Therapeutic Exercise

Definition

Exercise is a subset of physical activity that is planned,

structured, and repetitive and has as a final or an
intermediate objective the improvement or maintenance
of physical fitness. Physical fitness is a set of attributes
that are either health- or skill-related.
 EXERCISE
1. Flexibility
2. Muscular strength & endurance
3. Aerobic (Cardiovascular Endurance)
4. Neuromotor /Motor Skill/ Functional Fitness Training (Balance,
Coordination, Gait, Agility, Proprioceptive)
5. Others : aquatic, plyometric, challistenic, speed training,
relaxation
 1. FLEXIBILITY EXERCISE
Terdiri dari :
1. ROM exercise (on available ROM)
a. Passive ROM → MMT 0-1
b. Active-assisted ROM → MMT 2
c. Active ROM → MMT ≥ 3
2. Stretching exercise (beyond the available ROM)
ROM Exercise can be done by:
a. Doctor/therapist/practitioner
b. Manual self assisted
c. Machine : CPM (Continuous
Passive Motion)
Self-Assisted ROM Technique
a. Manual
b. Equipment :
• Wand / T-Bar
• Finger ladder, wall climbing, ball
rolling
• Pulleys
• Skate board/powder board
• Reciprocal exc device (bicycle,
upper body ergometer)
Manual Self-Assisted ROM

Kisner, C.
Kisner, C.
CONTINUOUS PASSIVE MOTION (CPM)

• Passive motion performed by mechanical device that

moves a joint slowly and continuously through a
controlled ROM.
• General guideline :
a. May be applied immediately after surgery
b. Initially 20-300 and progressed 10-150 /day as
tolerated
c. Rate of motion : 1 cycle/45 sec or 2 min
d. Amount of time : vary from continuous 1 hour
3x/day to 24 hours/day (best 4-8 hours/day)
e. Minimum duration : < 1 week or until
satisfactory ROM is reached
Kisner, C.
 ROM EXC RECOMMENDATION (Kisner C.)

• Rekomendasi :
• Repetisi 5-10 x. Number of repetition depends
on objectives program & px condition
• Move the segmen through its complete pain-free ROM,
smoothly & rhtmically.
 STRETCHING EXC

• Contracture → adaptive shortening of muscle-tendon unit & other

soft tissues that cross or surround joints that results in significant
resistance to passive/active stretch & limitation of ROM.
• Type of Contracture :
a. Myostatic (myogenic)
b. Pseudomyostatic → hypertonicity (spasticity / rigidity)
c. Arthrogenic and periarticular
d. Fibrotic
Types of stretching

• Static stretching

• Dynamic stretching
Stretching
Exercise
(ACSM)
Strengthening Exercise

Macam-macam strengthening:
• Isometric : tanpa gerakan sendi
• Isotonic : dengan gerakan sendi
• Isokinetic : kecepatan diatur dengan alat
Prinsip peresepan

Muscular Strengthening Cardio Endurance

Intensitas tinggi Intensitas rendah

Repetisi rendah Repetisi tinggi

ISOMETRIC STRENGTHENING (Kisner C.)
FITT-VP Recommendation
Frequency 2-3 day/week
Intensity 60-80% max isometric contraction
Time 10 seconds (2’ rise time, 6’ hold time, 2’ fall time)
Type Isometric
Volume -
Pattern 20x repetition, exercise at different specific angle
Progression As tolerated
 Resistance Exercise Recommendations (ACSM)
Frequency • 2-3 day/week
Intensity Strength :
• Begginer : 60-70% 1-RM
• Experienced : ≥ 80% 1-RM
• Older/sedentary : 40-50% 1-RM
Endurance : < 50% 1-RM
Time No specific duration
Type Involved each muscle group.
Use exercise equipment and or body weight.
Repetitions Strength : Adult : 8-12 repetitions ; Older : 10-15 repetitions
Endurance : 15-20 repetitions
Sets Strength : 2-4 set
Endurance : ≤ 2 sets
Pattern Rest interval 2-3 minutes between set; Rest ≥ 48 hours between
session
 3. AEROBIC (CARDIOVASCULAR ENDURANCE) EXERCISE
Measure Exercise Intensity :
a. HRR (Karvonen)
THR = % intensity x (HRmax-
HRrest) + HRrest
HRmax according to stress
test/age estimated
b. Age adjusted MHR
HRmax = 220-age
THR = % intensity x HRmax
Thank You
dr.Samiah Rachmawati,Sp.KFR