Erbil Polytechnic University

Erbil Health Technical College

Physiotherapy Department
Study Year : 2019-2020

Progressive resistive Exercise

Subject lecturer: Prepared By:

Dr. Mahdi Qadr -Hawar Omer Kakaways
-Marden shakr Muhamm
- Nur dilshad

Outline :
1. Introduction
2. Effect of resistance training
3. Method of progressive resistance
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 4. Criterion measures
5. 1RM (one repetition maximum)
6. Laboratory situation
7. Number of workouts
8. Why is progressive resistance needed?
9. Example
10. Conclusion
11. Reference

Introduction

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Progressive resistance exercise (PRE) is a method of increasing the ability of muscles to
generate force. However, the effectiveness and safety of PRE for clients of physical
therapists are not well known. The purpose of this article is to review the evidence on
positive and negative effects of PRE as a physical therapy intervention. Electronic
databases were searched for systematic reviews on PRE and any relevant randomized
trials published after the last available review. The search yielded 18 systematic reviews
under major areas of physical therapy: cardiopulmonary, musculoskeletal,
neuromuscular, and gerontology. Across conditions, PRE was shown to improve the
ability to generate force, with moderate to large effect sizes that may carry over into an
improved ability to perform daily activities. Further research is needed to determine the
potential negative effects of PRE, how to maximize carryover into everyday activities,
and what effect, if any, PRE has on societal participation.

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 Effect of Resistance Training

Strength training stimulates a variety of positive neuromuscular adaptations  that

enhance both physical and mental health. Studies have shown that regular
progressive resistance training develops:

 The strength and size of muscles

 Increases bone mass from young male athletes to older women.
 In addition, resistance exercise might be even more beneficial than aerobic
exercise for fat loss.

Resistance exercise has produced beneficial outcomes for numerous physiological

factors, including

 Increased blood glucose utilization

 Reduced resting blood pressure
 Improved blood lipid profiles
 Enhanced vascular condition
 Increased gastrointestinal transit speed
 Increased bone mineral density
 Improved body composition.
 It also has been shown to improve function in post-coronary patients (by
offering greater development of muscular strength, endurance, and mass) and
chronic obstructive pulmonary disease (COPD) patients, as well as to reduce
discomfort in people with low back pain and arthritis. In addition, strength training
has proved effective for decreasing depression and for reducing the risk of metabolic
syndrome, cardiovascular disease, and premature all-cause mortality.

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Methods of Progressive Resistance

There are many ways to achieve progressive resistance:

1-Increase the weight you're lifting. Do the same number of reps and sets each week,
but increase the weights. You should only increase the weights by 2 percent to 10
percent of your RM load at a time. The RM load is the maximum amount of weight you
can lift one time. For example, if you can lift 50 pounds once, you should only increase
the weight you lift with each rep by 2 to 5 pounds each week. You don't want to overdo
the increase in the load.
2- Increase the number of reps. Use the same weight for each workout, but increase
the reps each week.
3- Decrease the number of reps. Intermediate to advanced trainers can lift heavier
weights for fewer reps, known as heavy loading. When doing heavy loading, you
increased the rest time between sets to three to five minutes.
4- Increase the number of sets. A typical weight training workout for people with the
goal to lose weight will involve about two to four sets of each exercise. If you're a
beginner, one set may be enough to build strength and endurance but, as you get
stronger, you'll want to eventually work your way up to two to four sets, resting about
20 seconds to 60 seconds, depending on how heavy you're lifting.
5 -shorten the rest between the sets. If you're doing straight sets, e.g. three sets of
squats or three sets of pushups, you'll typically have a rest of about 10 seconds to 60
seconds between sets. One way to challenge your body and increase intensity is to
shorten the rest between sets. If your form starts to suffer, increase the rest period or
drop a little weight.
6- Lengthen the time under tension. This is how long your muscle fibers are under
stress. Use the same weight and reps, but slow down the exercise. For example, one
count to lift the weight, three counts to lower the weight.

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Criterion Measures

There are various guidelines for prescribing progressive resistance exercise training
which is person-centered i.e based upon age and health conditions. Before involving
in any progressive resistance exercises, it is very important to undergo a pre-
participation health screening  to ensure exercise training can be safely initiated. It is
also important to do exercise testing used for diagnostic (i.e., identify abnormal
physiologic responses), prognostic (i.e., identify adverse events), and therapeutic
(i.e., gauge impact of a given intervention) purposes as well as for physical activity
counseling and to design a prescribed exercise programme.

1RM (One Repetition Maximum)

There is an inverse relationship between the amount of weight lifted and the number
of repetitions. So the strength training literature is often based on a percentage of
one-repetition maximum (1RM) in order to define the individualized intensity of
training to ensure a participant's safety.

1RM is the maximum amount of weight one can lift in a single repetition for a given
exercise.
1RM test is done of only one exercise per day or made at different times and
intervals higher than 24 hrs in order to avoid possible neural fatigue. For instance,
1RM testing on chest press, leg press, lat pull down, triceps push down, knee
extension, seated row, and biceps curl at different intervals. It is considered the gold
standard for assessing muscle strength in non-laboratory situations.

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Based on 1 RM intensity, resistance exercises are determined to ensure
safety( Haslam et al found intra-arterial blood pressures during weight lifting in
cardiac patients to be within a clinically acceptable range at 40% and 60% of 1 RM).
It can be either calculated directly using maximal testing or indirectly using
submaximal estimation methods. There are various formulas to calculate 1 RM via
submaximal estimation method. Submaximal estimation method is preferred as it is a
safer and quicker method for those participants with co-morbidities and beginners.

Number of Workouts

If you have been doing strength workouts two to three days per week for six months,
you have reached the intermediate level. You may want to add another day per week to
your workout schedule to challenge your body more.

Why Is Progressive Resistance Needed?

Your body adapts to exercise and needs to be constantly challenged in order to continue
to see muscle growth and improved levels of fitness. Doing the same thing day after day
may maintain the muscle and strength you have already built, but you may stop seeing
improvements. If your goal is to lose weight, it puts you at risk for a weight loss plateau,
that frustrating time when your weight loss starts to stall.

Example
Progressive resistance training in patients with shoulder

Objective
To assess pain, function, quality of life, and muscle strength in patients with shoulder
impingement syndrome who participated in muscle strengthening exercises.
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Methods
A total of 60 patients diagnosed with shoulder impingement syndrome were selected
from the clinics of the Federal University of São Paulo and randomly distributed into
experimental and control groups. Patients were evaluated regarding pain, function,
quality of life, muscle strength, and the number of antiinflammatory drugs and
analgesics taken. Patients then participated in the progressive resistance training
program for the musculature of the shoulder, which was held twice a week for 2 months,
while the control group remained on a waiting list.

Results
Sixty patients were randomly allocated to the experimental group (21 women and 9 men,
mean age 56.3 years) and control group (25 women and 5 men, mean age 54.8 years).
Patients from the experimental group showed an improvement from 4.2 cm to 2.4 cm on
a 10‐cm visual analog scale (P < 0.001) regarding pain at rest and from 7.4 cm to 5.2 cm
(P < 0.001) regarding pain during movement. Function went from 44.0 to 33.2 (P <
0.007) using the Disabilities of the Arm, Shoulder, and Hand assessment and domains
from the Short Form 36. There was a statistically significant difference in improvement
in pain and function between patients in the experimental group and those in the control
group (P < 0.05).

Conclusion
The progressive resistance training program for the musculature of the shoulder in
patients with shoulder impingement syndrome was effective in reducing pain and
improving function and quality of life.

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Reference :-

 https://www.researchgate.net/publication/7513946_Progressive_resistance_exercise_in_physical_therap
y_A_summary_of_systematic_reviews
 https://www.physio-pedia.com/Resistance_Exercises
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 https://pubmed.ncbi.nlm.nih.gov/?term=progressive+resistive+exercise&filter=simsearch3.fft
 https://www.sciencedirect.com/science/article/abs/pii/S0012369209606838
 https://www.verywellfit.com/progressive-resistance-1229835
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324332/#:~:text=Progressive%20resistance
%20training%20(PRT)%20is%20often%20used%20to%20increase%20muscle,free%20weights%2C
%20and%20elastic%20bands.
 https://onlinelibrary.wiley.com/doi/full/10.1002/art.23576


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