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1. ACTIVE MOVEMENT – FREE EXERCISE
Prof. Dr. M. Rajesh, PT, M.P.T(cardio), BCRC
TRINITY MISSION AND MEDICAL FOUNDATION
MADURAI

2. INTRODUCTION
 Active exercise or active movement is a term commonly used by
physical therapy, rehabilitation and fitness centres. ‘Active
movement’ is that which an individual does voluntary
movement, one’s own strength or energy. Active exercise help
keep joints flexible, maintain good blood flow to the exercised
joints and may help prevent blood clots. A health care
practitioner may assign active exercises after an injury or in
connection with medications and other therapies to help
manage chronic pain.

3. VOLUNTORY MOVEMENT
Definition
 Movement performed or controlled by the voluntary action of
muscles, working in opposition to and external force.

4. CLASSIFICATION
 Free exercise – the working muscles are subject only to the
forces of gravity acting upon the part moved or stabilized.
 Assister exercise – when muscle strength or co-ordination 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 adapted 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 endurance of the muscles.

6. FREE EXERCISE
 Free exercises are those which 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 the
manner in which 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.

7.  A degree of relaxation is induced by exercises which are
rhythmical ore 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; co-ordination 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 the manner in which
it is performed, but also on the degree of co-operation obtained
from the patient and the skill of the instructor.

8.  The great advantage of free exercises lies in the fact that once
the patient has mastered the techniques of their performance
and is aware of their purposed, 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.

9.  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 re-
development or reinforcement of weak muscles. When there is
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 co-
operate in doing these exercises until their performance has
been facilitated and voluntary control has been established.

10. CLASSIFICATIONS OF FREE
EXERCISE
 Free exercises may be classified according to the extent of the
area involved; they may be
Localized
General (subjective, objective)

11. LOCALIZED
 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.

12. GENERAL
 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
Subjective
Objective

13. Subjective
 exercises which are subjective are usually formal and consist of
more or less anatomical movements performed in full range.
This attention of the patient is deliberately focused on the form
and pattern of the exercise to ensure accuracy of performance.

14. Objective
 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.

15. TECHNIQUES OF FREE EXERCISE
 The starting position is selected and taught with care to ensure
the maximum postural efficiency as a basis for movement
 Instruction is given in a manner which will gain the interest and
co-operation of the patient and lead him to understand both the
pattern and the purposed of the exercise.
 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.

16.  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,
between, ensure sufficient practice without undue fatigue.

17. 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.

18. 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 co-ordination.
 Exercise which work 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 pectoral muscles.

19. 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 over
pressure at the limit of the free range may serve to increase it.

20. 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 speed 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 mechanical
disadvantage of an adverse leverage provided by a long and
heavy limb.

21.  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 joint, the power can only be maintained or
improved by repeated static contractions, which the patient
must practice throughout the day

22. NEUROMUSCULAR CO-ORDINATION
 Co-ordination 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.

23. CONFIDENCE
 The achievement of co-ordinate and efficient movement assures
the patient of his ability to maintain subjective control of his
body, giving him confidence to attempt other and new activities,
together with a feeling of exhilaration and satisfaction when
they are accomplished, for example, jumping a rope, or
shooting a goal. Objective exercises and activities are usually
used for this purpose.

24. CIRCULATORY AND RESPIRATORY
CO-OPERATION
 During vigorous or prolonged exercise it is apparent that the
speed and depth of respiration is increased, that the heart beat
is faster and more forceful, and that heat is produced, whereas
in light exercise these changes are so slight that they are not
noticed.

25. The needs of the active tissues
 the active tissues involved during muscular exercise require a
free supply of oxygenated 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 co-operation of
the circulatory and respiratory systems is enlisted

26. 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 vaso-motor centre which form part of
the autonomic nervous system. Sympathetic fibre from these
centers convey impulses to the appropriate organs which, with
the help of adrenalin, which is released into the blood stream,
produce widespread results. These results include increased
respiration, increased frequency of the heart beat, a rise in
arterial blood pressure, and a re-distribution of blood, so that
the volume of blood in the muscles in increased at the expense
of that in the splanchnic area and the skin.

27.  All these change occur merely as the result of the anticipation of
exercise as those who have taken part in competitive sports
may have been aware.

28. 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 flows 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.

29. 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 of the thin walls of the
peripheral veins. Valves in these veins prevent regurgitation
increased during relaxation of the pressure.

30.  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.

31.  Active exercise can therefore be used to increase respiration, to
increase both the local and the general circulation, and to
proved work for the heart muscles.
 The effective of active exercise as a whole is so widespread and
varies so much in intensity according to the nature of the
exercise that it has been described here only in the briefest
outline.

32. THANK YOU
Prof. Dr. M. RAJESH, PT,M.P.T(cardio),B.C.R.C
TRINITY MISSIOIN AND MEDICAL FOUNDATION
MADURAI.
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