Difficulty with exercise prescription can vary on patient population.

Isometric programming and concentric exercise may be difficult for the cardiovascular impaired patient. Due to the force generation during isometrics, patients demonstrate increases in central blood pressure which may adversely affect an already compromised system.1 Many individuals are inclined to perform a Valsalva Maneuver which may further increase blood pressure.2 Concentric exercise has been demonstrated to increase cardiac markers greater than eccentric exercise.3
Eccentric exercise has been demonstrated to improve with maximal strength gains while preventing injuries.4 However, eccentric exercise requires significant control and coordination that may predispose the patient to fatigue, delayed onset muscle soreness or re-injury.5 Patients with with apraxia, ataxia or conditions with mental deterioration such as dementia or Alzheimer’s Disease may have difficulty following directions.

Plyometric exercise corresponds with a rapid eccentric phase followed by a rapid concentric phase. Individuals with tenodonitis/tendinopathy or partial thickness tears may undergo further tearing.6 Also, geriatric population with osteoporosis should not be subjected to high rate loading due to the possibility of fracture.


1. Tanaka S, Suguira T, et al. Differential response of central blood pressure to isometric and isotonic exercise. Scientific Reports. 2014. doi: 10.1038/srep05439.

2. Wicinski M. PHT 5236 Therapeutic Exercise II. 2014. Institute of Physical Therapy. St Augusinte, FL.

3. Bhavna M, Sandhu JS. Effects of concentric vs eccentric loading on cardiovascular variables and ECG. African J of Health Sciences. 2010. 17(3,4):47-51.

4. LaStayo PC, Woolf JM, Lewek MD, Snyder-Mackler L, Reich T, Lindstedt SL. Eccentric muscle contractions: their contribution to injury, prevention, rehabilitation, and sport. J Orthop Sports Phys Ther 33: 557–571, 2003.

5. Vogt M, Hoppeler HH. Eccentric exercise: mechanisms and effects when used as training regime or training adjunct. J Applied Physiology. 2014. 116(11):1446-54. doi: 10.1152/japplphysiol.oo146.2013

6. Kjaer M, Heinemeier KM. Eccentric exercise: acute and chronic effects on healthy and diseased tendons. J Applied Physiology. 2014. 116(11):1435:38. doi: 10.1152/japplphysiol.01044.2013.