Terapi Latihan Dasar dan Latihan Fungsi (2)

  Terapi Latihan Dasar dan Latihan Fungsi (2) Lenny Agustaria Banjarnahor, SSt, M. Fis Materi disampaikan pada mahasiswa/i Fisioterapi Program reguler Kepustakaan

  Wajib

  

  Kisner, Carolyn & Allen Colby, Lynn Therapeutic Exercise (Foundations & Techniques)

  Penunjang

  

  Basmajian, John V, Therapeutic Exercise (Third edition)

  

  Hollis Margaret, Practical Exercise Therapy

  

  Licth, Sidney, Therapeutic Exercise

  

  Situs/web relevan

  Outline 

  Benefits of exercise

  

  Concepts in therapeutic exercises

  

  Local and systemic effects of exercise

  

  Types of exercises

  

  Components of exercises

  

  Parameters of exercises

  

  Forms of exercises Benefits of exercise 

  Lifetime health and fitness benefits ›

  Increase in high density lipoproteins ›

  Decrease in triglycerides ›

  Improved lung function ›

  Helps reduce blood pressure, anxiety and depression ›

  Control weight ›

  Increase the body’s ability to dissolve blood clots by increasing fibrinolytic activity ›

  Increase levels of endorphins › Helps the bones to be stronger – inhibiting osteoporosis Concepts in Exercises: 

  Overload Principle:

  › Greater stress must be applied than that to which an organism or tissue is accustomed in order to have adaptation take place

  › Strengthening program must tax muscle groups towards it maximal capacity and beyond its usual functional capacity

  › To increase strength, a load that exceeds the metabolic capacity of the muscle must be used during exercise, this will lead to hypertrophy and recruitment resulting in increase in strength

   Adaptation

  › Cardiovascular system and muscles adapt to the training stimulus over time

  › Significant changes noted in 10 – 12 weeks

  › The higher the initial level of fitness, the greater the intensity of exercise needed to elicit a significant change

   

  Specificity of training:

  Reversibility principle:

  › Exercise adaptations

  › Beneficial effects of are directly related to

  exercise training are

  the nature of the

  transient and reversible

  exercise stimulus ›

  After only two weeks of

  › No strength training

  detraining,

  program will give a

  improvement begin to

  100% carry over to a

  be lost

  sporting or functional ›

  Frequency and duration

  activity unless the specific sports or

  of physical activity

  functional activity

  needed to maintain a

  makes up the training

  certain level of aerobic

  program

  fitness is less than that

  › Adaptive effects of

  required to improve it

  training are highly specific to the training methods used Effects of exercises

  Acute or immediate Systemic effects Systemic effects effects

• ^{• •}
• ^• Start of exercise: In isotonic exercises As exercise continues _{• •}

  at constant rate: increase heart rate decrease peripheral vascular resistance Steady State: heart ^{• •} increase cardiac rate ^• output increase in muscle ^• blood flow Blood pressure

  Increase in blood

• _{• •} ^• pressure In isometric exercises Cardiac output _{• •}
• ^• increase in venous Decrease in local At the end of exercise: return blood flow to the ^•

  Initial rapid drop in contracting muscles

• ^• increase in arterio-

  heart rate then ^• venous O2 Increased blood slower return to difference pressure normal

• ^• Decrease in blood pressure sudden if exercise is stopped abruptly
Effects of exercises
• _{• • the body’s ability to}
• _{• If exercise is greater than respiratory effects: Post exercise syncope}

  Systemic effects Systemic effects Systemic effects _{• • Respiratory rate Seen after vigorous} maintain: _{Heart rate plateaus at maximal exercise • Decreased stroke – 7 times • maximal level Tidal volume increases: 5 exercised extremity increases: 5 – 6 times in exercise Pooling of blood in the •}

• _{• • Hypotension • Constant O2 •}
• _{• consumption} volume, arterial blood _{pressure Hormonal effects: Decrease insulin risk of developing production dysrhythmia, cardiac Increase glycogen ischemia •}
_{Catecholamine release –} ^• _{• • Increase in growth,} ^• Fatigue sets in _{in intense exercises Increased catecholamine, production androgens TSH, adrenal and} adrenocorticotrophic,
Effects of exercises _{Arm exercises vs. leg respiratory effects: Post exercise syncope exercises: •} Systemic effects Systemic effects Systemic effects _{Respiratory rate Seen after vigorous • •}
• _{• • diastolic blood pressure maximal exercise Higher oxygen uptake Higher heart rate Tidal volume increases: 5 exercised extremity • •}
• _{– 7 times • •}
_{Hypotension • Pooling of blood in the} ^• Higher systolic and increases: 5 – 6 times in exercise ^• _{Exercise should use • than those used for LE in production dysrhythmia, cardiac workload 40 – 60 % lower Decrease insulin risk of developing} ^•
• ^• _{order to obtain systemic •} Hormonal effects: _{Increase glycogen Catecholamine release – ischemia • Increase in growth, •} effects _{in intense exercises Increased catecholamine, production androgens TSH, adrenal and} adrenocorticotrophic,

  Effects of exercises

  Systemic effects Local effects Local effects _{• • •} If exercise is greater In the muscles being During isometric than the body’s ability exerted: contraction: to maintain:

• _{• •} Increased oxygen Complete occlusion

  Heart rate plateaus extraction of blood flow ^• at maximal level

• ^{• •}

  Increased oxygen 70% of maximal ^• Decreased stroke consumption voluntary contraction volume, arterial level

  Increased carbon ^• blood pressure dioxide production Depletion of energy ^{• •} Constant O2 substrates ^• vasodilatation consumption

• ^• During isotonic ^•

  Fatigue sets in exercise: ^• Slow twitch fibers first to lose glycogen then followed by the fast twitch fibers

  Parameters of exercise 

  Mode of exercise: ›

  

Aerobic vs. anaerobic exercise



  Intensity of exercise 

  Duration of exercise 

  Frequency of exercise

  02/27/2019 COMPONENTS OF EXERCISE

  PRE EXERCISE WARM UP PRE-EXERCISE STRETCHING

  EXERCISE PROPER POST EXERCISE COLD DOWN POST EXERCISE STRETCHING

  1

PURPOSE OF WARM UP

  

  to raise the general body temperature

  

  to raise the deep muscle temperature - contracts more forcefully and relaxes more quickly

  

  to stretch collagenous tissue

  

  to reduce muscle viscosity, improving the mechanical efficiency

  

  to increase the speed of nerve impulses and augment the sensitivity of the nerve receptors

  2 

TYPES OF WARM UP

  

  RELATED WARM UP

  ›

  when the specific skills of an event are performed during the warm up

  ›

  preferred if activity starts slowly and progresses into more intense activity

  

  UNRELATED WARM UP

  ›

  when movements performed are different from the actual skills of the activity or event

  ›

  preferred if immediate participation in the

  3

  actual activity is required

WARM UPS

  

  15 - 20 minutes

  

  intensity and duration should be individualized

  

  enough to increase body temperature and perspire, not too intense to cause fatigue

  

  usually coupled with few minutes of high intensity exercise to result in better performance

  4 Warm up 

  the effects of warm up last up to 45 minutes

  

  the closer the warm up to the event, the more beneficial it will be in terms of effective performance

  

  should begin to taper off 10 - 15 minutes prior to the training or competition/ event STRETCHING 

  GOAL: to improve the range of motion at a given articulation by altering the extensibility of the musculotendinous units that produces the movements

  5 TYPES OF STRETCHING 

  BALLISTIC STRETCHING 

  STATIC STRETCHING 

  PNF STRETCHING 

  PASSIVE STRETCHING 

  ACTIVE STRETCHING

  6

BALLISTIC STRETCHING

   requires repetitive contraction of the agonist muscle to produce quick

stretches of the antagonist muscles

  

ADV: simulate sports specific skills -

functional

  7 Ballistic stretching 

  DISADV:

  ›

  predispose to muscle strain

  

› rapidly stretched muscle may increase

  intrafusal muscle spindle activity causing protective muscle contraction

  ›

  higher level of muscle soreness due to small tears in connective tissues and muscles

  › fails to provide tissues an adequate time

  to adopt to a stretch

  

STATIC STRETCHING

  

  passive or active stretching a given antagonist muscle by placing it in a maximal position of stretch and hold it for an extended time

  

  3 seconds to 60 seconds

  

  three to four times

  Static stretching 

  ADVANTAGES:

› requires lesser energy expenditure

› lesser degree of exceeding normal range of motion

  › less muscle soreness

  ›

allow adequate time to reset the

sensitivity of the stretch reflex

  › can induce muscular relaxation via firing of the GTO if the stretch is held long enough

PNF STRETCHING

  

AKA: muscle energy release

technique

   techniques:

  › contract - relax

  › contract - relax - contract  commonly used with athletes

and individuals with limited range of motion TYPES OF STRENGTHENING EXERCISE 

ISOMETRIC EXERCISES

  

ISOTONIC EXERCISES

  

ISOKINETIC EXERCISES

  Types of exercise 

  Isometric exercise:

  ›

  Static exercise with muscle contraction but no movement of the load resulting in no change in the total length of the muscle

  Type of exercise 

  Isotonic exercise:

  ›

  Dynamic exercise with a constant load but uncontrolled speed of movement Type of exercise 

  Isokinetic exercise:

  ›

  Exercise with movement controlled so that it occurs throughout a range at a constant angular velocity as the muscle shortens or lengthens but the load may be variable Exercise goals 

  To increase muscle strength 

  To increase muscle endurance 

  To increase speed 

  

To improve cardiovascular fitness



  To improve flexibility 

  To improve control and coordination

  MUSCLE STRENGTH AND ENDURANCE 

  STRENGTH: ability of the muscle to generate force against some resistance

  

  ENDURANCE: ability to perform repetitive muscle contraction against some resistance of an extended period of time

  

  POWER: large amount of force generated quickly; includes

  CLOSED KINETIC CHAIN EXERCISES 

  ADV: safer and produce stresses and forces that are potentially less of a threat to healing structures

  

  e.g. mini squats - 0 - 40 degrees

  ›

  leg press

  ›

  stair climbing

  ›

  lateral step up

  ›

  push ups , chin ups

  ›

  hand stands

  ›

  weight shifting exercises using medicine

CARDIOVASCULAR ENDURANCE

  

CONTINUOUS TRAINING

  › imposes submaximal energy requirement that is consistent throughout the training session

  › e.g. aerobic/ rhythmic walking, jogging, rowing, cycling, swimming

  

Cardiovascular endurance



INTERVAL TRAINING

  › uses a series of exercise stations that

consists of various combinations of

weight training, flexibility, calisthenics, brief aerobic exercises

CARDIOVASCULAR ENDURANCE

  

CIRCUIT TRAINING

  › followed by relief stations incorporates work intervals

   FARTLEKTRAINING

  › types of cross country running, means speed play, similar to interval training

PLYOMETRIC EXERCISES:

  

  exercises that encompasses a rapid stretching of muscle eccentrically, followed by a rapid concentric contraction

  

  the greater the stretch before concentric contraction, the greater the resistance the muscle can overcome

  

  emphasize the speed of the eccentric phase of rate of stretch is more critical than the magnitude of the stretch Plyometric exercises 

  ADV: control in dynamic movements

  

  DISADV: put more stress on the MS system, must be technically correct and specific to one’s age, activity and physical and skills devt.

TRAINING PERIODIZATION

  TRANSITION PERIOD (basic strength phase)

  ACTIVE REST ( off season )

  

  TRANSITION PERIOD ( peak or maintenance phase)

  

  COMPETITION PERIOD ( strength and power phase)

  

  

  MACROCYCLE - yearly ( 1 - 4)

  PREPARATION PERIOD ( pre season)

  

  MICROCYCLE - weekly

  

  MESOCYCLE - months

  

  

  PREREQUISITES FOR PLYOMETRICS 

  DYNAMIC

  ›

VERTICAL/ SINGLE LEG JUMP

  › LONG JUMP EQUAL TO HEIGHT

  

  STATIC

  › single leg stance

  › single leg 25% squat

  › single leg 50% squat

  ›

UPPER EXTREMITY

  CATEGORIES OF PLYOMETRICS 

  IN PLACE JUMPING

  

  STANDING JUMPING

  

  MULTIPLE RESPONSE JUMPS AND HOPS

  

  IN DEPTH JUMPING AND BOX DRILLS

  

  BOUNDING

  

  HIGH STRESS AND SPECIFIC SKILLS

  Functional training 

  Consists of evaluating the functional independence level of a physically handicapped individual and assisting the individual in gaining the highest practical level of independence in daily

  Areas in activities of daily living 

  Feeding and grooming

  

  Sitting/ standing balance and tolerance

  

  Bed mobility and transfers

  

  Perineal care and hygiene

  

  Ambulation