercise is good from the womb
to the tomb and everything along the way, whether
it be pre-natal classes or stroke rehab programs.
16
The most important thing for each of us to keep in
mind is to learn what is the proper dose to get the
ideal response. More is not always better and what
is right for one person may not be right for the
next person. Train Don’t Strain! No pain no Gain
is insane!
Exercise physiologists are grappling with this challenge. Currently fitness experts are trying to determine what is the correct dosage of exercise for
different conditions. This concept is not unlike
finding the correct prescription medication. The
key is to find what is the ideal amount of exercise
that provides maximum benefit without any undesirable side effects. When this magic formula is
developed then we will have finally found the
fountain of youth.
Exercise as Therapy
CHAPTER 3
A recent study reported in JAMA 276, 18 (1996):
1473–9 titled “Persons with Chronic Conditions”
stated that nearly 100 million Americans are
affected by a chronic disease. The number is
expected to increase to more than 134 million by
the year 2020.
The fitness professional of the future who can
bridge the gap from therapy to fitness will play a
pivotal role in tomorrow’s health care model. The
new paradigm is evolving where a cooperative effort
will be seen between the medical system and other
health care providers, this concept was supported by
IHRSA’s Institute on Exercise and Health’s Medical
Advisory Council.
EXERCISE AS MEDICINE
The role as Specialist in Exercise Therapy (SET) is to
provide safe and appropriate exercise that will not
aggravate our clients existing chronic/disease condi-
tion. It is imperative that the exercise therapy professionals be aware of their role and scope of practice. It
is not the duty of the SET to diagnose conditions nor
to prescribe therapy. It is the SET’s responsibility to
make sure that the exercises performed will not exacerbate the condition and will compliment those
activities assigned by the client’s therapist, physician
or chiropractor.
Exercise is much like medication: it must be
applied appropriately and monitored. It is prudent
that the SET keep the lines of communication
open between themselves and health professionals.
When in doubt, refer the client back to medical
community. In order to avoid a lawsuit know your
scope of practice and stay within it!
When to Refer to
Medical Professionals*
•
Shortness of breath
•
Dizziness
•
Numbness
•
Chest/arm/jaw pain
•
Persistence or gradual increase of soreness or discomfort
•
Decreased active range of motion
•
Swelling
•
Redness
•
Point tenderness
•
Increase in symptoms
•
Lack of progress
*Refer to a medical professional ANYTIME you
have concerns about a client’s progress or condition. It is always better to be safe than sorry!
USE IT OR LOSE IT
Exercise affects the majority of the body’s tissues,
organs and system to bring about a homeostatic stability and normal function. The body was designed
to move. If you are a sports fan you are well aware
17
Exercise as Therapy
CHAPTER 3
complications of disuse syndrome are numerous,
producing the following physiologic and biochemical
changes in organs and systems of the body.
The Effects of Sedentary Lifestyle
that rehabilitation is central to getting back on the
playing field. Most athletes are not told to “rest” until
they are completely healed, they are pro-actively
involved in the healing process. Thus, the role of the
SET is to facilitate total restoration of the client to
function at maximum ability.
It might seem logical that someone who has just had
a heart attack or low back pain should be resting in
bed. Researchers in Australia reviewed numerous
studies and found that bed rest delays or complicates recovery. Complete bed rest is a highly
unphysiologic and hazardous activity, which should
be used only for specific indications and terminated
when possible.
The question of how exercise is beneficial to the
person with a disability can best be explained by considering the deleterious effects of disuse syndrome.
Disuse syndrome results from disruption of the
normal balance between rest and physical activity,
thereby decreasing the optimal functional capacity of
an individual (Bortz 1992). Depending on the organ
or system involved, disuse syndrome can develop
within as little as 3 days of immobilization. Medical
18
•
Decreased physical work capacity
•
Muscle atrophy
•
Negative nitrogen and protein balance
•
Osteoporosis
•
Contracture of connective tissue
•
Cardiovascular deconditioning
•
Pulmonary restrictions
•
Decubitus ulcer
•
Mental depression
•
Loss of self-esteem
When disuse syndrome is coupled with a disability
and aging, the result is more functional loss than
would be predicted by the disability alone. The
greater the loss in functional capacity, the greater
the loss of independence in activities of daily living.
Thus the more negative impact the condition will
have on the lifestyle. Exercise can prevent, minimize, or reverse the effects of disuse syndrome even
if those disabilities are severe.
Unfortunately, many Americans who suffer from a
chronic condition sadly fall through the cracks, they
are not acutely ill, but they are not well enough to
function normally/optimally. This large and important segment of the population can greatly benefit
from the skills and expertise of the Specialist in Exercise Therapy. The Specialist in Exercise Therapy
working in concert with medical professionals can
make a significant and positive impact in their
clients’ quality of life.
Exercise as Therapy
CHAPTER 3
EXERCISE AND DISEASE
Helps
Prevent
Helps
Treat
Recommended
Ages
Coronary Heart Disease
•
•
all ages
Depression
•
•
all ages
Hypertension
•
•
all ages
Obesity
•
•
all ages
Osteoporosis
•
•
all ages
Stroke
•
Disease
all ages
Diabetes (Type I)
0–60
Diabetes (Type II)
•
•
0–60
Breast, Cervical, and Ovarian
Cancer
•
•
0–50
Back Pain
•
Colon Cancer
•
•
30–50
Congestive Heart Failure
•
•
30–50
•
60–100
Rheumatoid Arthritis
20–80
19
Muscles And Movement
CHAPTER 3
C h a p t e r
4
FUNCTIONAL FITNESS
To p i c s c o v e r e d i n t h i s c h a p t e r
FUNCTIONAL FITNESS
SUMMARY
20
Functional Fitness
CHAPTER 4
A relatively new concept to the fitness world is the concept of pre-habilitation, and post-rehabilitation, as
well as functional fitness.
It is a well-established fact that clients who receive
therapeutic applications of corrective exercise generally fare better than those left on their own.
With the new paradigm of managed health care, it is
now much more difficult for a patient to receive
unlimited physical therapy treatments. In most cases a
patient/condition has a ‘cap’ on the number of treatments they may receive. In many cases this number is
less than optimum.
An alternative to allowing a patient to exercise independently without supervision is to train a cadre of
fitness professionals to be knowledgeable Specialists
in Exercise Therapy to work in concert with the
trained health professionals. In this team approach,
the Specialist in Exercise Therapy could implement
and expand upon the health professional recommendations. With this team approach the client can
receive initial instruction and treatment with a therapist then progress to a fitness professional until a
plateau is reached and then be referred back to the
therapist for more advanced treatments.
To respond to this influx, fitness centers must be
physically as well as attitudinally accessible. Fitness
management must be open to expanding their
offerings to serve a diverse population. Fitness professionals must be educated about the idiosyncratic
needs of these clients.
The major reason why people come to rehabilitation
is to return to a pain-free, active life style. The first and
immediate reason for rehabilitation is to resolve the
clinical symptoms that exist after an insult to the body
part. Appropriate medication, physical modalities,
relative rest, and even immobilization are employed
in the early phase of rehabilitation. If the pathology
warrants, surgical procedures may be necessary.
Most people demand more than just relief of symptoms, most want full restoration of function. Restoration of function needs to address local and general
effects of the injury/condition. It is well documented
that muscular strength can decrease by 17% within 72
hours of immobilization and can lose up to 40% after
6 weeks of casting. Max VO2 decreases by 25% after 3
weeks of bed rest. Thus, a total functional fitness program is aimed at assisting the injured part back to
health while also minimizing deconditioning of unaffected parts and systems. Also, restoring the client to
previous functional level as much as possible is
desired. No longer is the goal for a client to attain a
particular ROM, but more important is, can they do
their activities of daily living (ADLs)?
“Functional Exercise” refers to exercises/activities that
mimic movements and patterns required to perform
ADLs. Functional exercise is simply application of the
S.A.I.D. principle; which is Specific Adaptation to
Imposed Demands. Muscles will adapt specifically to a
specific type of demand placed upon them.
Functional exercise is like specificity of training for a
21
Functional Fitness
CHAPTER 4
particular sport except in this case it is the sport of
living! Functional exercise should consider: What is
the role of the muscle/joint?
•
Is it a mover?
•
Is it a stabilizer?
•
Is it weight bearing or not?
•
Is the muscle too tight?
•
Is the muscle too weak?
•
Is the neuro-muscle unit intact?
•
Was the muscle normal before?
To make an exercise program as functional as possible
it helps to train the muscles in ways, method and roles
that mimic daily living. An example often used in football is, just because a lineman can bench press 300 lbs.
does not automatically translate into the fact he can
protect the quarterback. So it is with functional fitness,
just because someone has a 160˚ of ROM in the
shoulder does not translate into them being able to go
back to their job as a painter and function fully.
In functional training the plan is to gradually progress
from simple to complex, and from isolation type
moves at a single joint to movements that employ several joints and muscle groups and stabilizers.
22
Functional Fitness
CHAPTER 4
SUMMARY
Keys to proper functional exercise…
•
Simple before complex
•
Static before dynamic
•
Slow before fast
•
Low force before high force
•
Two arms before single arm
•
Two legs before single leg
•
Stable surface before introducing unstable
surface
•
Quality movements before quantity of
movements
•
Focus on core of trunk as well as stabilizers of
each joint
•
Correct usage of open kinetic chain vs.
closed kinetic chain exercise
•
Proper usage of concentric, eccentric, isometric, isokinetic and plyometric moves
NOTE:
Not all of the above apply to every condition or to
every client. Remember individualize! Don’t go outside your scope of practice and expertise and seek
advise as needed. Become part of the client’s postrehab team.
23
Contraindicated Exercises
CHAPTER 4
C h a p t e r
5
FUNDAMENTALS OF
EXERCISE THERAPY
To p i c s c o v e r e d i n t h i s c h a p t e r
BENEFITS OF EXERCISE THERAPY PROGRAMS
DESIGNING AN EXERCISE THERAPY PROGRAM
Gather Basic Information for Each Client
Design the Program with These Factors in Mind
PROPER BODY MECHANICS FOR THE INSTRUCTOR
Anatomy of the Back
Poor Body Mechanics
Good Body mechanics
EFFECTIVE TEACHING CONSIDERATIONS
General Principles of Learning
Accommodating Learning Style Preferences
Instructional Strategies
EFFECTIVE COMMUNICATION SKILLS
Tips for Leading Exercise Classes
24
Fundamentals of Exercise Therapy
CHAPTER 5
BENEFITS OF
EXERCISE THERAPY PROGRAMS
Whether their disabilities are congenital or acquired, whether they are
young or old, rich or poor, participants can all benefit from a fitness
thearpy program.
Congenital disability:
Disability present at birth,
regardless of causation
The question of how exercise is beneficial to the person with a disability can
best be explained by considering the deleterious effects of a sedentary
lifestyle, or disuse syndrome. Disuse syndrome results from disruption of
the normal balance between rest and physical activity, thereby decreasing the
optimal functional capacity of an individual (Portz 1992). Inactivity reduces
the opportunity for active muscle contractions and diminishes the influence
of gravity on weight-bearing bones. Depending on the organ or system
involved, disuse syndrome can develop within as little as three days of immobilization. Medical complications of disuse syndrome are numerous, producing deleterious changes in organs and systems of the body.
Acquired disability:
Disability that is not inherited
Disuse syndrome: Cessation
of use, practice, or exercise;
inusitation; desuetude; as, the
limbs lose their strength by
disuse
TA B L E 5 - 1
BENEFITS OF AN
EXERCISE THERAPY PROGRAM
PHYSIOLOGICAL
PSYCHOLOGICAL
SOCIAL
• Increases Muscular
Strength and
Endurance
• Improves Self Image
• Provides Enjoyable
Activity
• Facilitates Flexibility
• Enhances Circulation
• Increases Self
Confidence
• Increases Feeling of
Control
• Provides Contact with
Others
• Elevates Both
Respiration and
Metabolic Rates
• Develops Gross Motor
Coordination
• Improves/Maintains
Physical
Independence
25
Fundamentals of Exercise Therapy
CHAPTER 5
TA B L E 5 - 2
Sedentary: Sitting a lot; not
involved in any physical
activity that might produce
significant fitness benefits
NEGATIVE EFFECTS OF A SEDENTARY LIFESTYLE
PHYSIOLOGICAL
PSYCHOLOGICAL
Decreased physical work capacity
Depression
Muscle atrophy: within 3 weeks muscle may lose Loss of self-esteem
half its strength
Nitrogen and protein imbalance
Decrease in intellectual activity
Osteoporosis—depletion of mineral reserves
Permanent shortening of connective tissue
Cardiovascular deconditioning—orthostatic
hypotension can result in 3 to 5 days
Decreased appetite, constipation and/or diarrhea, nutritional deficits
Pulmonary restrictions (inability to fully expand
lungs, unproductive cough, pneumonia)
Altered sensation and coordination
Impaired circulation can lead to decubitus ulcers
and risk of blood clots
When a disability is coupled with disuse syndrome and aging, the result is a
greater functional loss than would be predicted by the disability alone. The
greater the loss in functional capacity, the greater the loss of independence in
activities of daily living. Thus, the more negative impact that condition will
have on lifestyle.
Exercise can prevent, minimize, or even reverse the effects of disuse syndrome
and should be available to all persons with disabilities, even if those disabilities
are severe. Although exercise may vary in type and mode, all forms of exercise
provide some degree of mental and physical benefits.
DESIGNING AN
EXERCISE THERAPY PROGRAM
Designing a safe and appropriate individualized exercise program is the goal of
an exercise therapy instructor. The more information you have about the
client, the more effective and safer the program design will be. Although the
recommendations below may seem burdensome, following them will improve
your effectiveness as well as your credibility within the community.
26
Fundamentals of Exercise Therapy
CHAPTER 5
Gather Basic Information for
Each Client:
•
All clients, regardless of age, should have medical clearance to
participate. If client is being seen by more than one health professional, be sure to have medical clearance from each
•
Pre-test client’s functional abilities and limitations
•
Compile a listing of all prior and/or existing medical conditions
•
Establish baseline of resting blood pressure and pulse
•
List recommended and contraindicated exercises
•
Have an emergency plan and contact phone number
•
List all medications taken and their side effects
•
Be aware of your client’s wishes regarding the “Do Not Resuscitate” order
•
Lastly, your own place-of-business rules that always take
precedence over the above
Design the Program with These
Factors in Mind:
•
Safety of location (accessibility to facilities, safety of the exercise environment)
•
Medications that client is taking and potential side effects
•
Communication skills of and with the client
•
Fitness evaluation
•
Exercise card/record keeping
•
Client’s interests and goals
Contraindicated: Exercises
that are inappropriate or
undesirable
Do Not Resuscitate: A donot-resuscitate (DNR) order
tells medical professionals
not to perform CPR. This
means that doctors, nurses
and emergency medical
personnel will not attempt
emergency CPR if the
patient’s breathing or
heartbeat stops
These are discussed in detail below.
1. Safety
Safety is a top priority in an exercise therapy program—for the clients as well
as the staff. Always try to anticipate any type of accident before it occurs. Be
alert to all clients’ physical and cognitive ability levels each day. Constantly
monitor the room and equipment for possible hazards.
Prevention of falls is of prime importance. Check to see that electrical cords
are placed out of walking paths, small pieces of equipment are not left on the
floor, and that people will have adequate room to maneuver, especially if
using canes or walkers.
Familiarize yourself with the chapters in this book on Proper Body
Mechanics, Transfer Techniques and Wheelchair and Ambulation Assistance
to ensure your safety and that of others. Establish a safety checklist.
27
Fundamentals of Exercise Therapy
CHAPTER 5
2. Medications
Angina: Chest pain due to a
lack of oxygen to the heart
muscle usually attributed to
an inadequate blood supply
caused by heart disease
Diabetes: (Type I) A
pancreatic disorder that
produces high sugar content
in the blood and urine. (Type
II) Adult onset diabetes is a
carbohydrate metabolism
disorder, different from Type I
All clients coming to the exercise therapy classes are expected to know what
medications they are taking and their potential side effects. Clients prone to
angina (chest pain) should carry nitroglycerin tablets and take as needed.
Clients with diabetes should carry candy or another sugary item in case of a
drop in blood sugar. Small cans of orange juice could be stored next to the first
aid kit for emergency purposes. At times, a client’s health status may require
his/her physician to prescribe a new drug, and thus the adjustment period may
take some trial and error. In terms of participation during an exercise class,
clients should be observed for signs of fatigue, breathlessness, dizziness, listlessness, and general malaise.
3. Communication with the Client
Being able to personally interact/communicate with another individual, and
having a positive impact on his/her life, is one of the most rewarding experiences you can have.
Your clients will look to you for leadership, encouragement, and feedback.
Here are some suggestions to help you develop a more professional working
relationship with them:
•
Make eye contact with the person and remember his or her name.
Express a sincere interest in the person you are working with
•
Focus on the task at hand: associate with your exercise
•
Determine how each client learns best
•
Provide corrective feedback to each client about how he or she
is doing
•
Encourage feedback from clients
•
Respect clients’ privacy at all times
•
Evaluate yourself periodically to see how you could enhance
your interaction skills
4. Fitness Evaluation and Goals
Physical assessment of the participant provides the instructor with data to:
establish the client’s current level of performance; identify realistic and individualized exercise goals; prescribe appropriate, adapted exercises; and monitor
progress upon post-testing. The assessment should begin by jointly determining the client’s long-term and short-term goals. Information provided on
the medical release and intake forms, as well as the client’s own goals, direct
the type of assessment conducted by the instructor (see the appendix for forms).
28
Fundamentals of Exercise Therapy
CHAPTER 5
5. The Exercise Card
Once the medical history and release have been
obtained and the physical assessment has been completed, the task of individualized exercise programming may begin. Assessment data should be
blended with the client’s medical history, type and
severity of disability, age, personal long-term and
short-term goals, and the physician’s recommendations to produce an individualized exercise program. The client’s input should be considered
essential to the development of this program. Input
from other allied health professionals working with
the client may also be helpful in creating the
optimal exercise program and teaching style. Periodic feedback from the client and his/her assistant
will ensure that the exercise program is achieving
the objectives set forth at the start of the program,
plus it will allow the chance to add new objectives as
appropriate (adjust objectives to changing needs).
Ideally, the medical release should be updated each
time the client re-enrolls in the program, or every
year, at a minimum. Any significant change in the
client’s medical condition would also warrant an
updated medical release from his/her physician.
For liability purposes, the client’s file should be
kept until the Statute of Limitation runs out on a
person’s right to litigate for negligence.
The Specialist in Exercise Therapy should write out
each individual’s entire exercise program on cards
or paper used to record information regularly. Some
programs have stored their clients’ exercise programs in computer files, eliminating the laborious
process of writing up programs. The exercise cards
might contain the following information:
•
Name of client
•
Dates for every day the client exercised
in the program
•
Names of exercises, techniques, and
body positions used
•
Daily recording of quantitative data
related to performance (e.g., number of
sets, repetitions, and weight lifted for
strength exercises; resting and exercising heart rates, resting and exercising blood pressures, duration of
exercise, and work rates for cardiovascular training)
•
Any exercise contraindications or precautions
•
Medical condition(s)
•
Medications
In addition, a card for ‘progress notes’ can be
attached to the exercise program card to allow for
recording of qualitative information (e.g., pain
occurring during an exercise), observations
regarding the client’s response to the session, and
progress toward goals.
The Exercise Participation Flowchart on the following page is a tool to assist you in deciding if you
need to have your client see the physician prior to
embarking on an exercise program. It is always prudent for the client to consult the physician prior to
an exercise program, but this chart will assist you in
evaluating just how critical this is. It can be copied
and given to your client for reference. The page following the Exercise Participation Flowchart is a list
of terms and their definitions that you will need to
familiarize yourself with.
29
Fundamentals of Exercise Therapy
CHAPTER 5
EXERCISE PARTICIPATION FLOWCHART
Do you have any of the following conditions?
1)
2)
3)
Unstable Angina
Myocardial infraction within past six months
Any serious surgical or medical condition
diagnosed within past 3 to 6 months
No
Yes/Unsure
Do you have any of the
following conditions?
1) Diabetes Mellitus, Type II
2) Renal Disease
3) COPD
4) Osteoporosis, severe
You need to see your physician
and go through a medically
supervised program first.
5) Severe back pain
6) Heart Disease, Stable
7) Arrhythmia
8) Cancer
Yes/Unsure
No
You must inform your physician
and receive approval prior to
participating.
Do you have any of the
following conditions?
1) Hypertension
2) Asthma
3) Peripheral vascular disease
4) Arthritis
5) Osteoporosis, mild
6) Gout
Yes/Unsure
No
You must inform physician, but
may participate.
30
You may participate fully in
exercise program.
Fundamentals of Exercise Therapy
CHAPTER 5
FUNDAMENTAL TERMINOLOGY FOR THE
SPECIALIST IN EXERCISE THERAPY
Activities of Daily Living (ADL): Self-care activities, including
dressing, bathing, eating, getting in and out of bed, using a
wheelchair, and ambulating short distances
Hemiparesis: Weakness on one side of the body
Hemiplegia: Paralysis of one side of the body
Ambulation/Gait-Training: Re-education in walking
Isometric: A static muscle contraction involving no movement at
the joint
Aphasia: Inability to express oneself in one or more of the
following ways: speaking, writing, making signs, and/or the
inability to comprehend spoken or written language
Isotonic: A muscle contraction that produces movement in the
joint
Arrhythmia: Variations in the regular rhythm of the heartbeat
Orthotic: An orthopedic appliance used to restore or improve
function, e.g., a leg brace
Arthritis: Inflammation of a joint, characterized by pain, swelling,
stiffness, and redness (commonly in fingers, hands, ankles, and
knees)
Ataxia: Lack of coordination in body movements due to some
form of nerve or brain damage
Beta-Blocker: A drug that slows heart activity, and thus lowers
blood pressure
Cerebral Palsy: A general term for non-progressive disorders of
movement and posture, resulting from damage to the brain
during pregnancy, birth, or early childhood
Cerebrovascular Accident (CVA or Stroke): Sudden rupture or
blockage of a blood vessel within the brain resulting in impaired
sensation, movement, or function
Contractures: An abnormal shortening of a muscle, tendons, or
scar tissue that produces deformity or distortion. Joint
contractures often affect hips, knees, and shoulders due to lack
of use of the joint
Contraindicated: Exercises that are inappropriate or undesirable
Diabetes: (Type I) A pancreatic disorder that produces high sugar
content in the blood and urine. Type II diabetes (adult onset
diabetes) is a carbohydrate metabolism disorder, different from
Type I
Osteoarthritis: Also known as degenerative arthritis, resulting
from wear and tear on the joints (commonly in spine, hips, and
knees)
Paralysis: Complete or partial loss of controlled movement,
caused by the inability to contract one or more muscles,
described as either flaccid or spastic
Paraplegia: Weakness or paralysis of both legs and sometimes
part of the trunk
Paresis: Weakness, rather than complete loss of movement
Proprioceptive Neuromuscular Facilitation (PNF): A form of
stretching that uses an isometric contraction prior to the stretch
Prosthesis: An artificial appliance used to replace a lost natural
structure, e.g., an artificial arm or leg, a glass eye, a breast, or
dental bridge
Quadriplegia: Paralysis of all four limbs and the trunk
Range of Motion (ROM): The limits of movement in a joint
(flexion, extension, pronation, supination, etc.)
Rheumatoid Arthritis: The most severe type of joint disease.
This is an autoimmune disorder characterized by extreme pain,
stiffness, and deformity
Edema: The swelling of body tissue due to excess fluid content
Seizure: A sudden change of consciousness, caused by an
abnormal brain discharge, as in epilepsy
Epilepsy: Recurring disturbances in the electrochemical activity
of the brain, marked by seizures and convulsions
Spasticity: Abnormal muscle tightness with exaggerated stretch
reflexes
Flaccidity: Absence of muscular tone. (Affected limbs have a
floppy appearance)
Transient Ischemic Attack (TIA): A brief interruption of the
blood supply to part of the brain that results in temporary
impairment of vision, speech, sensation, or movement; the
warning signs of stroke (CVA)
Goniometer: An instrument used to measure joint angles of
range of motion
31
Fundamentals of Exercise Therapy
CHAPTER 5
PROPER BODY MECHANICS
FOR THE INSTRUCTOR
Lower-back pain is an occupational hazard for many health care workers.
When you do any work that requires lifting, twisting, bending, or reaching,
your back is always vulnerable to injury. Using proper body mechanics can
help protect your back against injury by keeping its three natural curves in
their proper alignment while you work. Always take care of your own body
before attempting to assist anyone. To prevent injury, exercise regularly to
maintain strength and flexibility, and learn how to move safely and efficiently.
Anatomy of the Back
Your back consists of a column of individual bones (vertebrae) separated by cushions (discs) and held together by joints, ligaments, and
muscles. It supports your upper body, protects your spinal cord, and
allows you to move freely. The healthy spine is made up of 24 vertebrae aligned in three natural curves: the cervical curve of your neck;
the thoracic curve of your middle back; and the lumbar curve of
your lower back. When you maintain these three natural curves in
their normal alignment, your weight is evenly distributed throughout
the vertebrae and discs. This way, your back is minimally vulnerable
to injury. Your three curves are correctly aligned when your ears,
shoulders, and hips are in a straight line.
Poor Body Mechanics
Figure 5-1 Lumbar curve
of the lower back
With poor body mechanics, lifting even a slight weight can put an excessive
strain on your lower back. Do not reach and bend from the waist as that forces
your back to support your upper body plus the load. Poor body mechanics over
time can cause disc damage and pain, and lead to a herniated disc. Healthy discs
are shock-absorbing pads located between the vertebrae. They consist of a jellylike center surrounded by a tough, fibrous ring. A herniated disc occurs when
pressure on the front of the disc squeezes its jelly-like center out the back or
side. This puts pressure on the spinal nerve and causes pain.
Good Body Mechanics
By lifting a load close to your body, you give yourself leverage that reduces the
strain on your lower back. By keeping your three natural curves aligned, you
distribute the weight of the load evenly throughout your spine, lowering the
risk of injury. By contracting your abdominal muscles you reduce pressure on
the spine and maintain your lumbar spinal curve.
32
Fundamentals of Exercise Therapy
CHAPTER 5
Lifting
•
Use both arms
Lifting is the most common cause of back injury
among health care workers. So, always:
•
Tighten your abdominal muscles when
pushing
•
Keep the load close to your body
Posture While Standing
•
Bend your knees and hips
•
Tighten your abdominal muscles when
you lift; they help support your back and
help you maintain a neutral position in
the lower back
•
Lift with your legs and buttocks
•
Maintain the three natural curves of your
back
When you perform a task that requires prolonged
standing, such as talking to a person in a wheelchair,
you may slouch and forget to maintain your three
natural curves. This bad posture can cause muscle
tension, stiffness, fatigue, backache, and neckache. It
also contributes to degeneration of discs and ligaments. To maintain good posture:
•
Avoid twisting your back while lifting.
Lift first, and then pivot on your feet
•
Stand close to the person so you don’t
have to lean forward
•
Bend with your knees and maintain your
back’s three natural curves. Maintain
neutral-spine technique
•
Pull up a chair to talk with someone who
is seated
Reaching
Reaching, especially in high places, can injure your
back if you reach too far or lift too much weight.
Be sure to:
•
Avoid reaching (i.e., lifting objects above
your head or below your knees)
•
Reach only as high as is comfortable; do
not stretch. Use a stool if you need to
•
Test the weight of the load before lifting
by pushing up one corner
•
Let your arms and legs do the work—not
your back. Tighten your abdominal muscles as you lift
When a Person Falls
People fall for many reasons. They may be afraid or
become dizzy, or their knees may buckle. When
someone starts to fall:
•
Guide the person easily and safely to the
floor, bending your knees, not your back.
Don’t try to prevent the fall or you may
injure yourself
•
Stay close to the person
•
Mentally practice this maneuver before
an accident actually happens. Then
physically practice on someone simulating a fall. Practice maneuvers in several positions on various sides of the
person’s body
•
Use proper lifting techniques all the
time (whether lifting a pen or a person)
so that it is automatic when you must
do it suddenly
Pushing and Pulling
Pushing and pulling large objects such as wheelchairs can be as hard on your back as heavy lifting.
Remember to:
•
Stay close to the load; don’t lean forward
•
Whenever possible, push rather than
pull. You can push with twice as much as
you can pull without strain
33
Fundamentals of Exercise Therapy
CHAPTER 5
EFFECTIVE TEACHING CONSIDERATIONS
Optimal learning occurs when the teaching style is
congruent with the characteristics of the learner. No
single teaching style, strategy, approach, or method
is a panacea for all instructional situations. Effective
teachers appropriately adapt teaching styles to
match the various learning styles of their students.
In adaptive programs, instructors are faced with the
challenge of facilitating learning for a group of individuals who possess various disabling conditions
and learning styles. Understanding the learning
process in these situations is crucial and means the
difference between mediocre and effective programs. This chapter will review the different
learning styles one may encounter in adaptive programs and present instructional strategies for facilitating optimal learning.
Principle of Pleasurable Effect: Clients tend to accept and repeat those responses that are pleasant and
satisfying and avoid those which are not.
General Principles of
Learning
Principle of Vigor: A dramatic or exciting learning
experience is more likely to be remembered than a
routine or boring experience. Let your teaching
come alive. Use vivid examples and participate with
the clients. Remember that humor is a useful
teaching tool.
There are numerous principles that affect the
client’s rate and amount of learning. The teacher
must understand these principles to be successful
and effective.
34
Principle of Nothing-Succeeds-Like-Success: Make
every effort to see that clients achieve some success
during each class.
Principle of Primacy: First impressions are lasting.
Make those initial class meetings meaningful.
Principle of Practice and Repetition: The more
often an act is repeated, the quicker the skill is
established.
Principle of Disuse: A skill not practiced or knowledge not used will be forgotten quickly. Important
skills and concepts need to be reviewed.
Fundamentals of Exercise Therapy
CHAPTER 5
Accommodating
Learning Style Preferences
Each individual, whether disabled or not, has a preferential learning style
involving a dominant sensory channel. To foster the learning experience, the
instructor needs to know the learning style of each client. Table 5-3 will provide clues to decide if a client is primarily a visual, auditory, or kinesthetic
learner. A client will learn more quickly when taught through his/her dominant sensory mode.
Learning Styles:
• Visual Preference
• Auditory Preference
• Kinesthetic Preference
TA B L E 5 - 3
LEARNING STYLES
PRIMARY LEARNING STYLES INSTRUCTIONAL AND LEARNING IMPLICATIONS
TEACHING TIPS
Visual Preference
Provide an unobstructed
view to the teacher, the
board, and/or
demonstrations.
Visual Learners learn best when the instructor:
• Creates an image through descriptive language
• Uses examples and analogies
• Supplements lectures with: movie/videos, pictures,
graphs, observation of others
• Distributes structured outlines prior to the lecture
• Provides written directions
Auditory Preference
Auditory Learners learn best through:
•
•
•
•
•
Kinesthetic Preference
Lectures
Simple and consistent language
Verbal directions
Discussions and panels
Question/Answer sessions
Kinesthetic learners learn best through:
•
•
•
•
Role playing and simulation exercises
Experiments/demonstrations
Movement experiences and use of body parts
Use of tactile models: raised-line drawings,
clay models, etc.
Encourage student to
read material outloud or
talk outloud while
learning.
Provide a hands-on and
physically active
learning environment.
35
Fundamentals of Exercise Therapy
CHAPTER 5
Instructional Strategies
The importance of teacher/client interactions cannot be over-emphasized. The
primary function of the teacher is to hasten the client’s cognitive, psychomotor, and affective development as they relate to physical fitness. Teachers
should be aware of the types of interactions that foster the clients’ learning,
motivation to exercise, and attendance. The following section describes
instructional strategies in the visual, auditory, and kinesthetic domains. If a
client has a weak sensory channel—visual, auditory, or kinesthetic: then a
multi-sensory approach is warranted. This approach makes use of all the
senses to promote and reinforce the learning of knowledge or skills.
Visual: Denoting a person
who learns and remembers
more through sight than
through hearing or touch
Auditory: Denotes a person
who learns and remembers
more through hearing than
through sight or touch
36
If the client learns best within the visual domain:
•
Demonstrate a skill whenever possible
•
Tell the clients what to look for in your demonstrations
•
Be sure everyone in the group can see you
•
Maintain eye contact when speaking to clients
•
Use diagrams if necessary
•
Use visual cues to enhance body awareness and coordinated
movement (e.g., footprints placed on the floor; stickers placed on
the body or equipment; pointing to a body part; arrows or lines
on the floor)
If the client learns best within the auditory domain:
•
Whenever possible, provide the client with facts or background
information regarding exercises or procedure
•
If needed, verbally direct a client to perform a task
•
Allow clients with hearing impairments to see your mouth and
hand gestures. Do not over-exaggerate mouth movements
•
Provide corrective skill feedback—information regarding how to
correct an inadequate performance. Knowledge of results leads
to increased learning
•
Provide positive skill feedback—tell clients what they did correctly to reinforce the likelihood of the skill being correctly performed again
•
Ask questions regarding discomfort during exercises (e.g., pain
during passive range of motion; pain during cardiovascular
training). This information alerts the teacher to signs of exercise
distress and provides feedback regarding his/her technique. The
teacher should also ask questions regarding exercises or procedures for testing the client’s knowledge
Fundamentals of Exercise Therapy
CHAPTER 5
•
Listen to the client’s questions, responses, or attempts at conversation
•
Utilize praise, vocal intonation, claps, gestures, and expressions to activate or intensify motor performances or foster
appropriate behavior
•
Use simple verbal cues to assist the client in better visualizing
the movement
If client learns best within the kinesthetic domain:
•
Manually guide a client with a visual impairment through the
desired motions
•
Physically assist a client whenever needed (e.g., manual assistance that enables a client to reach full range of motion)
•
Tap the body part to facilitate movement in the correct direction
Kinesthetic: Denotes a
person who learns and
remembers more through the
sense of touch than through
sight or hearing
TA B L E 5 - 4
CHARACTERISTIC BEHAVIORS OF EFFECTIVE
EXERCISE THERAPY EDUCATORS
Hold and project high expectations for client success
Maximize opportunities for clients to engage in learning experiences
Manage their time well and organize the classroom efficiently
Pace the curriculum to maximize client success
Engage in active teaching with all clients whether individually or in groups of
varying size
Work toward mastery of knowledge and skills by systematically monitoring client
progress and providing feedback
Are sensitive to differences in rate of learning and type of teacher-client contact
required
Provide a supportive learning environment that is characterized by warmth and
personal support
Select equipment and activities that are appropriate for the developmental level of
the client
Remember that a client’s self-esteem is more important than any exercise or activity
Think of what the clients can do, not what they cannot do
Are well prepared—know the material, know the clients, and know the appropriate
teaching style
37
Fundamentals of Exercise Therapy
CHAPTER 5
EFFECTIVE COMMUNICATION SKILLS
Being able to personally interact with another individual, and having a positive impact on his or her
life, is one of the most rewarding experiences you
can have.
fully placing your personal problems in your pocket
for safekeeping. Later, when you are in a more
appropriate place, you can take them out and deal
with them.
Your students will look to you for leadership,
encouragement, and feedback. Here are some suggestions to help you develop a more professional
working relationship with the students:
Determine how each client learns best. Face the
person and be sure to speak clearly and efficiently.
Some understand better by seeing you demonstrate, others by following verbal directions. Students with limited vision may also benefit by your
hands-on guidance.
Make eye contact with the person and remember
his/her name. A warm and friendly manner puts
everyone at ease. Be aware that your attitude can be
a motivating force for others. Express a sincere
interest in the person you are working with. Respect
his/her privacy about their personal issues and
information. In the event that you are uncomfortable working with a particular individual, inform
your supervisor.
Focus on the task at hand. An experienced professional has learned how to separate work and personal issues. The key is to remember that you are
here for the client’s benefit, not your own. You
should not impose your personal worries on the
client. On occasion, you may also have to remind
the client that he/she is here to exercise and not
dwell on outside issues. One useful technique (share
it with the clients) is to imagine that you are care-
38
Provide feedback about how the client is doing. Be
encouraging, and try to make any criticism constructive. Remember, you can always learn from
clients, too. An important point to remember is to
allow the clients to do as much as possible for themselves. Even if something, such as putting on a
jacket, is a struggle, encourage them to keep trying.
You must use your best judgment based upon the
entire situation at the time.
Evaluate yourself periodically to see how you have
enhanced your performance in terms of self-confidence, general knowledge, leadership, and personal
interaction skills.
Encourage feedback from the clients on how to
improve the program or make it more enjoyable.
Fundamentals of Exercise Therapy
CHAPTER 5
Tips for Leading Exercise Classes
Always be aware of each individual’s abilities and
limitations.
You are a role model, so you must stand or sit in
clear view of all and demonstrate each exercise
properly. If you are unable to demonstrate a particular exercise, it is all right to designate someone else
who can. Learn to speak loudly and clearly so that
each client will know what to do. With practice, you
will build confidence as an instructor.
Demonstrate the exercise at a pace that everyone
can follow; slow down if needed. Going too fast can
discourage some people from trying at all.
Remember, you are here for their benefit, not yours.
Choose exercises that the greatest number of clients
can do. If one or two students cannot do a certain
movement, suggest a modification or alternate exercise for them.
If you forget what to do next, turn your attention
to your own body and ‘feel’ which joints/areas have
not been loosened yet.
If a client is having difficulty with any exercise, be
subtle in correction so as not to embarrass the
person. Additional instruction while still participating in the group can help the client with special
needs. You may also decide to work with that student on an individual basis later.
39
Fundamentals of Exercise Therapy
CHAPTER 5
For Visually Impaired Students:
Orient client to the classroom space, and provide a
safe area in which to exercise.
Verbally describe each movement clearly and concisely. Give each exercise a name that the client will
remember.
Another assistant can manually (hands-on) help
the client to assume the correct form.
40
Overall, you want to provide for the safety, success,
and enjoyment of the program for each client. Keep
it fun—add some light humor. In order that they
may receive full benefit from your efforts, encourage
clients to limit their conversation so that they may
focus full attention on the exercises they are doing.
Do not hesitate to solicit feedback or constructive
criticism from your clients.
(Flexors/Extensors)
Wrist Curl
Reverse Curl
Forearm
(Biceps)
Dumbbell/Barbell
Curl
Preacher Curl
Concentration Curl
FRONT VIEW
(Quadriceps)
Squat
Leg Extension
Leg Press
Lunge
Power Clean
Thigh
(Obliques)
Side-Bends
Oblique Crunch
Side
(Abdominals)
Bent Knee Sit-Up
Partial Sit-Up
Leg Raises (Bent Knee)
V-Ups
Stomach
(Pectorals)
Bench Press
Incline Press
Dumbbell Press
Decline Press
Bent-Arm Pull-Over
Push-Up
(Anterior/Middle Deltoid)
Military Press
Behind the Neck Press
Dumbbell Raises
Bench Press
Front of Arm
Chest
Front Shoulder
SIDE VIEW
(Gastrocnemius)
Standing/Seated Toe Raises
Calf
(Hamstring)
Leg Curl
Back of Thigh
(Erector Spinae)
Straight-Leg Deadlift
Regular Deadlift
Back Hyperextension
Good-Morning Exercise
Lower Back
(Triceps)
Triceps Pushdown
Lifting Triceps Extension
Bench Press
Bar Dips
One-Arm French Press
Back of Arm
(Posterior Deltoids)
Bent Over Dumbbell Raises
Rear Shoulder
EXERCISE AND MUSCLE GUIDE
BACK VIEW
(Gluteals)
Squat
Lunge
Power Clean
Buttocks
(Latissimus Dorsi)
Wide-Grip Pull Down
Bent Over Seated Row
Seated Row
Pull-Up
Back
(Trapezius)
Shoulder Shrug
Up-Right Row
Power Clean
Upper Back
Muscles And Movement
CHAPTER 3
C h a p t e r
6
MUSCLES AND MOVEMENT
To p i c s c o v e r e d i n t h i s c h a p t e r
ANATOMY FOR THE
EXERCISE THERAPY EDUCATOR
General Anatomical Movements
Muscles
EXERCISE THERAPY KINESIOLOGY
HOW MUSCLES WORK TOGETHER
42
Muscles and Movement
CHAPTER 6
Critical to the development and implementation of individualized exercise
programs is a basic understanding of kinesiology. This chapter will provide
a foundation for those who have never taken a course in kinesiology and
serve as a refresher for those who have.
ANATOMY FOR THE EXERCISE
THERAPY EDUCATOR
General Anatomical Movements
Anatomical movements are always described in reference to the anatomical
position. In this position, the individual stands erect, feet together, with the
arms at the sides and palms facing forward as described in Figure 6-1. General anatomical movements are defined in Table 6-1.
Anterior/Ventral: Towards the
front of the body
Posterior/Dorsal: Towards
the back of the body
Medial
Superior/Cranial: Towards
the head
Midline
Lateral
Inferior/Caudal: Towards the
feet
Superior
Medial: Towards the midline
of the body
Lateral: Away form the
midline of the body
Inferior
Posterior
Anterior
Proximal: A position nearest
the point of origin
Distal: A position farthest
from the point of origin
Supine: Facing up
Prone: Facing down
Dorsal Surface
Plantar Surface
Figure 6-1 Anatomical position
43
Muscles and Movement
CHAPTER 6
TA B L E 6 - 1
ANATOMICAL MOVEMENTS
TERM
DESCRIPTION
TERM
DESCRIPTION
ABDUCTION
Movement away from midline of
body
INVERSION
Raising the medial border of the foot
ADDUCTION
Movement toward the midline of the LATERAL FLEXION
body in the frontal plane
Flexing the trunk or the neck to the
left or the right in the frontal plane
ANTERIOR TILT
Forward tilt of the pelvic girdle (present in lordosis)
PLANTAR FLEXION
Pointing or extending the foot (ankle
joint) downward
CIRCUMDUCTION
Movement circumscribing a conical
area (e.g., hip and shoulder), involving flexion, abduction, extension,
and adduction in sequence
POSTERIOR TILT
Backward tilt of the pelvis
DEPRESSION
Downward movement of a part (e.g., PRONATION
shoulder and pelvic girdles)
Foot: Eversion combined with
abduction of the forefoot. Forearm:
Rotating wrist and hand towards the
radius
DORSIFLEXION
Flexion of the foot (ankle joint)
upward
PROTRACTION
Forward movement of a part (e.g.,
shoulder girdle)
ELEVATION
Upward movement of a part (e.g.,
shoulder and pelvic girdles)
RADIAL DEVIATION
Movement of the wrist and hand
towards the radius
EVERSION
Raising the lateral border of the foot
RETRACTION
Backward movement of a part (e.g.,
shoulder girdle)
EXTENSION
Movement resulting in the increase
of joint angle (i.e., straightening at a
joint). Return from flexion to
anatomical position
ROTATION
Movement of a bone around its long
axis
EXTERNAL
(OUTWARD)
ROTATION
Rotation of a bone in a clockwise
direction away from midline
SUPINATION
Foot: Inversion combined with
adduction of the forefoot. Forearm:
Rotating wrist or hand laterally from
elbow, as if drinking soup
FLEXION
Resulting in a decrease of a joint
angle (i.e., bending at a joint)
ULNAR DEVIATION
Movement of the wrist and hand
toward the ulna
HYPEREXTENSION
Movement beyond the position of
normal extension
UPWARD ROTATION Rotation of the scapula counterclockwise
INTERNAL (MEDIAL) Rotation of a bone in counter-clockROTATION
wise direction toward the midline
44
Muscles and Movement
CHAPTER 6
Muscles
A muscle is a bundle of contractile fibers held together by a sheath of connective tissue and attached to bones by means of tendons. After being
stretched, skeletal muscle will return to its normal resting length; therefore,
it is commonly said that muscles have properties of extensibility and elasticity. Muscles also have the capability to contract and relax because they
respond to irritability and conductivity. It must be remembered that muscles
are a part of a neuromuscular unit and that without neurological innervation, movement cannot occur and atrophy will follow. Muscles have the
capability of developing force within the fibers.
Muscle: a) A body tissue
consisting of long cells that
contract when stimulated and
produce motion b) An organ
that is essentially a mass of
muscle tissue attached at
either end to a fixed point and
that by contracting moves or
checks the movement of a
body part
Joint Stability
Basically, three factors account for the stability of a joint:
1. Muscles: such as the rotator cuff muscles of the glenohumeral
joint
2. Shape of articular surface: such as in ball socket construction of
the hip joint
3. Ligaments: such as the anterior cruciate ligament in the knee
area
a) Ligaments are tough and practically non-elastic
b) Ligaments hold bone to bone
c) Ligaments are generally found where more joint stability is
needed
d) Ligaments restrain undesirable motion, e.g., side-to-side motion
of knee
e) Ligaments will yield to continuous regular stretching: thus the
adage, “structure follows function.” This is why full squats and the
‘hurdler’s stretch’ are controversial
Ankle joint with muscles, lateral view
45
Muscles and Movement
CHAPTER 6
Roles in Which Muscles Respond
Muscles can do only two things: 1) develop tension
or 2) relax.
It is important to remember that muscles can function
individually or as a member of a team. While muscle
movement can be isolated, most of the time there
are several muscles involved to stabilize other areas
or assist in the movement.
Mover/Agonist: a muscle responsible for concentric
muscle actions. Mover/Agonist muscles are often
subclassified as prime movers or as assistant (or secondary) movers for a given action.
Prime Mover: a muscle primarily responsible for
eliciting a specific joint action.
Assistant Mover: a muscle or group of muscles that
aids the prime mover in effecting joint movement.
Antagonist: a muscle that produces an action that is
exactly the opposite of agonist. An example of this is
that the biceps brachii is an antagonist for the triceps brachii with respect to elbow extension, and
vice-versa with regard to elbow flexion.
Fixator/Stabilizer: a muscle that anchors, steadies,
or supports a bone or body part to enable another
muscle to have a firm base upon which to pull.
Neutralizer: a muscle that contracts in order to
counteract, “rule out,” or neutralize an undesired
action of another muscle acting upon that joint.
Synergist: a helper muscle.
Kinds of Muscular Contractions
In kinesiology, the term contraction/action refers to
the development of tension within a muscle. It does
not necessarily imply that any noticeable shortening
or movement occurs at the joint. There are three
different types of muscular contraction.
46
Static/Isometric Contraction: occurs when a
muscle does not develop enough tension to cause
movement to occur in a joint; thus, the length of
the muscle remains unchanged. Technically,
because the muscle remains at the same length, no
internal shortening of contractile components
occurs, thus muscle remains the same length, e.g.,
pushing hands together.
Concentric Contraction: occurs when a muscle
develops sufficient tension to overcome a resistance,
so that a muscle visibly shortens and joint movement occurs, e.g., bringing your hand to your face.
Bending/flexing at the elbow joint is an example of
a concentric contraction of the biceps brachii.
Eccentric Contraction: occurs when a resistance
overcomes the muscle tension so that the muscle
actually lengthens. We see this as weight training
when the athlete slowly lowers the weight to the
starting position: this is commonly called ‘negative.’
An example is when doing arm curls; you allow
biceps to relax slowly until you return to straightarm position. Remember you are not contracting
the triceps to extend your arm, but rather, slowly
releasing your biceps muscle.
Naming of Muscles
Muscles are named according to:
• Action: e.g., adductor longus
• Direction of fibers: e.g., transverse
abdominus
• Location: e.g., anterior tibialis
• Number of divisions comprising a muscle:
e.g., biceps, triceps
• Shape: e.g., trapezius, quadratus
• Point of attachment/origin and insertion:
e.g., sternocleidomastoid
Muscles and Movement
CHAPTER 6
8
9
5
6
5
4
3
10
2
1
9
11
7
12
14
16
13
15
1. Forearm Flexors
9. Serratus Anterior
2. Brachioradialis
10. Erector Spinae
3. Biceps
11. Abdominals
4. Triceps
12. Gluteals
5. Deltoids
13. Hamstrings
6. Pectorals
14. Quadriceps
7. Latissimus Dorsi
15. Gastrocnemius/Soleus
8. Trapezius
16. Iliopsoas
Figure 6-2 Major muscles and muscle groups of the body
Muscles and Movement
CHAPTER 6
EXERCISE THERAPY KINESIOLOGY
MUSCLES USED IN BREATHING
DIAPHRAGM
Origin:
Xiphoid process, costal cartilages of last six ribs and lumbar vertebrae
Insertion:
Central tendon
Nerve Innervation:
Phrenic nerve
Action:
Increases vertical length of thorax during inspiration
Exercise:
Breathing exercise to point where belly enlarges
INTERCOSTALS
Origin:
Insertion:
Nerve Innervation:
Action:
Exercise:
External: inferior border of rib
Internal: superior border of rib
External: superior border of rib
Internal: inferior border of rib
Intercostal nerve
External: elevate ribs during inspiration
Internal: assist in forced expiration
Deep forced-breathing inhalation and exhalation
MUSCLES OF THE NECK: ANTERIOR
STERNOCLEIDOMASTOID
Origin:
Sternum and clavicle
Insertion:
Mastoid process of temporal bone
Nerve Innervation:
Accessory nerve as well as C2 and C3
Action:
Contracting one muscle rotates face toward side opposite contracting muscle
Exercise:
‘Watching a tennis match’ exercise looking to the left, then to the right
48
Muscles and Movement
CHAPTER 6
MUSCLES OF THE CHEST: ANTERIOR
PECTORALIS MAJOR
Origin:
Clavicular and sternal head
Insertion:
Lateral surface of humerus at outer border of bicipital
groove
Nerve Innervation:
Anterior thoracic
Action:
Glenohumeral adduction, horizontal humeral adduction,
humeral internal rotation and humeral flexion
Exercise:
Cross-chest fly: horizontal adduction with pulleys and
bench press
MUSCLES THAT MOVE THE VERTEBRAL COLUMN: ANTERIOR
RECTUS ADBOMINIS
Origin:
Pubic crest and symphysis pubis
Insertion:
Cartilage of fifth to seventh ribs and xiphoid process
Nerve Innervation:
Branches of seventh through twelfth intercostal nerves
Action:
Flexes vertebral column
Exercise:
Bent-knee sit-ups, curl-ups
EXTERNAL OBLIQUES
Origin:
Lower eight ribs
Insertion:
Iliac crest, linea alba
Nerve Innervation:
Branches of eighth through twelfth intercostal nerves, iliohypogastic and ilioinguinal
nerve
Action:
Laterally flex vertebral column
Exercise:
Side bends, twisting sit-ups (right elbow to left knee, etc.)
49
Muscles and Movement
CHAPTER 6
SACROSPINALIS (ERECTOR SPINAE):
THIS MUSCLE GROUP CONSISTS OF THE FOLLOWING THREE INDIVIDUAL MUSCLES
MUSCLES THAT MOVE THE VERTEBRAL COLUMN: POSTERIOR REGION (1)
ILIOCOSTALIS LUMBORUM (lateral section)
Origin:
Iliac crest
Insertion:
Lower six ribs
Nerve Innervation:
Dorsal rami of thoracic nerve
Action:
Extends lumbar of spine, maintains erect posture
Exercise:
Hyperextension of back—in prone position, arches back.
NOTE: this could be contraindicated for some clients.
MUSCLES THAT MOVE THE VERTEBRAL COLUMN: POSTERIOR REGION (2)
LONGISSIMUS THORACIS (intermediate section)
Origin:
Transverse process of lumbar vertebrae
Insertion:
Transverse process of all thoracic and upper lumbar vertebrae and ninth and tenth ribs
Nerve Innervation:
Dorsal rami of spinal nerves
Action:
Extends thoracic portion of vertebral
Exercise:
See iliocostalis lumborum
MUSCLES THAT MOVE THE VERTEBRAL COLUMN: POSTERIOR REGION (3)
SPINALIS THORACIS (medial section)
Origin:
Spines of upper lumbar and lower thoracic vertebrae
Insertion:
Spines of upper thoracic vertebrae
Nerve Innervation:
Dorsal rami of spinal nerves
Action:
Internal flexion—extends vertebral column
Exercise:
See iliocostalis lumborum
50
Muscles and Movement
CHAPTER 6
MUSCLES OF THE SHOULDER GIRDLE: ANTERIOR
SERRATUS ANTERIOR
Origin:
Lateral portion of upper nine ribs
Insertion:
Anterior portion of vertebral border of scapula
Nerve Innervation:
Thoracic nerve
Action:
Scapula abduction and scapula rotation
Exercise:
Exercise for winged scapula
MUSCLES OF THE SHOULDER GIRDLE: POSTERIOR
TRAPEZIUS (large muscle that covers the upper parts of the back just beneath the skin)
Origin:
Occipital bone, spinous processes of 7th cervical, all thoracic vertebrae
Insertion:
Posterior portion of lateral aspect of clavicle, top of acromion process, upper border of
spine of scapula
Nerve Innervation:
Spinal accessory nerve as well as C3 and C4
Action:
Elevation of clavicle, upward rotation, adduction/retraction of scapula, elevation of
scapula or depression of scapula
Exercise:
Shoulder shrugs with barbells (elevation), raise shoulders up towards ears
RHOMBOIDS (lie beneath trapezius muscle: consists of major and minor)
Origin:
Insertion:
Major: spines of second to fifth vertebrae
Minor: spines of seventh cervical and first thoracic vertebrae
Major: vertebral border of scapula
Minor: superior angle of scapula
Nerve Innervation:
Dorsal scapular nerve
Action:
Adduction of scapula
Exercise:
Shoulder retraction: facing pulleys, grasp handles at shoulder height and towards
chest, pinching shoulder blades together
51
Muscles and Movement
CHAPTER 6
MUSCLES THAT MOVE THE ARM
DELTOID (Anterior portion)
Origin:
Anterior border of clavicle
Insertion:
Lateral aspect of humerus
Nerve Innervation:
Axillary
Action:
Glenohumeral flexion, horizontal adduction and internal rotation
Exercise:
Frontal raises with dumbbells or pulleys (glenohumeral flexion)
DELTOID (middle portion)
Origin:
Acromion process and outer end of clavicle
Insertion:
Lateral aspect of humerus
Nerve Innervation:
Axillary
Action:
Humeral abduction
Exercise:
Lateral raises with dumbbells (glenohumeral abduction)
DELTOID (Posterior portion)
Origin:
Lower margin of spine of scapula
Insertion:
Lateral aspect of humerus near mid-point
Nerve Innervation:
Axillary
Action:
Glenohumeral horizontal abduction, humeral extension and humeral external rotation
Exercise:
Shoulder retractions at pulleys
52
Muscles and Movement
CHAPTER 6
MUSCLES OF THE ROTATOR CUFF
SUBSCAPULARIS (protector of glenohumeral joint)
Origin:
Anterior surface of scapula
Insertion:
Lesser tuberosity of humerus
Nerve Innervation:
Subscapular nerve
Action:
Internal rotation
Exercise:
Internal rotation exercises—increasing strength of this muscle may prevent dislocations at
shoulder joint
SUPRASPINATUS (protector of glenohumeral joint)
Origin:
Supraspinous fossa of the Scapula
Insertion:
Superior facet of greater tubercle of the humerus
Nerve Innervation:
Suprascapular nerve
Action:
Shoulder abduction and stabilization
Exercise:
Lateral raises
INFRASPINATUS & TERES MINOR (These two muscles are protectors of the glenohumeral joint.
They both share a common origin and insertion.)
Origin:
Axillary border and inferior border of scapula spine
Insertion:
Greater tuberosity of humerus
Nerve Innervation:
Suprascapular and axillary nerve
Action:
Outward rotation and horizontal extension
Exercise:
Facing pulley machine, grasp handles (upper) and pull straight back, keeping arms parallel
with floor or external rotation exercise
53
Muscles and Movement
CHAPTER 6
ARM MUSCLES THAT MOVE THE ELBOW: ANTERIOR
BICEPS BRACHII (has two heads)
Origin:
Long head: upper portion of glenoid fossa
Short head: coracoid process of scapula
Insertion:
Tuberosity of radius
Nerve Innervation:
Musculocutaneous nerve
Action:
Elbow flexion and forearm supination
Exercise:
Arm curls with weights and dumbbell supination exercise
BRACHIALIS
Origin:
Anterior surface of lower portion of humerus
Insertion:
Tuberosity of ulna below coracoid process
Nerve Innervation:
Musculocutaneous, radial and medial nerve
Action:
Elbow flexion
Exercise:
Arm curls and weights and bringing palm towards shoulder with weights
BRACHIORADIALIS (large muscle of forearm)
Origin:
Upper section of lateral supracondyloid ridge of humerus
Insertion:
Styloid process of the radius
Nerve Innervation:
Radial Nerve (C5, C6)
Action:
Elbow flexion
Exercise:
Reverse curls, curls done with hands in pronated position on curling bar
TRICEPS (so-named because it has three heads)
Long head: infraglenoid tuberosity
Origin:
Lateral head: posterior and lateral surface of upper half of humerus
Medial head: posterior surface of lower two-thirds of humerus
Insertion:
Olecranon process of ulna
Nerve Innervation:
Radial nerve
Action:
Elbow extension
Exercise:
Triceps extension—can be done with dumbbell or lateral bar. The key to this exercise is to
extend the lower arm against a resistance slowly and completely.
Muscles and Movement
CHAPTER 6
MUSCLES OF THE UPPER LEG: ANTERIOR
ILIOPSOAS (made up of the psoas and iliac muscles)
Origin:
Transverse processes and lumbar bodies of lumbar vertebrae
Insertion:
Lesser trochanter of femur
Nerve Innervation:
L2 and L3
Action:
Flexes and rotates thigh laterally, flexes vertebral column
Exercise:
Straight-leg sit-ups
SARTORIUS
Origin:
Anterior superior spine of ilium
Insertion:
Medial surface of tibia
Nerve Innervation:
Femoral nerve
Action:
Flexion of the knee, and flexion and lateral rotation the hip
Exercise:
Flexes leg; flexes thigh and rotates it laterally, thus crossing-leg position
QUADRICEPS (comprises four muscles)
1. RECTUS FEMORIS
Origin:
Anterior portion of inferior iliac spine
2. VASTUS LATERALIS
Origin:
Superior portion of intertrochanteric line. Lateral aspect of linea aspera
3. VASTUS MEDIALIS
Origin:
Inferior portion of intertrochanteric line. Medial aspect of linea aspera
4. VASTUS INTERMEDIUS
Origin:
Anterior and lateral aspects of upper portion of femur
Insertion:
Tendon of each muscle unites to form the quadriceps, attaching to the patella and tibial
tuberosity by way of patella ligament
Nerve Innervation:
Femoral
Action:
Extension of lower leg
Exercise:
Leg extension
55
Muscles and Movement
CHAPTER 6
MUSCLES OF THE LOWER LEG: ANTERIOR
TIBIALIS ANTERIOR (The muscle that runs along the shin, felt when the foot is dorsiflexed)
Origin:
Lateral condyle and upper portion of lateral surface of the tibia
Insertion:
Plantar surface of first metatarsal and medial surface of first cuneiform
Nerve Innervation:
Deep peroneal
Action:
Ankle dorsiflexion and foot inversion
Exercise:
With foot resting off table edge, and weight on top of foot, point toe to head
MUSCLES OF THE UPPER LEG (HAMSTRING):POSTERIOR
BICEPS FEMORIS
Origin:
Long head: arises from ischial tuberosity
Short head: arises from linea aspera of femur
Insertion:
Head of fibula and lateral condyle of tibia
Nerve Innervation:
Tibial nerve from sciatic nerve
Action:
Flexes lower leg and extends thigh
Exercise:
Leg curls; student brings the heel towards buttocks
SEMIMEMBRANOSUS
Origin:
Ischial tuberosity
Insertion:
Medial condyle of tibia
Nerve Innervation:
See Biceps Femoris
Action:
See Biceps Femoris
Exercise:
See Biceps Femoris
SEMITENDINOSUS
Origin:
Ischial tuberosity
Insertion:
Proximal aspect of medial surface of body of tibia
Nerve Innervation:
See Biceps Femoris
Action:
See Biceps Femoris
Exercise:
See Biceps Femoris
Muscles and Movement
CHAPTER 6
ABDUCTION/ADDUCTION MUSCLES OF THE UPPER LEG: (HIP AND THIGH)
ADDUCTOR BREVIS (brevis = short)
Origin:
Inferior ramus of pubis
Insertion:
Linea aspera of femur
Nerve Innervation:
Obturator nerve
Action:
Adducts, rotates, and flexes thigh
Exercise:
Adduction exercise at pulleys; move leg toward midline of body, or in side-lying position, raise lower leg up
ADDUCTOR LONGUS (longus = long)
Origin:
Pubic crest and symphysis pubis
Insertion:
Linea aspera of femur
Nerve Innervation:
Obturator nerve
Action:
Adducts, rotates, and flexes thigh
Exercise:
See Adductor Brevis
ADDUCTOR MAGNUS (magnus = large)
Origin:
Inferior ramus of pubis, ischium to ischial tuberosity
Insertion:
Linea aspera of femur
Nerve Innervation:
Obturator nerve
Action:
Adducts, flexes, and extends thigh (anterior part flexes, posterior part extends)
Exercise:
See Adductor Brevis
GRACILIS
Origin:
Symphysis pubis and pubic arch
Insertion:
Medial surface of tibia
Nerve Innervation:
Obturator nerve
Action:
Adducts and flexes leg
Exercise:
Adduction exercise with pulleys attached at ankle and bring leg toward
midline of body
57
Muscles and Movement
CHAPTER 6
TENSOR FASCIA LATAE (tensor = to make tense; Fascia = band; Latus = wide)
Origin:
Iliac crest
Insertion:
Tibia by way of the iliotibial tract
Nerve Innervation:
Superior gluteal nerve
Action:
Flexes leg
Exercise:
Abduction while attached to pulley machine; move leg away from midline of body, or in
side-lying position, raise top leg up
GLUTEUS MAXIMUS
Origin:
Iliac crest, sacrum, coccyx and aponeurosis of sacrospinalis
Insertion:
Iliotibial tract of fascia lata and gluteal tuberosity of femur
Nerve Innervation:
Inferior gluteal nerve
Action:
Extends and rotates hip laterally
Exercise:
In prone position, elevate leg; or, while facing pulley machine; move whole leg straight
backwards
ILIACUS
Origin:
Iliac fossa
Insertion:
Tendon of psoas major
Nerve Innervation:
Femoral nerve
Action:
Flexes and rotates thigh laterally; slight flexion of vertebral column
Exercise:
Leg turns, moving leg laterally
58
Muscles and Movement
CHAPTER 6
HOW MUSCLES WORK TOGETHER
PRIME
MOVERS
Rhomboids
Levator Scapula
Pectoralis Minor
Trapezius
Pectoralis Minor
Rhomboids
Latissimus Dorsi
Anterior
Deltoid
PRIME
MOVERS
DOWNWARD ROTATION
(C - 3 TO T - 1)
Serratus Anterior
EXTENSION
(C - 5 TO T - 1) (C - 5 TO T - 1)
Latissimus
Dorsi
INTERNAL
ROTATION
(C - 5 TO T - 1)
Levator Scapula
EXTERNAL
ROTATION
(C - 4 TO C - 6)
ABDUCTION
(C - 5 TO T - 1)
Subscapularis Infraspinatus Middle
Teres Major
Teres Minor Deltoid
Pectoralis Teres Major
Minor
HORIZONTAL
ADDUCTION
(C - 4 TO C - 8) (C - 5 TO T - 1)
HORIZONTAL
ADDUCTION
ABDUCTION
(C - 5 TO T - 1)
Pectoralis
Minor
Supraspinatus Latissimus
Dorsi
Teres Major
Anterior
Deltoid
Middle
Deltoid
Pectoralis
Major
Posterior
Deltoid
Pectoralis
Minor
Infraspinatus
Teres Minor
Coracobrachialis
Biceps
ASSISTANT
MOVERS
GLENOHUMERAL JOINT (SHOULDER)
UPWARD ROTATION
(C - 2 TO C - 8)
Trapezius IV
FLEXION
Coracobrachialis
Triceps
Brachii
Anterior
Deltoid
Posterior
Deltoid
Pectoralis
Minor
PRIME
MOVERS
Biceps Brachii
ASSISTANT
MOVERS
Posterior
Deltoid
Anterior
Deltoid
Triceps
Brachii
Biceps Brachii
FLEXION (C - 5 TO T - 1)
ELBOW JOINT
DEPRESSION
(C - 4 TO T -1)
Trapezius I&II
ASSISTANT
MOVERS
SCAPULA
ELEVATION
(C - 1 TO T - 1)
EXTENSION (C - 6 TO T - 1)
Biceps
Brachii
(short head)
Biceps
Brachii
Latissimus
Dorsi
Teres Major
Triceps
Brachii
(short head)
PRONATION (C - 6 TO T - 1)
SUPINATION (C - 5 TO T - 1)
Triceps Brachii
Pronator Quadratus
Supinator
Flexor Carpi
Anoconeus
Flexor Carpi Radialis
Extensor Carpi Radialis Longus
Flexor Carpi Ulnaris
Extensor Carpi Radialis
Pronator Teres
Extensor Pollicis Longus
Brachialis
Brachioradialis
Flexor Carpi Radialis
Extensor Radialis Brevis
Adductor Pollicis Longus
Extensor Carpi Ulnaris
Biceps Brachii
59
Muscles and Movement
PRIME
MOVERS
FLEXION (C - 7 TO T - 1)
EXTENSION (C - 6 TO C - 7)
Flexor Carpi Radialis
Extensor Carpi Radialis Longus
Flexor Carpi Ulnaris
Extensor Carpi Radialis Brevis
Extensor Carpi Ulnaris
Palmaris Longus
ASSISTANT
MOVERS
RADIOCARPAL JOINT (WRIST)
CHAPTER 6
Extensor Digitorum
Flexor Digitorum Profundus
Flexor Digitorum Superficialis
Extensor Indicis
Extensor Digii Minimi
PRIME
MOVERS
INSPIRATION
(FORCED)
Diaphragm
Diaphragm
Transverse Adbominis
External Intercostals
External Intercostals
Rectus Abdominis
Internal Intercostals
Internal Intercostals
External Obliques
Erector Spine
PRIME
MOVERS
ASSISTANT
MOVERS
TRUNK
External Intercostals
Internal Intercostals
Quadratus Lumborum
Muscles of the Neck and Shoulder
SPINAL FLEXION (T - 5 TO T - 12)
60
EXPIRATION
(FORCED)
Internal Obliques
ASSISTANT
MOVERS
UPPER TORSO
INSPIRATION
(RESTING)
SPINAL EXTENSION
Rectus Abdominis
Sacrospinalis (Erector Spinae)
Tranverse Abdominis
Extensor Digitorum
External/Internal Obliques
Muscles and Movement
CHAPTER 6
FLEXION
(L- 1 TO S - 3)
PRIME
MOVERS
Rectus Femoris
Gluteus
Maximus
Pectineus
Biceps Femoris
Gluteus
Maximus
ABDUCTION
(L - 4 TO S - 1)
ADDUCTION
(I - 1 TO S - 4)
Gluteus Medius Pectineus
Gracilis
Adductor
Longus
Adductor Brevis
Tensor Fascia
Latae
Gluteus Medius
PRIME
MOVERS
Sartorius
Iliopsoas
Sartorius
Adductor
Longus
Iliopsoas
Semitendinosus Biceps Femoris
SemimemSix essential
branosus
rotators also
Adductor
Magnus
Muscles listed assist
under adduction
Gluteus
Minimus
Gracilis
Gluteus
Minimus
Tensor Fasciae
Latae
EXTENSION
(L - 2 TO L - 4)
Rectus Femoris
Tensor Fasciae
Latae
INTERNAL ROTATION
(L - 2 TO S - 5)
Semitendinosus
Rectus Femoris
Semitendinosus
Semimembranosus
Vastus Lateralis
Semimembranosus
Biceps Femoris
Vastus Intermedius
Sartorius
EXTERNAL ROTATION
(L - 5 TO S - 3)
ASSISTANT
MOVERS
Vastus Medialis
Sartorius
Gracilis
Gracilis
Adductor Longus
Gastrocnemius
Adductor Magnus
PRIME
MOVERS
Biceps Femoris
Plantaris
DORSIFLEXION
(I - 4 TO S - 1)
PLANTAR FLEXION
(T - 5 TO T - 2)
INVERSION
(L - 4 TO L - 5)
EVERSION
(L - 4 TO S - 1)
Tibalis Anterior
Gastrocnemius
Tibialis Anterior
Extensor Digitorum Longus
Extensor Digitorum
Longus
Soleus
Tibialis Posterior
Peroneus Tertius
Peroneus Longus
Peroneus Brevis
ASSISTANT
MOVERS
HIP JOINT (GROUP 2)
Gluteus
Minimus
EXTERNAL
ROTATION
(L - 1 TO S - 3)
Semitendinosus
FLEXION
(I - 2 TO S - 3)
TALOCRURAL JOINT (ANKLE)
INTERNAL
ROTATION
(L - 4 TO S - 2)
Adductor
Magnus
ASSISTANT
MOVERS
HIP JOINT (GROUP 1)
Iliopsoas
EXTENSION
(L - 4 TO S - 3)
Peroneus Tertius
Plantaris
Flexor Digitorum Longus
Extensor Hallucis
Longus
Peroneus Longus
Flexor Hallucis Longus
Flexor Digitorum Longus Extensor Hallucis
Longus
Flexor Hallucis Longus
Tibalis Posterior
61
C h a p t e r
7
CONTRAINDICATED EXERCISES
To p i c s c o v e r e d i n t h i s c h a p t e r
DOING IT RIGHT
FACTS AND MYTHS ABOUT EXERCISE
RISK
VS.
BENEFITS
Neck
Low-Back
Shoulder
Knee
Area
Area
Area
Area
BEYOND THE CORE
EXERCISES TO AVOID
EXERCISE THERAPY EXERCISE CONSIDERATIONS
Contraindicated Exercises
CHAPTER 7
DOING IT RIGHT
This chapter identifies facts and myths about fitness
and answers those questions that are most frequently asked. You are welcome to copy it and share
it with your clients.
One purpose of this chapter is to provide a rationale
for why some popular exercises fail the ”benefit-torisk” index. When they do fail the test, appropriate
alternate exercises are provided.
FACTS AND MYTHS
ABOUT EXERCISE
Everyone knows that physical activity & exercise is
good for the human body. Unfortunately, in our zest
to get fit we often hurt ourselves because we are
using outdated principles or being convinced by
some faulty assumptions. Just as the computer
industry has evolved over the past 20 years so has
the fitness industry.
Some exercises have been around so long that it
seems irreverent to question their efficacy. Successful coaches who have produced winning teams
have passed down some faulty myths. Often
training methods get adopted and later institutionalized based on antidotal information rather than
science. And even what is scientifically acceptable
today may change. Good sense suggests that even
proper exercise if done incorrectly can be injurious
to your health or your client’s health. Most of the
myths that we are going to discuss will not kill you
today or even really hurt you if done once or twice.
The problem is cumulative! Complications manifest
over time. Our bodies are very resilient but if persistently misused and abused, the deleterious effects
of improper exercise will show up in later years!
What you teach stays with your clients. If you make
the wrong recommendations now, your clients will
pay for it in years to come.
Many of us have grown up with faulty assumptions
about exercise that leaves us open to being vulner-
able to celebrity endorsement and glitzy info-mercials. Most info-mercials have just enough truth and
facts in them to make them seem plausible. Couple
that with your favorite celebrity telling us how good
it is or looking at airbrushed models it is no wonder
that we fall for these get fit quick gimmicks.
One expert stated that at least 90% of exercise programs include some exercises that are as detrimental as they are valuable. The key when
determining if an exercise is correct is: does it pass
the Benefits to Risk ratio!
The question to ask yourself is: is this exercise doing
me more harm than good and is their a safer more
effective way to get the desired results. The one that
comes to mind is the traditional sit-up vs. curl ups
or full squats.
When you design a fitness routine ask yourself or
your teacher the following questions:
•
Why am I doing this exercise?
•
What is the benefit of this exercise?
•
What are the risks of this exercise?
•
How do I feel while doing this exercise?
•
How do I feel when I am done with this
exercise?
•
Could I receive the same benefits doing
a safer exercise?
If an exercise fails the above criteria look for
another exercise!
An important concept to keep in mind is not to
become complacent about your exercise. It is critical
to be mindful of proper body mechanics when
doing your work-out and associate with your body
while working out. That means pay attention to
what you are doing!! Remember that only perfect
practice makes perfect!! Think PP, which means Perfect Posture!!
My goal today is to educate you to know how to
63
Contraindicated Exercises
CHAPTER 7
Exercise Smart NOT hard!! Any exercise that has
made it into your routine should give you maximum
return on investment!!
Whenever, you select an activity, exercise, or piece of
equipment keep in mind the following:
Safety – is it safe?
Targeted muscle: does it work targeted muscle?
Benefit vs. risk: benefits should outweigh risk.
Biomechanics: is it biomechanically correct?
Selection of exercise: does it fall in line with
other exercises?
Kinesthetic feedback: how does it feel?
Harm vs. hurt: is it harming a joint?
Time: does it take too much time to do?
Compatibility with exercise program goal.
RISK VS. BENEFITS
High-risk areas include the knees, shoulders, neck,
low back, hips, and ankles. Pay close attention when
implementing exercises that involve these areas.
Neck Area
Neck problems can occur in an exercise environment when the activities performed cause excessive
hyperextension. Doing fast warm-up motions
should be eliminated. Neck movements should not
be combined, i.e., avoid full-neck circles. Half-neck
circles, side-to-side, and front-to-back are okay,
however. Always remember good body mechanics.
Low-Back Area
The majority of adults will experience back pain at
some time in their life. It is critical that the back be
protected when exercising and that the low back be
stabilized. Never include any exercise that involves
forward flexion and rotations at the same time; for
example, windmill toe-touches. Any exercise that
creates hyperextension of the low-back area (bend-
64
ing back at the waist) should be eliminated, e.g.,
raising both hands above the head. Caution should
also be used when doing any movements that
cause lateral flexion of the spine, e.g., side bends.
Some exercisers injure their backs when they do
lateral leg raises because they lean too much at the
waist. The leg should only be raised 45 to 50
degrees, toes should point forward, and the trunk
should not move.
Shoulder Area
Shoulder impingement is increasingly becoming a
concern for exercisers. Caution should be exercised
in bringing the arms above the head. Movements
need to be controlled and the hands should be
supinated (palms up) if raising arms above shoulder
height. Using hand weights with arms fully extended can aggravate shoulder problems and may cause
elbow problems as well. Shoulders should be relaxed
when performing arm exercises (there is a tendency
to pull the shoulders up near the ears when exercising the arms). Also, encourage your client to keep
shoulder blades retracted as well.
Contraindicated Exercises
CHAPTER 7
Knee Area
The action of the knee is to flex and extend. Movements that hyperextend or rotate the tibia should be
eliminated. It is a good idea to keep “soft knees”
when doing a workout. In addition, you should
avoid twisting the body with the feet planted: only
include exercises that keep knees over the feet. In
addition, the knees and toes should always point in
the same direction.
When performing an exercise using the quadriceps,
remember that force, rather than speed, is better.
Another precaution is to avoid over-flexion of the
knee joint when doing quadriceps stretches; i.e.,
bringing the heel towards the buttocks.
BEYOND THE CORE
Today the focus is on Functional Fitness
By now the average fitness aficionado knows about
‘core stability’ or ‘core strength’ exercises. The fitness
industry has made great strides at making the general public aware of the importance of ‘core stabilization’. Much of the roots of core stabilization had
its roots in back stabilization and back rehab. Today
manufacturers of fitness equipment have core exercise products you can use at home or at the gym to
foster stabilization. Any trainer or exercise
instructor with at least minimal training mentions
stabilization during the exercise session.
The emphasis on developing stability and strength
in the abdominal and back muscles has over shadowed the importance of peripheral stability. Core
strength is important for a myriad of reasons from
sports training to rehab. As the core strength
increases this often equates to increased stability of
the trunk and better back health. However, core stability cannot replace the need for Peripheral stability. While attention to core stabilization and
training assures safer and better lifting techniques. It
is often seen in the gym or even in the pool doing
water exercise while focusing on the core and forgetting about the placement of their shoulders,
wrists and knees. It is to common to see students
focusing on their mid-section core while their
wrists and shoulders are far from being in the best
biomechanical position setting themselves up for
potential orthopedic problems whether now or
sometime later in life.
As the age of the general population increases the
incidence of orthopedic injuries become very
common. Joint injuries of the shoulder, elbow,
wrist or knee often incapacitate or limit normal
daily function in athletes and the general population alike. Stability training must go beyond core
stabilization to provide total body joint stabilization. This section will address the important joints
such as, the ankle, the knee and the shoulder and
wrist. The key to successful training is to direct the
client attention to the major areas of the body as
well as the lesser but still important aspects of the
human frame!
The ankle is fundamental to athletics as well as
being a major player of ambulating and is the
mainstay of such a simple task of basic standing.
Stability training of the ankle includes proprioceptive training as well as strength training. Simple
exercises such as toe raises and walking on the heels
are some basic active exercises that can foster ankle
joint function. For the more limited client adding
ROM moves that include inversion, eversion and
flexion and extension are often a good starting
point. As the client progresses add exercises that
will improve strength, PNF and proprioception of
the ankles. Wobble board exercises including
seesaw, pivot and balance can be added to these
exercises. Proprioceptive training can improve
dynamic balance. Some of the research in this area
has shown that this type of training might prevent
injuries and has been shown to decrease falls in the
older adult population.
65
Contraindicated Exercises
CHAPTER 7
The knee is a remarkable joint it is by all accounts
an engineering marvel. As more women take up
sports we are seeing more and more women come
to our classes with complaints about their knee.
Female knee injuries have surged, reaching almost
1.4 million a year. By the late 1990s, the rate of
injuries had doubled from a decade earlier. Some
experts in the field of orthopedics maintain that the
reason why some women have knee injuries is
because of the increased “Q” angle. These experts
suggest that the greater the angle from the hip to the
knee the greater the risk for the female runner/athlete to develop knee problems. Men still rack up
more knee injuries than females each year, this
could be because fewer women play sports or work
out. Knee stability exercises can be done easily and
without expensive equipment.
Many exercise specialists recommend closed
kinetic chain exercises to improve knee stability.
Terminal extension of the leg is often a recommended closed kinetic chain exercise that engages
the VMO. When the VMO increases muscle density and strength it can add to the stability of the
66
knee joint. Weakness in the area of the VMO
increases instability of the knee. This exercise can
be performed by standing on one leg and bending
the knee slightly, from 15 to 20 degrees. To
enhance the effect stand on a foam block with the
body weight shifted forward onto the ball of the
foot as you bend the knee. The foam block activity
has the added benefit of increasing ankle proprioception. Always spot the client to prevent a fall.
The shoulder joint is an amazing joint, because it
allows a person to gently rock a little baby to in
some cases allowing a pitcher to throw a 90 mph
fastball. The number of injuries to the shoulder
joint warrants special consideration in training.
Shoulder stability is often overlooked until the time
comes when an injury sidelines the individual. If
you can position the scapula in the right place and
control its movement during both static and
dynamic activity, the position of the glenoid, the
acromion process and the other entire joint structures are optimized. Hence there is less risk of
impingement and safer shoulder exercises. Performing rowing exercises such as the low pull with
emphasis on scapular retraction increase stability in
Contraindicated Exercises
CHAPTER 7
the scapula platform and shoulder joints. The
scapular muscles provide the positioning for inferior stability of the glenoid labrum for a snug fitting
humeral head. The rotator cuff muscles provide
glenohumeral stability. Rotator cuff abduction and
adduction exercises should be an integral part of
stability beyond the core. These smaller muscles are
often overlooked creating an imbalance with the
more developed deltoid muscles. Many common
exercises that are performed over the head increase
the risk of shoulder injury. Even a simple move such
as a lateral raise above 90˚ can compromise the
integrity of the shoulder joint.
Often when watching someone workout at the
gym or even doing water exercise using aqua-bells
the position of the wrist joint is less than ideal. We
as fitness professionals must advise, educate and
correct improper body mechanics. Just as the
physician oath states “do no harm” so it should be
with us. While these poor body mechanics will not
cause immediate harm, the long-term chronic
misuse can lead to chronic problems later in life. It
is our duty as body pros to inform our client of
the most effective way to use their bodies. As Dr.
Bortz said, in his book, “We live too short and die
too long”, many of the chronic conditions seen in
later life can be traced back to mis-use, dis-use
and abuse of our body. Thus, it becomes incumbent upon us to stay tuned to our client’s form
and make those minor adjustments when needed.
A good teacher is always selectively supervising
their client. If we can teach our students to listen
to their bodies and heed what it says then maybe
we can prevent further problems later on.
Recently, I had one client doing a simple closed
kinetic chain exercise for their knee who was complaining of pain. With just a simple adjustment of
placement of her knee she was able to perform the
movement in a pain free manner. Teach your
client to be aware that pain is the body’s signal
that something is not right. Overmedicating is
only masking the underlying problem.
67
Contraindicated Exercises
CHAPTER 7
EXERCISES TO AVOID
The purpose of this section is to present the reasons
why certain popular exercises and techniques are
contraindicated for many individuals. Where
appropriate, an adaptive exercise will be provided.
Furthermore, returning to the upright position puts
a strain on the back muscles. (Proper body
mechanics instructs us to use leg muscles rather
than back muscles).
1. Head Circles or Head-Rolling Exercises
Adaptation: While sitting on the floor or in a chair,
extend one, or both, legs out in front of the body.
Keeping back straight and knees slightly bent, slowly
bend forward at the waist and reach towards toes.
AVOID BECAUSE: May strain supporting ligaments, which maintain stability in the cervical spine
(neck area). These exercises can aggravate impingement of the nerves. Neck extensions can also put
pressure on the anterior arteries (carotid) of the
neck, which can cause high blood pressure and
compromise blood flow to the brain. Combined
with degenerative changes that occur with aging
(osteoporosis, for example), the individual is more
susceptible to injury, especially if posture is poor.
Standing Toe Touches
Adaptation: Slowly turn the head from left to right
or lean the head from side-to-side.
Emphasize proper alignment of head, neck, and
shoulders.
Head Circles
3. Bouncing During Warm-Up or Stretching Exercises
AVOID BECAUSE: Bouncing, or stretching ballistically, does not increase flexibility but actually
causes the stretched muscle to contract and
shorten, which may induce strain or micro-tears of
the muscle fibers.
2. Standing Toe Touches
AVOID BECAUSE: May hyperextend the joint capsule and stretch ligaments of the knee. In addition, cause excessive pressure on the intervertebral
disc in the lower back, which may strain the softtissue structures. Lastly, rounding of the upper
back is discouraged.
68
Adaptation: Slowly stretch to a point of mild discomfort and hold this position for 10 to 30 seconds.
Studies on the hamstring muscle show that 20 seconds is optimal.
4. Sit-ups with Straight Legs and Hands Behind
the Head
AVOID BECAUSE: Straight-leg sit-ups do not isolate the abdominal muscles and tend to primarily
work the hip flexor. (They do utilize the abdominal
muscles, but they are not a good choice for the reasons mentioned). This technique encourages a
Contraindicated Exercises
CHAPTER 7
hyperextended posture of the low back (lordosis)
and causes unnecessary strain to this area. Holding
hands behind the head may contribute to forward
head and kyphosis, as well as cause excessive pressure on the cervical area. In addition, holding one’s
feet during a sit-up is similar to doing straight-leg
sit-ups; the abdominal muscles are not the prime
movers, but the hip flexors are.
Adaptation: Lie flat on the floor, bend both knees,
and bring heels as close as possible to the buttocks.
Cross both arms across the chest and slowly tuck
chin to chest and lift shoulders off the floor. It is
unnecessary to go up further than halfway.
5. Full Squats or Deep Knee Bends
AVOID BECAUSE: Full squats cause excessive
stretching of the ligaments of the knee and may
pinch the joint cartilage. Once the ligaments of the
knee have been stretched, they cause instability to
the knee joint.
7. Hurdlers’ Stretch
AVOID BECAUSE: With the leg in this bent position, the knee ligaments are stretched excessively,
risking unnecessary damage.
Adaptation: Place both legs in front of body and
stretch forward at the waist, keeping back straight;
or bend one leg and place bottom of foot on inside
of thigh and reach towards toes.
8. Trunk Twist
AVOID BECAUSE: When standing, any twisting
strains the lumbar area and possibly the knee.
Torque generated by the twisting action in the
trunk causes considerable strain to the knee and
the lower back.
Trunk Twist
Adaptation: When squatting, do not go beyond a
point in which thighs are parallel to the floor.
PLEASE REMEMBER: STRUCTURE FOLLOWS
FUNCTION.
6. Double Leg Lifts
AVOID BECAUSE: Like straight-leg sit-ups, double
leg lifts work the abdominal muscles and hip flexors
and are very difficult to do correctly. They
encourage a hyperextended posture and create
excessive pressure in the lumbar area. There are
much safer, better alternatives.
Adaptation: To increase abdominal strength, perform sit-ups or curl-ups with both knees bent, feet
flat on the floor, arms across chest, and bring heels
as close to the buttocks as possible.
Double Leg Lifts
Adaptation: Lean left and right in a sitting position.
9. Isometric Exercises
AVOID BECAUSE: Contraindicated for those individuals over 40 years old or those individuals with a
history of cardiovascular disease, especially high
blood pressure. Isometric arm exercises increase
blood pressure.
Adaptation: To minimize the risk of unnecessary
high blood pressure, exercise with a comfortable
weight, breathe properly, and perform the exercise
through the entire range of motion possible for
the joint.
69
Contraindicated Exercises
CHAPTER 7
10. Active Hyperextension of the Back
AVOID BECAUSE: This motion decreases compression of the intervertebral discs and is used for disc
patients, but it increases irritation of the facet joints.
Adaptation: For active strengthening, lie face down,
with a pillow under the hips to prevent lumbar lordosis, and a towel roll under the forehead to prevent
neck strain. Stretch arms overhead and lift one arm
and the opposite leg and hold.
When to Seek Medical Assistance
(Call 911)
Anytime you feel it necessary, use common sense.
If your client experiences any of the following:
•
Chest pain (crushing feeling under
breast bone that radiates up to neck or
down left arm)
• Lengthy period of abnormal heart beats
(too fast, too slow, skips, fluttering, etc.)
•
Difficulty breathing (severe wheezing,
feeling that they “can’t get enough air,”
shortness of breath)
•
Feeling faint (syncope), especially in
conjunction with any of the other above
symptoms
Prone Trunk Raise
General Considerations
EXERCISE DOS AND DON’TS
(FOR YOU AND YOUR CLIENTS)
11. Immediate Rest After Intense Exercise
•
DO carry identification when exercising
AVOID BECAUSE: Prevents adequate return of
blood to the heart.
•
DO invest in good shoes and socks: your
feet and knees are worth it! DON’T exercise in rubberized or plastic clothing
•
DO listen to your body, if it hurts, STOP!
Consult your physician for unusual or
continuous pain
•
DON’T bounce when stretching, and stop
a stretch if it hurts
•
DO check your heart rate before, during,
and after exercise
•
DON’T squeeze a week’s worth of exercise into one day. DO spread exercise
sessions evenly throughout the week.
Make sure you alternate “hard” and
“easy” days
•
DON’T overestimate your body’s capacity
to exercise. However, DON’T underestimate it either. Remember, your body is
designed for movement, but DO let it
adapt slowly and gradually
•
DON’T hold your breath during exercise.
Adaptation: Continue with low-intensity exercise,
such as walking, to encourage proper return of
blood to the heart, preventing any blood-pooling
effect that may occur in the lower extremities.
70
Contraindicated
Exercises
Contraindicated
Exercises
CHAPTER 7
EXERCISE THERAPY EXERCISE CONSIDERATIONS
BIOMECHANICAL CONSIDERATIONS:
Do not tilt the head to the back (looking towards the ceiling)
Avoid positions in which the torso is bent forward with the legs extended, such as toe touches
Gently stretch without “bouncing”
Do not overextend or “lock out” any joints
Do not force or pull hard on any joint or part of the body
Keep your knees in line with your feet. Do not let the knees go forward beyond the toes
Avoid having weight on the legs if your knee angle (from the thigh to the lower leg) is less than 90 degrees
Avoid or use caution with trunk rotation and bending
Keep movements controlled and maintain good posture
VASCULAR CONSIDERATIONS:
Keep the head above heart level until you are cooled down
Move slowly between positions of lying down, sitting, or standing
Remember to perform a gentle, thorough warm-up (5 to 15 minutes) and cool-down (5 to 15 minutes)
Do not perform isometric exercise, in which you apply force without moving the muscles (e.g., pushing against a wall)
Stay well hydrated by drinking plenty of water before, during, and after exercise
SAFETY CONSIDERATIONS:
Body Part
Too Little Exercise
Too Much Exercise
See your doctor
Heart
Heart rate is below target range
Heart rate is above target range
Pain, tightness or heaviness in
chest, abnormal heart beats
(skips, fluttering etc.)
Lungs
Little increase in frequency/depth Panting, gasping for breath: can’t Painful breathing during exercise
of breathing
carry on conversation easily.
or for several days after exercise
Breathless over 10 min. after
exercising
Muscles/
Joints
Feeling that muscles aren’t work- Stiff and/or sore for days after
ing or slightly fatigued
exercise. Pain in body parts
• Stitch in side • Shin splints
• Muscle cramps • Joint Pain
General
You don’t break a sweat or you
Fatigue lasting over a day.
Dizziness, lightheadedness, contake frequent breaks during exer- Nausea, vomiting during or short- fusion, lack of coordination, cold
cise
ly after exercise
sweats
Severe muscle, joint or bone pain.
Pain and swelling that lasts more
than a few days
(CHART COURTESY OF DIANNE CHRISTOPHERSON, PHD, RN)
71
Contraindicated Exercises
CHAPTER 7
•
DON’T go directly into a sauna, hot
whirlpool (Jacuzzi), or steam bath after
exercising
•
DON’T use perspiration (sweating) as an
indication of how good (or bad) your
workout is: we all perspire at different
rates and in different amounts
•
DO drink plenty of water before, during,
and after each exercise session
72
•
DO consider solitary versus social aspects
of your chosen program
•
DO consider using music when exercising: it can be a great motivator. However: be careful using headphones when
exercising outdoors; you need to be able
to hear as well as see oncoming traffic,
pedestrians, bicyclists, etc
PA RT
OVERVIEW OF
CHRONIC CONDITIONS
Exercise is for Everyone
Common Health Problems
Seen Among Older Adults
Thoughts to Share with Clients
CARDIORESPIRATORY
CONDITIONS
2
High Blood Pressure
Low Blood Pressure
Heart Disease
Chronic Obstructive Pulmonary Disease
Asthma
METABOLIC CONDITIONS
Diabetes
Obesity
NEUROLOGICAL CONDITIONS
Acquired Brain Injury
Cerebral Vascular Accident or Stroke
Epilepsy
Peripheral Vascular Disease
Spinal Cord Injury
Learning Disabilities
Multiple Sclerosis
Parkinson’s Disease
ORTHOPEDIC CONDITIONS
Arthritis
Fibromyalgia Syndrome
Neck, Low-Back, Shoulder, Hip,
Knee, and Ankle Problems
Osteoporosis
Amputations
SENSORY IMPAIRMENT
Auditory Disorders
Visual Impairments
OTHER CONDITIONS
HIV/AIDS
Cancer
Pregnancy
Exercise Therapy
for Chronic Conditions
C h a p t e r
8
OVERVIEW OF CHRONIC
CONDITIONS
To p i c s c o v e r e d i n t h i s c h a p t e r
EXERCISE IS FOR EVERYONE
COMMON PHYSICAL HEALTH PROBLEMS
SEEN AMONG OLDER ADULTS
THOUGHTS TO SHARE WITH CLIENTS
Feedback Loop
74
Overview of Chronic Conditions
CHAPTER 8
EXERCISE IS FOR EVERYONE!
As America ages there will be a significant increase in the older population,
which will have a major impact on the nation’s healthcare system. More than
30% of all healthcare dollars are spent on older adults. There are moral and
ethical reasons for keeping older adults active. Ultimately, doing so will save the
nation a significant amount of money. Regardless of age and physical condition, functional fitness is a major factor in health maintenance, reducing disability in older adults.
Almost any condition can be improved, or at least maintained,
through regular sensible exercise, as long as the physician is
informed and the individual follows the doctor’s recommendations. We now have documentation that everything from
arthritis to Parkinson’s Disease can benefit from appropriate
exercise. It wasn’t too long ago that an individual was told to
stay in bed after a heart attack. Today we find a person up and
moving around very soon after having a heart attack.
Don’t let your clients be limited by their physical problems but
only by their expectations.
Many times, people with chronic conditions find themselves
asking, “Why me?” I sincerely believe that the quote on the
right, attributed to Roy Campanella, will give inner strength to
all of us no matter what our condition.
It is important to note that chronic conditions differ significantly from acute episodes. Chronic conditions usually cannot
be cured and often have an uncertain prognosis. Another farreaching implication of a chronic condition is how it predetermines a person’s life in psychosocial, financial, or medical
ways. Many times, chronic conditions lead to deficits in activities of daily living and often interfere with a person’s quality
of life. Approximately 5.6 million people over 65 years of age
have at least one deficit that limits how they perform those
daily activities of living such as dressing, getting around, using
the bathroom, cooking and eating, etc.
“A Creed For Those Who Have Suffered”
I asked God for strength, that I might achieve.
I was made weak, that I might learn humbly to
obey…
I asked for health, that I might do great things.
I was given infirmity, that I might do better
things…
I asked for riches, that I might be happy.
I was given poverty, that I might be wise…
I asked for power, that I might have the praise of
men.
I was given weakness, that I might feel the need of
God…
I asked for all things, that I might enjoy life.
I was given life, that I might enjoy all things…
I got nothing I asked for – but everything I had
hoped for.
Almost despite myself, my unspoken prayers were
answered.
I am, among men most richly blessed!
Improved functional fitness in adults will improve a person’s ability to participate more fully in society, lessen the burden on the family, and reduce medical costs. Functional physical fitness is defined as the fitness that improves a
person’s ability to live a fuller life.
By Roy Campanella,
from Chicken Soup for the Soul
Functional fitness: fitness
that improves a person’s
ability to live a fuller life
Exercise does not have to take the form of physical therapy to be therapeutic in
nature! As previewed in Chapter 5, regular exercise not only improves functional ability and affords physiological benefits but it also yields improvement
in the psychological and social areas of a person’s life.
75
Overview of Chronic Conditions
CHAPTER 8
COMMON PHYSICAL HEALTH PROBLEMS SEEN AMONG OLDER ADULTS
CARDIOVASCULAR SYSTEM
NEUROLOGICAL SYSTEM
Angina
Alzheimer’s disease
Arteriosclerosis
Cerebrovascular accident (stroke)
Congestive heart failure
Parkinson’s Disease
Hypertension
Myocardial infarction
GASTROINTESTINAL SYSTEM
REPRODUCTIVE SYSTEM
Constipation
Diverticulosis
Female:
Breast cancer
Fecal impaction
Cervical cancer
Gallbladder disease
Hemorrhoids
Male:
Impotence
Hiatal Hernia
Prostate cancer
INTEGUMENTARY SYSTEM
RESPIRATORY SYSTEM
Basal cell carcinoma
Emphysema
Pneumonia
Tuberculosis
MUSCULOSKELETAL SYSTEM
URINARY SYSTEM
Arthritis
Bladder cancer
Hip and other fractures
Incontinence
Osteoporosis
Urinary tract infection
Some of the physiological benefits derived from
corrective exercise are improvements in:
•
Muscular strength and endurance
While physiological benefits are important, the psychological benefits and social benefits are equally
valuable to your clients’ success.
•
Flexibility and mobility
Psychological benefits promote improvements in:
•
Cardiovascular fitness
•
Self-image
•
Coordination and balance
•
Self-confidence
•
Decrease in pain
•
Belief that one can do more
76
Overview of Chronic Conditions
CHAPTER 8
Social aspects of exercise are generally the reason
why people stick with an exercise program. A few
of the social benefits of exercise are:
•
Improved compliance and adherence to
the program
•
An enjoyable activity
•
An opportunity to make new friends
•
A healthy, positive way to spend time
Teach your clients when exercising to think about
the benefits of their successes (no matter how small)
rather than the consequences of any failure. Most
people give up on exercise too soon without giving
it a fair chance! It took them a long time to get into
the condition they are in now, but if they start
slowly and set themselves up to be a winner, a doer,
a healthier person, they can and will do it! Most
people expect results now and thus get sore and quit
too soon! Fitness is not the Fountain of Youth but
rather the Foundation of Youth! Promise them that
if they stick with the exercise program for at least six
months they will see changes by that time. The
changes may be within the social or psychological
aspects of exercise as witnessed by their feeling
better, not getting so tired, or by developing a new
group of friends to give them moral support.
If you are going to be successful with exercise
instruction, you need to teach your clients to:
•
Exercise in a pain-free range (not cause
themselves pain)
•
Learn to listen to their bodies
THOUGHTS TO SHARE
WITH CLIENTS
Unfortunately from time to time, you will have
minor setbacks. Remember that fitness is a life-long
commitment much like eating and sleeping. You
wouldn’t try to jam all your food or sleep into one
session and give up. The same is true with exercise.
Remember, just as not every meal you ever had was
great nor was every night’s sleep perfect, neither will
every exercise session be great or perfect. There will
be times you won’t feel like exercising, but just do 5
77
Overview of Chronic Conditions
CHAPTER 8
In following chapters, we will look more specifically
at many of those chronic conditions seen in adults.
Often, we deal with clients and patients who are
returning to physical activity after surgery, illness,
injury, or an extended period of inactivity.
Exercise, when done properly and prudently, will
generally have a positive outcome. Exercise is
therapy for the mind and/or the body: however, it is
our job to make sure it is done within the standards
and practices recommended for adults. It is also
important to remember that the physician’s and/or
physical therapist’s protocols supersede any exercise
program we have developed. If you have concerns
or disagreements about what a doctor or physical
therapist prescribes for a client, phone the doctor or
therapist to discuss their rationales. As said earlier,
our role is to be a team player in the client’s continuum of care.
to 10 minutes of your program and you’ll be
amazed how differently you’ll feel after that. The
hardest part of doing exercise is getting the motivation to just do it. Don’t let negative self-talk and
inertia destroy your health and good intentions. On
days you don’t feel like exercising, just do 2 or 3 of
your favorite exercises—it is better to do a little of
something than a lot of nothing. It is also better to
do 5 minutes of gentle exercise daily and be painfree than to do 30 minutes of hard vigorous exercise
three times a week and be sore.
Set yourself up to be successful. Don’t let friends
and relatives sabotage your program. Establish a
regular exercise time when you feel your best and
that is convenient to your schedule. Don’t be a fitness dropout, rather, be a fitness achiever! Regular,
sensible exercise is the key to being the best you can
be! Most people feel better after doing their exercise
program. Establish a positive addiction to exercise.
A positive addiction is something that is good for
you. While a negative addiction may feel good while
you’re doing it (e.g., eating ice cream or drinking), it
is bad for you and may at times leave you feeling
worse after doing it.
78
It is important to note that many of the health issues
common with older age respond favorably to regular and prudent exercise. It is critical to keep in
mind that your client is an individual to be
respected and cared for, and not just a person with
a bad back or a bum knee. Our mission is to help the
client function at optimum efficiency.
The rest of this section is divided into chapters on
orthopedic conditions, cardiorespiratory disease,
metabolic disorders, neurological conditions, and
sensory impairments.
Preventive healthcare is not apt to make as many
headlines as death and disease and dramatic cures,
but it quietly offers substantial benefits to people of
all ages—even the very old. It is regrettable that it
often seems more exciting to recount one’s illnesses
and treatments than to describe one’s plans for
health maintenance!
Feedback Loop
Communication is an important component in
your client’s safe return to activity. A common
mistake people make is to begin an exercise program without first consulting their physician,
Overview of Chronic Conditions
CHAPTER 8
physical therapist, exercise leader, or personal
trainer. A doctor or physical therapist can help set
any movement limitations for clients bodies as
well as prescribe appropriate exercises and set realistic goals. It is the client’s responsibility to communicate these movement limitations and goals to
you, to his or her exercise leader, or to his or her
personal trainer. Once you are aware of the client’s
condition, follow up with a phone call to the
client’s doctor or physical therapist. This way,
everyone involved with the client’s return to physical activity is aware of his or her condition, and all
can work together to provide the safest and most
effective program.
79
Cardio-Respiratory Conditions
CHAPTER 6
C h a p t e r
9
CARDIORESPIRATORY
CONDITIONS
To p i c s c o v e r e d i n t h i s c h a p t e r
HIGH BLOOD PRESSURE
LOW BLOOD PRESSURE
HEART DISEASE
Effects of Exercise
Keys to a Healthy Heart
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE (COPD)
Five Goals of Breathing Exercises
Correct Breathing Techniques
ASTHMA
80
Cardiorespiratory Conditions
CHAPTER 9
HIGH BLOOD PRESSURE
(HYPERTENSION)
Many adults have high blood pressure. It is believed
that hypertension is the third most common
chronic condition in the United States, right behind
sinusitis and arthritis. Generally, people with high
blood pressure will get cardiovascular disease after
65 years of age. Fortunately, most people who ‘have
hypertension’ are classified with only moderately
high (mild) blood pressure. That means that the
lower number (the diastolic pressure) is within the
range of 90 mm Hg to 105 mm Hg. Persons with
mild hypertension are often treated with a drug-free
approach, which includes losing weight and doing
aerobic exercise.
Most people have what is called essential hypertension, which means that the cause is unknown. Other
people have what is called secondary hypertension,
caused by renal or other endocrine factors.
CONTRAINDICATIONS
• Avoid heavy resistance training
•
If BP > 160/90 mm Hg, check with the
client’s physician prior to exercising
•
Instruct your client not to hold their
breath, as that increases blood pressure
•
Don’t start exercising a client until
approved by their physician
INDICATED EXERCISE PROGRAM
Numerous studies have shown that aerobic exercise
has a positive influence on lowering blood pressure.
Aerobic exercise includes such activities as walking,
swimming, and bike riding. Dr. Cade, Professor of
Medicine at the University of Florida, suggests that
hypertensive individuals start slowly and progress
over time. Dr. Cade says, “You don’t have to run to
get good results. Walking does the same thing as
running; it just takes longer.”
•
Exercising with light weights may be
acceptable, check with the physician
before starting
•
Emphasize warm-up and stretching portions of the workout as well as using a
prolonged cool-down session
•
Never have the client stop suddenly;
always keep them moving after vigorous
exercise until heart rate is close to their
pre-exercising resting level
EXERCISE PRECAUTIONS
• Focus on exhaling with each repetition
of an exercise
•
Emphasize muscular endurance versus
strength, perform a minimum of 10 to 15
repetitions of each exercise with a
lighter weight
•
Concentrate more of the program on
lower-extremity exercises. Upper bodywork is good, but pressing too much
weight overhead tends to elevate the
blood pressure
81
Cardiorespiratory Conditions
CHAPTER 9
LOW BLOOD PRESSURE
(HYPOTENSION)
In contrast to those with high blood pressure, some
older adults are prone to low blood pressure. Low
blood pressure can be problematic, resulting in
dizziness or a feeling of faintness if the individual
stands up too quickly. Many times, hypotension is
the result of tranquilizers, anti-depressants, or medications used for hypertension or heart disease. The
client should consult their physician if experiencing
lightheadedness when getting up.
INDICATED EXERCISE PROGRAM
• Do not stand in one spot too long
without moving. Blood will tend to pool
in the lower extremities, thus causing
lightheadedness, or dizziness
•
Do not get up too quickly from a lying
or sitting position. The circulation of
blood and/or oxygen to the brain may
not be as quick
STRESS REDUCTION
Many situations throughout the day can be
stressful for all of us. Learning to deal effectively
with these stresses involves developing an awareness of the causes as well as enacting a plan to
reduce or eliminate any negative effects. Physical
activity plays a large part in helping the body and
mind adapt to stress.
IN-CLASS ACTIVITIES
Based upon each individual’s needs, one or more of
the following activities can be engaged in:
•
Exercises that focus on controlled deep
breathing may help to lower blood pressure and quiet the mind
•
Tense muscles contribute to poor posture, pain, and fatigue. Stretching/flexibility exercises allow the body to relax
•
Vigorous activity is useful as a way to
release anxiety (e.g., riding a stationary
bicycle, walking on a treadmill, performing calisthenics, etc.)
82
OUTSIDE-CLASS ACTIVITIES
• Therapeutic massage
•
Yoga, Tai chi, or meditation groups or
classes
•
Deep relaxation and guided-visualization cassette tapes
•
Biofeedback training
•
Group self-awareness
classes
•
Individual counseling
•
Developing a good nutritional program
•
Allowing time for adequate rest and
developing a plan to ensure a good
night’s sleep
•
Participation in a hobby or other recreational pursuit
or
guidance
HEART DISEASE
There are many different types of heart disease.
They include high blood pressure, atherosclerosis,
coronary artery disease, angina pectoris, and congestive heart failure. Studies show that people who
are physically active have less heart disease than
their sedentary counterparts. Fit people who do
have a heart attack have a higher survival rate. Regular exercise helps to reduce the risk of getting
heart disease, but it is also used to rehabilitate a
person who has already suffered a cardiac event. A
sensible and prudent exercise program may lower
blood pressure and increase exercise tolerance, as
well as lower total cholesterol and increase the
desirable protective higher-density lipoproteins
(HDL cholesterol).
Heart disease is the leading cause of death in the
U.S. for both men and women, and many cardiologists contend that the aftereffects of a heart attack
are more devastating than the damage to the heart.
Many people who have had a heart attack are afraid
to live, in fear of dying. This is why a sensible and
regular exercise program is so important if the
person who has had a heart attack wants to return
Cardiorespiratory Conditions
CHAPTER 9
to the mainstream of life. A guided cardiac rehabilitation program is important in assisting your client
to achieve the ability to exercise independently.
Effects of Exercise
•
Assists in ridding the body of excess fat
and weight that place undue stress on
the heart
•
Eases stress and tension
•
Retards the aging process
•
May reduce blood pressure
•
Helps to reduce fats in the blood stream
•
Improves peripheral circulation
•
Makes the delivery of oxygen to the
body more efficient
Keys to a Healthy Heart
•
Stop smoking, if the client is a smoker
•
Eat right, eat lean
•
Control blood pressure
•
Reduce stress
•
Exercise aerobically
•
Have client heed their doctor’s advice
regarding medications and lifestyle
INDICATED EXERCISE PROGRAM
This exercise program, more than any other in this
book, must be approved and adjusted by the client’s
physician. Many people who suffer heart attacks are
Type A personalities who want everything done
now! The road back from a heart attack is a slow and
steady road. Caution must be used not to overdo it!
Watch for chest pain, nausea, pain in the arm or jaw,
etc. If any of these occur, call 911 immediately.
EXERCISE PRECAUTIONS
•
Never allow client to hold their breath
•
Don’t compete!
•
Get physician’s approval prior to starting
and follow the orders exactly! Ask the
physician how often and how hard your
client should exercise
•
If the client has angina, make sure they
carry their medication at all times
•
If your client is on beta-blockers, exercise heart rates are not useful for measuring the level of exertion. Use the talk
test; if the client can’t talk, slow down;
he/she is moving too fast or too hard
Most physicians will encourage their patients to do
gentle aerobic exercise. A walking program of five
minutes once a day is a good way to start. Then try
to do it two times a day. Studies at Stanford Disease
Prevention Center show that four bouts of five minutes per day is almost as good as 20 minutes of nonstop walking. If walking is hard on his/her joints, try
stationary biking, water exercise, or swimming.
Encourage client to go through a supervised cardiac rehabilitation program prior to engaging in
your classes.
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
Alveoli
(COPD)
COPD is a progressive disease of
the lungs characterized by the
destruction of the alveoli, retention of mucous secretions, narrowed airways, and respiratory
muscle weakness. Common conditions grouped under this heading
include bronchitis, asthma, emphysema, and sometimes allergies.
These conditions make respiration difficult. The long-term
effects can lead to cardiac instability and arrhythmia.
Research shows that a slow,
progressive general-conditioning exercise program
that ultimately leads to good aerobic fitness
improves exercise/activity tolerance. This improvement is believed to be due to improved efficiency of
the muscles involved in breathing and lessens anxiety when dyspnea (shortness of breath) occurs.
83
Cardiorespiratory Conditions
CHAPTER 9
Inhalation
Exhalation
Figure 9-1 When the diaphragm and breathing muscles lift the rib cage, the size of the chest cavity increases; as the rib cage
lowers, the size of the chest cavity decreases. Fluctuation in cavity volume causes air to move in and out of the lungs.
intensity must be based on the physician’s recommendations and the individual’s abilities
Five Goals of
Breathing Exercises
1. Improve ventilation
2. Improve strength and endurance of respiratory muscles
3. Maintain and improve chest and midback mobility
•
Never allow clients to overextend themselves! Moderate the pace depending on
how they feel
•
Have the client learn to use ‘pursed-lip
breathing’ (see following page), which
slows the rate of exhalation and
increases the comfort level
•
Intermittent activities that allow recuperative time are ideal. Research shows that
graded walking (short walks) until dyspnea, followed by recovery of 15 to 20
minutes, twice a day, five times a week,
works well. Stationary bike activities
have the advantage that one can exercise in a safe and comfortable spot, if
necessary (e.g., near a phone and close
to medications). Performing non-weightbearing exercises is easier on the cardiovascular system
4. Increase effectiveness of cough mechanism
5. Correct inefficient breathing patterns
Here is an effective way to relieve shortness of
breath: have the client sit in a relaxed position
leaning forward, resting their forearms on their
thighs, and breathe gently. Another way is to have
the client stand up and lean forward, supporting
themself on a table, and breathe gently.
INDICATED EXERCISE PROGRAM
• Individuals with COPD must start at a
very low level of activity—this level of
84
Cardiorespiratory Conditions
CHAPTER 9
CHEST MOBILITY IS IMPORTANT. EXERCISES
THAT ARE USED TO IMPROVE CHEST MOBILITY ARE:
•
Have the client sit upright with towel
around their ribs, then apply gentle force
and breathe rhythmically
•
Have the client lie down on their back
and apply gentle pressure to their ribs
with their hands
•
Work on improving the flexibility of
chest muscles and strengthening the
back muscles
•
Horizontal abduction of arm while
breathing deeply
TIPS AND SUGGESTIONS FOR CLIENTS
• Try to get clients involved in group-exercise classes with peers who have
breathing difficulties (e.g., Better
Breathing classes) or at least exercise
with a friend
•
Remember to have the client do postural
drainage and breathing exercises as
taught by their therapist
EXERCISE PRECAUTIONS
• Never force expiration. Expiration
should be relaxed and passive
•
Avoid hyperventilation
breathing, diaphragm breathing) are used to treat
persons with COPD. These breathing exercises are
designed to help such clients learn to breathe more
easily. When these individuals become short of
breath, they may feel anxious and tense—they may
begin to breathe rapidly and shallowly. Their air sacs
do not have enough time to fill or empty. The
harder they work to force the used air out of the
lungs, the more the small airways collapse. They end
up feeling worse! These breathing techniques
should be practiced several times during the day
until they become a habit.
PURSED-LIP BREATHING
The purpose of pursed-lip breathing is to prevent
the airways from collapsing and to avoid trapping
stale air in the lungs. This is done by creating a
resistance to airflow through pursed-lip breathing.
Breathing against this resistance increases pressure
in the airways and prevents them from collapsing.
Direct your clients to perform these steps:
1. Assume a relaxed position, either sitting
or semi-reclined
2. Inhale slowly through your
keeping your mouth closed
nose,
3. Purse your lips in a whistling position.
Exhale slowly and evenly through your
lips
Correct Breathing
Techniques
4. Exhale at least twice as long as you
inhale, e.g., 3 seconds in, 6 seconds out
Breathing is an automatic process, yet we can control our pace at will. Focusing on proper breathing
techniques during exercise is extremely important
for blood pressure control. Clients should never
hold their breath; rather, exhale while exerting any
strenuous effort. Shortness of breath is an indication to slow down.
5. Repeat for four breaths and then rest
Breathing Exercises
The following breathing exercises (pursed-lip
6. Do not exhale too forcefully or to the
point of discomfort
Breathing Tips
Pursed-lip breathing should be used when exerting
oneself or when one feels breathless. Because this
technique is used with other breathing exercises, it
is important that it is learned properly and practiced often.
85
Cardiorespiratory Conditions
CHAPTER 9
DIAPHRAGM BREATHING
The diaphragm is the major muscle of breathing.
Remember that in COPD, trapped air pushes down
on the diaphragm and flattens it. Because this flattened position makes it difficult for the diaphragm
to work, the upper chest and neck muscles try to
help out. However, these muscles require more
oxygen to work and are not as efficient as the
diaphragm. The diaphragm breathing exercise will
increase the mobility and strength of the
diaphragm. Instruct the client to use pursed-lip
breathing with this exercise. Have the client locate
their diaphragm by placing the palm of their hand
on the center of their stomach, then sniff quickly.
They will feel their diaphragm go up. Have the
client follow this procedure:
1. Lie down on a level surface with a pillow
under your knees to support your back
2. Place the palm of one hand on your
upper abdominal area (above your belly
button and below the ribcage)
3. Place the other hand on the upper chest
to feel for movement of the upper-chest
muscles
SYMPTOMS
• Cough or hack (due to increased
mucous)
•
Wheezing and dyspnea, leading to difficult exhalation
•
Severe bronchial constriction where an
individual becomes cyanotic, constituting an extreme medical emergency
4. Exhale slowly through pursed lips and
gently push inward with the lower hand
EMERGENCY PROCEDURES FOR ASTHMA
ATTACK
1. Have individual sit and attempt to relax
5. Inhale slowly and deeply through your
nose
2. Provide glass of warm water to break
down mucous
3. Administer medication
ASTHMA
Asthma is classified as a reversible (spontaneous or
therapeutically) obstructive airway disease,
resulting in the sudden onset of muscle spasms,
swelling, and the presence of mucous in the tracheo-bronchial tree. It is caused by a hyperirritability to a variety of stimuli (e.g., inhalants,
ingestants, environment, and exercise). Exerciseinduced asthma (EIA) is brought on by sustained
exercise such as running or bicycling for longer
than six minutes.
86
4. Call 911 if breathing is severely impaired
THE FOLLOWING INFORMATION SHOULD
BE IN THE PARTICIPANT’S MEDICAL FILE:
• Type and frequency of medication
•
Possible side effects of drugs
•
Procedures to follow during an attack
•
Substances that trigger the attack (such
as allergens)
•
Anecdotal record of all attacks
Cardiorespiratory Conditions
CHAPTER 9
PHYSICAL CHARACTERISTICS OF PERSONS WITH ASTHMA
•
Weak abdominals
•
Loss of flexibility in shoulders, lower
back, and hamstrings
•
Weak upper-back muscles (rhomboids)
•
Reduced FEV1 during and after cessation of exercise. FEV1 refers to the
forced expiratory volume of air in one
second. It is a flow rate measuring the
amount of air (liters) expired in one
second from a maximal exhalation. It is
usually expressed as a percentage of the
total amount of exhaled air (forced vital
capacity, or FVC)
•
EIA becomes increasingly severe as the
duration of exercise is increased. The
response appears to be greatest after six
to eight minutes of aerobic activity
87
Metabolic Conditions
CHAPTER 7
C h a p t e r
1 0
METABOLIC CONDITIONS
To p i c s c o v e r e d i n t h i s c h a p t e r
DIABETES MELLITUS
OBESITY
88
Metabolic Conditions
CHAPTER 10
DIABETES MELLITUS
When a person has diabetes mellitus, the person’s body doesn’t provide
enough of the hormone called insulin. Insulin helps regulate the amount of
sugar in the blood stream. There are two types of diabetes mellitus: Type I
and Type II. Type I is insulin-dependent diabetes (formerly called juvenile
diabetes), where the body’s immune system destroys insulin-producing cells,
and insulin needs to be injected into the bloodstream.
Type II is known as non-insulin-dependent diabetes (formerly called adultonset diabetes), where the body does not produce enough insulin. With Type
II, diet, exercise, and oral medications usually work well, so insulin injections
are not needed to control blood glucose levels. Most people who develop
Type II diabetes are over 40 years of age and are commonly obese. However,
studies find that young children are being diagnosed with Type II diabetes
and that this trend is increasing.
Diabetes mellitus: (Type I) A
pancreatic disorder that
produces high sugar content
in the blood and urine. Type II
diabetes (adult onset
diabetes) is a carbohydrate
metabolism disorder, different
from Type I
Regular exercise can help a person with Type II diabetes to stabilize the condition by, losing excess fat and weight, decreasing the need for insulin, lowering cholesterol, and avoiding further complications. Having diabetes or
being at risk for diabetes is not an excuse to avoid exercise, but rather a
reason to exercise! Before you upgrade or start an exercise program, always
consult your client’s physician for specific recommendations and precautions relevant to your client.
Exercising vigorously just once a week reduces a person’s risk of adult-onset
Type II diabetes by 23%. According to an article published in JAMA, the
Journal of the American Medical Association, a study of over 21,000 male
physicians aged 40 to 84 found that the more one exercises, the lower the risk
of diabetes. Exercising vigorously from two to four times a week reduced risk
by 38%, and exercising five or more times a week reduced risk by 42%. Lack
of exercise contributes to as much as a quarter of the cases of Type II diabetes, according to the authors of this study.
GENERAL CAUTIONS FOR DIABETICS
• Avoid activities stressful to the feet, such as jogging
•
Protect the feet, always dry between toes after bathing, and
always wear suitable footwear to avoid blisters
•
When blood sugar levels above 300 mg are present, do not
exercise
•
Diabetics with retinopathy should avoid intense exercise such
as heavy weight lifting, sprints, etc.
Retinopathy: Noninflammatory degenerative disease
of the retina
89
Metabolic Conditions
CHAPTER 10
EXERCISE GUIDELINES FOR DIABETICS
• Exercise heart rates should be between 50% and 70% of maximum heart rate
Hypoglycemia: Low blood
glucose level
•
Consult with physician to determine the correct level of insulin
for when exercising
•
Persons who experience hypoglycemia (low blood sugar) or too
much insulin in the blood should have easily digestible carbohydrates (orange juice, for example) available at all times
•
Don’t exercise on an empty stomach
•
Drink plenty of fluids
•
Always warm up and cool down
Be alert to the signs of hypoglycemia:
Diabetic coma: A coma
caused by either too much or
too little insulin
90
•
Double vision
•
Fatigue
•
Excessive hunger
•
Increased heart rate
•
Excessive sweating
•
Trembling
Be alert to the signs of diabetic coma:
•
Increased thirst
•
Stomach pain
•
Dehydration
•
Increased urination
•
Faulty breathing
•
Drowsiness
•
Nausea
•
Exercise at predictable times to minimize blood sugar fluctuation
•
Encourage the client to exercise with a buddy
Metabolic Conditions
CHAPTER 10
TA B L E 1 0 - 1
THE EFFECTS OF TOO MUCH OR TOO LITTLE INSULIN
ASPECT
INSULIN REACTION
DIABETIC COMA
Onset
Rapid (minutes)
Gradual (hours)
Symptoms
Headache
Nausea
Fatigue
Thirst
Vomiting
Tremulousness
Hunger
Frequent Urination
Irritability
Skin
Cold and Moist
Warm and Dry
Breathing
Normal and Shallow
Deep
Urine
Negative Glucose
Treatment
Sugar
Negative Acetone
4 + Glucose
Positive Acetone
Insulin
Medical Attention
OBESITY
Obesity has reached epidemic proportions in the
USA and is considered a leading cause of heart disease. Many of us confuse the word overweight with
‘over-fat.’ A very muscular individual could weigh
more than his/her desirable weight as given in the
standard insurance height/weight chart (see Table
10-2a and b). This is because muscle is heavier than
fat. While most of us are at least slightly over-fat,
most of us are not considered clinically obese. The
average college-age male is 15% body fat, while the
average college-age female is 25% body fat. Clinical
obesity is defined as above 25% body fat for males
and above 30% for females.
Obesity is associated with numerous medical problems. The excess fat places additional demands on
the heart and lungs. People who are obese have
increased incidence of hypertension and diabetes,
high levels of cholesterol, and poor ratios between
high-density and low-density lipoproteins. Another
side effect of obesity is the stress it places on weightbearing joints of the body. If an obese person could
lose weight, there would be less stress on the lower
back, hips, knees, and ankles. However, if it hurts to
exercise then the person won’t exercise; thus they get
pulled into a vicious cycle of inactivity and further
weight gain (see section on chronic pain). To lose
weight one has to increase activity levels just a little
and cut back on food intake a little.
RECOMMENDATIONS
By cutting back on only 50 calories a day (that’s just
1/2 of an apple) and increasing the activity level, a
person will lose at least a pound a month. “Well,”
one might say, “but I’ve got 30 pounds to lose.”
However, if all one does is what is stated above, in
one year they will have lost at least 12 pounds. Most
people who lose a lot of weight in a short period of
time gain it back, but if you lose 1 to 2 pounds per
month there is a good chance it will be gone forever!
Successful weight-loss programs require lifestyle
changes of eating less and moving more. Remember
that excess fat is just unused energy.
91
Metabolic Conditions
CHAPTER 10
Have client follow these recommendations:
•
Consult physician to obtain a medical
approval to exercise
•
See a registered dietitian (avoid fad diets
and health food scams)
•
Try walking slowly 5 minutes per day
and progress by 1 minute a week until
they can walk pain- and stress-free for 20
minutes (see cardiovascular section)
•
Try water exercise or stationary biking
•
Do something aerobic 3 to 5 times per
week
CONTRAINDICATIONS
• DO NOT go on a crash diet
SUMMARY OF OBESITY
•
DO NOT do high-intensity exercise
•
Watch heart rates and blood pressure
•
It is possible to be fit and ‘overweight’
•
Avoid weight-loss gimmicks
•
Set realistic weight goals for clients
•
Avoid exercising in hot climates
•
Encourage people to get more activity
into their lives
•
Be prudent about size of servings and
quality of food
INDICATED EXERCISE PROGRAM
• Start very, very slowly!
Metabolic Conditions
CHAPTER 10
TA B L E 1 0 - 2 a
TA B L E 1 0 - 2 b
1983 METROPOLITAN LIFE INSURANCE
1983 METROPOLITAN LIFE INSURANCE
HEIGHT-WEIGHT TABLE*
HEIGHT-WEIGHT TABLE*
MEN
WOMEN
HEIGHT
ft & in
SMALL
frame
MEDIUM
frame
LARGE
frame
HEIGHT
ft & in
SMALL
frame
MEDIUM
frame
LARGE
frame
5’2”
5’3”
5’4”
5’5”
5’6”
5’7”
5’8”
5’9”
5’10”
5’11”
6’0”
6’1”
6’2”
6’3”
6’4”
128
130
132
134
136
138
140
142
144
146
149
152
155
158
162
131
133
135
137
139
142
145
148
151
154
157
160
164
167
171
138
140
142
144
146
149
152
155
158
161
164
168
172
176
181
4’10”
4’11”
5’0”
5’1”
5’2”
5’3”
5’4”
5’5”
5’6”
5’7”
5’8”
5’9”
5’10”
5’11”
6’0”
102
103
104
106
108
111
114
117
120
123
126
129
132
135
138
109
111
113
115
118
121
124
127
130
133
136
139
142
145
148
118
120
122
125
128
131
134
137
140
143
146
149
152
155
158
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
134
136
138
140
142
145
148
151
154
157
160
164
168
172
176
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
141
143
145
148
151
154
157
160
163
166
170
174
178
182
187
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
150
153
156
160
164
168
172
176
180
184
188
192
197
202
207
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
111
113
115
118
121
124
127
130
133
136
139
142
145
148
151
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
121
123
126
129
132
135
138
141
144
147
150
153
156
159
162
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
131
134
137
140
143
147
151
155
159
163
167
170
173
176
179
* Weights at ages 25 to 59 years based on lowest comparative mortality. Weight in pounds according to frame size for men wearing indoor clothing
weighing 5 pounds, shoes with 1 inch heels; for women, wearing indoor clothing weighing 3 pounds with 1 inch heels. Statistical Bulletin,
Metropolitan Life Insurance Company, New York City.
The MetLife Height-Weight Tables were created in the early 1900s and revised in 1983. Though the
averages described in the tables are inaccurate for highly muscular people and people that are shorter
or taller than average, these tables are still used by many insurance companies. Also note that these
tables only categorize adults from 25 to 59 years of age.
93
Neurological Conditions
CHAPTER 8
C h a p t e r
1 1
NEUROLOGICAL CONDITIONS
To p i c s c o v e r e d i n t h i s c h a p t e r
ACQUIRED BRAIN INJURY (ABI)
Organization of the Brain
Definition of Acquired Brain Injury
CEREBRAL VASCULAR ACCIDENT OR STROKE (CVA)
Differences Between Persons with CVA and ABI
Teaching Tips for Persons with Left and Right Hemiplegia
Exercises for the Neurologically Impaired
EPILEPSY
Types of Epilepsy
PERIPHERAL VASCULAR DISEASE
SPINAL CORD INJURY
Types of Spinal Cord Injury
LEARNING DISABILITIES
Characteristics of Persons with Learning Disabilities
MULTIPLE SCLEROSIS (MS)
PARKINSON’S DISEASE
94
Neurological Conditions
CHAPTER 11
ACQUIRED BRAIN INJURY (ABI)
Acquired brain injury (ABI):
An acquired impairment of
brain functioning resulting in
the loss of cognitive, motor,
linguistic, psychosocial,
sensory perceptual abilities
(Also known as Traumatic Brain Injury)
Organization of the Brain
The brain is comprised of three main areas:
•
Cortex: Where most thinking functions occur
•
Cerebellum: Coordinates movement
•
Brain Stem: Controls consciousness, alertness, and basic bodily
functions such as breathing, respiration and pulse
The cortex is the largest part of the brain and is divided into four lobes, each
of which specializes in particular functions and skills:
•
Frontal Lobe: Emotional control, motivation, social functioning,
expressive language, inhibition of impulses, motor integration,
and voluntary movement
•
Temporal Lobe: Memory, receptive, language, sequencing,
musical awareness.
•
Parietal Lobe: Sensation, academic skills such as
reading, awareness of spatial relationships
•
Occipital Lobe: Visual perception
The cortex is divided into two hemispheres. The dominant hemisphere (usually the left hemisphere) controls verbal functions, including speaking,
contractures, and improve functional fitness skills.
The illustration on the right shows the functions of
the left and right hemispheres.
Definition of
Acquired Brain Injury
Speech
Language
Complex Motor
Functions
Spatial
Orientation
Picture/Pattern
Sense
Vifilance
Performance-Like
Functions
Paired Associate
Learning
Spatial Integration
Verbal Abilities
Linguistic Description
Verbal Skills
Creative Associative
Thinking
Calculation
Conceptual Similarities
Simple Language
Compensation
Time Analysis
Non-Verbal Skills
Acquired brain injury is an acquired impairment
of brain functioning resulting in the loss of cognitive, motor, linguistic, psychosocial, sensory
perceptual abilities. In recent years, it has been
reported that injuries to the brain have increased,
largely as the result of automobile and motorcycle
accidents, stroke, hang glider accidents, and to a
lesser extent, gunshot wounds. As you can see, there are
many causes of ABI. The impairment itself does not
depend on the cause of the lesion, but rather the location
affected within the brain.
Detail Analysis
Arithmetic
Writing
Calculation
Finger Naming
Right-Left
Orientation
Left Hemisphere
Facial Identification
Recognition of
Environmental Sounds
Non-Verbal Paired
Associate Learning
Tactile
Perception
Right Hemisphere
95
Neurological Conditions
CHAPTER 11
Cerebral Vascular Accident
(CVA): Denoting the sudden
development of focal
neurological deficits usually
related to impaired cerebral
blood flow
Hemiplegia: Paralysis of one
side of the body
Spasticity: A state of
increased muscle tone with
exaggeration or the tendon
reflexes
CEREBRAL VASCULAR ACCIDENT OR
STROKE (CVA)
Strokes are the third leading cause of death and a leading cause of disability in
the United States. Men experience strokes more frequently than women and
more African Americans incur strokes than Caucasians do. The incidence of
stroke increases dramatically with age and doubles with every decade after age
55. Because there are approximately three million people alive in the U.S. who
have incurred a stroke, it is essential that fitness educators of older adults have
some working knowledge of how to teach this population.
Due to the large number of clients enrolled in adaptive physical fitness programs who have had a stroke, it is very important to understand as much as
possible about this neurological disorder, and how best to assist them in
regaining normal function. A stroke occurs when a blood vessel bringing
oxygen and nutrients to parts of the brain bursts or becomes clogged. When
that happens, the nerve cells in that part of the brain die, resulting in a disturbance to the opposite side of the body. A right-sided stroke in the brain results
in left-sided paralysis (hemiplegia).
The nerve cells of the brain control how we receive and interpret sensations.
They also control most of our body movements. When some nerve cells in the
brain cannot function, then the part of the body controlled by them cannot
function either. This can result in difficulty speaking, inability to walk, loss of
memory, lack of bowel or urinary control, or other symptoms. The effects of a
stroke may be very slight or severe, temporary or permanent. This depends on
which brain cells have been damaged, how widespread the damage is, and how
quickly other areas of brain tissue take over the work of the damaged cells.
Spasticity (abnormal increases in muscle tone) interferes with the ability to
move normally. Spasticity develops insidiously a few days after the stroke has
occurred and gradually replaces the initial complete paralysis of the muscles of
the affected side of the body.
Careful positioning, as well as encouragement to use the affected limbs in a
functional manner throughout all daily activities, can help to prevent or
inhibit spasticity (tone) and abnormal primitive reflexes. This will help to
ensure that the likelihood of regaining normal functional movement is maximized. (A newborn has little control over his body, and his movements are dictated by reflexes, referred to as primitive reflexes. These reflexes are with us
throughout our lives. As the brain develops, it overrides, or inhibits, these
reflexes. When a person suffers brain damage, these primitive reflexes are considered abnormal when they re-emerge.)
96
Neurological Conditions
CHAPTER 11
TA B L E 1 1 - 1
DIFFERENCES BETWEEN PERSONS WITH CEREBROVASCULAR ACCIDENT
(CVA) AND ACQUIRED BRAIN INJURY (ABI)
FACTOR
CVA
ABI
Age
50+ (most common age group)
16 to 25 (most common age group)
Injuries
Brain tissue and secondary dysfunctions
Brain, secondary dysfunctions orthopedic
Brain damage
Local, specific
General nonspecific
Family
Head of household
Dependent or new head
Vocation
Retirement or approaching
Unestablished, student
Behavior
Somewhat predictable
Unpredictable
Sexuality
Mature, adjusted
Immature, confused
INDICATED EXERCISE PROGRAM
Often, persons with ABI are resistant to physical
activity, expecting that it will aggravate headaches,
cause dizziness, or fatigue them. Generally, exercise
will not aggravate any conditions. It is recommended that the individual spend at least 30 to 60
minutes daily participating in activities that will
develop muscular strength and endurance, cardiovascular endurance, balance, and coordination.
Small-group activities teaching balance and rangeof-motion have been found to be successful and
beneficial, providing that progress is monitored regularly. The time spent partaking in exercise, swimming, and/or sports activities is not only valuable
physically, but is also psychologically stimulating.
RECOMMENDATIONS FOR EXERCISE
It would be prudent to improve the ABI client’s balance by performing weight shifts. Time should be
allotted to maintaining and improving balance and
coordination. Remember that it is unwise to perform exercises that make a person even tighter in
already tight muscles. For example, doing bench
TA B L E 1 1 - 2
TEACHING TIPS FOR PERSONS WITH
LEFT AND RIGHT HEMIPLEGIA
Left Brain Damage, Right Hemiplegia
Speech and Language
Problems
Speak slowly, use short
sentences
Slow, cautious and disorganized behavior styles
Give frequent and accurate
feedback
Memory deficit relating to
speech
Be helpful but do not nag
Right Brain Damage, Left Hemiplegia
Spatial-perceptual probHave person demonstrate
lems: i.e., decreased ability skills rather than taking
to judge distances, sizes,
their work for it
etc.
Impulsive and too fast
behavior styles
Have person talk self
through tasks
Over-estimate abilities
Use caution
One-sided neglect
Arrange environment to
maximize sensory input
97
Neurological Conditions
CHAPTER 11
press motions or flys is not advisable. It would be
better to work the opposing muscle groups. The
water is a great place to work on ambulation skills—
when the client is supervised. If so, place a small
swim fin on the affected side; this will provide feedback to the ABI client if the affected leg is doing a circumvented gait and is not stepping straight through.
Flexibility: Activity is important to maintain joint
flexibility. Range-of-motion exercises that were prescribed by the therapist for ankle, hamstring, hip,
shoulder, wrist, and hand flexibility are critical and
should be performed according to the schedule set
forth to you by your client’s physician.
Muscular Strength: This area is still controversial,
depending on the therapist’s frame of reference.
Some therapists who utilize the Bobath approach
maintain that strength training causes spasms and
contractures. Other therapists believe that in order
to maintain greater independence, one must
develop enough strength to meet the demands of
activities of daily living. Any loss of muscle strength
will manifest itself in more and more loss of functional ability. (Always consult the client’s physician
pertaining to their needs). If your client notices loss
of flexibility, either cut back, or spend more time
participating in stretching, range-of-motion activities. Be mindful of increases in blood pressure!
Balance/Coordination: For persons with a head
injury, a significant portion of time should be
devoted to safe and functional balance activities.
Always make sure your clients are safe when doing
balance exercises.
Cardiovascular Exercise: This activity is not only
useful to increase aerobic capacity; it helps maintain
proper blood pressure. Aerobic exercise also
encourages reciprocal movements of the arms and
legs, which helps coordination. Always consult your
physician prior to doing aerobic exercise and ask for
specific guidelines relevant to work load, intensity,
and training heart rates!
98
Exercises for the
Neurologically Impaired
ARM/HAND STRETCH
Starting Position: Sitting. Assistant sits on affected
side.
Movement: Assistant straightens affected elbow,
wrist, and fingers, holding this position as long as
tolerated. If thumb is stretched out first, hand and
fingers will open more easily.
ELBOW FLEXION/EXTENSION
Starting Position: Lying on back, affected shoulder
flexed to ninety degrees, elbow straight. Assistant
should stabilize upper arm in this position, supporting at the hand and the elbow.
Movement: Bend elbow, bringing hand toward
opposite shoulder, then straighten. Assistant may
help to complete each movement only as needed.
With improvement, hand may be brought to
mouth, chin, nose, etc. This is a slow process,
requiring patience.
WEIGHT-BEARING ON FOREARMS
Starting position: Lying on stomach. Place forearms under chest. May clasp or cross hands to keep
in place.
Movement: Push up and support weight on forearms, keeping shoulders directly in line over elbows.
Shift weight toward affected side, holding to tolerance. Attempt to place affected hand flat on mat
with fingers outstretched to reduce tone.
WEIGHT-BEARING ON HANDS AND KNEES
Starting Position: Lying on stomach, bearing
weight on forearms, affected hand flat.
Movement: Lift hips off of mat (assistant may have
to help with this), and rise up onto hands and knees.
Attempt to straighten elbow, shifting weight toward
affected side. With practice, you can shift weight
forward and backward. Attempt to bend and
straighten elbows.
Neurological Conditions
CHAPTER 11
PELVIC MOBILITY
Starting Position: On hands and knees.
Movement: Isolated movement of pelvis: move buttocks side to side.
TRUNK STABILIZATION
Starting Position: On hands and knees.
Movement: Assistant applies resistance against outside of one shoulder and side of opposite hip. Student pushes against both points of resistance at the
same time.
PRONE KNEE BENDS
Starting Position: Lying on stomach.
Movement: Slowly bend knee, bringing heel toward
buttock. Bring the leg to a ninety-degree angle, and
stabilize it in this position. Hold as long as tolerated,
and then slowly lower leg back down. Assistant may
provide support as needed.
Figure 11-1 Achilles Tendon Stretch
HEEL SLIDES
Starting Position: Lying on back.
Movement: Bend and then straighten the affected
hip and knee, always keeping the heel in contact
with the mat. Perform a slow, controlled motion
throughout.
STANDING UP
Starting Position: Scoot buttocks to front edge of
chair. Place feet apart with stronger leg back and
under you. Clasp hands together, fingers interlaced,
and reach forward with the arms.
Movement: Lean forward, with body weight balanced equally over both legs. Stand up straight.
ACHILLES TENDON STRETCH
Starting Position: Stand with support. Step forward
with stronger leg, keeping affected leg back.
Movement: Bend front leg and lean forward until a
stretch is felt in the calf of the rear leg. Hold as tolerated (15 to 60 seconds).
WEIGHT-SHIFTING, FORWARD AND
BACKWARD
Starting Position: Stand with support. Step forward
with affected leg, keeping stronger leg back.
Movement: Bend front leg, shifting weight forward;
hold as tolerated, then shift weight backward.
Repeat several times.
WEIGHT-SHIFTING, SIDE-TO-SIDE
Starting Position: Stand with support, feet evenly
apart with toes pointing forward.
Movement: Shift weight onto affected leg; hold as
tolerated, then shift weight onto other leg. Repeat
several times.
99
Neurological Conditions
CHAPTER 11
EPILEPSY
Epilepsy: A chronic disorder
characterized by paroxysmal
brain dysfunction due to
excessive neuronal discharge,
and usually associated with
some alteration of
consciousness
Epilepsy is symptomatic of a central nervous system disorder and results in
excessive electrical discharges in the cerebrum (i.e., seizure). Epilepsy is a
syndrome in which seizures occur repeatedly and is classified according to
the severity of electrical discharge and according to the brain region where it
originates.
Etiology: all of the causes of
a disease or abnormal
condition
ETIOLOGY
• Idiopathic (cause unknown)
Idiopathic: arising
spontaneously or from an
obscure or unknown cause
100
DIAGNOSIS
Diagnosis of epilepsy involves a complete physical and neurological examination and occasionally a spinal tap. The electroencephalogram (EEG) is useful,
not only in identifying epilepsy, but in determining the most effective treatment. An EEG records the brain’s electrical patterns on a graph.
•
Genetic disposition (possible metabolic disorder)
•
Acquired (tumors, anoxic brain, hemorrhage)
•
Prenatal (infections, rubella)
•
Postnatal (infections such as meningitis)
Neurological Conditions
CHAPTER 11
FACTORS THAT PROVOKE SEIZURE
• Increased alkalinity of blood (dietary fat
and exercise will increase acidity of
blood)
•
Flashing strobe lights
•
Emotional stress
•
Edema
•
Hyperventilation at rest
•
Excessive fatigue
Types of Epilepsy
ABSENCE (PETIT MAL)
This type is more common in children than adults
and frequently disappears in adolescence. It is a very
mild form of seizure. Although the individual is
“unconscious” during the seizure (5 to 20 seconds),
the posture is maintained and convulsions do not
occur. The only signs may be staring with rapid
blinking or rolling of the eyes upward. Absence
seizures may occur up to 100 times per day.
TONIC-CLONIC (GRAND MAL)
The tonic-clonic seizure has 2 phases that last a total
of approximately 5 minutes. In the tonic phase, the
individual becomes unconscious and rigid, and may
fall to the ground. The clonic phase follows, characterized by rhythmic, muscular convulsions. After
the seizure has ceased, the individual is very tired
and may need to rest or sleep. These seizures often
occur during sleep.
COMPLEX-PARTIAL (PSYCHOMOTOR)
This type of seizure involves only a portion of the
brain and presents varying symptoms among individuals, depending upon the portion of the brain
affected. The duration of the seizure is usually from
2 to 5 minutes. The person often will perform purposeless, repetitive movements such as picking at
clothing or rubbing the hands together. It is not
unusual for the individual to walk around and
he/she should be steered clear of any danger.
Any type of seizure may be preceded by an aura.
This is an unusual feeling or sensation such as disturbed vision or a peculiar taste in the mouth.
Seizures are characteristic and prevalent in persons
with suspected brain damage such as cerebral palsy,
mental retardation, learning disabilities, autism,
and traumatic head injuries.
INDICATED EXERCISE PROGRAM
Historically, physicians for persons with epilepsy
contraindicated vigorous physical exercise and
competitive/contact sports. It was assumed that
additional head trauma from contact during
sports might increase the incidence or intensity of
seizures. However, research studies have never substantiated this notion. Furthermore, since aerobic
exercise actually increases the acidity of the blood
(due to metabolic acidosis), moderate physical
activity may actually create a “buffer” against
tonic-clonic seizures. The Specialist in Exercise
Therapy should be cautioned that overfatigue may
be a factor in all types of seizures, especially complex-partial (psychomotor) epilepsy.
When selecting physical activities, consider the individual’s desire to participate and weigh it against
medical management of the condition. Well-controlled seizures usually indicate unrestricted participation in contact sports, swimming, and tumbling.
Always obtain medical clearance from a physician
before allowing the individual to participate in an
exercise program.
Close supervision is always a must, especially in any
activity involving heights or a swimming pool. If the
exercise takes place in a pool, the client must be
watched constantly.
First Aid for a Tonic-Clonic
(Grand Mal) Epileptic Seizure
•
Keep calm. The person is usually not
suffering or in danger
•
Remove person to a safe environment if
necessary, move objects, but DO NOT
restrain convulsions
•
Loosen tight clothing and protect the
person’s head from injury by placing
101
Neurological Conditions
CHAPTER 11
something soft underneath it. If s/he is
wearing a helmet with straps (or any
type of headgear with straps), remove it
completely
•
As soon as possible, turn the person on
his/her side. This position will prevent
the tongue from falling to the back of the
throat and blocking the air passage.
Having the person in a side position will
also prevent choking from vomit or
saliva
•
DO NOT PUT ANYTHING BETWEEN THE
TEETH
•
DO NOT give the person anything to
drink
•
Stand by until the person has fully
recovered consciousness and has come
out of the confusion that sometimes follows a seizure
•
Let the person rest if tired
•
It is rarely necessary to call public
authorities, a doctor, or an ambulance.
102
However, in cases of repeated or prolonged seizures (over 10 minutes of stiffening or jerking), it is suggested that
medical help be secured
•
Fill out a record of the seizure. It is
important to observe the progression of
the seizure, especially if it is a first-time
occurrence. The diagnosis of the type of
seizure can be greatly aided by your
observations. Inform the participant that
an anecdotal record was written up on
the seizure
•
If the person is injured, it may be necessary to call the paramedics. Fill out an
injury report form
•
Have blanket to cover client
•
The individual may soil himself/herself:
have something available for this eventuality
•
Clear area of other people so that when
the client comes out of the seizure there
will be minimal embarrassment and
confusion
Neurological Conditions
CHAPTER 11
PERIPHERAL VASCULAR DISEASE
(PVD)
Peripheral Vascular Disease (PVD) is really a common name shared by a
collection of vascular-related problems that involve an atherosclerotic narrowing of the vessels. PVD usually involves the occlusion or blockage of
large- to medium-sized arteries to the lower extremities by hardened fatty
plaques. PVD is usually associated with other chronic conditions like high
cholesterol (hyperlipidemia), hypertension, and diabetes. The greatest risk
factor is smoking; more than 70% of people with PVD were moderate to
heavy smokers.
Most people with PVD will experience pain during exercise because of inadequate blood flow or ischemia. The damage to the vessels prevents the necessary amount of oxygen from getting into the working muscle. The muscular
ischemia results in a painful cramping sensation (claudication) in the calves
during activity, with the feeling subsiding when the activity is stopped. The
lack of oxygen leads to excessive accumulation of lactic acid and other waste
products in the muscle, and that causes the pain. If the exercise is continued,
the buildup can eventually cause shortness of breath. If the disease progresses
so that the client cannot achieve his/her minimum target heart rate because it
elicits pain, then the target heart rate should be lowered until pain is tolerable.
(Precaution: discontinue any exercise that provokes intense pain.)
Peripheral Vascular
Disease (PVD): A collection
of vascular-related problems
that involve an atherosclerotic
narrowing of the vessels
Ischemia: Local anemia due
to mechanical obstruction
(mainly arterial narrowing) of
the blood supply
Claudication: Cramping pain
in the calves during activity.
Training should be performed in intervals, alternating periods of exercise and
periods of rest. An optimal training program of five days per week, maintaining 20 to 30 minutes of cardiovascular exercise, should be the goal. The
intensity and duration of the exercise periods can be increased as the client’s
tolerance level increases. It is useful to use a subjective pain-rating scale like the
one shown below in Table 11-3 to help patients rate their pain and become
more in tune with their condition.
Ta b l e 1 1 - 3
SCALE FOR SUBJECTIVE
RATING OF CLAUDICATION DISCOMFORT
GRADE I
Initial discomfort (established, but minimal)
GRADE II
Moderate discomfort (attention can be diverted)
GRADE III
Intense pain (attention cannot be diverted)
GRADE IV
Excruciating and unbearable pain
Remember that clients should never be allowed to work beyond a Grade
II level of discomfort.
103
Neurological Conditions
CHAPTER 11
SPINAL CORD INJURY
Spinal cord injury: Damage
to the soft neural tissue of
the spinal cord
Spinal cord injury involves damage to the soft neural tissue of the spinal
cord. Once destroyed, these nerve cells cannot be replaced. Spinal nerve fibers
are unable to cross the site of injury and reestablish communication (unlike
the peripheral nervous system). In contrast to some portions of the brain, the
spinal cord has no alternate pathways or spare nerve cells that can take over the
function of the damaged portion.
Damage to the spinal cord results in motor, sensory, and autonomic impairments. Sensory tracts (afferent) ascend through the cord and carry information from the sensory organs to the brain. If these tracts are injured, sensation
(e.g., pain, temperature, touch) is lost below the level of injury. When motor
tracts (efferent) are damaged, voluntary muscle control is lost below the level
of injury. Autonomic deficits refer to damage to tracts that innervate smooth
muscles of the body. Depending on the location and extent of damage, function of the viscera, heart, vasomotor responses, sweat glands, temperature control, bladder, and bowel may be impaired below the level of injury.
ETIOLOGY
Most traumatic injuries are associated with trauma to the bony structure of
the vertebral column (e.g., contusion, crushing/compression, dislocation, and
fracture), while many non-traumatic injuries show little or no bone involvement. Non-traumatic injuries are generally associated with pathology such as
infection, vascular disease, or degenerative disorders.
Types of Spinal Cord Injury
The degree of impairment because of spinal cord injury varies according to the
level and extent of damage. Injuries are designated as complete or incomplete.
Complete compression or transection of the spinal cord results in complete loss
of any sensory, motor, and autonomic function below the level of injury. An
incomplete injury results in a partial preservation of neurologic tracts, with any
combination of motor, sensory, and autonomic function being retained. The
prognosis will vary with incomplete injuries.
The level of the spinal cord injury is designated as the lowest nerve root segment with preserved function. For example, a person with a C-7 injury will
have preserved function in the nerve root that exists below the seventh cervical
vertebrae.
Lower Motor Neuron (LMN) Lesion: Injury occurs below the first lumbar vertebrae (L-l). It is characterized by a loss of voluntary motor/sensory function
and the presence of flaccid paralysis below the level of injury. Reflex arcs are
destroyed, preventing involuntary spasms and hypertonic muscle.
104
Neurological Conditions
CHAPTER 11
Upper Motor Neuron (UMN) Lesion: Injury
occurs at or above the 12th thoracic vertebrae (T12). It is characterized by the loss of voluntary control and the occurrence of spastic paralysis below
the level of the injury. Spastic paralysis occurs when
the reflex arc is intact below the level of injury;
therefore, uninhibited stretch reflexes cause persistent involuntary muscular contractions and
abnormally high tone.
MEDICAL COMPLICATIONS
• Spasticity (hypertonic muscle, exaggerated stretch reflexes, clonus)
•
Contractures (hip flexors and adductors,
hamstrings, plantar-flexors)
•
Orthopedic deformities (e.g., scoliosis)
•
Inability to perspire below the level of
lesion (UMN lesions)
•
Bladder infections
•
Bladder stones
•
Gastrointestinal disorders
•
Infections from catheterizations
•
Respiratory disorders
•
Autonomic dysreflexia (lesions above T-6)
•
Decubiti ulcers (pressure sores)
SPINAL NERVES AND
THEIR SOMATIC DISTRIBUTION
There are 31 pairs (right and left) of spinal nerves.
Each spinal nerve exits between two adjacent vertebrae through the intervertebral foramen. There are
eight cervical (C), twelve thoracic (T), five lumbar
(L), five sacral (S), and one coccygeal (Cx) pair of
spinal nerves. Each spinal nerve is identified
according to its exit zone (C, T, L, S, or the area. For
example, spinal nerve T-9 exits through the Cx) and
its number in intervertebral foramen formed by
thoracic vertebrae 9 and 10 (Smith, 1974). There are
eight nerves that exit the cervical spine, but only
seven cervical vertebrae. The first through the seventh nerves exit above the cervical vertebra and
above the first thoracic vertebra. The first thoracic
nerve then exits below the first thoracic vertebra.
105
Neurological Conditions
CHAPTER 11
Learning disabilities:
disorders characterized by
difficulty with certain skills
such as reading, writing, or
maintaining concentration in
individuals with normal
intelligence
LEARNING DISABILITIES
There are a myriad of theories about non-inherited brain dysfunction. Some
of the present theories include brain injury, biochemical imbalances, maturational or developmental delay of the central nervous system, and sensorimotor dysfunctions.
Minimal Brain Dysfunction: caused by damage to the brain at birth or during
prenatal and postnatal periods. Lesions or scar tissue may be present.
Neural Transmission Defects: caused by improper transmission of nerve
impulses from one neuron to another across the synapse. Depending on
the ratio of the chemicals acetycholine and cholinesterase, which are
present at the synapse, the nerve impulse may be transmitted either too
slowly or too quickly.
OTHER POSSIBLE ETIOLOGICAL FACTORS
• Prematurity, low birth rate
•
Lack of oxygen at birth
•
Artificial food additives
•
Malnutrition
•
Infections (e.g., meningitis)
•
Toxins (e.g., lead)
•
Maternal drug abuse (e.g., cocaine)
•
Food Allergies
Characteristics of Persons with
Learning Disabilities
Learning disabilities can manifest themselves in many forms. The following are
but a few of the common areas of deficiencies.
VISUAL PERCEPTION
Figure-ground: Difficulty in seeing a specific image within a competing background.
Sequencing: Difficulty seeing figures in correct order; e.g., seeing letters
reversed.
Discrimination: Difficulty seeing the differences between two similar objects,
such as the letters “c” and “e.”
Spatial awareness: Difficulty in judging distance, depth, and direction.
Ocular tracking: Difficulty in tracking a moving object with the eyes.
106
Neurological Conditions
CHAPTER 11
AUDITORY PERCEPTION
Figure-ground: Difficulty in focusing on a specific image with competing
background noise.
Memory: Difficulty remembering a sequence of instructions.
Discrimination: Difficulty hearing the differences between two sounds or
words; e.g., “then” and “than.”
OTHER CHARACTERISTICS
• Hyperactivity
•
Disorders of attention (Attention Deficit Disorder)
•
Poor self-concept
•
Impulsivity
•
Apraxia (the inability to execute coordinated, sequential movement skills)
MULTIPLE SCLEROSIS (MS)
Having the condition of Multiple Sclerosis does not mean that a person
must forego an active lifestyle. MS is a progressive condition where the
brain and spinal cord lose their protective (myelin) covering. MS affects
people most often between their 20’s and 40’s and leaves them with the
challenge of physical adaptation into later life. MS symptoms include such
factors as double vision, poor balance and coordination, spasticity, and
weakness. Many of those who have MS complain of fatigue, which is exacerbated by heat.
People with MS need to remember the following tips to achieve success in
their exercise programs.
•
Avoid overexertion
•
Avoid getting overheated
•
Listen to your body: stop or interrupt your activity at the first
sign of fatigue
•
Suspend exercise during periods of flare-ups
Multiple Sclerosis (MS): A
progressive condition where
the brain and spinal cord lose
their protective (myelin)
covering. MS symptoms
include such factors as
double vision, poor balance
and coordination, spasticity,
and weakness
BENEFITS OF AN EXERCISE PROGRAM FOR PERSONS WITH MS
• Sensible exercise programs may help to diminish spasticity
•
Exercise can sometimes reverse atrophy, if the condition has
not existed for a long time and is not too severe
107
Neurological Conditions
CHAPTER 11
Proprioceptive
neuromuscular facilitation
(PNF): Training technique
that uses muscle and neural
reflexes to augment the
training stimulus
108
INDICATED EXERCISE PROGRAM
• Proprioceptive neuromuscular facilitation (PNF) techniques
should be employed as a primary means of restoration or maintenance of function. Hold-relax or contract-relax exercises can be
used to decrease spasticity and improve range of motion. Contractures are typically found in the plantarflexors, hamstrings,
hip flexors, and hip adductors. If PNF techniques are not possible, then active or passive range of motion should be utilized.
•
Swimming is recommended if the water is cool, because active
exercises may be performed more easily and with less fatigue
than on land and the water helps prevent overheating. The individual can sit in the shallow end and perform such movements
as hip flexion, hip adduction, knee extension, knee flexion, dorsiflexion, ankle eversion, trunk flexion, and trunk extension.
•
Balance activities are a necessary common component for persons with MS. (Each person’s ability will vary.)
•
Due to balance deficits and muscular weakness (e.g., drop foot),
gait training is usually instituted. Characteristics of the MS
(ataxic) gait include a wide base of support, drop foot, and circumducted hip during swing (see chapter 15). Stationary bicycling promotes reciprocal movement and strengthens the leg
extensors. However, overheating must not occur.
Neurological Conditions
CHAPTER 11
PARKINSON’S DISEASE
Parkinson’s Disease usually occurs between the ages of 40 to 80.
Parkinson’s is caused by damage to specific regions of the brain. Symptoms
appear over a period of months to years. Parkinson’s Disease affects motor
function but not cognitive abilities. The primary characteristics include:
•
Muscle rigidity and weakness
•
Gait/walking changes, as seen in shuffling
•
Posture change, as witnessed by hunched-over posture
•
Hand tremors, present at rest
Parkinson’s Disease: Caused
by damage to specific regions
of the brain. Parkinson’s
Disease affects motor
function but not cognitive
abilities
Exercise is very helpful for persons with Parkinson’s Disease. Exercise not
only improves their physical health, it improves their emotional health. Exercise allows them to feel good about the fact that they are actively having a
positive influence on the disease. Exercise allows people to gain self-esteem,
which may lead to expanding social contacts. Many communities have
Parkinson’s support groups that provide exercise classes specifically designed
for persons with the disease.
INDICATED EXERCISE PROGRAM
• Emphasis should be placed on stretching the tight muscles
•
Focus should be placed on mild strength-training exercises
done slowly and under control, facilitating coordination and
strength
•
Always do each exercise through the complete range of motion
to keep the joint supple
•
Work on breathing exercises to keep lungs as healthy as possible
•
A well-designed and supervised water exercise program can be
helpful. Look for a class where the water is as warm as possible
to encourage flexibility and reduce spasticity
EXERCISE PRECAUTIONS
• Do not allow the client to become fatigued. Teach clients to
start slowly and listen to their body. It is OK to back off if necessary
•
Work closely with the client’s physical therapist and physician
relevant to exercise
109
Orthopedic Conditions
CHAPTER 9
C h a p t e r
1 2
ORTHOPEDIC CONDITIONS
To p i c s c o v e r e d i n t h i s c h a p t e r
ARTHRITIS
FIBROMYALGIA SYNDROME (FMS)
Chronic Pain Cycle
NECK PROBLEMS
LOW BACK PROBLEMS
The Five-Step Program to Better Posture and Less Back Pain
SHOULDER PROBLEMS
The Rotator Cuff
HIP PROBLEMS
KNEE PROBLEMS
ANKLE PROBLEMS
OSTEOPOROSIS
AMPUTATIONS
Types of Amputations
110
Orthopedic Conditions
CHAPTER 12
ARTHRITIS
More than 36 million people in the United States have some form of
arthritis. Arthritis literally means inflammation of a joint. The term arthritis
is used to describe over 100 joint/connective tissue disorders. Several of the
most common forms of arthritis are osteoarthritis, rheumatoid arthritis, and
gout. Sometimes fibromyalgia is listed as an arthritic condition.
Osteoarthritis
Osteoarthritis is caused by the breakdown of the smooth hyaline cartilage
inside the joint. Without a smooth articulating surface movement in or
about the joint, it becomes painful. Osteoarthritis is commonly referred to as
the wear-and-tear arthritis because it is frequently seen in the weight-bearing
joints such as the knees, hips, ankles, and spine. The prognosis is usually
good; the condition progresses slowly and usually is not crippling. The usage
of medications and gentle exercise is very helpful. (Osteoarthritis is a less
severe inflammatory condition than rheumatoid arthritis.)
Rheumatoid Arthritis (RA)
Rheumatoid arthritis is a systemic autoimmune condition. RA often begins
before the age of 40. Symptoms include fatigue, tenderness on or around
joints, inflammation, pain, stiffness, and swelling. This condition follows an
unpredictable course of exacerbations and remissions. Many persons with
RA notice a loss in appetite, sometimes fever, as well as the development of
rheumatoid nodules under the skin. This condition entails much more than
simple joint pain; it is much more like a chronic illness.
Gout
Gout is caused by a metabolic disorder that allows uric acid to accumulate in
the blood. Crystals of uric acid are deposited within the joints, causing
inflammation. The most common site is the big toe, but other joints can be
affected. Gout is very painful. People used to believe that only the affluent, like
kings and queens, suffered from this condition; unfortunately, that is simply
not true.
Arthritis: Inflammation of a
joint or a state characterized
by inflammation of joints
Osteoarthritis: Arthritis
characterized by the erosion
of articular cartilage, which
becomes thin and soft; pain
and loss of function may
occur, mainly affects weightbearing joints, is more
common in overweight and
older persons
Rheumatoid Arthritis (RA):
A disease of the immune
system where the immune
system attacks the body’s
own healthy cells, mistaking
them for cells that don’t
belong causing inflammation
in the lining and connective
tissues of the joints
Gout: A purine metabolic
disorder that allows uric acid
to accumulate in the blood.
Crystals of sodium urate are
deposited within connective
tissues and articular
cartilage, causing
inflammation
No matter what type of arthritis your client has, one of the major problems
is combating the chronic pain cycle. When moving a joint causes pain, there
is a tendency to not move the joint. This causes more stiffness and weakness,
which ultimately leads to less ability and desire to move and, consequently,
more disability. This downward cycle must be broken, and sensible exercise
is a major component in reversing this cycle! Today, most enlightened therapists and doctors recognize the importance of sensible and regular exercise
in the care of arthritis. Research now shows that if you can increase the
strength of muscles around the affected joint, these muscles will aid in supporting the load placed on that joint.
111
Orthopedic Conditions
CHAPTER 12
TA B L E 1 2 - 1
CLINICAL AND LABORATORY DIFFERENCES BETWEEN
RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS
Rheumatoid Arthritis
Osteoarthritis
Occurs at any age, onset is more often in young
and middle-aged persons.
Usually occurs after age 45
Systemic illness
Local joint disorder
Undernutrition common
Overweight usual
Many joints involved
One of just a few joints are involved
Involvement often symmetrical; may affect any (and some- Involvement often asymmetrical; commonly affects knees,
times all) joints. In the hand, characteristically affects prox- hips, spine, and hands
imal interphalangeal joints
Diffuse inflammatory swelling
Diffuse inflammatory swelling
Fibrous nodules present in 15% to 20% of cases
Nodules are absent
Anemia common
Anemia usually absent
Anemia: Any condition in
which the number or red
blood cells per cu mm are
less than normal
REASONS EXERCISE IS IMPORTANT FOR PEOPLE
WITH ARTHRITIS
• Increases strength and flexibility around joints
•
Helps maintain or increase bone strength
•
Provides nourishment and lubrication to joints
•
Prevents disuse syndrome
•
Provides feelings of control and self-worth
HOW OFTEN AND WHEN SHOULD EXERCISE BE PERFORMED?
• On a daily basis
•
When there is the least amount of pain and stiffness
•
When the individual is least tired
•
When the individual receives the maximum benefit from medications during the day (generally 10:00 to 11:00 a.m.). However,
instruct client to not over-medicate to mask pain
Important: Prepare for exercise by thermally warming up the body: use massage, heating pad, warm shower, or gently rhythmic movements.
112
Orthopedic Conditions
CHAPTER 12
PRECAUTIONS
• Find out what type of arthritis client has
•
Minimize stress to joints. Learn about
appropriate activities such as swimming, water exercise, and walking
•
Avoid vigorously exercising an inflamed
joint; rather, gently put joint through
range of motion
•
Do not allow client to increase medications without physician’s approval
•
Have client wear warm clothes and peel
off layers
•
Modify the exercise routine depending
on how clients feel
CONTRAINDICATIONS
• Avoid positions of extreme weightbearing flexion or hyperextension
•
Avoid jarring movements or quick directional changes
•
Never exercise a “hot” joint
•
Never allow client to mask pain with
medication
INDICATED EXERCISE PROGRAM
For persons with osteoarthritis, proper body weight
is paramount. Obesity accelerates the damage to
diseased weight-bearing joints; thus a program of
either walking, water exercise, or mild stationary
biking, in combination with limiting the intake of
food can help facilitate the goal of losing weight.
Teach proper body mechanics.
Researchers, therapists, and doctors now realize that
exercise plays an important role in the health of
people with arthritis.
THE GOALS OF AN EXERCISE
PROGRAM FOR PEOPLE WITH
ARTHRITIS SHOULD INCLUDE:
• Use non-weight-bearing activities like
swimming, water exercise, chair series,
and stationary biking
•
Always do a thermal warm-up for 5 to 10
minutes prior to exercising, and always
stretch at the end of the program for 5 to
10 minutes
•
Do exercises that improve functional fitness, e.g., chair squat/leg curb squats
•
Don’t ‘make’ pain; always follow sound
biomechanical techniques. Listen to
your body. If you hurt, don’t quit; just
back off!
113
Orthopedic Conditions
CHAPTER 12
Fibromyalgia Syndrome
(FMS): FMS is a chronic and
often disabling condition,
characterized by widespread
body pain and severe fatigue
FIBROMYALGIA SYNDROME (FMS)
FMS is a chronic and often disabling condition, characterized by widespread
body pain and severe fatigue. Many times it is accompanied by other problems
such as irritable bowel, headache, and sleep difficulties. Other conditions that
many times are grouped into this same category are chronic fatigue syndrome
and myofasical pain. Persons with fibromyalgia suffer from chronic pain that
is often very debilitating. A person suffering from chronic pain not only suffers from the pain itself, but also psychologically. Loss of self-esteem, which
leads to depression and isolation, often triggers more pain that leads to further
disability; a vicious downward spiral of pain and disability.
Chronic Pain Cycle
For exercise to be effective for persons with chronic muscle pain, these persons
must first recognize that proper exercise is critical to maintain adequate
strength and mobility, in order to function more fully. As good as that sounds,
a person with chronic pain is often afraid to exercise, for fear that the pain will
be exacerbated. The first key to a sensible exercise program is to start very, very
slowly! If the person can do minimal exercise without significantly increasing
the pain level, that is real progress.
INDICATED EXERCISE PROGRAM FOR FMS
• A person with any chronic painful condition must be active in
his/her own care. The more time and effort clients take to learn
how they react to exercise; the better will be their progress.
Clients need to learn to listen to their body and heed what it says.
114
•
Learn and maintain proper body mechanics. Using proper body
mechanics while performing activities will help to prevent further pain.
•
Learn to relax periodically throughout the day. This will help to
break the cycle of muscle tension that often increases the pain
level.
•
Stretch often to keep muscles supple and flexible.
•
Increase the client’s aerobic fitness. Use low- or no-impact activities such as walking or even strolling at first, and then increase
the pace, as the person feels better. Stationary biking is useful—
many people like recumbent bikes because they can sit and be
more comfortable. Swimming and water exercise are also good
ways to get fit! (Try to find a warm therapeutic pool). Always
stretch after the exercise session.
•
Learn techniques to manage pain such as heat, ice, or whirlpool
baths. Therapists may employ such things as electrical stimulation and ultrasound. The client should not purchase over-thecounter devices without the physician’s approval.
Orthopedic Conditions
CHAPTER 12
tions of the neck. Many times a conservative
approach of exercises and improved body
mechanics, along with heat packs and the client’s
physician’s recommendations can result in significant improvement.
CONTRAINDICATIONS
People with neck problems should avoid movements that hyperextend the neck and thus aggravate
neck problems that can further cause impingement
of the neck arteries that supply blood to the brain.
Reducing blood flow to the brain can result in
serious problems.
Activities To Avoid
•
•
Stay as fit as possible. Research shows
that conditioning muscles through mild
to moderate aerobic exercise improves
the symptoms of FMS. Of course, start
very slowly! Start with a 1 to 3-minute
walk followed by 1 to 3 minutes of
stretching. If the pain is tolerable, then
add 2 to 5 minutes each week of additional walking and continue to progress
slowly until you can do three bouts of
10 minutes, with the goal of 30 minutes
of non-stop walking.
Set clients up to be successful. Establish goals that they can achieve and
when they surpass them, it will improve
their self-esteem.
•
Don’t ever overdo it!
•
Don’t mask pain with pills and drugs.
NECK PROBLEMS
Many adults experience a loss in flexibility of the
neck as they age. Often, neck pain is the result of
poor body mechanics, whether seated or lying.
Other neck problems result from arthritis of the
upper spine or disc problems. Home exercise programs are a critical component for persons with
cervical strains and other musculoskeletal condi-
•
Fast or jerky neck movements—never do
these!
•
Sitting with head too far forward
•
Lying down on the sofa or bed with your
head propped up high on the pillow
•
Head circles
RECOMMENDATIONS
• Always follow your physician’s advice
•
Try doing your gentle range-of-motion
exercises in the shower or with warm,
moist towels around your neck
•
Start very, very slowly
•
When sitting, sit up straight periodically
or get up and walk around
•
Always avoid the ‘turtleneck’ position
with head forward
INDICATED EXERCISE PROGRAM
• Turn head left to right
•
Empire State Building Watch—look up
and down
•
Shoulder Blade Squeeze—pull shoulder
blades together and hold and repeat
•
Head tilts—tilt head from left to right
•
Shrug shoulders and make circles backwards
115
Orthopedic Conditions
CHAPTER 12
LOW-BACK PROBLEMS
A sound exercise program is designed to provide
support and strength to the spine and to develop a
better awareness of proper body mechanics. Trunk
stabilization is essential for preventing injury to the
lower back while performing any movement or
daily activity. Many of these exercises are also suggested for any person who is recovering from a back
injury. Always begin these exercises slowly and carefully, i.e., begin by holding for a count of five,
allowing the muscles to loosen up gradually. Don’t
be alarmed if the exercises cause some mild discomfort, which lasts a few minutes. However, stop doing
any exercise that causes pain until you have checked
with your doctor.
TIPS TO REMEMBER
(find out if client has flexion bias or extension bias)
had a backache is ten times more likely to have
another episode. Therefore, an exercise program
that includes flexibility exercises, general overall
conditioning, and abdominal strengthening, along
with conditioning of the muscles that stabilize the
low-back area, is critical!
There are many causes of back pain, from tumors
and disc ruptures to poor body mechanics to facet
joint problems, not to mention muscle spasms.
Before starting any exercise program, it is wise to
consult the client’s physician for a proper diagnosis
and specific exercise recommendations.
If client experiences leg pain and backache, along
with the following, see a physician immediately:
•
High fever
•
Loss of bowel and bladder function
•
Rapid weight loss
•
Back pain lasting more than three days
•
Numbness in the pelvis and extreme
weakness in the leg
•
Stand with weight evenly distributed
over left and right feet
•
Stand with weight evenly distributed
over front and back of feet
•
Stand with head back and chin parallel
to floor
•
Stand with slightly bent knees (do not
lock knees)
•
Stand with firm abdominal muscle support
•
Have knees higher than hips when sitting
•
Squeeze fanny
•
Move the driver’s seat closer to steering
wheel
•
Tighten abdominal muscles whenever
you are about to lift anything
•
Never bend at the waist and lift—rather,
bend at hip hinge joint
•
Do flexibility exercises daily
•
Do back exercises regularly
•
Never twist forcefully!
•
Push, don’t pull—better yet, ask for help!
•
Strengthen core muscles of torso
If you live long enough, you are likely to suffer
from some form of back problem. Over 80% of
Americans have experienced backache. Back problems rank second to the common cold for time loss
from work.
Dr. Herring of the Puget Sound Sports & Rehabilitative Center believes that only about 1% of patients
with back problems require surgery. For the other
99% of us with chronic lower-back problems, this
means that sensible exercise and proper body
mechanics could lessen our pain. A person who has
116
COMMON SENSE
WAYS TO REDUCE BACK PAIN
• Make sure home and car are set up to
minimize further pain
Orthopedic Conditions
CHAPTER 12
TA B L E 1 2 - 2
THE FIVE-STEP PROGRAM TO BETTER POSTURE AND LESS BACK PAIN
TEACH YOUR CLIENT TO STAND WITH PERFECT SPINE POSITION.
HAVE THE CLIENT:
1. Stand with weight evenly distributed over the balls of the feet
2. Then straighten and bend your knees until you find the most comfortable position for the knees
3. Now move your hips forward and backward until your back feels its best
4. Now stand up straight and put your head back: don’t look up!
5. Reassess. If you are now standing straight and more weight is on your heels, you are leaning too far back. If you are
feeling the weight on your forefoot, you are leaning too far forward. Readjust your posture! Practice standing against
the wall.
Postural Self Check: Walk backward to the wall. If your fanny touches the wall and your upper back
touches much later, you are leaning too far forward. If your upper back touches first, you are leaning
too far back. Ideally, the fanny touches first then about one to two seconds later, the upper back and
then your head should touch.
>
>
>
>
>
Figure 12-1 Postural Self Check
117
Orthopedic Conditions
CHAPTER 12
SHOULDER PROBLEMS
The design of the shoulder is remarkable: it allows
baseball pitchers to throw baseballs at 90 mph, it
allows us to reach and grab things high or low, as
well as to hug our loved ones. Shoulder problems
can be the result of many different causes, such as
osteoarthritis, trauma, bursitis, tendonitis, or may
even be idiopathic (i.e., no known cause). Many
times the corrective exercises are the same, regardless of the cause. Prior to doing these exercises,
make sure that the physician has approved them.
The Rotator Cuff
The shoulder is a ball-and-socket joint much like
the hip joint, except that the hip joint is a much
deeper joint and thereby provides a lot more support, although with more limited mobility. The
shoulder joint is a flatter and smaller joint. If you
can visualize a golf tee with a golf ball on it, you
begin to sense the design of the shoulder joint.
While this design affords us a great deal of movement, we pay the price for it with a joint that is at
risk for misuse and abuse. Spring is the time of year
you begin to hear a lot about shoulder problems—
baseball is in full swing (pun intended), folks are
returning to lap swimming, and recreational tennis
players are doing all those overhead smashes.
Some experts believe that when you move your arm,
as many as 26 muscles are engaged in the movement.
Go to any gym and you will see men and women
doing all kinds of overhead presses to build up the
‘show’ muscles. However, they often neglect the very
important SITS muscles. The rotator cuff musculature is made up of these SITS muscles. Research suggests that the rotator cuff muscles display the
greatest electrical activity during the eccentric phase
of the follow-through of major arm movements.
S
I
T
S
Figure 12-2 The “SITS” Muscles
Orthopedic Conditions
CHAPTER 12
CAUSES OF ROTATOR CUFF INJURIES
Three major contributors to rotator cuff problems
are described below:
• Age: The risk for a rotator cuff injury
increases with age. Normal wear and
tear, an increase in calcium deposits
within the joint, and bone spurs can irritate the rotator cuff.
• Trauma: An injury to the shoulder—
whether it is from a fall or any other kind
of trauma—is another source of problems for the shoulder joint.
• Overhead activities: The outcome is likely
to be the same whether the excessive
overhead activity stems from playing
too much tennis or simply from lifting
too many boxes—which leads me to a
major pet peeve. After observing
numerous water exercise classes, I
noticed a lot of overhead movements
and activities that involve bringing the
arms out from under the water. If you
include a lot of these movements in your
water exercise classes, please ask yourself, “Why am I emphasizing this movement? Is it the safest and most effective
movement for the shoulder joint?” A
participant whose trainer frequently conducts these moves might well ask, “Why
am I doing so much out-of-water activity
when I signed up to be in a water-conditioning class?”
Corrective Exercises
After a trained medical professional has made a
diagnosis and has given your client permission to
exercise, the following exercises might be appropriate. Many times, rest is the best thing for your
client to do for the first couple of days. However,
remind him/her not to allow the joint to freeze up.
Six basic shoulder exercises are described below:
THE V SODA CAN LIFT
Starting Position: Stand erect with arms alongside
the body.
Movement: Then, as if holding a soda can with the
thumbs facing down, slowly lift the arms outwards
as if pouring the soda on the floor. Raise the arms to
the height of the shoulders with hands slightly
behind the back.
INTERNAL ROTATOR
Starting Position: Stand erect with the elbow bent,
the elbow and upper arm against the body, and the
hand straight ahead.
Movement: Then slowly allow the hand to move
toward the abdomen. As the client improves, resistance can be added (via a hand paddle in the pool or
an elastic exercise band on land).
EXTERNAL ROTATOR
Starting Position: Have the client stand as in the
internal rotator exercise just described.
Movement: Assume the same basic position, except
this time slowly allow the hand to move outward
and then return to the starting position.
FORWARD CANE LIFT
Starting Position: Standing upright with optimal
posture, use both hands to hold onto a towel or
broom handle. (The towel should be in a horizontal
position across the front of the body; the hands
should be placed a comfortable distance apart with
the palms up).
Movement: Slowly lift the arms as high as possible
without arching the back or causing pain. Then
return to starting position.
REAR CANE LIFT
Starting Position: Standing erect, hold onto a dowel
or broom handle behind the buttocks.
Movement: Straighten both arms and very slowly
lift them as far away from the buttocks as is possible
to do comfortably.
CHOKER STRETCH
Starting Position: Stand erect with the arms out at
90˚ angle to the body.
Movement: Gently pull the arm across the front of
the body until a pleasant stretch is felt in the back of
the arm and in the shoulder muscles.
119
Orthopedic Conditions
CHAPTER 12
HIP PROBLEMS
The hip joint is the workhorse of the lower body,
and while it is able to move in many different directions, it is also designed for bearing weight. The hip
joint is referred to as a ball-and-socket joint. The
joint structure is built for stability, and it gains
additional stability from the muscles positioned in
that area.
Hip problems are caused by unequal leg lengths,
hip muscle imbalances, and poor body mechanics,
as well as by the cumulative effects of overuse,
misuse, and arthritis. Many adults who have suffered from pain and disability may opt for a total
hip replacement after more conservative
approaches have failed. As with all exercises, it is
prudent to always have the physician and/or physical therapist know what exercises you have
planned and give you their approval and input,
especially after hip-replacement surgery.
CONTRAINDICATIONS
• Avoid full flexion, i.e., deep squats or
pulling knee to the chest
•
Avoid crossing legs when exercising or
moving either leg past mid-line
RECOMMENDATIONS
• Because a tight musculature is often
implicated in hip problems, a gentle
stretching and flexibility program would
be prudent
•
Avoid high-impact activities
•
A well-designed water exercise program
would be useful
make sure that these exercises are appropriate for
your client’s specific condition. If your client has
been told to wear a knee brace, make sure she/he has
it on when exercising.
CONTRAINDICATIONS
• Never go past a safe range of motion
•
Do not use additional medication to
mask the pain
•
Do not sit with knee bent underneath
you. Try to sit with the knee almost
straight whenever possible
•
Avoid squatting, kneeling and stair
climbing whenever possible
RECOMMENDATIONS
For people who have pain around the knee, it is
important to keep the thigh muscles as strong as
possible.
•
Be faithful to and regular with the exercise program and your joint will say,
“Thank-you!”
•
Do gentle range of motion exercises
within your safe range
•
Avoid full squats
•
Use ice when appropriate
•
If pain increases significantly, speak with
physician and rest the joint until advised
to go resume the exercise
•
Don’t ‘make’ pain
INDICATED EXERCISE PROGRAM
• Quad setting
•
Wall squats
KNEE PROBLEMS
•
Halfway-down chair squats
Knee problems are common in adults. The causes
are many and range from rheumatoid arthritis,
osteoarthritis, chondromalacia patellae, and joint
trauma to joint replacement and reconstructive surgery of the knee. If the client is recovering from
knee surgery, be sure to check with the physician to
•
Closed-knee extension
•
Terminal leg extension
•
Seated leg extension (with permission)
•
Forward lunges with knee over foot
•
Leg curls
120
Orthopedic Conditions
CHAPTER 12
ANKLE PROBLEMS
Ankle sprains are very common. Ankle sprains
occur when a ligament connecting the bones or cartilage of the ankle is ruptured or torn.
Factors that contribute to ankle problems are:
The two keys to improving your ankle health are:
•
Maintain and improve range of motion
•
Improve
strength
and
endurance of the ankle joint
muscular
INDICATED EXERCISE PROGRAM
• Heel cord stretch
•
Previous injury
•
Weak or imbalanced muscles
•
Seated gas pedal
•
Inappropriate/worn-out shoes
•
Seated ankle circles
•
Walking on uneven surfaces
•
Seated foot inward/outward
•
Being overweight
•
Elastic hard gas pedal
•
History of weak/unstable ankles
•
Elastic hard foot inward/outward
Figure 12-3 Ligaments of the ankle
121
Orthopedic Conditions
CHAPTER 12
OSTEOPOROSIS
Some of the leading causes of osteoporosis include
family history, lack of regular weight-bearing exercises, inadequate calcium and vitamin D, and low
levels of estrogen following menopause. Osteoporosis is a loss of normal bone-density mass,
which leads to increased porosity of the bone,
which in turn makes the bone more vulnerable to
fractures. Osteoporosis is more common in
women, but does affect men later in life. Women
who smoke and/or are thin and have fair complexions are more susceptible.
If you suspect that your client has
osteoporosis, alert him/her to the following:
•
Avoid caffeine
•
Avoid quick twisting movements
•
Avoid poor posture
standing, and lifting
•
Be careful of drugs that cause you to get
dizzy or that could cause you to fall
•
Get involved in a safe exercise program,
especially including weight bearing
when
sitting,
Topics for the client
to discuss with the physician:
•
Discuss whether calcium supplements
would be helpful
•
Avoid all situations that could possibly
lead to a fall
•
•
Get rid of throw rugs and light up dark
hallways to prevent falls
Ask if hormone replacement therapy
would be useful
•
•
Quit smoking and drinking an excessive
amount of soft drinks
What type of exercise is the client
cleared to begin?
•
Does client need a bone scan?
122
Orthopedic Conditions
CHAPTER 12
INDICATED EXERCISE PROGRAM
• Start a slow-walking program. If unstable, try stationary biking
or using a cane while walking
•
Strengthen the muscles of the upper back and stretch the chest
muscles. A recent study showed that by doing strength and
flexibility exercises, the effects of the ‘dowager’s hump’ were
diminished (See Strength Section)
• Swimming and water exercise are good for cardiovascular
exercise, but the verdict is still out as to whether these really
increase bone density. A study at the Jewish Hospital in Israel
showed that water exercise, not swimming, did improve bone
density, but until more research confirms that fact, be sure to
combine water exercise with regular walking to increase bone
density. Be careful when in the locker room or around the
pool, not to slip and fall
•
Do not bend over to lift anything. This places undue stress on
the bones of the lower back. Instead, bend the knees when
lifting
•
Start doing some basic strength-training exercises
AMPUTATIONS
Amputation refers to the loss of an upper or lower extremity. The term
includes both acquired and congenital limb losses.
ETIOLOGY
• Trauma
•
Peripheral vascular disease
•
Diabetes
•
Frostbite
•
Chronic infection of bone
•
Tumor
•
Congenital deformity where existing limb is not capable of
functioning properly
The phantom limb syndrome is a frequent complaint of the person with
an amputation. This syndrome refers to the persistent awareness of the
removed limb. This pain may occur shortly after trauma or surgery. Generally, these sensations are temporary, becoming less common once a prosthesis is applied.
Amputation: The loss of an
upper or lower extremity. The
term includes both acquired
and congenital limb losses
Phantom limb syndrome:
The persistent awareness of
the removed limb
123
Orthopedic Conditions
CHAPTER 12
TA B L E 1 2 - 3
TYPES OF AMPUTATIONS
(ACCORDING TO THE SITE AND LEVEL OF LOSS)
CONGENITAL ABSENCES
(OCCURRING AT OR BEFORE BIRTH)
AMPUTATION LEVEL
Amelia (terminal transverse)
Shoulder Disarticulation
Hemimelia (terminal transverse)
Above the elbow (AE)
Partial hemimelia
Below the elbow (BE)
Acheiria (congenital absence of the hands) Wrist disarticulation;
Trans-metacarpal amputation
Amelia (terminal transverse)
Hip disarticulation
Hemimelia (terminal transverse)
Above the knee (AK)
Partial hemimelia
Below the knee (BK)
Apodi (congenital absence of feet)
Syme amputation
Adactylia (congenital absence of fingers or Trans-metatarsal amputation
toes)
Hemimelia denotes one-half of a limb. Amelia refers to total absence of a
limb.
Prosthesis: Fabricated
substitute for a diseased or
missing part of the body
INDICATED EXERCISE PROGRAM
The initial rehabilitation program for a person with an amputation consists of
training in the use of the prosthesis. For the person with a lower-extremity
amputation this includes:
•
Balance activities
•
Ambulation
•
Pivoting
•
Stair climbing
•
How to fall to and rise from the ground
After this stage, the exercise treatment should develop strength and endurance
in both the impaired and normal extremities. Manual resistance would be
employed for strengthening the stump.
124
Orthopedic Conditions
CHAPTER 12
The aerobic capacity of the person should be maintained as much as possible. Swimming is an excellent
aerobic choice for even the person with a bilateral
BK. Swim fins may be attached to the stumps by special prosthesis. (If swimming, have a platform avail-
able that the person can hang onto if he/she becomes
fatigued.) Arm crank ergometry may be another
choice for those with limited weight-bearing capabilities. Some persons may use the leg cycle
ergometer while wearing their prostheses.
125
Sensory Impairments
CHAPTER 10
C h a p t e r
1 3
SENSORY IMPAIRMENTS
To p i c s c o v e r e d i n t h i s c h a p t e r
AUDITORY DISORDERS
VISUAL IMPAIRMENTS
126
Sensory Impairments
CHAPTER 13
To be an effective educator of adults, it is important
to understand the pathology of your clients’ special
conditions. However, it can be even more important
to know how to teach and convey essential information to your clients. This is ever so evident when
teaching the client who has difficulty hearing or
seeing you.
AUDITORY DISORDERS
Auditory, or hearing, disorders may result in loss of
amplitude (decibels) and pitch (hertz). The term
‘deaf ’ signifies that speech cannot be heard even
through amplification. Total deafness is rare. However, hearing disorders are one of the most common
chronic physical impairments in the United States.
SPECTRUM OF
HEARING IMPAIRMENTS
30 to 40
dB loss
40 to 60
dB loss
SEVERE
Use pictures and charts to reinforce
demonstrations
•
Do not exaggerate or raise voice when
speaking to someone with a hearing aid.
•
Remind clients to remove hearing aids
during water activities
•
Encourage clients to keep a spare battery handy
•
If balance dysfunction exists, be mindful
of that fact when doing activities
requiring balance
•
Teach principles of equilibrium
VISUAL IMPAIRMENTS
Most individuals who are described as ‘blind’ can
see some level of light or gray. Generally, they do not
live in total darkness.
TA B L E 1 3 - 1
MARGINAL MODERATE
•
PROFOUND
60 to 75
dB loss
75 +
dB loss
CHARACTERISTICS OF PERSONS WITH
AUDITORY IMPAIRMENTS
Balance (static or dynamic) problems are seen in
people who have hearing difficulties when there
exists a sensorineural (inner ear) loss. However, the
person may compensate through the use of visual
and kinesthetic cues.
TEACHING STRATEGIES
• Do not have clients face into the sun
when you are instructing
•
Do not talk while facing away from
clients
•
Keep hands away from your face
•
Use visual cues to get clients’ attention
during activities
All definitions of visual impairments refer to how
well the individual can see even with the best of corrective lenses. Normal vision is technically referred
to as 20/20. This numerical ratio is interpreted as
the ability to see at 20 feet what the normal eye can
see at 20 feet. A person is considered partially
sighted or visually impaired if visual acuity is 20/70
or worse with correction—interpreted as needing
an object to be 20 feet away to see what the normal
eye can see at a distance of 70 feet. Visual acuity is
measured with a Snellen Chart (lines of letters
which become smaller with each line). Over 75% of
persons with visual impairments in the United
States have some usable vision.
Visual impairments take many forms. Some individuals may see a tiny portion or spot of the visual field
and even though the spot of vision is 20/20, they may
be considered legally blind. Terms like ‘fuzzy vision’,
‘peripheral vision’, and ‘tunnel vision’ make the
description of visual impairment difficult to understand. The amounts of light and contrast in the environment influence visual ability in persons with
impairments. Thus, for example, a person may not
need a guide during daylight hours because contrasts
are sufficient to permit independent movement.
127
Sensory Impairments
CHAPTER 13
Most visually impaired individuals can perform
most activities once they are oriented to the
facility. Some visually impaired people swim, golf,
lift weights, ride tandem bikes, etc., as long as they
do not have any other issues to contend with.
ETIOLOGY
Macula Degeneration: The macula is located in the
central portion of the retina. Degeneration affects
central vision, but the person maintains good
peripheral vision. Usually this condition does not
progress to total blindness.
Glaucoma: Excessive high pressure within the eyeball, creating tunnel vision.
Cataracts: A clouding of the cornea. The incidence
of blindness from cataracts has decreased due to
surgical techniques.
Retinitis Pigmentosa: An inherited condition in
which the rod-shaped cells in the retina degenerate.
This disorder leads to total blindness.
Diabetic Retinopathy: Because diabetes can induce
vascular changes, the retina is particularly susceptible to hemorrhage, scarring, and loss of vision.
Stroke: Blindness can be caused by lack of blood
supply to the visual cortex located in the occipital
lobe. Blindness occasionally occurs in stroke cases
where the person is only capable of seeing out of
one side of each eye (hemianopsia).
Refractory Errors: This includes farsightedness,
nearsightedness, and astigmatism.
Other Causes: Blindness can be a result of venereal
disease, the aging process, trauma causing detached
retina, tumors, or exposure to bright light (e.g., sun,
welding light).
CHARACTERISTICS
The functional ability of a person who is blind or
visually impaired varies, depending upon age of
onset and whether the impairment is total or partial. A person who is visually impaired or has some
perception of form and light may be completely
128
independent with full use of his/her other senses.
With proper training in the use of Braille, large type
books, tape recorders, new technological equipment
and good mobility skills, individuals who are blind
can be as functionally independent as their community will allow. Individuals who are blind and have
been totally blind since birth do not have any visual
memory and therefore learn to use their intact
senses to perceive what others see. Some individuals
with visual impairments may display mannerisms
such as eye poking or rocking, usually due to a need
for physical stimulation.
TECHNIQUES FOR GUIDING A PERSON
WITH VISUAL IMPAIRMENT
Making contact: Lightly brush forearms with the
person so he/she can find the back of your arm,
proximal to the elbow. Keep you elbow flexed to 90
degrees. This position enables the person to be at
your side but about a half-step behind.
Familiarize the person to the environment. When
you give directions, give them according to the way
the person is facing—left or right. When entering a
room, indicate number of people present, size of
room, and general description.
Pause before any stairs or curbs. Describe the
height of the step up or down.
When approaching a door, inform the person
whether the door will swing “toward” or “away”
from him/her and if it opens to the right or left.
Swing the door open as far as possible and lead the
person through before it swings shut.
When seating, deposit the person at the back of the
chair and allow him/her to seat himself/herself.
Alternate method: back person up into the seat
until the calves touch.
If going through a narrow passageway, keep your
elbow flexed, but internally rotate your shoulder,
placing your arm behind your back. The person
will then slide the hand from the back of your bicep
to the middle of the forearm and step directly
behind you.
Sensory Impairments
CHAPTER 13
INDICATED EXERCISE PROGRAM
It is recommended that each person with visual
impairments have a medical verification completed
by an ophthalmologist. These doctors have differing
philosophies regarding physical activities for persons with visual impairments (e.g., bending over
during exercise, putting the face in the water when
swimming). Therefore, a phone call to the attending
eye care specialist would be useful, especially in the
case of diabetic retinopathy.
The mode of exercise may vary depending on the
degree of vision remaining and risk of injury to the
eye. If an individual has no functional vision,
his/her choice of physical activities may actually
expand without fear of further deterioration or
aggravation of injury.
Encourage Cardiovascular Exercise: The person
with visual impairments rarely gets an opportunity
to engage in aerobic activities due to the amount of
supervision or guiding required and thus generally
suffer from low endurance. Utilize stationary
cycling, low intensity rowing on a rowing machine,
tandem cycling, folk and square dancing, aerobic
dance, swimming, and jogging. If an indoor track is
available, a guide wire can assist with walking or
running. On an outdoor track, a sighted guide can
assist with walking or jogging by simply touching
forearms occasionally as the two move side by side;
another method is to extend a short rope between
the two persons to maintain contact and control.
Swimming is an ideal activity because it builds
strength and cardiovascular endurance while
requiring minimal assistance from a partner. Swimming is easily adaptable as buoys and rope lanes
prevent an individual from straying out of a lane
while swimming laps. A “bonker” (a soft sponge ball
attached to a long wooden dowel) may be used to
tap the swimmer on the head and signal the edge of
the pool and end of a lap.
Develop individual sport activities and leisure
skill that have lifelong, carry–over value. Because
of equipment adaptations in sports such as archery,
persons with visual impairments are able to
recreate and compete alongside sighted persons.
Teaching adaptations have also broadened sports
participation by persons with visual impairments;
for example, snow skiing may be accomplished
through sighted guide and auditory input. Folk
dancing may be performed by mingling sighted
partners with nonsighted partners. Circle formations are especially helpful in providing spatial orientation during these dance steps.
Postural exercises may need to be prescribed for
lordosis and kyphosis. These will be prescribed by
their attending physician and/ or physical therapist.
Goal ball, a modified form of soccer played while
positioned on the hands and knees, is a very popular sport created for athletes with visual impairments. It is played in an indoor gymnasium with
two teams and an audible ball. National competitions are held each year.
A person desiring to participate in competitive sports
for athletes with visual impairments should write to
the United States Association for Blind Athletes, 33
N. Institute Street, Brown Hall, Suite 015, Colorado
Springs, CO 80903, for membership information and
the yearly calendar for track and field, goal ball, snow
skiing, and archery competitions.
129
Sensory Impairments
CHAPTER 10
C h a p t e r
1 4
OTHER HEALTH CONDITIONS
To p i c s c o v e r e d i n t h i s c h a p t e r
HIV/AIDS
CANCER
PREGNANCY
130
Other Health Conditions
CHAPTER 14
HIV/AIDS
You might associate HIV/AIDS with young people;
unfortunately more and more older people are getting the disease. Although AIDS remains an incurable disease, medical advancements have allowed
people to live longer and with fewer symptoms.
There are three stages of this disease:
Stage I – During this period the body produces
detectable levels of HIV antibodies.
Stage II - This stage begins with the early symptomatic HIV infections referred to ARC, (Aids Related
Complex)
Stage III – This stage signifies late stage HIV or fullblown AIDS.
For more information about the stages of AIDS
consult:
Centers for Disease Control
www.cdc.gov/hiv
TIPS:
• Avoid contact with body fluids
•
Do not cause fatigue
•
Work closely with client to be aware of
the effects of medications on exercise
and clients health
Sample Exercise Program
Indicated Exercise Program
Numerous studies have shown that regular mild to
moderate exercise increases and or maintains T cell
production and CD4 cells. Progressive resistance
exercise maintains lean body mass. Studies showed
that individuals diagnosed with full blown AIDS
who participated in a progressive resistance exercise
program lived approximately 6 months longer than
those who lost 10% of their body weight.
Contraindications to Exercise
•
Intense exercise, since it is associated
with a depression of immune function
should be avoided!
•
Swollen joints
•
Vomiting
•
Open sores
•
Severe dizziness
Stage I – Client
F = frequency (3 to 5 days/week)
I = intensity (50% to 60%)
T = time (20 to 30 minutes at gradual progression)
Stage II – Client
F = frequency (3 to 4 days/week)
I = intensity (50% to 60%)
T = time (15 to 20 minutes)
Stage III – Client
F = frequency (2 to 3 weeks if possible)
I = intensity (as tolerated)
T = time (break bouts into tolerated increments)
131
Other Health Conditions
CHAPTER 14
CANCER
Cancer is a very general term that refers to more
than 100 different types, each with its own characteristics and recommendation. This section is an
overview, however each client must be evaluated
and treated individually. At this juncture there are
no standard exercise recommendations, other than
to progress slowly and treat each client as an individual who will have good and bad days emotionally and physically.
If the client is recovering from surgery have them
consult the surgeon and therapist for recommendations. It was not until recently that physicians
advised cancer clients to engage in physical activity.
Research has shown that too much rest is deleterious to the client, thus making a simple activity of
daily living more and more difficult, due to the fact
that their body is deconditioning.
Contraindications to Exercise
are diagnosed with cancer. Studies have shown that
the immune system is improved for clients engaged
in physical activity. Research shows that quality of
life, self-efficacy and decreased anxiety are by-products of a sensible exercise programs.
Each exercise program must be suited to the client’s
needs and health status. A woman/man who has
had her breast removed may need to focus on ROM
of the shoulder area and deal with lymph drainage,
whereas a client with lung cancer will have other
objectives. Exercise should not be touted as a means
of fighting cancer or improving survival rates.
Sample Exercise Program
AEROBIC PROGRAM
Mode – walking, water exercise and stationary bikes
can be used to foster aerobic fitness.
F = frequency (3 to 5 days/week)
•
Recent surgery
•
Individuals undergoing
I = intensity (40% to 70% of volitional fatigue
or mild to moderate)
•
Bone marrow treatments
T = time (20 to 30 minutes or as tolerated)
•
Radiation
•
Chemotherapy
•
Someone who was inactive prior to
cancer must be extremely careful if now
starting a program
•
Be aware of other health issues
•
Chemotherapy patients should not
exercise for 48 hours post treatment
and nausea subsides.
Exercise Indications
Proper exercise and good nutrition appear to help
to prevent most types of cancer. Even after the diagnosis of cancer is made exercise can be a useful part
of the total treatment plan. There is growing evidence that proper exercise benefits individuals who
132
STRENGTH PROGRAM
Consult MD for guidelines train the major muscle
groups of the body, be aware of muscle imbalances
and surgical scars and reduced flexibility. Start with
1-2 sets of 6-12 reps with good form.
FLEXIBILITY PROGRAM
Focus on tight musculature and aim towards functional fitness goals. Be aware of areas affected by
surgery. Work toward total body flexibility with
ROM within normal limits.
DO NOT FORCE ROM. Refer to therapist when
necessary.
Breathing and Relaxation can be a nice adjunct to a
total body fitness program.
Other Health Conditions
CHAPTER 14
PREGNANCY
Prenatal And Post Partum Fitness
In 1994, the American College of Obstetrics and
Gynecology (ACOG) published new exercise guidelines. Current research suggests that conditioning
programs of moderate intensity help maintain fitness levels and ideal body weight, and fat levels.
Moderate exercise in general has no adverse effects
on labor duration and neonatal parameters or fetal
development in utero if done within a physician’s
guidelines. Hence, exercise is deemed today as a
routine part of a healthy pregnancy.
During pregnancy the uterus stimulates the release
of the hormones estrogen, progesterone, and
relaxin. These hormones cause an increase in the
laxity of the ligaments and all soft tissues. Estrogen
affects the cervix, vagina, and fallopian tubes. Progesterone affects the endometrium, uterine motility,
and oviducts. Human Chorionic Gonadotropin
(HCG) maintains the corpus luteum during initial
pregnancy. In essence, HCG keeps the maternal
immune system separate from the fetus and prevents it from rejecting the fetus as a foreign entity.
Relaxin affects remodeling of collagen fibers such as
the pubic symphysis, creating a separation of the tissues during labor and delivery.
Levels of relaxin increase greatly at around 38 weeks
and peaks during labor and delivery where it helps
separate the symphysis pubis joint as the baby
passes through the birth canal.
Aerobic training is still the mainstay of conditioning
during pregnancy, as it enhances aerobic capacity,
ventilation, and heart rate. Most research has been
performed using aerobic activities so it should be
included in any overall conditioning program
during pregnancy. Training should be implemented
using the following criteria: proper exercise prescription, safety of programming, convenience, and
fun. This prescriptive exercise should also take into
consideration the pre-pregnancy exercise status of
the mother. If she has been sedentary, then starting
off with low-level aerobic training on machines
such as the upper body ergo meter or a recumbent
bike are beneficial in that they may be used by most
pregnancy women throughout gestation and are
associated with little disturbance in the uterus
during training (i.e., contractions). Many women
find water exercise and/or swimming as a viable way
to maintain fitness while pregnant. Heavy lifting
should be avoided!
Contraindications to Exercise
The following is a list of symptoms or conditions,
which are among those serious enough to merit
immediate cessation of exercise and consultation
with a physician. These conditions are mentioned
so that fitness instructors realize their seriousness.
Their inclusion is not meant to needlessly frighten
participants, as they very rarely occur; still, they
should be noted:
•
Vaginal bleeding
•
Persistent contractions following exercise
•
Dizziness, faintness, shortness of breath
•
Any gush of water from the vagina
(mild or moderate amounts of fluid)
•
Swelling of ankles, feet, hands, and face
•
Swelling, pain, and redness in the calf
area of one leg (phlebitis)
•
Chronic severe back pain
•
Pain in the pubic area
•
History of 3 or more miscarriages
•
Placenta previa
133
Other Health Conditions
CHAPTER 14
Strength Training Exercises for Pregnant Women (Per Trimester)
Done With Light To Moderate Loads
Lower Body
1st
2nd
3rd
Lunges (front, alternating stationary)
(ROM may be compromised in 2nd, 3rd trimester)
Yes
Yes
Yes
Walking lunges
(ROM may be compromised in 2nd, 3rd trimester)
Yes
Yes
Yes
Squats (wall squats, plies – not full)
Yes
Yes?
?
Machine Exercises
1st
2nd
3rd
Seated leg extension
Yes
Yes
Yes
Seated hamstrings
Yes
Yes
Yes
Prone hamstrings
Yes
No
No
Side lying hamstrings
Yes
Yes
Yes
Standing hamstrings
Yes
Yes
Yes
Upper Body
1st
2nd
3rd
Biceps curl
Yes
Yes
Yes
Triceps extensions
Yes
Yes
Yes
Lateral pull downs
Yes
Yes
Yes
Lateral raises
Yes
Yes
Yes
Supine dumbbell flies
Yes
No
No
Incline dumbbell flies
Yes
Yes
Yes
Seated chest presses
Yes
Yes
Yes
Abdominal
No sit-ups after the 1st trimester. There are different reasons for this, one of
them being that it will make it difficult to have a flat abdominal region after
pregnancy.
Yes
No
No
134
ProgrammingSports
for Ambulation
Medicine
PA RT
CCHHAAPP
TT
EE
R R1 5
PROGRAMMING FOR
AMBULATION
3
Transfers and Ambulation Aids
Progressive Mobilization
Ambulation Aids
Gait Training
PROGRAMMING FOR AQUATICS
Water Exercises for Special Populations
Adaptive Aquatics: Hydrogymnastics
Assessment of Aquatic Skills
PROGRAMMING FOR BALANCE AND
PERCEPTUAL-MOTOR SKILLS
Balance Progressions
Perceptual-Motor Skills
Fine Motor Tasks
PROGRAMMING FOR
CARDIOVASCULAR FITNESS
Cardiovascular Exercises
How to Take a Pulse
Determining Target Heart Rate
PROGRAMMING FOR
FLEXIBILITY AND RANGE OF MOTION
Flexibility
Range of Motion
Programming for Flexibility
Range-of-Motion Exercises
PROGRAM FOR MUSCULAR
STRENGTH AND ENDURANCE
General Progressive Resistance Guidelines
Strength Training
General Guidelines for Adaptive Weight Training
Sample Strength Training Program
PROGRAMMING FOR POSTURE
Assessment of Posture
Procedures for Spinal Screening
Posture Exercises
Adaptive Programming
Programming for Ambulation
CHAPTER 15
C h a p t e r
1 5
PROGRAMMING FOR AMBULATION
To p i c s c o v e r e d i n t h i s c h a p t e r
TRANSFERS AND AMBULATION AIDS
Basics of Assisting a Person in a Wheelchair
Tranfers
PROGRESSIVE MOBILIZATION
Mat Activities
Summary
AMBULATION AIDS
Typical Walker
Crutches
Canes
Wheelchairs
Additional Ambulation Exercises
GAIT TRAINING
Gait Analysis
136
Programming for Ambulation
CHAPTER 15
TRANSFERS
AND AMBULATION AIDS
Ambulation: to move from
place to place: walk
Basics of Assisting a Person
in a Wheelchair
Many people are unsure how to act when confronted by a person in a wheelchair. A wheelchair is part of the user’s body space and should be respected.
Always ask whether the wheelchair user needs assistance. Always explain
what you are doing and where you are going before starting to push a chair.
Never surprise a person from behind by moving his or her chair. Wheelchairs
can be tricky to handle, so here are some points to remember:
•
Be aware that the wheelchair user might be able to walk with
the assistance of a cane, crutches, or braces
•
Don’t try to maneuver a wheelchair alone unless you are sure
you can handle the weight and movement safely
•
Ask how the chair operates. Are the armrests, leg rests, and
body supports secure? Is there a seat belt? Are the brakes
working properly? The brakes are located on both sides of the
chair, just above the large wheels, and can be operated by a
lever. Locate the brakes before you attempt to move the chair.
Learn how to safely tip a chair back
•
Be sure to lock the brakes when leaving the client even for a
moment. Be sure to lock the brakes when transferring in or out
of the chair
•
Plan a route for where you are taking the client in the chair.
Avoid narrow doorways and openings, stairs, bumpy surfaces,
and wet floors. Be alert for objects in your path. Ask the client
if there is a preferred path to take
•
If you are assisting by pushing a wheelchair over rough terrain,
the chair will ride easier and jolt its occupant less if it is tilted
back on its rear wheels
•
While descending a curb with a wheelchair, the pusher should
be behind the chair, tilting it back on its rear wheels. The
pusher can then control the descent by the use of pressure
against his own legs. It is important that both wheels touch the
lower level simultaneously to avoid jolting the occupant
•
If assisting while ascending a curb, tip the chair back, and place
the front or small wheels on the upper level; then, using the
rear wheels, ride on to the upper level or sidewalk, using your
legs to provide pressure
137
Programming for Ambulation
CHAPTER 15
Transfers
Transfer: the relocation of an
individual from one surface to
another; can be classified as
either “standing” or “sitting”
Transfer refers to the relocation of an individual from one surface to another
and can be classified as either ‘standing’ or ‘sitting’. Variations on these two
types of transfers depend on the capabilities of the client and the type of surface to which s/he is transferring. Many individuals have developed a personal
technique for executing a transfer, and this preference should be discussed
before the assistant or instructor attempts to help. It is paramount that the
safety of client and transfer be of utmost concern. Allow the client to do as
much as is safely possible to do.
Techniques for Assisting a Person to Transfer
Students coming to class in a wheelchair may need to transfer into a regular
chair or onto a mat to better perform the exercise program. Other students
who walk with a cane or walker may also need guidance when standing up, sitting down, or getting on or off of a piece of exercise equipment. The inabilities
and abilities that are identified at the time of assessment will determine the
amount and kind of assistance required by a person during a transfer. The
person should only be given the assistance actually needed. The principal
guideline for assistance is to provide safety and protection during the transfer.
In the case of an especially obese person, two assistants may be required. Do
not attempt any activity beyond your capacity. The following basic concepts
will help you to transfer anyone:
• Stand as close to the client as possible. This means standing in
front of the client to assist with a sitting transfer. For standing
transfers that require extensive assistance, stand in front of the
client so that you can actually provide support and protection. If
only minimal assistance is needed in the standing transfer, you
may stand by the client’s side, preferably by the weaker side.
Lightweight chairs need to be stabilized as well; either hold on to
the back of the chair, or place it against a solid wall or table.
• Stand with a broad base of support. In other words, your feet
should be kept apart, with one foot slightly ahead of the other.
This will improve your balance and also permit a shift of weight
with greater ease.
• Assist the client at the waist rather than pulling his arms or
shoulders. The use of the belt of the pants or a transfer belt
allows a good grip without causing the client pain.
• Bend your hips and knees, keeping your back straight, while
actually assisting the client to move from one surface to another.
• Make sure that the client can see the surface to which he or
she is transferring.
138
Programming for Ambulation
CHAPTER 15
• Always move your body in the direction in which the transfer
is taking place.
• Make sure that the client is wearing shoes (and a brace if this
has been prescribed), in order to prevent possible slipping, foot
injury, or turning of an ankle.
• Be sure your client understands when you are transferring
him or her. Count out loud so you both move together.
Sitting Transfers—Unassisted
Any sitting transfer, assisted or unassisted, has the following basic elements:
•
The person should wear a transfer belt around the waist in case
assistance might be needed.
•
The wheelchair should be positioned at a 45° angle to the
opposite surface if the armrests are not removable. If the armrests are removable, the chair can be positioned directly parallel to the opposite surface.
•
Brakes must be locked.
•
Footrests should be moved away in most cases.
•
If a sliding board is used, it must rest securely on both surfaces, i.e., the surface to which the client is transferring and the
surface from which the client is transferring.
•
It is recommended that the hemiplegic person learn to transfer
toward the uninvolved side.
Sliding board: support board
used to facilitate a transfer by
bridging the gap between two
areas
139
Programming for Ambulation
CHAPTER 15
Sitting Transfers—Assisted
The basic elements of unassisted transfers also
apply to assisted transfers.
In an assisted sitting transfer, the client comes to the
edge of the bed or mat as in the unassisted transfer.
Bend your hips and knees to lower yourself to the
level of the client. Grip the transfer belt from underneath, or support the client under the armpits, and
assist as the client angles toward the chair. As the
client moves from one surface to another, support
the client’s knees with your own knees. Using the
Figure 15-1 Stand and pivot
Figure 15-2 Pull to stand in parallel bars
Figure 15-3 Sitting transfer, one man front-facing
transfer belt, you are able to lift the buttocks up and
onto the other surface. Throughout the transfer, the
client leans forward in order to maintain trunk balance. Once in the chair, you may have to help to
position the client by pushing the knees back by
pressure from your own. This is done while leaning
the trunk forward or doing a push-up.
You can also move the client back into the chair by
standing behind the chair and utilizing the client’s
transfer belt.
Programming for Ambulation
CHAPTER 15
Standing Transfers—Assisted
When you use a transfer belt around the client’s
waist, stand directly in front of the client with your
feet slightly apart. You may also support under the
shoulders. Bend your hips and knees to the level of
the client and assist by pulling him/her to the
standing position by grasping the belt at the waist
from underneath. If the client has weakness at the
knee, you can brace your knee against the client’s
weak knee in order to stabilize it. Once s/he is in a
standing position, you can assist the client to pivot.
The person should lean forward and gently lower
into the chair.
Summary: A Dozen Tips for
Performing Transfers
1. Reduce the distance between the
transfer surfaces. Removing arm rests
and detachable footrests will permit
closer positioning of the client to the
transfer surface.
2. Always secure wheelchair brakes. They
are essential for safety and stability.
3. Transfer to a surface of equal height if
possible. A sliding board may be used to
eliminate the gap between the two surfaces. Be sure to stabilize the sliding
board on both transfer surfaces.
4. When transferring an individual with
one-sided involvement (e.g., hemiplegia), position the wheelchair alongside the table on the individual’s
stronger side. Provide assistance from
the weaker side.
5. Keep a wide base of support. Placing
one foot ahead of the other allows you
to shift your weight more easily.
6. Keep your back straight while flexing at
the hips and knees during the transfer.
Hold the client as close as possible and
lift with the thigh muscles, extending at
the knees and hips, not with your back.
7. If possible, allow the individual to view
the surface to which s/he is being transferred.
8. To increase the stability of the wheelchair, place the casters (i.e., the front
wheels) in a forward position.
9. Give clear instructions regarding the
transfer to the client.
10. Count “1-2-3 go,” so that you and the
client move together.
11.Get additional assistance if necessary.
12.Always protect your back! Consider
using back-support braces.
141
Programming for Ambulation
CHAPTER 15
PROGRESSIVE MOBILIZATION
Progressive mobilization is the term used to
describe the gradual, step-by-step development of a
person’s ability to move around and gain independence. The following activities are designed to build
on one another.
Mat or Bed Activities
These are generally accomplished in the hospital as
bed activities, and include bed positioning, rangeof-motion exercises, moving up and down in bed,
moving sideways, and rolling over in bed. However,
as the students prepare to perform exercises lying
down on the mats, we frequently need to remind
them of the proper techniques involved in moving
around as well as getting up and down.
1. To move up, down, or sideways:
Instruct as follows: “Bend your knees
and put your feet flat on the mat.” You
can assist by holding down one or both
knees and feet if they slip. Instruct, “Lift
your hips off the mat by pushing with
your feet. Move your hips in the desired
direction (up, down, or sideways) before
putting them down.” You may also have
to assist by putting your arm or arms
142
under the buttocks. Remember your
proper body mechanics.
2. Rolling Over: Example for rolling onto
right side: “Move sideways to the left to
ensure that there is enough room to roll
to the right” (many people become
frightened when they get too close to
the edge). “Cross your left leg over the
right leg as far as possible. Cross the left
arm over your chest. Pull on the mat or
railing as needed. If you need
momentum, swing the arm or leg across
your body.”
3. Assuming a Sitting Position: Instruct
the client: “From a side-lying position,
slide your arm underneath you with your
elbow bent. Now do these two things at
the same time: Drop your legs off the
mat and start pushing up with your
elbow. After your weight has been transferred onto your elbow, shift your weight
to your hand and keep pushing until your
are upright.” If the client needs help,
assist as necessary, but encourage them
to do as much as possible by themselves. Watch for dizziness when upright.
Programming for Ambulation
CHAPTER 15
Sitting: (Sitting down is addressed after Standing):
Sitting tolerance (length of time out of bed) is
accomplished during the hospital rehabilitation
phase. Sitting balance is an activity often practiced
in the adaptive physical fitness class. This helps
develop trunk stability for standing and walking.
The person should ultimately be able to sit unsupported, even against resistance. Instruct the client
to: “Sit level on the mat or chair—weight even, on
both buttocks. Position feet flat on the floor—wide
base of support. Place arm or arms where you can
push to maintain a good, erect position.”
As sitting balance improves, the client should be
able to sit without holding on to the edge of the
mat and should be able to move his/her arms
around at will. The client should practice reaching
above the head, out to the side, and out in front. A
mirror may be helpful.
After the client can do the aforementioned, add
resistance to the activity by pushing on the client
from either side, from the front, or from the back.
(Let the client know that you are going to do this
exercise, and get permission first!) Good sitting balance is achieved when the client can do all of this.
Standing: The ‘stand-up’ is a necessary exercise
even if the client cannot yet walk, because it facilitates pulling up pants, going to the bathroom, and
many other functions. Strength and balance are
increased, as is overall circulation.
A person will feel tremendously successful when he
or she is able to stand up alone. However, don’t let
the client rush to do it; make sure the correct steps
are followed so that it will be done properly and efficiently. Give the following instructions: “Scoot your
hips/buttocks to the front edge of the chair. Put your
feet flat on the floor, feet apart, with your stronger
leg a little further back and under you. The legs will
do the work. Use your hands only for balance (on
the table, chair, or bars). Lean your head and shoulders forward and stand on the count of 1-2-3.”
Sitting down: Sitting down is accomplished in the
reverse of standing. Instruct the client to lean forward while bending the knees and to touch down
slowly with the buttocks. If a person is too weak to
perform the stand-up exercise alone, adjust the chair
as high as possible and provide assistance until (s)he
can stand alone. To evaluate when a person is able to
stand, test quadriceps strength. If (s)he can hold
against some resistance, (s)he can probably stand.
Also, try to help the client stand. If the client can
stand, it is obvious that (s)he can perform the
exercise. If the client cannot stand, use resistive
exercises until leg strength increases sufficiently to
enable standing.
If balance is very poor, have the client assume a wide
base of support on the bars with the hands. Then
have the client lift his/her hands off the bars and
raise them sideways and overhead while maintaining balance. The client’s ability to complete this
exercise will increase with practice and gradual gain
in strength. Later, resistance can be given by pushing
the client unexpectedly from side to side, forward
and back. This will stress balance and will increase
ability. (Agian, let the client know that you are going
to do this exercise, and get permission!)
AMBULATION AIDS
People with a lower-extremity disability usually
require some form of assistive device during ambulation. Canes, crutches, and walkers serve as extensions that permit the upper extremities to transmit
force to the floor, providing support for the lower
extremities and improving balance. Because of the
diversity of ambulation aids, their prescription and
fit should be carefully evaluated by a physician or
licensed physical therapist. The person with a disability should receive instruction in their use,
including proper gait pattern, ascending and
descending stairs, and sitting and arising. Pre-ambulation exercises and training are often necessary for
persons with severe disabilities (Jebsen, 1967).
143
Programming for Ambulation
CHAPTER 15
Crutches
The use of crutches requires more balance, strength,
and coordination than a walker. One or two
crutches may be used, depending upon the extent of
support needed.
Types of Crutches
1. Axillary crutch.
2. Canadian, Lofstrand, or Elbow Extension Crutch. This crutch has no shoulder
rest and is usually prescribed for persons who can ambulate using the fourpoint crutch gait and need support for
weak arm musculature.
3. Gutter Crutch. This crutch has been
designed for persons with a significant
flexion deformity at the elbow, painful
wrist, or very poor hand function. The
forearm may be secured to the crutch by
a Velcro strap or other fastening.
Walkers
1. Auxillary Crutch
Types of Walkers
1. Walkerette. This model has runners
attached to the bars and is pushed forward along the floor. It is not lifted by the
user like a standard walker.
2. Roller Walker. This model has wheels on
the front legs so that the individual can
raise the rear legs off the floor and roll
the walker forward.
2. Canadian Crutch
3. Gutter Crutch
3. Crutch Walker. This model has crutches
attached to the horizontal bars to support body weight. It also has a seat for
the individual to rest on when fatigued.
The crutches can be removed or draped
to the sides when not in use.
4. Walk-abouts.
Figure 15-4 Types of crutches: Auxillary Crutch,
Canadian Crutch, and Gutter Crutch.
144
Programming for Ambulation
CHAPTER 15
Crutch Adjustment
The crutch height should always be adjustable. It is
also preferable to use crutches that are adjustable
with respect to length and position of the arm support (Cash, 1976). The length of the axillary crutch
should extend from a point two inches below the
axilla (armpit) to a point near the foot indicated in
the illustration below. The height of the handgrip
should be positioned so that the elbow is flexed
between 15° to 30°. The wrists should be hyperextended and the weight borne on the palms. When
fitting axillary crutches, it is essential that the user
be instructed not to bear weight on the axillary bar.
This may cause compression of the radial nerve,
resulting in paralysis, which may take months to
resolve. The true purpose of this bar is to provide
lateral stability of the crutch via pressure against the
chest wall. Regularly check crutch tips for worn
areas, cracking, or plugging of the grooves with lint
and dirt.
6”
2”
Canes
Canes are generally prescribed when some weight
bearing can be taken on the affected extremity or
when only mild balance deficits exist. It is difficult
for a person to develop a normal walking pattern
with one cane. Because a cane supports approximately 20-25% of the body weight, the tendency is
to lean the body over the cane and shorten the stride
on that side.
Types of Canes
1. Standard Cane. This model is made of
wood or aluminum with a C-curved
handle. A telescoping cane is available
that can be adjusted to between 22 to
38 inches.
2. Tripod Cane. This model has three
prongs at the end of the shaft with flexible rubber sockets, allowing for movement of the shaft while the prongs
remain in contact with the ground
during ambulation.
3. Quad Cane. This model has four prongs
that come in contact with the floor. It is
adjustable in length and provides maximum support and balance with four
contact points on the ground. This
device is frequently prescribed for those
with athetoid cerebral palsy.
Cane Adjustment
The length of the cane is determined by measuring
the vertical distance from the greater trochanter
(the top of the femur) to the floor. The elbow
should be flexed approximately 15° to 30°. The cane
should be held in the hand opposite the affected leg.
During ambulation, the cane should be held fairly
close to the side to avoid leaning.
145
Programming for Ambulation
CHAPTER 15
Wheelchairs
The market currently offers a wide selection of
wheelchairs, from heavy-duty chairs to light sport
models with racing tires. In addition, a variety of
sizes are available such as Adult, Narrow-Adult, Tall,
Junior, and Children’s sizes. Some companies will
even customize the size of a chair to the individual.
Sport and Spokes, a magazine for athletes with disabilities, publishes an annual review of the latest
models of sport wheelchairs. A physician or physical
therapist familiar with the sizes, models, and components of wheelchairs will prescribe a suitable
chair for an individual.
Assistants should become familiar with the basic
components of the wheelchair and their operation.
The following is a description of the most basic
components of a typical wheelchair. There are many
additional accessories, which can be attached to the
wheelchair to enhance its effectiveness to the user.
1. Wheels. For ease of ride over outdoor
terrain (soft, sandy or rough ground),
pneumatic tires (i.e., air-filled, like
bicycle tires) are recommended.
2. Handrims. Handrims are connected to
the wheels to allow the user to move the
wheelchair without injuring the hands.
Handrims come in a variety of sizes and
types, depending on the sport and the
ability of the individual. Rubber-coated
handrims are available to persons with
quadriplegia. For the client with severe
limitations of grip, a handrim consisting
of eight rubber-tipped vertical projections is available.
3. Backrest. The height of the backrest
depends on the height of the user and
the degree of trunk stability. Reclining
backrests are available for those who
need to be in a partially or fully reclined
position.
4. Armrest. Armrests may be either
detached or fixed. Detachable armrests
easily lift off to allow the convenience of
146
side transfers. The height of the armrests can usually be adjusted to accommodate the changes created by a
wheelchair cushion.
5. Wheel locks (brakes). These brakes prevent the wheelchair from rolling forward
or backward on inclines and during
transfers.
6. Casters. These small wheels sit towards
the front of the wheelchair. Casters are
most stable when they have anti-flutter
caster bearings. Casters also come in the
following styles: heavy-duty, lightweight, and pneumatic (for a cushioned
ride with a freer roll).
7. Front rigging. This consists of a footrest
or legrest. Legrests are used with those
who need the legs elevated. Both types
of rigging typically have a swing-away
feature, which allows for a close
approach to transfer surfaces. Heelloops help prevent feet from sliding off
of the footplate.
Additional
Ambulation Exercises
1. Forward walking
2. Backward walking
3. Side walking
4. Cross-over sideways – front and back
5. Knee bends
6. High-knee walking
7. Bent-knee walking
8. Step over obstacles
9. Treadmill – 1 mph, 3% grade
10. Metronome walking
11. Obstacle course
12. Bicycle (stationary and 3-wheel)
Programming for Ambulation
CHAPTER 15
GAIT TRAINING
Gait training: re-education in
walking
For safety and liability purposes, the Specialist in Exercise Therapy should
obtain medical clearance from the client’s physician prior to assessing the
gait pattern and implementing an exercise program. This is strongly urged
because if the participant has not stood or walked for an extended period
of time, bones may be osteoporotic, strength may be diminished, and balance may be impaired. It would be prudent to refer the client back to physical therapy for evaluation and exercise recommendations.
Normal Gait: Ideally, our attempts at gait training are designed to teach
our students to walk as normally possible. Often, due to the disorder, the
client is not able to perform these normal movements. You must be able to
recognize the phases comprising a normal gait so that you can provide
accurate feedback to the client who is re-learning how to walk.
The Step Cycle of Normal Gait
Normal gait is typically evaluated by examining the gait or step cycle. The
step cycle is defined as the period from heelstrike to heelstrike of the same
foot. There are two phases in the step cycle:
1. Stance phase (comprises 60% of step cycle)
• Period of partial or full weight-bearing.
• Begins with heelstrike and ends when same foot is plantarflexed
in toe-off and weight is shifted to other extremity.
• Divided into three stages known as heelstrike, midstance (weight
shifted from heel to ball of foot), and toe-off.
2. Swing phase (comprises 40% of step cycle)
• Begins as weight is shifted off extremity with accompanying hip
and knee flexion. Ends when knee is in full extension prior to
heelstrike.
• Divided into three stages known as acceleration, midswing, and
deceleration.
147
Programming for Ambulation
CHAPTER 15
TA B L E 1 5 - 1
STANCE PHASE
ONE STEP CYCLE OF A NORMAL GAIT
Midstance
Toe-off
Acceleration
Midswing
Deceleration
SWING PHASE
Heelstrike
Components of Normal Gait
(Daniels & Worthingham, 1972; Hpoenfeld, 1976)
• Head erect
•
Pelvis tilts in the frontal plane (5° downward)
•
Pelvis laterally tilts toward the supporting
leg
•
Pelvis and trunk shift laterally approximately 1 inch toward the supporting leg to
center the body weight over the hip
•
During swing, the pelvis rotates 40° forward and the opposite hip acts a fulcrum
for rotation
•
Shoulders level
•
Trunk vertical
•
Base of support: 2 to 4 inches from heel
to heel
•
Arms swing reciprocally and with equal
amplitude
•
Steps are the same length
•
Vertical oscillations of the center of
gravity (COG) are about 2 inches and
even in tempo
•
Average walking speed: 3 feet/second or 2
mph to 2.5 mph
•
Average cadence: 90 to 120 steps/minute
•
Knee flexes in stance (except at heel
strike) to prevent vertical rise in the COG
•
Average step length: 15 inches
•
Pelvis slightly rotates in the transverse
plane 4°
Programming for Ambulation
CHAPTER 15
TA B L E 1 5 - 2
DYSFUNCTIONAL GAIT PATTERNS
Each person will present a different problem regarding his or her gait pattern. Our challenge is to assist them to walk as
normally as possible with respect to their physical limitations. The table below describes a number of such patterns. Some
of the common gait disorders include circumduction gait and hip-hiking.
GAIT PATTERN
CHARACTERISTICS
Antalgic
Pain on weight-bearing joint
Quick stance phase on affected lower extremity (LE)
Short stride (swing)
Less flexion of affected LE
Ataxic-Cerebellar
Wide-based, staggering gait
Loss of stability with eyes open or closed
Unilateral lesions result in sway toward side of lesion
May have foot-stamping
Ataxic-Spinal
Loss of position sense with eyes closed (involvement of proprioceptive pathways)
May evidence foot slap (landing flat-footed)
Festinating
Short, accelerating shuffling steps
Dystrophic
Wide-based waddling gait with lateral lurch and trunk hyper-extended
Spastic/Scissors
Excessive hip flexion, internal rotation, and adduction
Knee flexion or extension
Ankles may be plantarflexed
Knees cross in front of one another during gait due to spasticity
Toes may drag
Steppage/Dropfoot
Excess hip and knee flexion during swing due to foot drop (flaccid dorsiflexors)
Instead of heelstrike, the foot strike is plantigrade (flat-foot landing)
Trendelenburg
Gluteus medius lurch
Exaggerated drop of the pelvis toward unaffected side during stance phase of the affected
extremity
Circumduction
During swing, the hip is circumducted so the lower leg and foot clear the ground
May also involve tilting the pelvis upward
149
International Sports Sciences Association
Gait Analysis Form
Name
Date
Disability
Ambulatory aids
Gait pattern
Right side
Left side
Antalgic
Ataxic
Festinating
Dystrophic/Waddling
Spastic/Scissors
Steppage
Trendelenburg
Circumduction
Foot
Hip/Knee
Trunk/Arms
Other
Temporal and Distance Factors
1. Average Velocity
in
sec
inches/sec*60
2. Average Cadence (90 to 120)
steps/min
3. Average Stride Length
R
inches
R
inches
L
inches
4. Average Step Length
Programming for Ambulation
CHAPTER 15
Guarding Against Falls
When falling, most people (particularly stroke victims) will fall toward their weak side. They can also
fall forward or backward. They fall primarily because
their muscles are weak and their legs crumple under
them or because their balance is poor.
The following is a description of how you, the
instructor, should look while guarding the client
against falls. For example, if the client’s left side is
weaker, stand at the client’s left side and just a little
behind. Put your right hand on their belt or gait
training belt and your left hand on the front of their
shoulder. In this position you can push back on
their shoulder and push forward on their hips to
straighten them up, or you can pull them against
yourself. If you cannot hold the client up, you are in
a good position to ease them gently to the floor if
they should start to fall. Remember to use good
body mechanics. If a person is falling, you can do
more harm to your back and to them by straining to
hold them up than if you ease them to the floor. You
should never hold a person only by the arm or let
them hold onto you, because if they suddenly start
to fall, you will both fall over.
As a person’s walking ability improves, the
instructor should gradually release his or her hold
until the client is on his own. However, always stand
in the same position to catch the client if necessary.
You can practice this with a partner by keeping your
feet spread apart for good balance and taking a step
each time your partner does; coordinate your steps
with theirs.
When guarding a person, be careful that you do not
hold onto them so tightly that they do not have
freedom of movement. Remember that you are
there to teach and assist them to walk, not to drag
them around the room. If the student leans on you
too much, they will learn to depend on that support
and will not learn to support themselves for independent walking.
Development of Strength and
Endurance in Muscles Utilized in Walking
This development includes muscles of the lower
extremities, particularly the flexors and extensors of
the hip, knee, and ankle. Strengthening the muscles
of the trunk provides further stability during
walking. Whenever possible, strength should be
developed in whole patterns of movement (i.e.,
multi-joint movement) rather than single-joint
movement. This technique will allow more transfer
of strength and coordination.
Development of Even Length and
Timing of Steps
The length of the step on the affected extremity will
be shorter than normal. The participant should be
encouraged to take larger steps on the affected side.
A metronome may be used to aid to improve the
tempo of steps.
Instruction in Proper Placement of Feet,
Legs, Trunk, and Arms to Facilitate
Stability and Coordination
The instructor should provide consistent cues and
constant feedback to the client. This practice
requires careful observation by the instructor.
Skilled feedback is usually provided in the following areas:
•
Heel-strike (heel-to-toe progression of
the foot)
•
Direction of forefoot (should point
slightly out from line of travel)
•
Degree of flexion or hyperextension in
the knee
•
Lateral tilt of the pelvis
•
Anterior tilt of the pelvis
•
Erect trunk and head
•
Relaxed, reciprocal movement of the
arms.
151
Programming for Ambulation
CHAPTER 15
Development of Flexibility
Contractures and spasticity may interfere with
standing and the gait pattern.
Progressions in Gait Training
(from most stable to least stable):
Walking aids should be used progressively in the following order:
1. walker or crutches
2. hemi-walker (start here for a stroke
victim)
3. quad cane (four-point support)
4. cane
base support, with one foot on each step. Be close
enough to the client to balance them if necessary or
hold them if they start to fall. Again, remember your
body mechanics! If it is evident that the client
cannot regain their balance and will fall, you should
hold them close, keep your back straight, bend your
knees, and lower them to the floor or sit them down
on the step.
A common assistive device used is the short leg
brace. Stroke victims often have weakness of the
ankle muscles (dorsi-flexors). This causes a
‘dropped foot’, which is the inability to pick up the
toes and put the heel down first. The short leg brace
keeps the ankle flexed at 90° and allows the heel
strike to occur.
5. stand-by assistance from you and
finally,
6. INDEPENDENCE!
Stair Climbing
Stair climbing increases the strength of the
quadricep muscles and increases the ability to stand
and balance while the body is in motion. For some
persons, stair climbing can be taught before
walking. This exercise can be done on a wooden
staircase, or just practiced on a small step-up beam.
The saying to remember is, “Up with the strong leg,
down with the weak.”
Watch for full foot placement on stairs, as well as
keeping the feet spread about six inches apart.
Assist only as needed, but ensure safety and
encourage good balance. The client should hold on
to the banister.
Going upstairs, the strong leg steps first. Bring the
weak one up next to it, one step at a time. Going
downstairs, the weak leg steps first. If the client is
afraid of going down forward, he or she may back
down once the top is reached (the weak leg still steps
down first). The eye-to-floor distance is much less
this way, and the client will have more confidence.
To assist, you should be below the client whether
they are going up the stairs or down. Use a wide-
152
During normal gait, each leg alternates between the
stance phase, during which the foot is on the
ground, and the swing phase, during which the leg
is brought from behind to the forward position.
Each phase has distinct characteristics, many of
which are very important to teach the client so that
they will be able to walk effectively and efficiently.
Table 15-3 discusses ach step in the order that it
occurs during normal gait.
TA B L E 1 5 - 3
STANCE PHASE
Heelstrike
Midstance
Toe
1. Heel strike: Normally, the heel contacts the floor first because the foot is dorsiflexed. Persons occasionally will attempt
to put down their toes first, but they should be encouraged to follow the normal pattern. The foot should be pointed
straight ahead when it hits the floor, with the knee in full extension, and ahead of and apart from the other foot.
2. After the heel strike, the client rolls over onto the ball of the foot and bends slightly (about 15°) at the knee. The knee
is then fully extended. They must be able to stand straight on that leg. A strong quadriceps muscle or an assistive
device might be needed to produce this stance position and allow the client to walk. If the knee “buckles” at this
point, the other leg cannot be lifted off the floor.
3. Also, during the same stance phase, the trunk must be maintained in an upright position to enable forward movement
of the other leg. This is accomplished by the action of the gluteus maximus muscle. If the gluteus maximus is not
functioning when the involved leg is in stance position, the trunk falls forward to compensate for this weakness. The
person must be instructed to stand very straight with the shoulders back and the pelvis forward. You might need to
assist the client in initially maintaining this position.
4. Push-off: The person then pushes off with the toes and the ball of the foot, simultaneously bending the hip and knee
slightly. The push-off action proceeds into the swing phase.
SWING PHASE
Acceleration
Midswing
Deceleration
1. The opposite leg is now in stance phase.
2. With the hip and knee bent, the ankle and foot held at about a 90° angle, and the body weight shifted onto the other
leg, the leg begins to swing forward.
3. When the leg swings past the opposite leg, the knee extends by a combined action of the hamstrings (to control speed
of extension) and the quadricep muscles (to produce full extension of the knee). All steps produced are equal in length.
4. With the knee straight, the foot dorsiflexes beyond a 90° angle and the client’s leg is again in a position for heel strike.
The gait pattern repeats.
Programming For Aquatics
CHAPTER 12
C h a p t e r
1 6
PROGRAMMING FOR
AQUATICS
To p i c s c o v e r e d i n t h i s c h a p t e r
WATER EXERCISE FOR SPECIAL POPULATIONS
ADAPTIVE AQUATICS: HYDROGYMNASTICS
Entering and Exiting the Pool
Swim Instruction tips
Hydrotherapy Tips
ASSESSMENT OF AQUATIC SKILLS
154
Programming for Aquatics
CHAPTER 16
WATER EXERCISE FOR SPECIAL POPULATIONS
Water workouts are a sensible and comprehensive
way to improve one’s physical-fitness levels without
subjecting the body to the stress often associated
with such exercises as jogging, weight training,
and/or aerobic dancing. A water workout is the only
true non-impact exercise available. Because of this
fact, water workouts are ideal for the beginning
exerciser, the overweight individual, the older adult,
the injured athlete, the physically impaired person,
as well as the exercise enthusiast.
Other benefits of this type of exercise program are:
(1) improved circulation; deeper water has
increased pressure that assists venous circulation,
especially in the lower legs; and (2) you can easily
control the difficulty of your workout by varying
the speed of your movements.
Water workouts offer a new and challenging option
to an already established exercise program and
complement the traditional workouts of jogging,
stationary pedaling, and lap swimming. A water
workout can provide a sensible and enjoyable exercise program: one from which everyone can benefit.
Water exercise is well suited to meet the needs of
everyone. A water workout can be strenuous enough
to challenge the world-class athlete and yet appropriate for the senior citizen or disabled adult. This
type of program is perfect for those who want a comprehensive and total body workout without sweating!
You may ask, “How can this be accomplished? Is it
too good to be true?” Not really. The swimmer’s
goal is to maintain a streamlined body that minimizes the resistance of the water. Water exercises,
on the other hand, are designed to maximize the
resistance to the body as it moves through the
water. By simple modification and placement of the
hands, and with the use of swim fins and boards,
you can vary the amount of resistance involved in
an exercise to make it very simple or very difficult,
or anything in between.
To maximize the benefits of water exercises, water
resistance must be increased. Pushing against the
water faster and harder increases the resistance
factor and is similar to the difference between lifting
a lightweight as opposed to a heavy weight. Resistance increases the amount of work the muscles
must perform and is easily controlled at any given
moment in the water.
The physiological benefits of water exercise
include increases in:
•
Muscular strength
•
Toning
•
Endurance
•
Flexibility
Another benefit, cardiovascular improvement, can
be achieved without the constant pounding of the
body against the ground seen so commonly in jogging and in many aerobic classes. A water workout is
ideally suited for the fitness enthusiast with orthopedic/joint limitations or lower-back problems, the
novice exerciser, and the overweight person.
155
Programming for Aquatics
CHAPTER 16
TA B L E 1 6 - 1
BENEFITS OF HYDROGYMNASTIC EXERCISE
PHYSIOLOGICAL BENEFITS
PSYCHOLOGICAL BENEFITS
•
Increases muscular strength and
endurance.
•
Reduced risk of many kinds of injuries.
•
Facilitates improvement in flexibility
•
Enhances peripheral circulation and provides opportunities to address cardiovascular endurance.
•
Provides an exercise setting where respiration and metabolic rates are elevated.
COMPONENTS OF A SUCCESSFUL
ADAPTIVE AQUATICS PROGRAM
•
Allows the participant an opportunity to
develop gross motor coordination skills.
•
Will induce relaxation in a warm-water
environment.
In order to have your participant derive the aforementioned
benefits, your comprehensive adapted aquatics program
should include:
SOCIAL BENEFITS
•
Provides an enjoyable activity. The time
spent in the pool may be the only time
when joints and muscles don’t hurt.
•
Offers an opportunity to socialize. The pool
is a place where persons, both able-bodied
and physically limited, can share and compete equally.
•
Provides a recreational opportunity. Within
an aquatic session, the participant with a
disability can participate in vigorous physical activities not possible on land.
•
Sets up additional healthy recreational
opportunities: from learning to swim , the
student can branch out to other water
activities, such as sailing, water skiing, or
snorkeling.
CONTRAINDICATIONS
Please note: There are some conditions under which
water workouts are contraindicated, such as severe
hypertension or hypotension, cardiac conditions,
and infectious skin disorders. If your clients suffer
from any of these disorders, consult their physician
prior to starting a water workout program.
156
A participants self-image and confidence may be
boosted. In the water, a disability is less noticeable.
The participant is less limited in the water. Therefore, the aquatic environment provides an opportunity for the participant with physical limitations to
feel more like his/her able-bodied peers.
•
Therapeutic exercise to develop muscular
strength and endurance, flexibility, and cardiovascular fitness
•
Water-safety skills
•
Instruction in swimming skills, modified to
the capabilities of the participant
•
Gait training, using weighted canes,
walkers, etc., (Participants with paralysis of
the lower extremities should wear socks to
prevent scrapes)
•
Lap swimming to provide opportunity for
cardiovascular training
•
Instruction in games and sports to
enhanced psychomotor skills, as well as
fostering greater interaction and sportsmanship.
For safety, never allow clients to exercise alone in
water. Fainting, seizure, etc., could result in
drowning. The key to success is to ‘train, not strain’.
Regularity and commitment are paramount.
Programming for Aquatics
CHAPTER 16
ADAPTIVE AQUATICS: HYDROGYMNASTICS
During an adaptive aquatics session, the participant
can experience both success and mobility due in
part to the buoyancy of the body in water. Buoyancy
neutralizes the effects of gravity. Water supports the
individual so that he/she will notice a sensation of
weightlessness. This feature allows the participant to
move more freely and with less energy expenditure
than when on land.
One advantage of performing exercises in the pool
is the ability to modify resistance easily. As the participant’s strength increases, simple changes in the
speed of movement or in the placement of the
extremities against the line of movement will
increase the resistance. If further resistance is
desired, the incorporation of hand paddles, kickboards, or swim fins while performing the exercises
will generate significant resistance.
Many people prefer hydrogymnastics because these
exercises are performed in a warm pool (92 to 93
degrees F). It is believed that warm water decreases
pain and induces relaxation. With the reduction in
pain, many participants can see noticeable improvement in their range of motion. It is a well-estab-
lished fact that warm water is a vasodilator, which
increases peripheral blood flow. An important physiological point to remember is that as one enters the
water, coetaneous vessels constrict momentarily
causing a rise in blood pressure. However, during
immersion, the arterioles will dilate, possibly
causing the participant to feel light-headed.
The benefits of hydrogymnastics are many and can
be categorized into three areas: physiological, psychological, and social. (See Table 16-1.)
Entering/Exiting the Pool
Entering and leaving the pool can present a potentially difficult situation for participants with severe
impairments. It is essential that assistants be present
both on the deck and in the pool as lifeguards,
helpers, and spotters.
Place flotation devices (if needed) in position prior
to the participant entering the water. Remove flotation devices before the participant exits the water.
For participants who will be entering and exiting
the pool by means of the ladder, it is important to
157
Programming for Aquatics
CHAPTER 16
teach them to always face the ladder. This method
allows for greater control and safety.
If your program includes participants who have
incurred a cerebrovascular accident, it is recommended that you pad the rungs of the ladder to prevent bruising of the shins. Participants with
hemiparesis should lead with the weak leg going
down the ladder as they enter the pool. When
exiting from the pool, the participant should lead
with the strong leg up the ladder (remember the
adage, “Up with the good; down with the bad.”)
If the participant is unable to maneuver down the
ladder, the decision of using a mechanical lift or a
two-man transfer must be made. It is important to
ask the participant which method is preferred,
because many persons with disabilities do not like
the lift. This method tends to attract attention to the
participant, and it is uncomfortable to sit in a wet,
cold lift while waiting to be placed in the water.
Before deciding which method will be used, it is
essential to take into consideration the weight of the
participant and the strength of the assistants.
158
Generally, the two-man transfers are easily and
safely accomplished when the assistants work as a
team. The assistants take up positions on either side
of the participant. The same techniques are used as
in a typical two-man transfer. Then, once the participant is on the deck and ready to enter the water,
one assistant will stand behind him/her and grasp
the forearms from under the axillas. The second
assistant should be in the water, and with hands
positioned around the participant’s waist, will guide
the person into the pool.
When assisting the participant out of the pool with
the two-man lift, utilize the buoyancy of the water
by ‘bouncing’ the participant several times before
lifting. Extreme care should be taken that the participant does not hit his/her tailbone on the deck
after being pulled out of the water. Also watch legs
to avoid scrapes, bruises, etc.
Teaching Suggestions
The following techniques have proven useful when
working with participants in a hydrogymnastic set-
Programming for Aquatics
CHAPTER 16
ting. These tips are categorized into two groups:
(1) tips related to swim instruction and (2)
hydrotherapy tips related to ambulation training
and therapeutic exercise.
ASSESSMENT OF
AQUATIC SKILLS
•
Set up the situation so that the participant will succeed
The forms at the end of the chapter can be used to
evaluate pre-, beginning, and advanced swim
skills. The participant should be pre-tested and
post-tested to determine improvements derived
from the training program.
•
Teach the appropriate sequence of
skills, dependent upon disability, motivational level, and interests
Definitions of Test Items on Hydrogymnastic
Assessment Tool
•
For participants with hemiparesis, teach
symmetric, bilateral, underwater
recovery strokes first (e.g., elementary
backstroke, breaststroke)
ZIPPER STRETCH TEST
Starting Position: Stand with right hand over right
shoulder, and left hand up back.
•
Use flotation and swim aids as necessary, but try not to develop overdependency on such equipment
Movement: Try to touch the fingers of the right
hand to the fingers of the left hand, measure the distance between the fingertips. Repeat, opposite side.
Swim Instruction Tips
Hydrotherapy Tips
•
When teaching ambulation skills, make
sure that the participant is sufficiently
buoyant
•
During gait training, do not allow participant to drag the feet on the bottom of
the pool. Have participant wear socks or
shoes to prevent scrapes
•
It is recommended when teaching
ambulation skills to have the assistant
wear a facemask in order to observe leg
movements
•
When practicing walking, ‘draft’ weaker
participants by walking backwards in
front of them to decrease the resistance
of the water. Later, if additional resistance is desired, have the participant
push a kickboard while walking
Figure 16-1 Zipper Stretch Test
•
The water is an excellent medium to
teach the participant the techniques of
self-range of motion
STRAIGHT LEG RAISES
Starting Position: Stand in the pool with back to
the wall.
•
Watch for signs of fatigue, exertion, or
seizure
Movement: Raise the leg up as close to the surface of
the water as possible.
159
Programming for Aquatics
CHAPTER 16
KICKBOARD PUSH
Starting Position: Stand in the water with the kickboard held lengthwise.
KNEES TO CHEST
Starting Position: Hold onto the edge of the pool
with back against the wall.
Movement: Push and pull kickboard as fast as possible for 30 seconds.
Movement: Bring the knees to the chest repeatedly
for 30 seconds.
ARM CIRCLE
Starting Position: Stand in the water with the arms
abducted.
JOG ACROSS POOL
Starting Position: Stand In chest-deep water.
Movement: Make large circles backwards for 30 seconds.
LEG FLUTTERS
Starting Position: Hold onto the wall in a prone
position.
Movement: Kick as fast as possible for 30 seconds.
160
Movement: Jog across pool as fast as possible. Measure the time it takes to cross the pool and note the
heart rate.
International Sports Sciences Association
Adaptive Aquatics Evaluation Sheet
Test A: Pre-Swimming Skills
pg. 1 of 1
Student Information
Student Name
Admission Date
Evaluation Log
Evaluator
Date
Evaluator
Date
Evaluator
Date
Pre-Swimming Skill Analysis
Enters water
Stands in waist-/chest-deep water
Walks forward in waist-/chest-deep water
Walks side-stepping in waist-/chest-deep water
Walks backward in waist-/chest-deep water
Holds on to wall
Holds on to wall and traverses perimeter of pool
Jumps up and down in chest-deep water
Comments
Assisted (date achieved)
Unassisted (date achieved)
International Sports Sciences Association
Adaptive Aquatics Evaluation Sheet
Test B: Beginner Swim Skills
pg. 1 of 2
Student Information
Student Name
Admission Date
Evaluation Log
Evaluator
Date
Evaluator
Date
Evaluator
Date
Beginner Swim Skill Analysis
Assisted (date achieved)
Unassisted (date achieved)
Puts face in water
Blows bubbles
Supine float
Prone float
Flutter kick-board or assist
Supine float and recovery
Prone float and recovery
Glide-prone and supine
Prone glide with kick
Basic crawl stroke and breathing
Sculling hands figure 8’s
Change position prone to supine
Change position supine to prone
Underwater swim
Symmetrical strokes
a) skulling: yes_____ no_____
b) finning: yes_____ no_____
c) elementary back stroke:
arms only_____ legs only_____ arms & legs_____
d) breast stroke: arms only_____ legs only_____
arms & legs_____
Asymmetrical strokes
a) crawl/freestyle: arms only_____ legs only_____
arms & legs_____
b) backstroke: arms only_____ legs only_____
arms & legs_____
International Sports Sciences Association
Adaptive Aquatics Evaluation Sheet
Test B: Beginner Swim Skills
pg. 2 of 2
Student Information
Student Name
Beginner Swim Skill Analysis cont.
Can breathe while doing crawl stroke
Retrieves object from bottom
Surface-dives to bottom
Jumps into deep water and is caught
Jumps into deep water and swims to side
Changes direction right
Changes direction left
Changes horizontal plane, front to back
Changes horizontal plane, back to front
Changes vertical plane, front to back
Changes vertical plane, back to front
Uses kickboard
Comments
Assisted (date achieved)
Unassisted (date achieved)
International Sports Sciences Association
Adaptive Aquatics Evaluation Sheet
Test C: Advanced Swim Skills
Student Information
Student’s Name
Admission Date
Test A passed on (date)
Test B passed on (date)
Evaluation Log
Evaluator
Date
Evaluator
Date
Evaluator
Date
Advanced Swim Skill Analysis
Date Achieved
Bobs without pushing off bottom (6’ depth)
Crawl (C) stroke with out-of-water recovery
Crawl stroke with breathing to the side
(20’)
(40’)
Basic backstroke
(20’)
(40’)
Racing backstroke (RBS)
(20’)
(40’)
Breaststroke (BS)
(20’)
(40’)
Sidestroke (SS)
(20’)
(40’)
Head-first dive
assisted
unassisted
Surface dive
7’ depth
9’ depth
Distance swim (30 min), any stroke
Comments
pg. 1 of 1
International Sports Sciences Association
Hydrogymnastics Assessment Tool
pg. 1 of 1
Student Information
Student’s Name
Admission Date
Pre-Test Date
Post-Test Date
Evaluation Log
Evaluator
Date
Evaluator
Date
Evaluator
Date
Hydrogymnastic Skill Analysis
Ability to swim across pool
❑ no
❑ yes stroke __________________
Stroke Proficiency
Crawl
Elementary backstroke
Side stroke, right
Side stroke, left
Breast stroke
Butterfly
__________________
__________________
+
+
+
+
+
+
+
+
o
o
o
o
o
o
o
o
Muscular Endurance
-
Kickboard push 30 sec
Arm circle 30 sec
Leg flutters 30 sec
Knees to chest 30 sec
Jog across pool rate
Body Composition
Flexibility
Zipper stretch test
Straight Leg Raises
Comments
___________________
___________________
___________________
___________________
______time ____# sec & heart
________%________%
Alternates
right
left
right
left
up
up
up
up
yes
yes
yes
yes
close
close
close
close
no
no
no
no
______________________________________
______________________________________
______________________________________
______________________________________
Programming For Balance And Perceptual-Motor Skills
C h a p t e r
1 7
PROGRAMMING FOR BALANCE
AND PERCEPTUAL-MOTOR
SKILLS
To p i c s c o v e r e d i n t h i s c h a p t e r
BALANCE PROGRESSIONS
Activities for Developing Static and Dynamic Balance
PERCEPTUAL-MOTOR SKILLS
Activities for Developing Kinesthetic Awareness
FINE MOTOR TASKS
166
Programming for Balance and Perceptual-Motor Skills
CHAPTER 17
The term perception refers to “… the detection, recognition, discrimination, and interpretation of simple stimuli received through the individual
sense modalities.” The four regions of the brain that are responsible for perception are: (1) the cerebral cortex, (2) the thalamus, (3) the hypothalamus,
and (4) the cerebellum.
Perception: The detection,
recognition, discrimination,
and interpretation of simple
stimuli received through the
individual sense modalities.
The following disabilities are typically associated with perceptual-motor
impairments:
•
Learning disabilities
•
Multiple sclerosis
•
Mental retardation
•
Ataxia
•
Acquired Brain Injury (ABI)
•
Stroke (CVA)
•
Spinal bifida
•
Aphasia
•
Cerebral palsy
The natural course of aging can diminish perceptual-motor skills due to
degeneration of the central and peripheral nervous systems.
Perceptual-motor impairments are also associated with the following
behavioral traits:
•
Hyperactivity
•
Distractibility
•
Emotional instability
•
Impulsivity
•
Short attention span
The Perceptual-Motor Checklist, Table 17-1, can be used to screen participants suspected of having deficiencies and guide the instructor in determining which areas require evaluation that is more rigorous. For a more
comprehensive listing of perceptual-motor test items, the reader is referred
to excellent books by Lerch et al. (1974), Pyfer and Johnson (1983), Evans
(1980), Williams (1983), and Sherrill (1986).
The term perceptual-motor skills generally refer to a person’s ability to
receive, interpret, and respond appropriately to a sensory stimulus. A comprehensive program to enhance perceptual-motor skills should provide
activities involving the visual, auditory, tactile, and proprioceptive
(vestibular and kinesthetic) senses. A perceptual-motor program may be
useful for remediating many neurological dysfunctions: brain trauma,
learning disabilities, mental retardation, aphasia, cerebral palsy, multiple
sclerosis, and Parkinson’s Disease.
Perceptual-motor skills:
Generally refers to a person’s
ability to receive, interpret,
and respond appropriately to
a sensory stimulus
This chapter provides details of programming for:
•
Balance
•
Kinesthetic awareness
•
Fine motor tasks
167
Programming for Balance and Perceptual-Motor Skills
CHAPTER 17
TA B L E 1 7 - 1
PERCEPTUAL-MOTOR DEFICIT CHECKLIST
Client Name:
Disability:
Dose not demonstrate opposition of limbs during walking and/or running
Fails to shift weight from one foot to the other when throwing
Fails to imitate various body positions of evaluator, or fails to identify body parts on command
Evidences flaccid muscle tone
Is unable to use one body part without “overflow” into another
Is unable to keep rhythm by clapping the hands or tapping the feet
Cannot jump rope
Is unable to coordinate the hands at the midline or cross the midline with one hand during activities
Has difficulty identifying the right and left sides of the body
Has difficulty distinguishing between vertical, horizontal, up, down, and other directions of space
Cannot hop
Has difficulty maintaining balance on one foot
Has difficulty tying shoes, using scissors, and manipulating small objects
Has difficulty staying between lines
Cannot discriminate by feel between different textures, shapes, and sizes
Fails to maintain eye contact with moving objects
Bumps into things; misjudges locations when moving to them. Is unable to move between or through objects
Fails to match geometric shapes to one another (visually)
Cannot recognize letters and numbers
Cannot distinguish between foreground and background in a picture
Has difficulty catching balls
Has difficulty walking on a balance beam
Adapted for Sherrill (1986)
The perceptual-motor checklist can be used to screen participants suspected of having deficiencies and guide the
instructor in determining which areas require evaluation that is more rigorous. For a more comprehensive listing of
perceptual-motor test items, the reader is referred to excellent books by Lerch et al. (1974), Pyfer and Johnson (1983),
Evans (1980), Williams (1983), and Sherrill (1986).
168
Programming for Balance and Perceptual-Motor Skills
CHAPTER 17
TA B L E 1 7 - 2
MOST FREQUENTLY ASSESSED AREAS IN PERCEPTUAL-MOTOR FUNCTIONING
GROSS MOTOR
FINE MOTOR
Balance
Static
Dynamic
Intersensory coordination
Intersensory coordination
Eye-hand
Eye-foot
Kinesthesis
Body awareness
Laterality (awareness of right-left)
Bi-lateral coordination or integration
Motor Planning (praxia)
Spatial awareness/orientatio
Figure-groun
Memor
Discriminatio
Ocular tracking
AUDITORY PERCEPTION
Figure-ground
Memory (e.g., remembering a series of directions)
Discrimination
TACTILE PERCEPTION
One-point discrimination
BALANCE PROGRESSIONS
Balance is a capability underlying nearly every static
and dynamic posture that requires the body to be
stabilized against the pull of gravity. The physical
management of the participant with impaired balance should be progressive in design. Developmentally, balance proceeds in a cephalo-caudal pattern:
i.e., stability is acquired in the neck region first and
then proceeds downward (e.g., neck before shoulders, trunk before lower extremities).
•
Standing balance with assistance (static)
•
Standing balance without assistance
(static)
•
Standing balance with assistance
(dynamic)
•
Standing balance without assistance
(dynamic)
•
Ambulation training
More specifically, balance activities should
progress in the following sequence:
•
Training in ascending and descending
stairs, ramps, and curbs
•
Rolling supine to prone, and prone to
supine
•
Sitting with assistance
•
Sitting without assistance
•
Balancing with 4-point, 3-point, and 2point stances
•
Kneeling balance with a 2-point stance
Remember, when the participant is relearning a
psychomotor activity, break the skill down into
small components, give clear instructions, provide
proper demonstration, and provide corrective feedback. Watch for orthostatic hypotension when
bringing an individual from a lying position to a
seated position.
169
Programming for Balance and Perceptual-Motor Skills
CHAPTER 17
Activities for Developing Static and Dynamic Balance
SUPINE ON MAT (OR IN BED)
Roll from back to front, and reverse in one smooth,
continuous movement.
Roll from right side to left, hold for 2 seconds, and
reverse with proper momentum so as not to land on
back or front side.
LONG-SITTING POSITION
ON MAT (OR IN BED)
Lean from side to side, using palms to retain balance. Work up to leaning as far as possible with no
arm supports.
Resisted: Participant attempts to maintain upright
position while assistant slowly applies pressure forward, backward, to right and left sides, and in rotation right and left. The assistant should hold each of
these resistances for about 5 seconds each. Eventually, the assistant can give gentle pushes in the same
directions while the participant attempts to maintain balance.
Participant attempts to bring right finger to nose.
Repeat with left. Facing the assistant, the participant
attempts to touch the right fingers to the assistant’s
right shoulder. Repeat with left.
BRIDGES
While in ‘hook-lying’ position, participant elevates
buttocks off the mat. Assistant may need to straddle
the participant to keep the knees together and assist
in elevating buttocks off mat.
If participant can perform this maneuver independently, assistant can provide resistance at the anterior
superior iliac spinus (ASIS), attempting to push
buttocks back down to mat or side-to-side. Participant resists and attempts to maintain each position
for about 5 seconds each.
4-POINT STANCE ON MAT
(ON HANDS AND KNEES)
Increase holding time in this position. Assistant may
need to straddle participant and spot them.
3-POINT STANCE ON MAT
While on hands and knees, participant raises and
holds requested extremities (e.g., right arm, left arm).
2-POINT STANCE ON MAT
While on hands and knees, participant supports
body weight on two extremities while raising any
combination of two other extremities (e.g., right
arm with left leg).
CRAWLING FORWARD/BACKWARD
Assistant kneels behind participant, assists participant with crawling by moving arms, and legs as
needed. Once the participant can maneuver forward and backward, teach participant to go right
and left.
Note: This activity is precluded for those with joint
trauma (e.g., knee and shoulder pain or inflammation). See physician or physical therapist for
approval.
KNEELING ON MAT
Kneeling is more difficult because it raises the center
of gravity and the base of support is smaller. The
participant should be taught to rise to the kneeling
position from the prone position. Eventually the
participant is taught to rise from a kneeling position
to a standing position.
The assistant generally spots from the front of the
participant. As balance improves, the assistant can
170
Programming for Balance and Perceptual-Motor Skills
CHAPTER 17
spot from behind. Once the participant can master
a skill independently, a mirror should be placed in
front of the participant. The participant should
practice leaning right and left, forward and backward, successfully recovering balance each time.
ASSISTED KNEELING
The participant is assisted to a kneeling position.
The participant then places both hands on the assistant’s shoulders for support. The assistant may also
need to stabilize at hips, trunk, or shoulders.
KNEELING TO STANDING
Participant faces stall bars in supported kneeling
position. Standing behind the participant, the
instructor will place one hand on the shoulder and
the other on the hip of participant. Ask the participant to position the strong leg (flexed and slightly
abducted) under body and extend with leg while
pulling with strong arm.
Eventually the participant should be taught to come
to standing position without use of stall bars.
RESISTED KNEELING
Participant should be able to balance on both knees,
unassisted, for as long as possible.
STANDING IN PARALLEL BARS
Increase time for standing stationary (both supported and unsupported).
Facing the participant, the instructor places his/her
hands on the client and attempts to push the participant backward. The participant should resist for
approximately 5 seconds.
Add swaying by shifting weight from side to side,
gradually widening the base of support.
Place one foot forwards and one foot back to sway
The instructor gently eases up on the pressure and
slides the right hand around posteriorly. From this
position, the instructor attempts to rotate the
trunk to the participant’s right. The participant
should resist for 5 seconds and maintain the faceforward position.
The instructor eases up on the pressure and slowly
slides the left hand around posteriorly. From this
position, the instructor attempts to pull the participant forward. The participant should resist for
about 5 seconds, maintaining the upright posture.
KNEE WALKING
(Whenever suggesting knee drills, consult the
person’s physician regarding health status of the
knee joint.)
Walk forward, to each side, and backwards on knees
with or without assistance.
Gradually increase distance.
Rock side-to-side in a rhythmic fashion.
Balance on one knee only.
171
Programming for Balance and Perceptual-Motor Skills
CHAPTER 17
forward and back. Switch positions of the feet. If one
foot is more affected, keep that one in front first.
Resisted balancing: see resisted-balance activities
under Resisted Kneeling. Perform same sequence in
a standing position. Use both feet positions (i.e.,
side-by-side and forward-back).
STANDING STATIC
BALANCE IN PARALLEL BARS
With arms abducted out to sides, participant
attempts to balance on one leg. The other leg
should be flexed at the knee and adducted at the
hip. This position is called a ‘stork stand.’ As balance improves, hands can be moved to hips and
then placed across the chest. The stork stand should
be performed with the eyes closed as well. Then
have participant perform these static positions on a
balance beam.
TILT BOARDS
Have participant begin with a wide base of support
and progress to a narrow base. Increase time on the
tilt board.
DYNAMIC BALANCE
• Have participant step over low objects
placed on the floor. Use a mirror to allow
participant to observe. Other variations
include crossing leg over the midline
while walking sideways.
•
Have participant walk a straight line
marked on the floor with a spotter
•
Have participant walk heel-to-toe on the
balance beam. Practice forward, back,
sideways. Always have a spotter
present. Vary the width of the balance
beam
•
Have participant walk heel-to-toe on a
circle marked on the floor with a spotter
•
Have participant ascend and descend
ramps and stairs. Step up with the
172
stronger leg first. Step down the stairs
with the weaker leg first
•
Have participant practice vertical jumps
•
Have participant practice horizontal
jumps (standing broad jump)
•
Progress to taking successive jumps.
•
Have participant practice hopping on
each foot. Progress to hopping across
the room
•
Walk on different surfaces (asphalt,
grass, sand, etc.)
PERCEPTUAL-MOTOR
SKILLS
Activities for Developing
Kinesthetic Awareness
A prerequisite to the development of gross motor
coordination is kinesthesis, or awareness of one’s
body in space. A simple test for up, down, right,
left, forward, backward, and sideways may be given
to determine the starting level for the individual.
The following activities are designed to increase
the individual’s body awareness, laterality, and
bilateral coordination.
Programming for Balance and Perceptual-Motor Skills
CHAPTER 17
IDENTIFICATION OF BODY PARTS
• Have participant touch body parts one
by one in response to one-word commands. For example: “elbow”, “wrist”,
and “chin”
•
Upon command, touch two body parts
simultaneously
•
Touch five body parts in the same
sequence as the assistant calls them
•
Repeat all of the above with eyes closed
RIGHT-LEFT DISCRIMINATION
• Use the right hand to touch parts named
on the right side
•
Use the right hand to touch parts named
on the left side. (This involves crossing
the midline and should be more difficult
than the previous task)
•
Use the left hand to touch parts named
on the left side
•
Use the left hand to touch parts named
on the right side
•
Provide opportunities to touch body
parts of a partner who is facing the participant:
a. Use right hand to touch body parts on
the right side of the partner
b. Use right hand to touch body parts on
the left side of the partner
•
OTHER MAT EXERCISES (SUPINE)
• Lift right knee and intercept it with the
right palm. Repeat for the left side
•
Lift right knee and intercept it with the
left palm. Repeat for the left knee and
right palm
•
With one leg raised, have the participant
“write” numbers, letters, and names in
the air with the foot
FINE MOTOR TASKS
Fine motor tasks usually refer to those involving use
of the hands and fingers. Prehension and opposition are two terms used commonly when referring
to tasks of this nature. Prehension refers to the
ability to grasp an object with the fingers, while
opposition refers to the ability to oppose any of the
fingers with the thumb.
The following exercises emphasize fine motor coordination. Fine motor activities are generally harder
to perform than gross motor activities.
•
Make a fist and then extend the fingers
completely. Repeat while moving as
fast as possible. Try to perform with
one palm facing up and the other palm
facing down. Reverse directions of
palms for each hand. Try to perform
with one fist open and one closed
simultaneously.
•
With fingers extended, abduct and
adduct together in unison. Try abducting
and adducting fingers one at a time. Do
one and then both hands at the same
time.
•
Make a circle with each individual finger.
•
With the dominant hand, touch the
thumb to each finger of that hand indi-
Imitation of
Postures/Movements
Have the participant imitate the arm movements
and leg movements of the assistant in the sequence
outlined below:
CROSS-LATERAL MOVEMENTS
• Move the right arm and left leg apart and
together simultaneously while the other
limbs remain stationary
•
Move the left arm and right leg apart and
together simultaneously while the other
limbs remain stationary
Provide opportunities to imitate arm
movements of the assistant as described
on the following page, have participant
start and stop both arms simultaneously
without verbal instruction or mirroring
173
Programming for Balance and Perceptual-Motor Skills
CHAPTER 17
vidually. Proceed from the index finger
to the little finger, and reverse the direction back up to the index finger again.
Work up to using both hands at the same
time. Eventually, increase the speed and
perform with the eyes closed.
•
With arm stretched out in front, touch
the index finger to nose, and to a real
(dot on board) or imaginary point
straight ahead. Repeat as fast and accu-
rately as possible within 30 seconds.
Later, try the same with the eyes closed.
Use the dominant arm before the nondominant arm.
•
Try to touch the right index finger to the
nose while extending the left arm out to
the side. Alternate by touching the nose
with the left index finger while simultaneously extending the right arm out to
the side.
TA B L E 1 7 - 3
PERCEPTUAL MOTOR DYSFUNCTIONS AND GAMES FOR IMPROVING THEM
DYSFUNCTION
GAME
Balance
Stone Walk
Bilateral Coordination
Crisscross Walk
Body Awareness
Jump and Turn, Name Body Parts, Roll it
Crossing Midline
Cats in the Sand
Directionality
Bean Bag Catch, Jump and Turn, Stone Walk
Dynamic Balance
Jump and Turn, Step and Walk, Walk and Toss
Eye-Hand Coordination
Ball Bounce in Hoops, Bean Bag Toss, Pick It, Walk and Toss
Fine Motor
Pick It
Following Directions
Listen and Do
Gross Motor
Bounce It, Throw It
Kinesthetic Awareness
Cross It
Laterality
Bean Bag Toss, Roll It, Stone Walk
Motor Planning
Stone Walk
Spatial Awareness
Walk and Dribble
Tactile Awareness
Cross It, Walk and Toss
Visual-Motor Coordination
Step and Walk
174
Programming for Balance and Perceptual-Motor Skills
CHAPTER 17
TA B L E 1 7 - 4
PERCEPTUAL MOTOR GAMES
ACTIVITY
OBJECTIVE
DESCRIPTION
Bean Bag Catch
Directionality
Hop to right, skip to left, etc., to catch bean bag
Stone Walk
Motor Planning, Laterality,
Directionality, Balance
Write numbers on sheets of paper on the ground. Give
verbal or written directions for how to go through the
sequence of numbered papers.
Bean Bag Toss
Eye-Hand Coordination, Laterality
Throw bags at target with assigned point values, stress
proper throwing techniques.
Step and Walk
Visual-Motor Coordination, Dynamic Step over objects of various heights and widths.
Balance
Name Body parts
Body Awareness
Tough specific body parts as directed.
Crisscross Walk
Bilateral Coordination
Step across line with each leg.
Ball Bounce in
Hoops
Eye-Hand Coordination
Bounce ball once in hoop #1. Bounce twice in hoop #2
Jump and Turn
Directionality, Body Awareness,
Dynamic Balance
Jump and turn to specific angle or direction requested.
Walk and Dribble
Eye-Hand Coordination, Tactile
Awareness
Walk around a course of cones while dribbling maintaining
ball control.
Walk and Toss
Dynamic Balance, Eye-Hand
Coordination, Tactile Awareness
While walking a straight line on balance beam, throw nerf
ball at target.
Roll It
Laterality, Body Awareness
Roll ball up and down leg, around body, through legs.
Emphasis on concepts of up and down, in, and out.
Bounce It
Gross Motor
Bounce ball to assistant using one arm and two arms. Toss
ball to designated heights.
Throw It
Gross Motor
Throw ball to assistant using one arm and two arms. Toss
ball to designated heights.
Cross It
Tactile Awareness, Kinesthetic
Awareness
Have various objects of different sizes, weights, and textures. Have participant find similar object from inside of
“surprise box.”
Pick It
Fine Motor, Eye-Hand Coordination
Fill pan with small objects. Use tweezers to pick objects up.
Listen and Do
Following Directions
Participant imitates the actions of assistant who puts hand
on his own head, etc. Have participant follow spoken work
while assistant touches unrelated parts of his own body.
Cats in the Sand
Crossing Midline
Participant responds to directions for movements. Example:
“Move right arm and left leg while lying supine.”
175
Programming For Cardio-Vascular Fitness
CHAPTER 14
C h a p t e r
1 8
PROGRAMMING FOR
CARDIOVASCULAR FITNESS
To p i c s c o v e r e d i n t h i s c h a p t e r
CARDIOVASCULAR EXERCISES
Walking
Treadmills
Swimming and/or Water Exercise
Bicycling
KARVONEN’S FORMULA
HOW TO TAKE A PULSE
Determining Your Target Heart Rate
176
Programming for Cardiovascular Fitness
CHAPTER 18
The cardiovascular system includes the heart, lungs, and vascular system,
which are critical to a good quality of life. Part of the disuse syndrome that
occurs when an individual is immobilized is the loss of cardiovascular
endurance. This reduction in aerobic capacity has many health implications
in regard to obesity and heart disease. Regular, moderate physical activity
may aid efforts to control cigarette smoking, hypertension, lipid abnormalities, diabetes, obesity, and emotional stress. The following section provides
some guidelines for instituting a cardiovascular training program.
Cardiovascular: Relating the
heart and the blood vessels or
the circulation
CARDIOVASCULAR EXERCISES
Cardiovascular exercise is one of the most important components of physical fitness. Not only does it help increase the ability of the circulatory system
to carry oxygen and necessary nutrients to every cell of the body more effectively, but it also helps prevent heart disease. Since heart disease is the leading
cause of death in this country, cardiovascular exercise is a preventive
measure we must participate in regularly.
Cardiovascular exercises are those exercises that require the body’s circulatory system to work harder to meet the demands of the exercise. For
example, when one climbs a flight of stairs the heart will begin to beat faster
and breathing will become deeper and/or faster. These are cardiovascular
adjustments necessary to transport more oxygen throughout the body in
order to meet the demands of climbing a flight of stairs. If you were to climb
consecutive flights of stairs without stopping and you were to do this for
approximately 20 minutes, this would then be considered aerobic exercise.
Aerobic exercise requires oxygen and sustained effort.
Aerobic exercises are those types of activities that are long, slow, and continuous, and require the use of large muscle groups (for example, walking or
swimming). In order for your cardiovascular system (heart, lungs, arteries,
veins, etc.) to benefit from cardiovascular exercise, you should try to maintain an exercise intensity that elevates your heart rate to a target zone. Both
your age and your current level of fitness determine this target zone.
Aerobic exercise: Physical
activity in which oxygen from
the blood is required to fuel
the energy-producing
mechanisms of muscle fibers
Once you have calculated your target heart rate, you are all ready to begin a
cardiovascular exercise program. The first step is to properly warm up and
stretch. Then participate in an aerobic exercise at least three times per week at
your target heart rate for a minimum of 20 minutes. Two to three bouts of ten
minutes is almost as good as twenty to thirty minutes non-stop. Remember
to monitor your heart rate as you are participating in your activity.
177
Programming for Cardiovascular Fitness
CHAPTER 18
Walking
Bicycling
Walking is the safest form of exercise and yet one of
the most beneficial. Walking does not require a lot
of equipment, it can be done continuously almost at
anytime, anywhere, and injuries are infrequent. To
ensure safety, walk in an area that has plenty of light,
especially when walking in the evening, and make
sure that the walking surface is smooth and stable.
Shopping malls are becoming very popular sites in
which to walk. They provide plenty of space and a
safe and well-lit environment and are usually kept at
a constant temperature.
Bicycling is another excellent form of aerobic exercise if done continuously. Not only does it help
increase cardiovascular endurance, but it also helps
increase muscular strength and endurance of the leg
muscles. For those who have difficulty with balance
or lack a safe place to ride, a stationary bicycle provides the same benefits. With a stationary bicycle,
one need not worry about traffic or outdoor conditions. It allows you the opportunity to exercise at
any time in the privacy of your own home.
The only equipment necessary is a good pair of
proper-fitting walking shoes, which provide plenty
of support and traction. Wear comfortable clothing,
which allows a person to move freely and doesn’t
constrict bodily movement.
Treadmills
Whether cycling outdoors or on a stationary
bicycle, it is necessary to exercise continuously for a
minimum of 20 minutes. Caution: seat height
should not allow the legs to completely extend when
pedaling. Recumbent bikes are good alternatives for
those who cannot use upright bikes because of poor
balance, bad back, etc.)
Instructions for operation are listed on the treadmills. Be sure the client has read and understands
the instructions prior to using the treadmill.
Using a Stationary Bicycle
Make sure that each person has the physician’s and
the physical therapist’s permission before using the
treadmill. Have the person straddle the belt before
turning the power on. Encourage the person to walk
upright and at the front of the belt. Make sure that
the person slows before stopping, instead of just
stopping abruptly.
Check to see that the knees are aligned with the toes
while pedaling. Special pedals, blocks, and straps are
available for persons whose legs are too short to
reach the pedals.
Swimming
and/or Water Exercises
Considered one of the best forms of exercise, aquaactivities are ideal for those who may suffer any
orthopedic difficulties. Not only does water exercise
allow the orthopedically disadvantaged the opportunity to participate freely, it also provides an environment that is quite relaxing. Water exercisers are
far less susceptible to injuries due to the body’s
buoyancy and the resistance of the water. Water
exercise requires one to use all of the major muscle
groups, thus making it an excellent aerobic exercise
if done continuously.
178
Adjust the seat so the person will have a 15º bend in
the extended leg when cycling.
If a person’s hand will not stay on the handlebars
(e.g., s/he can’t grasp with the hand), a special mitt
or ace bandage may be used.
Programming for Cardiovascular Fitness
CHAPTER 18
ADAPTIVE MODIFICATION
When a person lacks the ability to mount the stationary bicycle, he or she may cycle while seated in
a chair or wheelchair positioned behind the bicycle
(the bicycle seat is removed). Back the chair up to a
wall so that it will not tip over backward during
pedaling. If a wheelchair is being used, always lock
wheelchair brakes! If the bicycle slides around, place
rubber pads under its legs.
imal heart rate averages about 10 beats lower for
arm than for legwork. Thus, when using Karvonen’s
predicted, age-adjusted maximal heart rate (220
minus age) for determining work intensity, subtract
10 beats to correct for arm exercise (i.e., 210 minus
age). (See box below.) Resting heart rates can be
obtained by taking a 60-second count prior to the
exercise bout.
KARVONEN FORMULA
Rehab Trainers (Arm Cycles)
Assist the person to sit with the body lined up with
the center of the machine. If in a wheelchair, lock
the brakes. Adjust the machine so that the fulcrum
of the crank arm is even with the shoulder height of
the person. A hand that cannot grasp can be held in
place with a mitt or an ace bandage. Check for possible friction spots on the person’s skin.
Example:
220
220
–____ Subtract age
– 30
____ Predicted, age-adjusted maximum
–____ Subtract resting heart rate
– 70
____ Heart rate reserve
120
x____ Multiply by exercise intensity of 60-80%
____
ARM-CRANK ERGOMETRY
PROTOCOLS
190
x 0.70
84
+____ Add resting heart rate back in
____ Target heart rate (beats/minute)
+ 70
154
Duration of Exercise
Studies involving arm pedaling have primarily used
interval training for improving fitness parameters
of those with lower-extremity disabilities. Significant improvements in physiologic responses have
occurred using three 4-minute work bouts separated by 2-minute rest intervals. Pollock and associates alternated 1-minute bouts of high and low
work rates, progressing to 30 minutes of continuous
high work rate by the 19th week of training for persons with paraplegia.
FREQUENCY OF EXERCISE
Researchers generally agree that training should
take place three to five times per week.
INTENSITY OF EXERCISE:
TARGET HEART RATE
The purpose of the target heart rate (THR) is to
establish the intensity of exercise necessary to produce a training effect on the cardiovascular system.
Several factors must be considered when determining THR for arm-crank ergometry. The max-
The percentage entered into the formula for the
exercise intensity depends on how much training
one has had in the past. The following percentages
are recommended.
Over 39 years of age
Beginner
60% to 70%
College-age
Beginner
70% to 80%
Trained
less than 2 yrs
75% to 85%
Trained
more than 2 yrs
85% to 95%
Special Note for clients with spinal cord injuries:
Due to disturbances in the sympathetic nervous
system and partial paralysis of the arm and shoulder
musculature, persons with spinal cord lesions above
thoracic nerve root 6 cannot use Karvonen’s formula because of deficient exercise tachycardia: the
179
Programming for Cardiovascular Fitness
CHAPTER 18
heart rate reaches a ceiling between approximately 100 to 130 beats/minute.
Therefore, the individual with this type of disability should not attempt to
achieve his/her ceiling heart rate during training bouts. Also, clients on beta
blockers and pacemakers should not rely on heart rates.
HOW TO TAKE A PULSE
Pulse: Palpable rhythmic
expansion of an artery,
produced by the increased
volume by the contraction of
the heart
1. Take a pulse at the thumb side of the wrist on the palm or inner
side of the forearm. Place your fingers at the area near inside
wrist and you will feel a throb there. Do not use your thumb
because it has its own pulse. Do not take a pulse from the carotid
arteries in the neck.
2. Look at the second hand of a clock or watch and count how many
beats you feel in 10 seconds. Multiply this number by six to
obtain the pulse for one minute. If the pulse is weak and irregular, count for a full minute.
CHART FOR IDENTIFYING HEART RATE
FROM 10-SECOND PULSE COUNT
(10-SEC PULSE COUNT = HEART BEATS/MINUTE)
180
15 = 90
(15 x 6)
19 = 114
(19 x 6)
23 = 138
(23 x 6)
27 = 162
(27x 6)
16 = 96
(16 x 6)
20 = 120
(20 x 6)
24 = 144
(24 x 6)
28 = 168
(28 x 6)
17 = 102
(17 x 6)
21 = 126
(21 x 6)
25 = 150
(25 x 6)
29 = 174
(29 x 6)
18 = 108
(18 x 6)
22 = 82
(22 x 6)
26 = 156
(26 x 6)
30 = 180
(30 x 6)
Programming for Cardiovascular Fitness
CHAPTER 18
DETERMINING TARGET HEART RATE
Target Heart Rate: The heart
rate at which one aims to
exercise at a THR of 60 to 90
percent of maximum heart
rate reserve
1. Calculate your approximate maximum heart rate:
220 minus your age = _________. This is your maximum heart
rate.
2. Multiply your maximum heart rate by 0.6:
Maximum heart rate x 0.6= ______. This number is your lowerlimit heart rate for aerobic exercise.
3. Multiply your maximum heart rate by 0.8:
Maximum heart rate x 0.8=.______. This number is your upperlimit heart rate for aerobic exercise.
4. Your target heart rate range during aerobic exercise, then, is
defined by your lower and upper heart rate limits: between
60% and 80% of your maximum heart rate.
5. If doing arm cycling, subtract 10 bpm.
TARGET HEART RATE
100%
170
167
162
160
157
155
152
150
145
140
127
125
121
120
118
116
114
112
109
105
119
117
113
112
110
109
106
105
102
98
75%
BORG SCALE
50%
25%
102
0%
AGE 50
100
97
96
94
93
91
90
87
84
53
58
60
63
65
68
70
75
80
Teaching Tip: If you take certain heart or blood pressure medications, i.e.,
beta-blockers, the target rate during exercise may be lower than these calculations. Thus, you must rely on a system called ‘Perceived Exertion’. This is called
the Borg Scale. You rate how you feel during your exercise program. An overall
feeling of effort is rated on a scale of 1 to 10. The chart on the right is a modified perceived-exertion scale. For a good cardiorespiratory training effect, aim
for level 4, ‘somewhat hard’.
An even simpler way to determine exercise intensity is called the ‘talk test’. If
you are able to carry on a conversation while you are exercising, you are not
working too hard. If you become out of breathe and unable to talk, this is an
indication for you to slow down.
0
nothing at all
0.5
very, very light
1
very light
2
light
3
moderate
4
somewhat hard
5
hard
6
hard
7
very hard
8
very hard
9
very, very hard
10
extremely hard
181
Programming For Flexibility And Range Of Motion
CHAPTER 15
C h a p t e r
1 9
PROGRAMMING FOR
FLEXIBILITY AND
RANGE OF MOTION
FLEXIBILITY
RANGE OF MOTION
PROGRAMMING FOR FLEXIBILITY
Optimal Conditions for Eliciting a Stretch
RANGE-OF-MOTION EXERCISES
182
Programming for Flexibility and Range of Motion
CHAPTER 19
FLEXIBILITY
All movements in the body occur at joints and depend upon muscles to provide their motion. The greater the flexibility of the muscles and joint structure, the greater the range of motion that can occur at each joint. Each joint
has a normal range of motion, which can be maintained by performing
stretching exercises. The ‘sit-reach’ and ‘shoulder stretch’ tests are examples of
tests used to measure flexibility. Stretch before and after exercising, but don’t
stretch cold, tight muscles. Warm up first with 5 to 10 minutes of gentle exercise. When you begin to perspire slightly, or at least feel warm, it is safe to start
stretching. Otherwise, you may cause microscopic tears in your muscles. The
best kind of stretch is a ‘static’ stretch, where you gradually increase the stretch
without straining the muscles and hold the stretch for a minimum of 10 to 15
seconds. You may progress up to 60 seconds. Although recent studies have
failed to show that stretching after a too-strenuous workout heads off muscle
soreness, it does promote flexibility and can keep your muscles from tightening up quickly. Flexibility exercises can be done daily.
Flexibility: Denotes the total
range of motion at a joint
dependent on normal joint
mechanics, mobility of soft
tissues and muscle
extensibility
RANGE OF MOTION (ROM)
The term range of motion describes the extent to which the joint can move
within a measurable range. An instrument called a goniometer measures
degrees of motion, and is used mainly in a therapeutic setting. Range-ofmotion exercises are generally performed while the person is lying down, but
they can also be done in a sitting position, depending upon individual circumstances.
Both active and passive ROM tests should be utilized when determining limitations in flexibility. Active ROM tests are performed with the participant
actively contracting muscles, taking the joint and the limb through their
entire range of motion. If a participant can move a limb through the normal
range of motion during an active ROM test, then a passive ROM test is not
required. Passive testing consists of an assistant moving joints and limbs
through the client’s ROM. Passive ROM is typically greater than active ROM.
Range of Motion: 1) Denoting
the measured beginning and
terminal angles, as well as
the total degrees of ROM,
traversed by a joint moved by
active muscle contraction or
by passive movement. 2) Joint
movement (active, passive, or
a combination of both) carried
out to assess, preserve, or
increase the arch of joint
ROM.
When an individual cannot elicit movement independently, an assistant can
apply passive range-of-motion exercises. This will help to prevent stiffening
or contractures (shortening of the muscles) that result from disuse. For those
persons with spasticity, it is most useful to do range-of-motion exercises
prior to walking (gait training). This allows for better stance and balance. As
a person improves, the assistant may only have to assist each movement,
thereby allowing the individual to work as independently as possible. Providing ‘manual resistance’ to each movement allows for an increase in
strength. Students should also be encouraged to perform as many of their
own range-of-motion exercises as possible. For example, a person who has
183
Programming for Flexibility and Range of Motion
CHAPTER 19
had a stroke can use the unaffected arm to help
stretch the paralyzed arm.
Normal values are usually recorded on the evaluation sheet as ‘WNL’ (within normal limits), while
limitations are recorded as ‘LOM’ (limitation of
motion). Always determine ROM bilaterally for
comparison (i.e., the ROM for the non-involved
joint can be used as the standard for evaluating the
LOM in the involved joint). You can use a
goniometer to measure ROM.
PROGRAMMING
FOR FLEXIBILITY
Optimal Conditions
for Eliciting a Stretch
Connective tissue displays both properties of elasticity (rebound to original length) and plasticity
(permanent deformation). To increase flexibility, it
is important to affect the plastic property of connective tissue. The optimal conditions for
achieving a permanent increase in flexibility
include the following:
Hold the Stretch for a Sufficient Duration (the
Longer the Better)
Although research has not demonstrated what the
optimal duration for a stretch is, it has been agreed
that longer durations will produce better results. For
purposes of this manual, it is suggested that each
stretch be held for a duration of 30 to 60 seconds. If
executed properly, discomfort felt due to stretching
will diminish the longer the stretch is held.
Stretching Should Always Be Performed Through
the Pain-Free Range of Motion
Do not perform stretching if pain, infection, or
edema is present.
Incorporate Stretches at the End of Cool-Down
To Prevent Adaptive Shortening and Promote
Relaxation of Muscle.
Muscle that has been subjected to a vigorous
workout will generally be in a contracted state. Performing stretching at the end of the workout will
return the muscle to its resting length and promote
additional elongation of connective tissue.
Stretching Techniques
Engage in Warm-Up Prior to Stretching
Increasing tissue temperature will facilitate the viscous (plastic) property of connective tissue,
resulting in a greater elongation or stretch. In other
words, a warm muscle will stretch farther than a
cold one! Warm-up may include easy laps around
the track until a sweat is broken (5 to 10 minutes).
The same result may be achieved by performing calisthenics in place.
There are two basic types of stretching techniques:
active and passive. Active stretching is performed
without assistance, using a volitional muscle contraction to move the joint through the full range of
motion. In contrast, passive stretching occurs
without any muscle contraction and is performed
by an assistant. A third technique, PNF (proprioceptive neuromuscular facilitation) Hold-Relax,
also described in this chapter, utilizes both active
and passive stretching.
Do Not Apply Too Much Force to the Stretch
Lower amounts of force induce less injury and
tearing to connective tissue than high amounts of
force. Vigorous and/or ballistic stretching may cause
bleeding in the joint, as well as tearing of soft tissue.
ACTIVE STRETCHING (SLOW STATIC)
This technique involves slowly stretching a muscle
for 15 to 60 seconds (or longer) by contracting the
opposing muscle group. If proper stretching is to be
accomplished, the lengthened muscle must be held
184
Programming for Flexibility and Range of Motion
CHAPTER 19
at the point of limitation with a tension level that
does not activate, to any marked extent, the stretch
reflex mechanism. After holding the stretch for a
period of time, the discomfort of tension should
diminish to some degree. At this time the individual
may increase the stretch and establish a new point of
limitation. This process can be repeated until no
further range of motion is attainable. Overstretching is recognized by discomfort that becomes
greater the longer the stretch is held or when the
lengthened muscle quivers or vibrates. Avoid
bouncing or ballistic movements.
PASSIVE STRETCHING
This technique is applied when the individual
cannot perform an active stretch. It is performed by
the assistant and involves ranging every affected
joint to prevent contractures from developing
through disuse. The assistant moves each joint
slowly through the permissible range of motion,
using one hand to stabilize the body while the other
moves the limb. Hold at the point of limitation for
30 to 60 seconds. Prolonged, moderate stretching is
more effective than momentary, vigorous
stretching. Two to five repetitions are usually sufficient for passive range of motion.
PNF (PROPRIOCEPTIVE NEUROMUSCULAR
FACILITATION) HOLD-RELAX
PNF hold-relax is a relaxation/lengthening technique
in which the individual isometrically and maximally
contracts a muscle group prior to stretching it to a
new point of limitation. The contraction is held for
six seconds. When the maximal number of motor
units are contracting simultaneously, the Golgi
Tendon Organs within that muscle will fire, causing
the muscle to relax. This phenomenon is known as
autogenic inhibition. During this post-contraction
depression, lasting for about six seconds, the Golgi
Tendon Organs override the reflex activity of the
muscle spindles. The individual or assistant then
moves the limb to a new point of limitation. The
sequence is repeated until no new further range of
motion is obtainable. This technique may be performed with single joint movements, or more ideally,
in the spinal/diagonal PNF patterns.
Hold-Relax Sequence:
1. The assistant (passively) or the participant (actively) moves the limb to the
point of limitation. Active movement
should be encouraged whenever possible. The participant then isometrically
and maximally contracts the muscle on
stretch against a resistance provided by
the assistant for six seconds. This is the
hold period of the technique and the
limb should not be allowed to move. The
maximal contraction should be brought
on gradually, not suddenly.
2. The participant then relaxes the
stretched muscle and moves the limb to
a new point of limitation either actively
or passively with help of the assistant.
This relaxation period for the stretched
muscle should last six seconds. Repeat
the sequence of holds and relaxations
until no further range of motion is
obtained.
185
Programming for Flexibility and Range of Motion
CHAPTER 19
Contraindications
for Performing Stretching
•
Infections around a joint
•
Exacerbation (attacks) of inflammatory
disease, especially when pain is present
•
Edema – joint capsule is subject to tears
•
Functional contractures (e.g., finger
flexors, elbow flexors, and pronators
may actually assist the participant to pull
objects toward him/her)
•
VIGOROUS STRETCHING OF CONTRACTURES. This technique may cause
bleeding in the joint. It is the role of a
physical therapist, not a Specialist in
Exercise Therapy, to improve ROM in
severe contractures
Performance Requirements
for Stretching Techniques
•
Know the anatomical motions that occur
at each joint (see Chapter 6)
•
Stabilize the extremities at the joint, e.g.,
at the elbow or wrist. For someone with
a painful joint, such as caused by
arthritis, support the extremity in the
muscular area
•
Try to avoid touching the muscle or tendons being stretched as this may trigger
unwanted reflex activity
•
Stretch in opposition to the line of pull of
muscle
•
Use a firm but comfortable grip
•
Perform motions slowly and smoothly
•
Do not exceed the participant’s existing
range of motion, especially in the case of
paralyzed limbs. Movements should not
be forceful
•
•
Never force a stretch if spasticity occurs.
Stop applying force and hold the limb or
return to the starting position. When the
spasticity has subsided, proceed again
more slowly and smoothly
Remember that two-jointed muscles (e.g.,
hamstrings) need a two-jointed stretch
186
RANGE-OF-MOTION
EXERCISES
General Guidelines for Performing Range-ofMotion Exercises
1. Learn the various motions for each joint
2. Use proper body mechanics so that you
prevent injury to yourself
3. Know the individual’s abilities and limitations from medical records. Also, communicate with the person before starting
each session about any necessary
changes to the routine. Only work within
their permissible range
4. Work with only one joint at a time,
placing hands on either side of the joint
with a firm but gentle grip. Support and
stabilize the extremity. Sometimes it is
effective to cradle the limb with your
arms
5. Perform rhythmic motions slowly and
smoothly to lubricate the joints, followed by holding in a stretched position
for 15 to 60 seconds. You can spend several minutes on each joint
6. If spasticity occurs, you must stop
applying force and hold the limb. Thus,
it will relax and allow you to go farther.
Proceed slowly and smoothly
7. Some experts suggest working in a
distal or proximal direction (from the farthest extremities in toward the body, i.e.,
ankle-knee-hip). Each person is different;
therefore, you must vary your procedure
accordingly
Programming for Flexibility and Range of Motion
CHAPTER 19
The following are a few of the most-used ROM
exercises. It is recommended that you consult a
physical therapist for instruction in these techniques prior to using them with a client.
Note: Return each limb to the starting position
before repeating.
Shoulder
FLEXION AND EXTENSION
Starting Position: Support the arm above the elbow
and at the wrist.
Movement: Slowly lift the arm straight up and over
the head. It is all right to bend the elbow if a wall is
in the way, or to provide you with a better hand
position for leverage.
Movement: Bend the client’s hand in the direction
of the thumb (radial deviation), and then toward
the little finger (ulnar deviation).
Thumb
FLEXION AND EXTENSION
Starting Position: Support the person’s hand with
one of your hands and hold the thumb with your
other hand.
Movement: Bend the thumb into the palm of the
person’s hand, and then straighten it out.
ABDUCTION AND ADDUCTION
Starting Position: Support the person’s hand with
one of your hands and hold the thumb with your
other hand.
Movement: Move thumb apart from the index
finger, and then move thumb next to the index
finger.
Fingers
FLEXION AND EXTENSION
Starting Position: Use one hand to support the
forearm near the wrist.
Figure 19-1 Shoulder Flexion and Extension
ABDUCTION AND ADDUCTION
Starting Position: Support the arm at the elbow and
at the wrist.
Movement: Keeping the elbow at a 90˚ angle, move
the upper arm to the side.
Wrist
FLEXION AND EXTENSION
Starting Position: Use one hand to support the
forearm near the wrist, and hold the person’s hand
with your other hand.
Movement: Bend the client’s hand forward, and
then backward.
RADIAL AND ULNAR DEVIATION
Starting Position: Use one hand to support the
forearm near the wrist and hold the person’s hand
with your other hand.
Movement: Use your other hand to close the
person’s fingers into a fist, and then to extend them
out straight. Note: If the person has spasticity in the
hand, extend and abduct the thumb first, and hold
it there. This may allow you to more easily extend
the fingers.
ABDUCTION AND ADDUCTION
Starting Position: Hold the index finger with your
other hand.
Movement: Spread the fingers apart, and then back
together. Repeat for all fingers.
Hip and Knee
FLEXION AND EXTENSION (consult M.D. for
approval)
Starting Position: Place one of your hands under
the person’s knee; cup the heel in your other hand.
Movement: Lift the leg bending it at the knee and at
187
Programming for Flexibility and Range of Motion
CHAPTER 19
the hip. Slowly continue to move the knee toward
the chest. Lower the leg part way, then straighten the
knee by lifting the foot toward the ceiling.
ABDUCTION AND ADDUCTION (consult
M.D. for approval)
Starting Position: Support the leg under the knee
and under the heel. Keep the knee straight and hold
the leg several inches up from the mat.
Movement: Bring the leg out toward you (abduction). Bring the leg back toward the other one.
Ankle
time, pull the heel of the foot. Slide your hand to the
top of the foot, just below the toes. Press down on
the forefoot to point the toes. At the same time,
push against the heel with the cupping hand.
INVERSION AND EVERSION
Starting Position: Grasp forefoot with one hand
(your palm against ball of foot). Hold the ankle
firmly with your other hand.
Movement: Turn the foot in so that the sole faces
toward the other foot. Then turn the foot out so that
the sole faces away from the other foot.
DORSIFLEXION AND PLANTAR FLEXION
Starting Position: Cup the heel in your hand with
your forearm resting against the ball of the foot.
Steady the ankle by placing your other hand on the
leg just above the ankle.
Toes
Movement: Press your arm against the ball of the
foot (not the toes), bringing the foot up. At the same
Movement: Curl the toes down, then straighten and
gently stretch them back.
Figure 19-2 Toe Flexion and Extension
188
FLEXION AND EXTENSION
Starting Position: Grasp toes with one hand. Hold
the foot firmly with your other hand.
ACTIVE RANGE OF MOTION WORKSHEET
LOWER BODY
Toes
Ankle
UPPER BODY
HL
Back
Trunk
Fingers
Wrist
Shoulders
Neck
NAME:
PRE
1
2
3
4
5
6
7
8
9
10
11
12
Programming For Muscular Strength And Endurance
CHAPTER 16
C h a p t e r
2 0
PROGRAMMING FOR
MUSCULAR STRENGTH AND
ENDURANCE
To p i c s c o v e r e d i n t h i s c h a p t e r
GENERAL PROGRESSIVE RESISTANCE
GUIDELINES
STRENGTH TRAINING
Terminology
Techniques in Strength Training
GENERAL GUIDELINES FOR ADAPTIVE WEIGHT TRAINING
Conducting a Safe and Beneficial Strength Program
SAMPLE STRENGTH TRAINING PROGRAM
190
Programming for Muscular Strength and Endurance
CHAPTER 20
The development and maintenance of muscular strength and endurance
are critical for a healthy lifestyle. The purpose of this chapter is to acquaint
the reader with common weight-training exercises that will assist you in
keeping your body toned and firm. If you are concerned that lifting weights
will make you bulky and muscle-bound, know that this will not occur if you
follow the guidelines described within this chapter. In addition, studies have
shown that adults take much longer to develop than younger people. Women
do not need to be afraid that lifting weights will make them lose their femininity, because they lack the male hormone testosterone.
Endurance: The capacity to
continue a physical
performance over a period of
time
GENERAL PROGRESSIVE
RESISTANCE GUIDELINES
The difference between a young body and an old body has more to do with
physical activity and genetics than age. Muscle is the furnace that helps burn
calories. The perfect program includes cardiovascular exercise done most
days of the week, combined with a program of progressive overload training
one to three times a week, with 1 to 3 sets of 8 to 12 repetitions. Make sure
that the program utilizes the major muscles of the body, following up with a
safe-and-sane stretching routine.
•
Always warm up prior to lifting weights
•
Exercise all the muscle groups of your body
•
Exercise the large muscle groups before the small muscle
groups (e.g., chest and legs before arms, shoulders before
wrists)
•
Always stretch after weightlifting
STRENGTH TRAINING:
THE FORGOTTEN COMPONENT OF FITNESS
Those of us who have been around the fitness industry for a while can
remember back to the 1970’s and 1980’s when “working out” meant only
jogging or doing aerobics. Endurance sports such as running, cycling, or
swimming are excellent for cardiovascular health and reducing body fat.
Unfortunately, they appear to provide very little help to prevent the loss of
muscle tissue associated with aging. Only a systematic method of progressively overloading the muscle can protect a person from age-related
muscle loss.
Less than 25% of Americans get adequate amounts of regular exercise. Inactive people can expect to lose about 30% of their strength and 40% of their
muscle mass between the ages of 20 and 70.
However, loss of muscle and bone mass is not inevitable. Numerous scientific studies have proven that older people who participate regularly in
191
Programming for Muscular Strength and Endurance
CHAPTER 20
weight training can maintain muscle strength into
old age and even reverse a previous loss. Some
studies have demonstrated that men in their seventies had the same muscle size and power as sedentary men in their twenties and thirties. To me, this
shows that strength training is the foundation/
fountain of youth.
Strength training is not only helpful for men but has
proven to be helpful for older women (60 to 77
years old). Strength training can significantly help
improve functional fitness skills such as the ability
to get up from the toilet, increase walking speed,
and possibly prevent falls.
BASIC TERMINOLOGY COMMONLY USED WHEN LIFTING WEIGHTS
TERM
DEFINITION
Concentric Contraction
an isotonic contraction in which the muscle shortens (e.g., biceps curls)
Eccentric Contraction
an isotonic contraction in which the muscle lengthens (e.g., returning Biceps curls to
starting position)
Hypertrophy
when the muscle size increases, as a result of weight training.
Isokinetic
a contraction where the resistance stays constant through the full range of motion
(e.g., cybex equipment)
Isometric
a contraction where no movement occurs and the resistance stays constant (e.g.,
pushing against an immovable object)
Isotonic
a contraction in which the muscle length changes and movement occurs (e.g., lifting
free weights such as barbells, etc.)
Muscular Endurance
the ability of a muscle to continue to contract for a prolonged period of time.
To improve muscular endurance, a high number of repetitions should be utilized.
Muscular Strength
the amount of force (weight) that a muscle can exert
Progressive Resistance
Exercise (PRE)
where the weight/force is increased as the muscle strength increases
Repetitions (“Reps”)
the number of consecutive times a movement is repeated
Set
a grouping of repetitions
Techniques in Strength Training
Strength-training techniques currently available to adaptive fitness instructors include:
•
Active-assistance exercise
•
Active exercise
•
•
192
•
Proprioceptive Neuromuscular
Facilitation (PNF)
Isometric exercise
•
Isotonic exercise
Manual resistive exercise with a partner
•
Isokinetic exercise
Programming for Muscular Strength and Endurance
CHAPTER 20
The definitions, advantages, and disadvantages of
each exercise technique are presented below. (The
initials in brackets beside each subheading suggest
how the technique can be indicated on the exercise
program card.)
Active-Assistive Exercise [AA]
Active-assistive exercise is recommended when the
agonist muscle group is so weak that it cannot move
the limb through the entire range of motion
without assistance from another person. The participant should initiate the movement (e.g., elbow
flexion), but the assistant helps overcome the
“sticking point”: (i.e., where weight of the limb and
gravity are too great to overcome voluntarily) and
takes the limb through the remainder of the range.
This type of exercise may be performed in an antigravity or gravity-neutralized position. For particular muscle groups, such as the abdominals,
eccentric contractions may be indicated when using
active-assistive exercise. Muscles can usually accommodate more resistance with an eccentric contraction than with a concentric one. For example, if a
participant requires a great deal of assistance to perform an abdominal curl, the assistant should bring
the participant to the fully curled position, but then
allow the participant to lower himself/herself to the
mat without help. Once sufficient strength has been
achieved with eccentric contractions, the participant should progress to concentric contractions.
Active Exercise [A]
The participant contracts the agonist muscle group
(e.g., elbow flexion) through the range of motion
without any resistance other than the weight of the
limb and gravity. Active exercise can also be performed in an anti-gravity position. When the participant is able to perform one set of 10 repetitions
through the entire range of motion, then he/she
should progress to some form of resistive exercise.
Resistive Exercise [R]
During resistive exercise, the participant contracts
the agonist muscle group through the full range of
motion against a given resistance. The amount of
resistance and the number of repetitions performed
will vary depending on whether the individual is
working on strength or endurance.
Types of Resistive Exercises
Isometric Exercise [I]
Isometric exercise involves exerting muscular force
against an immovable object, thereby creating a
static contraction. It may also be created by simply
contracting a muscle group statically. Thus, no
movement occurs (i.e., no change in the length of
the muscle or joint angle). Although tension and
heat are produced, mechanical work does not occur.
The force exerted may be submaximal or maximal,
depending upon the purpose of the exercise. The
advantage of isometric exercise is that it does not
require any equipment or space to execute. It is also
useful if a contracture exists. The disadvantages of
isometric exercise are that (1) it may raise the blood
pressure to high levels, (2) the strength gain is specific to the angle trained at (i.e., not much strength
gain for the remaining range of motion except 15
degrees to either side of the training angle), and (3)
the amount of transfer to functional activities is
questionable. Isometric exercise is usually performed in sets of 10 repetitions. Each contraction is
held for approximately 5 to 10 seconds.
Manual Resistive Exercise [MR]
In manual resistive exercise, the participant contracts the agonist muscle group through the range
of motion against a resistance applied by the assistant. This effort may be maximal or submaximal,
and may be performed concentrically or eccentrically. It is usually performed in sets of 10 repetitions
or in one continuous set to fatigue. The exercise
should be performed rhythmically, and if desired,
resistance can be applied in both directions of
movement (i.e., flexion and extension). The advantages of MR are that (1) it requires no equipment or
space, (2) it is accommodating to the participant’s
strength levels, and (3) it is useful when contractures prevent positioning on equipment. Manual
resistive exercise is typically performed with single-
193
Programming for Muscular Strength and Endurance
CHAPTER 20
joint movements in one plane only (e.g., elbow
flexion, sagittal plane); therefore, it does not simulate the majority of functional human movements.
Progressive Resistive Exercise does not necessarily
mean you must have weights.
Proprioceptive Neuromuscular
Facilitation [PNF]
PNF is a group of relaxation and strengthening
techniques used to rehabilitate neuromuscular deficiencies. It refers to the facilitation of neuromuscular activity by stimulating proprioceptive sensory
input, which regulates muscle function, joint movement, locomotion, posture, and body space. For
example, PNF takes advantage of the neuromuscular phenomena of autogenic inhibition, reciprocal inhibition, and stretch reflex to facilitate
voluntary movements and relaxation. Proprioceptors include the muscle spindle, Golgi tendon
organ, and joint receptors. However, PNF takes
advantage of all the senses. Additional facilitation is
achieved through use of the eyes (e.g., individual
observes movement), ears (e.g., individual receives
commands; posture regulated by the inner ear), and
the exteroceptors of the skin (e.g., tactile input by
the therapist). Treatments are directed toward the
improvement of the individual’s ability to perform
functional activities.
The patterns of motion utilized in PNF follow
spiral/diagonal pathways (e.g., shoulder flexionadduction-internal rotation) to make total use of
the muscles. The inclusion of rotation adds synergistic muscles to the movement. PNF should only be
performed through the pain-free range of motion.
PNF techniques are based upon many of
Sherrington’s Principles (1947): (1) facilitating
strong components before weak, (2) applying maximal resistance (irradiation), and (3) successive
induction. It is beyond the scope of this manual to
provide a comprehensive explanation of the techniques involved in PNF. It is also a method that
requires much experience with it to become compe-
194
tent. Several textbooks are available at medical
bookstores that describe the technique in detail.
Isotonic Exercise,
Progressive Resistive Exercise [PRE]
In isotonic exercise, resistance is provided by a
weight such as a dumbbell, pulley, ankle/wrist
weight, or weight training machine. Because the
resistance remains constant throughout the movement, this form of exercise does not accommodate
the changes in strength that occur as the joint angle
changes (i.e., a muscle group is strongest at
midrange and weaker at the end ranges). Thus, isotonic exercise may be considered submaximal when
compared to MR or PNF because it cannot fully
accommodate the strongest portion of the range.
Some mechanical devices (e.g., Nautilus, Universal
Centurion machines) use cams to change the
amount of resistance encountered through the
range of motion. This type of machine accommodates the muscle capabilities to a much greater
degree than the constant resistance provided by a
dumbbell or the standard Universal equipment.
Protocols using isotonic exercise vary widely. Progressive Resistance Exercise (PRE) is one technique that has been used extensively in
rehabilitation and strength training programs for
several decades. De Lorme and Watkins were the
first to describe the technique in 1951. PRE constitutes only one aspect of the total rehabilitation
program: the development of absolute strength. It
does not necessarily purport to develop muscular
endurance or speed of movement.
PRE relies upon both concentric and eccentric
contractions of the muscle as the weight is lifted
and lowered. Additional muscles are utilized
through static contractions to stabilize skeletal
parts while movement is occurring. During the
eccentric contraction, the muscle is taken beyond
its normal resting length, thus facilitating greater
force development than in the corresponding concentric contraction.
Programming for Muscular Strength and Endurance
CHAPTER 20
To overload the muscle for strength development,
PRE prescribes the heaviest load that can be lifted
through the range of motion for 10 repetitions (10
to RM). This is preceded by two warm-up sets of 10
repetitions at submaximal loads. The purpose of
the warm-up is to increase muscle irritability and
to allow practice of the lifting technique. A fourth
and fifth set at 10-RM facilitates the development
of endurance.
Isokinetic Exercise
The participant contracts the agonist muscle group
through the range of motion against a lever of constant speed, thereby achieving a maximal effort at
every point in the range. Because it accommodates
the strength changes that occur as the joint angle
changes, isokinetic exercise theoretically enables
one to perform more work than with isotonic
methods. Only reciprocal movements with concentric contractions occur with isokinetic exercise. The
exerciser does not lift weight but pushes against a
lever that moves at a fixed speed in both directions
(e.g., flexion/extension). Thus, it allows the
instructor to measure strength imbalances around a
joint (e.g., knee flexors should be approximately
60% of the strength of knee extensors at slower
velocities of movement). Isokinetic devices offer a
range of speeds to select for training.
TA B L E 2 0 - 1
MUSCLE GRADING CHART
GRADATIONS
CRITERIA
5 - Normal
Complete range of motion against gravity with full resistance
4 - Good
Complete range of motion against gravity with some resistance
3 - Fair
Complete range of motion against gravity
2 - Poor
Complete range of motion gravity eliminated
1 - Trace
Evidence of slight contractility, no joint motion
0 - Zero
No evidence of contractility
195
Programming for Muscular Strength and Endurance
CHAPTER 20
TA B L E 2 0 - 2
PHASES OF A STRENGTH/ENDURANCE PROGRAM
ACTIVITY
PHASE I
PHASE II
PHASE III
Warm-Ups
1 to 2
Sets
1 to 2
1 to 3
1 to 3
Reps
15
8 to 12
12 to 20
Load
Light
Moderate
Moderate
Minimum Duration
2 Weeks
6 to 8 Weeks
Indefinite
Purpose
Practice
Strength
Endurance
GENERAL GUIDELINES
FOR ADAPTIVE WEIGHT TRAINING
When using resistive exercise, the weight training
program can be divided into three phases (Table 202). This same protocol can be followed whether
using weights or manual resistance.
The purposes of Phase I are to (1) learn the
mechanics of the lift, (2) practice the proper
breathing pattern, and (3) prevent injury to previously weak and atrophied muscles. Individuals who
have not exercised for an extended period are especially prone to sudden strains, soreness, or inflammations if they immediately begin a rigorous exercise
regime. Phase I involves lifting relatively light
poundage doing a set of 15 repetitions at a time. This
regime continues for approximately two weeks.
During Phase II, the poundage is increased while
repetitions are decreased to between 8 and 12 per set
(1 to 3 sets). It is advisable to establish a 10-RM at
this time and follow the PRE protocol (see under
Isotonic Exercise earlier in this chapter). Always have
your participants perform at least one warm-up set
prior to a 10-RM! If the participant can lift the
weight for more than 12 repetitions during the final
set (i.e., exceeds the 10-RM), then increase the
amount of weight on the next exercise day.
196
If muscular endurance is desired, the participant
can proceed to Phase III.
Rather than increasing the amount of weight lifted,
the repetitions are increased to between 12 and 20.
These repetitions may be performed in sets of
three. Poundage should be selected that allows only
the desired number of repetitions to be completed.
If manual resistance or PNF is used, perform one
continuous set to fatigue. For many persons who
use manual wheelchairs, the development of muscular endurance may be more important than
absolute strength.
New guidelines suggest at least one set of 8 to 12
repetitions with a minimum of 8 to 10 different
exercises, covering most parts of the body, 2 to 3
days a week. However, recent research done by
Michael Pollock of the University of Florida, found
that there is no major significant improvement in 3
sets over 1 set, when worked to point of exhaustion.
Please note, however, that while more is not necessarily better, fitness needs to be enjoyable. If every
time your client works out, it is all work and no fun,
the client will be more likely to discontinue their
workout routine.
Programming for Muscular Strength and Endurance
CHAPTER 20
Conducting a Safe and Beneficial Strength Program
•
Keep accurate, daily records of the participant’s performance. This procedure
includes recording the date, poundage
used, and the number of sets and repetitions performed
•
Retest every few weeks to re-establish
the 10-RM
•
Supervise with a spotter (assistant)
when a participant is lifting free weights,
no matter how light the poundage
Maintain good muscular balance by
strengthening opposing muscle groups,
unless an imbalance already exists
•
Breathe properly during weight lifting.
Think: Exert=Exhale.
• Example: Exhale on raising weight,
inhale when lowering weight. However,
certain exercises have a different flow
•
flexibility exercises to prevent adaptive
shortening from occurring. Muscles
retain some residual tension or contraction after strenuous exercise and
should be brought back to their original
resting length
•
Perform exercises that involve larger
muscle groups first. For example, perform shoulder-strengthening exercises
before wrist exercises
•
Allow sufficient recovery time between
sets (usually several minutes), especially
for those individuals with degenerative
neuromuscular conditions. For highly fit
athletes, the rest period can be reduced
as strength and endurance improve
•
Have participant watch self in a mirror
while performing the movement
•
Begin an exercise from a position of ‘on
stretch’ and then move into a concentric
contraction. Lift weight slowly and
return weight slowly
•
Lift no more often than every other day
with the same strength-training routine
•
Develop strength before endurance in a
weight training program
•
Perform each repetition slowly and
rhythmically and without a pause at the
beginning or end of the range of motion
•
•
Precede maximal lifts with a warm-up set
•
Follow a weight-lifting session with
Increase the difficulty of a weight
training program by increasing resistance, repetitions, or number of sets.
Remember: using too heavy a weight
may cause improper form (leading to
injury) and should be avoided
197
Programming for Muscular Strength and Endurance
CHAPTER 20
SAMPLE STRENGTH-TRAINING PROGRAM
When working with weights, proper form is critical
in order to prevent injury. The proper stance is with
your feet shoulder-width apart, your knees slightly
bent, and your pelvis and spine in good alignment.
Pay attention to your body as a whole. You must
then isolate each particular muscle group as you
work to strengthen it. Work through the full range
of motion.
For achieving a strength gain, use a weight that can
be lifted for a set of approximately 8 to 12 reps. If
endurance is desired, lift a lighter weight, one that
can be repeated 12 to 20 times. Start training with
one set, and work up to completing three sets of
each exercise. Rest approximately one minute
between sets.
These same exercises can be performed using
“manual resistance” from an assistant, rather than
working with the equipment. This is very helpful for
persons who cannot yet work independently with
free-weights.
Chest Series
BENCH PRESS
(THIS EXERCISE CAN BE PERFORMED WITH DUMBBELLS OR BARBELLS)
Beginning:
1 set
3 to 5 reps
Muscles Used: Chest (Pectorals, deltoids, triceps)
Intermediate:
2 sets
5 to 7 reps
Exercise: Lie face up on exercise bench with knees
bent and back flat. Holding dumbbells at chest level,
press the weights directly over chest: slowly: and
return to starting position.
Advanced:
3 sets
8 to 12 reps
Hint: Watch your breathing, exhale on the way up.
Programming for Muscular Strength and Endurance
CHAPTER 20
DUMBBELL INCLINE BENCH CHEST PRESS
Muscles Used: Chest (pectorals, deltoids, triceps)
Exercise: Lie face up on incline exercise bench with
back flat and knees planted firmly on the floor,
holding dumbbells over your chest with a
pronated grip.
Beginning:
1 set
3 to 5 reps
Intermediate:
2 sets
5 to 7 reps
Advanced:
3 sets
8 to 12 reps
Hint: Try using soup cans or books with this
exercise initially.
199
Programming for Muscular Strength and Endurance
CHAPTER 20
Shoulder Series
DUMBBELL LATERAL RAISES
Muscles Used: Shoulders (deltoids, trapezius)
Exercise: Stand with feet shoulder-width apart,
knees slightly bent, and back straight. Grasp dumbbells with palms facing each other and arms slightly
bent. Now raise arms to the height of your shoulders. Return to starting position.
200
Beginning:
1 set
3 to 5 reps
Intermediate:
2 sets
5 to 7 reps
Advanced:
3 sets
8 to 12 reps
Hint: Protect your back. Keep knees slightly bent,
abdominal muscles tight, and back straight.
Programming for Muscular Strength and Endurance
CHAPTER 20
Upper Arm Series
BICEPS CURLS
(THIS EXERCISE CAN BE PERFORMED WITH BARBELL
OR DUMBBELLS)
Muscles Used: Front of arm (biceps)
Exercise: From standing position, palms facing forward, bring palms to shoulders. Return to starting
position, slowly.
Beginning:
1 set
3 to 5 reps
Intermediate:
2 sets
5 to 7 reps
Advanced:
3 sets
8 to 12 reps
Hint: Try to keep from leaning backward or swinging
arms. Keep elbows close to your body.
201
Programming for Muscular Strength and Endurance
CHAPTER 20
ONE ARM DUMBBELL TRICEPS EXTENSION
ON STABILITY BALL OR BENCH
Muscles Used: Back of arm (triceps)
Exercise: Sit on a stability ball or flat bench with
your feet planted firmly on floor. Place a dumbbell
in one hand and rest the other arm across the
stomach. Extend the dumbbell over the head.
Bring back to starting position and repeat.
202
Beginning:
1 set
3 to 5 reps
Intermediate:
2 sets
5 to 7 reps
Advanced:
3 sets
8 to 12 reps
Hint: Make sure weight plates are secure. Let the back
of your arms do the work. If this hurts your elbows, stop.
Programming for Muscular Strength and Endurance
CHAPTER 20
Leg Series
LUNGES WITH BARBELL OR DUMBBELLS
Muscles Used: Thigh (quadriceps)
Exercise: Stand erect with feet shoulder width apart.
Let your arms hang straight down holding weights
at the sides of the body. Keep your eyes focused
straight ahead on a fixed point. Take a large step forward. Keep the torso erect. Firmly plant the stepping
foot, but keep the planted foot in the fixed position.
Feet should be pointed straight ahead. Slowly flex
(lower) the lead hip and knee until the planted leg’s
knee comes within one to two inches from the floor.
Contract the quadriceps of the front leg and push
back to the starting position.
Beginning:
1 set
3 to 5 reps
Intermediate:
2 sets
5 to 7 reps
Advanced:
3 sets
8 to 12 reps
Hints: Keep back flat. Never lower yourself more than
halfway down.
Note: Going lower than halfway can damage cartilage and ligaments of the knee.
Programming for Muscular Strength and Endurance
CHAPTER 20
Lower Leg Series
SEATED CALF RAISE
Muscles Used: Calf (gastroc, soleus)
Exercise: Place the balls of your feet flat on the step
with your feet and legs parallel to each other. Make
sure the toes are pointed straight ahead. Position the
thighs securely underneath the pads. Keep your
upper body erect, maintaining a neutral spine. This
is the starting position. Begin by plantar flexing the
ankles and removing the support lever. Relax the
ankles, allowing the heels to drop off below the step
204
(starting position). Push up on your toes through a
full range of motion. Slowly lower your heels to the
starting position and repeat.
Beginning:
1 set
3 to 5 reps
Intermediate:
2 sets
5 to 7 reps
Advanced:
3 sets
8 to 12 reps
Hints: Remember to stretch calf muscles after this exercise (e.g., heel cord stretch).
Programming for Muscular Strength and Endurance
CHAPTER 20
205
Chapter
21
PROGRAMMING FOR
POSTURE
To p i c s c o v e r e d i n t h i s c h a p t e r
ASSESSMENT OF POSTURE
Posture Evaluation
Anterior View
Posterior View
Lateral View
PROCEDURES FOR SPINAL SCREENING
POSTURE EXERCISES
206
Programming for Posture
CHAPTER 21
ASSESSMENT OF POSTURE
Prior to assessing postural deviations, it is necessary to have an understanding of possible underlying causes of deviations. This knowledge will
assist in determining whether medical referral or exercise prescription is the
more appropriate intervention.
To conduct a posture evaluation, the Specialist in Exercise Therapy utilizes a
posture screen or plumb line in conjunction with observations. A plumb line
is a thick piece of rope suspended from the ceiling with a weighted end that
does not reach to the floor. If pictures are used, the participant should be
photographed in anterior, posterior, and lateral views. The participant
should be barefoot, wearing a swimsuit, and have hair pulled back behind
the ears. If a large group has to be screened at the same time, stations should
be set up with individuals rotating to each station.
Posture: The position of
different parts of the body at
rest or during movement.
Postural deviation(s): An
abnormality or departure from
correct posture
Posture Evaluation
Strength
Abdominals
Weak abdominal musculature has been implicated in the occurrence of lowback pain. No norm-referenced test exists that purely measures abdominal
strength; current tests also involve the hip flexors. Bent-knee sit-ups partially
eliminate the action of the hip flexors during movement.
Flexibility
Chest and Shoulders
Participant assumes a “hook-lying” position. Keeping the lower back
pressed to the floor (assistant should check by placing a hand between the
lumbar region and floor), the participant extends arms overhead and
presses the back of the arms and hands to the floor. Elbows must remain
locked at all times.
Scoring:
Within Normal Limits (WNL): Contact of dorsum of hands with the floor.
Limitation of Motion (LOM): Contact of fingers only or cannot make contact with floor without arching the lower back.
Spine and Hip Extensors
Scoring:
WNL: If thigh remains flat on the table.
LOM: If thigh lifts upward. Estimate angle between leg and table.
Note: If thigh rotates outward or inward, rotators are tight. Indicate this on
evaluation form.
207
Programming for Posture
CHAPTER 21
Anterior/Posterior View
Have the participant stand so that a plumb line is at
a point midway between the medial malleoli,
bisecting the body (see following illustration).
Head Twist/Tilt
Shoulder Level
Note any of the following:
•
Head Twist (torticollis) or Head Tilt:
Check the evenness of the earlobes and
indicate left or right drop
•
Shoulder Level:
•
Linea Alba: Indicate a left or right shift
•
Anterior Superior Iliac Spines (hip): Note
Linea Alba
Note evenness of
acromion process and indicate left or
right drop
Anterior
Superior Iliac
Spines (Hips)
evenness and indicate left or right drop
•
Leg Alignment: Beginning at the center of
Leg Alignment
the knee, draw a line perpendicular to
the floor
Anterior
a) Internal or external rotation at the hip.
The knee and foot both point outward
or inward.
b) Internal tibial torsion. The patella faces
inward when the feet are together,
pointing forward.
c) Genu valgum (knockknees). Note the
space between the medial malleoli when
knees are touching.
Middle of
Vertebrae
d) Genu varum (bowlegs). Note the space
between the femoral condyles when the
feet are together.
e) Pronation. The big toe (first metatarsal)
falls laterally to the plumb line drawn
from the center of the knee.
Middle of
Buttocks
Lateral View
Draw a plumb line beginning with a point 1 inch
anterior to the center of the lateral malleolus and
precede upward, perpendicular to the floor. In ideal
posture, the plumb line should pass through the following fixed checkpoints: center of the knee
(behind the patella), center of the hip (greater
208
Posterior
Heel Distance
Programming for Posture
CHAPTER 21
trochanter), center of the shoulder (acromion
process), and the earlobe (tragus). Postural abnormalities are based on the deviation (forward or
backward) from this line.
Note any of the following:
•
Body Lean: Indicate whether forward or
backward
•
Through
Earlobe
Head: Considered forward if the earlobe
is in front of the acromion process
•
Shoulders:
•
Kyphosis: Excessive flexion in the thoracic spine. Check for structural kyphosis
in ‘Adam’s position’ (bending forward
about 90° with hands together, feet
together, and head down as if diving into
a pool)
•
Considered forward if
acromion process is in front of plumb
line
Through
Greater
Trachanter
of Femur
Ptosis: Protrusion of the abdomen.
Posterior to
Patella
Abdominals should not extend beyond a
line drawn down from the sternum
•
Through
Acromion
Process
Lordosis: Excessive hyperextension in
lumbar spine
•
Patella
Genu Recurvatum (hyperextended knees):
Lateral
1.5 inches front of
Lateral Malleolus
Patella falls behind plumb line
Proper Posture
Lordosis
Kyphosis
Scoliosis
Programming for Posture
CHAPTER 21
Orthopedic Evaluation: should be performed by qualified professional.
Scoliosis: Abnormal lateral
curvature of the vertebral
column. Depending etiology
there may be one curve, or
primary and secondary
compensatory curves
Scoliosis Check
See “Procedure for Spinal Screening” below. Scoliosis screening is usually performed on children in elementary and secondary grades, since treatment is
very difficult after bone growth is complete. However, older participants experiencing low-back pain may benefit from this type of screening to determine
the nature of their pain.
PROCEDURES FOR SPINAL
SCREENING
First
Ask if there is a history of Scoliosis in the family.
Second
Look at participant’s back while he/she is standing. Ask yourself:
Even Curve
•
Are the earlobes level?
•
Are the shoulders (acromion processes) the same level?
•
Are the inferior borders of the scapulae the same level?
•
Are the arms the same distance from the body?
•
Are the trunk contours the same on both sides of the body?
•
Are the hips level?
•
Are the poplitial creases level?
The above are pieces of a puzzle. A positive finding in any of the above may be
a normal variant or may indicate scoliosis. The next check is perhaps the most
important.
Third
The participant bends forward about 90˚ with hands together, feet together,
and head down as if diving into a pool (Adam’s position). View the participant
from the back. Ask yourself:
Is one side of the thoracic or lumbar spine higher than the other?
Fourth
The participant bends forward as above, but view the participant from the
front. Ask yourself:
Peak
210
•
Is one side of the thoracic or lumbar spine higher than the other?
Programming for Posture
CHAPTER 21
Fifth
Take a quick look at the side view of the participant
as a check for kyphosis. Ask yourself: Is the curve
even or does it peak? With children and teenagers a
medical referral is warranted if an asymmetry is
noted in Adam’s position, indicating possible structural Scoliosis. Adults are generally not referred
because bone growth is complete. Exercises can be
prescribed to combat pain and loss of flexibility.
POSTURE EXERCISES
STARTING POSITION
MOVEMENT
PURPOSE
POSTURAL DEVIATION(S): FORWARD HEAD
Neck Flattener
Press back of neck firmly to floor (feel Strengthen neck flexors and extensors
contraction in both neck extensors and
flexors)
Hold for 5 seconds
Reps:
Revolving Neck Flattener
Reps:
Sets:
Notes:
Press back of neck firmly to floor
Slowly turn head from side to side
Strengthen neck flexors, extensors,
and rotators
Sets:
Notes:
POSTURAL DEVIATION(S): FORWARD SHOULDER/KYPHOSIS
Shoulder Retraction
Reps:
Wall Lean
Clasp hands over lower back
Attempt to draw elbows together
Strengthen muscles that retract the
shoulders and adduct the scapula
(rhomboids, trapezius)
Sets:
Notes:
Face corner of room, one hand on
either wall at shoulder height
Stretch anterior chest muscles (pectorals)
Incline body toward the corner, bending elbows (heel on floor)
Reps:
Prone Lift Arms
Extended Sideward
Sets:
Notes:
Pinch shoulder blades together
Raise arms slightly from mat
Raise head from mat (chin in)
Hold for 5 seconds
Reps:
Sets:
Notes:
211
Programming for Posture
CHAPTER 21
POSTURE EXERCISES, CONTINUED
STARTING POSITION
MOVEMENT
PURPOSE
POSTURAL DEVIATION(S): FORWARD SHOULDER/KYPHOSIS, CONTINUED
Neck Flattener
Hands placed on lower back
Stretch anterior chest muscles
Slowly slide hands up back, attempting Strengthen muscles that retract the
to bring elbows together
shoulders and adduct the scapula
(rhomboids and trapezius)
Reps:
Towel
Stretch
Sets:
Notes:
Raise towel overhead. Hold for 10 sec- Strengthen muscles that retract the
onds
shoulders and adduct the scapula
Lower towel obliquely across back.
Hold for 10 seconds
Strengthen external rotators of shoulders
Reverse position
Stretch anterior chest muscles
Reps:
Sets:
Notes:
Shoulder
Stretch
Allow gravity to hyperflex the shoulder
joint Note: it may be necessary to flex
the knees slightly if the hamstrings are
tight
Strengthen muscles that retract the
shoulders and adduct the scapula
Hold for 10 to 30 seconds
Stretch anterior chest muscles
Reps:
Sets:
Notes:
Bent-Arm Press Supine
Elbows flexed, arms in external
rotation
Stretch the anterior chest muscles and
internal rotators of shoulders
Strengthen external rotators of shoulders
Press with the back of the hand
against a hard surface, keeping the
lower back on the floor
Hold for 10 seconds
Reps:
Sets:
Notes:
Push-Up
Tighten abdominal and gluteal muscles Strengthen external rotators of the
shoulders
Bend elbows, lowering the body to
floor
Raise the body. Do not bend at the
waist
Reps:
Sets:
Notes:
Prone Flys
Slowly raise dumbbells out to side and
above level of body
Strengthen the muscles that retract
the shoulders and adduct the scapula
Note: Arms may be slightly bent
Reps:
Sets:
Notes:
Programming for Posture
CHAPTER 21
POSTURE EXERCISES, CONTINUED
STARTING POSITION
MOVEMENT
PURPOSE
POSTURAL DEVIATION(S): FORWARD SHOULDER/KYPHOSIS, CONTINUED
Shoulder Flexion with
Pulleys
Keeping arms straight, slowly lift pulleys overhead
Strengthen upper-back extensors
(trapezius)
Do not arch lower back
Reps:
Sets:
Notes:
POSTURAL DEVIATION(S) OF THE LOWER EXTREMITIES
Heel Cord Stretch
Standing at arms length from wall,
body inclined slightly forward, back
flat feet in-toed slightly
Hands on wall shoulder high and
To stretch heel cord and back of leg.
shoulder width apart, elbows slightly
Beneficial in pes planus, pronation
bent. Bend arms until chest nearly
touches the wall. Keep body in straight
line, keep heels on the floor
Progression: From starting position,
move backward about an inch at a
time keeping heels on the floor
Heel cord stretch board with back flattened against the wall may b used as
an advanced exercise
Hold for 30 seconds
Reps:
Sets:
Notes:
Ankle Stretch
Raise on toes as high as possible
Standing on lower rung of stall bar,
feet slightly in-toed and weight on
balls of feet. Grasp an upper rung for
support to aid in balancing
Lower body to stretch heel cord as
heels are slowly below the level of the
support. Be sure weight is on the outer
margin of feet at all times and stand
tall throughout the exercise
To stretch anterior tibial and calf muscles
Beneficial in pes planus and pronation,
fractures of the ankles, post-operative
repair, and following the use of a cast
on the limb
Hold for 30 seconds
Reps:
Sets:
Foot Supinator
Cross leg so the ankle of right foot
Strengthens invertors and supinators
rests across left knee, keeping the foot of foot
at right angles to the right leg and turn- Beneficial in pes planus and pronation
ing the sole of the foot upward
Sitting Tall
Notes:
Place left palm on medial border of
right foot. Attempt to push the right
foot downward (pronation). Resist and
hold the right foot insupination
Hold for 10 seconds
Reps:
Sets:
Notes:
Programming for Posture
CHAPTER 21
Your notes:
214
Sports Medicine
CHAPTER 5
P
ART
4
ABBREVIATIONS
SUPPORT MATERIALS
GLOSSARY
INDEX
REFERENCES
Appendix
Programming For Ambulation
CHAPTER 11
APPENDIX
To p i c s c o v e r e d i n t h i s c h a p t e r
ABBREVIATIONS
SUPPORT MATERIALS
Emergency Procedures
Fisrt Aid for Seziures
Forms
GLOSSARY
INDEX
REFERENCES
216
Appendix
A B B R E V I AT I O N S
The following abbreviations are typically found on medical histories, physical evaluations, prescriptions and
exercise programs for persons with disabilities. This acceptable format expedites the process of filling in
forms and results in consistency among personnel. Some of the abbreviations have been created by the
authors and found to be useful in writing exercise programs. The instructor and assistants should become
familiar with these abbreviations and their meanings. (A)=Abbreviation, (T)=Term
(A)
(T)
(A)
(T)
(A)
(T)
@
at
E.M.G.
Electromyogram
p
after
ADL
Activities of Daily Living
etiol.
etiology
ll bars
parallel bars
AK
Above Knee
F.B.S.
Fasting Blood Sugar
Post-op Post-Operative
AMA
Against Medical Advice
FWB
Fluu Weight Bearing
PRE
Progressive Resistive Exercise
ant.
anterior
Fx
Fracture
pt.
patient
A.P.
Anterior-Posterior
gm
gram
P.T.
Physical Therapy
b.i.d.
Twice a Day
ht.
height
PVC
Premature Ventricular
Contraction
BK
Below Knee
I.C.U.
Intensive Care Unit
PWB
Partial Weight Bearing
B.M.R.
Basal Metabolic Rate
I.E.P.
Individualized
Education Program
Increase
q.d.
every day or daily
BP
Blood Pressure
I.V.
Intravenous
q.h.
every hour
bmp
beats per minute
l or Lt.
Left
ROM
Range of Motion
c
with
LBP
Low Back Pain
rpm
revolutions per minute
CCU
Coronary Care Unit
<
Less Than
Rt.
Right
cm
centimeter
LE
Lower Extremity
Rx
Prescription
CNS
Central Nervous System
LOM
Limitation of Motion
s
without
C/O
Complains Of
L-spine
Lumbosacral
SCI
Spinal Cord Injury
CPR
Cardiopulmonary
Resuscitation
MBC
Maximum Breathing
Capacity
2/2
secondary to
C-Spine
Cervical Spine
meds
Medications
SOB
Shortness of Breath
CVA
Cerebrovascular Accident
mg
milligram
THR
Target Heart Rate
D.C.
Discontinue
M.I.
Myocardial infarction
t.i.d.
three tines per day
disch.
discharge
>
More Than
V.A.
Veteran’s Administration
DOE
Dyspnea On Exertion
0
None
V.C.
Vital Capacity
Dx
Diagnosis
O2
Oxygen
WNL
Within Normal Limits
E.C.G.
Electrocardiogram
Op
Operation
wt.
weight
E.E.C.
Electroencephalogram
O.T.
Occupational Therapy x
times
217
Appendix
S U P P O R T M AT E R I A L S
EMERGENCY PROCEDURES
When any type of an accident occurs, notify the instructor immediately. First
Aid will be administered and medical help will be called, if needed. As an assistant, you can help by making sure that the other students are safe, as well as
keeping people away from the accident area.
Please notify the instructor if you see any student coming to class with any
open/oozing sores or cuts. These should be cleaned and covered so that others
are not exposed to any contaminants. Rubber gloves are available for treating
anyone who is bleeding or oozing from an open wound or sore. You will be
taught the proper technique for using rubber gloves.
Know the locations of the telephone, first aid kit and other supplies, emergency information files, and local fire stations.
How to Get Help:
1. Dial 911. Be prepared to give a description of the injury, your
location, and the phone number you are calling from.
2. Continue to provide first aid to the person until help arrives.
3. Have ready the person’s Emergency Information Card to assist
the medical personnel.
4. File an accident report.
218
Appendix
S U P P O R T M AT E R I A L S
FIRST AID FOR SEIZURES
Convulsions usually begin violently, and the person becomes unconscious.
The muscles may be rigid for a few seconds or for as long as a half a minute,
followed by jerking movements and foaming at the mouth or drooling. The
attack gradually becomes less severe, after which the person is usually drowsy
or disoriented for a time.
What to Do:
1. Do not restrain anyone who is having convulsions.
2. Protect the person from injury, especially the head.
3. Push away nearby objects.
4. Do not put anything between the teeth.
5. When the jerking is over, keep the person lying down on one
side, so that vomit or other fluids will not be inhaled into the
lungs.
6. Loosen the clothing around the neck.
7. Provide for undisturbed rest.
8. If the seizure is prolonged (over 5 minutes), or the person
injures himself by falling, call for medical assistance.
9. If the person has a history of seizure activity, paramedics may
not have to be called. In any case, contact the doctor or family
for advice before releasing.
219
Appendix
S U P P O R T M AT E R I A L S
COMMON MEDICATIONS
If a participant is taking medications, the following information should be
recorded in his/her medical file for each drug: (1) name of dug, (2) purpose,
(3) dose, and (4) side effects. Include medications that are taken on an infrequent or as needed basis. This information should be readily accessible in case
of an emergency. Encourage the participant to become knowledgeable about
the effects of medication on exercise performance. In addition, inform the
assistant of any side effects which may affect the participant’s exercise performance (e.g., beta-blockers may keep the heart rate depressed during aerobic
exercise) or affect behavior (e.g., seizure medication such as phenobarbital
may induce drowsiness). Supervision is warranted when a participant uses
equipment that may be dangerous if he/she is drowsy or uncoordinated due to
medication. The appearance of side effects varies among individuals and
depends upon dose, individual body chemistry, and if other medications are
being taken concomitantly. The side effects associated with anticonvulsant
drugs are typically mild and occur only at the beginning of therapy (Epilepsy
Society, 1981). In addition to prescription drugs, over-the-counter medications (e.g., colds, allergies) have side effects which may affect behavior.
Common medications and their purposes are listed below
(Larson & Snobl, 1978):
1. Urinary Tract Antibiotics – Macrodantin, Gantrisin, Geocillin,
Keflex, Septra, Ampicillin, Tetracycline.
2. Urinary Acidifiers – Ascorbic acid (Vitamin C) and Mandelamine
are used together to acidify and sterilize the urine.
3. Spasticity – Valium (CNS depressant), Dantrium, Lioresal.
4. Pain – Aspirin, Darvon, Dolene, Tylenol.
5. Seizures – Dilantin, Phenobarbital, Mysoline, Tegretol, Mebaral,
Diamox, Depakene.
6. Laxatives – Modane, Dulcolax.
7. Stool Softeners – Colace, Surfax.
8. Anti-histamines – Brompheniramine, Chlorpheniramine, Diphenhydramine, Triprolidine, Promethazine.
9. Muscle relaxant, relief of anxiety – Diazepam.
220
International Sports Sciences Association
Health Intake Form
Page 1 of 1
NAME_______________________________________________DATE_____________AGE_______
Do You Have or have you had any of the following? Y=Yes, N=No, U=Unsure
______Abnormal Blood Lipids
______Abnormal Resting or Stress ECG
______Chest Pain At Rest Or Exertion
______Diabetes
______Drug Allergies
______Family History of Heart Disease, Stroke
______Heart Attack, Coronary Bypass, Cardiac Surgery, Stroke
______High Blood Pressure - What Was Last Measurement ______Resting Heart Rate
______Light Headedness or Fainting
______Medications - List on Back of Page
______Orthopedic Problems (Arthritis, or any other bone, joint or muscle problems) - List on Back of Page
______Sedentary Lifestyle
______Pulmonary Disease (Asthma, Emphysema & Bronchitis)
______Recent Illness, Hospitalization or Surgical Procedure
______History of Smoking
______Irregular, or Skipped Heart Beats
______Shortness of Breath
______Bleeding Conditions
RECOMMENDATIONS PRIOR TO EXERCISE TESTING:
Has your doctor approved you for exercise?
YES NO
Are you currently being seen by a health professional?
YES NO
If yes please explain.____________________________________________________________________
_____________________________________________________________________________________
Have you been told to avoid certain activities?
YES NO
If yes please explain.____________________________________________________________________
International Sports Sciences Association
Personal Health History
Page 1 of 1
PERSONAL INFORMATION
NAME
DATE
ADDRESS
CITY
STATE
PHONE (day)
PHONE (eve)
SEX
AGE
ZIP
EMERGENCY CONTACT
PHONE
PERSONAL PHYSICIAN
PHONE
PHYSICAL ACTIVITY READINESS
Please circle “yes” or “no.”
YES
NO Has your doctor ever said that you have heart trouble?
YES
NO Do you frequently have pains in your heart and chest?
YES
NO Do you often feel faint or have spells of severe dizziness?
YES
NO Has your doctor ever said that your blood pressure was too high?
YES
NO
Has your doctor ever told you that you have a bone or joint problem
such as arthritis that might worsen with exercise?
YES
NO
Is there a good physical reason not mentioned here why you should not
follow an activity program?
YES
NO Are you unaccustomed to vigorous exercise?
PERSONAL HISTORY
Date and results of last physical exam
Has your doctor ever limited your physical activity?
YES
NO
YES
NO
YES
NO
Are you currently pregnant, or have you been in the last year?
YES
NO
Are you currently taking any medications?
YES
NO
If yes, how?
Do you have any chronic or serious illnesses?
If yes, please describe
Have you been hospitalized in the last 3 years?
If yes for what
If yes, please list.
International Sports Sciences Association
Health History Questionnaire
Page 1 of 4
ANSWER EACH QUESTION BY PRINTING THE NECESSARY INFORMATION. YOUR ANSWERS ARE CONFIDENTIAL.
Name:
Date of Birth:
Age:
Address:
City, State, Zip:
Home Phone:
Work Phone:
Employer:
Occupation:
In case of emergency, please notify:
Name:
Relationship:
Address:
City, State, Zip
Home Phone:
Work Phone:
MEDICAL INFORMATION
Physician:
Phone:
Are you under the care of a physician, chiropractor, or other health care professional for any reason?r Yes
If yes, list reason:
r No
r Yes
r No
Are you taking any medications?
(If yes, complete the following)
Type:
Dosage/Frequency:
Reason for Taking:
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Please list any allergies:
Has your doctor ever said your blood pressure was too high?
r Yes
r No
Has your doctor ever told you that you have a bone or joint
problem that has been or could be made worse by exercise?
r Yes
r No
Are you over the age of 65?
r Yes
r No
Are you unaccustomed to vigorous exercise?
r Yes
r No
HealthHistory_0805
International Sports Sciences Association
Health History Questionnaire
MEDICAL INFORMATION,
Page 2 of 4
CONTINUED
Is there any reason not mentioned why you should not follow a regular exercise program?
If yes, please explain:
r Yes
r No
Have you recently experienced any chest pain associated with either exercise or stress?
If yes, please explain:
r Yes
r No
SMOKING
Please check the box that describes your current habits:
r
r
r
r
r
r
FAMILY
Non-user of former user; Date quit:_______________________
Cigar and/or pipe
15 or less cigarettes per day
16 to 25 cigarettes per day
26 to 35 cigarettes per day
More than 35 cigarettes per day
AND
PERSONAL MEDICAL HISTORY
If there is family history for any condition, please check the box to the left. If you are personally experiencing any of these conditions, fill the information in on the line to the right.
r Asthma:________________________________________________________________________________________________
r Respiratory/Pulmonary Conditions:________________________________________________________________________
r Diabetes: Type I:_______________ Type II:_______________ How Long?_______________________________________
r Epilepsy: Petite Mal:_______________ Grand Mal:_______________ Other:_______________
r Osteoporosis:__________________________________________________________________________________________
LIFESTYLE
AND
DIETARY FACTORS
Please fill in the information below:
r Occupational Stress Level:
r Low / r Medium / r High
r Energy Level:
r Low / r Medium / r High
r Caffeine Intake/Daily:_________ r Alcohol Intake/Weekly:_________
r Colds Per Year:_________
r Anemia:______________________
r Gastrointestinal Disorder:_______________________________________
r Hypoglycemia:________________________________________________
r Thyroid Disorder:______________________________________________
r Pre/Postnatal:_________________________________________________
CARDIOVASCULAR
Please fill in the information below:
r High Blood Pressure:_____________________
r Hypertension:_____________________
r High Cholesterol:__________________________________________________________________
r Hyperlipidemia:____________________________________________________________________
r Heart Disease:_____________________________________________________________________
r Heart Disease:_____________________________________________________________________
r Heart Attack:____________________________
r Stroke:____________________________
r Angina:_________________________________
r Gout:____________________________
HealthHistory_0805
International Sports Sciences Association
Health History Questionnaire
FAMILY
AND
PERSONAL MEDICAL HISTORY,
Page 3 of 4
CONTINUED
MUSCULOSKELETAL INFORMATION
Please describe any past or current musculoskeletal conditions you have incurred such as muscle pulls, sprains, fractures, surgery, back pain, or general discomfort:
r Head/Neck:_______________________________________________________________________________________________
r Upper Back:______________________________________________________________________________________________
r Shoulder/Clavicle:___________________________________________________________________________________________
r Arm/Elbow:____________________________________________________________________________________________
r Wrist/Hand:____________________________________________________________________________________________
r Lower Back:___________________________________________________________________________________________
r Hip/Pelvis:____________________________________________________________________________________________
r Thigh/Knee:____________________________________________________________________________________________
r Arthritis:______________________________________________________________________________________________
r Hernia:______________________________________________________________________________________________
r Surgeries:____________________________________________________________________________________________
r Other:_______________________________________________________________________________________________
NUTRITIONAL INFORMATION
Are you on any specific food/diet plan at this time?
If yes, please list:
r Yes
r No
Do you take dietary supplements?
If yes, please list:
r Yes
r No
Do you experience any frequent weight fluctuations?
r Yes
r No
Have you experienced a recent weight gain or loss?
If yes, list change:
r Yes
r No
Over how long?
How many beverages do you consume per day that contain caffeine?
How would you describe your current nutritional habits?
Other food/nutritional issues you want to include (food allergies, mealtimes, etc.)
HealthHistory_0805
International Sports Sciences Association
Health History Questionnaire
Page 4 of 4
WORK AND EXERCISE HABITS
Please check the box that best describes your work and exercise Habits.
r
r
r
r
r
r
Intense occupational and recreational exertion
Moderate occupational and recreational exertion
Sedentary occupational and intense recreational exertion
Sedentary occupational and moderate recreational exertion
Sedentary occupational and light recreational exertion
Complete lack of all exertion
To what degree do you perceive your environment as stressful?
r Minimal
r Moderate
r Average
r Extremely
Home: r Minimal
r Moderate
r Average
r Extremely
Work:
Do you work more than 40 hours a week?
r Yes
r No
Please make any other comments you feel are pertinent to your exercise program.
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
NAME: _______________________________________________________________________________
SIGNATURE: ________________________________________________________________________
DATE: ________________________________________
SIGNATURE OF PARENT: _____________________________________________________________
or GUARDIAN (for participants under the age of majority)
WITNESS:_____________________________________
HealthHistory_0805
International Sports Sciences Association
Intake Questionnaire
Page 1 of 2
PLEASE DISCUSS THE FOLLOWING WITH ALL NEW CLIENTS AT YOUR FIRST
• Why did you respond to our advertisement?
a) What were you curious about?
b) What do you think we do?
c) Why would you be interested in that?
d) Ideally, what would you like us to do for you?
e) Why is that important?
f) How would it change your life?
• Our definition of fitness.
a) Experiencing abundant physical health.
b) Absence of pain, discomfort, illness, and disease.
c) Experiencing vitality and high energy, sufficient
to enable one to do what one wants.
MEETING
i) If you could improve or change all these
things, what would it mean to you?
j) How would it impact your feelings of self
worth?
k) Do you think you deserve to be fulfilled in this
area of your life?
• What is your current fitness program?
a) Exercises:
b) Nutrition and supplementation:
c) What do you know about how to improve your
conditioning?
• How well is your current fitness program
working for you?
a) Why isn’t it working?
d) Looking attractive and fit, proud of one’s appearance.
b) Are you willing to make some changes?
e) Capable of living a long, healthy life.
c) Do you care enough about your own wellbeing to make it a priority?
f) Able to participate in sports and active recreational activities.
g) Having a healthy emotional and mental outlook
fostered by the foundation of feeling good.
Do you agree with this definition?
Is there anything you would add or delete?
• What is the current state of your fitness?
a) On a scale of 0-10 with 0 being barely alive and
10 being totally fit, how do you rate your fitness?
b) What illnesses or medical conditions do you
have?
c) How is your energy level?
d) How would you rate the quality of your nutritional intake?
e) Do you feel refreshed and energized after sleep?
f) Is your sex life fulfilling? (Don’t ask this of clients of
the opposite sex as it may be misconstrued.)
g) What areas of your personal fitness would you
like to improve?
h) What specific thing would you like to change?
What else?
What else?
• Aside from financial cost, is there anything
that would stop you from embarking on a
fitness program?
(Overcome all non-cost objections before proceeding.)
• If you had everything you wanted in life
except for good health, would that be
satisfactory?
a) How much do you pay for medical insurance?
b) How much do you pay for doctor bills?
c) Given the expensive cost of health care after
one gets sick, doesn’t it make sense to you to
spend a little money to prevent health problems?
d) How much is your health worth?
• If there were an affordable program that
could give you everything you want in the
way of health and fitness, would you do it?
When?_____________ (If they are not willing to act now,
you should terminate interview at this point and ask them to
come back when they are ready to make a change.)
continued on back
Intake_0805
International Sports Sciences Association
Intake Questionnaire
Page 2 of 2
PLEASE DISCUSS THE FOLLOWING WITH ALL NEW CLIENTS AT YOUR FIRST MEETING
Okay (Name), let me tell you a little about my experience and my personal philosophy of fitness. In
working with clients, I like to focus on... (expand). I
have lots of experience in... (expand on your areas
of expertise). Most of my clients are able to
achieve their goals because... (expand on your
motivational skills).
At the end of the introductory session, we’ll make
a decision as to whether you should become my
regular client or not. If the decision is “no” we’ll
just part as friends. If it’s “yes,” I’ll ask you to
commit to a series of sessions and we’ll carefully
define your goals and make sure that you reach
them. Does that sound fair to you? (Yes.)
Another reason for my high success rate is that I
confine my practice to only those individuals who
are really serious about improving their fitness.
Are you? (Answer.)
Good. What time of the day works best for you for
the sample session… morning, afternoon, or
evening? (Answer) Okay, I have two time slots
open this week. (Tuesday at one o’clock or
Wednesday at two o’clock) Which is better for you?
(Choice.) Great, then I’ll see you at (time). (While
shaking hands enthusiastically...) It’s been a
pleasure meeting you.
Okay (Name), the next step is to set up an introductory session so that we can get a feel for how
effectively we can work together. The session will
last for forty-five minutes and the cost is just $.
Notes:
Intake_0805
International Sports Sciences Association
Medical Release
Page 1 of 1
________________________________________ has
enrolled in an adaptive fitness program. This program
involves individualized exercise programs (with or
without assistance) for improvements in muscular
strength, range of motion, cardiovascular endurance, posture, and balance. In order for the instructor(s) to provide
a safe and beneficial program, it is requested that you
examine the individual to determine his/her eligibility to
participate in the named activities. It is also requested that
you provide any medical information which would affect
the selection of activities. Physician’s recommendations
and limitations have been most helpful with past programs. All medical information will be handled in strict
confidence. Thank you for your cooperation.
Physician to Complete the Following
It is my understanding that _______________________________ will be participating in a fitness evaluation and exercise
program. This patient is permitted to participate in the following activities. (Please check all that apply.)
1. Comprehensive physical fitness assessment including:
r resistance exercise program
r cardiovascular exercise program
r submaximal aerobic capactiy test for cardiovascular enduarnce
r nutritional recommendations
r resting heart rate, resting blood pressure
r other: _____________________________
r body composition analysis
r flexibility
r baseline upper and lower body strength measures
Please check the appropriate response:
r baseline upper and lower body endurance measures
r other: _____________________________
2. Exercise/rehabilitation program including:
r This patient may participate with no restrictions.
r This patient may participate with the following limitations:
r This patient may not participate. (If checked, the individual will not be accepted.)
r Other:
Diagnosis/Recommendations/Limitations:
Signature
PHYSICIAN NAME (please print)
PHYSICIAN SIGNATURE
DATE
PARTICIPANT NAME (please print)
PARTICIPANT SIGNATURE
DATE
MedicalRelease_0805
PAR-Q and YOU
(A Questionnaire for People Aged 15 to 69)
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being
more active is very safe for most people. However, some people should check with their doctor before they start becoming
much more physically active.
If you are planning to become much more physically active than you are now, start by answering the seven questions in the
box below. If you are between the ages of 15 to 69, the Par-Q will tell you if you should check with your doctor before you
start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.
Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one
honestly. Check YES or NO.
YES
NO
q
q
q
q
q
q
q
q
q
q
q
q
q
q
1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you are not doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem (for example, back, neck, knee, or hip) that could be
made worse by a change in your physical activity?
6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or
heart condition?
7. Do you know any other reason why you should not do physical activity?
YES to one or more questions
if
you
answered
Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have
a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.
• You may be able to do any activity you want—as long as you start slowly and build up gradually. Or, you may need
to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you
wish to participate in and follow his/her advice.
• Find out which community programs are safe and helpful to you.
NO to all questions
If you answered NO honestly to all PAR-Q questions, you can be
reasonably sure that you can:
• start becoming much more physically active – begin
slowly and build up gradually. This is the safest and easiest way to go.
• take part in a fitness appraisal – this is an excellent way to
determine your basic fitness so that you can plan the best
way for you to live actively. It is also highly recommended
that you have your blood pressure evaluated. If your
reading is over 144/94, talk with your doctor before you
start becoming much more physically active.
DELAY BECOMING MUCH MORE ACTIVE:
• If you are not feeling well because of a temporary illness such as a cold or a fever – wait unit
you feel better; or
• If you are or may be pregnant – talk to your
doctor before you start becoming more active.
PLEASE NOTE: If your health changes so that you then answer YES
to any of the above questions, tell you fitness or health professional.
Ask weather you should change your physical activity plan.
Informed use of the PAR-Q: The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who undertake physical activity, and if in doubt after completion of this questionnaire, consult your doctor prior to physical activity.
NOTE: If the PAR-Q is being given to a person before he or she participates in a physical activity program or a fitness appraisal, this section may be used
for legal or administrative purposes.
“I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.”
NAME: _____________________________________________________________________________
SIGNATURE: ________________________________________________________________________
SIGNATURE OF PARENT: ______________________________________________________________
or GUARDIAN (for participants under the age of majority)
DATE: ________________________________________
WITNESS:_____________________________________
NOTE: This physical activity clearance is valid for a maximum of 12 months form the date it is completed and becomes invalid
if your condition changes so that you would answer YES to any of the seven questions.
ParQ_0805
Appendix
GLOSSARY
GLOSSARY
Adduction: Movement of a body part toward middle axis of the body. Returning
arms to the side from extended position at shoulders.
A
Adenosine Triphosphate (ATP): The body’s energizer, an organic compound
present in muscle fibers that is broken down through a variety of enzymatic
processes. The resultant spark of energy released stimulates hundreds of microscopic
filaments within each cell, triggering muscle contraction.
Abduction: Movement of a body part away from the median plane, such as
extending arms outward at shoulder height from a hanging-down position.
Abs: Slang for abdominal muscles.
Adherence: Sticking to something. Used to describe a person’s continuation in an
exercise program. See also compliance.
Absolute Strength: Developed through heavy weight training, typically involving
above the 80-85% of maximum effort for each lift. Its 3 components are concentric,
eccentric and static strength. No ergogenic aids (e.g., drugs, therapies or nutritional
products) are used in training for absolute strength, whereas such ergogens are used
to acquire limit strength. 1. Concentric strength refers to the one-rep maximum for
a movement. 2. Eccentric is the one-rep maximum lowering a weight under control
(usually 40% more than concentric). 3. Static is the maximum holding strength in a
given position (20% more than concentric).
Adhesion: Fibrous tissue holding muscles or other parts together that have been
altered or damaged through trauma.
Acclimation: A program undertaken to induce acclimatization to new environmental conditions, such as changes in temperature or altitude.
Aerobic Activities: Activities using large muscle groups at moderate intensities that
permit the body to use oxygen to supply energy and to maintain a steady state for
more than a few minutes. See also steady state.
Acclimatization: The body’s gradual adaptation to a changed environment, such as
higher temperatures or lower pressures (from high altitude).
Accommodating Resistance: A weight training machine which, through the use of
air, fluid or clutch plates in tandem with a flywheel, controls the speed with which
you are able to move. By controlling speed, the exertion you are able to deliver is
always at maximum throughout the entire range of motion of an exercise. This technology is very useful during rehabilitation, when injuries are present, and also in
sports training for speed-strength. (See Isokinetic Resistance, Variable Resistance
and Constant Resistance)
Acetyl Coenzyme A (acetyl CoA): A chief precursor of lipids. Formed by an acetyl
group attaching itself to coenzyme A (CoA) during the oxidation of amino acids,
fatty acids, or pyruvate.
Achilles Flare: A bowing of the Achilles tendon toward the midline of the body (Helbing’s sign) which is associated with eversion or pronation of the foot.
Acid-Base Balance: Refers to the condition in which the pH of the blood is kept at a
constant level of 7.35 to 7.45. The acidity of blood is kept from becoming too acidic
or alkaline through respiration, buffers, and work done by the kidney.
Acromegaly: A chronic pituitary gland disorder developing in adult life characterized by increased massiveness of the bones, organs and other body parts and elongation and enlargement of the bones.
Actin: Long, thin contractile filaments. One of the fibrous protein constituents of the
protein complex actomyosin. It is a protein which, when combined with myosin
forms actomyosin, the contractile constituent of muscle.
Activities of Daily Living: Self-care activities performed on a daily basis in order to
maintain health and well-being (e.g. getting in and out of bed, personal hygiene,
eating, performing manual tasks, ambulating or using a wheelchair).
Actomyosin: The system involved in muscle contraction and relaxation, which is
composed of actin and myosin protein filaments.
Acute: Sudden, short-term, sharp or severe. See also chronic.
Adam’s Position: From a standing position with the feet together, flex forward at the
hips while allowing the trunk to relax, head down, and arms to hang down with the
palms together. Used to determine structural scoliosis.
Adaptation: The adjustment of the body (or mind) to achieve a greater degree of fitness to its environment. Adaptations are more persistent than an immediate
response to the new stimuli of the environment. See also response.
Adaptive Behavior: Behavior that aids the individual in effective, age-appropriate
social interactions, mobility, and independence.
Additives: Substances other than a foodstuff present in food as a result of production, processing, storage or packaging. Examples: preservatives, coloring, thickeners
(gums), excipients and binders.
Adipose Tissue: Fat tissue.
Adrenal glands: Two glands that release hormones that help the body to cope with
stress.
Aerobic: Occurring with the use of oxygen, or requiring oxygen.
Aerobic Endurance: The ability to continue aerobic activity over a period of time.
Aerobic Exercise: Activities in which oxygen from the blood is required to fuel the
energy-producing mechanisms of muscle fibers. Examples are running, cycling and
skiing over distance. Aerobic means “with oxygen.”
Aerobic Power: Also known as VO2 Max. See also Functional Capacity.
Aerobic Strength Endurance: Force produced footfall-per footfall (or movementper-movement) in the face of massive oxygen debt, such as that incurred in long distance training or competition (see cardiovascular/cardiorespiratory endurance).
While many factors contribute to aerobic strength endurance, there are at least 9 critical components: (1.) Cardiovascular endurance relates to the efficiency in getting
oxygenated and nutrient-rich blood to the working muscles, and “spent” blood back
to the heart. (2.) Cardiorespiratory endurance involves the efficiency of the “loop”
where the blood goes from the heart to the lungs, gets rid of water and carbon
dioxide, picks up oxygen, and returns to the heart for delivery to the body. (3.) Max
VO2 Uptake: Maximum Volume of Oxygen Taken up by the working muscles,
expressed in milliliters of oxygen per kilogram of body weight per minute
(ml/kg/min). (4.) Stroke Volume: The volume of blood pushed out of the left ventricle with each beat. (5.) Ejection Fraction: The percentage of the total volume of
blood in the left ventricle that’s pushed out with each beat. (6.) Heart Rate: The
number of times your heart beats during each minute. (7.) Willingness to endure
pain (especially from lactic acid accumulation). (8.) Skill (at running, etc.) (9.) Total
Body Limit Strength: The 8 factors above being equal, the strongest will win.
Afferent System: The part of the PNS that sends messages to the CNS.
Affective: Pertains to feelings or emotions.
Agonist: A muscle which directly engages in an action around a joint which has
another muscle that can provide an opposing action (antagonist).
Albumin: A type of simple protein widely distributed throughout the tissues and
fluids of plants and animals. Varieties of albumin are found in blood, milk, egg
white, wheat, barley and muscle.
Aldosterone: A mineralocorticoid which functions as the primary electrolyte-regulatory steroid hormone. It is secreted by the adrenal cortex.
Allergen: A substance that causes an allergy or hypersensitivity.
All-or-none reaction: Concept stating that a unit is either completely relaxed or fully
contracted; it is never partly contracted.
Alpha Ketoisocaproate (KIC): KIC is an alpha-ketoacid of L-leucine. It is well supported in the research literature as a stimulant of lymphocyte blastogenesis and antibody response, and it can also increase muscle growth and decrease fat deposition.
Recently, KIC has been used extensively in fat loss preparations and in high-protein
supplements used clinically to retard muscle wasting.
231
Appendix
GLOSSARY
Alveoli: Capillary-rich air sacs in the lungs where the exchange of oxygen and carbon
dioxide takes place.
Aphasia: An inability to interpret or execute spoken language (receptive and expressive, respectively) which is not related to diseases of the vocal cords or ears.
Amino Acids: The building blocks of protein. There are 24 amino acids, which form
countless number of different proteins. They all contain nitrogen, oxygen, carbon
and hydrogen. Amino acids are either essential or nonessential. The “L” isomer of the
amino acids has greater biological value, and is distinguished from the “molecular
mirror image” isomer which is called the “D” form. Thus, references to the individual
amino acids often begin with the prefix “L.”
Appendicular Skeleton: Bones consisting of the upper and lower extremities,
including the pelvic and shoulder girdles.
Ammonia Scavengers: Combinations of certain amino acids (especially glutamic
acid in combination with vitamin B-6) and minerals that help remove ammonia
from the blood. Ammonia is a toxic by-product of intense training (caused by the
breakdown of amino acids for energy) and endurance events, which can accumulate
to cause severe fatigue.
Aquatics: Exercise or sports activities in or on the water.
Amputation: Congenital or acquired loss of an extermity or portion thereof.
Anabolic: Pertaining to the putting together of complex substances from simpler
ones, especially to the building of body proteins from amino acids.
Anabolic-Androgenic Steroids (AAS): A group of synthetic, testosterone-like hormones that promote anabolism, including muscle hypertrophy. Medical uses include
promotion of tissue repair in severely debilitated patients, but their use in athletics
is illegal in the USA and many other countries, and is considered unethical and
therefore banned by almost all international sports governing bodies. Abuse and
misuse of this potent class of drugs carry numerous health risks.
Anabolism: The metabolic processes which build up living body substances, that is,
the synthesis of complex substances from simple ones. Example: muscle-building by
combining amino acids together. Anabolism uses the available energy generated by
catabolic processes to form the chemical bonds which unite the components of
increasingly complex molecules. Anabolism is the opposite of catabolism.
Anaerobic: Occurring without the use of oxygen.
Apraxia: Inability to motor plan (i.e., execute a series of movements in a coordinated
and efficient manner).Probably related to poor input from the tactile, vestibular and
proprioceptive systems.
Arachidonic Acid: An essential fatty acid found in the liver, brain, and other organs.
It is the biosynthetic precursor of prostaglandins. In experiments with mice, the deprivation of all fat intake caused scaly skin, kidney lesions, bloody urine, and early
death. These conditions were cured by the administration of arachidonic acid, linoleic
acid, and linolenic acid. Arachidonic acid is used therapeutically as a nutrient.
Arrhythmia: Any abnormal rhythm of the heart beat. Since some causes of
arrhythmia may have serious health consequences, exercisers experiencing irregular
heart beats should be referred for medical evaluation.
Ataxia: Difficulties with balance; reflected in a gait pattern that utilizes by a wide
base of support. A type of cerebral palsy in which balance is affected. Generally
involves a medical condition of the cerebellum.
Arteriosclerosis: Thickening and hardening of the artery walls by one of several diseases. See also atherosclerosis.
Artery: Vessel which carries blood away from the heart to the tissues of the body.
Articular: The area of bone where it is joined together with another bone as a joint.
Arthritis: Inflammation of the joints which causes pain, stiffness and limitation of
motion. May be symptomatic of a systemic disease, such as rheumatoid arthritis,
which can affect all age groups. See also osteoarthritis.
Anaerobic Exercise: Short-term activities (usually highly intense) in which muscle
fibers derive contractile energy from stored internal compounds without the use of
oxygen from the blood. These compounds include ATP, CP and Glycogen. Short
bursts of “all-out” effort, such as sprinting or weightlifting are examples of anaerobic
activities.
Assistant Mover: Muscle that plays a secondary role to the prime mover involved.
Anaerobic Threshold: The point where increasing energy demands of exercise
cannot be met by the use of oxygen, and an oxygen debt begins to be incurred.
Athetosis: A type of cerebral palsy which is characterized by rotary, involuntary
movements. Involves a medical condition of the basal ganglia.
Anatomy: The science of the structure of the human body.
ATP/CP Pathway: ATP and PCr provide anaerobic sources of phosphate-bond
energy. The energy liberated from hydrolysis (splitting) of PCr re-bonds ADP and Pi
to form ATP.
Anemia: A subnormal number or hemoglobin content of red blood cells caused
when blood loss exceeds blood production. Symptoms may include fatigue, pale
complexion, light headedness, palpitations, and loss of appetite.
Angina: A gripping, choking, or suffocating pain in the chest (angina pectoris),
caused most often by insufficient flow of oxygen to the heart muscle during exercise
or excitement. Exercise should stop, and medical attention should be obtained.
Anomalies: Congenital deformity or abnormal development of organ, tissue or
bone.
Anorexia: A condition where a person experiences a loss of appetite; it is distinguished from anorexia nervosa (below).
Anorexia Nervosa: A psychological and physiological condition (most commonly
among young women) characterized by inability or refusal to eat, or an extreme
aversion to food, leading to severe weight loss, malnutrition, hormone imbalances,
and other potentially life-threatening biological changes.
Antagonist: A muscle that can provide an opposing action to the action of another
muscle (the agonist) around a joint.
Anterior: Front or in front of.
Anthropometry: The science dealing with the measurement (size, weight, proportions) of the human body.
Antioxidants: Compounds that protect against cell damage inflicted by molecules
called oxygen-free radicals, which are a major cause of disease and aging.
232
Atherosclerosis: A very common form of arteriosclerosis, in which the arteries are
narrowed by deposits of cholesterol and other material in the inner walls of the
artery. See also arteriosclerosis.
ATP: Adenosine triphosphate; an organic compound found in muscle which, upon
being broken down enzymatically, yields energy for muscle contraction.
ATP/CP Sports: Explosive strength sports with movement lasting a second or two at
most (examples: shot put, powerlifting, Olympic weightlifting, vertical jump).
ATPase: The enzyme which acts to split the ATP molecule. Three major isoforms of
ATPase exist, and correspond to Type I, Type IIa and Type IIb muscle fibers. ATPase
is released from the knobby ends of the cross-bridges located on the myosin myofilaments.
Atrophy: Withering away, a decrease in size and functional ability of bodily tissues
or organs, typically resulting from disuse or disease. See also hypertrophy.
Auditory Discrimination: The ability to detect subtle differences among sounds in
words (e.g., tap-cap, then-than).
Autonomic System: System that processes and activates involuntary action.
Average Life Expectancy: This term is often misunderstood. It is commonly used to
refer to the number of years that the average person will live from birth. This number
has increased significantly over the past century from 45 years to 76 years in developed countries. The increase is mainly due to reductions in infant mortality, deaths
due to childbirth, and reduction in infectious diseases rather than extension of the
adult life span.
Axial skeleton: Bones consisting of the skull, spine, ribs and sternum.
Appendix
GLOSSARY
B
retaining from the food you eat. This translates into the potential for quality muscle
growth and strength.
Back-Cycling: Cutting back on either numbers of sets, repetitions, amount of weight
or (especially) the “negative” contraction (eccentric contraction) used during an
exercise session in order to fully recover. An archaic phrase. A more contemporary:
and useful: phrase is “periodization.”
Biomechanics: The study of the mechanical aspects of physical movement, such as
torque, drag, and posture, that is used to enhance athletic technique.
Balance: Relates to the maintenance of equilibrium while stationary or moving.
Ballistic Movement: An exercise or sports-related movement in which part of the
body is “thrown” against the resistance of antagonist muscles or against the limits of
a joint. The latter, especially, is considered dangerous to the integrity of ligaments
and tendons. High-impact, rapid, jerking movements.
Ballistic Training: Life, and especially sports, is full of ballistic episodes, and it’s
important to 1) prevent such episodes from causing injury (microtrauma or macrotrauma), and, paradoxically, 2) make your movements more ballistic in sports where
such will provide an advantage (e.g., throwing a 100 m.p.h. fastball). Following a
carefully periodized, highly specialized training, nutritional and supplementation
regimen will accomplish these goals.
Barbell: Weight used for exercise, consisting of a rigid handle 5-7’ long, with detachable metal discs at each end.
Basal Metabolic Rate: The minimum energy required to maintain the body’s life
function at rest. Usually expressed in calories per hour per square meter of body surface. See also met.
Behavior Modification: A procedure that is based on the assumption that all behaviors are learned and depend upon consequences. Therefore, behavior can be
changed through a methodically applied system of rewards and punishments.
Behavioral Objectives: Objectives which are written to describe what a student will
be able to do as a result of some planned instruction. These are usually written as
objectives that can be measured in some definitive or quantitative way.
Beta-Carotene: A carotenoid (pigment) found in yellow, orange and deep green vegetables which provides a source of vitamin A when ingested. This substance has been
found to have antioxidant and anticancer properties.
Beta oxidation: A series of reactions in which fatty acids are broken down.
Biceps Brachii: The prominent muscle on the front of upper arm.
Bilateral Coordination: A lack of coordination between the two sides of the body.
An inability to use two hands and/or legs together in a coordinated fashion. If
unable to cross over the midline of the body, the individual may appear ambidextrous (using the left hand on the left side only and vice-versa).
Bilberry: The active component of bilberries are the anthocyanosides. Its chief
action as an antioxidant is its powerful synergy with Vitamin E. Studies show that
bilberry extract 1)protects blood capillaries, 2) protects the heart, 3) shows excellent
anti-inflammatory action, 4) inhibits cholesterol-induced atherosclerosis, 5) inhibits
serum platelet aggregation (clotting).
Bile: A thick, sticky fluid secreted by the liver via the bile duct into the small intestine where it aids in the emulsification of fats, increases peristalsis and restores putrefaction. Normally the ejection of bile only occurs during duodenal digestion. The
normal adult secretes about 800 to 1,000 milliliters daily.
Biofeedback: A process which permits a person to see or hear indicators of physiological variables, such as blood pressure, skin temperature, or heart rate, which may
allow the person to exert some control over those variables. Often used to teach
relaxation techniques.
Bioflavonoids (Vitamin P): Water-soluble substances that appear in fruits and vegetables as companions to vitamin C. By name, they are citrin, rutin, hesperidin,
flavone and flavonols. They increase the strength of capillaries and regulate their permeability for the countless biochemical transfers that occur between blood and
tissue. No RDA. Dietary sources: Citrus fruit pulp, apricots, buckwheat, berries.
Biological Response: The immediate response to stress on the body.
Biological Value: A non-standardized test that describes the efficiency in which protein provides the proper proportions of the essential amino acids needed for protein
synthesis. It rates just how efficiently your body uses a specific protein source. The
higher the biological value, the more amino acids and nitrogen your body is
Biotin: A member of the B complex vitamin family essential for metabolism of fat,
protein, and vitamins C and B-12. It helps alleviate muscle pains, eczema, dermatitis.
No RDA. Dietary sources: egg yolk, liver, whole rice, brewer’s yeast.
Blood: The fluid which circulates through the heart, arteries, veins and capillaries. It
is composed of red blood cells, white blood cells and blood platelets, and an interstitial fluid called plasma. It derives its reddish color from the iron within the hemoglobin. Blood functions to provide nutrition and respiration for tissues located far
from food and air supplies. It also transports waste from the tissues to the excretory
organs. Blood provides chemical and thermal regulation to the body and helps in
preventing infection by transporting antibodies.
Blood Glucose: Refers to the amount of sugar in the blood. The blood sugar level in
humans is normally 60 to 100 milligrams per 100 milliliter of blood; it rises after a
meal to as much as 150 milligrams per 100 milliliter of blood but this may vary.
Blood Pressure: A measurement of the force with which blood presses against the
wall of a blood vessel. Blood pressure, as popularly used, is the pressure determined
indirectly, existing in the large arteries at the height of the pulse wave. When a blood
pressure reading is taken, the systolic over diastolic value is determined. Systolic
pressure is primarily caused by the heartbeat or contraction. The diastolic pressure
is taken when the heart is filling with blood between beats. Blood pressure values
vary appreciably depending on age, sex, and ethnicity. A typical adult reading may be
120mm Hg over 80mm Hg, stated 120 over 80.
Body Awareness: The ability to locate and identify body parts. Also includes an
awareness of the relationship of the body parts to each other and to the environment. The development of the body scheme is based on receiving accurate sensory
information from the skin, muscles, and joints (i.e., proprioception).
Body Composition: The proportions of fat, muscle, and bone making up the body.
Usually expressed as percent of body fat and percent of lean body mass.
Body Density: The specific gravity of the body, which can be tested by underwater
weighing. Compares the weight of the body to the weight of the same volume of
water. Result can be used to estimate the percentage of body fat.
Body Fat: The percentage of fat in the body. In bodybuilding, the lower the percentage, the more muscular the physique appears.
Body Mass Index: Divide your weight (in kilograms) by your height (in meters)
squared. Under new government guidelines, people with Body Mass Indexes of 25 to
29.9 are considered overweight while those with BMIs of 30 and above are considered obese. There is strong evidence that weight loss in overweight people reduces
the risk of cardiovascular disease and diabetes. These guidelines obviously do not
apple to extremely muscular people.
Bodybuilding: The application of training sciences: particularly nutrition and
weight training: to enhance musculature and physical appearance.
Boron: A nonmetallic earth element. It is required by some plants as a trace element
and occurs as a hard crystalline solid or as brown powder. Boron forms compounds
such as boric acid or borax. Taken as a supplement (3 mg./day), it shows decidedly
favorable anti-osteoporosis activity in middle aged women. Despite its widespread
use as a bodybuilding supplement, there is no evidence that it has anabolic properties among otherwise healthy bodybuilders.
Bradycardia: Slow heart beat. A well-conditioned heart will often deliver a pulse rate
of less than 60 beats per minute at rest, which would be considered bradycrotic by
standard definitions. See also tachycardia.
Brain Stem: Consists of the medulla, pons, and midbrain.
Branched Chain Amino Acids (BCAA): The amino acids L-leucine, L-isoleucine
and L-valine, which have a particular molecular structure that gives them their
name, comprise 35 percent of muscle tissue. The BCAAs, particularly L-leucine, help
increase work capacity by stimulating production of insulin, the hormone that opens
muscle cells to glucose. BCAAs are burned as fuel during highly intense training, and
at the end of long-distance events, when the body recruits protein for as much as 20
percent of its energy needs.
233
Appendix
GLOSSARY
Brewer’s Yeast: A non-leavening yeast used as a nutritional supplement for its rich
content of vitamins (particularly B complex), minerals and amino acids.
Brindall Berry: Fruit from the Garcinia Cambogia plant. See also Hydroxycitrate.
Bromelain: A protein-splitting enzyme in pineapple juice. Used to reduce inflammation and edema and accelerate tissue repair. Pineapple eaten fresh is the best
source.
Buffed: Slang for good muscle size and definition.
Bulimia: The abnormal and unhealthful intake of large amounts of food. It is often
followed by the use of laxatives and/or self-induced vomiting.
Bulking Up: Gaining body weight by adding muscle, bodyfat or both.
Bursa: A cushioning sac filled with a lubricating fluid that alleviates friction where
there is movement between muscles, between tendon and bone, or between bone
and skin.
Bursitis: The inflammation of a bursa, sometimes with calcification in underlying
tendon.
C
Caffeine: A chemical occurring in coffee, black tea and cola drinks with an ability to
stimulate the nervous system. In small amounts, it can create mental alertness. In
larger amounts, it can cause nervousness, anxiety, sleeplessness, and is used medicinally as a diuretic and headache remedy.
Calcium: The most abundant mineral in the body, a vital factor for bones, teeth,
muscle growth, muscle contraction, the regulation of nutrient passage in and out of
cells, and nerve transmissions. RDA: 800-1,400 mg. Dose increases with age. Dietary
sources: milk and dairy, soybeans, sardines, salmon, peanuts, beans, green vegetables.
Calisthenics: A system of exercise movements, without equipment, for the building
of the strength, flexibility and physical grace. The Greeks formed the word from
“kalos” (beautiful) and “sthenos” (strength).
Calorie: When used as a unit of metabolism (as in diet and energy expenditure)
equals 1,000 small calories, and is often spelled with a capital C to make that distinction. It is the energy required to raise the temperature of one kilogram of water
one degree Celsius. Also called a kilocalorie (kcal).
Calorie Cost: The number of Calories burned to produce the energy for a task. Usually measured in Calories (kcal) per minute.
Cancer: A multi-step process in which cells escape growth regulation and are undergoing evolution due to the selective pressures brought to bear by the environment of
the body.
Capillary: the tiny blood vessels that receive blood flow from the arteries, interchange substances between the blood and the tissues, and return the blood to the
veins.
Capillarization: An increase in size and number of tiny blood vessels surrounding
cells.
Carbohydrate: Chemical compound of carbon, oxygen and hydrogen, usually with
the hydrogen and oxygen in the right proportions to form water. Common forms are
starches, sugars, cellulose, and gums. Carbohydrates are more readily used for energy
production than are fats and proteins. One of the three basic foodstuffs (proteins
and fat are the others), carbohydrates are a group of chemical substances including
sugars, glycogen, starches, dextrins, and cellulose. They comprise the body’s main
source of raw material for energy. They contain only carbon, oxygen, and hydrogen.
Usually the ratio of hydrogen to oxygen is 2:1. Carbohydrates can be classified as
either a simple carbohydrate or a complex carbohydrate.
Carbohydrate Loading: An eating and exercise technique used to build up ultra high
reserves of glycogen in muscle fibers for maximum endurance in long-distance athletic events. Benefits only events over 60 minutes long, where glycogen can become
depleted to inhibit work capacity.
Carbon Dioxide: A colorless, odorless gas that is formed in the tissues by the oxidation of carbon, and is eliminated by the lungs. Its presence in the lungs stimulates
breathing.
234
Cardiac: Pertaining to the heart.
Cardiac Muscle: One of the body’s 3 types of muscle, found only in the heart.
Cardiac Output: The volume of blood pumped out by the heart in a given unit of
time. It equals the stroke volume times the heart rate.
Cardiac: Pertaininng to the heart.
Cardiopulmonary Resuscitation (CPR): A first-aid method to restore breathing and
heart action through mouth-to-mouth breathing and rhythmic chest compressions.
CPR instruction is offered by local Heart Association and Red Cross units, and is a
minimum requirement for most fitness-instruction certifications.
Cardiorespiratory Endurance: The ability of the body to sustain prolonged exercise.
See also aerobic endurance.
Cardiovascular: Pertaining to the heart and blood vessels.
Carotid Artery: The principal artery in both sides of the neck. A convenient place to
detect a pulse.
Cartilage: A firm, elastic, flexible, white material found at the ends of ribs, between
vertebrae (discs), at joint surfaces, and in the nose and ears.
Catabolism: The breaking down aspect of metabolism, including all processes in
which complex substances are progressively broken down into simpler ones.
Example: the catabolism of protein in muscle tissue into component amino acids,
such as occurs in intense training. Another common example is breaking down carbohydrates or fats for use in energy expenditure. Both anabolism and catabolism
usually involve the release of energy, and together constitute metabolism.
Catheter: A tube used for evacuating fluid from the bladder or brain. In the case of
the bladder, the catheter may be indwelling or external.
Cauda Equina: The terminal portion of the spinal cord (conus medullaris) and roots
of the spinal nerves below the first lumbar nerve.
Cellulite: A commercially created name for lumpy fat deposits. Actually this fat
behaves no differently from other fat; it is just straining against irregular bands of
connective tissue.
Central Nervous System: System comprised of the brain and spinal column.
Chelate: A chelate is a complex formation of a metal ion and two or more charged
molecule groups. An ion is an atom or molecule which carries an electric charge; it
can be either a cation or an anion.
Cholesterol: A steroid alcohol found in animal fats. This pearly, fat-like substance is
implicated in the narrowing of the arteries in atherosclerosis. Plasma levels of cholesterol are considered normal between 180 and 230 milligrams per 100 milliliters.
Higher levels are thought to pose risks to the arteries.
Choline: A B complex vitamin associated with utilization of fats and cholesterol in
the body. A constituent of lecithin, which helps prevent fats from building up in the
liver and blood. Essential for health of myelin sheath, a principle component of
nervous tissue, and plays important role in transmission of nerve impulses. No RDA.
Dietary sources: lecithin, egg yolk, liver, wheat germ.
Chromium: This essential micronutrient activates insulin for vital functions relating
to blood sugar, muscle growth and energy, and helps control cholesterol. Chromium
deficiency is widespread. Exercise and high consumption of sugar causes depletion.
No RDA. Average adult intake should be 50 to 200 micrograms. Dietary sources:
brewer’s yeast, shellfish, chicken liver, oysters. Commercially available chromium
supplements include picolinate (chromium bound to zinc) and polynicotinate
(chromium bound to niacin) varieties. Research is unclear as to their respective
“anabolic” activities, but both appear to act as glucose tolerance factor (GTF) regulators. That is, they aid in regulating your blood sugar (and therefore insulin) levels.
Chronic: Continuing over time.
Circuit Training: A series of exercises, performed one after the other, with little rest
between. Resistance training in this manner increases strength while making some
contribution to cardiovascular endurance as well. (It remains controversial as to
whether a significant cardiovascular benefit will be achieved in the absence of very
consistent motivation or close supervision of the sessions.)
Circulatory system: System consisting of the heart and blood vessels that serves as
the transportation system.
Appendix
GLOSSARY
Circumduction: Movement of a part, e.g., an extremity, in a circular direction.
Co-contraction: When both the agonist and antagonist undergo contraction.
Coenzyme Q10: Also called “Ubiquinone,” it is a naturally occurring biochemical
within the cells’ mitochondria. Specifically, it acts as an electron carrier in the production of ATP. As a supplement, it is believed to be 1) a potent antioxidant, 2) an
immune system booster, 3) energy enhancer, 4) an aid in preventing cardiac arrhythmias and high blood pressure, and 5) a performance enhancer for aerobic athletes,
particularly if the athlete is in less than peak condition.
Collagen: Fibrous protein that forms tough connective tissue. The most abundant
type of protein in the body. Forms tough connective tissue, the scaffolding holding
a muscle in place which becomes the tendons that tie muscles to bones. Connective
tissue literally keeps your body together: skin, bones, ligaments, cartilage and organs.
Collateral Circulation: Blood circulation through small side branches that can supplement (or substitute for) the main vessel’s delivery of blood to certain tissues.
Colostrum: The IGF-I and IGF-II found in colostrum are known to be critical “in
vivo” for promoting growth. That’s why it exists in mothers’ milk during the critical
first few days of lactation. “IGF” stands for “insulin-like growth factor.” The effectiveness of colostrum is measured by its “IGg” (immunoglobulin) value.
Columnar Epithelium: Epithelium consisting of one or more cell layers, the most
superficial of which is composed of elongated and somewhat cylindrical cells projecting toward the surface.
Compensatory Acceleration Training: A weight lifting technique used to develop
explosive strength whereby you accelerate the bar as leverage improves through the
movement.
Complete Protein: Refers to protein which contains all essential amino acids in sufficient quantity and in the right ratio to maintain a positive nitrogen balance. The
egg is the most complete protein food in nature, with an assimilability ratio of 94-96
percent. That is, up to 96 percent of the protein in eggs will be used as protein. In
contrast, about 60-70 percent of the protein in milk, meat or fish can be used as protein (see essential amino acids).
Cool Down: A gradual reduction of the intensity of exercise to allow physiological
processes to return to normal. Helps avoid blood pooling in the legs and may reduce
muscular soreness.
Coordination, Fine Motor: Pertains to usage of small muscle groups for manipulation (e.g., writing, cutting).
Coordination, Gross Motor: Pertains to usage of large muscle groups for locomotion and manipulation (e.g., jumping, running, throwing, catching).
Copper: A mineral that helps convert the body’s iron into hemoglobin for oxygen
transportation through the bloodstream. Essential for utilization of vitamin C. No
RDA. Dietary sources: legumes, whole wheat, prunes, liver, seafood.
Coronary Arteries: The arteries, circling the heart like a crown, that supply blood to
the heart muscle.
Coronary Heart Disease (CHD): Atherosclerosis of the coronary arteries.
Cortisol: A corticosteroid that causes a breakdown of protein in muscles.
Cortisone: A hormone isolated from the cortex of the adrenal gland, it may be prepared synthetically also. It is believed to be both a precursor and metabolite of cortisol (hydrocortisone). Prior to this conversion to cortisol, it is largely inactive.
Cortisol, however, is highly catabolic. Cortisone is important for its regulatory action
in the metabolism of proteins, carbohydrates, fats, sodium, and potassium. Pharmacologically as an anti-inflammatory in various conditions, including allergies, collagen diseases and adrenocortisol replacement therapy. Disadvantages may include
temporary relief and also potential toxicity.
Creatine: Organic acid generally found in the muscle as phosphocreatine (creatine
phosphate) that supplies energy for muscle contraction.
Creatine Monohydrate: Clinically used in improving plasma creatine concentrations by as much as 50 percent. Research shows this substance to be effective in
improving training intensity and recovery. It is able to pass through the gut wall and
into the bloodstream intact, and upon entering the muscle cells, is converted into
creatine phosphate (CP), See also creatine phosphate.
Complex Carbohydrates: Foods of plant origin consisting of 3 or more simple
sugars bound together. Also known as polysaccharides. The starch in grains is an
example. Compared to monosaccharides (refined carbohydrates such as table sugar
and white flour products), complex carbs require a prolonged enzymatic process for
digestion and thus provide a slow, even and ideal flow of energy. This avoids fluctuations in glucose (blood sugar) levels which can affect energy. Complex carbs contain fiber and many nutrients.
Creatine Phosphate (CP): a high-energy phosphate molecule that is stored in cells
and can be used to immediately resynthesize ATP.
Compliance: Staying with a prescribed exercise program. (Often used in a medical
setting.) See also adherence.
Crunches: An abdominal exercise which isolates the abdominals while, at the same
time, eliminating unwanted action from the iliopsoas muscles (hip flexors).
Concentric: A contraction in which a muscle shortens and overcomes a resistance.
Cuboidal epithelium: Epithelial tissue consisting of one or more cell layers, the most
superficial of which is composed of cube-shaped or somewhat prismatic cells.
Concentric Contraction: Muscle action in which the muscle is shortening under its
own power. This action is commonly called “positive” work, or “concentric contraction.” See also eccentric action, isometric action.
Cross Bridges: Projections of myosin molecules that link with actin filaments to
create a grabbing, pulling effect, resulting in contraction.
Cross-Sectional Study: A study made at one point in time. See also longitudinal
study.
Cutting Up: Reducing bodyfat and water retention to increase muscular definition.
Concussion: An injury from a severe blow or jar. A brain concussion may result in
temporary loss of consciousness and memory loss, if mild. Severe concussion causes
prolonged loss of consciousness and may impair breathing, dilate the pupils and disrupt other regulatory functions of the brain.
D
Conditioning: Long-term physical training, typically used in reference to sports
preparation.
Defribrillator: A device used to stop weak, uncoordinated beating (fibrillation) of
the heart and allow restoration of a normal heart beat. Part of the “crash cart” at cardiac rehabilitation program sites.
Connective Tissue: A fibrous tissue (primarily composed of collagen) that binds,
supports, and provides a protective packing medium around organs, muscles and
structures of the body. See also fascia, joint capsules, ligament, tendon.
Constant Resistance: Weight training technology wherein the weight you are lifting
always remains the same, regardless of changing leverage throughout a given exercise
movement. The standing example of constant resistance training is lifting a dumbbell or a barbell. See also Accommodating Resistance and Variable Resistance.
Contraction: The shortening of a muscle or increase in tension.
Contraindication: Any condition which indicates that a particular course of action
(or exercise) would be inadvisable.
Deadlift: One of three powerlifting events. A maximum (1-RM) barbell is lifted off
the floor until the lifter is standing erect.
Dehydration: The condition resulting from the excessive loss of body water.
Dehydroepiandrosterone (DHEA): Ruled a drug (hormone) by the FDA, DHEA is
the second most abundant steroid molecule in humans. The ruling is controversial
because, whereas hormones tend to be held in reserve in the gland which produced
them, and liberated as needed, DHEA is produced by the adrenal gland and immediately released into the bloodstream for cellular metabolism. Research tends to support its antiobesity, anti-aging, energizing, memory-enhancing, immune boosting,
cardiotonic and anti-carcinogenic activities. Nowadays it’s widely available outside
the USA as a nutritional supplement. However, DHEA is apparently legal without a
script here in the USA, as well. The studies were done on older men. DHEA is produced in the body until age 25 then ceases.
235
Appendix
GLOSSARY
Deltoids: The large triangular muscles of the shoulder which raise the arm away
from the body and is a prime mover in all arm elevation movements.
Depletion: Exhaustion following a workout before the body has fully recuperated.
Never train when feeling depleted.
Detraining: The process of losing the benefits of training by returning to a sedentary life.
Diastole: Relaxation phase of the heart. See also systole.
Diastolic pressure: Pressure exerted on the walls of the blood vessels during the
refilling of the heart.
Diet: The food one eats. May or may not be a selection of foods to accomplish a particular health or fitness objective.
Efficiency: The ratio of energy consumed to the work accomplished. Exercisers utilizing the same amounts of oxygen may differ in their speed or amount of weight
moved in a given time because of differing efficiencies.
Eicosapentaenoic Acid (EPA): A fatty acid found in fish and fish oils which is
believed to lower cholesterol, especially cholesterol bound to low density lipoproteins (LDL).
Ejection Fraction: The percentage of blood inside the heart’s left ventricle that is
pushed out into the body after contraction. The average training athlete, working at
80 percent maximum, ejects about 75%. This factor is positively affected by either
anaerobic or aerobic training.
Elastin: Elastic fibrous protein found in connective tissue.
Digestion: The process of mechanical or chemical breakdown of food into
absorbable molecules.
Electrocardiogram (EKG, ECG): A graph of the electrical activity caused by the
stimulation of the heart muscle. The millivolts of electricity are detected by electrodes on the body surface and are recorded by an electrocardiograph.
Digestive System: System consisting of the digestive tract and glands that secrete
digestive juices into the digestive tract. Responsible for the breakdown of foods and
waste elimination.
Electrolytes: Minerals such as sodium, potassium, chloride, calcium and magnesium
that provide conductivity functions for fluid passage (osmosis) through cellular
membranes.
Diplegia: Paralysis/paresis of all four extremities, with more severe involvement of
the lower extremities.
Electron Microscope: A microscope that uses electrons instead of visible light to
produce powerfully-magnified images of objects smaller than the wavelengths of visible light.
Directionality: The ability to determine directions and locations in the environment
(e.g., left, right, up, down, over, under, across, through). The concept of moving
right or left.
Electron transport: The passing of electrons over a membrane aiding in a reaction
to recover free energy for the synthesis of ATP.
Diuretic: Any agent which increases the flow of urine. Used ill-advisedly for quick
weight loss, diuretics can cause dehydration.
Endocrine: Refers to a secretion that flows directly into the bloodstream. It is the
opposite of exocrine.
DL-Phenylalanine (DLPA): A mixture consisting of equal parts of the D- and Lforms of phenylalanine. Phenylalanine is a naturally occurring amino acid, discovered in 1879, essential for optimal growth in infants and for nitrogen equilibrium in
human adults. DLPA is used in the control of pain, through a mechanism believed
to involve a sparing effect on opiate-like substances naturally secreted by the brain
(i.e., endorphins and enkephalins).
Endocrine Glands: Organs which secrete hormones into the blood or lymph systems
to regulate or influence general chemical changes in the body or the activities of
other organs. Major glands are the thyroid, adrenal, pituitary, parathyroid, pancreas,
ovaries and testicles.
DNA (Deoxyribonucleic Acid): A complex protein present in the nuclei of cells. The
chemical basis of heredity and carrier of genetic programming for the organism.
Endomorph: A heavyset person with a predominantly round and soft physique.
Dorsiflexion: Turning upward to the foot or toes or of the hand or fingers.
Endorphins: Brain chemicals that ease or suppress pain. D-phenylalanine and Lphenylalanine, amino acids, intensifies and prolongs the effects of these natural
painkillers.
Double Split Training: Working out twice a day to allow for shorter, more intense
workouts. See also Variable Split.
Dry-Bulb Thermometer: An ordinary instrument for indicating temperature. Does
not take into account humidity and other factors that combine to determine the heat
stress experienced by the body. See also wet-bulb thermometer, wet-globe temperature.
Dumbbell: Weight used for exercising, consisting of rigid handle about 14” long
with sometimes detachable metal discs at each end.
Duration: The time spent in a single exercise session. Duration, along with frequency and intensity, are factors affecting the effectiveness of exercise.
Dysfunction: Difficult function, improper functioon, or non-function.
Dyspnea: Difficult or labored breathing.
E
Eccentric: A contraction in which a muscle lengthens and is overcome by a resistance.
Eccentric Action: Muscle action in which the muscle resists while it is forced to
lengthen. This action is commonly called “negative” work, or “eccentric contraction;” but since the muscle is lengthening, the word “contraction” is misapplied. See
also concentric action, isometric action.
Ectomorph: A thin person with a lean physique and light musculature.
Efferent System: System designed to cause action; consists of the somatic and autonomic systems.
236
Endocrine system: System consisting of the glands and tissues that release hormones. It works with the nervous system in regulating metabolic activities.
Endurance: The capacity to continue a physical performance over a period of time.
See also aerobic endurance, anaerobic endurance.
Energy: The capacity to produce work.
Enzyme: Any of numerous proteins or conjugated proteins produced by living
organisms and functioning as biochemical catalysts.
Epidemiological Studies: Statistical study of the relationships between various factors that determine the frequency and distribution of disease. For example, such
studies have linked exercise to reduced mortality.
Epinephrine: A hormone produced by the adrenal gland that causes the “flight or
fight” response.
Epiphyseal Plates: The sites of new bone growth, separated from the main bone by
cartilage during the growthperiod. This is a potential injury site to be avoided in prescribing exercise to prepubescent individuals.
Epiphyses: The ends of long bones, usually wider than the shaft of the bone.
Equilibrium Reactions (Cortical): The automatic movements which keep one balanced during static and dynamic postures such as sitting, standing, and walking.
Involves automatic responses of the head, trunk and limbs.
Ergogenesis: Substances and practices that improve sports performance are called
ergogenic aids. Ergogenesis is a word coined by Dr. Fred Hatfield in the mid 80s
which refers to a “genesis” (new beginning) for athletes attempting to divorce themselves of steroid use by utilizing nutritional, psychological, and biomechanical
training technologies.
Appendix
GLOSSARY
Ergogens: A host of substances or treatments that may improve a person’s physiological performance or remove the psychological barriers associated with more
intense activity, and can be nutritional, physiological, psychological, mechanical,
physical, environmental or pharmacological in nature.
Fat (total): Describes the fat consumed from both saturated and unsaturated
sources. High intake of total dietary fat increases risk of obesity, some types of
cancer, and possibly gallbladder disease.
Fat-Free Weight: Lean body mass including muscles, bones, and organs.
Ergometer: A device that can measure work consistently and reliably. Stationary
exercise cycles were the first widely available devices equipped with ergometers, but
a wide variety of endurance-training machines now have ergometric capacity.
Fatigue: A loss of ability to continue a given level of physical workload or performance.
Erythrocyte: Blood cell that contains hemoglobin to carry oxygen to the bodily tissues; a biconcave disc that has no nucleus. Red blood cell.
Fat-Soluble Vitamins: Vitamin A, vitamin D, vitamin E, and vitamin K: vitamins
which can be dissolved in fats or fatty tissue.
Essential Amino Acids: Those amino acids that the body cannot make for itself.
They are isoleucine, leucine, lysine, methionine, phenylalanine, tryptophan, and
valine.
Fatty Acid: Any of a large group of monobasic acids, especially those found in
animal and vegetable fats and oils. One of the building blocks of fat. Used as fuel for
muscle contractions. (See Essential Fatty Acids)
Essential Fatty Acid (EFA): “Good” fats needed for strong cell walls, metabolism,
and other important functions of the thyroid and adrenal glands: Essential Fatty
Acids include Linoleic acid, Linolenic acid and Arachiokonic acid.
Feedback loop: Section of a control system that serves as a regulatory mechanism;
return input as some of the output.
Essential Hypertension: Hypertension without a discoverable cause. Also called primary hypertension. See also hypertension.
Estrogen: The sex hormone that predominates in the female, but also has functions
in the male, is a generic term for estrus-producing steroid compounds which are
formed by the ovaries, placenta, testes, and adrenal cortex. They can also be isolated
from plants or produced synthetically. Besides stimulation of female secondary
sexual characteristics, they exert systemic effects, such as growth and maturation of
long bones and female responses to exercise. Estrogens are used therapeutically in
any disorder attributable to estrogen deficiency, to prevent or stop lactation, to suppress ovulation, and to ameliorate carcinoma of the breast and of the prostate.
Estrone and estradiol, both estrogens, induce the growth of female genital organs
and stimulate the changes characteristic of the estrus cycle.
Etiology: The cause of a medical condition.
Fiber (dietary): Dietary fiber is the edible parts of plants or analogous carbohydrates
that are resistant to digestion and absorption in the human small intestine with complete or partial fermentation in the large intestine. Dietary fiber includes polysaccharides, oligosaccharides, lignin, and associated plant substances. Dietary fibers
promote beneficial physiological effects including laxation, and/or blood cholesterol
attenuation, and/or blood glucose attenuation.
Fiber (muscle): The long and string-like muscle cells which contract to produce
strength. They range from microscopic size to one foot long. There are several hundred to several thousand individual groups (fasciculi) of fibers in each major muscle
structure. These groups are something like pieces of string bound tightly together
inside a protective sheath.
Fibromyalgia Syndrome (FMS): A chronic and often disabling condition characterized by widespread body pain and severe fatigue.
Eversion: Turning outward, as of the eyelid or foot.
Fitness: Good health or physical condition, especially as the result of exercise and
proper nutrition.
Exercise: Physical exertion of sufficient intensity, duration, and frequency to achieve
or maintain fitness, or other health or athletic objectives.
Fitness Testing: Measuring the indicators of the various aspects of fitness. See also
graded exercise test, physical work capacity.
Exercise Prescription: A recommendation for a course of exercise to meet desirable
individual objectives for fitness. Includes activity types, duration, intensity, and frequency of exercise.
Flex: Contracting a muscle (or muscles) isometrically, as in bodybuilding competition. It can also refer to joint movement. See also flexion.
Exertional Headaches: Pain triggered by a variety of exercise activities ranging from
weightlifting to jogging, and including sexual intercourse.
Flexion: A movement which moves the two ends of a jointed body part closer to each
other, as in bending the arm. The act of flexing or bending. See also extension.
Expiration: Breathing air out of the lungs. See also inspiration, respiration.
Flush: Cleansing a muscle of metabolic toxins by increasing the blood supply to it
through exertion.
Extension: The act of bringing the distal portion of a joint in continuity with the
long axis of the proximal portion.
Extensor: A muscle that extends a jointed body part.
F
Faint: See syncope.
Fascia: Connective tissue which surrounds muscles and various organs of the body.
Fast-Twitch Fibers: Muscle fiber type that contracts quickly and is used most in
intensive, short-duration exercises, such as weightlifting or sprints. See also slowtwitch fibres.
Fat: 1. A white or yellowish tissue which stores reserve energy, provides padding for
organs, and smooths body contours. 2. A compound of glycerol and various fatty
acids. Dietary fat is not as readily converted to energy as are carbohydrates. One of
the three basic foodstuffs (along with carbohydrates and protein). The most concentrated source of energy in the diet, furnishing twice the calories of carbs or proteins. The components of fat are fatty acids: saturated or unsaturated. Saturated fatty
acids are generally solid at room temperature and are derived primarily from animal
sources. Unsaturated fatty acids, on the other hand, are usually liquid and come from
vegetable, nut, or seed sources. Fat deposits surround and protect organs such as the
kidneys, heart and liver. Fats are the primary substance of adipose tissue. A layer of
fat beneath the skin, known as subcutaneous fat, insulates the body from environmental temperature changes thereby preserving body heat.
Flexibility: The range of motion around a joint.
Folic Acid: A B-complex vitamin essential in formation of red blood cells and
metabolism of protein. Important for proper brain function, mental and emotional
health, appetite, and production of hydrochloric acid. Very often deficient in diets.
RDA: 400 micrograms. Dietary sources: green leafy vegetables, liver, brewer’s yeast.
Food Allergies: Sensitivities to certain foods which can cause both mental and physical symptoms.
Foot-Pound: The amount of work required to lift one pound one foot.
Forced Repetitions: Assistance to perform additional repetitions of an exercise when
muscles can no longer complete movement on their own.
Free Radicals: Highly reactive molecules which target your tissues’ protein bonds,
the DNA in your cells’ nuclei and the important polyunsaturated fatty acids within
your cells’ membranes. Once initiated, a chain reaction begins that ultimately results
in the total destruction of that cell. Scientists have determined that over 60 agerelated maladies are a direct result of long-term damage resulting from free radical
activity. There are seven different “species” of free radicals: Superoxide Anion Radical, Hydrogen Peroxide, Hydroxyl Radical, Singlet Oxygen, Polyunsaturated Fatty
Acid Radical, Organic /Fatty Acid Hydroperoxides, and Oxidized Protein.
Freestyle Training: Training all body parts in one workout (obsolete phrase).
Frequency: How often a person repeats a complete exercise session (e.g. 3 times per
week). Frequency, along with duration and intensity, affect the effectiveness of exercise.
237
Appendix
GLOSSARY
Frontal (coronal) plane: Separates the body into anterior (front) and posterior
(back) parts.
Fructose: Fruit sugar.
Functional Capacity: Also known as maximal oxygen uptake or (VO2 Max) the
maximal capacity for oxygen consumption by the body during maximal exertion.
Also known as aerobic power, maximal oxygen intake, max oxygen consumption,
and cardiorespiratory endurance capacity.
G
Gamma Oryzanol: A substance extracted from rice bran oil which some athletes
believe has nonsteroidal, growth-promoting properties when taken as a supplement.
It allegedly helps increase lean body mass and strength, decreases fatty tissue,
improves recovery from workouts, and reduces post-workout muscle soreness, particularly among female athletes.
Ginkgo Biloba: Native to China and Japan, the ginkgo tree lives over 1000 years! The
active component of ginkgo leaves are quercetin and the flavoglycosides. Ginkgo
extract is shown to 1) reduce clots or thrombi formation in the veins and arteries, 2)
increase cellular energy by increasing cellular glucose and ATP, 3) scavenge free radicals, 4) prevent the formation of free radicals, 5) reduce high blood pressure, and 6)
promote peripheral blood flow (especially to the brain), which also ameliorates
inner ear problems. Ginkgo also has been shown to improve alertness, short-term
memory, and various cognitive disorders.
Glycogen: The common storage form of glucose in the liver and muscles that is biochemically processed as part of the energy-producing cycle. Glycogen, a polysaccharide commonly called animal starch, is readily converted into glucose as the energy
needs of the body require.
Glycogen Granule: Structure of the cell that stores glycogen and enzymes for
glycogen breakdown and synthesis.
Glycogenolysis: Process describing the cleavage of glucose from the glycogen molecule. The cellular breakdown of stored glycogen for energy, which is regulated by the
enzyme phosphorylase.
Glycolysis: The metabolic process that creates energy via splitting a molecule of glucose to form either pyruvic acid or lactic acid and produce ATP molecules. Glycolysis in an important part of anaerobic metabolism.
Glycolytic Pathway: Glucose is broken down to produce energy anaerobically.
Glycolytic Sports: Sports such as wrestling, boxing, 200 meter dash and other long
sprint or mid-distance sprints wherein the glycolytic pathway of muscle energy production (the breakdown of muscle sugar, glycogen, in order to produce more CP and
ATP) is involved (see glycogen, ATP and CP).
Glandular: Of, relating to, affecting, or resembling a gland or its secretion.
Golgi Tendon Organs: Nerve sensors (“proprioceptors”), located at the junction of
muscles and tendons, that pick up messages of excess stress on the muscle and cause
the brain to shut off muscle contraction. The purpose may be to protect against separating the tendon from bone when a contraction is too great. Called “the feedback
loop,” this shut-off threshold can be pushed back or delayed (e.g., toward one’s maximum strength potential) through “jerk training,” where you carefully perform
repeated submaximum jerks with weights. See also muscle spindle, proprioceptor.
Glucagon: A hormone produced by the pancreas that stimulates an increase in blood
sugar levels, thus opposing the action of insulin. Liver glucose is freed when the
blood sugar level drops to around 70 milligrams/100 milligrams of blood. Exercise
and starvation both increase glucagon levels, as does the presence of amino acids in
the blood after a high protein meal. Glucagon produces smooth muscle relaxation
when administered parenterally.
Gompterz Law: Refers to a phenomenon observed years ago by an actuary named
Benjamin Gompterz. He observed that death rates for human populations doubled
every decade between the ages of 20 and 80. However it has recently been observed
that this phenomenon does not apply to the oldest old (those older than 85). As a
group, those who have advanced to extreme old age are healthier than the population two decades younger (age 65).
Gluconeogenesis: Chemical process that converts lactate and pyruvate back into
glucose. When glycogen (sugar stored in muscles) stores are low, glucose for emergency energy is synthesized from protein and the glycerol portion of fat molecules.
This is one important reason that ATP/CP athletes and glycolytic athletes are warned
to stay away from undue aerobic exercise: it’s muscle-wasting.
Graded Exercise Test (GXT): A treadmill, or cycle-ergometer, test that delivers heart
rate, ECG, and other data. Workload is gradually increased until an increase in workload is not followed by an increase in oxygen consumption; this identifies the individual’s maximal oxygen uptake. Allows the prescribing of exercise to the
individual’s actual, rather than estimated, heart rate or aerobic capacity. Requires
medical supervision. See also physical work capacity.
Glucose: Principal circulating sugar in the blood and the major energy source of the
body.
Glucosamine: A substance that occurs naturally in the human body and helps to
keep cartilage spongy.
Glucose (blood sugar): A simple sugar, the breakdown product of carbohydrates
that becomes the raw material for energy production inside cells.
Glucose Polymers: A low glycemic carbohydrate supplement that delivers a steady
source of energy for workouts and restoration. “Branching” glucose polymers (i.e.,
glucose molecules comprised of differing glycemic indexes due to their structural
complexity) are available as drinks, powders and tablets.
Glucose Tolerance: Refers to an individual’s ability to metabolize glucose.
Glucose-Lactate Cycle (Cori Cycle): The metabolic partnership between muscles
and liver to support active muscle work. Refers to the sequence involving breakdown
of carbohydrates, glycogen storage in liver, passage of glucose into the bloodstream
and subsequent storage in muscle fibers as glycogen, the breakdown of glycogen
during muscle activity, the production of lactic acid in this process, and the conversion of lactic acid to glycogen again.
Gluteals: Abbreviation for gluteus maximus, medius and minimus; the hip extensor
muscles. Also called buttocks or glutes.
Glycemic Index: A rating system that indicates the different speed with which carbohydrates are processed into glucose by the body. In general, complex carbohydrates are broken down slower, providing a slow infusion of glucose for steady
energy. Refined, simple carbohydrates usually are absorbed quickly, causing energydisturbing fluctuations of glucose.
238
Grand Mal (Tonic-Clonic) Seizure: One of the more serious forms of epilepsy
which involves stiffening and convulsions of the body.
Green Tea: Also known as GTA (green tea antioxidant) or GTE (green tea extract),
has been clinically shown to be as much as 200 times more effective than vitamin E
at scavenging hydrogen peroxide and superoxide anion radicals (see Free radicals).
As such, it is perhaps the most potent antioxidant known to man in its ability to prevent 1) antibacterial and antiviral activity, 2) anti-platelet and hyocholesterolemic
activity, 3) lung cancer due to smoking, 4) skin damage and skin cancer due to radiation, 5) a host of other age-related maladies. The active ingredients of green tea are
called polyphenol catechins, with Epigallocatechin Gallate (EGCg) being by far the
most important. Green tea is unprocessed; black tea is the same plant but highly
processed; Oolong tea, also from the same plant, is partially processed tea.
Growth Hormone (HGH or hGH): A growth hormone is any substance that stimulates growth, especially one secreted by the pituitary (somatotropin) which exerts a
direct effect on protein, carbohydrate and lipid metabolism, and controls the rate of
skeletal, connective (collagenous) tissue and and body weight gain.
H
Habilitation: Maximizing the potential of an individual who is disabled from birth.
Hamstring: The big muscle along the back of your upper leg which extend from
above the hip to below the knee.
Hayflick Limit: Refers to a phenomenon that occurs when human cells are grown in
tissue culture. Under these conditions it is observed that the population can only
double a limited number of times (around 50) before the cells senesce, becoming
unable to grow any more. It is named after noted biogerontologist Lonard Hayflick.
Appendix
GLOSSARY
Health Risk Appraisal: A procedure that gathers information about a person’s
behaviors, family history, and other characteristics known to be associated with the
incidence of serious disease, and uses that information to compare the individual’s
present risks with the lower risks that could be achieved by changing certain behaviors.
Hyperextension: Extension of a limb or part beyond the normal limit.
Heart Attack: An acute episode of any kind of heart disease.
Hyperplasia (muscle splitting): A controversial subject among sports scientists
regarding the possibility of muscle fibers to actually split, giving more strength from
increased contractile potential and/or connective tissue. An increase in number of
cells in a tissue or organ, excluding tumor formation, whereby bulk of the part or
organ may be increased.
Heart Rate: The number of times your heart beats in one minute.
Heart Rate Reserve: The difference between the resting heart rate and the maximal
heart rate.
Heat Cramps: Muscle twitching or painful cramping, usually following heavy exercise with profuse sweating. The legs, arms, and abdominal muscles are the most
often affected.
Heat Stroke: A life threatening illness when the body’s temperature-regulating
mechanisms fail. Body temperature may rise to over 104 degrees F, skin appears red,
dry, and warm to the touch. The victim has chills, sometimes nausea and dizziness,
and may be confused or irrational. Seizures and coma may follow unless temperature is brought down to 102 degrees within an hour.
Heat Syncope: Fainting from the heat. When a lot of blood is sent to the skin for
cooling, and the person becomes inactive enough to allow blood to pool in the legs,
the heart may not receive enough blood to supply the brain. Once the person is in a
horizontal position, consciousness is regained quickly.
Helping Synergy: When two muscles contract together to create one movement.
Hemiplegia: Paralysis of one side of the body.
Hemoglobin: An oxygen-transporting protein found in blood cells. Hemoglobin is
a crystallizable, conjugated protein consisting of an iron-containing pigment called
heme and a simple protein, globin. It is the pigment of red blood cells. Hemoglobin
carries oxygen from the lungs to the tissues.
Herbs: An often-used definition is any part of a plant which can be used as a medical treatment, nutrient, food seasoning or dye. However, this definition is too shortsighted to be relevant to the needs of otherwise healthy athletes whose major
objective in life is to excel in their respective sports. You can use herbs to enhance
your performance in many ways.
High Blood Pressure: Abnormally high blood pressure. It is usually defined as systolic pressure above 140 mm Hg or diastolic pressure above 90 mm Hg in adults. See
also hypertension.
High-Density Lipoprotein (HDL): A type of lipoprotein that seems to provide protection against the buildup of athersclerotic fat deposits in the arteries. Exercise
seems to increase the HDL fraction of total cholesterol. HDL contains high levels of
protein and low levels of triglycerides and cholesterol. See also lipoprotein, low-density lipoprotein.
Hyperglycemia: Abnormally high level of glucose in the blood (high blood sugar).
The clinical hallmark of diabetes mellitus. Usually defined as a blood sugar value
exceeding 140 mg/dl.
Hypertension: Persistent high blood pressure. Readings as low as 140/90 millimeters
of mercury are considered a threshold for high blood pressure by some authorities.
See also blood pressure.
Hyperthermia: Body temperatures exceeding normal. See heat cramps, exhaustion,
heat stroke, and heat syncope. See also hypothermia.
Hypertonic: Describes a solution concentrated enough to draw water out of body
cells. See also osmolarity.
Hypertrophy (general): An enlargement of a body part or organ by the increase in
size of the cells that make it up. See also atrophy.
Hypertrophy (muscle): Increase in both gross muscle size as well as individual
muscle cell size resulting from training (especially weight training); due to the adaptive process whereby the muscles add more mitochondria, sarcoplasm, myofibrils,
interstitial substances such as water, fat, satellite cells, etc. in response to highly specific forms of stress.
Hypervitaminosis: Undesirable symptoms caused by an excess of certain (typically
fat soluble) vitamins.
Hypnotherapy: An effective method to shed accumulated negativity and self-doubt
that can limit confidence and performance potential.
Hypoglycemia: Literally means “low blood glucose level.” There are two general categories of this disorder: fasting (or spontaneous) and reactive. In fasting hypoglycemia, serum glucose levels are low in the fasting state (for example, before
breakfast). This form of hypoglycemia is relatively uncommon and is not what most
people generally refer to when they claim to have “hypoglycemic symptoms.” In reactive hypoglycemia, fasting glucose levels are normal. They become abnormally low
only in reaction to the increased serum levels of glucose which follow the ingestion
of a meal.
Hypothermia: Body temperature below normal. Usually due to exposure to cold
temperatures, especially after exhausting ready energy supplies. See also hyperthermia.
Hypotonic: Describes a solution dilute enough to allow its water to be absorbed by
body cells. See also osmolarity.
Homeostasis: The automatic tendency to maintain a relatively constant internal
environment. Example: A buildup of carbon dioxide increases the respiration rate to
eliminate it and draw in more oxygen.
Hypoxia: Insufficient oxygen flow to the tissues, even though blood flow is adequate.
See also ischemia.
Hormones: Hormones are chemical substances which originate in an organ, gland,
or body part, and are conveyed by the blood to affect functions in other parts of the
body.
I
Horsepower: A workrate measure equal to 746 watts, or about 550 foot-pounds per
second.
Impulse-Inertial Training: A system originally designed for NASA space stations
(where there’s no gravity: dumbbells and barbells would be useless in space) whereby
a moving, weighted sled is alternately moved very rapidly back and forth on a set of
tracks in order to effectively improve starting strength (see starting strength).
Human Growth Hormone (hGH): A hormone secreted by the anterior pituitary
gland in response to various stressful stimuli such as heat, starvation and intense
physical stress (e.g., exercise), as well as by an innate pulsatile periodicity. The principal functions of HGH are to stimulate anabolism and to mobilize stored fat
(triglycerides) for energy, thus sparing muscle glycogen.
Hydroxycitrate (HCA): Sometimes referred to as hydroxycitric acid: a natural fruit
acid found in abundance in the Brindall berry, the fruit of the Garcinia Cambogia
plant (found in India primarily). HCA is cited in the research as able to inhibit lipid
(fat) synthesis. Possible mechanisms for this effect may be 1) an appetite suppressant
response due to enhanced gluconeogenesis which would promote a feeling of satiety,
and 2) inhibition of certain enzymes necessary for biosynthesizing fat.
Iliac Crest: The upper, wide portion of the hip bone.
Inertia: The tendency of an object to remain in its current state (in motion or at
rest).
Infarction: Death of a section of tissue from the obstruction of blood flow
(ischemia) to the area. See also myocardial infarction.
Inflammation: Body’s local response to injury. Acute inflammation is characterized
by pain, with heat, redness, swelling and loss of function. Uncontrolled swelling may
cause further damage to tissues at the injury site.
239
Appendix
GLOSSARY
Informed Consent: A procedure for obtaining a client’s signed consent to a fitness
center’s prescription and leadership of his/her program. Includes a description of the
objectives and procedures, with associated benefits and risks, stated in plain language, with a consent statement and signature line in a single document.
Inosine: A naturally-occurring compound found in the body that contributes to
strong heart muscle contraction and blood flow in the coronary arteries. As a supplement taken before and during workouts and competition, it stimulates enzyme
activity in both cardiac and skeletal muscle cells for improved regeneration of ATP.
What this means in training terms is that you’ll be able to get a rep or two more out
of yourself in each set. It means that you’ll be able to do your wind sprints with
greater stamina. Better workouts equals better gains.
Inositol: A B complex vitamin. Combines with choline to form lecithin, protecting
against the fatty hardening of arteries and cholesterol buildup. Important in the
nutrition of brain cells. Promotes healthy hair. No RDA. Dietary sources: liver,
brewer’s yeast, dried lima beans, beef brains and heart, cantaloupe.
Insertion: The distal attachment; generally considered the most moveable part or
the part that attaches furthest from the midline or center of the body.
Insulin: A peptide hormone made of two polypeptide chains, and is secreted from
the beta cells of the pancreas. The function of insulin is to increase the ability of certain organs, such as muscles and the liver, to utilize glucose and amino acids. Insulin
also increases the total quantity of protein in the body by increasing the flow of
amino acids into cells, accelerating messenger RNA translation, and increasing DNA
transcription to form more RNA. Insulin is essential for the proper metabolism and
proper maintenance level of blood sugar.
Insulin-Like Growth Factors (IGF-I & IGF-II): Theorized to be liberated into the
interstitial spaces surrounding muscle cells (especially Type IIb fibers) damaged by
severe stress (especially eccentric contractions). Their collective function is to ensure
fusion between the nearby satellite cells with the damaged fiber, thereby decreasing
that fiber’s proneness to injury. It is theorized to be the single most contributory
factor in muscle hypertrophy.
Integumentary system: Bodily system consisting of the skin and its associated structures, such as the hair, nails, sweat glands, and sebaceous glands.
Intensity: The rate of performing work; power. A function of energy output per unit
of time.
Interval Training: An exercise session in which the intensity and duration of exercise are consciously alternated between harder and easier work. Often used to
improve aerobic capacity and/or anaerobic endurance in exercisers who already have
a base of endurance training.
Intramuscular\Intracellular Friction: The natural friction between and within
muscle fibers caused by contraction (especially eccentric contraction). Leads to some
reduction in strength output. The greatest amount of friction occurs in eccentric
movements, such as the lowering of weights, where the muscle lengthens against
resistance. This can be very damaging to contractile components inside fibers, and
to the fibers themselves (called “microtrauma”).
Ischemia: Inadequate blood flow to a body part, caused by constriction or obstruction of a blood vessel. See also hypoxia.
Isokinetic Contraction: A muscle contraction against a resistance that moves at a
constant velocity, so that the maximum force of which the muscle is capable
throughout the range of motion may be applied. See also isotonic contraction.
Isokinetic Exercise: Exercise equipment using accommodating resistance technology. For example, Keiser equipment uses compressed air to provide accommodating resistance. With this form of isokinetic movement, the harder you push the
harder the machine resists, providing the net effect of controlling the speed of movement. See also Accommodating Resistance.
Isometric Contraction: A muscular contraction in which the muscle retains its
length while increasing in tension, but no movement occurs. Also called static contraction.
Isotonic Contraction: A concentric muscular contraction in which the load remains
constant but the tension varies with the joint angle. Also called dynamic contraction.
J
Jerk: The part of the Olympic lift known as the “clean and jerk,” where the lifter
drives the barbell from his or her shoulders overhead to a locked position.
Joint: Formed where two bones come together. Not all joints have the same range of
motion, and some joints don’t move at all. The range of motion of a joint is limited
by the structure of the bone and the attachment of muscle to bone.
Joint Capsules: A sac-like enclosure around a joint that holds synovial fluid to lubricate the joint.
K
Ketone: Bodies produced as intermediate products of fat metabolism. They are normally created in limited amounts when fat is oxidized. However, in drastic conditions where carbohydrate is insufficient or unavailable for energy needs such as
starvation or untreated diabetes, excessive amounts of fat are oxidized and ketone
bodies accumulate. This condition is known as ketosis.
Ketosis: An elevated level of ketone bodies in the tissues. Seen in sufferers of starvation or diabetes, and a symptom brought about in dieters on very low carbohydrate
diets.
Kilocalorie (kcal): A unit of measurement used in metabolic studies, being the
amount of heat required to raise the temperature of 1 kilogram of water 1 degree
Celsius at a pressure of 1 atmosphere. It is 1,000 times larger than the small calorie
used in chemistry and physics. The term is used in nutrition to express the fuel or
energy value of food.
Kilogram (kg): A unit of weight equal to 2.204623 pounds; 1,000 grams (g).
Inversion: A turning inward, upside down, or in any direction contrary to the
existing one.
Kilogram-meters (kg•m): The amount of work required to lift one kilogram one
meter.
Involuntary muscle tissues: Receive nerve fibers from the autonomic nervous
system and cannot be voluntarily controlled, except in a few rare cases. (e.g., the
heart)
Kilopond-meters (kp•m): Equivalent to kilogram-meters, in normal gravity.
Iodine: An essential element for the function of the thyroid gland, which regulates
metabolism and energy. RDA: 150 micrograms. Dietary sources: All seafood, kelp.
Ion: An atom or molecule which carries an electric charge; it can be either a cation
or an anion. The most important cations in the body are sodium, potassium, calcium and magnesium (the electrolytes). The most important anions in the body are
bicarbonate, chloride, phosphate and sulfate.
Iron: Combines with protein and copper to make hemoglobin, a pigment that colors
the blood red and which carries oxygen through the bloodstream from the lungs to
all bodily tissue. Also forms myoglobin, which transports oxygen in muscle tissue for
use in fueling contractions. Deficiency is common in athletes. Without enough iron,
you cannot train. Iron is easily lost through sweat, urine, feces and menstrual flow.
Runners in particular are suspected of inefficient absorption of dietary iron. RDA:
10 mg. (men), 18 mg. (women). Dietary sources: liver, oysters, lean meat, leafy green
vegetables, whole grains, dried fruits, legumes.
240
Kinesiology: The science or study of movement, and the active and passive structures involved, also referred to as biomechanics.
Kinesthesis: The ability to perceive the position or movement of body parts and the
amount of force exerted by the muscles.
Knee Wraps: Elastic strips used to wrap knees for better support when performing
squats and dead lifts.
Krebs Cycle (citric acid cycle): Refers to a complicated series of 8 reactions, arranged
in a cycle, by which fragments from any of the energy nutrients (proteins, carbohydrates, and fats) are completely broken down to carbon dioxide and water, releasing
energy for the formation of adenosine triphosphate (ATP). It is the final common
pathway for all nutrient metabolites involved in energy production, and provides
more than 90% of the body’s energy. This is the oxidative portion of energy production where short carbon chains from the breakdown of glucose, fatty acids, and protein are broken down and the energy is used to form more ATP. Oxygen is involved
in this phase of metabolism where hydrogen atoms combine with oxygen to form
water. This process takes place in the mitochondria.
Appendix
GLOSSARY
L
Lactate: Lactic acid is an acid with the chemical formula C3H6O3. Lactate is any salt
of lactic acid. When lactic acid releases H+ the remaining compound joins with Na+
or K+ to form salt. Anaerobic glycolysis produces lactic acid but it quickly dissociates and the salt-lactate is formed. For this reason the terms are used interchangeably.
Lactic Acid: A by-product of glucose and glycogen metabolism in anaerobic muscle
energetics. A minute accumulation causes muscular fatigue and pain, and retards
contraction. Lactic acid is carried by the blood to the liver, where it is reconverted to
glucose and returned as blood glucose to the muscles. It is this elevation of blood
lactic acid in sustained strenuous exercise, such as in marathon running, which
results in muscle fatigue and pain. Recovery follows when enough oxygen gets to the
muscle, part of the lactic acid being oxidized and most of it then being built up once
more into glycogen. The metabolic cooperation between contracting skeletal muscle
and the liver to support active muscle work is called the Cori cycle.
Lactose: A disaccharide of milk which on hydrolysis yields glucose and galactose.
Bacteria can convert it into lactic acid and butyric acid, as in the souring of milk. It
is used in infant feeding formulas, in other foods and as an osmotic laxative and
diuretic. Lactose is not tolerated in many persons after weaning, owing to a reduced
lactase activity.
Laterality: The awareness of the sides of the body – right, left, front, back, side, top,
bottom.
Lats: Short for latissimus dorsi, the large muscles of the back that are the prime
movers for adduction, extension and hyperextension of the shoulder joints.
Law of Gaseous Diffusion: Principle that states that a gas will move across a semipermeable membrane (alveolar, capillary, etc.) from an area of high concentration to
an area of lower concentration.
L-carnitine: Neither an amino acid nor a vitamin, L-carnitine is a derivative of
hydroxybutyric acid. It is naturally obtained from red meat, and helps release stored
bodyfat (triglycerides) into the bloodstream for use in cellular energy processing. Its
physiological role is to transport long-chain fatty acids into the mitochondria for
energy production. This is believed to improve one’s fat metabolism (lower body fat
level) as well as long-term energy level. Research has also shown L-carnitine to have
a value in treating certain cardiovascular disorders, including hardening of the
arteries.
L-glutamine: An amino acid that reduces the effects of cortisol, which results in less
tissue breakdown–anti-catabolic action.
Lean Body Mass: All of you, except your fat. Includes bone, brain, organs, skin, nails,
muscle, all bodily tissues. Approximately 50-60% of lean body mass is water.
Lean Body Weight: The weight of the body, less the weight of its fat.
Left Ventricle Ejection Fraction: The percentage of blood inside the left ventricle
pushed out into the body after contraction.
Leukocyte: Cell whose primary function is to combat infections.
Lever: A rigid object (bone), hinged at one point (joint) to which forces (via muscle
contraction or resistance) are applied at two other points. A lever transmits and
modifies force or motion, and has three parts: 1) a fulcrum, 2) a force arm and 3) a
resistance arm. There are three classes of levers, depending on the location of the
three parts relative to each other.
Ligament: The fibrous, connective tissue that connects bone to bone, or bone to cartilage, to hold together and support joints. See also tendon.
Linolenic Acid: An essential fatty acid found in vegetables, peanut oil, and other
plants. A linolenic acid deficiency will result in hair loss, poor wound healing, and
scaly dermatitis. Linolenic acid is used in the manufacture of paints, coatings, and
vitamins. Linolenic acid is also used therapeutically as some vitamins.
Lipid: A number of body substances that are fat or fat-like.
Lipogenesis: The formation of fat.
Lipoprotein: Combination of a lipid and protein. Cholesterol is transported in the
blood plasma by lipoproteins. See also high-density lipoprotein, low-density
lipoprotein.
Longitudinal Study: A study which observes the same subjects over a period of time.
See also cross-sectional study.
Lordosis: The forward curving of the spine at the neck (cervical spine) and lower
back (lumbar spine). Often used to refer to an abnormally increased curvature of the
lumbar spine.
Low Blood Sugar: Also known as hypoglycemia, a low blood glucose level. See also
hypoglycemia.
Low-Density Lipoprotein (LDL): A lipoprotein carrying a high level of cholesterol,
moderate levels of protein and low levels of triglycerides. Associated with the
building of other sclerotic deposits in the arteries. See also lipoprotein, high-density
lipoprotein.
Lower Abs: Slang for abdominal muscles below the navel. Conventional training
wisdom holds that one can “isolate” the lower from the upper abs through leg raises
or reverse crunches. In reality, when the abdominals contract, the contractile force is
generated throughout the entire abdominal wall.
Lumbar: Pertaining to the lower back, defined by the five lumbar vertebrae, just
above the sacrum.
Lymphatic system: Subsystem of the circulatory system, which protects the body
against disease.
M
Macronutrients: A category of nutrients—including carbohydrates, proteins, and
fats—that are present in foods in large amounts.
Magnesium: A pivotal mineral important to protein synthesis, energy production,
muscle contractions and a strong heart muscle. Essential for metabolism of calcium,
phosphorus, sodium, potassium and vitamin C. Chronic muscle cramps is a typical
sign of a shortage. RDA: 350 mg. (men), 300 mg. (women). Dietary sources: figs,
lemons, grapefruit, yellow corn, almonds, nuts, seeds, dark green vegetables.
Maintenance Load: The intensity, duration and frequency of exercise required to
maintain an individual’s present level of fitness.
Manganese: A key enzyme activator. Also vital to the formation of thyroid and
reproductive hormones, normal skeletal development, muscle reflexes, and the
proper digestion and utilization of food. No RDA. Dietary sources: whole grains, egg
yolks, nuts, seeds and green vegetables.
Maria Thistle: The active compound in Maria Thistle is silymarin. It is known to be
1) a potent hepatoprotector and antihepatotoxic agent (thereby restoring normal
metabolic function to the liver), 2) promotes cellular regeneration via increased protein synthesis, 3) aids in protecting the kidneys, and 4) acts as a powerful antioxidant
principally through its sparing effects on glutathione (which also probably accounts
for its potency in improving liver function).
Limit Strength: Absolute strength enhanced by hypnosis, electrotherapy, ergogenic
substances of any form (including nutritional supplements or drugs) or other techniques. Such aids increase the potential for strength above normal capacity. Absolute
strength is reached solely through training.
Max: Maximum effort for one repetition of a weight training exercise. Also expressed
as one’s “1-RM” or “one rep max.” See also maximal oxygen uptake.
Linoleic Acid: An unsaturated fatty acid which brings oxygen to all cells, tissues and
organs through the blood. It maintains the resilience and lubrication of all cells, and
combines with protien and cholesterol to form living membranes which hold the
body cells together. It also helps regulate the rate of blood coagulation, and breaks
up cholesterol deposited on arterial wall. Linoleic acid cannot be synthesized in
many species and therefore must be provided in the diet.
Maximal Heart Rate: The highest heart rate of which an individual is capable. A
broad rule of thumb for estimating maximal heart rate is 220 (beats per minute)
minus the person’s age (in years). See also graded exercise test.
Max V02 Uptake: The maximum usable portion of oxygen uptake.
Maximum Minute Volume: The amount of air that a person can process during one
minute of vigorous exercise.
241
Appendix
GLOSSARY
Maximal Oxygen Uptake: The highest rate of oxygen consumption of which a
person is capable. Usually expressed in milliliters of oxygen per kilogram of body
weight per minute. Also called maximal aerobic power, maximal oxygen consumption, maximal oxygen intake. See also VO2 max.
Motor Unit: The basic unit of movement: a motor nerve fiber and all of the muscle
fibers it supplies. In the quadriceps muscle, one neuron can activate as many as 1,000
fibers. In the eye, where great precision is required, one nerve cell may control only
3 fibers.
Maximal Tests: An exercise test to exhaustion or to levels of oxygen uptake or heart
rate that cannot increase further with additional work loads. See also graded exercise
test.
Motor Unit Recruitment: One of the factors affecting strength. Refers to your ability
to get maximum stimulation through the nervous system to trigger the maximum
amount of contractile force through maximum motor unit recruitment. This can be
built up over time through heavy resistance and explosive strength training.
Maximum Life Span: The maximum life span is basically the record survival length
for a species. For humans it is currently believed to be about 120. It has recently been
proposed to be about 130 years.
Medical History: A list of a person’s previous illnesses, present conditions, symptoms, medications and health risk factors. Used to prescribe appropriate exercise
programs. Persons whose responses indicate they may be in a high-risk category
should be referred for medical evaluation before beginning an exercise program.
Medical Referral: Recommending that persons see a qualified medical professional
to review their health status and determine whether medical treatment is needed or
whether a particular course of exercise and/or diet change is safe.
Mesomorph: A person whose physique features powerful musculature.
Met: A measure of energy output equal to the resting metabolic rate of a resting subject. Assumed to be equal to an oxygen uptake of 3.5 milliliters per kilogram of body
weight per minute, or a caloric expenditure of 50 Kcalories per square meter of body
surface per hour. Hard exercise, for example, requires up to eight METs of energy
expenditure, which equals eight times the resting energy requirement.
Metabolic set point: The base rate of metabolism that your body seeks to maintain;
results in your basal metabolic rate.
Metabolism: The total of all the chemical and physical processes by which the body
builds and maintains itself (anabolism) and by which it breaks down its substances
for the production of energy (catabolism).
Metabolite: Any substance which forms as a by-product of the catabolism, growth,
or anabolism of living tissue.
Midline: A longitudinal (imaginary) line that travels down the center of the body.
Military Press: Pressing a barbell from upper chest upward in standing or sitting
position.
Minerals: There are 96 times more minerals in the body than vitamins. As vitamins,
they are necessary for life itself and combine with other basic components of food to
form enzymes. Minerals are ingested through food and water. Many minerals are
deficient in the diet because of mineral-poor agricultural soil, the result of intensive
farming and long-term use of chemical fertilizers and pesticides.
Minimum Daily Requirement (MDR): The minimum amounts of protein, vitamins
and minerals considered necessary to maintain health. See also recommended daily
allowance, optimal daily allowance.
Mitochondria: The rod-shape organelles found in the cytoplasm of cells. They are
the source of energy in the cell and are involved in protein synthesis and lipid metabolism.
Moment Arm: The perpendicular distance from the line of pull of a muscle to the
axis of rotation.
Muscle: Tissue consisting of fibers organized into bands or bundles that contract to
perform bodily movement.
Muscle Fiber: Synonymous with muscle cell. See also fiber.
Muscle Fiber Arrangement: Long fibers are created for large movements and speed
rather than strength. Short fibers are designed for strength with a lesser movement
capability. Knowledge of fiber arrangement can help you train muscle groups in a
scientific manner.
Muscle Group: Specific muscles that act together at the same joint to produce a
movement.
Muscle Pull (strain): Major or minor damage to muscles from excessive stretching
or use. The key to avoiding muscle pulls is proper conditioning and strict adherence
to a thorough program of warm-up and cool-down.
Muscle Spasm: Sudden, involuntary contraction of muscle or muscle group.
Muscle Spindle: The “computer” of muscle tissue, a modified fiber which responds
reflexively to mental impulses and muscle movement such as stretching. Measures
and delivers the quantity of muscle force needed to perform a given action. Rapid
stretching of the muscle, for example, results in messages being sent to the nervous
system to contract the muscle, thereby limiting the stretch. See also Golgi tendon
organ, proprioceptor.
Muscle Substitution: The employment of a different muscle or muscle group to
replace a muscle that can no longer be used.
Muscular System: System consisting of large skeletal muscles that allow us to move,
cardiac muscle in the heart, and smooth muscle of the internal organs.
Muscle Tone: The degree of tension and vigor in a gross muscle. Muscle tone is
increased through weight training, which results in a greater number of muscle fiber
“firing” while at rest.
Musculoskeletal System: Body system that consists of the bones, joints, connective
tissue, and muscles.
Musculotendinous: Of, relating to, or affecting muscular and tendinous tissue.
Myocardial Infarction: A common form of heart attack, in which the blockage of a
coronary artery causes the death of a part of the heart muscle. See also infarction.
Myofibril: The functional units within muscle fibers that cause contractions. The
more you have, the greater your strength. Myofibrillarization: increasing myofibrils:
is achieved with the use of heavy weight training.
Myofilaments: The elements of a muscle cell which comprise myofibrils that actually shorten (thereby providing contractile force) by sliding across one another via
action of “cross bridges.” They are comprised of the proteins actin and myosin.
Moment Of Force: Degree to which force tends to rotate an object about a specified
fulcrum. It is defined quantitatively as the magnitude of a force times the length of
its arm.
Myoglobin: An iron-containing protein responsible for oxygen transport and
storage in muscle tissue, similar to hemoglobin in blood.
Monoplegia: Paralysis of one extremity only.
Myosin: The most abundant protein (68%) in muscle fiber. It is the main constituent
of the thick contractile filaments which overlap with the thin actin filaments in the
biochemical sequence that produces contractions.
Monounsaturated Fat: Dietary fat whose molecules have one double bond open to
receive more hydrogen. Found in many nuts, olive oil, and avocados. See also
polyunsaturated fat, saturated fat, unsaturated fat.
Motor Neuron: A nerve cell which conducts impulses from the central nervous
system to a group of muscle fibers to produce movement.
242
Myoneural Junction: The connection of a neuron to a muscle fiber.
Myositis: Inflammation of a skeletal muscle.
Myositis Ossificans: The deposit of bony materials in the muscle. Bruises from contact sports may result in this condition. Severe bruises should be iced, and evaluated
by a physician.
Appendix
GLOSSARY
N
O
Nautilus: Variable resistance-type exercise machine which attempts to match the
amount of resistance with the user’s force output. Arthur Jones, developer of Nautilus equipment in the 1970s is considered one of the true pioneers of fitness technology.
Obesity: Excessive accumulation of body fat.
Negative Reps: An eccentric contraction. One or two partners assist in lifting a
weight up to 20: 40% heavier than an individual could normally lift. Once hoisted to
the extended position, the weight is slowly lowered without help. This type of exercise is extremely damaging to connective tissue, and (according to the “cataclysmic”
theory of overtraining) is the elemental factor in overtraining and cumulative
microtrauma.
Octacosanol: The active, energy-boosting component of wheat germ oil which is
known to improve endurance, reaction time, and muscle glycogen storage. Taken as
a supplement.
Nerve Impulse: A brief reversal of the membrane potential that sweeps along the
membrane of a neuron.
Olympic Set: High-quality, precision-made set of weights used for competition. The
bar is approximately 7’ long. All moving parts have either brass bushings or bearings.
Plates are machined for accurate weight.
Nervous system: System comprised of brain, spinal cord, sense organs and nerves.
Regulates other systems.
Neutralizer: When a muscle contracts to counteract an undesirable action of
another muscle.
Neuromuscular Reeducation (NMR): Therapy involving deep rolfing massage and
neurological stimulation to eliminate painful strength- and movement-limiting
adhesions and scar tissue in muscles caused by trauma. Developed by Drs. Gary
Glum and Joseph Horrigan, Los Angeles chiropractors specializing in soft-tissue
injuries in sports.
Neurotransmitter: A biochemical that spans the gaps between nerve cells, transmitting an electrical impulse.
Nicotine: An alkaloid found in the tobacco plant. Nicotine first stimulates the central nervous system, then depresses it. It is absorbed easily through the mucous
membranes and the skin, and is highly toxic; symptoms include nausea, vomiting,
twitching, and convulsions. Nicotine is used as an agricultural insecticide.
Nitrogen Balance: An estimate of the difference between nitrogen intake and output
in the body to measure protein sufficiency. Derived by subtracting amount of urea
nitrogen in a urine sample from an individual’s total protein intake. If urea value is
larger than protein intake, the nitrogen balance is negative, indicating that not
enough protein was eaten to meet the body’s nutritional needs. In this situation,
muscle protein is sacrificed to provide additional protein to fund metabolic
processes. Prolonged negative balance results in muscle wasting. Positive nitrogen
balance is achieved by ingesting complete protein to meet the body’s metabolic
needs. Nonresistance Training: Training without weights in which you pit muscle
strength against body weight to develop general and aerobic fitness. Includes mild
running, calisthenics, jumping, skipping, swimming, and bicycling.
Nordihydroguaiaretic Acid (NDGA): The primary active constituent of the chaparral bush, which grows in southwestern USA (to over 1000 years old!). It is widely
known in the scientific community as a powerful antioxidant, and has the official
designation as a “lipoxygenase inhibitor.” Both research and folklore classify NDGA
as effective in 1) cellular respiration, 2) analgesic activity, 3) anti-inflammatory
activity, and 4) vasodepressant activity. These functions make NDGA a potent antiageing substance.
Nutriceutical: Actually nothing more than a cross between the two words, “nutritional” and “pharmaceutical,” a nutriceutical is any nutritional supplement designed
for any specific clinical purpose(s). Thus, engineered foods such as Ensure, Enfamil,
Nutriment, Met-Rx and IGF-33 are regarded as nutriceuticals. Due to FDA and FTC
regulations, clinical or medical claims cannot be made for them. Thus, all are functionally (legally) on the market as foods for general consumption (or “health foods”)
to be used as “supplements” to nutrition (diet). Medical doctors frequently utilize
these and other nutritional supplements in myriad clinical settings. See also supplements, nutrition.
Nutrients: Food and its specific elements and compounds that can be used by the
body to build and maintain itself and to produce energy. Conventionally, this word
refers to the macronutrients (water, protein, fats, carbohydrates) and the micronutrients (vitamins, minerals and trace elements) that are essential for energy and
growth. On a legal (FDA) level, it specifically excludes substances for which claims
are made (legitimately or illegitimately) for amelioration, cure or prevention of any
disease entity or other clinical functions beyond growth and energy.
Nutrition: The programmatic use of nutrients.
Obliques: Short for external and/or internal obliques, the muscles to either side of
abdominals that rotate and flex the trunk.
Olympic Lifts: The two weightlifting movements used in Olympic competitions: the
snatch, and the clean and jerk. The military press was eliminated as a contested lift
after the 1972 Olympics. See also weightlifting.
One Repetition Maximum, 1 RM: The maximum resistance with which a person
can execute one repetition of an exercise movement. See also repetition.
Optimal Daily Allowances (ODA): Applied to active people such as athletes and fitness enthusiasts whose nutritional requirement are beyond those of the normal
(sedentary) people upon whom the FDA’s old RDA scale was devises.
Origin: The attachment of a muscle to the less moveable or proximal (closer to the
center of the body) structure.
Ornithine: Produced in the urea cycle by splitting off the urea from arginine and is
itself converted into citrulline. On decomposition it gives rise to putrescine. It has
been demonstrated to be of value as a growth hormone stimulator when administered intravenously; there is no solid evidence that it stimulates growth hormone to
a significant degree (enough to stimulate muscle growth) when taken orally.
Ornithine Alphaketoglutarate (OKG): Clinically shown to: (1.) decrease muscle
protein catabolism (2.) improve nitrogen retention in muscle tissue (3.) augment
muscle tissue polyamine (PA) response (4.) mediate an insulin increase (5.) improve
both protein synthesis and wound healing in muscles (6.) promote anabolic (muscle
building) processes. It is successfully used in treating burn patients as well as traumatized, surgical and malnourished individuals.
Osmolarity: The concentration of a solution participating in osmosis (e.g., a sugarwater solution of high osmolarity is concentrated enough to draw water through the
membranes of the digestive tract to dilute the sugar.) See also hypertonic, hypotonic.
Osmosis: The movement of fluid through a membrane, tending to equalize the concentrations of the solutions on both sides. See also osmolarity.
Ossification: The formation of bone. The turning of cartilage into bone (as in the
joints). See also myositis ossificans, osteoarthritis.
Osteoarthritis: A noninflammatory joint disease of older persons. The cartilage in
the joint wears down, and there is bone growth at the edges of the joints. Results in
pain and stiffness, especially after prolonged exercise. See also arthritis.
Overload: Subjecting a part of the body to efforts greater than it is accustomed to,
in order to elicit a training response. Increases may be in intensity or duration.
Overload Principle: Applying a greater load than normal to a muscle to increase its
capability.
Overtraining: Excessive training, principally of the eccentric contraction phase of
lifting weights or running. Can cause injuries, loss of body weight, insomnia, depression, chronic muscle soreness and retard workout recovery.
Overuse: Excessive repeated exertion or shock which results in injuries such as stress
fractures of bones or inflammation of muscles and tendons.
Overuse Syndrome: Injury resulting from overtraining.
Oxidation: The chemical act of combining with oxygen or of removing hydrogen.
Oxidative Pathway: Oxygen combines with lactic acid resynthesizing glycogen to
produce energy aerobically.
Oxidative Sports: Sports such as long distance running or cycling wherein oxygen
must be present to allow movement to continue (see ATP/CP Sports and Glycolytic
Sports).
243
Appendix
GLOSSARY
Oxygen (O2): The essential element in the respiration process to sustain life. The colorless, odorless gas makes up about 20 percent of the air, by weight at sea level.
Phosphorus: Works with calcium to build up bones and teeth. Provides a key element in the production of ATP. RDA: 800 mg. Dietary sources: animal protein, whole
grains.
Oxygen Consumption: See oxygen uptake.
Oxygen Debt: The oxygen consumed in recovery from exercise above the amount
that would normally be consumed at rest. In intense endurance activities, oxygen
debt refers to the amount of oxygen that is “owed” to the system to oxidize lactic acid
buildup. One’s tolerance for an accumulated debt is generally proportional to the
level of fitness.
Oxygen Deficit: The energy supplied anaerobically while oxygen uptake has not yet
reached the steady state which matches energy output. Becomes oxygen debt at end
of exercise.
Oxygen Uptake: The amount of oxygen intake used up at the cellular level during
exercise. Can be measured by determining the amount of oxygen exhaled as compared to the amount inhaled, or estimated by indirect means.
P
Paralysis: Lack of innervatio to muscle , resulting in loss of voluntary motion.
Paraplegia: Paralysis of the lower extermities only.
Physical Conditioning: A program of regular, sustained exercise to increase or
maintain levels of strength, flexibility, aerobic capacity, and body composition consistent with health, fitness or (especially) athletic objectives.
Physical Fitness: The physiological contribution to wellness through exercise and
nutrition behaviors that maintain high aerobic capacity, balanced body composition, and adequate strength and flexibility to minimize risk of chronic health problems and to enhance the enjoyment of life.
Physical Work Capacity (PWC): An exercise test that measures the amount of work
done at a given, submaximal heart rate. The work is measured in oxygen uptake,
kilopond meters per minute, or other units, and can be used to estimate maximal
heart rate and oxygen uptake. Less accurate, but safer and less expensive than the
graded exercise test.
Physiology: The science concerned with the normal vital processes of animal and
vegetable organisms.
Plantarflexion: Extension of the ankle, pointing of the foot and toes.
Plasma: The fluid portion of blood.
Paresis: Muscular weakness.
Platelet: Cytoplasmic body found in the blood plasma that functions to promote
blood clotting.
Parcourse Training: A concept borrowed from outdoor parks and applied to the
gym during sports-specific phase of foundation training for aerobic athletes.
Involves the performance of aerobic activities: jogging, skipping rope, straddle
jumping, bicycle ergometer: between exercises of a weight training routine.
Plyometric: A type of exercise that suddenly preloads and forces the stretching of a
muscle an instant prior to its concentric action. An example is jumping down from
a bench and immediately springing back up.
Partial Reps: Performing an exercise without going through a complete range of
motion. Exercise mythology has it that one must exercise a muscle through a full
range of motion of the joint upon which the muscle acts in order not to become
“muscle bound” and to derive maximum strength and growth. In reality, partial
movements often provide better overload because more weight can be moved.
Peak Contraction: Exercising a muscle until it cramps by using shortened movements.
Peak Heart Rate: The highest heart rate reached during a work session.
Pecs: Slang for pectoral muscles of the chest.
Peptide: Any member of a class of compounds of low molecular weight which yield
two or more amino acids on hydrolysis. Formed by loss of water from the NH2 and
COOH groups of adjacent amino acids, they are known as di-, tri-, tetra- (etc.) peptides, depending on the number of amino acids in the molecule. Peptides (“polypeptides”) form the constituent parts of proteins.
Peridoxine Alphaketoglutarate (PAK): Vitamin B6 (peridoxine) is ionically combined with the complexing agent, alphaketoglutarate to form a high energy compound. It is widely used as a nutritional supplement by athletes wishing to improve
energy output.
Periodization: “Periodized training” is a phrase which refers to how one’s training is
broken down into discreet time periods called “macrocycles, mesocycles and microcycles.”
Peripheral Heart Action (PHA): Developed in the early 60s by Chuck Coker
(inventor of the “Universal” multi-station exercise machines), PHA training is an
excellent all-around system of weight training whereby muscles are exercised in an
alternating sequence of upper and lower body. This method keeps blood circulating
constantly throughout the body, prevents undue fatigue in any given muscle, facilitates recovery and provides a holistic muscular development. It is mildly cardiovascular.
Peripheral Nervous System: Relays messages from the CNS to the body (the efferent
system), and relays messages to the CNS (the afferent system) from the body.
Perseveration: Inability to stop responding to a stimulus of a device.
pH: A measure of acidity, relating to the hydrogen ion (H+) concentration. A pH of
7.0 is neutral; acidity increases with lower numbers, and alkalinity increases with
higher numbers. Body fluids have a pH of about 7.3.
244
Polyunsaturated Fat: Dietary fat whose molecules have more than one double bond
open to receive more hydrogen. Found in safflower oil, corn oil, soybeans, sesame
seeds, sunflower seeds. See also monounsaturated fat, saturated fat, unsaturated fat.
Post-Exercise Muscle Soreness: Microtrauma to connective tissue releases an amino
acid called hydroxyproline which, within 48 hours, causes irritation to local nerve
endings, triggering pain. Typically occurs from exertion or concentrated movement
after a long period of disuse but even affects the most physically fit athletes after
excessively stressful exercise.
Potassium: Teams with sodium to regulate body’s water balance and heart rhythms.
Nerve and muscle function are disturbed when the two minerals are not balanced.
Insufficient potassium can lead to fatigue, cramping and muscle damage. Physical
and mental stress, excessive sweating, alcohol, coffee, and a high intake of salt
(sodium) and sugar deplete potassium. No RDA. Dietary sources: citrus, cantaloupe,
green leafy vegetables, bananas.
Power: Work performed per unit of time. Measured by the formula: work equals
force times distance divided by time. A combination of strength and speed. See also
strength.
Power Training: System of weight training using low repetitions and explosive
movements with heavy weights.
Powerlifts: Three lifts contested in the sport of powerlifting: the squat, bench press
and deadlift. Powerlifting was first organized in the USA in the early 60s from the
“odd lifts” competitions which used to be part of almost all bodybuilding and
weightlifting competitions. Of the over 40 odd lifts contested, these three lifts were
chosen as being the most representative test of total body limit strength.
Preload: The stretching of a muscle prior to contracting it, thereby providing both a
“stretch reflex” and a viscoelastic component, adding to the total force output.
Primary Risk Factor: A risk factor that is strong enough to operate independently,
without the presence of other risk factors. See also risk factor, secondary risk factor.
Prime Mover: The muscle or muscle group that is involved in a concentric contraction. See also agonist.
Progressive Resistance Exercise: Exercise in which the amount of resistance is
increased to further stress the muscle after it has become accustomed to handling a
lesser resistance.
Appendix
GLOSSARY
Pronation: Assuming a facedown position. Of the hand, turning the palm backward
or downward. Of the foot, lowering the inner (medial) side of the foot so as to flatten
the arch. The opposite of supination.
Prone: Lying in a face-down position.
Proprioception: Sensory feedback concerning movement and position of the body,
occurring chiefly in the muscles (spindles), tendons (Golgi tendon organs), and joint
receptors.
Proprioceptive Neuromuscular Facilitation (PNF) Stretch: Muscle stretches that
use the proprioceptors (muscle spindles) to send inhibiting (relaxing) messages to
the muscle that is to be stretched. Example: The contraction of an agonist muscle
sends inhibiting signals that relax the antagonist muscle so that it is easier to stretch.
(Term was once applied to a very specific therapeutic technique, but now is being
widely applied to stretch techniques such as slow-reversal-hold, contract-relax, and
hold-relax.)
Proprioceptor: Self-sensors (nerve terminals) that give messages to the nervous
system about movements and position of the body. Proprioceptors include muscle
spindles and Golgi tendon organs.
Protease: A category of enzymes which attack specific bonds between amino acids
and proteins. The proteases break amino acid bonds to split up the protein molecule
into smaller pieces of lined amino acids. Examples of proteases are renin and pepsin;
these enzymes can be found in animals. Rennin is used in the thickening of milk and
is isolated from the stomach of the calf; pepsin is found in the gastric juices of
humans and other animals where it breaks down proteins at specific places.
Protein: One of the three basic foodstuffs: along with carbohydrates and fat. Proteins
are complex substances present in all living organisms. It comprises 90 percent of the
dry weight of blood, 80 percent of muscles, and 70 percent of the skin. Protein provides the connective and structural building blocks of tissue and primary constituents of enzymes, hormones and antibodies. The components of protein are
amino acids. Dietary protein is derived from both animal and plant foods. Protein is
essential for growth, the building of new tissue, and the repair of injured or brokendown tissue. They serve as enzymes, structural elements, hormones, immunoglobulins, etc. and are involved in oxygen transport and other activities throughout the
body, and in photosynthesis. Protein can be oxidized in the body, liberating heat and
energy at the rate of four calories per gram. See also amino acids, essential amino
acids.
Protein Efficiency Ratio (PER): A system of rating the quality of dietary protein by
the number and proportions of the essential amino acids contained in it. Eggs rank
highest. They contain all eight essential amino acids in a proportion regarded as the
most readily assimilable and usable combination of naturally-occurring amino
acids. Eggs are the standard by which all other protein sources are rated for assimilability.
Psychomotor: Pertaining to movement(both fine and gross)
Pulmonary: Pertaining to the lungs.
Pulmonary (ventilatory) Capacity: The efficiency of gas exchange in the lungs.
Q
Quadriceps: A muscle group at the front of the thigh connected to a common
tendon that surrounds the knee cap and attaches to the tibia (lower leg bone). The
individual muscles are the rectus femoris, vastus intermedius, vastus lateralis, and
vastus medialis. Acts to extend the lower leg.
Quadriplegia: Paralysis affecting all four limbs.
Quads: Slang for quadriceps.
Quality Training: Training prior to bodybuilding competition where intervals
between sets are reduced to enhance muscle mass and density, and low-calorie diet
is followed to reduce bodyfat.
R
Radial Pulse: The pulse at the wrist.
Rating of Perceived Exertion: A means to quantify the subjective feeling of the
intensity of an exercise. Borg scales, charts which describe a range of intensity from
resting to maximal energy outputs, are used as a visual aid to exercisers in keeping
their efforts in the effective training zone.
RDA (Recommended Daily Dietary Allowances): Estimates established by the
National Research Council of the National Academy of Sciences for nutritional
needs necessary for prevention of nutrient depletion in healthy people. Does not
take into account altered requirements due to sickness, injury, physical or mental
stress, use of medications or drugs, nor compensate for the nutrient losses that occur
during processing and preparation of food. RDA standards do not apply to athletes,
who have extraordinary nutrient needs. While they were designed to meet the needs
of a majority of people, RDAs are nonetheless far too low for serious athletes and
even for fitness enthusiasts who exercise regularly. (See ODA: Optimal Daily
Allowances)
Reciprocal Innervation: A phenomenon in which the opposing muscle group is
stimulated to relax while the prime mover muscle(s) is simultaneously stimulated to
contract, thereby allowing movement to occur.
Recruitment: Activation of motor units; the greater the resistance encountered, the
greater will be the Rectus recruitment necessary to overcome its inertia.
Rectus Femoris: The long, straight muscle in the front of the thigh which attaches
to the knee cap. Part of the quadriceps muscle group.
Recuperation: A physiological process involving full body and muscle recovery and
subsequent muscle growth during a rest period between training sessions.
Rehabilitation: A program to restore physical and psychological independence to
persons disabled by illness or injury in the shortest period of time.
Renal: Pertaining to the kidney.
Rep Out: Repeat the same exercise movement until you are unable to continue.
Pumped: Slang term to describe the tightness in a muscle made large through exercise. The pumped sensation results from blood engorgement and lactic acid accumulation in the exercised muscle.
Repetition: An individual completed exercise movement. Repetitions are usually
done in multiples. See also one repetition maximum, set.
Pumping Iron: Slang for lifting weights, a phrase used since the 1950s.
Reproductive System: System consisting of gonads, associated ducts, and external
genitals concerned with sexual reproduction.
Pyramid Training: A training protocol incorporating an upward- then-downward
progression in weight, rep-per-rep or set-per-set.
Pyruvate: A byproduct of glycolysis. See also Pyruvic Acid.
Pyruvic Acid: The end product of the glycolytic pathway. This three-carbon metabolite is an important junction point for two reasons: it is the gateway to the final
common energy-producing pathway, the Krebs cycle; and it provides acetyl coenzyme A (acetyl CoA), through which fatty acids, and in turn fat, are produced from
glucose. Pyruvic acid converts to lactic acid as needed. Pyruvic acid increases in
quantity in the blood and tissues in thiamine (vitamin B-1) deficiency. Thiamine is
essential for its oxidation.
Residual Volume: The volume of air remaining in the lungs after a maximum expiration. Must be calculated in the formula for determining body composition
through underwater weighing.
Resistance: The amount of weight used in each set of an exercise, or the force which
a muscle is required to work against.
Respiration: Exchange of oxygen and carbon dioxide between the atmosphere and
the cells of the body. Includes ventilation (breathing), exchange of gasses to and from
the blood in the lungs, transportation of the gasses in the blood, the taking in and
utilizing of oxygen, and the elimination of waste products by the cells. See also expiration, inspiration, ventilation.
245
Appendix
GLOSSARY
Respiratory Quotient (RQ): A method of determining the “fuel mix” being used
giving us a way to measure the relative amounts of fats, carbohydrates, and proteins
being burned for energy.
Respiratory System: System consisting of the lungs and air passageways, which supplies oxygen to the body and removes carbon dioxide.
Response: An immediate, short-term change in physiological functions (such as
heart-rate or respiration) brought on by exercise. See also adaptation.
Resting Heart Rate: The number of times the heart beats in one minute: 72 beats per
minute fo the average adult.
Seziure: Abnormal electrical output of the brain.
Shin Splints: Pain in the front of the lower leg from inflammation of muscle and
tendon tissue caused by overuse. See also overuse.
Siberian Ginseng (eleutherococcus senticosus): A cousin of traditional Oriental
ginsengs widely used among Russian athletes for boosting stamina and endurance,
speeding workout recovery, and as a health tonic to normalize systemic functions
and counter stress. An adaptogenic substance that enables athletes over time to adapt
to increased training intensity.
Retest: A repetition of a given test after passage of time, usually to assess the progress
made in an exercise program.
Simple Carbohydrates: Monosaccharides and disaccharides occurring naturally in
fruits, vegetables, and dairy products. Some examples of simple carbohydrates are
glucose, galactose, and fructose, all of which are monosaccharides, and sucrose, lactose, and maltose, all of which are disaccharides. Most simple carbohydrates elevate
blood sugar levels rapidly, providing “instant energy” which is quickly utilized and
dissipated. Fructose is an exception. Additionally, refined sources of simple carbohydrates, such as candy, contribute only calories to the diet. These “empty calories” are
often consumed in place of foods which would provide important nutrients in addition to the energy.
Ripped: Slang meaning extremely visible muscularity resulting from both hypertrophy and subcutaneous fat removal.
Size Principle of Fiber Recruitment: Principle stating that fibers with a high level of
reliability are recruited first; those with lower levels of reliability are recruited last.
Risk Factor: A behavior, characteristic, symptom, or sign that is associated with an
increased risk of developing a health problem. Example: Smoking is a risk factor for
lung cancer and coronary heart disease. See also primary risk factor, secondary risk
factor.
Skeletal Muscle: Muscle that attaches to the skeletal system and causes body movement by a shortening or pulling action against its bony attachment.
Rest Interval: Pause between sets of an exercise which allows muscles to recover partially before beginning next set.
Rest Pause Training: Training method where you press out one difficult repetition,
replace bar in stand, then perform another rep after a 10-20 second rest, etc.
RM: Acronym for “repetitions maximum.” Thus, for example, 5RM stands for the
maximum amount of weight you can perform for five repetitions.
Roids: Slang for anabolic steroid.
Rotation: Turning or movement of a body round its axis.
Rotator Cuff: A band of 4 muscles that hold the arm in the shoulder joint.
S
Sagittal (Anteroposterior) Plane: Separates the body into right and left sections.
Sarcoplasm: Jelly-like intracellular fluid found in the muscle fiber.
Sartorius: The longest muscle in the body, involved in the movement of the thigh at
the hip joint.
Saturated Fat: Dietary fat from primarily animal sources. Excessive consumption is
the major dietary contributor to total blood cholesterol levels and is linked to
increased risk for coronary heart disease.
Saturated Fatty Acid: An acid which, by definition, has no available bonds in its
hydrocarbon chain; all bonds are filled or saturated with hydrogen atoms. Thus the
chain of a saturated fatty acid contains no double bond. The saturated fatty acids are
more slowly metabolized by the body than are the unsaturated fatty acids. Saturated
fatty acids include acetic acid, myristic acid, palmitic acid, and steric acid. These
acids come primarily from animal sources, with the exception of coconut oil, and are
usually solid at room temperature. In the case of vegetable shortening and margarine, oil products have undergone a process called “hydrogenation,” in which the
unsaturated oils are converted to a more solid form. Other principal sources of saturated fats are milk products and eggs.
Screening: Comparing individuals to set criteria for inclusion in a fitness program,
or for referral to medical evaluation.
Secondary Risk Factor: A risk factor that acts when certain other risk factors are
present. See also primary risk factor, risk factor.
Sedentary: Sitting a lot; not involved in any physical activity that might produce significant fitness benefits.
Selenium: A major nutrient antioxidant along with vitamins A, C and E. No RDA.
Dietary sources: wheat germ, bran, tuna.
Sensory Integration: Neurological process of organizing information from one or
more sensory channel.
Set: A group of repetitions of an exercise movement done consecutively, without
rest, until a given number, or momentary exhaustion, is reached. See also repetition.
246
Skeletal System: System consisting of bone and cartilage that supports and protects
the body.
Sliding Filament Theory: Theory stating that a myofibril contracts by the actin and
myosin filaments sliding over each other.
Slow-Twitch Fibers: Muscle fiber type that contracts slowly and is used most in
moderate-intensity, endurance exercises, such as distance running. A muscle fiber
characterized by its slow speed of contraction and a high capacity for aerobic glycolysis.
Somatic System: System responsible for voluntary action.
Smooth Muscle: Involuntary muscle tissue found in the walls of almost every organ
of the body.
Snatch: Olympic lift where weight is lifted from floor to overhead (with arms
extended) in one movement.
Sodium: An essential mineral for proper growth, and nerve and muscle tissue function. A diet high in salt (40% of salt is sodium) causes a potassium imbalance and is
associated with high blood pressure. No RDA. Dietary sources: salt, shellfish, celery,
beets, artichokes.
Somatotype: A classification of body types. See also endomorph, ectomorph, mesomorph.
Spasm: The involuntary contraction of a muscle or muscle group in a sudden, violent manner.
Spasticity: A neurological disorder of the upper motoneuron, resulting in abnormally active stretch reflexes. Muscle appears hypertonic and demonstrates exaggerated reflexes or clonus when perturbed (i.e., stretched).
Spatial Awareness/Orientation: The awareness of one’s position in space and the
location of objects in relation to self and other objects. Includes judgements of distance, depth and directionality.
Specificity: The principle that the body adapts very specifically to the training
stimuli it is required to deal with. The body will perform best at the specific speed,
type of contraction, muscle-group usage, and energy-source usage it has become
accustomed to in training.
Speed-Strength: A type of strength typically referred to as power. Power, however, is
an inadequate term as it does not differentiate between the two important types of
speed-strength. (1.) Starting strength involves turning on a maximum number of
muscle fibers instantly in any given movement. Ballistic athletes, such as sprinters,
need this strength the most to make their muscles fire simultaneously with each
stride. A boxer does the same with each punch, a baseball pitcher each time he hurls.
(2.) Explosive strength describes the firing of muscles fibers over a longer period of
time after initial activation, for the purpose of pushing, pulling or moving a
weighted object. Examples: weightlifting, shotputting and football.
Appendix
GLOSSARY
Spinal Nerves: The 31 pairs of nerves radiating outward from the spinal cord which
relay impulses to and from the skeletal muscles.
Stretching: Lengthening a muscle to its maximum extension; moving a joint to the
limits of its extension.
Spot Reducing: An effort to reduce fat at one location on the body by concentrating
exercise, manipulation, wraps, etc. on that location. Though there are some minor
exceptions, research indicates that any fat loss is mostly generalized over the body,
however.
Striations: Grooves or ridge marks of muscles’ individual myofibrils visible through
the skin, and resulting from both hypertrophy training and extremely low subcutaneous fat deposits; the ultimate degree of muscle definition.
Sprain: A stretching or tearing of ligaments. Severity ratings of sprains are firstdegree, partial tearing; third-degree, complete tearing. See also strains.
Squamous Epithelium: Epithelium consisting of one or more cell layers, the most
superficial of which is composed of flat, scalelike or platelike cells.
Squats: An upper leg and hip exercise usually performed with a barbell resting on
the shoulders. A deep knee bend is performed; the squatter then returns to an erect
standing position. There are several methods of squatting, each having its own
unique advantages and disadvantages. The squat is also one of the three lifts contested in the sport of powerlifting.
Stroke Volume: The volume of blood pumped out of the heart into the circulatory
system by the left ventricle in one contraction.
Submaximal: Less than maximum. Submaximal exercise requires less than one’s
maximum oxygen uptake, heart rate, or anaerobic power. Usually refers to intensity
of the exercise, but may be used to refer to duration.
Succinates: Succinic acid’s biological activities are varied. Their chief function is in
their enzyme activity, but they also combine with protein to rebuild muscle fiber and
nerve endings, and help fight infection.
Stabilization: The act of being stable or balanced.
Sucrose: A sweet disaccharide that occurs naturally in most land plants and is the
simple carbohydrate obtained from sugarcane, sugar beet and other sources. It is
hydrolyzed in the intestine by sucrase to glucose and fructose.
Stabilizer: A muscle that stabilizes (or fixes) a bone so that movement can occur efficiently at another bone articulating with the stabilized bone.
Sulfur: A mineral of major structural importance to proteins, enzymes, antibodies,
skin and hair. No RDA. Dietary sources: beans, beef, eggs.
Starch: Starch is a polysaccharide made of glucose linked together. The body must
convert starch into glucose which can be utilized for immediate energy or converted
to glycogen and stored in the liver for later energy needs. It exists throughout the
vegetable kingdom, its chief commercial sources being the cereals and potatoes.
Superset: Alternating back and forth between two exercises until the prescribed
number of sets is completed. The two exercises generally involve a protagonist and
antagonist (e.g., the biceps and triceps, or the chest and upper back); however,
common usage of the term also can mean any two exercises alternated with one
another.
Static Contraction: See isometric action.
Steady State: The physiological stare, during submaximal exercise, where oxygen
uptake and heart rate level off, energy demands and energy production are balanced,
and the body can maintain the level of exertion for an extended period of time.
Steroids: Naturally-occurring and synthetic chemicals that include some hormones,
bile acids, and other substances. See anabolic steroids.
Straight Sets: Groups of repetitions (sets) interrupted by only brief pauses (30-90
seconds).
Strain: A stretching or tearing of a musculotendinous unit. Degrees of severity
include first-degree, stretching of the unit; second-degree, partial tearing of the unit;
third-degree, complete disruption of the unit. See also sprain.
Strength: The application of muscular force in any endeavor (speed and distance are
not factors of strength): such as to a barbell, a ball, or to the ground underfoot. There
are 5 broad categories of strength, each with its own special training requirements:
absolute, limit, speed, anaerobic and aerobic.
Strength Training: Using resistance weight training to build maximum muscle force
is the traditional way of defining the practice of strength training. However, a more
global definition would account for the metabolic circumstances under which force
is being applied (i.e., the energy contribution from ATP/CP, glycolytic or oxidative
sources).
Stress: The general physical and psychological response of an individual to any real
or perceived adverse stimulus, internal or external, that tends to disturb the individual’s homeostasis. Stress that is excessive or reacted to inappropriately, may cause
disorders.
Stress Fracture: A partial or complete fracture of a bone because of the remodeling
process’s inability to keep up with the effects of continual, rhythmic, nonviolent
stresses on the bone. See also overuse.
Stress Management: A group of skills for dealing with stresses imposed on an individual without suffering psychological distress and/or physical disorders.
Stress Test: See graded exercise test.
Stretch Reflex: To prevent overextension and serious injury to muscles and tendons,
muscles are equipped with specialized nerve cells (spindles) that “apply the brakes”
when elasticity maximum is reached. Careful ballistic training augmented with plyometric drills can heighten the threshold of the stretch reflex mechanism and
improve strength-generating ability.
Supination: Assuming a horizontal position facing upward. In the case of the hand,
it also means turning the palm to face forward. The opposite of pronation.
Supplements: Any enterally (taken into the body by mouth) or parenterally (taken
into the body other than by mouth) administered substance which serves health,
ergogenic, growth, or other bodily processes which food alone either cannot accomplish or cannot accomplish as efficiently is referred to as a supplement. Supplements
can be nutritional or non-nutritional in nature. The traditionally identified classifications of supplements are health foods, additives, herbals (botanicals), nutriceuticals (engineered foods), micronutrients, macronutrients, adaptogens (bodily
adaptation enhancers), ergogenic (work enhancing) compounds and anabolic
(growth enhancing) compounds. See also nutriceutical.
Sympathetic Nervous System: An automatic system that speeds up most activities
in the body.
Symptom: Any evidence by which a person perceives that he/she may not be well;
subjective evidence of illness. See also sign.
Syncope: Fainting. A temporary loss of consciousness from insufficient blood flow
to the brain.
Syndrome: A group of related symptoms or signs of disease.
Synergism: The combined effect of two or more parts of forces or agents which is
greater than the sum of the individual effects. Example: the synergistic effect of a
multiple vitamin and mineral formula compared to the benefits of one or two vitamins.
Synovial Fluid: A fluid that lubricates the smooth cartilage in joints.
Systole: The contraction, or time of contraction, of the heart. See also diastole.
Systolic Blood Pressure: Blood pressure during the contraction of the heart muscle.
See also blood pressure.
T
Tachycardia: Excessively rapid heart rate. Usually describes a pulse of more than
100 beats per minute at rest. See also bradycardia.
Tactile: Pertaining to the sense of touch; discrimination of texture and shape; detection of pressure, heat, and pain.
247
Appendix
GLOSSARY
Target Heart Rate (THR): The heart rate at which one aims to exercise at a THR of
60 to 90 percent of maximum heart rate reserve.
Traps: Slang for trapezius muscles, the largest muscles of the back and neck that elevates the shoulder girdle and draws the scapulae medially.
Telomarase: An enzyme that is normally active only in stem cells as well as the cells
that give rise to sperm and egg. However when cells become cancerous, telomerase
is activated. These cells can then replicate without a limit and this process is called
“immortalization.” There is currently debate about the actual role that telomerase
activation plays in tumor formation. Telomerase uses an RNA template to maintain
the ends of linear chromosomes. It is active in immortal cell lines (cancer, single
celled organisms, germ cells) but inactive in most normal multicellular tissues.
Triceps Brachii: The muscles on the back of the upper arm, prime movers for
extending the elbow.
Tendon: A band or cord of strong, fibrous (collagenous) tissue that connects muscles to bone.
Troponin: A protein that reacts with calcium to set the contractile mechanism into
action within muscle fibers.
Tendonitis: Inflammation of a tendon.
True Synergy: When a muscle contracts to stop the secondary action of another
muscle.
Testing Protocol: A specific plan for the conducting of a testing situation, usually
following an accepted standard.
Testosterone: The sex hormone that predominates in the male is responsible for the
development of male secondary sex characteristics and is involved in the hypertrophy of muscle. See also estrogen. Anabolic steroids are synthetic chemicals that
mimic the muscle-building effects of testosterone. Testosterone is an androgen, a sex
hormone produced by all humans. It is important in the development of male
gonads and sex characteristics. In females, testosterone is an intermediate product in
the production of estradiols. As a pharmaceutical drug, it is used to stimulate sex
characteristics, to stimulate production of red blood cells, and to suppress estrogen
production. Long-term use can lead to kidney stones, unnatural hair growth, voice
changes, and decreased sperm count.
Therapy: Treatment of illness or disability.
Thermogenic effect: The heat liberated from a particular food is thus a measure not
only of its energy content but also of its tendency to be burned as heat.
Tiron: (Sodium-4,5-dihydroxybenzene-1,3-disulfonate) A chelator mentioned in
the research literature which effectively clears vanadium from body tissues right
from the first day of use. It is currently not available in supplement form. See also
vanadyl sulfate.
Tissue: A collection of similar cells and their intracellular substances.
Tissue (or interstitial) Leverage: The degree of extra mechanical advantage gained
by super heavyweight strength athletes by packing sheer mass from extra fat, liquid
and protein between and inside muscle fibers.
Tissue Elasticity: Also known as viscoelasticity: involved in all explosive sports,
including shot put, boxing, the baseball and javelin throw, and powerlifting. After
being stretched, most bodily tissues: including muscles, but not so much with ligaments and tendons: return to their original shape or length. The quicker they do, the
more force there is added to the force output stemming from both stretch reflex and
muscle contraction.
Torque: Moment of force; the turning or twisting effect of a force.
Training: Subjecting the body to repeated stresses with interspersed recovery periods
to elicit growth in its capacity to handle such stresses.
Training Effect: Increase in functional capacity of muscles and other bodily tissues
as a result of increased (overload) placed upon them.
Training Technologies: Athletes can tap into eight broad categories of accepted
methods to attain performance goals: weight training, light resistance training, medical support, therapeutic modalities (Jacuzzi, massage, acupuncture, etc), psychological support, biomechanics, diet and nutritional supplements.
Training to Failure: Continuing a set in weight training until inability to complete
another rep without assistance.
Training Zone: See target heart rate.
Transcendental Meditation (TM): An effortless meditation technique scientifically
shown to sweep away energy-sapping mental and physical stress and deep-rooted
fatigue. Among athletes it improves energy, reaction time, workout recovery, mental
alertness and coordination.
Transverse (horizontal) Plane: Separates the body into superior (top) and inferior
(bottom) sections.
248
Triglyceride: A combination of glycerol with three fatty acids: stearic acid, oleic acid,
and palmitic acid.
Trimming Down: Gaining hard muscular appearance by losing body fat (a more
contemporary phrase is “trimming and toning”).
Twitch: A brief muscle contraction caused by a single volley of motor neuron
impulses. See also fast-twitch fibers, slow-twitch fibers.
Type IIc: A fast-twitch fiber that results from the ‘fusion’ of Type IIb with surrounding satellite cells.
U
Universal Machine: One of several types of weight lifting devices where weights are
on a track or rails and are lifted by levers or pulleys. Developed in the early 60s by
Chuck Coker, the phrase originally referred to a multi-station gym.
Unsaturated Fatty Acids (UFA): Important in lowering blood cholesterol and may
thus help prevent heart disease. They are essential for normal glandular activity,
healthy skin, mucous membranes and many metabolic processes. Unsaturated fatty
acids (UFA) are fatty acids whose carbon chain contains one or more double or
triple bonds, and which are capable of receiving more hydrogen atoms. They include
the group polyunsaturates, are generally liquid at room temperature and are derived
from vegetables, nuts, seeds or other sources. Examples of unsaturated fatty acids
include corn oil, safflower oil, sunflower oil and olive oil. Replacing saturated fats
with unsaturated fats in the diet can help reduce cholesterol levels. A small amount
of highly unsaturated fatty acid is essential to animal nutrition. The body cannot
desaturate a fat, such as vegetable shortening or margarine, sufficiently by its own
metabolic processes to supply this essential need. Therefore, the dietary inclusion of
unsaturated or polyunsaturated fats is vital. The three essential fatty acids (those
which the body is unable to manufacture) are linoleic acid, linolenic acid, and
arachidonic acid. However, these fatty acids can be synthesized from linoleic acid if
sufficient intake occurs. Linoleic acid should provide about 2% of total dietary calories. Corn, safflower and soybean oils are high in linoleic acid. See also monounsaturated fat, polyunsaturated fat, saturated fat.
Upper Abs: Abdominal muscles above navel. See also lower abs.
Urinary System: Main excretory system of the body, which consists of the kidneys,
ureter, urinary bladder and urethra.
V
Valsalva Maneuver: If the glottis (the narrowest part of the larynx is closed following
full inspiration and the expiratory muscles are fully activated, the compressive forces
of exhalation can increase the intrathoracic pressure from 2 or 3 mm Hg to upwards
of 100 mm Hg above atmospheric pressure. This forced exhalation against a closed
glottis is called the Valsalva maneuver (named after the Italian anatomist who first
explained the phenomenon), and is common in weightlifting or other activities
requiring short rapid maximum force application. The intrathoracic pressure causes
the veins to compress and this in turn results in significantly reduced venous blood
flow into the heart and into the brain. Dizziness, “spots” before the eyes and blackout
can ensue. This is one good reason why those with cardiac problems should refrain
from all-out straining (as in isometric contraction), and instead should engage in a
more rhythmic type of weightlifting technique.
Vanadyl Sulfate: Vanadyl sulfate (VOSO4) has been very extensively studied for its
insulin-like activity as a blood glucose lowering agent. In other words, vanadyl sulfate dramatically increases glucose uptake by your muscle cells. There are many benefits: • Increased energy for workouts. • More rapid recovery following workouts. •
Muscle glycogen (what glucose becomes when stored in your muscles) is more abun-
Appendix
GLOSSARY
dant, thereby providing a protein-sparing effect. • This protein-sparing effect provides for better protein synthesis (muscle growth and repair). • Increased storage of
muscle glycogen provides a fuller, more dense appearance to your visible muscles.
Care must be taken with this substance however. Vanadium can build up in various
tissues of the body, especially the kidneys. Tiron (see Tiron) is the only known
chelator capable of eliminating this danger, although vitamin C, glutathione and
other antioxidants can help.
Variable Resistance: Strength training equipment which can, through the use of
elliptical cams and other such technology, vary the amount of weight being lifted to
match the strength curve for a particular exercise. Nautilus machines, for example,
provide this feature. See also constant resistance and accommodating resistance.
Variable Split Training: A weight training system developed in the mid 80s by Dr.
Fred Hatfield that systematizes workout schedules according to the recuperation of
individual muscle groups and body parts. This method maximizes development by
eliminating effects of overtraining or undertraining. Also Variable Double Split and
Variable Triple Split for multiple daily workouts.
Vascularity: Increase in size and number of observable veins. Highly desirable in
bodybuilding.
Vasoconstriction: The narrowing of a blood vessel to decrease blood flow to a body
part.
Vasodilation: The enlarging of a blood vessel to increase blood flow to a body part.
Vein: A vessel which returns blood from the various parts of the body back to the
heart.
Ventilation: Breathing. See also expiration, inspiration, respiration.
Vertigo: Sensation that the world is spinning or that the individual is revolving; a
particular kind of dizziness.
Vital Capacity: Maximal breathing capacity; the amount of air that can be expired
after a maximum inspiration; the maximum total volume of the lungs, less the
residual volume. The usable portion of the lungs.
Vital Signs: The measurable signs of essential bodily functions, such as respiration
rate, heart rate, temperature, blood pressure, etc.
Vitamin: Organic food substances present in plants and animals, essential in small
quantities for the proper functioning of every organ of the body, and for all energy
production. Most are obtained from food, but supplementation is almost always
advised, and regarded as critical for athletes in heavy training.
Vitamin A: A fat-soluble vitamin occurring as preformed vitamin A (retinol), found
in animal origin foods, and provitamin A (carotene), provided by both plant and
animal foods. Maintains healthy skin, mucous membranes, eyesight, immune system
function, and promotes strong bones and teeth. Vital to the liver’s processing of protein. RDA: 5,000 International units. Dietary sources: fish liver oil, liver, eggs, milk
and dairy, green and yellow vegetables, and yellow fruits.
Vitamin B-1 (thiamine): Essential for learning capacity and muscle tone in the
stomach, intestines and heart. RDA: 1.4 mg (men), 1.0 mg. (women). Dietary
sources: brewer’s yeast, wheat germ, blackstrap molasses, whole wheat and rice, oatmeal, most vegetables.
Vitamin B-12 (cobalamin): Necessary for normal metabolism of nerve tissue and
formation and regeneration of red blood cells. RDA: 3 micrograms. Dietary sources:
animal protein. Liver is the best.
Vitamin B-2 (riboflavin): An essential cofactor in the enzymatic breakdown of all
foodstuffs. Important to cell respiration, good vision, skin and hair. RDA: 1.6 mg.
Dietary sources: liver, tongue, organ meats, milk, eggs. The amount found in foods
is minimum, making this America’s most common vitamin deficiency.
Vitamin B-3 (niacin): Essential for synthesis of sex hormones, insulin, and other
hormones. Effective in improving circulation and reducing blood cholesterol. RDA:
19 mg. (men), 13 mg. (women). Dietary sources: lean meats, poultry, fish and
peanuts.
Vitamin B-5 (pantothenic acid): An important stress, immune system and antiallergy factor. Vital for proper functioning of adrenal glands, where stress chemicals
are produced. Promotes endurance. RDA: 10 mg. Dietary sources: organ meats, egg
yolks, whole-grain cereals.
Vitamin B-6 (pyridoxine): Essential for the production of antibodies and red blood
cells, and the proper assimilation of protein. The more protein you eat, the more B6 you need! Facilitates conversion of stored liver and muscle glycogen into energy.
RDA: 1.8 mg. (men), 1.5 mg. (women). Dietary sources: brewer’s yeast, wheat bran,
wheat germ, liver, kidney, cantaloupe.
Vitamin B-Complex: A family of 13 water-soluble vitamins, probably the singlemost important factor for the health of the nervous system. They are essential to the
conversion of food into energy. When you exercise strenuously, your body quickly
burns up its vitamin B supply. A shortage of Bs affects both performance and
recovery. High consumption of sugar, caffeine, processed food and alcohol cause
depletion. These vitamins are grouped together because of their common source,
distribution, and their interrelationship as coenzymes in metabolic processes. All
must be present together for the B-complex to work. Vitamin B-complex consists of
the following vitamins: • Biotin • Choline • Inositol • Vitamin B-1 (thiamine) •
Vitamin B-2 (riboflavin) • Vitamin B-3 (niacin) • Vitamin B-5 (pantothenic acid) •
Vitamin B-6 (pyridoxine) • Vitamin B-9 (folacin) • Vitamin B-12 (cyanocobalamin)
The best food source for vitamin B-complex is Brewer’s yeast.
Vitamin C: A critical health-protection nutrient. Body stores are depleted rapidly by
drugs, toxins, smoking, exercise and stress. Fortifies the immune system against virus
infections, strengthens blood vessels, reduces cardiovascular abnormalities, lowers
fat and cholesterol levels; as a natural anesthetic it reduces many kinds of pain, helps
detoxify chemical and metal contaminants found in the air, water and food, slows
down lactic acid buildup, helps heal wounds, scar tissue and injuries. Necessary in
the formation of connective tissue. RDA: 60 mg, but tolerated in doses exceeding
10,000 mg (10 grams) daily. Dietary sources: citrus fruits, berries, green and leafy
vegetables, tomatoes, potatoes.
Vitamin D: A fat-soluble vitamin, acquired through sunlight or diet. Aids the body
in utilization of vitamin A, calcium and phosphorus. Helps maintain stable nervous
system and normal heart action. RDA: 400 International units. Dietary sources: fishliver oils, sardines, salmon, tuna, milk and dairy.
Vitamin E: This fat-soluble vitamin is an active antioxidant retarding free-radical
damage, as well as protecting oxidation of fat compounds, vitamin A, and other
nutritional factors in the body. Important to cellular respiration, proper circulation,
protection of lungs against air pollution, and prevention of blood clots. Helps alleviate leg cramps and “charley horse.” RDA: 15 International units (men), 12
(women). Dietary sources: wheat germ, cold-pressed
Vitamin K (“Koagulation”): This vitamin is implicated in proper blood clotting. It
is synthesized in the intestinal flora. Because it is fat-soluble, it has the potential for
toxicity if taken in large doses. There is no established RDA.
VO2 Max: Maximum Volume of Oxygen consumed per unit of time. In scientific
notation, a dot appears over the V to indicate “per unit of time.” See also maximal
oxygen uptake.
Voluntary Muscle Tissues: Receives nerve fibers from the somatic nervous system
that can be voluntarily controlled. (e.g., skeletal muscles)
W
Waist-to-Hip Ratio: Your waist girth divided by your hip girth. People who carry
excess fat in their abdominal area (the “apple” shape) appear to be at greater risk for
diabetes, heart disease and high blood pressure than those who carry weight in the
hips and thighs (the “pear” shape). For women, a desirable waist -to-hip ratios is 0.8
or lower. For men, the number is 1.0 or lower.
Warm-Up: A gradual increase in the intensity of exercise to allow physiological
processes to prepare for greater energy outputs. Changes include rise in body temperature, cardiovascular- and respiratory-system changes, increase in muscle elasticity and contractility, etc. Flexibility exercises and stretching are NEVER advised as
a warm-up strategy because of the damage that is easily caused to cold muscles.
Watt: A measure of power equal to 6.12 kilogram-meters per minute.
Weight Training: Exercise that utilizes progressive resistance movements to build
strength. Practiced intensely by powerlifters, weightlifters and bodybuilders in particular, and by all athletes interested in developing any form of strength.
249
Appendix
GLOSSARY
Weight Training Belt: Thick leather belt developed by weightlifters in the early part
of the century, usually 4 inches wide in the back and 2 inches wide in the front, used
to support lower back while doing squats, military presses, dead lifts, bent rowing,
etc. A more comfortable narrow belt going around the back, is far superior to the
belts traditionally worn. This new belt is called a “LORA” (acronym for Lumbar
Orthopedic Repositioning Appliance).
Weightlifter’s Headache: An exertional type of pain which may be due to intense
clenching of the jaws during heavy lifts.
Weightlifting: An Olympic sport where athletes compete in defined weight classes to
lift the most weight overhead. The two lifts contested are the snatch and the clean
and jerk. Three attempts are given in each of the two lifts. See also Olympic lifts.
Wellness: A state of health more positive than the mere absence of disease. Wellness
programs emphasize self-responsibility for a lifestyle process that realizes the individual’s highest physical, mental, and spiritual well-being.
Wet-Bulb Thermometer: A thermometer whose bulb is enclosed in a wet wick, so
that evaporation from the wick will lower the temperature reading more in dry air
than in humid air. The comparison of wet-and dry-bulb readings can be used to calculate relative humidity. See also dry bulb thermometer, wet-globe temperature.
Wet-Globe Temperature: A temperature reading that approximates the heat stress
which the environment will impose on the human body. Takes into account not only
temperature and humidity, but radiant heat from the sun and cooling breezes that
would speed evaporation and convection of heat away from the body. Reading is
provided by an instrument that encloses a thermometer in a wetted, black copper
sphere. See also dry-bulb thermometer, wet-bulb thermometer.
Whey: A milk by-product with a biological value of 80-88. In recent years, clinical
scientists have improved the BV by enzymatically altering the bonds between the
amino acids forming the protein complex. Called “engineered” whey, the BV is
slightly higher than eggs. See also BV.
White Blood Cell: Nucleated cells, originating from the bone marrow, that make up
the infection-fighting components of the blood. White blood cells fight infections by
producing antibodies, releasing immune factors, or ingesting invading bacteria or
viruses.
Work: Force times distance. Measured in foot-pounds and similar units. Example:
Lifting a 200-pound barbell 8 feet and lifting a 400-pound barbell 4 feet each require
1,600 foot-pounds of work.
Workout: A complete exercise session, ideally consisting of warm-up, intense aerobic
and/or strength exercises, and cool-down.
Workrate: Power. The amount of work done per unit of time. Can be measured in
foot-pounds per second, watts, horsepower, etc.
250
X
Xiao Pangmei (XPM): pronounced “shou-pang-may”: Recently put to a single blind
test by Drs. Qin Zhengyu (physiologist) and Xu Aihua (endocrinologist), both
researchers at the First Military Medical University in China. These researchers noted
a highly significant body fat reduction in comparison to a control group and a
placebo group, which, upon further testing they discovered had resulted from: • Inhibition of the appetite center of the brain • Inhibition of intestinal absorption of glucose (direct inhibition of intestinal membrane transport) • Strengthened physical
capacity (XPM subjects could swim longer and showed zero decrease in muscular
strength despite significant weight loss) • There were no side effects found.
Y
Yeast: A one-celled fungus used in brewing and leavening bread. Some yeast, such as
brewer’s yeast, is highly nutritious. Many individuals are allergic to yeast. Candida
albicans is a common yeast living within the body but which can multiply and produce sickness-causing toxins. Antibiotics, sugar-rich diets, birth control pills, cortisone and other drugs stimulate Candida growth.
Yerba Mate: An extract from a South American (especially Argentina and Paraguay)
plant used extensively as a stimulating tea drink. Contains vitamins B-1, B-2 and C,
and a natural substance called mateina, which enhances energy and mental concentration. Mateina is molecularly described as a “stereo isomer” of caffeine. It initiates
a thermogenic response (e.g., increased heart rate) as does caffeine, but without caffeine’s “jittery” side effects.
Z
Zinc: Has significant roles in protein synthesis, maintenance of enzyme systems,
contractibility of muscles, formation of insulin, synthesis of DNA, healing processes,
prostrate health and male reproductive fluid. RDA: 15 mg. Deficiencies are common
due to food processing and zinc-poor soil. Excessive sweating can drain up to 3 mg.
daily. Dietary sources: meat, wheat germ, brewer’s yeast, pumpkin seeds, eggs. Zinc
Chelate is the element zinc in supplemental form and coated with protein, thus
increasing the percentage that can be assimilated by the body. Deficiency in zinc is
associated with anemia, short stature, hypogonadism, impaired wound healing, and
geophagia. Zinc salts are often poisonous when absorbed by the system, producing a
chronic poisoning resembling that caused by lead.
Appendix
INDEX
INDEX
Arm Circles, 160
Arm Cycles, 179
Arm-Crank Ergometry, 179
A
Arrhythmia
Abduction
Arthritis 111-113
definition, 44
ABI see Acquired Brain Injury
Absence (Petit Mal) Seizure
overview, 101
Acquired Brain Injury (ABI), 95, 97t
as a perceptual-motor impairment, 167
differences between ABI and CVA, 97
Acquired Disability, 25
Active Range of Motion Worksheet, 189
Active Stretching, 185
Active-assistive Exercise, 193
Activities of Daily Living (ADLs)
definition, 8
exercise therapy and, 4
functional fitness and, 21
Adaptive Aquatics, 156, 157-159
Adaptive Aquatics Evaluation Sheet
test A, 161
test B, 162-163
test C, 164
Adaptive Physical Education, 7
Adaptive Weight Training, 196
Adduction, 44, 57, 59, 60
Ambulation, 136-153
aids, 143-146
definition, 136
exercises for, 146
gait training for, 147-149
Ambulation Aids, 143-146
Amelia, 124
Americans with Disabilities Act, 9
Amputation, 123-125
etiology, 123
indicated exercise program, 124
phantom limb syndrome, 123
types, 124
Anatomical Movements, 43-44
Anatomy
for the Specialist in Exercise Therapy, 43-47
of the back, 32
Angina, 28
Ankle
ambulation and, 65
problems, 121
Antagonist, 46
Anterior Tilt, 44
Anterior/Ventral, 43
Aphasia
as a perceptual-motor impairment, 167
definition, 31
Aquatics, 154-165
assessment, 159-160
evaluation, 161-165
programming for, 154-160
Arm
circles, 160
cycles, 179
exercises for, 41, 201-202
muscles of, 47f, 52
stretch, 98
definition, 31
COPD and, 83
contraindications, 113
exercise frequency, 112
exercise goals, 113
definition, 111
indicated exercise program, 113
osteoarthritis, 111, 112
rheumatoid, 111, 112
types, 111
Assessment
aquatic skills, 159-160
hydrogymnastics assessment tool, 165
of fitness goals, 28
perceptual-motor skills checklist, 167, 168t
posture, 207
Assistant Mover, 46
Brain
acquired brain injury, 95
cerebellum, 95
brain stem, 95
cerebral vascular accident, 96
cortex, 95
epilepsy, 100
lobes of, 95
organization of, 95
stroke, 96
Breathing, 84f
asthma, 86
cancer and, 132
chronic obstructive pulmonary disease, 83
diabetes and, 90, 91
diaphragm, 86
difficulty, 70
exercises, 84
lowering blood pressure, 82
muscles used, 48
Parkinson’s and, 109
pursed-lip, 85
techniques, 85
Breathing Exercises, 85
Asthma, 86-87
COPD and, 83
Ataxia, 31
C
Auditory Disorders, 127
Canes, 145
Auditory Domain, 35-36
Cardiorespiratory Conditions, 80-87
learning styles, 35
Auditory Perception, 107
B
Back
anatomy, 32-33, 50
contraindicated exercises, 64, 68-70
exercises for, 41
low-back problems, 116
osteoporosis, 122-123
pregnancy and, 123
posture evaluation, 207
water exercise and, 155
Balance, 169-172
activities for, 170
dynamic, 170-172
progressions in, 169
static, 170
Beta-Blocker
clients taking medications, 220
definition, 31
level of exertion and, 83
heart rates and, 180, 181
Bicycling
adaptive modifications, 179
arm-crank ergometry, 179
cardiovascular fitness, 178
duration of exercise, 179
intensity of exercise, 179
rehab trainers, 179
stationary bike, 178
target heart rate, 179
Biomechanical Considerations, 71
Body Mechanics, 32-33
anatomy of back, 32
good body mechanics, 32-33
lifting, 33
poor body mechanics, 32
posture while standing, 33
pulling, 33
pushing, 33
reaching, 33
asthma, 86
chronic pulmonary obstructive disease, 83-86
correct breathing techniques, 85
heart disease, 82
hypertension (high blood pressure), 81
hypotension (low blood pressure), 82
Cardiovascular
definition, 177
disease, 14
exercises, 177-180
Cardiovascular Exercises, 177-180
bicycling, 177
swimming, 178
treadmills, 178
walking, 178
water exercises, 178
Cardiovascular Fitness, 176-181
aerobic exercise, 165
Borg scale, 181
bicycling, 177
exercise, 177-180
programming for, 176-181
pulse, 180
swimming, 178
target heart rate, 181
treadmills, 178
walking, 178
water exercises, 178
Cataracts, 128
Cerebral Palsy
as a perceptual-motor impairment, 167
ambulation aids and, 145
seizures, 101
definition, 31
Cerebral Vascular Accident (CVA or stroke), 96-99
as a perceptual-motor impairment, 167
exercise program for, 97
exercises for, 98-99
definition, 31
differences between CVA and ABI, 97
teaching tips, 97
exercises for, 98-99
visual impairments and, 128
Borg Scale, 181
251
Appendix
INDEX
Chest
exercises for, 41, 198-199
flexibility, 85
mobility, 85
muscles of, 49
Chronic Conditions
communication with physician, 78-79
communication with physical therapist, 78-79
exercise and, 16, 75
intervention, 11
older adults and, 10
overview, 75-79
“Persons with Chronic Conditions”, 17
Chronic Obstructive Pulmonary Disease (COPD),
83-86
breathing exercises, 84
breathing techniques, 85
chest mobility, 85
exercise precautions, 85
indicated exercise program, 84
Chronic Pain, 114
Fibromyalgia Syndrome and, 114
cycle, 111,114
Chronic Pain Cycle
arthritis and, 111
Fibromyalgia Syndrome and, 114
Circumduction
definition, 44
gait, 146
Circumduction gait, 146
Claudication, 103
rating discomfort, 103
Client Goals, 27, 28
program design, 27
treatment plan and, 3
Common Questions
exercise, 55
Communication
skills, 38
with client, 28
with physician, 78
Communication Skills, 38
Complex-Partial Epilepsy, 101
Concentric Contraction
active exercise and, 193
definition, 46, 192
isokinetic exercise and, 195
isotonic exercise and, 194
Correct Breathing Techniques, 85
breathing exercises, 85-86
diaphragm breathing, 86
pursed-lip breathing, 85
Cortex
four lobes of, 95
perception and, 167
Crutches, 144-145
adjustment, 145
types, 144
CVA see Cerebral Vascular Accident
D
Depression
anatomical movement, 44
Diabetes (Diabetes Mellitus), 89-91
definition, 28, 31, 89
diabetic coma, 90
exercise guidelines, 90
general precautions, 89
hypoglycemia, 90
insulin, 91
overview, 89
retinopathy, 89
types, 89
Diabetic Coma, 90
Diabetic Retinopathy, 89
sensory impairments and, 128
Disabled Persons
attitude towards, 8-10
evolution of exercise for, 7
role of exercise for, 11
understanding, 6-11
Distal
definition, 43
Disuse Syndrome, 18, 25
benefits of physical activity, 8
definition, 8, 25
Do Not Resuscitate (DNR), 27
Dorsiflexion
definition, 44
flexibility and, 188
DNR see Do Not Resuscitate
definition, 31
flexibility and, 183, 185, 186
gait training and, 152
Multiple Sclerosis and, 108
neural control, 95
resistive exercise and, 193
stroke victims and, 98
spinal cord injury and, 105
Contraindicated
definition, 27, 31
exercises, 62-72
Contraindicated Exercises, 62-72
benefit-to-risk ratio, 63
dos and don’ts, 70-72
exercises to avoid, 68-70
knee area, 65
low-back area, 64
neck area, 64
overview, 63
shoulder area, 64
252
Absence (Petit Mal), 101
definition, 15, 100
diagnosis, 100
etiology, 100
factors that provoke seizure, 101
indicated exercise program, 101
overview, 100
Tonic-Clonic (Grand Mal), 101
types, 101
Eversion
definition, 44
Exercise
ABI, 95
ambulation, 137
aquatics, 155
arthritis, 111
auditory disorders, 127
cardiovascular fitness, 177
considerations, 71
CVA, 96
diabetes mellitus, 89
fibromyalgia syndrome, 114
hydrogymnastics, 154-155
learning disabilities, 106
MS, 107
obesity, 91
Parkinson's Disease, 109
posture exercises, 211-213
PVD, 103
spinal cord injury, 104
stroke, 96
visual impairments, 127
Exercise and Muscle Guide, 41
Exercise Card, 29
Exercise Classes
tips of leading, 39
Exercise Participation Flowchart, 30
Exercises
range of motion, 186
Exercises To Avoid
overview, 68
Extension
definition, 44
External (outward) Rotation
definition, 44
Dynamic Balance
activities for developing, 172
Dysfunctional Gait patterns, 149
Congenital Disability, 25
Contractures
Epilepsy, 100-102
E
F
Falls
instructor techniques, 151
Feedback Loop
Eccentric Contraction
assistive exercise and, 193
definition, 46, 192
isotonic exercise and, 194
Edema
definition, 31
seizure and, 101
stretching and, 184, 186
Elbow
muscles of, 54
Elevation
anatomical movement, 44
Endurance
programming for, 190-205
training, 179
Endurance Training, 196
communication with client, 66
overview, 78
Fibromyalgia Syndrome (FMS)
orthopedic conditions, 114
Fine Motor Tasks, 173
Exercise Therapy
benefits of, 25
body mechanics, 32
designing programs, 26
disability and, 13
exercise considerations, 71
for chronic conditions, 73-134
fundamentals of, 24-41
kinesiology, 48
learning styles and, 34-37
medications and, 28
overview, 4-5
role, 17
safety and, 27
teaching considerations, 34
Appendix
INDEX
Fixator/Stabilizer
muscles, 46
Flaccidity
definition, 31
Flexibility
programming for, 184
Flexion
definition, 44
Forms
intake, 227-228
medical history, 222-226
medical release, 229
Functional Fitness, 21
Fundamental Terminology, 31
G
Gait Analysis Form, 150
Gait Patterns, 149
Gait Training
ambulation, 147
dysfunctional gait patterns, 149
gait analysis form, 150
normal gait, 147
step cycle, 147
Glaucoma
Intake Forms
program design, 28, 221-230
Intake Questionnaire, 227-228
Internal (medial) Rotation
definition, 44
Inversion
definition, 44
Ischemia
PVD, 103
Isokinetic Exercise
resistive exercise, 195
Isometric
definition, 31
Isometric Exercise
resistive exercise, 193
Isotonic
definition, 31
Isotonic Exercise
resistive exercise, 194
J
Joint Stability, 45
definition, 31
Gout
orthopedic conditions, 111
Guarding Against Falls
overview, 151
H
Handicap
overview, 4
Health History Questionnaire, 222-226
Heart Disease, 82
Height-Weight Tables, 93
Hemimelia
amputation, 124
Hemiplegia
neurological conditions, 96
teaching tips for, 97
definition, 31, 96
High Blood Pressure (Hypertension)
cardiorespiratory conditions, 81
Hip Problems, 120
Hold-Relax Sequence
stretching, 185
Hydrogymnastics, 156-159
Hydrogymnastics Assessment Tool, 165
Hyperextension
definition, 47
Hypoglycemia
diabetes mellitus, 90
K
Karvonen formula
target heart rate, 179
Kinesiology
arm, 52
breathing, 48
chest, 49
elbow, 54
how muscles work together, 59-61
lower leg, 56
neck, 48
rotator cuff, 53
shoulder girdle, 57
upper leg, 55-58
vertebral column, 49-50
Kinesthetic Awareness
identification of body parts, 173
perceptual-motor skills, 172
right-left discrimination, 173
Kinesthetic Domain, 37
Knee
contraindicated exercises, 65
Knee Problems, 120
L
Lateral
definition, 43
Lateral Flexion
definition, 44
Learning Disabilities, 106
as a perceptual-motor impairment, 167
Learning Styles, 35
Ligaments
joint stability, 45
Low Blood Pressure (Hypotension)
I
overview, 82
Inferior/Caudal
definition, 43
Insulin
diabetes, 89-91
Macula Degeneration
definition, 128
Manual Resistive Exercise
overview, 193
Mat Activities
ambulation, 142
Medial
definition, 43
Medical Assistance
when to seek, 70
Medical History
program design, 28
Medical Release
program design, 28
Medications
program design, 29
Metabolic Conditions
diabetes Mellitus, 89-91
obesity, 91-93
Minimal Brain Dysfunction
learning disorders, 106
Movement
definition, 128
Goniometer
M
muscles, 43
Mover/Agonist
muscles, 46
definition, 46
Multiple Sclerosis (MS)
as a perceptual-motor impairment, 167
neurological conditions and, 107-108
Muscle Grading Chart, 195
Muscles
antagonist, 46
assistant mover, 46
fixator/stabilizer, 46
how they work together, 59-61
joint stability, 45
major groups of the body, 47
movement, 43
muscular contractions, 46
naming of, 46
neutralizer, 46
prime mover, 46
prime mover/agonist, 46
roles of, 46
synergist, 46
Muscular Contractions
types of, 46
overview, 46
Muscular Strength
programming for, 191
overview, 191
Myths
exercise, 63
N
Neck
contraindicated exercises, 64
muscles used in movement of, 48
Neck Problems
overview, 115
Low-Back Problems
orthopedic conditions, 116
Lower Leg
muscles used in movement of, 56
253
Appendix
INDEX
Neurological Conditions
Acquired Brain Injury, 95
Cerebral Vascular Accident, 96-99
epilepsy, 100
hemiplegia, 96
learning disabilities, 105
Multiple sclerosis (MS), 107
PVD, 103
spasticity, 96
spinal cord injuries, 104
Neutralizer
muscles, 46
Normal Gait
components of, 147
O
Posture
evaluation of flexibility, 207
body mechanics, 33
evaluation, 207
evaluation of strength, 207
for instructor, 33
programming for, 207-213
scoliosis, 210
spinal screening, 210
Posture Evaluation, 208
Posture Exercises
overview, 211-213
Prime Mover
muscles, 46
definition, 46
Principles of Learning
overview, 34
Obesity, 91-93
Program Design, 26-29
Older Adults, 76
Programming
Orthopedic Conditions
amputations, 123
ankle problems, 121
arthritis, 111
fibromyalgia, 114
hip problems, 120
knee problems, 120
low-back pain, 116
neck problems, 115
osteoporosis, 122
shoulder problems, 118
Orthotic
definition, 31
Osteoarthritis
orthopedic conditions, 111
Osteoporosis
orthopedic conditions, 112
P
Paralysis
definition, 31
Paraplegia
definition, 31
Paresis
definition, 31
Parkinson’s Disease, 109
Passive Stretching, 184-185
Perception
the areas of the brain, 95
definition, 95
Perceptual-Motor Deficit Checklist, 168
ambulation, 137-153
posture, 207-213
aquatics, 154-165
balance and perceptual motor skills, 167-175
cardiovascular fitness, 177-181
flexibility and ROM, 183-184
Muscular Strength and Endurance, 191-205
Progressive Mobilization
Perceptual-Motor Skills
programming for, 167-175
Peripheral Vascular Disease (PVD), 103
Phantom Limb Syndrome
amputation, 123
Physical Activity
benefits of, 8
disuse syndrome, 8
Plantar Flexion
definition, 44
Posterior Tilt
definition, 44
Posterior/Dorsal
definition, 43
Postural Deviations, 207-210
254
definition, 128
Resistive Exercise
isokinetic exercise, 195
isometric Exercise, 193
isotonic Exercise, 194
manual resistive exercise, 193
progressive resistive exercise, 194
proprioceptive neuromuscular facilitation (PNF), 194
Retinitis Pigmentosa
definition, 128
Retinopathy, 89
sensory impairments and, 128
diabetic, 89
Retraction
definition, 44
Rheumatoid Arthritis (RA)
definition, 99
orthopedic conditions, 111-112
Rotation
definition, 44
Rotator Cuff
muscles used in movement of, 53
shoulder problems, 118-119
S
mat activities, 142
Progressive Resistive Exercise
overview, 194
Pronation
definition, 44
Prone
definition, 43
Proprioceptive Neuromuscular Facilitation (PNF)
flexibility, 185
resistive exercise, 194
stretching, 185
definition, 31
Prosthesis
amputation, 123
definition, 31, 123
Proximal
definition, 43
Pulse
how to take, 180
definition, 180
Sacrospinalis
muscles used in movement of, 50
Safety
program design, 27
Safety Considerations
overview, 71
Sample Medical Release, 229
Sedentary Lifestyle, 18
Seizure
epilepsy, 100
definition, 31
Sensory Impairments, 127-129
Short Leg Brace
ambulation aids, 152
Shoulder Girdle
muscles used in movement of, 51
Shoulder Problems, 118-124
Sitting Transfers—Assisted
overview, 140
Q
Quadriplegia
definition, 31
Sitting Transfers—Unassisted
sliding board, 139
overview, 139
Sliding Board
definition, 139
Perceptual-Motor Impairments
associated disabilities, 167-175
Refractory Errors
R
Radial Deviation
definition, 44
Range of Motion (ROM)
exercises, 186-188
guidelines for exercises, 186
programming for, 183-189
definition, 31
Range-of-Motion Exercises
ankle, 188
fingers, 187
hip, 187
knee, 187
shoulder, 187
thumb, 183
toes, 188
wrist, 187
Slow Static
active stretching, 184
Soft Knees
definition, 65
Spasticity
neurological conditions, 96
definition, 31, 96
Spinal Cord Injury, 104
Spinal Nerves
somatic distribution, 105
Spinal Screening
posture, 210
procedures, 210
Stance Phase
gait, 147
Standing Transfers—Assisted
overview, 141
Appendix
INDEX
Static/Isometric Contraction
definition, 46
Stationary Bicycle
cardiovascular fitness, 178
using, 178
Statute of Limitation, 13
Step Cycle
gait, 147
Strength Training
a beneficial and safe program, 197
Active Exercise, 193
active-Assistive Exercise, 193
basic terminology, 192
endurance, 191
phases of program, 196
resistive exercise, 193
techniques, 192
types of resistive exercise, 193
Stretching
contraindications, 186
performance requirements, 186
T
V
Target Heart Rate
Vascular Considerations
overview, 179
Teaching Considerations, 34
Techniques for Assisting a Person to Transfer, 138
Thoughts to be Shared with Clients, 77
Tonic-Clonic (Grand Mal) Seizure, 101
Transfers
sitting—Assisted, 140
sitting—Unassisted, 139
standing—Assisted, 141
techniques, 138
Transient Ischemic Attack (TIA)
definition, 31
Treadmills
cardiovascular exercise, 178
overview, 71
Vertebral Column
muscles used in movement of, 49-58
Visual Domain
learning styles, 36
Visual Impairments
characteristics, 127
etiology, 127
guiding techniques, 127
indicated exercise program, 129
overview, 126
Visual Perception
overview, 106
Visually Impaired
teaching tips, 127
U
W
Superior/Cranial
Ulnar Deviation
Walkers
definition, 43
definition, 44
Stroke see Cerebral Vascular Accident
Supination
definition, 44
Supine
definition, 43
Swing Phase
gait, 147
Synergist
Upper Leg
muscles used in movement of, 55-58
Upward Rotation
definition, 44
types of, 144
Weight Lifting
basic terminology, 192
Weight-Training
progressive resistance guidelines, 191
Wheelchairs
components of, 146
assisting clients in, 137
muscles, 46
255
Appendix
REFERENCES
REFERENCES
AAHPED Health-Related Fitness Test. AAHPERD Publications, 1900 Association Drive, Reston, VA 22091
American College of Sports Medicine (1983). Reference Guide for
Workshop/Certification Programs in Preventive/Rehabilitative Exercise.
American of Sports Medicine (1986, 3rd ed.). Guidelines for Exercise Testing
and Prescription. Philadelphia: Lea and Febiger, p.7.
Chawla, J.C., Bar, D., Creber., Price, J., & Andrew B. (1980). Techniques for
Improving the Strength and Fitness of Spinal Cord Injured Patients. Paraplegia,
17, 185-190.
Cornelius, W.L. (1990). “Modified PNF Stretching: Improvement in Hip
Flexion.” National Strength and Conditioning Association Journal, 12(4), 44-45.
Daniels, L., & Worthingham, C. (1972). “Muscle Testing. Philadelphia:” W.B.
Saunders. De Anza College (1984). Adapted Physical Education Manual.
Cupertino, CA
Fox, S.M. Naughton, S.P., & Haskell, W.L. (1971). “Physical Activity and the
Prevention of Coronary Heart Disease.” Annuals of Clinical Research, 3, 404.
Franklin, B. (1985). “Exercise Testing, Training, and Arm Ergometry.” Sports
Medicine, 2, 100-119.
Hay, J.G., & Reid, J.G. (1982). The Anatomical and Mechanical Bases of Human
Motion. Englewood Cliffs, NJ: Prentice-Hall.
Hoppenfeld, S. (1976). Physical Examination of the Spine and Extremities. New
York: Appleton-Century-Crofts.
Mason, E., & Dando, H. (1975). Corrective Therapy and Adapted Physical Education. Chillicothe, Ohio: American Corrective Therapy Association.
Sorenson, L., & Ulrich, P.G. (1977, 2nd ed.). Ambulation Guide for Nurses. Minneapolis: Sister Kennedy Institute.
Toohey, P., & Larson, C.W. (1977). Range-of-Motion Exercise: Key to Joint
Mobility. Minneapolis: Sister Kennedy Institute.
256
Fitnes: La Guía Completa Libro de Trabajo y Guía de Estudio
1015 Mark Avenue • Carpinteria, CA 93013
1.800.892.4772 • 1.805.745.8111 (international)
ISSAonline.com
Guía de Estudio de ENTRENADOR DE FITNES CERTIFICADO
International Sports Sciences Association
800.892.4772 • ISSAonline.com
Fitnes: La Guía Completa
Libro de Trabajo y Guía de Estudio
Novena Edicion
Guía de Estudio de ENTRENADOR DE FITNES CERTIFICADO