NUR FARHANA MD YUNUS

PT DEPARTMENT

Upon completion of this course, students

should be able to:

Explain the concept, selections, effects and

uses of the strengthening exercises (C2,A2,
PLO1)

Show the procedures of strengthening

exercises. (C3, P2, A2, PLO1,PLO2)

Any form exercise in which a dynamic/static

muscular contraction is resisted by an
external force.

3 types:
Isotonic resistance exs.
Isometric resistance exs.
Isokinetic resistance exs.

To increase:

Muscle strength
Muscle power
Muscle endurance

Contractility Ability of a muscle to shorten

with force

Excitability Capacity of muscle to respond

to a stimulus

Extensibility Muscle can be stretched to its

normal resting length and beyond to a
limited degree

Elasticity Ability of muscle to recoil to

original resting length after stretched

Muscle size
Muscle structure fusiform, pennate
Proportion of muscle fibres
Biomechanical and histochemical properties
Neurological factors:
Coordination
Limitation by disease that affect
neuromuscular system.

Cross-sectional size
Length and tension relationship at the time
of contraction
Recruitment of motor units
Type of muscle contraction
Speed of muscle contraction
Motivation of patient

TYPE I

Red fibers
Smaller
Endurance
More blood
Slow twitch

TYPE II

It is the most common form of resistance

training exercise which uses free weights
such as dumbells and barbells.

Dynamic form of exercise

Muscle contracts and shorten (concentric
and lengthen (eccentric).
Produces visible motion
A measurable amount of tension and force
output are produced by the muscle with
mechanical work done (force x distance)
Sources of resistance manual, body
weights, free weights, machine

It involves muscular actions in which the

length of the muscle does not change and
occur against an immovable resistance.

Static form of exercise

Muscle contracts and produces force
without change in length
No visible motion occur
A measurable amount of tension and force
output are produced by the muscle but with
no mechanical work done (force x distance)
Sources of resistance manual, maintaining
a position against body weights and
pushing or pulling an immovable objects

Types:
Manual resistance
Mechanical resistance

Definition:
Any form of exercise in which resistance is
applied by therapist using a static and
dynamic muscle contraction

Limitation:
Force cant be measured
Mild to moderate force
Depend on therapist strength

Prior to the exercise:

- Evaluate patients ROM and strength
Explain the plan ad procedure
Position the patient comfortable,
supported
Demonstrate movement
Explain to patient to perform with maximal
effort
Ensure that patient does not hold breath

During the exercise:

Consider the site of application of
resistance
Passive on distal end
Determine the direction of movement
Provide stabilization
Apply appropriate amount of resistance
(dynamic, smooth, pain-free)
- Reduce the resistance if:
Patient unable to complete ROM
Site of resistance is painful
Developing of muscle tremor
Substitute motion occur

Isotonic concentric
Isotonic eccentric
Isometric
PNF (Proprioceptive Neuromuscular
Facilitation)

Definition:
Any form of exercise in which resistance is
applied by some type of equipment.

Advantage:
Best form exercise to increase power, strength
and endurance
Pt can exercise independently
Force is measurable
Variable resistance
- Mild to full resistance
No limitation
Constant resistance

Free weights

Barbells
Dumbells
Sandbags
Weight boots

Elastic resistance

Thera-band
Medicine/physio balls

Pulley and spring system

Working stations
Others
ergometer, rower, quads bench, leg-press bench

Load and number of repetition

Sets and frequency
Duration
Speed
Type of muscle contraction
Submaximal vs maximal
ROM short arc vs full arc
Starting position

Used as a starter strength

Comparison for progression
Type:
- One repetitive maximum (1RM)
Ten repetitive maximum (10RM).
Spring balance technique.
Trial and error techniques.

Common formula used to calculate 1RM

- Epley Formula:

r is the number of repetitions

performed
w is the amount of
weight used

maximum amount of weight one can lift in a

single repetition for a given exercise
can be used for determining an individual's
maximum strength
method for determining the winner in
events such as powerlifting and
weightlifting competitions
can also be used as an upper limit, in order
to determine the desired "load" for an
exercise (as a percentage of the 1RM)

Definition:
A weight that muscle can lift with maximal
effort for 10 times without fatigue.

Can be estimated in 2 ways:

Using spring balance
Trial and error:
Using specific weight

Using therapist manual resistance testing

Set spring balance 90 to the middle range

of motion
Ask patient to perform 3 max effort
Calculate mean for load

Depend patient strength kg, 1 kg, 3, kg,

5 kg..
Try and error
Ask patient to perform 10 lift effort
Observe the muscle for sign of tremor

Perform manual muscle testing on patient

Take weight that almost on the therapist
resistance
Ask patient to perform 10 lift effort
Observe the muscle for sign of tremor
For experienced physiotherapist

Regime

DeLorme

Oxford

McQueen

Usage

Rehabilitation
Progressive Resistive
Exercise (PRE)
Strengthening

Rehabilitation
Strengthening
Endurance

Rehabilitation

Sets

10 x 10RM
10 x 10RM
10 x 10RM

10 x 10RM
10 x 10RM
10 x 10RM

10
10
10
10

Procedures

Determine 10RM
Sets lifting
Repeat 10 RM testing
every week

Determine 10RM
Sets lifting
Repeat 10 RM
testing every week

Determine 10RM
Sets lifting
Repeat 10 RM
testing every week

Intensity

Minimum of 4 sets per

week

Minimum of 4 sets
per week

Minimum of 4 sets
per week

Endurance

x
x
x
x

10RM
10RM
10RM
10RM

Regime

DAPRE

Circuit training

Usage

Conditioning using
daily adjustable
progressive
resistance exercise
Endurance
Strengthening

Using sequence of
variety of exercise for
total body conditioning
Endurance
Strengthening

Sets

10 x WW
6 x WW
As many as possible
x WW
As many as possible
x WW

Bench press,
leg press,
push up,
chin up,
sit up,
shoulder press
etc using repetition
and time

Commence at the level of patients

capability
Progress gradually
Stick to safety aspects
- eg warm up, stretching
React appropriately if patient experience
pain or discomfort