What Is Active Exercise and its effect in Physiotherapy?

Definition Of Voluntary or Active Movement is Movement performed or controlled by the voluntary action of muscles, working in opposition to an external force.

Classification Of Active Exercise

Free Exercise: The working muscles are subject only to the forces of gravity acting upon the part moved or stabilized.

Assisted Exercise: When muscle strength or coordination is inadequate to perform a movement an external force is applied to compensate for the deficiency.

Assisted - resisted Exercise: Muscles may be strong enough to work against resistance in part of the range and not in others. This type of exercise ensures that the external forces applied are adopted in every part of the range to the abilities of the muscles.

Resisted Exercise: The forces of resistance offered to the action of the working muscles are artificially and systematically increased to develop the power and endurance of the muscles.

Free exercises are performed by the patient's own muscular efforts without the assistance or resistance of any external force, other than that of gravity. They vary widely in character and effect, not only because of the nature and extent of the movement but according to how they are performed. This type of exercise can be used to obtain any of the effects which are produced by exercise as a whole, if and when it is used judiciously.

A degree of relaxation is induced by exercises that are rhythmical or pendular in character; muscle tone is maintained and power increased according to the speed, leverage, and duration of the exercise, and the relationship of the part moved to gravity; coordination is trained or improved as the natural pattern of group action is employed, and confidence in the ability to perform and control movement is established. Success in achieving the required effect depends not only on the selection of a suitable exercise and on how it performed but also on the degree of cooperation obtained from the patient and the skill of the instructor.

The great advantage of free exercises lies in the fact that once the patient has mastered the technique of their performance and aware of their purpose, they are his own, to practice when and where he pleases. He has, in fact, been given the means to cure or to help to cure himself and need no longer rely on others for this purpose. Whether or not he uses the exercise for home practice to help himself largely depends on his desire for rehabilitation and his confidence in the efficacy of the exercises. The disadvantage of free exercises is that they frequently make insufficient demands on the patient's neuromuscular system to elicit the maximal response required for the rapid redevelopment or reinforcement of weak muscles. When there is a muscular imbalance, compensatory rather than normal patterns of movement may be used unless movements are carefully taught and supervised. Patients who have suffered brain damage or who are unable to initiate movement cannot cooperate in doing these exercises until their performance has been facilitated and voluntary control has been established.

Classification of Free Exercises 

Free exercises may be classified according to the extent of the area involved; they may be :
a. Localized b. General. 

a. Localized exercises are designed primarily to produce some local and specific effect, for example, to mobilize a particular joint or to strengthen particular muscle groups, Movement is localized to one or more joints, either by the use of a suitable starting position or by voluntary fixation of other areas by the patient's own muscular effort.

b. General exercises usually involve the use of many joints and muscles all over the body and the effect is widespread, for example, as in running. The character of a particular exercise may be :
a. Subjective b. Objective 

a. Subjective exercises are usually formal and consist of more or less anatomical movements performed in full range. The attention of the patient is deliberately focused on the form and pattern of the exercise to ensure the accuracy of performance.
b.Objective exercises are those during the performance of which the patient's attention is concentrated on the achievement of a particular aim which will result from his efforts, e. g. standing; Arm stretching upwards, to touch a mark on the wall, or to throw a ball. The presence of a goal to be reached is stimulating to effort, like the proverbial carrot held in front of the donkey's nose, but care must be taken to see that the accuracy of the movement is not sacrificed to the achievement of the aim; e. g . in walking across a room to get a cup of tea, the quality of the walking must not be allowed to deteriorate.

The Technique of Free Exercises 

  1.  The starting position is selected and taught with care to ensure maximum postural efficiency as a basis for movement. 
  2.  Instruction is given in a manner that will gain the interest and cooperation of the patient and lead him to understand both the pattern and the purpose of the exercise.  
  3. The speed at which the exercise is done depends on the effect required. It is usually slow during the period of learning and later the patient is either allowed to find his own natural rhythm or the speed required is dictated by the physiotherapist. It often helps the patient to maintain his natural rhythm at home if, during practice under supervision, he is encouraged to count aloud. 
  4. The duration of the exercise depends very largely on the patient's capacity. Usually, three bouts of practice for each exercise, with short rest periods, or a change of activity,, ensure sufficient practice without undue fatigue.
lady performing yoga Active exercise in big room What Is Active Exercise and its effect in Physiotherapy?

The Effects and Uses of Free Exercise 

The effect and consequent uses of any particular free exercise depend on the nature of the exercise, its extent, and the intensity and duration of its performance.

Relaxation. Rhythmical swinging movements and those which are pendular in character assist the relaxation of hypertonic muscles in the region of the joint moved. The alternating and reciprocal contraction and relaxation of the opposing muscle groups, which is required to sustain the movement, helps to restore the normal state of relaxation which follows contraction. This type of exercise is used in conjunction with other methods which induce relaxation to reduce a state of wasteful tension in muscles, which limits the range of joint movement and reduces the efficiency of neuromuscular coordination.
Exercises that work for particular muscle groups strongly achieve reciprocal relaxation of the opposing groups, e. g. work for the Scapular Retractors and Shoulder Extensors assists relaxation of the Per Muscles.

joint Mobility. The normal range of joint movement is maintained by exercises performed in full range. If and when the range of movement is limited, rhythmical swinging exercises incorporating overpressure at the limit of the free range may serve to increase it.

Muscle Power and Tone. The power and endurance of the working muscles are maintained or increased in response to the tension created in them. This tension is greater when the exercise is performed at any speed which is slower, or more rapid, than when the natural sneed of movement is employed, and it increases with the duration of the exercise. A high degree of tension and consequent increase in power can be developed by free exercises when the muscles work for any time against the resistance offered by the body weight, or against the mechanical disadvantage of adverse leverage provided by a long and heavy limb. Normally, muscle power is maintained adequately by a minimum of everyday activities, most of which are performed in the middle range. Under abnormal conditions, however, for example during fixation of a joint, the power can only be maintained or improved by repeated static contractions, which the patient must practice throughout the day.

A lady doing plank on elbow active exercise in big room

Neuromuscular Coordination. Coordination is improved by the repetition of an exercise. As the pattern of movement is established, it is simplified and becomes more efficient, and the conduction of the necessary impulses along the neuromuscular pathways is facilitated. Exercises or activities, which at one time required concentration and much effort, become with practice more or less automatic in character, and skill is developed, as for example in walking or playing the piano.

Confidence. The achievement of coordinated and efficient moves meant assures the patient of his ability to maintain subjective cont of his body, giving him the confidence to attempt other and new act ties, together with a feeling of exhilaration and satisfaction when the is accomplished, for example, jumping a rope, or shooting a goal Objective exercises and activities are usually used for this purpose.

Circulatory and Respiratory Cooperation. During vigorous of longed exercise, it is apparent that the speed and depth of respiration are increased, that the heartbeat is faster and more forceful, and heat is produced, whereas in light exercise these changes are that they are not noticed. depth of respiration forceful and that e changes are so slight.
a lady performing abdominal crunches active exercise

a. The Needs of the Active Tissues. The active tissues during muscular exercise require a free supply of oxygenated on ve tissues involved generated blood and the removal of metabolic products to enable them to continue their activity. To meet these demands and to keep pace with them. the cooperation of the Circulatory and Respiratory Systems is enlisted.

b. Preparation for Activity. It is probable that the cerebral cortex, which initiates the muscular contraction, also prepares the body to supply the needs of the tissues concerned, by communicating with the Respiratory, Cardiac, and Vasomotor centers which form part of the Autonomic Nervous System. Sympathetic fibers from these centers convey impulses to the appropriate organs which, with the help of adrenalin, which is released into the bloodstream, produces widespread results. These results include increased respiration, increased frequency of the heartbeat, a rise in arterial blood pressure, and a redistribution of blood so that the volume of blood in the muscles is increased at the expense of that in the splanchnic area and the skin. All these changes occur merely as the result of the anticipation of exercise as those who have taken part in competitive sports may have been aware.

c. Local Circulatory Changes in the Muscles. During active exercise, the capillaries in the working muscles dilate and their permeability is increased. Many capillaries that were closed when the muscle was at rest become open and blood flow through them. In this way, the capacity of the muscles to contain blood is markedly increased and the interchange of fuel and waste products between the blood and the tissue fluids is facilitated.

d. Regulation of Circulatory and Respiratory Function during Exercise. The venous return to the heart is increased during exercise and results in an increase in cardiac output. The increased venous return is caused partly by the pressure variations in the abdominal and thoracic cavities resulting from increased respiratory movements which exert a pumping action upon the large veins in the direction of the heart, and partly by the pressure of the contracting muscles on the thin walls of the peripheral veins. Valves in these veins prevent regurgitation during the relaxation of the pressure.

Muscular contraction increases both the carbon dioxide content and the temperature of the blood, and both these factors stimulate the circulatory and respiratory systems to further activity. The rise in temperature of the body is kept within normal limits by dilation of the skin capillaries and stimulation of the sweat glands, thus enabling heat to be lost from the surface. Active exercise can, therefore, be used to increase Respiration, to increase both the local and the general Circulation, and to provide work for the Heart Muscle.

Post a Comment

Previous Post Next Post