Introduction to exercise

1. INTRODUCTION TO
EXERCISE
Avanianban Chakkarapani

2. Therapeutic Exercise
 The exercise, which is needed for the treatment purpose, is called as
therapeutic exercise.
 Which are performed to come out from ones ailment or disease.
 The main goal of the therapeutic exercise is preparing or making the patient
independent or symptom-free movements.

3. TYPES OF MOVEMENTS
1. Active movement
i. Assisted
ii. Free
iii. Assisted and resisted
iv. Resisted.

4. TYPES OF MOVEMENTS
2. Passive movement
i. Relaxed passive movement
ii. Passive manual mobilization techniques
iii. Mobilization
iv. Manipulation
v. Stretching.

5. INDICATIONS AND GOALS FOR ROM

6. Passive ROM
Indications for PROM
 In the region where there is acute, inflamed tissue,
passive motion is beneficial.
 Inflammation after injury or surgery usually lasts 2 to 6
days.
 When a patient is not able to or not supposed to actively
move a segment or segments of the body, as when
comatose, paralyzed, or on complete bed rest, movement
is provided by an external source.

7. Passive ROM
Goals for PROM
 Maintain joint and connective tissue mobility
 Minimize the effects of the formation of contractures
 Maintain mechanical elasticity of muscle
 Assist circulation and vascular dynamics
 Enhance synovial movement for cartilage nutrition and
diffusion of materials in the joint
 Decrease or inhibit pain
 Assist with the healing process after injury or surgery
 To maintain the patient’s awareness of movement

8. Other Uses for PROM
 When a therapist is examining inert structures, PROM is
used to determine limitations of motion, to determine joint
stability, and to determine muscle and other soft tissue
elasticity.
 When a therapist is teaching an active exercise program,
PROM is used to demonstrate the desired motion.
 When a therapist is preparing a patient for stretching,
PROM is often used preceding the passive stretching
techniques.

9. Active ROM
Indications for AROM
 If a patient is able to contract the muscles actively and move a
segment with or without assistance,AROM is used.
 If a patient has weak musculature and is unable to move a
joint through the desired range (usually against gravity),A-
AROM is used.
 AROM can be used for aerobic conditioning programs
 During immobilization, AROM is used on the regions above
and below the immobilized segment to maintain the areas in
as normal a condition as possible and to prepare for new
activities, such as walking with crutches.

10. Active ROM
Goals for AROM
 Maintain physiological elasticity and
contractility of the participating muscles
 Provide sensory feedback from the contracting
muscles
 Provide a stimulus for bone and joint tissue
integrity
 Increase circulation and prevent thrombus
formation
 Develop coordination and motor skills for functional
activities

11. LIMITATIONS OF ROM EXERCISES

12. Limitations of Passive Motion
 True passive, relaxed ROM may be difficult to obtain
when muscle is innervated and the patient is conscious.
 Passive motion does not:
 Prevent muscle atrophy
 Increase strength or endurance
 Assist circulation to the extent that active, voluntary muscle
contraction
does
Limitations of Active ROM
 For strong muscles, active ROM does not maintain or
increase strength.
 It also does not develop skill or coordination except in the
movement

14. PRINCIPLES AND
PROCEDURES
FOR APPLYING ROM
TECHNIQUES

15. Examination, Evaluation, and
Treatment Planning
1. Examine and evaluate the patient’s impairments
and level of function, determine any precautions and
prognosis, and plan the intervention.
2. Determine the ability of the patient to participate in
the ROM activity and whether PROM,A-AROM, or
AROM can meet the immediate goals.
3. Determine the amount of motion that can be safely
applied for
the condition of the tissues and health of the
individual.

16. 4. Decide what patterns can best meet the goals. ROM
techniques may be performed in the
a. Anatomic planes of motion:frontal,sagittal,transverse
b.Muscle range of elongation:antagonistic to the line of pull of
the muscle
c. Combined patterns:diagonal motions or movements
that incorporate several planes of motion
d.Functional patterns:motions used in activities of daily living
(ADL)
5. Monitor the patient’s general condition and responses during
and after the examination and intervention; note any change in
vital signs, any change in the warmth and color of the
segment, and any change in the ROM, pain, or quality of
movement.

17. Patient Preparation
1. Communicate with the patient. Describe the plan and
method of intervention to meet the goals.
2. Free the region from restrictive clothing, linen, splints, and
dressings.
Drape the patient as necessary.
3. Position the patient in a comfortable position with
proper body alignment and stabilization but that also
allows you to move the segment through the
available ROM.
4. Position yourself so proper body mechanics can be used.

18. Application of Techniques
1.To control movement, grasp the extremity around the
joints. If the joints are painful, modify the grip, still providing
support necessary for control.
2.Support areas of poor structural integrity, such as a
hypermobile joint,
recent fracture site, or paralyzed limb segment.
3.Move the segment through its complete pain-free range to
the point of tissue resistance. Do not force beyond the
available range. If you force motion, it becomes a
stretching technique.
4.Perform the motions smoothly and rhythmically, with 5 to
10 repetitions.The number of repetitions depends on the

19. 1. During PROM the force for movement is external, being
provided by a therapist or mechanical device.When
appropriate, a patient may provide the force and be
taught to move the part with a normal extremity.
2. No active resistance or assistance is given by the
patient’s muscles that
cross the joint. If the muscles contract, it becomes an
active exercise.
3. The motion is carried out within the free ROM, that is,
the range that is available without forced motion or
pain.
Application of PROM

20. Application of AROM
1. Demonstrate the motion desired using PROM; then ask
the patient to perform the motion. Have your hands in
position to assist or guide the patient if needed.
2. Provide assistance only as needed for smooth
motion.When there is weakness, assistance may be
required only at the beginning or the end of the ROM, or
when the effect of gravity has the greatest moment arm
(torque).
3. The motion is performed within the available ROM.

21. ACTIVE MOVEMENTS
(ACTIVE—BY HIS /HER OWN)
Assisted Exercise:
• If the strength or the coordination of the muscle is insufficient to perform
an activity, the external force is utilized to compensate the lack.
• The muscle has the strength or endurance but is not sufficient to perform an
activity or control an action.

22. Types of Assisted Exercises

23. Active assistance
• The patient himself can assist with his opposite extremity to perform the
assisted exercise.
For example,
a. The opposite leg is used by the patient to increase the flexion movement of
the knee in high sitting.
• The main advantage is the patient, he himself only knows the pain limit and
availability of range of movement.
• So, that he can perform the exercise conveniently within the pain limit.

24. Passive assistance
It is classified into:
1. Manual assisted exercise
2. Mechanical assisted exercise.

25. Principles of Assisted Exercise
• Range
• Command
• Concentration
• Speed
• Repetition

26. Uses
• Increase the ROM of the joint.
• Increase the strength, power and the endurance of the muscles.
• It breaks the adhesion formation around the joint.
• It reduces the spasm of the muscles.
• It stretches the tightened soft tissue.
• It reminds the coordinated movement of the joint or a muscle.
• Increase the blood circulation and venous return to the joint and muscle.

27. Free Exercise
• There are two types of free exercises.
1. Localized
2. General body.

28. Characteristics of the Free Exercises
• Subjective
• Objective
• Example: Bending and touching the great toe with the middle finger. Here the
goal is set to touch the toe.

29. Uses
• Increases the joint range.
• Increases the muscle strength, power and endurance.
• Increases the neuromuscular coordination.
• Increases the circulation and venous drainage.
• Increases the relaxation of the muscle by the swinging movements and the pendular movements.
• Repeated active movement breaks the adhesion formation and elongates the shortened soft
tissues.
• Regulating the cardiorespiratory function, and the active exercise increases the respiratory and
venous return so that the O2 supply to muscles and blood circulation to the muscle increases.

30. Resisted Exercises
• Performed by opposing the mechanical or manual resistance is called as
resisted exercises.
• Types of Resisted Exercises
1. Manual
2. Mechanical

31. Manual Resisted
• These exercises can be operated by:
1. The therapist
2. Patient himself
3. Relatives and friends

32. Mechanical Resisted
• Mechanical resisted exercises can be performed by :
1. Weights
2. Springs
3. Pulleys
4. Water

33. Mechanical Resisted
• These resisted exercises can be stated when the muscle power is 2., i.e. from
gravity eliminated position.
• We can increase the resistance;
• By altering the leverage
• By increasing the weight
• By altering the speed
• By changing the duration.

34. Uses of Resisted Exercises
• Resisted exercises increase the strength of the muscle earlier.
• The weak muscle can be strengthened much earlier than the any other exercise
regimen.
• Can be started from the muscle power 2 onwards.
• Strength of the muscle is directly proportional to the tension created inside the
muscle.
• The resisted exercise can create the more amount of intramuscular tension.
Strength α Tension

35. Uses of Resisted Exercises
• Increases the endurance of the muscle.
• Powerful muscle contraction increases the blood flow of the muscle fiber
and it gets nutrition and the O2.
• Resisted exercise increases the muscular power.
• Power is related to the strength of the muscle and the speed.
Power = Force × Distance / Time

36. Progressive Resisted Exercise
• Repetition Maximum :
The maximum amount of the weight a person can lift throughout the range
of motion exactly 10 times.
3 types of progressive resisted exercise regimens are available.
1. DeLorme and Watkins
2. MacQueen
3. Zinovieff (Oxford technique).

37. De Lorme and Watkins
• 10 times with 1/2 10 RM.
• 10 times with 3/4 10 RM.
• 10 times with 10 RM.
Progression
i. 30 times weekly 4 sessions
ii. Every week 10 RM progression.

38. De Lorme and Watkins
• a. For example:
Consider 10RM—1 kg
First week.
1/2 of 10 RM—1/2 kg.
3/4 of 10 RM—3/4 kg
Full of 10 RM—1 kg
Exercise regimen is 10 times with 1/2 kg, 10 times with 3/4 kg, 10 times with 1 kg

39. De Lorme and Watkins
• Second week
Progression 10 RM
= 10 RM + 10 RM
= 1 kg +1 kg
= 2 kg
Exercise Regimen is
10 times with 1 kg
10 times with 11/2 kg
10 times with 2 kg

40. De Lorme and Watkins
• In this exercise regimen, the weight is increased, i.e. first with 1/2 kg
followed by 3/4 kg and 1 kg.
• Each and every session the patient has to lift the above said three types of
weights 10 times each.
• So, that daily 30 times lifting been done.

41. De Lorme and Watkins
• In each and every session 30 times the exercise should be done with 2
breaks by the patient. i.e. 10 times 1/2 10 RM (1/2 kg) → Break → 10 times
with 3/4 10 RM (3/4 kg) → Break→ 10 times 10 RM (1 kg)
• Weekly 4 sessions the exercise has to be practiced.
For example:
Monday, Wednesday, Friday, Sunday (i.e. every alternative day’s) exercise has to
be practiced and remaining days, i.e. Tuesday, Thursday, Saturday given rest.

42. Thank you