TITULACIÓN EN LA ESO CON MATERIAS PENDIENTES

The number of exercises selected for inclusion in a programme can mean the difference between success and continued improvement, or failure and non-adherence. If too many exercises are prescribed, the risk of injury increases, as the body can only recover from a certain level of physical stress. This is an important factor in clients with injury, as a significant number of resources will already be involved in combating pain or inflammation present.

Specificity is also reduced when too many exercises are used as the body has limited capacity to adapt to multiple stimuli.

Exercise sequence

The order in which exercises are performed is often overlooked, but it is an important factor that can contribute significantly to the success of an exercise programme. The following should all be considered when sequencing an exercise programme: 1 Highly integrated exercises should be

performed before isolation exercises, to avoid fatigue of stabiliser muscles. Injury may result if stabiliser or smaller

synergistic muscles are exercised in isolation first, and they may destabilise associated joints during the later

execution of complex movement patterns. 2 Training should progress from the most

important to the least important exercises,

in relation to the objectives of exercise. This will prioritise specific skill and movement acquisition over those that are not as important.

3 Exercise should move from the most to the least neurologically demanding. The use of proprioceptive aids, such as stability balls and balance-boards, will significantly increase neural drive to muscles via further activation of righting and tilting reflexes. If placed at the start of a programme, these exercises will

significantly challenge the client without too much risk of nervous fatigue.

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Clinical perspective

Consideration of the spine is important in the sequencing of exercises within a single session. Prior activities and positions can affect the mechanics of the spine in ensuing activities. For example, the ligamentous and disc creep that occurs after prolonged sitting can result in ligament laxity and subsequent risk of injury. Although disc volume appears to redistribute evenly on standing, this can take time, sometimes up to half an hour. With this in mind, exercises involving loading under flexion should be avoided initially, before being sequenced

alternately with exercises involving extension.

In order to reduce viscous friction within the spine, specific movement patterns should be performed as part of a warm-up. The most effective are those performed in a slow, continuous manner that emphasise precision and control of movement, for example, the cat-camel exercise or a sequence of Feldenkrais movements.

Repetitions

Corrective exercise programmes should generally begin with a 12–15 repetition range as this allows for a safe lifting load prior to progression. Further progression will then be dependent on the following factors:

1 Whether the client’s rehabilitation objectives are power, strength, hypertrophy or muscular endurance/stabilisation

2 Biomotor ability – if the client does not have adequate biomotor skill to perform a prescribed exercise with good technique, a reduction in repetitions may be

necessary to enhance motor development, before increasing repetitions

3 Available time – repetitions can be decreased if time is a factor.

Sets

The number of sets performed will depend on training experience and age, occupational and recreational demands and time

availability. Performing more sets will greatly increase the volume and overall intensity of an exercise programme, thereby increasing recovery needs.

Tempo

Tempo refers to the speed at which

repetitions are performed and is described in terms of concentric, isometric and eccentric movements. Therefore a ‘2-1-2’ tempo would describe a movement which involves 2 seconds of concentric and eccentric

movement, with a 1-second isometric pause (or hold) in the middle. Of the acute exercise variables, tempo is usually given the least consideration, but has an important

role in rehabilitation. In the early phases of corrective exercise, where the development of new movement patterns is important, tempo should be slower and controlled to facilitate optimal muscle recruitment. Medicine balls and other plyometric

exercises are favoured for task-specific high- speed movements.

Manipulation of the isometric component can produce holding patterns which can be used to improve muscular endurance. These patterns are integral to daily living where a number of isometric holds may be required, for example, gardening. To ensure optimal recovery of muscle, this duration should not exceed 8 seconds. When 8 seconds of isometric contraction can be achieved, an increase of repetitions and load should be prescribed. Corrective exercise programmes for endurance/stabilisation development should include both higher-repetition routines and holding patterns for optimal functional adaptation.

Rest

This refers to the rest period between sets of repetitions and is a crucial element in the client’s recovery and consequent

performance of an exercise. Too little rest may not provide adequate musculoskeletal and neuromuscular recovery, increasing the risk of immediate injury. Too much rest may reduce the overall intensity of exercise and may slow down or even prevent the desired adaptive response.

Load

The chosen load will be concurrent with repetitions performed and the expected adaptation. It is usually described as a percentage of the client’s 1-repetition

33 Principles of programme design

maximum, as determined objectively using resistance, or subjectively via perceived exertion.

A guide for how to manipulate sets,

repetitions, load, tempo and rest for different objectives is given in Table 5.1.

34 _{Corrective Exercise: A Practical Approach}

Table 5.1. Manipulation of acute exercise variables for muscular endurance/stabilisation, strength, muscle hypertrophy and power

Adaptation Sets Repetitions Load Tempo Rest Muscular endurance 1–3 15–20 40–60% 1-2-4 0–60 seconds

1-8-4

Strength 2–4 4–6 80–90% 2-0-2 60–90 seconds

Hypertrophy 3–5 6–12 75–85% 1-2-3 30–60 seconds

Power 3–5 1–5 85–100% Explosive 2–4 minutes

2

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