Resistance exercises for muscle

performance
Dr. Elham Al-Shorman
April 2014
Definitions and guiding principles
• Muscle performance: capacity of a muscle to do work
(force*distance).

• Despite the simplicity of the definition, muscle performance is a

complex component of functional movement and is influenced by
all of the body systems

• For a person to anticipate, respond to, and control the forces

applied to the body and carry out the physical demands of
everyday life in a safe and efficient manner, the body’s muscles
must be able to produce, sustain, and regulate muscle tension to
meet these demands

• morphological qualities of muscle; neurological, biochemical, and

biomechanical influences; and metabolic, cardiovascular,
respiratory, cognitive, and emotional function
 Definitions and guiding principles
• Key elements of muscle performance:
▪ Strength
▪ Power
▪ Endurance

• If any one or more of these areas of muscle performance is impaired,

functional limitations and disability or increased risk of dysfunction may
arise.

• Many factors, such as injury, disease, immobilization, disuse, and

inactivity, may result in impaired muscle performance leading to weakness
and muscle atrophy

• When deficits in muscle performance place a person at risk for injury or

hinder function, the use of RESISTANCE EXERCISE is an appropriate
therapeutic intervention to improve the integrated use of strength,
power, and muscular endurance during functional movements, reduce the
risk of injury or reinjury, and enhance physical performance
Definitions and guiding principles
• Resistance training: active exercise in which
dynamic or static muscle contraction is resisted by
an outside force applied manually or mechanically

• Resistance exercise, also referred to as

RESISTANCE TRAINING

• Essential element of rehabilitation programs for

persons with impaired function and an integral
component of conditioning programs for those
who wish to promote or maintain health and
physical well-being,
Potential benefits of resistance
training
Definitions and guiding principles
• Strength:
▪ ability of contractile tissue to produce tension
and a resultant force based on the demands
placed on the muscle.
▪ greatest measurable force that can be exerted by
a muscle or muscle group to overcome resistance
during a single maximum effort
▪ Insufficient muscular strength can contribute to
major functional losses of even the most basic
activities of daily living.
Definitions and guiding principles
• Strength training:
▪ The development of muscle strength is an integral
component of most rehabilitation or conditioning
programs for individuals of all ages and all ability levels

▪ A systematic procedure of a muscle or muscle group lifting,

lowering, or controlling heavy loads (resistance)

▪ Relatively low number of repetitions or over a short period

of time
Definitions and guiding principles
• Power:
▪ Rate of performing the work/ muscle strength * speed of
movement
▪ The rate at which a muscle contracts and produces a resultant
force
▪ When muscles contract or stretch in moving a load they do work,
and energy is transferred from one form to another. The power
of muscles refers to how quickly the muscles can do this work
and transfer the energy

▪ work (force * distance) produced by a muscle per unit of time

(force * distance/time).
▪ a single burst of high-intensity activity (such as lifting a heavy
piece of luggage onto an overhead rack or performing a high
jump) or by repeated bursts of less intense muscle activity (such
as climbing a flight of stairs).
 Example:
• A weightlifter lifts 100 kg up a distance of 1.5 m.
100 kg has a weight force of 1000 newtons. Use
this formula to calculate the work done (energy
transferred) by the weightlifter:

• If the weightlifter lifts the 100 kg explosively and

takes only 0.5 seconds to make the lift, use this
formula to calculate the power their muscles
produce:
Definitions and guiding principles
• Power training:
▪ Muscle strength is a necessary foundation for
developing muscle power
▪ Power can be enhanced by either increasing the
work a muscle must perform during a specified
period of time or reducing the amount of time
required to produce a given force.
▪ The greater the intensity of the exercise and the
shorter the time period taken to generate force,
the greater is the muscle power.
 Definitions and guiding principles
• Endurance:
• ability to perform low-intensity, repetitive, or sustained activities
over a prolonged period of time.
• Total body endurance (cardiopulmonary)/ walking, cycling,
swimming, etc

• Muscle endurance (Local endurance)/ability of a muscle to

contract repeatedly against a load (resistance), generate and
sustain tension, and resist fatigue over an extended period of time

• In fact, almost all daily living tasks require some degree of muscle
and cardiopulmonary endurance.
• .

• Muscle strength and muscle endurance do not always correlate

with each other. Just because a muscle group is strong, it does not
prevent the possibility that muscular endurance is impaired
Definitions and guiding principles
• Endurance training:
▪ characterized by having a muscle contract and
lift or lower a light load for many repetitions or
sustain a muscle contraction for an extended
period of time.
▪ Key elements: low-intensity muscle contractions, a
large number of repetitions, and a prolonged time
period
▪ Adaptations: aerobic capacity/ oxidative and
metabolic capacity----better delivery and use of
oxygen
• Self reading 151-159 from your book
 Definitions and guiding principles
• Overload principle:
▪ Muscle performance is to improve the muscle must be
challenged to perform at a level greater than that to
which it is familiar
▪ The overload principle focuses on the Progressive
loading of muscle by manipulating intensity or
exercise volume
▪ Strength training/amount of resistance (intensity)
▪ Endurance training/number of repetitions (volume)
Definitions and guiding principles
• P R E C A U T I O N : To ensure safety, the extent
and progression of overload must always be
applied in the context of the underlying
pathology, age of the patient, stage of tissue
healing, fatigue, and the overall abilities and goals
of the patient. The muscle and related body
systems must be given time to adapt to the
demands of an increased load or repetitions
before the load or number of repetitions is again
increased.
 Definitions and guiding principles
• SAID principle:
• Specific adaptation to imposed demands

• specificity of the exercise/ improvement of muscle strength,

power, and endurance are highly specific to the training method
employed.

• The SAID principle helps therapists determine the exercise

prescription and which parameters of exercise should be selected
to create specific training effects that best meet specific functional
needs and goals.
• For example, if the desired functional activity requires greater
muscular endurance than strength, the intensity and duration of
exercises should be geared to improve muscular endurance
Definitions and guiding principles
• Reversibility principle:
▪ Adaptive changes in the body’s systems, such as
increased strength or endurance, in response to a
resistance exercise program are transient unless
training-induced improvements are regularly used for
functional activities.
▪ Detraining, reflected by a reduction in muscle
performance, begins within a week or two after the
cessation of resistance exercises and continues until
training effects are lost.
▪ it is imperative that gains in strength and endurance
are incorporated into daily activities as early as
possible in a rehabilitation program
Determinants of resistance training
Many elements (variables) determine
whether a resistance exercise program
is appropriate, effective, and safe.
 Determinants of resistance training
• To strengthen a specific muscle or muscle group effectively and avoid
substitute motions, appropriate positioning of the body and alignment of
a limb or body segment are essential.

• Substitute motions are compensatory movement patterns caused by

muscle action of a stronger adjacent agonist or a muscle

• If the principles of alignment and stabilization for manual muscle testing

are applied whenever possible during resistance exercise, substitute
motions can usually be avoided.

• Alignment
• Proper alignment is determined by the direction of muscle fibers and the
line of pull of the muscle to be strengthened
• Is important to prevent substitute motions
• Muscle action: e.g: to strengthen the gluteus medius/hip must extended,
and the pelvis anteriorly rotated. If the hip is flexed as the leg abducts, the
tensor fasciae latae becomes the prime mover and is strengthened
• Gravity: position of the limb relative to the gravity is important/ position
of limb to act against gravity (e.g: gluteous medius/side-lying position)
 Determinants of resistance training
• Stabilization
▪ Is important to maintain appropriate body
alignment
▪ External stabilization:
▪ manually by the therapist
▪ equipment/ belts or straps
▪ Firm support surface
 Determinants of resistance training
• Intensity: is the amount of resistance (weight)
imposed on the contracting muscle during each
repetition of an exercise. (amount of resistance;
training load)
▪ Overload principle: to improve muscle performance the
muscle must be loaded to an extent greater than loads
usually incurred
▪ Progressive gradual program: to gradually increase the
amount of resistance used in the exercise program

▪ The intensity of exercise dependent on the volume,

frequency, and order of exercise or the length of rest
intervals
Submaximal Versus Maximal Exercise
Loads
• Many factors, including the goals and expected
functional outcomes of the exercise program, the
cause of deficits in muscle performance, the extent
of impairment, the stage of healing of injured
tissues, the patient’s age, general health, and
fitness level, determine whether the exercise is
carried out against submaximal or maximal muscle
loading.

• In general, the level of resistance is often lower in

rehabilitation programs for persons with
impairments than in conditioning programs for
healthy individuals.
 Determinants of resistance training
• Submaximal loading (low to moderate intensity)
▪ At the beginning of an exercise program to evaluate the patient’s
response to resistance exercise, especially after extended periods of
inactivity
▪ In the early stages of soft tissue healing when injured tissues must be
protected
▪ After periods of immobilization when the articular cartilage is not
able to withstand large compressive forces or
▪ When bone demineralization may have occurred, increasing the risk
of pathological fracture
▪ For most children or older adults
▪ When the goal of exercise is to improve muscle endurance
▪ To warm up and cool down prior to and after a session of exercise
 Determinants of resistance training
• Near maximal or maximal loading (high intensity loading)
▪ When the goal of exercise is to increase muscle strength
and power and possibly increase muscle size
▪ For otherwise healthy adults in the advanced phase of a
rehabilitation program after a musculoskeletal injury in
preparation for returning to high-demand occupational or
recreational activities
▪ In a conditioning program for individuals with no known
pathology
▪ For individuals training for competitive weight lifting or
body building
▪
 Determinants of resistance training
• Initial level of resistance
• It is always challenging to estimate how much resistance to
apply manually or how much weight a patient should use
during resistance exercises to improve muscle strength
particularly at the beginning of a strengthening program.

• With manual resistance exercise the decision is entirely

subjective, based on the therapist’s judgment during exercise.
• In an exercise program using mechanical resistance the
determination can be made quantitatively
▪ A repetition maximum (RM) is defined as the greatest
amount of weight (load) a muscle can move through
the available range of motion (ROM) a specific number
of times.
▪ 1 RM is commonly used in clinical setting.
• There are two main reasons for determining a
repetition maximum:
1. to document a baseline measurement of the
dynamic strength of a muscle or muscle group
against which exercise-induced improvements in
strength can be compared

2. to identify an exercise load (amount of weight)

to be used during exercise for a specified number
of repetitions.
 Determinants of resistance training
Training zone
▪ Exercise load is calculated as a percentage of 1RM
▪ The lower percentage of this range is safer at the beginning of a
program
▪ Low to moderate intensity is recommended for children and
elderly
▪ For patients with significant deficits; low to moderate intensities
are safe yet challenging

Sedentary life style; of 1RM % 30-40 Low intensity

children and elderly;
severe deficit in
muscle strength
of 1RM 60-70% Moderate intensity

of 1RM % 80-90 High intensity

 Determinants of resistance training
• Volume:
▪ Number of repetitions and sets multiplied by the
resistance
▪ Inverse relationship/the higher the intensity, the
lower number of repetitions
 Determinants of resistance training
• Repetitions: The number of repetitions in a dynamic exercise program
refers to the number of times a particular movement is repeated
▪ A percentage of the 1 RM used as the exercise load influences the
number of repetitions a patient is able to perform
▪ Is often within a range rather than an exact number of repetitions
▪ The number of repetitions selected depends on the patient’s status
and whether the goal of the exercise is to improve muscle strength or
endurance.

Repetitions Intensity
repetitions 15 1RM 60%
Average untrained repetitions 10 1RM 75%
individual
repetitions 4-5 1RM 90%
 Determinants of resistance training
• Sets (bouts):
▪ A predetermined number of repetitions grouped
together
▪ Number of repetitions followed by periods of rest.
▪ No optimal numbers of sets
▪ At early phases of rehab programs----single set at
low intensity---progression to multiple sets
 Determinants of resistance training
• Frequency
▪ Number of exercise sessions per day or per week
▪ Dependents on other parameters:
▪ Intensity and volume
▪ Patient goals
▪ General status
▪ Greater intensity and volume---lesser frequency/ to allow for
periods of recovery from fatigue
▪ Causes of decline in performance due to overtraining:
▪ Excessive frequency
▪ Inadequate rest
▪ Progressive fatigue
▪ Some forms of exercises need lesser frequency (e.g: high
intensity eccentric exercise)----needs longer recovery time
 Determinants of resistance training
• Duration:
▪ Total number of weeks or months of the
resistance exercise program
▪ Varies depending on the aetiology and the status
of the patient
▪ Early strength gain (2 to 3 weeks)---
▪ Significant changes to occur (6 to 12 weeks)---
 Determinants of resistance training
• Rest intervals (RI):
▪ Allow the muscle to recover from the acute effect
of exercise (e.g: fatigue or muscle soreness)
▪ RI dependent on the intensity and volume of
exercise
▪ The higher the intensity, the longer the rest interval.
▪ Moderate intensity---2-3 minute rest interval after
each set
▪ High intensity---- 4 to 5 minute rest interval after each
set
 Determinants of resistance training
• Mode of exercise:
▪ Type of exercise (how muscle contraction occurs)
▪ Weight bearing vs non-weight bearing
▪ Closed vs open chain exercises
▪ How resistance is applied (manual or mechanical)
 Determinants of resistance training
• Mode of exercise: Type of muscle contraction
▪ Isometric (static) muscle contraction--- muscle
generate the force without changing the length
▪ Dynamic muscle contraction
▪ Concentric (shortening) vs eccentric (lengthening) muscle
contractions.
▪ Eccentric need to control, slow-down the lengthening of a
muscle, a “braking” contraction (e.g: biceps on lowering
weight; quadriceps on descending stairs or hill
▪ Isokinetics: The muscle contraction velocity remains
constant, while force is allowed to vary
▪ velocity is held constant by a rate controlling device.
 • The tibialis anterior muscle
in the shin flexes the foot up when it contracts. But when walking or running,
it contracts eccentrically to control the descent of the toes after heel strike.
Without it, your feet would slap something awful with every step.

• The quadriceps muscle group

contracts eccentrically as you descend stairs or a hill. The quadriceps are
“anti-gravity” muscles when contracting concentrically, extending the knee
powerfully to lift you up. But when you step down, your knee starts straight
and then bends like a spring as your body follows: the quadriceps contract
eccentrically to keep the knee from collapsing too fast or too far.

• The extensor muscle group on the back of forearm

on the back of your forearm gets heavy eccentric use in raquet sports, where
you are constantly swinging a heavy “weight” — the end of the racquet. That
weight would drag your wrist into deep, floppy flexion with every swing … if
not for eccentric contraction of the muscles on the back of the arm, which
resist the flop and keep your wrist stable and reasonably straight. It still bends
back, but it’s controlled and limited.
 Determinants of resistance training
• Position for Exercise: Weight-Bearing or
Non-Weight-Bearing
▪ A non-weight-bearing position----the distal
segment (foot or hand) moves freely during
exercise---Open chain exercise
▪ A weight-bearing position----the body moves over
a fixed distal segment----- Closed-chain exercise
 Determinants of resistance training
• Energy system: Energy systems are metabolic systems
involving a series of biochemical reactions resulting in the
formation of adenosine triphosphate (ATP), carbon
dioxide, and water
• Anerobic exercise--- high intensity (near maximal) with
low number of repetitions--- muscle rapidly fatigue
(strength training). Anaerobic means with series of
chemical reactions that does not require the presence of
oxygen (intense enough to trigger lactic acid formation)
▪ Aerobic exercise---low intensity with high number of
repetitions--- increase muscular and cardiopulmonary
endurance. Aerobic refers to the presence of oxygen
 Determinants of resistance training
• Range of Movement: Short-Arc or Full-Arc
Exercise
▪ Full arc exercise---Resistance through the full,
available range of movement
▪ Short arc exercise---- Resistance through a portion
of the ROM
▪ Used to avoid a painful arc of motion
▪ Unstable joint
▪ Protect tissue healing after injury or surgery
 Velocity of Exercise
• The velocity at which a muscle contracts significantly
affects the tension that the muscle produces and
subsequently affects muscular strength and power

• The velocity of exercise is frequently manipulated in

a resistance training program to prepare the patient
for a variety of functional activities that occur across
a range of slow to fast velocities
 Force- velocity Relationship
• The force-velocity relationship is different
during concentric and eccentric muscle
contractions

• Concentric Muscle Contraction: As the

velocity of muscle shortening increases,
the force the muscle can generate
decreases.

• Eccentric Muscle Contraction

• During an eccentric contraction, as the
• velocity of active muscle lengthening
increases, force production in the muscle
initially also increases but then quickly
levels off: a protective response of the
muscle when it is first overloaded. This
increase may be important for shock
absorption or rapid deceleration of a limb
during quick changes of direction
 Type of resistance exercise
• There is no one best form or type of resistance
training.
• Manual vs. mechanical
• Prior to selecting specific types of resistance
exercise for a patient’s rehabilitation program,
a therapist may want to consider the following
questions
 Types of resistance training
• Isometric exercise: Isometric exercise is a static form of exercise in which a muscle contracts
and produces force without an appreciable change in the length of the muscle and without
visible joint motion. Although there is no mechanical work done (force *distance), a
measurable amount of tension and force output are produced by the muscle

• Duration of muscle activation: min 6 seconds but not more than 10 seconds to avoid fatigue
 Dynamic (eccentric and concentric)
• Rationale
▪ Combination of eccentric and
concentric contractions evident in
ADL---needs to incorporate it in
rehab
▪ Eccentric training is important to
reduce risk of injury during
activities of high intensity
decelerating and quick change of
direction
▪ Eccentric contractions also act as a
source of shock absorption during
high-impact activities.
 Dynamic (eccentric and concentric)
• Energy expenditure
▪ Eccentric exercise consumes less oxygen and
energy stores than concentric exercise against
similar loads.
▪ Therefore, the use of eccentric activities such as
downhill running may improve muscular
endurance more efficiently than similar
concentric activities ---- muscle fatigue occurs less
quickly with eccentric exercise
 Dynamic (eccentric and concentric)
• Cross-training effect
▪ A slight increase in strength in the same muscle
group of the opposite, unexercised extremity
▪ Not clearly understood phenomenon
▪ No evidence that it has impact on patient’s
functional outcome
 Open-Chain and Closed-Chain Exercise
• Open-Chain: applies to completely
unrestricted movement in space of
a peripheral segment of the body,
as in waving the hand or swinging
the leg. Non Distally fixated, joint
isolation exercise

• During closed kinetic chain

movements the peripheral
segment meets with “considerable
external resistance,distally fixated,
kinetice chain exercise.
 Open Chain Exercise
• Open-chain exercises involve motions in which
the distal segment (hand or foot) is free to move
in space, without necessarily causing
simultaneous motions at adjacent joints.

• Limb movement only occurs distal to the moving

joint. Muscle activation occurs in the muscles that
cross the moving joint.
• during resistance training, the exercise load
(resistance) is applied to the moving distal
segment.
 Precautions of resistance training
• Valsalva manoeuvre
• A deep inspiration is followed increases intra-abdominal and intrathoracic
pressures, which in turn forces blood from the heart, causing an abrupt,
temporary increase in arterial blood pressure
▪ Happens with high effort isometric and eccentric muscle contraction
▪ At risk patients: a history of coronary artery disease, myocardial
infarction, cerebrovascular disorders, or hypertension, neurosurgery
or eye surgery or intervertebral disc pathology
▪ What to do: Prevention During Resistance Exercise
▪ Caution the patient about breath-holding.
▪ Ask the patient to breathe rhythmically, count, or talk during
exercise.
▪ Have the patient exhale with each resisted effort.
▪ Be certain that high-risk patients avoid high-intensity resistance
exercises.
Precautions of resistance training
• Overtraining and overwork:
▪ Overtraining (chronic fatigue): decline in physical
performance in healthy individuals participating in
high-intensity, high-volume strength and endurance
training programs
▪ Symptoms: progressively fatigues more quickly and requires
more time to recover from strenuous exercise
▪ Causes: inadequate rest intervals between exercise
sessions, too rapid progression of exercises, inadequate diet
and fluid intake
▪ What to do: reversible phenomenon/ tapering the training
program for a period of time by periodically decreasing the
volume and frequency of exercise (periodization).
Precautions of resistance training
• Overtraining and overwork:
▪ Overwork weakness: progressive deterioration of
strength in muscles already weakened by
nonprogressive neuromuscular disease.
▪ Noted in Guillain-Barré syndrome and Postpolio
syndrome
▪ What to do: prevention is the key
▪ Patients who are susceptible to muscle fatigue must be
monitored closely
▪ Patient should not reach the fatigue point
▪ Patients should be given longer and more frequent rest
intervals
Precautions of resistance training
• Exercise induced muscle soreness
▪ Acute muscle soreness:
▪ during or directly after strenuous exercise
▪ Cause: lack of adequate blood flow and oxygen
(ischemia) and a temporary buildup of
metabolites, such as lactic acid
▪ The sensation is characterized as a feeling of
burning or aching in the muscle. Transient and
subsides quickly after exercise when adequate
blood flow and oxygen are restored to the muscle
▪ An appropriate cool-down period of low-intensity
exercise
Precautions of resistance training
• Delayed onset muscle soreness
Precautions of resistance training
• Prevention and treatment of (DOMS)
▪ Progressing intensity and volume of exercise gradually
▪ Low intensity warm-up and cool down activities
▪ Gentle stretching exercises before and after training
▪ Concentric training before eccentric
▪ Regular performance of exercises after an initial
episode of DOMS developed and remitted
▪ Light, high-speed (isokinetic), concentric exercise has
been reported to reduce muscle soreness
▪ Message and physical modalities (cryotherapy and
electrical stimulation)
Precautions of resistance training
• Pathological fractures
▪ People at risk (e.g: osteoporosis, osteopenia):
resistance training is important but has yet to be
safe
▪ enough load to achieve the gaols of exercise program
but not too heavy to cause pathological fractures
Precautions of resistance training
 Contraindications of resistance
training
• Pain/ severe pain during active unrestricted movement or during
isometric resisted contraction

• Inflammation
▪ Inflammatory neuromuscular disease (e.g: Guillain-Barré)--- static and
dynamic are contraindicated
▪ Inflammatory muscle disease (e.g: polymyositis, dermatomyositis)---
static and dynamic are contraindicated
▪ Acute inflammation of the joint----dynamic is contra-indicated

▪ Severe cardio respiratory disease

▪ E.g: coronoray artery disease; cardiac myopathy
▪ Following to myocardial infarction or coronary artery bypass surgery
----postpone for up to 12 week or until getting a clearance from a
physician
 Resistance training regimens
• Progressive resistance exercise
▪ Load is incrementally increased
▪ RM is used as a basis for determining and progressing
the resistance
▪ Delmore regime vs Oxford regime
▪ Delmore incorporate warm up in the protocol
▪ Both include rest intervals between sets
▪ Both incrementally increase resistance over time
▪ DAPRE regime
▪ increase the weight by 5% to 10% when all prescribed
repetitions and sets can be completed easily without
significant fatigue
Determinants of resistance training
 Resistance training regimens
• Circuit weight training
▪ Sequence (circuit) of continuous exercises is
performed
▪ Target a variety of major muscle groups
▪ Each exercise is performed for specific number of
repetitions
 Resistance training regimens
• Polymetric training
▪ High velocity; high
intensity exercises
▪ Important if patient to
return to high demand
activities
Equipments to be used with
resistance training

Free weight
Weight pulley system
Mechanical machine
Elastic bands
Equipments to be used with
resistance training