While physicians are the most influential at encouraging people to begin exercising, less than 50% of physicians recommend exercise as part of their patient’s treatment, and even less among those with cardiovascular disease. This number will hopefully increase as physicians understand that the benefits of physical activity usually outweigh the risks. The American College of Sports Medicine (ACSM) has launched a new initiative encouraging physicians to write prescriptions for physical activity through their “Exercise is Medicine” campaign.

German researchers at Ruhr-University in Bochum Germany have started a feasibility study on a 12-week multi-modal home exercise program including Thera-Band resistance bands. General practitioners and exercise therapists will work together to provide the well-rounded home exercise program along with physical activity counseling and exercise consultation, pedometers, educational material, telephone counseling, and home visits. Each participant receives 2 meter yellow and red Thera-Band resistance bands. Participants will be community-dwelling older adults over 70 years of age without serious cardiovascular, metabolic, pulmonary, or neurological conditions. The goal of the feasibility study is to prepare for a randomized controlled trial of the intervention with eventual dissemination in primary medical care.

REFERENCE: Hinrichs T, et al. Feasibility of a multidimensional home-based exercise programme for the elderly with structured support given by the general practitioner’s surgery: study protocol of a single arm trial preparing an RCT [ISRCTN58562962]. BMC Geriatr. 2009 Aug 17;9:37.

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Disclosure: Thera-Band Academy provided bands for this study, but did not provide monetary support

Previously, German researchers created a strength and proprioceptive training program using Thera-Band elastic resistance and Stability Trainers. The results, published in 2003 noted improvements in strength and proprioception. The authors felt that a balance training component was important to prevent fall-related injuries in persons with hemophilia.

More recently, researchers at the University of Tennessee Health Sciences Center created an individualized 6-week program using Thera-Band resistance in 33 patients with bleeding disorders. They used 3 levels of progression based the participant’s strength. Download the Thera-Band exercise protocol here. The patients then used a specific color of Thera-Band resistance corresponding to the prescribed intensity (% of an isometric manual muscle test). Subjects also performed stretching and cardiovascular exercise.  A physical therapist supervised the program 2 days a week. At the end of the 6-week program, there were no injuries, pain, edema, or bleeding episodes reported. The patients significantly improved their range of motion, strength, and cardiovascular status without causing additional hemarthrosis.

This individualized exercise program using Thera-Band resistance in hemophilia was safe and effective; however, the study was limited by a small sample size and presence of additional health conditions among subjects. As reported by Heilberg et al (2003) the addition of a proprioceptive training component to Thera-Band strengthening may provide additional benefits, though more research is needed.

 Reference: Mulvany R et al. Effects of a 6-week, individualized, supervised exercise program for people with bleeding disorders and hemophilic arthritis.Phys Ther. 2010 Apr;90(4):509-26.

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Thera-Band® resistance band exercises are commonly used in rehabilitation of shoulder impingement. In fact, nearly 75% (9 out of 13) of the studies in a systematic review of physiotherapy exercises for impingement included elastic resistance exercise for the rotator cuff and scapula. In their review, Kromer and colleagues found that passive treatments (such as modalities only) are not effective and cannot be justified when treating shoulder impingement.

The authors found that physiotherapist-led exercises were as effective as surgery for shoulder impingement. In addition, home-based exercises were as effective as physiotherapy interventions, although manual therapy in the clinic may provide additional short-term relief. Based on these conclusions, Thera-Band resistance band exercises in the clinic or home can be an effective and safer alternative to surgery.

Kromer TO, et al. Effects of physiotherapy in patients with shoulder impingement syndrome: a systematic review of the literature. J Rehabil Med. 2009;41(11):870-80.

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Dialysis patients often have reduced physical function and quality of life because of their disease complications and lack of physical activity. Unfortunately, there is little research on exercise in dialysis patients. Researchers performed a multi-center randomized controlled trial in Spain to determine the effects of a resistance training program with ankle weights and elastic bands.

27 hemodialysis patients were randomly assigned to a resistive-exercise group or a low-level aerobic exercise group. Both groups, supervised by physiotherapists, exercised 3 times a week for 6 months. Each session included 5 minutes of stretching as part of warm-up and cool down, and 25 minutes of either resistance training or stationary bike riding. The resistance training group performed training at an RPE of 12-14, and emphasized lower extremity exercise.

At the end of the study,  the resistance training group significantly increased in physical function compared to the control group. The researchers concluded that an exercise program including elastic resistance and ankle cuff weights was safe and effective for hemodialysis patients.

Segura-Ortí E, Kouidi E, Lisón JF. Effect of resistance exercise during hemodialysis on physical function and quality of life: randomized controlled trial. Clin Nephrol. 2009 May;71(5):527-37.

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The debate of elastic resistance versus isotonic resistance

Elastic resistance is commonly used in rehabilitation exercises, and has been shown to increase strength and function in over 100 randomized controlled trials (www.thera-bandacademy.com). Even with this amount of clinical evidence, elastic resistance is sometimes criticized because of the difficulty in quantifying intensity. Despite the fact that force elongation charts are available to quantify elastic resistance intensity, it is sometimes difficult to use these clinically. Because of this limitation, few studies have compared elastic and isotonic resistance directly because of the intensity-dosing issue.

Quantifying EMG and RPE of elastic and isotonic resistance

Researchers in Denmark compared elastic and isotonic dumbbell resistances for muscle activation and perceived exertion levels. Healthy females performed 3 different exercises with standard dumbbells ranging from 2 to 7.5 kg, and Thera-Band elastic tubing (red, green, blue, black and silver).  The researchers developed a chart comparing isotonic and Thera-Band elastic resistance stretched 125 to 150%.

Each subject randomly performed 3 exercises with both types of resistance: standing lateral raise, shoulder external rotation at 0° of abduction, and seated wrist extension. The elastic tubing was stretched 125-150% during each exercise. Electromyographic (EMG) activity of neck, shoulder and forearm muscles was assessed during each exercise along with perceived loading using a Borg CR10 scale for rating of perceived exertion (RPE).

The investigators found no significant difference in muscle activation between isotonic and elastic resistance, noting increasing levels of muscle activation with increasing levels of resistance.  Interestingly, the researchers noted approximately a 10% increase in EMG activity between resistance levels in both conditions. In addition, the researchers found that perceived exertion was correlated with resistance level and EMG with both types of resistance. This means that clinicians might be able to use RPE to dose resistance at approximate EMG levels; however, this relationship needs to be validated in patient populations as well.

Elastics and isotonics exhibit similar biomechanics

These results are not surprising in light of the biomechanical and clinical data suggesting that elastic resistance is similar to isotonic resistance. Both types of resistance produce similar ‘bell-shaped’ strength curves (Hughes et al. 1999). Recently, researchers in Spain reported that elastic and isotonic resistance produce the same increases in strength and muscle mass (Colado et al. 2008). They also found that the OMNI RPE scale can be used effectively to dose elastic resistance exercise; therefore it seems that both the Borg CR10 and OMNI scales can be used effectively with Thera-Band elastic resistance.

Lead researcher Lars Andersen PhD and his colleagues concluded, “Comparable levels of muscle activation were obtained during resistance exercises with dumbbells and elastic tubing, indicating that therapists can choose either type in clinical practice.”

REFERENCE: Andersen LL, Andersen C, Mortensen OS, Poulsen OM, Bjornlund IBT, Zebis MK. Muscle activation and perceived loading during rehabilitation exercises: comparison of dumbbells and elastic resistance. Physical Therapy. 2010;90:538-549.

Disclaimer: The Thera-Band Academy provided elastic tubing for this study and did not provide monetary funding.

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