Ther Ex 2

Front 1

Verschuren et al.

Back 1

Resistance training is disputed for kids w/ CP • 4 RCT's. All 4 meet guidelines for frequency (2-3). 2 met NSCA guidelines for intensity. None met guidelines for duration (8-20 weeks is guidelines; these were 5-12 weeks)

Front 2

article take home message

Back 2

RECOMMENDATIONS FOR CHILDREN W/ CP = RECOMMENDATIONS FOR ALL.Will have a reduce capability so the form of exercise may be different but with same time, intensity and days

Front 3

resistive exercise

Back 3

any training that uses a resistance to the force of muscular contraction. Needs to be task specific for children; they do not transfer skills very well due to motor learning

Front 4

modes of RT

Back 4

Weight training. Resistive bands/tubing. Hydrotherapy. Functional exercises. Isometrics.Plyometrics

Front 5

RT benefits

Back 5

Improve sports performance. Prevents injury- trains neuromuscular system to increase response, trains mm to increase BF and force. Rehab. Enhances general health- cardiovascular fitness, body comp, bone density, blood lipid profiles, mental health. Children will not hypertrophy until they have androgens

Front 6

RT kids pops

Back 6

All abilities. 7-18 years old. Pre vs post puberty guidelines and expected outcomes are different. Train more like adults post puberty

Front 7

AAP med eval for

Back 7

hypertension, chemo w/ anthracyclines, cardiomyopathy, moderate to severe pulmonary hypertension, Marfan syndrome (affects all CT, weak), seizure disorder

Front 8

AAP safety

Back 8

Avoid power lifting, body building, and maximal lifts until done growing- Injury to the growth plates; break off a piece. Educated about health risks of using performance enhancing drugs. Resistive tubing and free weights more appropriate than weight machines

Front 9

AAP pre req

Back 9

Address all major muscle groups, no isolation. Stop w/ any sign of illness or injury; evaluated fully. Instructors should have certification. Proper technique and strict supervision are critical

Front 10

AAP intensity

Back 10

Use low resistance until proper technique is perfected. Increase load in 10% increments after 8-15 repetitions can be performed

Front 11

AAP duration/frequency

Back 11

20-30 min. 5-10 minute warm up and cool down. 2-3x/w on non-consecutive days. Couple w/ aerobic conditioning if general health benefits are the goal. 8 to 10 weeks

Front 12

NSCA general guidelines

Back 12

instruction/supervision. env safe. 5-10m warm-up. Begin light loads, focus on correct technique. 1-3 sets of 6-15 reps, variety of UE/ LE exercises. rest 1m b/s sets. increase 5-10%/w as strength does. cool w/ calisthetics & stretch. Perceived exertion. 2-3x/w w/ rest day. Use workout logs, vary program. nutrition, hydration, sleep. Edu parents on proper support

Front 13

perceived training

Back 13

Appropriate for 10 and up. HR for others, physical cues- red face, sweaty, fatigue

Front 14

NCSA vs AAP

Back 14

rest period 1m b/n sets. More than 1 set. Use perceived exertion

Front 15

NCSA power training

Back 15

(not max lifts, low weights, more about motor learning and not hypertrophy) 1-3 sets ○ 3-6 reps

Front 16

NCSA strength training

Back 16

(start w/ this and move to power training)1-3 sets6-15 reps

Front 17

mechanisms of improvement in strength for kids

Back 17

1. Increased neuronal control (neuromuscular learning); most of changes. Increased firing rate, # neurons firing, improved motor unit recruitment & coordination. 2.Intrinsic m adaptation. hypertrophy small 3.Maturation change; does exercise or growth increase strength. 24h change. M & F respond similarly to RTF stronger earlier on due to earlier puberty

Front 18

how should kids do RT

Back 18

benefit the most from practicing and perfecting motor skills. RT can improve m performance and coordination of m groups. Training adaptations are specific to: mov't pattern and speed, the contraction type and forc.

Front 19

blocked periodization

Back 19

to continue to adapt we need variability, increase weight, frequency, sets, time. A block is usually several weeks; needs to change after a few and throughout the yea. Individualization, rate of change in body, specificity, intensity, regularity

Front 20

Expected motor improvements w/ RT

Back 20

Mod effect on running speed (.53 effect size)

Mod effect on jumping distance or height (.54)

Large effect on throwing distance & speed (.99)

Small effect on improving strength (.38)

Front 21

motor learning principles w/ children

Back 21

Short, precise, verbal cues. Children require more feedback. longer periods of practice. Thousands of reps Ex. need to walk 13m before able to walk by themselves. Feedback should be gradually reduced. Ask to reflect on their performance better than adjusting their body position, demo, or lengthy explanations.

Front 22

implementing a RT program

Back 22

establish a goal. choose a type of RT. plan training program. monitor progress and outcomes

Front 23

choose a type of RT

Back 23

Specific to the mov't pattern and mov't speed. The contraction type and force. The secondary impairments, limitations, and restrictions of the child

Front 24

plan the training program

Back 24

Frequency. Duration. Intensity (amount of resistance) and volume. Rest intervals. Choice and order of exercises. Method of increasing exercise load. Warm-up and cool-down. Program variation. Safety

Front 25

monitor progress and outcomes

Back 25

Develop a workout log. Define expected outcomes. Measurement of expected outcomes and goal. Body structure/function

Front 26

PT role in infection management

Back 26

Inspect before/after exercise. Redness, tissue necrosis Palpate for tenderness and edema. Note signs of drainage. Check mobility as it heals. Education on wound care

Front 27

maximum protect phase

Back 27

Decrease inflammation and pain, protect tissue, education, start ROM if allowed (PROM, AAROM, or AROM). Mm setting to prevent atrophy, relaxation, TENS. Ranges from a few days to 6 weeks

Front 28

moderate protection phase

Back 28

No pain at rest and some no/low pain ROM. Restore ROM and arthrokinematics, improve neuromuscular control and stability, gradually increase strength. Begins at 4-6 weeks and lasts 4-6 weeks

Front 29

minimum protect/return to function phase

Back 29

Full or almost full pain free ROM w/ a stable capsule if involved. Restore functional strength and increase functional activities. Begins 6-12 weeks and last 6m and up to a year

Front 30

DVT risks

Back 30

Total knee/hip, Post op/fx immobilization, Bed rest, Sedentary life/sitting during long travel, Trauma to venous vessels, Limb paralysis, Active malignancy past 6m, Hx of it, Advanced age, Obesity, CHF, oral contraceptives, Pregnancy

Front 31

ways to reduce DVT

Back 31

Anticoagulants, Elevating legs, No prolonged sitting, Ambulate ASAP, Pumping exercises, Compression stockings, Sequential compression units

Front 32

open sx

Back 32

Deep cut so operation field is fully visible Extensive disturbance of soft tissues. Through skin, fascia, mm, and joint capsule. Lengthy rehab and healing

Front 33

arthroscopic sx

Back 33

Outpatient more often. Several small incisions in skin, mm, and joint capsule for insertion of camera and tools. Minimal disturbance of soft tissues.Rehab quicker

Front 34

why repair a tendon quick

Back 34

Otherwise the tendon will retract making the procedure harder to do. Within a few days

Front 35

cemented

Back 35

uses an acrylic based cement, tends to break down, causes loosening and pain. Used in older, sedentary patients

Front 36

uncemented

Back 36

Less likely to loosen. Younger and more active get it. Biological fixation- microscopic ingrowth of bone into porous coated prosthetic surface.

Macrointerlock- b/n a nonporous component and bone w/ a bioactive compound applied to the component to improve osseous integration. Press fit- tight fit b/n bone and implant. Screws, bolts, nails

Front 37

hybrid

Back 37

noncemented component of one joint surface and a cemented component on the other

Front 38

arthrodesis

Back 38

fusion of joint; keep function w/ reducing pain

Front 39

osteotomy

Back 39

cutting and realigning of bone; done with arthritis, improperly formed hip

Front 40

open reduction internal fixation ORIF

Back 40

fx came out of skin, use a wire, plate, screw to hold the fx together

Front 41

epicondylitis

Back 41

Discontinue aggravating activity. Isometric. Concentric. Eccentric

Front 42

lateral epicondylitis

Back 42

Isometrics: start in more elbow flex and then do isometrics. Some pain good (3/4 out of 10). As it gets better more elbow ext and wrist flexion

Concentric: bend elbow and ext wrist

Eccentric: slowly move elbow ext & wrist flexion Add weight. Return to function depends on activity. Many in manual labor

Front 43

medial epicondylitis

Back 43

Isometrics: start in more elbow ext and then do isometrics. As it gets better more elbow flex and wrist ext

Concentric: elbow ext and wrist flex

Eccentric: slowly move into elbow flex and wrist ext. Return to function depends on activity

Front 44

D1 flexion

Back 44

GH flex, add, ER

Elbow flex

Supination

Wrist flex, radial deviation

Finger flexion

Front 45

D2 flexion

Back 45

GH flex, abd, ER

Elbow ext

Supination

Wrist ext and RD

Finger ext

Front 46

stress urinary incontenence

Back 46

Involuntary leakage of urine on effort or exertion, or on sneezing or coughing. Correlated with parity (# of children had), age, overweight. Exercise- Improve support of bladder and urethra. Improve closure of urethra. well accepted evidence for, but how many, position, hold?

Front 47

Urge urinary incontinence

Back 47

Involuntary leakage accompanied by or immediately preceded by urgency

Front 48

overactive bladder

Back 48

Urinary urgency, with or without urinary incontinence, usually accompanied by frequency =/> than 8/day, and nocturia

Front 49

Post-prostatectomy incontinence

Back 49

Incontinence occurring after prostate surgery, likely caused by bladder dysfunction or urethral sphincter dysfunction due to muscle or nerve injury.

Front 50

Fecal incontinence

Back 50

Involuntary passage of feces

Front 51

pelvic organ prolapse

Back 51

Abnormal descent of pelvic organs (uterine prolapse, cystocele, rectocele)

Front 52

Peripartum low back and pelvic girdle pain

Back 52

Pain in the low back or pelvic girdle occurring during or after pregnancy

Front 53

high risk pregnancy

Back 53

Pregnancy in which the mother, fetus, or newborn is at risk of increased morbidity or mortality before, during, or after pregnancy.

Front 54

Diastasis recti abdominus

Back 54

Separation of the two sides of the rectus abdominus at the linea alba with a widening of the linea alba greater than 2 cm

Front 55

Peripartum incontinence

Back 55

Urinary incontinence during or after pregnancy

Front 56

Cesarean birth

Back 56

Surgical delivery of baby through wall of uterus instead of through vagina

Front 57

Pelvic pain syndromes

Back 57

Pain in the pelvic floor musculature or surrounding structures; may be associated with a variety of diagnoses.

Front 58

superficial pelvic layer

Back 58

Urogenital triangle. Superficial transverse perineal m. Bulbo- and ischiocavernosus mm. External anal sphincter. Actions: support, sexual, sphincteric

Front 59

middle layer of pelvic layer- urogenital diaphragm

Back 59

Compressor urethrae, urethrovag sphincter, deep transverse perineal. Innervation: Dorsal n. of penis/clitoris (branch of pudendal, S2-4). Function: Sphincteric (close urethra).

Front 60

deep layer- pelvic diaphragm

Back 60

Levator ani- Puborectalis. Pubococcygeus. Iliococcygeus. Coccygeus (moves tail side to side) Function: support (biggest area to work on), sexual

Front 61

accessory mm of pelvic floor

Back 61

piriformis and obturator internus. Relevance: Proximity- hip and pelvic floor issues are largely related. Innervation levels. Interplay between hip, l/s, pelvic floor.

Front 62

causes of SUI

Back 62

Urethral hypermobility- females move more ant/post, less passive tissue resistance due to shorter urethra. Weak muscles- vaginal birth. Chronic coughing/straining. Decreased estrogen- menopause, affects urethral tissue.

Front 63

PERFECT model

Back 63

Exercise prescription based on patient’s strength and endurance

P = power (MMT)

E = endurance in seconds (type 1); do these first

R = repetitions of endurance hold (type 1)

F = fast contractions (type 2 fibers) PERFECT score of 3/6/5/10

Front 64

Kari bo approach

Back 64

SUI. Based on exercise physiology and principles of strength and conditioning. 8-12 reps of 6-8 sec holds, multiple positions, followed by 3-4 maximum quick contractions, 3x/week. less individualized, doesn't help if really weak

Front 65

PERFECT rationale

Back 65

Levator ani are 70% type I and 30% type II. E and R components of PERFECT address type I.F component addresses type II.

Front 66

pros and cons perfect and kari bo

Back 66

PERFECT Pro: Individualized Con: Does not follow standardized principles of strengthening programs

Bo Pro: follows established strengthening principles Con: not as individualized

Front 67

perfect vs kari bo

Back 67

No direct comparisons. Recommendations for ex prescription- Consider fiber type, Overload (cones vs increasing sets and reps and decreasing rest time), Position, Neural adaptation vs hypertrophy,Co-contraction of transversus abdominus? It requires hypertrophy!!

Front 68

TA and incontinence

Back 68

PFM contractions and TrA contractions normally occur together, many w/ incontinence lose this ability. Research: Unclear whether adding TrA to training program improves outcome. May help if cannot get a contraction

Front 69

causes of OAB and UUI

Back 69

Diet, bad bladder habits, genetics

Front 70

treatment for UUI and OAB

Back 70

Behavioral modification. Exercise. Behavior modification- Avoid “just in case voiding.” Establish normal voiding interval- q 2-4 hours during the day, 0-1x/night. Recognize contributing dietary factors (OAB)- Caffeine. Artificial sweeteners.Acidic foods and beverages.

Front 71

exercises for UUI and OAB

Back 71

Quick pelvic floor m. contractions- Cause reflex inhibition of detrusor decreasing feelings of urgency. Practice: deep breath, relax, contractions. Endurance exercise prn. E stim- Setting causes reflex inhibition of detrusor.

Front 72

post prostatectomy UI

Back 72

Caused by surgery for prostate cancer. 8-56% of men treated have UI 1 year post. Recommendations from research: Ensure correct contraction, Use estim prn

Front 73

bowel function

Back 73

Normal function: 1. Stool enters descending colon. Contracted PR (puborectalis) “kinks” colon; EAS and IAS both active a no voiding 2. When ready, PR, EAS, and IAS all relax and voiding occurs Probs: 1. No “unkinking” = constipation 2. Inadequate contraction of any m. = incontinence of feces or gas

Front 74

fecal incontinence

Back 74

Neural considerations- EAS is voluntary. Inferior anal n. S2-4, can rehab. IAS is involuntary. Pelvic splanchnic nn. S2-4. Tear during childbirth- grade 4 through IAS, incontinent for a while, cannot rehab, build up other mm

Front 75

Cystocele and urethrocele

Back 75

anterior defect. Bladder or urethra bulges into vagina

Front 76

rectocele

Back 76

posterior defect. Rectum bulges into vagina

Front 77

uterine prolapse

Back 77

uterus drops down into vagina. more common w/ a straighter uterus

Front 78

Pelvic floor mm strengthening for prolapse

Back 78

PT avoid to sx. Exercise beneficial even if sx chosen. Avoid Valsalva – extra important! Gravity-assisted PFM exs- if bad; elevate pelvis in supine. Evidence: 1:1 PT decreases POP s/s (NNT of 3). Changes sustained 2 years later

Front 79

biofeedback for prolapse

Back 79

Types: Intravaginal (or rectal) sensor. Ultrasound imaging. Tactile feedback. Useful for people with difficulty learning how to contract PFMs.

Front 80

vaginal weights for prolapse

Back 80

Weighted device placed in vagina above levator ani. Promote endurance training.Progress by increasing activity level (walking vs exercise), weight, duration of use. Not used as much- functional?

Front 81

estim for prolapse

Back 81

Indicated: very limited PFM contraction ability. Similar parameters and contraindications as estim for other mm, + contraindicated with active infection, pregnancy. For women and men. Also used for urinary urgency.

Front 82

posture changes due to forward shift of center of gravity due to prego

Back 82

Forward head.

Rounded shoulders.

Increased lumbar lordosis. Changes frequently lead to pain- Prevalence of LBP in pregnancy is 47-82% (Kalus, Wang)

Front 83

posture exercises for prego

Back 83

Neck strengthening/stretching.

Mid trapezius/rhomboid strengthening.

Pectoralis stretching.

Low back stretch.

Special attention to avoiding LOB. Encourage maintenance in post-partum period.

Front 84

Causes of peripartum LBP

Back 84

Altered load due to weight gain, Change in COG, Decreased ligamentous stability due to hormonal changes.

Do stabilization exercises work?

Front 85

research on postpartum LBP

Back 85

Exercise with emphasis on global musculature not helpful (Mens ’00). Emphasis on local mm. followed by exercise for global mm. decreased pain (Stuge ’04)

Front 86

aerobic exercise guidelines during prego

Back 86

Healthy pregnant and postpartum women:150 m/w moderate intensity. 20-30 m/d most/all days. Okay to continue “vigorous” exercise, provided health is maintained. Upper limit not established; use pre-pregnancy activities as guideline

Front 87

aerobic exercise effects on fetus

Back 87

Exercise in early and mid pregnancy stimulates placental growth (Clapp 2006). Continuing to run during pregnancy increases placental volume

Front 88

aerobic exercise safety and prego

Back 88

Safe and healthy to continue pre-preg exercise level, even very intense exercise, unless joint pain or incontinence develops. Safe to start low-level exercise program even if inactive before. Start slowly; monitor closely. HR moitoring not good- to variable, RPE 13-14 on Borg 6-20 scale

Front 89

aerobic exercise and effects on the woman

Back 89

improved long-term fitness into perimenopausal period. Decreased gestational diabetes risk. Decreased rate of C section. Improved fitness; smaller babies (maybe). Decreased postpartum recovery time

Front 90

excessive weight gain and prego

Back 90

Excessive gain correlated w/ HTN, post-partum overweight, delivery complications (C-section), overweight babies. Only need 300 cal/day extra. Guidelines for weight gain:28-40# if underweight 25-35# if normal weight 15-25# if overweight 11-20# if obese

Front 91

pyshiological and morpholigal changes in prgo

Back 91

Resting HR ↑

Stroke volume and blood volume ↑

Change in COG

Change in weight

Front 92

relative contraindications for aerobic exercise during prego

Back 92

Anemia. Cardiac arrhythmia. Chronic bronchitis. Poorly controlled type 1 diabetes. Extreme obesity or extreme underweight. Hx of extremely sedentary lifestyle. Intrauterine growth restriction. Poorly controlled HTN. Orthopedic limitations. Poorly controlled seizure or thyroid dz. Heavy smoker

Front 93

absoulte contraindications to aerobic exercise in prego

Back 93

Severe heart or lung dz. Incompetent cervix or cerclage. Pre-term labor. Multiple gestation at risk for pre-term labor. Persistent 2nd or 3rd trimester bleeding. Placenta previa after 26w. Premature rupture of membranes. Prego induced HTN or pre-eclampsia. Severe anemia

Front 94

safe exercise for prego woman

Back 94

Walking Swimming Stationary cycling Aerobics Yoga* Pilates Running or jogging* Strength training*

*Running and strength training if done previously. Yoga: avoid hypotensive positions and dec. venous return

Front 95

exercise to avoid during prego

Back 95

Contact sports (boxing, soccer, basketball)High fall risk sports (skiing, surfing, off-road cycling, gymnastics, horses)Scuba divingSky diving“hot yoga”

Front 96

high risk pregnancy

Back 96

mother, fetus, or newborn is at risk or may be at risk of increased morbidity or mortality before, during, or after pregnancy

causes: preterm labor, multiples, vaginal bleeding, placenta previa, incompetent cervix, hx of complications

Front 97

bed rest

Back 97

should not be routinely recommended- not effective prevention for preterm birth for high risk pregnancy

Front 98

guidelines for bed rest exercises

Back 98

Several exercises 2-4x/day. Position: semi-reclined, sidelying, or ¾ sidelying. Avoid increases in IAP- exhale with exertion. Examples: Backward shoulder rolls. Ankle pumps. Hip ab/adductionPNF patterns. Abdominal drawing in. Cervical ROM. Heel slides. Quadriceps and gluteal setsPF contractions.

Front 99

diastasis recti abdominus

Back 99

Separation of 2 sides of recti > 2 cm. Due to physical stress + laxity from hormones. Decreased abdominal musculature capacity leads to probs w/ posture, trunk stability and motion, urination and defecation. Exercises to correct:Approximate 2 sides of rectus w/ hands or w/ sheet, Perform slight posterior pelvic tilt and gently exhale while lifting head

Front 100

external support and prego

Back 100

Helps w/ compressed pelvic joints. Lifts abdomen. Comfortable; many women will wear it at night. While strength will not be bad the changes often happen to slow and this can help. SI pain, abdominal pain, sleep better, can continue to exercise longer

Front 101

peripartum UI

Back 101

Prevalence of UI in pregnancy: 40-50%. 34% continent during pregnancy will develop postpartum UI. Exercise during pregnancy helps prevent UI in late pregnancyExercise in early postpartum period for women with UI decreases UI at 1 year

Front 102

recommendations for exercise and peripartum UI

Back 102

Ensure correct contraction. Perform 3x8 submax contractions held 8-10s, followed by 3-4 fast contr, 2x/d throughout prego. Perform exercises in multiple positions. Influence of episiotomy on muscle recovery. Cut through, or lateral to, perineal body

Front 103

episiotomy for peripartum UI

Back 103

Immediately postpartum: No difference, doesn't prevent perineal laceration, pain levels, pain med use. Long-term: Does not prevent incontinence, reduce incidence of impaired sexual function. Pain w/ intercourse more common among women w/ episiotomy. (Hartmann 2005)

Front 104

C section

Back 104

Rate in US: Approx. 1/3 of all deliveriesRange: 3% - 70%Major abdominal surgery affects muscles of abdomen. Consider effect on lifting ability.

Front 105

categories of C section

Back 105

Elective/Planned: Less physical stress on pelvic joints and pelvic floor because not pushing.Many OR hospitals banned elective sections in 2011

Unplanned: Higher strain on pelvic floor mm. and pelvic joints, especially in certain positions

Front 106

C section exercises

Back 106

Diaphragmatic breathing and huffing. Ankle pumps. Quads and gluteal iso. Bridging w/ abdominal drawing in. Walking short distances. Pelvic floor contractions. 10 reps several times per day. Can begin day of sx. Avoid increases in IAP until uterus is healed (6-8 weeks)Lifting baby??

Front 107

pelvic pain syndrome

Back 107

Variety of conditions affecting tissues around pelvic floor musculature- Endometriosis, Pelvic organ prolapse, Fibromyalgia, IBS, PID, PCOS, Vaginismus, vulvodynia, dyspareunia. Chronic Pelvic Pain Syndrome- Interstitial cystitis/painful bladder syndrome. Chronic prostatitis

Front 108

PT and pelvic pain syndrome

Back 108

Address musculoskeletal dysfunction associated with pathology. Does not cure pathology. Examples of musculoskeletal dysfunction:Deconditioning due to limited activity, Adaptive shortening of external and internal musculature

Front 109

pelvic pain tx

Back 109

General conditioning: Cycling and high-impact may aggravate PFMs, Walking and low-impact: better. Stretching peri-pelvic musculature. Strenghtening- Hamstrings. Hip add, flexors, rotators. Exercise for internal musculature: Stretching w/ dilators, EMG, General relaxation techniques, Strengthening prn. Multi modal tx

Front 110

PT goals and C section exercises

Back 110

Goals:Decrease effects of anesthesia. Facilitate m. recovery while protecting incision. Minimal research; recommendations are from general recommendations post-abd surgery

Front 111

EMG and pelvic pain syndrome

Back 111

pelvic floor tension myalgia may be a contributing factor to CPPS; maximum muscle contraction can promote maximal muscle relaxation. Electrodes placed on perineum, vaginally, or rectally. Max contraction followed by max relax

Front 112

exercise and sensitive NS

Back 112

Chronic pain causes central sensitization. Complex interaction of tissue injury and patient beliefs about injury. Can result in decreased inhibition of pain, and ultimately increased disability and decreased functioning. Exercises to promote sensory awareness, such as pelvic tilts and guided sensory training in various postures. Deep breathing, cardio, yoga

Front 113

function

Back 113

Those activities identified by an individual as essential to support physical, social and psychological well-being and to create a personal sense of meaningful living

Front 114

functional testing

Back 114

Assess pts ability to move through and control 3 planes of mov't. quantitative and qualitative data. Used to determine if pt. can participate in their work/sport/activity safely w/o functional limitations. Isokinetic strength does not correlate strongly w/ functional tasks. Monitor progress, ID dysfunction, progress tx, reduce re-injury risk (ACL 15x retear, 30% another reinjury 1y)

Front 115

safe functional test selection

Back 115

Tissue healing times. Do they have the strength capacity the test? proper warm up Avoid testing in fatigued state. However many injuries are happening in a fatigued state; some train in a fatigued state on balance and stability.least fatiguing/high skill test before endurance or strength testing. 5 mins rest b/n tests to restore phosphagen energy system

Front 116

ATP-PC energy source phosphagen

Back 116

20-30s. work:rest ratio = 1:12 to 1:20 for work at 90-100%1:3-1:5 for work at 75-90%

Front 117

Phosphagens and anaerobic glycolosis energy source

Back 117

30-90s. work:rest ratio 1:3 to 1:4

Front 118

Anerobic glycolosis and aerobic metabolism energy source

Back 118

90-180s. Work:rest ratio 1:1 to 1:3

Front 119

Oxygen (aerobic metabolism) energy source

Back 119

after 2nd min. work:rest ratio 1:1 long duration less intensity1:3 short duration higher intensity

Front 120

selecting a functional test

Back 120

safety, relevant to them, specificity to their sport and injury hx, validity, accuracy, practicality

Front 121

criteria for functional testing

Back 121

at least 75% of the uninvolved side strength. ROM w/in 10% of uninvolved side. Pain <3/10 on VAS. Rules for how you test: Be consistent on how you test for the same client. Avoid unwanted compensation. Allow 3 practice tests but remember that practice makes perfect- no practice at home

Front 122

trunk functional mov'ts

Back 122

prone bridge ( Female 51.2 +19.9 Male 92.9 +29.3), side bridge (L 85 +36 R 81+36), back extensor enurance test (113.86s +/- 45.59s).

Front 123

LE functional tests

Back 123

single leg squat, star excursion balance test, single leg hop, t test.

Front 124

single leg squat

Back 124

assess strength, balance and neuromuscular control on single leg. No stats on the test and somewhat subjective. Have pt stand on 1 leg w/o shoes and hands on hips- Instructed to squat down as far as possible bending at the hip knee and ankle. Watch for compensation in frontal plane and sagittal plane

Front 125

star test

Back 125

Used to determine balance and postural control. Pt is asked to reach as far as possible in 8 different directions at 45 degree increments while maintaining balance on fixed stance foot. Most research ant, med-ant, med, med-post. >4cm R/L diff 2.5x more likely LE injury. chronic ankle instability- sig shorter diff in

Front 126

single leg hop

Back 126

assess knee function. side to side comparison. Progression. any LE injury rehab for progressing. in conjunction w/ other tests (figure 8, up down test, side hop). Ensure proper warm up/education and trial sessions (25%, 50%, 75% efforts) Jump as far, hold 2s, mark heel. high correlation to knee extensor torque. <88% at 6m ACLR less success long term

Front 127

t test

Back 127

Pt sprints 10 yd forward touches R hand to base of cone. Side shuffle L 5 yd and touch base of cone w/ L hand. Side shuffle R 10 yd and touch base of cone w/ R hand. Side shuffle L 5 yd and touch base of cone w/ L hand. Backpedal 10 yd. Do 2x, take best time Rest 1-2 min b/n trials Stats Tests speed, agility and postural control in all planes of movement

Front 128

UE functional tests

Back 128

modified pull up, single arm shot put, shot put CKCU Test, functional throwing performance index, softball throw for distance

Front 129

modified pull up

Back 129

Get arms parallel to floor- do not need to get chin to it Max reps or # in 15s. Best predictor of performance for softball throw for distanc. Normatives but need more data. men 9-17 female 4-9

Front 130

single arm shot put

Back 130

Tests power and strength of upper extremity Patients sits in chair with legs out straight Patient ‘puts’ a 2.72kg shot put with dominant hand25%, 50%, 75%, 100% effort. high reliability. normative data

Front 131

shot put

Back 131

Patients seated against wall with knees at 90 degrees Throws a 10# shot put with both hands from the chest Reliability improves with controlling angle of release. Gillespie and Keenum 1987 Reliability r=.95. Johnson and Nelson 1979Significant correlation with bench press powe

Front 132

CKCU Test

Back 132

measure strength, endurance and CKC stability in the UE. Pt on knees for females and toes for males w/ hands just inside the tape lines which are 36 in apart. Instruct pt to move as quickly as possible and cross over touching each line alternatingly. Count # of touches in 15 s. Normative 18-20. reliable

Front 133

progression?? when

Back 133

Perhaps when they can perform at 85-90% of the uninvolved side or as compared to normative data

Front 134

selelct functional mov't assessment

Back 134

Algorithm to assess and classify movement and help direct the practitioner in manual techniques and exercise prescription

Front 135

regional interdependence

Back 135

concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint.

Front 136

injury causes altered motor control FSMA

Back 136

Previous injury is the best indicator for future injuryAnkle instability star excursion testingEMG studies for TA and LBP. regional interdependence

Front 137

crossed syndrome

Back 137

Upper- inhibited deep neck flexors, lower traps and SA; and facilitated upper trap and levator, SCM, pecs

Lower- inhibited abs, glut min/max/med, facilitated RF, iliopsoas, thoracolumbar extensors

Front 138

FSMA neurodevelopment

Back 138

Patterns not individual muscle activationBreathing, rolling, prone on elbows, crawling, tripod, kneeling, standing, walking, running. Make sure the patterns are all correct, sequencing correctly

Front 139

top tier assessment gross mov'ts

Back 139

Active Cervical Flexion Active Cervical ExtensionActive Cervical Rotation/SidebendUpper Extremity pattern 1&2 (ER overhead and IR behind back)Multi-segmental Flexion Multi-segmental ExtensionMulti-segmental RotationSLSDynamic Leg swingOverhead squat

Front 140

top tier assessment provaction tests

Back 140

Impingement sign- pull arm across body.

Horizontal Adduction- hand to opp GH and lift up. Pain w/ either?

Front 141

SFMA scoring

Back 141

Functional Non-painful (FN)Functional Painful (FP)Dysfunctional Painful (DP)Dysfunctional Non-painful (DN).

No coachingObserve from the front, side and backIs there pain?

Front 142

SFMA active cervical flexion

Back 142

Should be able to touch chin to sternum w/ mouth closed

Front 143

SFMA active cervical ext

Back 143

Look to ceiling; about 10 degrees from parallel to ground

Front 144

SFMA active cervical rotation/sidebend

Back 144

Chin to collarbone, mouth closedNo shoulder elevation- usually suttle

Front 145

SFMA UE pattern 1 and 2

Back 145

Up and over, touch opp shoulder blade- Down and up to touch shoulder blade- inferior angleWatch for lordosis, hinge at TL junction

Front 146

SFMA multi segment flexion

Back 146

Touch toes w/ no knee flexionTL junction over toesSacral angle >79 degrees

Front 147

SFMA multisegment ext

Back 147

Arms over head, arms in line w/ ears bend backASIS ant to toesSpine of scap post to heelsUniform spinal curve

Front 148

SFMA multisegment rotation

Back 148

Twist all the way to each sideStand directly behindShould see opp shoulder, no loss of height or vertical deviation, 50 degrees rotation at pelvis and shoulders

Front 149

SFMA SLS

Back 149

1 knee up to 90 and hold 10 seconds, no handsEach side, then do each side with eyes closedNo change in foot position, no loss of height, no arm flailing

Front 150

SFMA dynamic leg sign

Back 150

Stand on one side and swing other legLook for trendelberg, excessive pelvic rotation, leaning. No change in foot position, no loss of height, no arm flailing

Front 151

SFMA overhead squat

Back 151

Using a broom/stickFeet GH apart, arms over head and out to side, elbows at 90 then reach upSquat, keep heels on groundHip need to break 90, dowel remain up, tibia in line w/ trunk, toes do not rotate out. Do last. If anything in previous tests where no functional then this will not be functional.

Front 152

TED

Back 152

Mobility. tissue extensibility dysfunction. Crosses multiple joints Neural tension Muscle shortening (HS tightness) Active/Passive muscle insufficiency

Front 153

JMD

Back 153

Mobility. joint mobility disfunction. At 1 joint. OA. Fusion. Adhesive Capsulitis. Dislocation/Subluxation

Front 154

mobility tx

Back 154

Joint mobilization SNAGS/NAGS, MWM Taping Active Release Techniques Stretching Static/dynamic

Front 155

stability

Back 155

Static and Dynamic. Motor Control Dysfunction- HS dominance. Apical breathing. Prime mover compensation (hip flexors)

Front 156

stability tx

Back 156

Lumbar stabilization/cervical stabilization exercise. Taping/Bracing/Orthotics. Balance. Perturbations. Muscle firing sequencing. Hip stabilization exercise. Scapular stabilization Open chain/closed chain

Front 157

SFMA breakouts

Back 157

Recommend to start with dysfunctioal nonpainful mov't patterns. Algorithm tests all regions involved in the movement to isolate the limitations. Active vs passive. Weight-bearing vs non weight-bearing. Unilateral vs bilateralSingle joint vs multiple joints

Front 158

multisegment flexion breakout

Back 158

Single leg forward bendLong sitting forward bendActive Straight leg raise testPassive Straight leg raise testProne Rocking (Childs pose)Supine bilateral knees to chestRolling breakout

Front 159

rolling breakouts

Back 159

Legs are 'paralyzed'-Use the are opp of side you are rolling to to roll you to your stomach.Slow and controlled.Gh felx, H add, obliques.Use foam roll to prop up if they cannot get it.Then arms are paralyzed and only use opp leg to turn.Supine to prone UE lead.Supine to prone LE lead.Prone to supine UE lead.Prone to supine LE lead.

Front 160

mobility then stability

Back 160

reset, reinforce, reload. corrective exercises are in 4x4 model

Front 161

reset

Back 161

Manual techniquesImproved motor control with joint compression (PNF)Address chemical response (inflammation)

Front 162

reinforce

Back 162

Taping. Ergonomic changes. Orthotic. Bracing. Posture. Avoiding aggravating factors

Front 163

reload

Back 163

Corrective exerciseStretching/mobilizationStabilizationStrengthening

Front 164

corrective exercise 4x4 model

Back 164

Front 165

lactate threshold

Back 165

The highest VO2 w/o a sustained rise in lactic acid. blood lactate/lactic acid may have a - effect on mm preformance due to increase in H ions, leads to increase in acidity of inter cellular environment. acidosis bad for mm contraction.

Front 166

bioenergetics

Back 166

Creatine phosphate for things 10s

Anaerobic system- glycolysis 60-90s; lactic acid?

Oxidative system >90s

Front 167

VO2

Back 167

Measure of person’s ability to take in and useoxygen. O2 deficit: increase in uptake until = demands. Oxygen uptake remains above resting levels to restore the body to the pre-exercise conditio. 2 day to make any change, 3-5 recommended, elite 6x/w

Front 168

HR as exertions measurement

Back 168

HR max age predicted or Karvoene (HHR)

Good correlation b/n HR and VO2

Front 169

RPE

Back 169

Not used much w/ athletes b/c pain thresholds higher. 6-20; add a 0 = 0 HR

Front 170

long slow distance

Back 170

type of aerobic endurance training. Equivalent to approximately 70% VO2max Distances greater than race distance

Front 171

pace/temp aerobic endurance training

Back 171

Intensity close to or slightly higher than race/competition intensity Equal to lactate threshold

Front 172

interval training endurance training

Back 172

Intensities close to VO2max Work to rest ratio 1:1

Front 173

rep training aerobic endurance

Back 173

Conducted at intensities greater than VO2max Typically last 30-90 seconds Work to Rest ratio 1:5

Front 174

fartlek training- aerobic endurance

Back 174

Swedish for “Speed Play” Combination of a number of previously mentioned methods Involves easy running combined with either hills work or short fast bursts of running

Front 175

ACSM VO2 intensities

Back 175

The min training intensity threshold for improvement in VO2 is 40-50% to 85% of VO2max or 55-90% of maximum (HRRmax).

Lower ranges for sedentary and unfit individuals

For athletic population greater than 70% of VO2max or 75% of HRR

Front 176

resistance training steps

Back 176

Needs analysis Exercise selection Training frequency Exercise order Training load and repetitions Volume Rest periods

Front 177

Needs analysis (1)

Back 177

Eval sport- mov't, physiological, injury analysis

Assess the athlete- training status, understanding, development

Front 178

exercise selection (2)

Back 178

specific to their activity, mm they use. Variables- equipment, time per session

Front 179

core exercises

Back 179

Recruit one or more large mm areas (i.e.; chest, shoulders, back, hip or thigh), involve 2 or more primary joints and receive priority when one is selecting exercises because of their direct application to the sport

Front 180

assistance exercises

Back 180

Recruit smaller muscle areas (i.e.; upper arm, abdominals, calf, neck, forearm, lower back and anterior lower leg); only involves one primary joint and are considered less important to improving sport performance.

Front 181

training frequency (3)

Back 181

# of session. Factors: training status, load and exercise type, sport season

Front 182

Hamstring and quad ratio

Back 182

The strength ratio of hamstrings to quadriceps should be at least 60 percent but ideally 75 percent. Suggested that higher H:Q torque ratios, and not muscle strength per se, are associated with a lower metabolic cost of running.

Front 183

exercise order (4)

Back 183

Power, other core, then assistance exercises. Upper and lower body (Alternated). “Push” and “Pull” Exercises (Alternated. Supersets and compound sets

Front 184

superset

Back 184

two sequentially performed exercises that stress two opposing muscles or muscle areas (i.e.; agonist and antagonist)

Front 185

compound set

Back 185

sequentially performing two different exercises for the same muscles.

Front 186

training loads and reps (5)

Back 186

amount of weight assigned to an exercise set. rep max. based on goal of training and resistnace goal

Front 187

volume (6)

Back 187

amount lifted that training session. hypertrophy- 6-12 reps. endurance- 12 reps or more

Front 188

rest periods (7)

Back 188

goal? strength, power- longer period. hypertrophy- short to mod. endurance- very short

Front 189

clean

Back 189

clean and jerk, snatch. divide into things that make sense into the sport. engage nearly all of your muscles to move weights farther and faster than conventional exercises, and they activate your fast-twitch muscle fibers— the muscles with the greatest potential for size and strength.

Front 190

CNS adaptations

Back 190

Increased activity in motor cortex. § …especially as the level of force developed increases and when new exercises or movements are being learned

Front 191

PNS adaptations

Back 191

“Selective recruitment” of fast twitch muscle fibers- Bypassing traditional “size principle” and fire the fast twitch first. Ex- lifting car. Increase rate of motor unit firing. Increased size end plate at neuromuscular junction. Enhancement of muscle spindle (stretch reflex) response.

Front 192

agility

Back 192

broadly defined as an athlete’s collective coordinative abilities

Front 193

adaptive ability

Back 193

modification of action sequence upon observation or anticipation of novel or changing conditions and situations

Front 194

balance

Back 194

Static and dynamic equilibrium

Front 195

combinatory ability

Back 195

coordination of body movements into a given action

Front 196

preseason

Back 196

Focus on increasing intensity ® Address specific deficiencies

Front 197

in season

Back 197

Focus on maintaining fitness level. Frequency and Duration of exercise can vary without adverse effects on VO2max.However a small drop off in intensity can reduce VO2max significantly.

Front 198

post season

Back 198

Main focus on recovery

Front 199

periodization

Back 199

the systematic planning of athletic or physical training. The aim is to reach the best possible performance in the most important competition of the year. It involves progressivecycling of various aspects of a training program during a specific period

Front 200

periodization phases

Back 200

macro, meso, microcycles

Front 201

macrocycle

Back 201

long term goal. Emphasis on an athlete’s developmental status

Front 202

mesocycle

Back 202

medium term goal. Exploit complementary training effects at optimal times and minimize the compatibility problems associated with concurrent training

Front 203

microcycles

Back 203

short term. Task specificity- Sport specificity. Matching metabolic pathway.Fatigue management.

Front 204

hard style

Back 204

Much like sprints; general fitness; slight more variety 2 categories of exercises: ballistics and grind. Strong first, RKC, strength matters

Front 205

ballistic hard style

Back 205

accelerate the kettle bell and it continues floating. Kettle bell swing, clean, snatch Steep learning curve b/c no slow down. Requires tension and relaxation at same time- cyclical. Goal: is to apply maximal power into every lift no matter the weight. swing is foundation

Front 206

grind hard style

Back 206

if I stop applying force the kettle ball will stop moving. Squat variations, Turkish get up, army shoulder press. Goal: Get max tension throughout entire system to get most mov't in desired joints & stability in others 5 reps or less w/ high sets. Radiation. get up is foundation

Front 207

GS kettle bell style

Back 207

Competition style kettle bell lifting. Being as efficient as possible, loose, relaxed and smooth. Very specialty; not general fitness. Snatch, clean, jerk

Front 208

fitness kettle bell style

Back 208

Misuse of equipment- as a dumbbell w/ a handle

Front 209

radiation

Back 209

part of grind hard style kettle bells. a skill that needs developing, conscious effort to pulling all slack out of system. Hard work Strong and safer

Front 210

momentum and kettle bells

Back 210

Huge. Setting weight on foot vs dropping weight on foot. The weight you are lifting x 10 This is why TRAINING IS REQUIRED

Front 211

kettle bell technique

Back 211

Hip hinge- most of motion here, spine stays the same, 45 degrees to ground, GH higher than hips, hips higher than knees.

Core- no excessive T arch. Supine, knees over hips, press w/ hands and tighten abs until no change b/n ribs and ab.

Front 212

dead lift, this before swing

Back 212

1. Stand over with kettle bell b/n heels (for teaching, may move forward later on)2. Pinky fingers in hips, bend hips until hands can touch kettle. Loads hips and keep cylinder more 3. Stand up w/ it. Make sure the core stays the same cylinder. Be really tight everywhere. 4. Back down

Front 213

get up

Back 213

Foundation for grind mov'ts. Supine, arm up, w/ weight in hand. Move from a flat back position to standing to back to flat back w/o bending arm. Different styles. Supporting the weight. 5 steps. alignment first then tension. curl around, in center, roll then lift. wrist straight. resisting the rotation

Front 214

kettle bell swing

Back 214

trunk is a tree, arms and bell are swing. foundation for ballistic mov't. same as dead lift but now 1 ft behind bell.

Front 215

physical fitness

Back 215

ability to carry out ADL w/ vigor and alterness w/o undue fatigue

Front 216

exercise

Back 216

PA that is planned, structured, repetitive, that has a final or intermediate objective- the improvement or maintance of physical fitness

Front 217

energy expenditure

Back 217

total amount of energy expended during exercise including resting energy expenditure

Front 218

PA

Back 218

any bodily mov't produced by skeletal mm that results in energy expenditure above resting levels

Front 219

MET

Back 219

an index of energy expenditure, the ratio of the rate of energy expended during an activity to the rate of energy expended at rest

1 MET = the uptake of 3.5 mL/kg/min; sitting at rest

Front 220

MET minutes

Back 220

quantifies the total amount of PA performed in a standardized manner across individuals and activitiesMETs x mins x days done

Front 221

CV/respiratory benefits from exercise

Back 221

Increase O2 uptake (# mito, CO, mm fiber changes, # myoglobil, # RBC), capillary density in skeletal mm, lactic acid threshold, exercise threshold for onset of dz s/s.

Decrease HR and BP.

Front 222

reduction in CV dz risk w/ exericse

Back 222

Decrease systolic/diastolic BP, tryglicerides, intra-abdominal fat, insulin needs, blood platelets adhesiveness, inflammation.

Increase HDLs- take fat from periphery to GI, liver, to excrete

Front 223

decreased mobidity and mortality w/ exercise

Back 223

Lower death rates CAD.Lower rates of- CVD, CAD, CVA, type 2 DM, metabolic syndromes, osteoporotic fx, colon cancer, breast cancer, gall bladder dz

Front 224

other benefits of exericse

Back 224

Decreased anxiety, depression, risk of fall, injury in older adults.Increased cognitive function, physical function and I living in older adults, feelings well being, performance of work, rec, sports

Front 225

preparticipiation PE

Back 225

BW- BMI, waist girth, body comp.Apical pulse- murmors, gallops, clicks, rubs.BP- seated, supine, standing.Auscultation of lungs.LE palaption for edema and arterial pulses.Inspection of skin for those w/ DM.

Front 226

low to mod risk lab tests

Back 226

Total cholesterol (<200), LDL (<100), HDL (>45) cholesterol.Tryglycerides (<150).Fasting plasma glucose (70-110).Thryoid function if dyslipidemia is present.

Front 227

high risk lab tests

Back 227

If high BP or high other tests. Resting 12 lead ECG, Holter monitor, coronoary angiography, echocardiography.Carotid ultrasound & other peripheral vascular studies.CXR.Blood chemistry panel and CBC

Front 228

modes of exercise testing

Back 228

Field tests-Cooper 12 min walk/run test; 6 min walk test; 1.5m test for time. Motor driven treadmill.Mechanically braked cycle ergometers. Stop test.

Front 229

aerobic exercise frequency and duration

Back 229

>/= 5d/w mod exercise or >/= 3d/w vigorous exercise or a combo 3-5

30-60min/d (150min/w) of purposeful, mod intensity.Or 20-60min/d (75min/w) of vigorous exercise or a combo.

Front 230

aerobic exercise type, volume, pattern, progression

Back 230

regular, purposeful exercise- major mm groups and continuous and rhythmic in nature

500-1000 MET min/w; >/= 7000 steps

1 session or >/= 10 min to accumulate the desired duration and volume; interval training may be effective

gradual, adjust volume, frequency, duration, and/or intensity

Front 231

RT frequency, intesnsity

Back 231

each major mm group 2-3x/w

60-70% 1 RM (mod-hard) for novice to intermediate; >/= 80% 1 RM for experience, build mass; 40-50% (very light-light) 1 RM for older persons beginning RT, <50% (light-mod) 1 RM for endurance

Front 232

RT volume, reps, sets, pattern, progression

Back 232

each major mm group; variety is best

8-12 reps strength/power; 10-15 reps strength in middle age to older; 15-20 reps endurance

2-4 for stength and power; 1 for older and novice; 1-2 sets for endurance

rest intervals 2-3 min b/n sets; rest 48h b/n session for a single mm group.

gradual, resistace, reps, sers, frequency

Front 233

flexibility time and type, pattern

Back 233

PNF 3-6s; 20-75% max voluntary contraction followed by 10-30s assisted stretch is desired

series of exercises for each mm group; static (active or passive), dynamic, ballistic, PNF all effective

2-4 of each, most effective when warmed up first

Front 234

neuromotor freq and intensity, type, pattern/volume, progression

Back 234

>/= 2-3x/w; >/= 20-30min/d

effective intensity not determined

balace, agility, coordination, gait, proprio; multifaceted- tai chi, yoga

not established

not established

Front 235

normal aging

Back 235

Will happen to us all.INcrease SBP.Decrease max HR, VO2 max.Artherosclerosis.Loss of motor neurons.Pereferntial loss of type II mm fibers.Overall decrease in lean mm and increase in fat mm-Less water content; dehydrated easier.Chainges in collagen-Increased stiffness; loss of elasticity

Front 236

sarcopenia

Back 236

age rleated loss of mm mass.Mm strength decreases w/ age.Begins at 40, most noticable after 60, accelerates at 80.Can loose up to 35% mm mass.Motor neuron loss- denervated fibers gets inn by adjacent nn.This loss is not enough to cause changes in function.

Front 237

collagen changes w/ age

Back 237

water loss in supporting matrix

increased # crosslinks

decreased elastisity

Front 238

wawter loss in supporting matrix

Back 238

Discs have less water, lose height. Articular cartilage can break down easier. Decreased ability to absorb shock. Decreased ROM

Front 239

increased # cross links

Back 239

Decreased ROM.Increased stiffness.Greater chance of avulsion vs rupture.Increased passive tension requiring more effort for mov't.

Front 240

age related increased risk

Back 240

HTN. Arthritis. Heart dz. Cancer. Diabetes. Hearing loss. Medication ADR's/side effects

Front 241

the 4 F's

Back 241

FunFunctionFrailtyFailure. Cross a threshold where they are at some point not able to do things that are fun anymore- can only do what is functional.From this then may cross a thershold where they become frail and does not have all the capacity to complete their ADLs.Then failure. Individual thersholds

Front 242

vigor

Back 242

overall physiological capacity

Front 243

fun

Back 243

physiological state that allows for unrestricted partipication in work, home and leisure activities

Front 244

function

Back 244

can do most work and home activities, may be modify how, start to self restrict their leisure activities

Front 245

frailty

Back 245

managing basic ADLs but that takes up all their capacity, limitations in community activites, may need assistance. Loss of reserve

Front 246

failure

Back 246

requires assistance w/ IADLs and ADLS, possible bedridden

Front 247

TUG

Gait speed

6m walkl test

30s chair stand

4 square step test

and 4Fs

Back 247

<8s, 9-20s, >20s --

>1.5m/s. 9-1.5m/s. 3-.8m/s <.3m/s

500m, 350-500m, 200-350m, <200m

>15 reps, 8-15 reps, <8 reps, 0 reps

<10s, 10-15s, 15-20s, >20s

Front 248

CDC exercise recommendations older adults

Back 248

Option 1-2.5h /150min of mod aerobic/w.RT 2+ d/w major mm groups.

Option 2-75 vigorous aerobic.RT 2+d/w.

Option 3-Equivalent mix of mod-vigorous aerobic.RT 2+d/w.

Front 249

activity levels by age

Back 249

45-64y- 42% in no activity/exercise

65-74y- 50%

75+- 66% (16% could not lift 10#.21% could not walk up 10 strairs.29% could not walk .25mile.28% could not stoop, crouch, kneel.)

Front 250

HR max methods

Back 250

220-age (less reliable once over 40, underestimates)

208-.7(age) preferred method once over 40, underestimates when younger than 40

Front 251

RT intensity for older adults

Back 251

60% 1RM min overload for mm adaptations; gains lost faster if stopped b/c motor learning.80% 1RM results in greater strength gains and cab be tolerated by even frail older adults.

Front 252

determing right resistance older adults

Back 252

Pick a resistance, do a couple reps, then have them rate b/n the 3 options- fairly light, somewhat hard, very hard. If somewhat hard- continue until they cannot- stop w/ fatigue. Increase speed, form decreases, tremor, concentration look, not full ROM.

Front 253

right resistance responses, %, # reps older adults

Back 253

Fairly light-somewhat-30-60%.12-15 rep; 60% about 15.Somewhat hard-hard-70-80%.8-12 reps.If less then somewhat hard w/ first few reps increase, if hard may need to drop down. 10% increases when able to do more than 15-Initial gains 6-8w.Long lasting gains 12-16w.May want to start around 40% if deconditioned and then be up to 60% by 4th session or so.

Front 254

RT sets, frequency, duration and older adults

Back 254

1 set in untrained is good.More sets- greater gains, also greater risk of injury.Time is also a factor for how many sets.Frequency should be 2-3x/w w/ 24-48h rest b/n groups.12-16 weeks.

Front 255

RT modes and older adults

Back 255

Functional greater gains in actual function.Resistance training group had greater gains in strength; did not carry over to function.

Front 256

power and older adults

Back 256

strength w/ speed.Often impaired in older adults.Need it for losses of balance, functional sit to stands and stairs. 20% 1RM and up to 60%.Fast con and slower ecc.OKC (speed in con) and functional exercises. 30s sit to stand

Front 257

home health

Back 257

provide services in the pt.'s home.Wide range.Less expensive, more convienty, just as effective as a hospital or SNF. Covered by ins45-60min. Interventions around and in home. High collaborative, be careful of overlapping services

Front 258

criteria 1

Back 258

the pt. must either. Have a condition such that leaving homs is medically contraindicated. Illness/injury requires supportive devices, special transport, need help

Front 259

criteria 2

Back 259

one of the above (contraindicated, inable to leave)+ there must be a normal inability to leave home and leaving home must require considerable and taxing effort

Front 260

goal of home health PT

Back 260

Safe and function at home vs in community.Most want to stay at home.Ther ex: develop pt's physical, physiological, and functional strength to ensure safe return to function within their home

Front 261

OASIS

Back 261

(outcome and assessment info set)Interventions are based on this tool. Outcomes are tracked w/ this tool. home health

Front 262

OASIS categories

Back 262

Functional capacity- physical performance testBarthel index2 min step test. TOUR

Strength MMT

TransfersTimed up and goSupine to sitting in chair transfers.

BalanceDynamic gait indexFunctional reach4 square step test

Walking6 min walk test50ft walk test

Front 263

Home as a gym

Back 263

Chair, recliner, lift chair (measure what they can get up from, set a goal to lower).Steps, stiars- multidirection.Towels.Sinks, counters.Pulleys, bands.Weighted vests.Tape measure, stop watch, slide board.All must be disinfected before you take it out.,

Front 264

variables in home health program

Back 264

Set, reps.Time of day- highly variable, start at best time then move to worst times.Level of support available.Distractions- pets, TV, family, caregivers.Location- room, living community, mail box.

Front 265

dosing in homehealth program

Back 265

Priotitize functional ones.Greater than 60% 1RM.Speed matters-Super slow resistance can increase strength gains by 50% compared to normal speed.High velocity training can increase peak power in older women.

Front 266

HH strength tools

Back 266

Gravity.BW.Everyday weights.Weights.Resistance bands.Weighted vests/belts. Canned food- 12-16ozBox sugar- 1#Liter of water 2.2#Bag flour 5#Gallon water 8#

Front 267

Theraband 1 RM

Back 267

unpublished methodology.High variability w/ the length and how much weight that actually is. Requires: Appropriate/approximate color of band.Approximate 1RM.Length of arc of motion- tape measure.Resting length of band- where it is secured to hand- mark on band where each should be for consistency.

Front 268

transfer training HH

Back 268

Break down into constructive parts and trained individually.Involves: Global muscle strength, Local muscle strength, Power, Coordination, Balance.

Front 269

gait training HH

Back 269

Location, distance, device, skill and safetyModify- reps, length, time, speed, surface, time of day

Front 270

ADL HH

Back 270

Showering, grooming, dressing, cooking, housekeeping, entering and exiting.Involves: global mm strength, endurance, ROM, strength against gravity, balance.Progress sitting to standing, assisted to unassisted.Integrate into a part of their life- before getting out of bed, stand up 3x each..

Front 271

HEP HH

Back 271

2-3 exercises.Task specific.Involve family or not?Written w/ pictures, exlpanation, and location for them.Integrate into a part of their life- before getting out of bed, stand up 3x each..

Front 272

adhernece

Back 272

Patient contributes to plan, pt and clinician come to agreement on a plan; Pt follows plan.Adherence implies less paternalism and lower power differential between clinician and patient than compliance

Front 273

compliance

Back 273

Patient does as told. Pt is passive recipient

Front 274

concordance

Back 274

Suggests total involvement by pt in decisions and plan

Front 275

self efficacy

Back 275

belief in capability to complete an actionExercise task self efficacy- belief in ability to PHYSICALLY COMPLETE a task. barriers- fatigue, time. exercise barriers self efficacy- I can do ability in face of barriers. Get task efficacy first

Front 276

fostering adherence behavrioal theories

Back 276

self efficacy. outcome expectations. health benefits. stages of change

Front 277

outcome expectations w/ adherance

Back 277

What results someone expects from a behavior.More likely to change if change will lead to desirable outcome.Less likely if they believe they will fail, or will produce undesired outcome

Front 278

health beliefs w/ adherance

Back 278

Beliefs about condition influence willingness to change.Ex: “Bad backs run in my family” People will “act” (make changes) if they:Believe condition has serious consequences, they are susceptible to condition and action will decrease it,. they can be successfully. PT recognize what they bellieve and try to edu

Front 279

stages of change

Back 279

Precontemplation – no intention of making change.

Contemplation – intends to make change.

Preparation – taking steps toward making change; plans to make changes soon.

Action – has changed the behavior (< 6 mos).

Maintenance – has changed behavior (> 6 mos).

Front 280

how to increase self efficacy

Back 280

1. Successfully complete task2. Be told that they can “ “3. See someone else “ “

Front 281

motivational interviewing

Back 281

conversation method that allows patient and provider to work together to make plan for achieving desired outcome. Pt. makes plans. Open-ended questions to explore thoughts and beliefs about condition and exercise. Use reflection and the pt's language. Cause? Role of exercise? Time for it?

Front 282

behavioral contracts/goal setting

Back 282

Use a patient/client-generated goal to create an action plan.SMART or ABCDEF.Enhances buy-in and accountability.

Front 283

replase prevention

Back 283

Identify situations likely to negatively influence ability to perform HEP.Create plans for maintaining HEP during these situations.

Front 284

Relapse remediation

Back 284

if-then” rules – a plan for slip-ups.“If I stop my HEP during my vacation, then I will re-start it within two days of returning home.”

Front 285

# exercises

Back 285

No more than 3!Under 3: best adherence (3,4).Important to explain HOW and WHY to do exercise.Provide a reference.Handout.Video or picture on phone.

Front 286

HH intervention categories

Back 286

Strength

ADL

Transfers

gait

Balance/fall prevention