Active movement free exercise

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1. ACTIVE MOVEMENT –FREE EXERCISE
Prof. Dr. M. Rajesh, PT, M.P.T(cardio), BCRC
TRINITY MISSION AND MEDICAL FOUNDATION
MADURAI

2. INTRODUCTION
Activeexerciseoractivemovementisatermcommonlyusedby
physicaltherapy,rehabilitationandfitnesscentres.‘Active
movement’isthatwhichanindividualdoesvoluntary
movement,one’sownstrengthorenergy.Activeexercisehelp
keepjointsflexible,maintaingoodbloodflowtotheexercised
jointsandmayhelppreventbloodclots.Ahealthcare
practitionermayassignactiveexercisesafteraninjuryorin
connectionwithmedicationsandothertherapiestohelp
managechronicpain.

3. VOLUNTORY MOVEMENT
Definition
Movementperformedorcontrolledbythevoluntaryactionof
muscles,workinginoppositiontoandexternalforce.

4. CLASSIFICATION
Freeexercise–theworkingmusclesaresubjectonlytothe
forcesofgravityactinguponthepartmovedorstabilized.
Assisterexercise–whenmusclestrengthorco-ordinationis
inadequatetoperformamovementanexternalforceisapplied
tocompensateforthedeficiency.
Assisted-resistedexercise–musclesmaybestrongenoughto
workagainstresistanceinpartoftherangeandnotinothers.
Thistypeofexerciseensuresthattheexternalforcesapplied
areadaptedineverypartoftherangetotheabilitiesofthe
muscles.
Resistedexercise–theforcesofresistanceofferedtotheaction
oftheworkingmusclesareartificiallyandsystematically
increasedtodevelopthepowerenduranceofthemuscles.

6. FREE EXERCISE
Freeexercisesarethosewhichareperformedbythepatient’s
ownmusculareffortswithouttheassistanceorresistanceofany
externalforce,otherthanthatofgravity.
Theyvarywidelyincharacterandeffect,notonlybecauseof
thenatureandextentofthemovement,butaccordingtothe
mannerinwhichtheyareperformed.
Thistypeofexercisecanbeusedtoobtainanyoftheeffects
whichareproducedbyexerciseasawhole,ifandwhenitis
usedjudiciously.

7. Adegreeofrelaxationisinducedbyexerciseswhichare
rhythmicalorependularincharacter;muscletoneismaintained
andpowerincreasedaccordingtothespeed,leverageand
durationoftheexercise,andtherelationshipofthepartmoved
togravity;co-ordinationistrainedorimprovedasthenatural
patternofgroupactionisemployed,andconfidenceinthe
abilitytoperformandcontrolmovementisestablished.
Successinachievingtherequiredeffectdependsnotonlyon
theselectionofasuitableexerciseandonthemannerinwhich
itisperformed,butalsoonthedegreeofco-operationobtained
fromthepatientandtheskilloftheinstructor.

8. Thegreatadvantageoffreeexercisesliesinthefactthatonce
thepatienthasmasteredthetechniquesoftheirperformance
andisawareoftheirpurposed,theyarehisown,topractice
whenandwherehepleases.Hehas,infact,beengiventhe
meanstocureortohelptocurehimselfandneednolonger
relyonothersforthispurpose.
Whetherornotheusestheexerciseforhomepracticetohelp
himselflargelydependsonhisdesireforrehabilitationandhis
confidenceintheefficacyoftheexercises.

9. Thedisadvantageoffreeexercisesisthattheyfrequentlymake
insufficientdemandsonthepatient’sneuromuscularsystemto
elicitthemaximalresponserequiredfortherapidre-
developmentorreinforcementofweakmuscles.Whenthereis
muscularimbalance,compensatoryratherthannormalpatterns
ofmovementmaybeusedunlessmovementsarecarefully
taughtandsupervised.Patientswhohavesufferedbrain
damageorwhoareunabletoinitiatemovementcannotco-
operateindoingtheseexercisesuntiltheirperformancehas
beenfacilitatedandvoluntarycontrolhasbeenestablished.

10. CLASSIFICATIONS OF FREE
EXERCISE
Free exercises may be classified according to the extent of the
area involved; they may be
Localized
General (subjective, objective)

11. LOCALIZED
localizedexercisesaredesignedprimarilytoproducesomelocal
andspecificeffect,forexample,tomobilizeaparticularjointor
tostrengthenparticularmusclegroups.Movementislocalized
tooneormorejoints,eitherbytheuseofasuitablestarting
position,orbyvoluntaryfixationofotherareasbythepatient’s
ownmusculareffort.

12. GENERAL
GeneralExercisesusuallyinvolvetheuseofmanyjointsand
musclesalloverthebodyandtheeffectiswidespread,for
example,asinrunning.
Thecharacterofaparticularexercisemaybe
Subjective
Objective

13. Subjective
exerciseswhicharesubjectiveareusuallyformalandconsistof
moreorlessanatomicalmovementsperformedinfullrange.
Thisattentionofthepatientisdeliberatelyfocusedontheform
andpatternoftheexercisetoensureaccuracyofperformance.

14. Objective
Objectiveexercisesarethoseduringtheperformanceofwhich
thepatient’sattentionisconcentratedontheachievementofa
particularaimwhichwillresultfromhiseffortse.g.standing;
armstretchingupwards,totouchamarkonthewall,orto
throwaball.Thepresenceofagoaltobereachedisstimulating
toeffort,liketheproverbialcarrotheldinfrontofthedonkey’s
nose,butcaremustbetakentoseethattheaccuracyofthe
movementisnotsacrificedtotheachievementoftheaim.E.g.
inwalkingacrossaroomtogetacupoftea,thequalityofthe
walkingmustnotbeallowedtodeteriorate.

15. TECHNIQUES OF FREE EXERCISE
Thestartingpositionisselectedandtaughtwithcaretoensure
themaximumposturalefficiencyasabasisformovement
Instructionisgiveninamannerwhichwillgaintheinterestand
co-operationofthepatientandleadhimtounderstandboththe
patternandthepurposedoftheexercise.
Thespeedatwhichtheexerciseisdonedependsontheeffect
required.Itisusuallyslowduringtheperiodoflearningand
laterthepatientiseitherallowedtofindhisownnatural
rhythm,orthespeedrequiredisdictatedbythephysiotherapist.
Itoftenhelpsthepatienttomaintainhisnaturalrhythmat
homeif,duringpracticeundersupervision,heisencouragedto
countaloud.

16. Thedurationoftheexercisedependsverylargelyonthe
patient’scapacity.Usuallythreeboutsofpracticeforeach
exercise,withshortrestperiods,orachangeofactivity,
between,ensuresufficientpracticewithoutunduefatigue.

17. EFFECTS AND USES OF FREE
EXERCISE
Theeffectandconsequentusesofanyparticularfreeexercise
dependonthenatureoftheexercise,itsextentandthe
intensityanddurationofitsperformance.

18. RELAXATION
Rhythmicalswingingmovementsandthosewhicharependular
incharacterassisttherelaxationofhypertonicmusclesinthe
regionofthejointmoved.Thealternatingandreciprocal
contractionandrelaxationoftheopposingmusclegroups,
whichisrequiredtosustainthemovement,helpstorestorethe
normalstateofrelaxationwhichfollowscontraction.Thistype
ofexerciseisusedinconjunctionwithothermethodswhich
inducerelaxationtoreduceastateofwastefultensionin
muscles,whichlimitstherangeofjointmovementandreduces
theefficiencyofneuromuscularco-ordination.
Exercisewhichworkparticularmusclegroupsstronglyachieve
reciprocalrelaxationoftheopposinggroups,e.g.workforthe
scapularretractorsandshoulderextensorsassistsrelaxationof
thepectoralmuscles.

19. JOINT MOBILITY
Thenormalrangeofjointmovementismaintainedbyexercises
performedinfullrange.Ifandwhentherangeofmovementis
limited,rhythmicalswingingexercisesincorporatingover
pressureatthelimitofthefreerangemayservetoincreaseit.

20. MUSCLE POWER AND TONE
Thepowerandenduranceoftheworkingmusclesare
maintainedorincreasedinresponsetothetensioncreatedin
them.Thistensionisgreaterwhentheexerciseisperformedat
anyspeedwhichisslower,ormorerapid,thanwhenthe
naturalspeedofmovementisemployed,anditincreaseswith
thedurationoftheexercise.Ahighdegreeoftensionand
consequentincreaseinpowercanbedevelopedbyfree
exerciseswhenthemusclesworkforanymechanical
disadvantageofanadverseleverageprovidedbyalongand
heavylimb.

21. Normally,musclepowerismaintainedadequatelybyaminimum
ofeverydayactivities,mostofwhichareperformedinthe
middlerange.Underabnormalconditions,however,forexample
duringfixationofjoint,thepowercanonlybemaintainedor
improvedbyrepeatedstaticcontractions,whichthepatient
mustpracticethroughouttheday

22. NEUROMUSCULAR CO-ORDINATION
Co-ordinationisimprovedbytherepetitionofanexercise.As
thepatternofmovementisestablished,itissimplifiedand
becomesmoreefficient,andtheconductionofthenecessary
impulsesalongtheneuromuscularpathwaysisfacilitated.
Exercisesoractivities,whichatonetimerequiredconcentration
andmucheffort,becomewithpracticemoreorlessautomatic
incharacter,andskillisdeveloped,asforexampleinwalkingor
playingthepiano.

23. CONFIDENCE
Theachievementofco-ordinateandefficientmovementassures
thepatientofhisabilitytomaintainsubjectivecontrolofhis
body,givinghimconfidencetoattemptotherandnewactivities,
togetherwithafeelingofexhilarationandsatisfactionwhen
theyareaccomplished,forexample,jumpingarope,or
shootingagoal.Objectiveexercisesandactivitiesareusually
usedforthispurpose.

24. CIRCULATORY AND RESPIRATORY
CO-OPERATION
Duringvigorousorprolongedexerciseitisapparentthatthe
speedanddepthofrespirationisincreased,thattheheartbeat
isfasterandmoreforceful,andthatheatisproduced,whereas
inlightexercisethesechangesaresoslightthattheyarenot
noticed.

25. Theneedsoftheactivetissues
theactivetissuesinvolvedduringmuscularexerciserequirea
freesupplyofoxygenatedbloodandtheremovalofmetabolic
productstoenablethemtocontinuetheiractivity.Tomeet
thesedemandsandtokeeppacewiththem,theco-operationof
thecirculatoryandrespiratorysystemsisenlisted

26. Preparationforactivity
Itisprobablethatthecerebralcortex,whichinitiatesthe
muscularcontraction,alsopreparesthebodytosupplythe
needsofthetissuesconcerned,bycommunicatingwiththe
respiratory,cardiac,andvaso-motorcentrewhichformpartof
theautonomicnervoussystem.Sympatheticfibrefromthese
centersconveyimpulsestotheappropriateorganswhich,with
thehelpofadrenalin,whichisreleasedintothebloodstream,
producewidespreadresults.Theseresultsincludeincreased
respiration,increasedfrequencyoftheheartbeat,arisein
arterialbloodpressure,andare-distributionofblood,sothat
thevolumeofbloodinthemusclesinincreasedattheexpense
ofthatinthesplanchnicareaandtheskin.

27. Allthesechangeoccurmerelyastheresultoftheanticipationof
exerciseasthosewhohavetakenpartincompetitivesports
mayhavebeenaware.

28. Localcirculatorychangesinthemuscles
Duringactiveexercisethecapillariesintheworkingmuscles
dilateandtheirpermeabilityisincreased.Manycapillariesthat
wereclosedwhenthemusclewasatrestbecomeopenand
bloodflowsthroughthem.Inthiswaythecapacityofthe
musclestocontainbloodismarkedlyincreasedandthe
interchangeoffuelandwasteproductsbetweenthebloodand
thetissuefluidsisfacilitated.

29. Regulationofcirculatoryandrespiratoryfunctionduringexercise
Thevenousreturntotheheartisincreasedduringexerciseand
resultsinanincreaseincardiacoutput.Theincreasedvenous
returniscausedpartlybythepressurevariationsinthe
abdominalandthoraciccavitiesresultingfromincreased
respiratorymovementswhichexertapumpingactionuponthe
largeveinsinthedirectionoftheheart,andpartlybythe
pressureofthecontractingmusclesofthethinwallsofthe
peripheralveins.Valvesintheseveinspreventregurgitation
increasedduringrelaxationofthepressure.

30. Muscularcontractionincreasesboththecarbondioxidecontent
andthetemperatureoftheblood,andboththesefactors
stimulatethecirculatoryandrespiratorysystemstofurther
activity.Theriseintemperatureofthebodyiskeptwithin
normallimitsbydilationoftheskincapillariesandstimulationof
thesweatglands,thusenablingheattobelostfromthe
surface.

31. Activeexercisecanthereforebeusedtoincreaserespiration,to
increaseboththelocalandthegeneralcirculation,andto
provedworkfortheheartmuscles.
Theeffectiveofactiveexerciseasawholeissowidespreadand
variessomuchinintensityaccordingtothenatureofthe
exercisethatithasbeendescribedhereonlyinthebriefest
outline.

32. THANK YOU
Prof. Dr. M. RAJESH, PT,M.P.T(cardio),B.C.R.C
TRINITY MISSIOIN AND MEDICAL FOUNDATION
MADURAI.
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