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Resistance exercise
 Definisi
• Resistance exercise is any form of active
exercise in which dynamic or static muscle
contraction is resisted by an outside force
applied manually or mechanically.
Resistance exercise ,also referred to as
resistance training, is an essential element of
rehabilitation programs for persons with
impaired function and an integral component
of conditioning programs for those who wish
to promote or maintain health and physical
well-being, potentially enhance performance
of motor skills, and reduce the risk of injury
and disease.
 Principle of Resistance
• Overload Principle
The overload principle is a guiding principle of
exercise prescription that has been one of the
foundations on which the use of resistance
exercise to improve muscle performance is
based. Simply stated, if muscle performance is
to improve, a load that exceeds the metabolic
capacity of the muscle must be applied—that is,
the muscle must be challenged to perform at a
level greater than that to which it is accustomed.
If the demands remain constant after the muscle
has adapted, the level of muscle performance
can be maintained but not increased.
• SAID Principle
The SAID principle (specific adaptation to
imposed demands). This principle applies to
all body systems and is an extension of
Wolff’s law (body systems adapt over time to
the stresses placed on them). The SAID
principle helps therapists determine the
exercise prescription and which parameters of
exercise should be selected to create specific
training effects that best meet specific
functional needs and goals.
• Reversibility Principle
Adaptive changes in the body’s systems, such
as increased strength or endurance, in response
to a resistance exercise program are transient
unless training-induced improvements are
regularly used for functional activities.
INDICATION OF RESISTANCE EXERCISE
1. STRENGTH
2. POWER
3. ENDURANCE
STRENGTH
Muscle ```strength is a broad term that refers to the
ability of contractile tissue to produce tension and a resultant
force based on the demands placed on the muscle. Functional
strength relates to the ability of the neuromuscular system to
produce, reduce, or control forces, during functional activities,
in a smooth, coordinated manner
Strength training (strengthening exercise) is defined as
a systematic procedure of a muscle or muscle group lifting,
lowering, or controlling heavy loads (resistance) for a
relatively low number of repetitions or over a short period of
time.
POWER
Muscle power, another aspect of muscle
performance, is related to the strength and speed of
movement and is defined as the work (force × distance)
produced by a muscle per unit of time (force ×
distance/time). In other words, it is the rate of performing
work. Force and the relationship of force and velocity are
factors that affect muscle power.
The greater the intensity of the exercise and the
shorter the time period taken to generate force, the
greater is the muscle power.
ENDURANCE
Endurance is a broad term that refers to the ability to
perform low-intensity, repetitive, or sustained activities over a
prolonged period of time
The key parameters of endurance training are low-
intensity muscle contractions, a large number of repetitions, and
a prolonged time period. For many patients with impaired muscle
performance, endurance training has a more positive impact on
improving function than strength training. In addition, using low
levels of resistance in an exercise program minimizes adverse
forces on joints, produces less irritation to soft tissues, and is
more comfortable than heavy resistance exercise.
Contraindications to Resistance
1. Pain
2. Inflammation
3. Severe Cardiopulmonary Disease
PAIN
During testing, if a patient experiences acute
muscle pain during a resisted isometric
contraction, resistance exercises (static or
dynamic) should not be initiated. If a patient
experiences pain that cannot be eliminated by
reducing the resistance, the exercise should be
stopped.
Inflammation
Dynamic and static resistance training is
absolutely contraindicated in the presence of
inflammatory neuromuscular disease. For example,
in patients with acute anterior horn cell disease
(Guillain-Barré) or inflammatory muscle disease
(polymyositis, dermatomyositis) resistance
exercises may actually cause irreversible
deterioration of strength as the result of damage
to muscle.
Severe Cardiopulmonary Disease
Severe cardiac or respiratory diseases or
disorders associated with acute symptoms
contraindicate resistance training. For example,
patients with severe coronary artery disease, carditis,
or cardiac myopathy should not participate in vigorous
physical activities, including a resistance training
program, nor should patients with congestive heart
failure or uncontrolled hypertension or dysrhythmias.
After myocardial infarction or coronary artery bypass
graft surgery resistance training should be postponed
for at least 5 weeks (that includes participation in 4
weeks of supervised cardiac rehabilitation endurance
training) and clearance from the patient’s physician has
been received.
 Determinants of Resistance
Exercise
• Intensity
The intensity of exercise in a resistance training
program is the amount of resistance (weight)
imposed on the contracting muscle during each
repetition of an exercise. The amount of
resistance is also referred to as the exercise
load (training load)—that is, the extent to which
the muscle is loaded or how much weight is
lifted, lowered, or held.
• Volume
In resistance training the volume of exercise is
the summation of the total number of repetitions
and sets of a particular exercise during a single
exercise session times the intensity of the
exercise. The same combination of repetitions
and sets is not and should not be used for all
muscle groups.
• Exercise Order
The sequence in which exercises are performed
during an exercise session has an impact on
muscle fatigue and adaptive training effects.
When several muscle groups are exercised in a
single session, as is the case in most
rehabilitation or conditioning programs, large
muscle groups should be exercised before small
muscle groups, and multi-joint exercises should
be performed before single-joint exercises.
• Frequency
Frequency in a resistance exercise program
refers to the number of exercise sessions per
day or per week Frequency also may refer to the
number of times per week specific muscle
groups are exercised or certain exercises are
performed
• Duration
Exercise duration is the total number of weeks or
months during which a resistance exercise
program is carried out.
 Procedural
• Examination and Evaluation
1. Perform a thorough examination of the patient,
including a health history, systems review, and
selected tests and measurements.
2. Interpret the findings to determine if the use of
resistance exercise is appropriate or
inappropriate at this time. Be sure to identify the
most functionally relevant impairments, the goals
the patient is seeking to achieve, and the
expected functional outcomes of the exercise
program.
3. Establish how resistance training will be
integrated into the plan of care with other
therapeutic exercise interventions,such as
stretching, joint mobilization techniques,
balance training, and cardiopulmonary
conditioning exercises.
4. Re-evaluate periodically to document progress
and determine if and how the dosage of
exercises (intensity, volume, frequency, rest)
and the types of resistance exercise should be
adjusted to continue to challenge the patient.
 Preparation for Resistance Exercises

1. Select and prescribe the forms of resistance

exercise that are appropriate and expected to
be effective, such as whether to implement
manual or mechanical resistance exercises, or
both.
2. If implementing mechanical resistance exercise,
determine what equipment is needed and
available.
3. Review the anticipated goals and expected
functional outcomes with the patient.
4. Explain the exercise plan and procedures. Be
sure that the patient and/or family understands
and gives consent.
5. Have the patient wear nonrestrictive clothing
and supportive shoes appropriate for exercise.
6. If possible, select a firm but comfortable
support surface for exercise.
7. Demonstrate each exercise and the desired
movement pattern.
 Implementation of Resistance
Exercises
Warm-Up
Prior to initiating resistance exercises, warm-up
with light, repetitive, dynamic, site - specific
movements without applying resistance.
Placement of Resistance
Resistance typically is applied to the distal end of
the segment in which the muscle to be
strengthened attaches. Distal placement of
resistance generates the greatest amount of
external torque with the least amount of manual
or mechanical resistance (load).
• Direction of Resistance
During concentric exercise resistance is applied
in the direction directly opposite to the desired
motion, whereas during eccentric exercise
resistance is applied in the same direction as the
desired motion
• Stabilization
Stabilization is necessary to avoid unwanted,
substitute motions.
• Intensity of Exercise/Amount of Resistance
Initially, have the patient practice the movement
pattern against a minimal load to learn the
correct exercise technique.
• Cool-Down
Cool-down after a series of resistance exercises
with rhythmic, unresisted movements, such as
arm swinging, walking, or stationary cycling.
Gentle stretching is also appropriate after
resistance exercise.
Mechanical Resistance Exercise
1. Application in Rehabilitation Programs
2. Application in Fitness and Conditioning
Programs
3. Special Considerations for Children and Older
Adults
Application in Rehabilitation Programs

Application in Rehabilitation Programs

Mechanical resistance exercise is commonly
implemented in rehabilitation programs to
eliminate or reduce deficits in muscular strength,
power, and endurance caused by an array of
pathological conditions and to restore or improve
functional abilities.
Application in Fitness and Conditioning
Programs
There is a growing awareness through health
promotion and disease prevention campaigns that training
with weights or other forms of mechanical resistance is an
important component of comprehensive programs of physical
activity designed to improve or maintain fitness and health
throughout most of the life span. As in rehabilitation
programs, resistance training complements aerobic training
and flexibility exercises in conditioning and fitness programs.
Guidelines for a balanced resistance training program for the
healthy, but untrained adult (less than 50 to 60 years of age)
recom- mended by the American College of Sports Medicine
Special Considerations for Children and Older
Adults
Children and older adults often find it
necessary or wish to engage in resistance
training either as part of a rehabilitation
program to correct impairments and reduce
functional limitations or a program of physical
activity designed to improve fitness, reduce
health-related risk factors, or enhance physical
performance. Resistance training can be safe
and effective if exercise guidelines are modified
to meet the unique needs of these two groups.
Manual Resistance Exercise
Upper Extremity
FIGURE 6.14
Resisted shoulder
flexion.

FIGURE 6.15 Resisted

shoulder abduction
FIGURE 6.16 (A) Resisted external FIGURE 6.16—cont’d (B)
rotation of the shoulder with Resisted internal rotation of
the shoulder positioned in flexion and the shoulder
abduction (approaching the with the shoulder in 90° of
plane of the scapula). abduction.
FIGURE 6.17 Elevation of FIGURE 6.18 Resisted
the shoulders (scapulae), elbow flexion with
resisted proximal stabilization.
bilaterally.
FIGURE 6.19
Resisted elbow
extension.

FIGURE 6.20 Resisted

pronation of the forearm.
FIGURE 6.21 Resisted
FIGURE 6.22 Resisted flexion of the
wrist flexion and
proximal interphalangeal (PIP)
stabilization of the
joint of the index finger with stabilization
forearm.
of the metacarpophalangeal
(MCP) and distal interphalangeal (DIP)
joints.
FIGURE 6.23 Resisted
opposition of the thumb.
Manual Resistance Exercise
Lower Extremity
FIGURE 6.24 Resisted
flexion of the hip with the
knee flexed

FIGURE 6.25 Resisted hip and

knee extension with the hand
placed
at the popliteal space to prevent
hyperextension of the knee.
FIGURE 6.26 Resisted end-range hip
extension with stabilization of
the pelvis.

FIGURE 6.27 Resisted hip

abduction.
FIGURE 6.28 Resisted external rotation of
the hip with the patient
lying supine.

FIGURE 6.29 Resisted internal

rotation of the hip with the
patient
lying prone.
FIGURE 6.30 Resisted knee flexion with
stabilization of the hip.

FIGURE 6.31 Resisted knee

extension with the patient
sitting and
stabilizing the trunk with the
upper extremities and the
therapist
stabilizing the thigh.
FIGURE 6.32 (A) Resisted dorsiflexion. (B) Resisted plantarflexion
of the ankle.