Updated: 6/2/2021

Exercise Science

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  • Types of Contractions/Movements
    • Types of Contractions/Movements
      Type
      Definition
      Example
      Isotonic

      Force remains constant through ROM -improves motor performance

      Biceps curls using free weights
      Isometric

      Constant muscle length and tension that is proportional to the external load-Causes muscle hypertrophy
      Pushing against an immovable object
      Concentric 

      Shortened muscle and tension that is proportional to the external load

      Biceps curl with elbow flexing
      Eccentric 

      Force remains constant as muscle lengthens
      Most efficient method of strengthening muscle
      Biceps curl with elbow extending
      Isokinetic

      Muscle contracts at a constant velocity through varied resistance.-often used to objectively evaluate muscle strength during injury rehabilitation
      Require special machines (e.g, Cybex).
      Plyometric

      Rapid eccentric-concentric shortening
      Good training for sports that require power
      Box jumps

      Open chain 

      Distal end of extremity moves freely

      Seated leg extensions and curls
      Closed chain
      Distal end of extremity is fixed
      Squats with planted foot
  • Anaerobic vs. Aerobic
    • Anaerobic vs. Aerobic 
      Anaerobic 
      Glycolytic
       Aerobic
      Energy source


      ATP-CP


      Lactic acid


      Oxidative phosphorylation (Krebs cycle)
      Glycogen and fatty acids 
      Muscle type

      Type II (A, B) muscle
      -fast twitching
      Type I muscle
      -slow twitching
      Exercise duration
      10 seconds of high intensity
      2-3 minutes
      endurance
      Note





      • Type IIA: aerobic and anaerobic
      • Type IIB: primarily anaerobic, last to be recruited


      • Low ATP yield
      • Lactic acidosis after several minutes



      • High yield ATP
      • Requires O2
      • "Slow red ox muscles"
      • First to be recruited 


  • Exercise Programs Definitions
    • Periodization
      • strength and conditioning term for planned variation in intensity and duration of a specific workout over a predefined duration of time
    • Dynamic exercise improves cardiac output by increasing cardiac stroke volume
    • Endurance (aerobic) Training
      • results in changes in circulation and muscle metabolism
      • contractile muscle adapts by increasing energy efficiency
      • increases in mitochondrial size, number, and density
      • increases in enzymes involved in Krebs cycle, fatty acid processing, and respiratory chain
      • over time, increased use of fatty acids > glycogen
      • over time, oxidative capacity of Type I, IIA, and IIB fibers increase
        • percentage of more highly oxygenated IIA fibers increases
      • Aerobic Threshold: level of effort at which anaerobic energy pathways become significant energy producer
      • Anaerobic (lactate) Threshold: level of effort at which lactate production > lactate removal
    • Strength Training
      • typically high-load, low-repetition activities
      • results in increased cross-sectional area of muscle due to muscle hypertrophy
        • hyperplasia (increased number of fibers) less likely
      • results in increased motor unit recruitment +/- improved synchronization of muscule activity
      • maximal force production is proportional to muscle physiologic cross-sectional area
      • adolescents can safely participate in appropriate strength training programs
        • gains in strength largely due to improved neuromuscular activation and coordination rather than muscle hypertrophy
        • gains for adolescents are reversible if training is discontinued
  • Aquatic training
    • Benefits
      • decreases joint stress by lowering vertical component of the ground reaction force through buoyancy
      • unique advantages in cardiorespiratory fitness when compared to land training
      • less abrupt increases in heart rate
      • increased oxygen consumption
      • prevents secondary injuries to the lower limb
  • Exercise Induced Laryngeal Obstruction (EILO)
    • Commonly mistaken for exercise-induced bronchoconstriction in athletes
    • Epidemiology
      • gender - more common in females
    • Mechanism - unknown
    • Symptoms
      • dyspnoea
      • wheezing
    • Differential diagnoses
      • exercise-induced bronchoconstriction (EIB, or exercise-induced asthma)
      • hyperventilation
      • cardiac conditions
    • Diagnosis
      • negative bronchodilator reversibility test (with beta2-agonist)
        • positive in EIB
      • negative bronchoprovocation tests (e.g. methacholine challenge, mannitol challenge, eucapnic voluntary hyperventilation test)
        • positive in EIB
      • positive continuous laryngoscopy during exercise (CLE)
    • Types (anatomic location)
      • supraglottic level
      • glottic level
    • Treatment
      • optimum treatment is being investigated
  • Exercise-Induced Hematuria
    • Epidemiology
      • Incidence
        • Microscopic hematuria present in 16.7 - 46.7% of athletes
        • Macroscopic hematuria present in 3.1 - 19.2% of athletes
      • Risk Factors
        • Exercise intensity
        • Posture
        • Age
        • Heat load
        • Altitude
        • Pre-existing kidney disease
    • Pathophysiology
      • Proposed pathophysiology of exercise-induced hematuria
        • Bladder/kidney contusion from up and down motion
        • Vascular spasm to kidney
    • Presentation
      • History
        • Presence of hematuria correlates with increased exercise intensity
      • Symptoms
        • Asymptomatic
    • Differential
      • Urinary tract infection or Sexually transmitted infection
        • Pyuria and dysuria
      • Papillary necrosis
        • Personal or family history of Sickle cell trait or disease
      • Kidney Contusion
        • Blunt impact to flank and flank pain
      • Kidney Stone
        • Dysuria and flank pain
    • Treatment
      • Nonoperative
        • Cessation of exercise, repeat urinalysis in 48-72 hours
        • Further workup indicated if:
          • Hematuria persists >7 days after cessation of exercise
          • Age >50
  • Weight training
    • Effects on muscles
      • increased cross-sectional area
      • increased strength
      • increased mitochondria
      • increased capillary density
      • thickened connective tissue
    • Adult strength gains are associated with muscle hypertrophy
    • Adolescent strength gains occur more from increased muscle firing efficiency and coordination
  • Nutritional training
    • Carbohydrate loading
      • involves increasing carbohydrates three days prior to an event and decreasing physical activity to build up carbohydrates stores
      • increases the stores of muscle glycogen to provide improved endurance, especially in events lasting > 90 minutes when the bodies normal supply of glycogen runs low
      • best technique for athlete is to instead maintain normal diet
    • Fluid loading and replacement
      • magnitude of core temperature and heart rate increase accompanying work are proportional to the magnitude of water debt at the onset of exercise
      • best technique is to replace enough water to maintain prepractice weight
    • Fluid carbohydrate and electrolyte replacement
      • best done with low osmolarity (< 10%) fluids of carbohydrates and electrolyties which enhances absorption in the gut
        • glucose polymers decrease osmolarity
  • Muscle Injury
    • Muscles soreness
      • caused by edema and inflammation in the connective tissue
        • leads to increased intramuscular pressure
        • occurs primarily in Type IIB fibers
      • worse with unaccustomed eccentric exercise
      • often with delayed onset: Delayed-Onset Muscle Soreness (DOMS)
        • peaks at 24-72 hours
      • elevated CK levels seen in serum
    • Muscles strain
      • occurs commonly at myotendinous junction (often during eccentric contraction which produces highest forces in skeletal muscle)
      • pathoanatomy in inflammation followed by fibrosis
    • Muscle contusion
      • non-penetrating blunt injury
      • leads to hematoma and inflammation
      • extracellular connective tissue forms within 2 days, peaks between 5-21 days
      • healing characterized by late scar formation, variable muscle regeneration
      • myositis ossificans (bone formation within the muscle tissue)
        • most apparent 4 weeks post-injury
    • Muscle laceration (complete tear)
      • typically occur near myotendinous junction
      • characterized by abnormal muscle countour
      • fragments heal by dense connective scar tissue
        • mediated by myofibroblasts
          • TGF-beta stimulates differentiation and proliferation of myofibroblasts
      • regeneration and renervation: unpredictable and likely incomplete
  • Muscle Immobilization
    • Can result in shorter muscle position and atrophy
    • Leads to decreased ability to generate tension and increased fatigability
    • Results in fatty infiltration
    • Atrophy occurs faster in muscles crossing a single joint
    • Atrophy occurs at a non-linear rate
      • most changes occur during initial days of disuse
      • seen at cellular level: loss of myofibrils within the fibers
      • related to duration of immobilization
    • Atrophy is more prominent if immobilization occurs without tension
      • quadriceps atrophy greater than hamstrings with knee immobilization in extension
  • Treatment
    • Local treatments designed to assist with soft tissue recovery or rehabilitation
    • Goals of treatment
      • decrease inflammation
      • increase local blood flow
      • increase tissue compliance
    • Modalities include
      • cryo or heat treatments
      • massage
      • ultrasound
      • electrical stimulation
      • Iontophoresis
        • use of an electrical current to drive charged molecules of medicine through the skin to the deep tissues
        • medications including steroids, local anesthetics, salicylates, and non-steroidal anti-inflammatory drugs (see table below)
        • indications - see table below
        • contraindications
          • susceptibility to applied currents e.g. cardiac pacemakers
          • hypersensitivity/allergy to drug used
        • Iontophoresis
          Indication
          Iontophoresis Drug/Solution
          Hyperhydrosis
          Tap water, glycopyrrolate
          Muscle spasm
          Magnesium sulfate, calcium chloride
          Edema
          Hyaluronidase
          Adhesive conditions
          Iodine
          Inflammation

          Dexamethasone, hydrocortisone, prednisone, lidocaine, salicylates
          Calcific tendinitis
          Acetic acid
          Myositis ossificans
          Acetic acid
          Open wounds
          Zinc oxide, tolazoline hydrochloride
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(SAE13BS.12) Delayed-onset muscle soreness (DOMS) is initially evident at the muscle tendon junction and can spread throughout the entire muscle. It is primarily associated with what type of exercise?

QID: 8245
1

Concentric

15%

(77/528)

2

Isometric

6%

(34/528)

3

Eccentric

73%

(387/528)

4

Plyometric

5%

(27/528)

L 2 D

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(OBQ13.72) Which of the following cytokines has been shown to promote scar tissue formation in lacerated skeletal muscle?

QID: 4707
1

Fibroblast growth factor (FGF)

59%

(2806/4755)

2

IGF-1

6%

(290/4755)

3

Nerve growth factor (NGF)

1%

(28/4755)

4

VEGF

4%

(187/4755)

5

TGF-Beta

30%

(1424/4755)

L 5 C

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(OBQ12.226) Regarding muscle biology, all of the following descriptions are correct EXCEPT?

QID: 4586
1

Isotonic: constant tension as the muscle length changes

5%

(326/5937)

2

Isokinetic: constant effort through a variable speed

87%

(5147/5937)

3

Isometric: contraction with no change in muscle length

3%

(172/5937)

4

Eccentric: muscle fibers lengthen as the muscle contracts

3%

(173/5937)

5

Concentric: muscle fibers shorten as the muscle contracts

1%

(75/5937)

L 1 B

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(OBQ11.23) Which of the following remains constant during an isotonic exercise?

QID: 3446
1

Muscle tension

87%

(2439/2799)

2

Muscle length

7%

(186/2799)

3

Contraction velocity

3%

(83/2799)

4

Muscle work

2%

(66/2799)

5

Contraction acceleration

1%

(14/2799)

L 1 C

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(OBQ10.246) The exercises shown in Figure A are most appropriately described as which of the following?

QID: 3345
FIGURES:
1

Isokinetic

4%

(109/2817)

2

Plyometric

1%

(21/2817)

3

Isometric

2%

(58/2817)

4

Open chain

85%

(2405/2817)

5

Closed chain

7%

(211/2817)

L 2 B

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(OBQ10.31) Iontophoresis, as commonly used in physical therapy, is a modality best defined by which of the following descriptions?

QID: 3119
1

Induction of muscle contraction facilitating metabolic byproduct removal

4%

(97/2369)

2

Transcutaneous delivery of medication with electrical current

82%

(1944/2369)

3

Transmission of high frequency acoustic waves to soft tissues

7%

(158/2369)

4

A low level laser treatment

1%

(15/2369)

5

Utilization of pulsed magnetic fields for recalcitrant muscle pain

6%

(134/2369)

L 2 C

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(OBQ10.178) A 78-year-old male with a history of chronic low back pain and bilateral knee arthritis enrolls in an aquatic exercise program after land training has become too painful for him. Each of the following are true regarding aquatic exercises EXCEPT:

QID: 3271
1

They function to minimize joint stress

2%

(75/3758)

2

Secondary injuries of the lower limb joints can be prevented

1%

(47/3758)

3

They are associated with lower maximal heart rates when matched against comparable land exercises

12%

(458/3758)

4

Oxygen consumption is increased when compared to equivalent exercises on land

7%

(252/3758)

5

The vertical component of the ground reaction forces increases compared to equivalent exercises on land

77%

(2909/3758)

L 2 C

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(SAE07SM.96) Closed-chain exercise differs from open-chain exercise in which of the following ways?

QID: 8758
1

Distal portion of the extremity is free during exercise

13%

(58/446)

2

More commonly used in upper extremity exercise

2%

(8/446)

3

Predictable movement is produced by co-contraction of muscles

74%

(330/446)

4

Joint compression is decreased

7%

(32/446)

5

Usually involves a single joint

4%

(16/446)

L 3 E

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(SAE07SM.26) What type of exercise is used early in the rehabilitation process to safely stimulate co-contraction of the scapular and rotator cuff muscles?

QID: 8688
1

Resistive active motion

5%

(20/421)

2

Facilitated active motion

29%

(120/421)

3

Plyometrics

7%

(28/421)

4

Open kinetic chain

10%

(40/421)

5

Closed kinetic chain

49%

(207/421)

N/A E

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(OBQ07.17) ACL rehabilitation often includes exercises with the distal end of the extremity fixed in place with axial loading and co-contracture of muscle groups to help stabilize the joint. This type of exercise is more commonly referred to as:

QID: 678
1

Eccentric contraction

1%

(29/3321)

2

Closed chain exercise

89%

(2948/3321)

3

Open chain exercise

1%

(35/3321)

4

Proprioceptive neuromuscular facilitation

1%

(41/3321)

5

Isometric contraction

8%

(254/3321)

L 2 C

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(SBQ07SM.26) Which of the following best describes the use of closed chain kinetic exercises for shoulder rehabilitation?

QID: 1411
1

Closed chain exercises are not used for upper extremity rehabilitation

6%

(45/694)

2

Causes compression of the glenohumeral joint increasing the demand on the rotator cuff

10%

(67/694)

3

Causes distraction of the glenohumeral joint reducing the demand on the rotator cuff

7%

(51/694)

4

Allows for co-contraction of the periscapular and rotator cuff muscles

72%

(498/694)

5

Involves extrinsic loads such as exercise tubing or hand weights

4%

(25/694)

L 2 C

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(OBQ07.264) Which term used in rehabilitiation describes a strengthening exercise performed at a constant speed?

QID: 925
1

Open chain

0%

(4/1507)

2

Closed chain

0%

(4/1507)

3

Isotonic

2%

(30/1507)

4

Isometric

3%

(41/1507)

5

Isokinetic

94%

(1423/1507)

L 1 D

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(OBQ06.259) The strength and conditioning term for planned variation in intensity and duration of workouts over a predefined duration of time is?

QID: 270
1

Isokinetic modulation

6%

(103/1763)

2

Periodization

77%

(1355/1763)

3

Static progressive exercise

4%

(75/1763)

4

Progressive overload

6%

(99/1763)

5

Stacking

7%

(128/1763)

L 2 D

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(OBQ05.206) What is the term used to describe a treatment modality that uses galvanic current and medication?

QID: 1092
1

Electromyography

2%

(16/910)

2

Transcutaneous electrical nerve stimulations (TENS)

18%

(165/910)

3

Photophoresis

1%

(5/910)

4

Phonophoresis

2%

(22/910)

5

Iontophoresis

77%

(698/910)

L 1 D

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(OBQ05.22) A physical therapist asks whether "open chain" exercises may be used in rehabilitation after knee surgery. This term refers to what type of exercises?

QID: 59
1

Supine heel slides

3%

(26/858)

2

Seated leg press

3%

(27/858)

3

Recumbent bicycle riding

5%

(40/858)

4

Standing leg press

3%

(28/858)

5

Seated leg extensions

86%

(735/858)

L 1 C

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(OBQ04.72) Isokinetic refers to which of the following types of training?

QID: 1177
1

Bicycling at a constant pedal velocity with varied resistance

78%

(926/1183)

2

Bicycling at a variable pedal velocity with constant resistance

17%

(206/1183)

3

Running a fixed distance with variable speeds (ie. intervals)

1%

(12/1183)

4

Running at variable speed to maintain a constant heart rate

2%

(23/1183)

5

Swimming the same distance each day at different speeds

1%

(9/1183)

L 2 D

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(OBQ04.55) Which of the following Figures represents the exercise type that strengthens muscle most efficiently?

QID: 1385
FIGURES:
1

Figure A

8%

(100/1275)

2

Figure B

75%

(956/1275)

3

Figure C

3%

(41/1275)

4

Figure D

5%

(69/1275)

5

Figure E

8%

(103/1275)

L 3 D

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