Exercise is a common term used by people in the different spectrum. Some will say workout is the same as exercise. While this topic can be a very basic for PTs, it is not so basic for other healthcare professionals. I have been asked several times regarding the types of exercise. Specifically, what do they mean and what is the difference between each type. So, let’s talk about what exercise is, and the different types based on the level of assistance required.
What is Exercise?
Exercise, in common words, is when an individual is moving a body part in a certain way to achieve a certain result. The result can be to improve mobility, strength, to maintain range of motion or to prevent contractures or stiffness. One can also perform exercises to reduce pain and spasm, this will mainly be done by a therapist or a trained professional.
Different Types of Exercise
There are four main levels of exercises.
- Passive Range of Motion (PROM)
- Active Assisted Range of Motion (AAROM)
- Active Range of Motion (AROM)
- Progressive Resistance Exercise (PRE) or Graded Resistance exercise
Let’s talk about each type of exercise and what they mean:
Passive Range of Motion (PROM):
Passive Range of Motion is a type of exercise in which someone else moves a patient’s body part. Here an individual, whose body part is being moved, does 0% of the movement. This is done when a person is unable to move his or her body parts due to a medical condition like stroke, brain injury, or due to deconditioning where a person does not have enough strength to move the body parts. The patient does not need to generate any force to perform this kind of movement. The main benefits of PROM are to maintain joint mobility, prevent contracture, strengthen or rebuild the neuromotor connection with repetition, and facilitate neuromuscular pattern etc.
Active Assisted Range of Motion (AAROM):
Active Assisted Range of Motion is a type of exercise where the patient needs assistance to perform the range of motion. It varies when and what part of the range of motion an individual needs assistance to perform the movement. What range is weaken is usually based on type and severity of the injury. Fatigue level also plays a role while performing the range of motion.
Active Range of Motion (AROM):
Active Range of Motion is where a person is able to perform full range without any assistance. Depending on strength, the range can be performed against gravity (which can act as an external force) or in gravity eliminated plane(to eliminate external force due to weakness). Active Range of Motion is basically the complete opposite of Passive Range of Motion.
Progressive Resistance Exercise (PRE):
Progressive resistance exercise is your strengthening exercise. You can add resistance gradually based on patient’s tolerance to challenge the muscle fibers. Usually, we use thera bands, dumbbells, or weighted physio balls etc. You can also make free weight exercises as PRE with increments in frequency or by challenging the body position.
There are many ways to perform PRE. You can choose resistance and types of exercises, based on the goal that you want to achieve out of that exercise. For example, I can concentrate on just isolated muscle for strengthening if my patient has pain or functional inability because of the weakness of that muscle or injury to that particular muscle. I can choose to perform PRE of full functional task like sit to stand to concentrate on a group of muscles at the same time. In this example of sit to stand, I am strengthening Gluts, quads, hams, Abductors, PFs, abdominal muscles etc…
If I am concentrating on slow twitch muscle fibers to increase strength, I will ask my patient to hold the movement for 5 to 7 seconds in the air before they release. This can be done with or without any resistance like weights. It is up to a physical therapist or your trainer to decide what part of the movement they want to strengthen and why. Sometimes, I prescribe exercise that mixes various kinds of PRE to overload the muscles.
Types of Contractions:
I chose to write about types of contractions with this articles as it is very important to know how muscle works with particular ROM in order to gain strength and flexibility. Now technically, we need to learn about actin-myosin filament in order to learn the full muscle physiology and how the force is generated. That information will be too deep and long for purpose of this article. So I am not going into that detail. What I want to talk about is the change in the length of muscle fibers or muscles in our case. This change in length is how the force is generated. This change in length is nothing but muscle contraction. It may require more strength/ energy to perform certain kind of contraction.
Two major types of contractions are (1) Isometric contraction (2). Isotonic contraction. Isotonic contractions can be further divided into Concentric and Eccentric contraction.
As the name suggests, there is no change in length of muscles while performing this contraction. This means force is generated but the muscle fibers are not lengthened nor shortened. Example of this exercise is Quad sets.
This is where the length of muscle changes. Muscles fibers can be lengthened (Eccentric) or shortened (Concentric). Example of this exercises are: Elbow curls (concentric exercise) and performing controlled sitting from standing position (Eccentric contraction). Generally speaking, eccentric contractions are harder and need higher force generation. In other words, eccentric contraction requires more strength than concentric contraction.
With this article, I hope I have been able to familiarize make my non-PT friends with different types of exercises and how one is different from other. Hope this helps!!