Accelerated Muscular Development Programs
Resistance exercise (RE) incorporates all types of strength and weight training and will lead to improvements in both muscle strength and endurance. RE has many proven health benefits, including increases in lean muscular mass, and it has been shown to complement aerobic exercise in the maintenance of basal metabolic rate, important for weight management (Pollock, et al., 2000). In addition, RE can reduce the risk of falling by improving muscular strength and balance (ACSM, 2001). Favourable effects on bone density are associated with resistance exercise (Bjarnason-Wehrens, et al., 2004). Many women in CR, if they are older, will be post-menopausal, and for this group prevention and treatment of osteoporosis are added benefits. The incidence of coronary heart disease increases with age and after the menopause (BHFS, 2004). This coincides with an age-related decline in muscular strength and fat-free mass after the age of 50 (ACSM, 2001). RE has been shown to prevent decline in muscle...
The number of calories used by an individual is determined by three factors basal metabolic rate, the thermic effect of the food eaten, and the calories used during physical activity. The basal metabolic rate is the amount of energy needed to maintain bodily functions when an individual is at rest. This component accounts for 60 to 75 percent of the daily calorie requirement in sedentary adults. The major determinant of the basal metabolic rate is the amount of fat-free mass in the body. Muscle is one example of fat-free mass. Resistance (strength) training can increase the amount of muscle and therefore increase the basal metabolic rate. Resistance training also can help prevent the loss of lean mass that normally occurs with aging. Men
Maintenance or increase in range of movement. Electrical muscle stimulation (EMS) is used to strengthen muscle and facilitate voluntary motor function. Although EMS devices are often advertised for muscle toning and weight reduction, they are authorized by the FDA only as prescription devices for maintaining or increasing range of motion, relaxation of muscle spasm, prevention or retardation of disuse atrophy, muscle reeducation, increasing local blood circulation, and postsurgical stimulation of calf muscles to prevent the formation of blood clots.
Contrary to popular belief, simply eating more dietary protein, in excess of recommended amounts, will not result in bigger muscles. Our bodies do not store excess protein. If we eat more protein than our bodies need to replenish the amino acids we have used during the day, the excess amino acids are converted to, and stored as, fat. Dietary protein, like carbohydrates, supplies about 4 calories of energy per gram. Because our requirements for protein mainly depend on our body's size, our need for protein increases during times of rapid growth. Therefore, the recommendations for protein are age-dependent and are slightly higher for pregnant and breastfeeding women than for other adults (see the Appendix Dietary Reference Intakes, page 421). The recommended allowances ensure an adequate protein intake by nearly all healthy people. Nevertheless, many Americans typically consume twice this amount, often in the form of meat and dairy products that are high in
There is some dispute as to when coronary heart disease patients should commence an RE programme. There is general consensus that patients should complete a period of aerobic exercise prior to initiating resistance training. The ACSM (2001) and SIGN (2002) recommend a period of four to six weeks' aerobic acclimatisation. This period allows for patients' haemodynamic responses to exercise to be assessed and for any complications to be ruled out before progression to RE. Additionally, the patient can use this time to become familiar with self-monitoring and to establish the correct training intensity. Prior to commencing upper limb resistance training CABG patients should have their wound and sternal area assessed, to ensure adequate healing and stability (Pollock, et al., 2000). Caution is advised for patients who demonstrate symptoms of chest clicking or discomfort, as this can signify problems with healing. There is some evidence that an exercise programme should avoid any exercises...
In these cases, two types of sensory retraining can be used. The first type partly uses biofeedback training, as sensory retraining is coupled to sphincter strength training. In response to repeated rectal distensions induced by inflation of the catheter-mounted balloon with volumes above or below the sensory threshold, the patient contracts the anal sphincter as strongly as possible, with feedback on contraction strength 2 . The second type involves twice-daily administration of a tepid water enema (volumetric rehabilitation) 19 . The initial volume is equal to the maximally tolerated manometric volume. The patient holds the liquid using the strongest possible anal contraction for the longest period of time possible. In the days following, the enema volume is gradually either increased or decreased by 30 ml until the patient achieves a normal value of rectal sensation the volume is increased if the patient has a resting low-conscious threshold and decreased if the resting conscious...
Different diets have been used successfully in IGT, usually combined with some form of exercise. The recommended exercises have mostly been some form of light aerobic exercise or resistance training. The various diets have several characteristics in common, including decreased calories for weight reduction, decreased fat (
In the UK, aerobic circuit interval training for group exercise training is commonly used and is an effective method for delivering aerobic exercise (SIGN, 2002). In addition to the aerobic conditioning phase, resistance training is part of CR exercise. Home-based exercise is also prescribed with self-monitoring skills being used by the patients. Typically an exercise class consists of a warm-up, an aerobic conditioning phase, a cool-down period and a conditioning phase. The exercise programme should be tailored to the needs of the patient.The latter is important to encourage adherence to exercise. Details regarding the exercise component of CR are provided in Chapters 3-5.
Endurance training at submaximal levels of VO2 increases the oxidative capacity of muscle without causing muscle hypertrophy. Muscle size does not change but there are increases in the number of mitochondria and enzymes for fatty acid oxidation, the citric acid cycle, and the electron transport chain. Capillary density and
Aerobic activities should be prescribed with the following considerations it is important that all exercises are dynamic, as isometric exercise will increase BP. Isometric activities associated with the valsalva manoeuvre should be avoided. Resistance training should be prescribed using lower resistance and higher repetitions, ensuring the patients are not over-gripping equipment.
Blood flow is redistributed during exercise away from vegetative organs and toward actively exercising muscles by both intrinsic (local) and extrinsic (reflex) mechanisms. In isometric exercise, muscle blood flow may actually decrease with compression of arteries and veins in contracted muscles. In contrast, active hyperemia, or an increase in blood flow, occurs in muscles during dynamic exercise. Arterioles dilate in exercising muscles in direct response to local metabolic changes (decreased O2, increased CO2 and H+ ion), adenonsine, and nitric oxide (NO). This local control of muscle blood flow overrides the effect of sympathetic stimulation to
The measurement of plasma catecholamines has inherent difficulties, but there is now broad consensus that plasma catecholamine concentrations fall from the first to the third trimesters. There is some blunting of the rise in noradrenaline (reflecting mainly sympathetic nerve activity) seen on standing and isometric exercise in pregnancy, but the adrenaline response (predominantly adrenal) is unaltered 16 .
Amount of information about and preparation for the respective changes is an important predictor of positive adjustment. Girls who are not prepared for menar-che and boys who are not prepared for semenarche often experience undue anxiety and shame. Cultural standards of physical attractiveness for males versus females and the fact that adolescents' pubertal body changes are said to have social stimulus value (meaning that others notice the changes and react to them) also come into play. For example, puberty brings an increase in lean body mass (i.e., muscle) for males, but a decrease in lean body mass (and an increase in body fat) for females. Depending on the degree to which these normal changes in body shape and composition occur for boys versus girls, the adolescent's body image and overall self-esteem may be enhanced or diminished.
Statin-related muscle symptoms affect 3 to 5 of the population, and some of the pathology may be due to mitochondrial dysfunction (Baker and Tarnopolsky, 2001, 2003, 2005). Consequently, it may be of interest to determine whether CrM supplementation could have a beneficial affect with respect to myalgias and or the development of myopathy. There is currently no proven therapy for inclusion body myositis except for strength training. Given that these patients are usually older men, and that creatine enhances the gains in strength in older adults during strength training, the potential for creatine as a therapy for inclusion body myositis does exist.
Arterial blood pressure increases during exercise, but the increase is much greater in isometric than in dynamic exercise. During isometric exercise, the blood vessels are clamped shut by sustained contractions, and resistance increases. This leads to anaerobic metabolism and strong stimulation of the muscle chemoreflex. Without the benefits of local vasodilation in isometric muscle contraction, the net effect is an increase total peripheral resistance and arterial pressure.
The use of multi-gym weight training is widely recommended, but can be an expensive option. Weight machines maintain equilibrium, ensure the movement plane is well controlled and have easily altered resistance. This mode of resistance training may be useful for those with balance difficulties because the machines provide support. Prior to participating in RE patients should have an induction session. This is important to ensure safety. The induction should include advice and demonstration on positioning, moving and handling, and setting the resistance at the prescribed level. During all types of resistance training patients should be advised to avoid excess gripping and breath holding to help prevent valsalva. This advice should also be discussed in relation to heavy household or lifting tasks that are carried out at home or elsewhere.
Aging is characterized by shrinking of muscle fibers and protein loss from these muscle fibers. Bone is also lost, and matrix and mineral levels are also lost equally. The predominant breakdown of synthesis is probably the fundamental cause of both muscle and bone loss. Little can be done to prevent this by dietary means, but physical activity is of vital importance in helping to maintain the integrity of both muscle and bone. Resistance training is an effective means of preserving or increasing skeletal muscle mass and functional status in the elderly. In addition, resistance training has been demonstrated to increase energy requirements, protein retention, bone mass, and levels of physical activity in the healthy elderly as well as the very old and frail. The influence of 4 wk of anaerobic training program with 30-min sessions of weight lifting per week in middle-aged, moderately trained men (40-50 yr) was studied, and significant increases of the mean arm muscle force by 7 was...
The management of weight loss is a controversial area. At present there is inconclusive evidence regarding the relative effectiveness of physical activity combined with diet, versus diet alone or physical activity alone (Mulvihill and Quigley, 2003). As adipose tissue contains about 7000kcal kg, with physical activity alone it is difficult to lose much weight (BHF, 2004). Therefore, management of obese participants should include advice on diet, physical activity and a behavioural modification component in order to be comprehensive and effective. The most favourable alterations in body composition will occur with low-intensity, long duration aerobic exercise and aerobic exercise combined with high repetition resistance training (Mulvihill and Quigley, 2003).
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