Active movement resisted exercises

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1. ACTIVE MOVEMENT –
RESISTED EXERCISE
Prof. Dr. M. Rajesh, PT, M.P.T(cardio), B.C.R.C
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. VOLUNTARY 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.

5. RESISTED EXERCISE

6. THE PRINCIPLES OF
RESISTANCE
Anexternalforcemaybeappliedtothebodyleverstooppose
theforceofmuscularcontraction.Tensionisincreasedwithin
themusclesbytheopposingforce(orresistance)andthe
musclesrespondbyanincreaseintheirpowerandhypertrophy.
Astheincreaseinmusculardevelopmentoccursinresponseto
theincreaseinintramusculartensionitfollowsthatthe
applicationofthemaximumresistancewhichisconsistentwith
theabilityofthemusclestoovercomeitwillelicitthemaximum
development.

7. Theresistingforceappliedtoanisotoniccontractionmustbe
sufficienttoincreaseintra-musculartensiontothemaximum
withoutinterferingwiththeabilityofthemusclestoproduceco-
ordinatedmovement.Amaximumincreaseinintra-muscular
tensionduringanisometriccontractioniselicitedbya
resistancewhichequalsthemusclesabilitytomaintainthehold.
Therearefivefactorswhichcontributetothedevelopmentof
muscularefficiency,i.e.power,endurance,volume,speedof
contractionandco-ordination.Thefirstthreeareinter-related
andcanbebuiltupbytheuseofresistedexercise.

8. POWERdevelopsinresponsetotheapplicationofthemaximum
resistancewhichisconsistentwiththeabilityofthemusclesto
overcomeit,thereforepowercanbebuiltupwhentheywork
againstaprogressivelyincreasingresistance.Astheessential
factorinpowerdevelopmentisthemagnitudeoftheresistance
themethodusedtopromoteitiscalledPREGRESSIVE
RESISTANCE-LOWREPETITIONEXERCISE,thenumberoftimes
themovementisrepeatedbeingrelativelyfewtoallowthe
resistancetobeasgreataspossible.

9. ENDURANCEisaqualitywhichdevelopsinresponseto
repetitivecontraction,thereforeasitisthenumberof
contractionswhichistheessentialfactor,themethodusedin
thiscaseiscalledLOWRESISTANCE-HIGHREPETITION
EXERCISE.
VOLUME,whichcanbeobservedormeasuredasanindication
ofhypertrophy,usuallydevelopsinproportiontopower.It
servesasameansofdemonstratingprogresstothepatient
althoughitisnotinvariablyareliableindicationofsuccessful
treatment.
Skillisestimatingthecapacityofthemusclesateverystageof
treatmentandinmatchingthiswiththecorrectamountof
resistanceisthekeynotetosuccessintheuseofresisted
exercise.

10. VARIATIONS OFTHEPOWEROF
MUSCLESINDIFFERENTPARTSOF
THEIRRANGE
Muscleswhicharecapableofproducingaconsiderablerangeof
jointmovementarenotequallypowerfulinallpartsoftheir
range.
Physiologically,musclesarecapableofexertingtheirgreatest
strengthwhentheyarefullyextended,i.e.inouterrange,and
astheyshortentheirforcediminishes.This,however,is
modifiedinthecaseofsomemusclesbymechanicalfactors
suchastheangleofpulloftensionofinsertion,i.e.theeffectof
thepullontheleverisgreatestwhentheangleofpull
approachesarightangle.

11. Forexample;physiologicallytheflexorsoftheElbowarestrongest
intheirouterrange,butmechanicallystrongerataboutmid-range.
Whenboththesefactorsaretakenintoaccount,andallowanceis
madeforovercomingtheinitialinertiaatthebeginningofthe
movement,itcanberoughlyestimatedthatthemuscleswillbe
mostefficientintheouterpartofthemiddlerange.This,infact,
canbeprovedbyexperiment.
Itseems,however,thattherelativeimportanceofthesefactors
variesindifferentmusclegroupsbut,broadlyspeaking,eachgroup
isfoundtobemostpowerfulinthepartoftherangeinwhichitis
habituallyused,i.e.Shoulderflexorsinouterrange,hipextensors
ininnerrange.Ingivingmanualresistancethesevariationsin
powercanbefeltandtheresistanceadjustedaccording,butother
meansofprovidingresistancearenotsoaccuratefromthispointof
view.

12. TECHNIQUES OF RESISTED
EXERCISE

13. STARTING POSITION
Startingposition–comfortandstabilityforthebodyasawhole
ensuresthatthepatient’swholeattentioncanbeconcentrated
onthepatternofmovementandtheeffortrequiredto
overcometheresistance.

14. THE PATTERN OF MOVEMENT
Thepatternofmovement–thismustbewellknownbythe
patientandcanbetaughtaspassivelyorafreeexercise.The
patternselectedshould,wheneverpossible,beonewhich
allowscontractionofthemusclesinfullrangeanditshouldbe
basedonanaturalpatternofpurposefulmovement.

15. STABILIZATION
Stabilization-stabilizationoftheboneorbonesoforiginofthe
musclestoberesistedimprovestheirefficiency.This
stabilizationoftherarelystaticwhenanaturalpatternof
movementisusedasitisconstantlybeingadaptedtothe
circumstancesofthemovement.Providedthemusclesnormally
responsibleforthestabilizationhaveremainedefficientthey
shouldbesuedforthispurpose,astheiractionisconsideredto
providereinforcementforthemusclesproducingthemovement.
If,however,thereisatendencyformovementtobetransferred
toneighbouringjointssothatthepatternofmovementis
altered,thenadditionalmeansoffixationsuchasmanual
pressureorastrapmustbeusedtoensuremovementatthe
requiredjoints.

16. TRACTION
Traction–preliminarystretchingofthemusclestoelicitthe
myotatic(stretch)reflexprovidesapowerfulstimulusto
contraction,andtractionmaintainedthroughouttherange
facilitatesjointmovementandmaintainstensiononthemuscles
andsoaugmentstheeffectoftheresistingforce.

17. THE RESISTING FORCE
Theresistingforce-avarietyofmeansmaybeemployedto
supplytheforceusedtoresistthecontractionoftheworking
muscles,e.g.manualpressure,weights,springs,etc.,butin
everycaseitshouldbeappliedinamannerwhichensuresthat
pressureisexertedonthesurfaceofthepatient’sskinwhichis
inthedirectionofthemovement.Theadvantageofmanual
pressureisthatitcanbeadjustedaccuratelytomatchthe
powerofthemusclesinallcircumstancesandineverypartof
therange,butitalsohasthedisadvantageofnotbeingeasily
measurable.Mechanicalresistancesareusuallymeasureable
andthereforeprovedausefulmeansofrecordingprogress.

18. Themagnitudeoftheresistingforce,inrelationtothatofthe
musclepower,variesaccordingtothepurposeforwhichitis
used.Maximalresistanceelicitsmaximaleffortonthepartof
themusclesanditisthereforeusedtodeveloppowerand
hypertrophy.Asthequalityofmuscularenduranceisdeveloped
byrepeatedcontractionagainstresistancethelatteris
considerablylessthanmaximaltoallowagreaternumberof
repetitionstomakeplace.

19. THE CHARACTER OF THE
MOVEMENT
Thecharacterofthemovement–themovementisessentially
smoothandcontrolledthroughout,theeffortinvolved
commandingthepatient’sfullattention.Thespeedof
movementisconsistentwiththeoptimumrateofcontraction
fortheparticulargroupofmusclesinrelationtotheresistance
whichconstitutestheload.Therangemovementisfull
wheneverpossible,butresistancecabbeappliedinanypartof
therangewhichisconvenientordesirableandthemusclescan
alsoberesistedsothattheyworkstaticallyatanyparticular
pointintheirrange.

20. REPETITIONS
Repetitions–thenumberoftimesthemusclesarethrowninto
actionagainstaresistancevariesaccordingtotheconditionand
theindividualpatient,anditisinadvisabletoacceptanyruleof
thumbprocedure.

21. Lowresistance-highrepetitionexercisesappeartobemoresuitable
forweakorelderlypatientswhosemusclesarelessresilientthan
thoseoftheyoungandstrong,andtheyhaveprovedtobe
effectiveinsuchconditionsasOsteo-arthritis.Highresistance-low
repetitionsexercisesontheotherhandundoubtedlybuilduppower
andhypertrophymusclessufferingfromdisuseastheresultof
traumaticinjuryorinconnectionwithorthopaedicsurgery,e.g.
menisectormy,whenthereiseffusionorjointchangesarepresent,
asinRheumatoidarthritis,staticresistedcontractionofthemuscles
passingoverthejointwithahighrepetitionfigurearevaluablefor
retainingmuscularefficiencyandtheycanbeperformedInanypart
oftherangewhichispain-free.Thenumberofrepetitionsmayalso
bedeterminedbythedesirabilityof,orthecontraindicationto,
fatiguingtheneuromuscularmechanisminthetreatmentofa
specificcondition.

22. THE CO-OPERATION OF THE
PATIENT
Theco-operationofthepatient–theeffortexertedbythe
patientandhisinterestinthetreatmentundoubtedlyplayand
importantpartinthedevelopmentofhismusclesbymeansof
resistedexercise.Interestisstimulatedbyprecisioninapplying
theresistance,regularmeasurementandrecordingofprogress,
verbalencouragementand,insuitablecases,bycompetition.

23. RESISTANCE
Aresistanceforceotherthatprovidedbygravityandfrictionmay
beprovidedby:
Thephysiotherapist
Thepatient
Weights
Weightandpulleycircuits
Springsandotherelasticstructures
Substanceswhicharemalleable
water

24. RESISTANCEBYTHEPHYSIOTHERAPIST
Thisisusuallyappliedmanuallyinthelineofthemovement,
andthephysiotherapist’shandisplacedonthesurfaceofthe
skinwhichisinthedirectionofthemovement.Toprevent
wasteofeffortandtoensuresmoothcontrolledpressurethe
physiotherapist’sstancemustbeinthelineofthemovement,
sothatthethrustingactionofthelegsandthebodyweightare
utilized.Tractionorapproximationmaybemaintained
throughoutthemovementandtheresistancevariedaccording
tothevariationinpowerindifferentpartsofthemuscles’s
range.

26. RESISTANCEBYTHEPATIENT
Thepatientcanresisthisownmovementswiththesoundlimb,
orbyusinghisownbodyweight.Thelattermethodisprobably
moreaccuratelyclassifiedasafreeexercise,butisincluded
hereasthequantityofresistanceisobviouslymuchgreater
when,asinthiscase,themusclesworkwithreversedorigin
andinsertiontomovethetrunkonthelimbs.Thistypeof
resistanceisconvenient,buttendstobeunreliableasitcannot
bemeasuredorfeltbythephysiotherapistanditrequires
carefulinstructionandtheco-operationandunderstandingof
thepatient.

28.  EXAMPLES–fromhighsittingtheextensorsofoneknee
canberesistedbytheweightandpressureoftheotherleg
whentheanklesarecrossed.Thebodycanbepressedupfrom
thefloorbythearms,iftheirstrengthissufficient.

29. RESISTANCEBYWEIGHT
Thedirectapplicationofweightstothebodyformsasimpleand
effectivemethodofresistingactiveexercise.Theapparatus
requirediscommonlysandbags,metalweightsoramedicine
ball,whichcanbeappliedbybeingheldinthehand,by
attachmenttoashoe,ortoanyotherpart,bysuitablestraps.
Whensandbagsormetalweightsareused,acanvasbagmay
bestrappedtothepartandanynumberofunitsofweightcan
beinsertedtopprovidetherequiredresistance.Itisessential
thatthemeansofattachmentshouldbecomfortableand
efficient,butitneednotbeelaborate.

30. Bythismethod,resistancemust,ofnecessity,begiveninthe
direcxtionofgravity;itseffectincreasesprogressivelyifthe
weightismovedawayfromthecentralaxisofthebody.Itisa
convenientmethodandsuitableforhomepracticeafter
adequateinstructionhasbeengiver.
 EXAMPLES–Liftingaweightheldinthehandorattached
tothefootorthrowingamedicineballarecommonexamples.
 Resistancebyweightsisalsousedforthetechniqueknown
as“progressiveresistanceexercise”.

32. RESISTANCEBYWEIGHTANDPULLEYCIRCUIT
Theuseofaropeandpulleyallowstheforceexertedbya
weighttoactinanydirection.Thereforethemusclesneednotbe
requiredtoworkagainsttheresistanceofbothgravityandthe
weight.Theeffectofgravitycabbecounterbalancedifthe
movementtakesplaceinahorizontalplane.Thisprovidesa
usefulmethodofarrangingresistanceforweakmuscleswhen
thelimbisheavy.
 EXAMPLE–insittingtheresistanceofgravitytotheknee
extensorsisapproximately5kg.ifthesemusclesareunableto
straightenthekneeagainstthisresistance,theymaystillbeable
toperformtheexerciseadequatelywhen,insidelying,thelegis
supportedhorizontallyandresistanceof,perhaps,4kgisapplied.

33. Astheangleofpulloftheropebywhichitisapplied.And
thereforetheresistanceitself,mustvaryduringthecourseofa
movement,aresistancecanbeofferedtothemuscleswhich
matchesthevariationoftheirpowerindifferentpartsofthe
rangemoreaccuratelythanthatsuppliedbymeansofaweight
applieddirectlytothepartorbyaspring.
 Assumingthataparticularmusclegroupismostpowerful
inmidrangeitistherethattheresistanceisappliedatright
angles.Boththepowerofthemusclesandtheforceofthe
resistancewilldiminishoneithersideofthispoint.


34. Toensurerelaxationandlackofstrainonthejointsbetween
movementsarelaxationstopisincorporatedonthecircuitby
meansofacliporknotwhichpreventstheropefrompassing
thepulley,orbyarrangingfortheweighttobesupportedatthe
endofthemovement.Psychologically,itisofthegreatest
importanceforthepatienttobeabletoseetheweightmoving
astheresultofhisworkandtoknowandrecordthepoundage
lifted.

36. RESISTANCEBYSPRINGSANDOTERELASTICSUBSTANCES
Theresistingforceofaspringincreasesprogressivelyasitis
stretchedorcompressedaccordingtothetypeofspringused.
 Althoughconvenienttoarrange,theuseofspringsfor
resistingmuscularcontractionmustberegardedasasomewhat
crudemethodasitisvirtuallyimpossibletomatchtheir
resistancetothecapacityofthemuscleswithregardtoboth
powerandrangeofmovement.
 Whenspringsareusedthespeedofmovementmustbe
carefullycontrolledbythemusclesbothincontractionand
duringcontrolledrelaxationastheaccumulatedenergyinan
extendedspringmakesitsnaturalspeedofrecoilverygreat.

37.  Othersensiblematerialssuchasrubberelasticofvarious
widthsandthicknessbehaveinamannersimilartothatof
springs,buttheyarenotsodurable.Theelasticpropertiesof
SORBORUBBERareapparentonpressure,andrubbersponges,
Dunlopilloandrubberballsaffordvaryingresistanceswhichare
particularlyusefulindevelopingthegrippingmusclesofthe
hand.

39. RESISTANCEBYSUBSTANCESWHICHAREMALLEABLE
Substancessuchasputty,clay,somekindsofwax,plasticine
andwetsandcanbemouldedintodifferentshapes.The
resistancetheyoffertothischangeinformisvariableandcan
beusedbothforstrengtheningandformobilizingthehands.

41. RESISTANCEBYWATER
Asthepowerofthemuscleincreases,theresistancemustbe
increasedproportionately.

43. METHODS OF INCREASING
RESISTANCE
There are four main methods of increasing resistance to muscle
action. Each method may be used singly or in combination with
any other method:
1.Increase in poundage or weight of the resisting force
2.Increase in leverage of the resistance force
3.Alteration in the speed of movement
4.Increases in the duration of the exercise

44. INCREASEINPOUNDAGEORWEIGHT
Forexample:itisfoundthatamusclegroup,abletoachieve
full-rangecontractionagainstaweightof2kg.whenitis
appliedataspecificpoint,cancontractataspecificspeedand
foraspecificduration.Asthemusclepowerincreases,the
weightisincreasedproportionatelyto2.3kg,3kg,or4kg.,
whiletheotherconditionsremainconstant.Theactualamount
oftheincreaseisvariableaccordingtotheparticularmuscle
group,itsrateofprogresstorecoveryandthefrequencyat
whichanincreaseismade.

45. INCREASEINLEVERAGE
Thetotalresistanceofferedbyagivenweightdependsonthe
positionofitspointofapplicationinrelationtothefulcrum.(
momentofforce=weight×perpendiculardistancefromthe
fulcrum)thegreatertheperpendiculardistanceofthepointof
applicationfromthefulcrum,i.e.thejointatwhichmovement
takesplace,thegreatertheresistanceofferedbytheweight.
 EXAMPLE–theeffectofaresistance,whichconstant,
giventotheshoulderabductorswiththearmstraight,ismuch
greaterwhenappliedatthewristthanattheelbow.

46. ALTERATIONINTHESPEEDOFMOVEMENT
Muscularcontractionismostefficientwhenittakesplaceatan
optimumornaturalspeed.Thisspeedvariesaccordingtothe
formandstructureofthemusclesconcerned,theresistance,
andtheindividual.Increaseordecreaseinthisnaturalspeedof
contractionincreasestheeffectoftheresistancetheslowerthe
movementthegreatertheeffectoftheresistance,i.e.
concentricworkiseasiestatnaturalspeed,eccentricworkat
highspeeds.
 EXAMPLE–Itiseaiertoclimbasteephillatyourown
speedthanatonedictatedbyacompanionwhomaypreferto
gofasterorslowerthanyoudo,butitiseasiertocomedown
rapidly.

47. INCREASEINTHEDURATION
Asmuscleswarmuptotheirtaskofovercomingaresistance,
theybecomemoreefficientandthereforetheeffectofthe
resistancedecreasesandtheexerciseseemseasier.If,
however,itiscontinuedasufficientnumberoftimes,fatigue
reducestheefficiencyofthemusclesandtheresistance
thereforeappearsgreater.
 EXAMPLE–Sawingalogofwoodmayseemtobecome
easierasyouwarmuptoit,butitbecomeshardworkbythe
endofanhour.

48. EFFECTS AND USES OF
RESISTED EXERCISES
1.Musclepowercanonlybemaintainedorincreasedby
contraction,andintheseexercisestheworkingmusclesare
strengthenedandhypertrophiedinresponsetothetension
createdinthembytheresistance.Theirpowerandendurance
isincreased.
Resistedexercisesareusedtobuildupweakmusclesandsoto
restorethebalanceofmusclepowerwhichisessentialfor
stabilityandco-ordinatedmovement.

49. 2.Thebloodflowtotheworkingmusclesisincreasedin
proportiontotheamountofworktheyarecalledupontodon
thusprovidingthematerialsforrepairandhypertrophy.
Althoughtheflowisimpededduringtheactualcontraction,the
amountofbloodcontainedinthemusclesimmediatelyafter
contractionmaybeasmuchastentimesasgreatduring
strenuousexerciseastheamountcontainedduringrest.
Thisincreaseinthebloodflowtothemusclescontinuesfor
sometimeafterexercise,bringingoxygenandnutritiontothe
partandassistingtheremovalofmetabolicproducts.

50. 3.Ageneralriseinbloodpressurefrequentlyanticipates
exerciseandmaybeincreasedbythementaleffortrequiredto
performtheseexercisescorrectly

51. 4.Heat,whichisproducedastheresultofstrenuousmuscular
activity,stimulatestheheat-regulatingcentrecausingvaso-
dilatationintheskin.Thisfollowsaconstrictionofthesevessels
whichoccursinthefirstplacetocompensatefortheincreasein
thebloodflowtothemuscles.Iftherehasbeensufficient
exercise,theskinfeelswarmandpossiblemoistandappears
pink,indicatingthatheatisbeinglostfromthesurfaceto
balancethegainfrommuscleactivityandsokeepthebody
temperaturewithinnormallimits.Thedegreeofmoisture
dependslargelyonthetemperature,humidityandmovementof
theatmosphere.

52. 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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