Resistance Exercise

In this post we will learn about resistance exercise in physiotherapy. We know there are two types of movement: broadly active and passive. The resisted exercises come within active movement, alongside the assisted exercise, free-exercise, and assisted-resisted exercise types covered there.

So, before we proceed, let me broadly explain what resistance exercise is.

What Is resistance exercise?

In resisted exercises the movement happens against some resistance. Our muscles contract against some resistance, producing movement. This is what we call resistance exercise.

So, here are some basic principles. Let’s understand them.

The first is that an external force is applied to oppose the force of muscular contraction, following the same force and gravity principles used across exercise therapy.

When resistance force is applied, the tension within the muscle increases.

If the resisted exercises done regularly, the muscle responds to this tension by

1. increasing muscle power,
2. by improving endurance and
3. increasing muscle volume due to hypertrophy.

But to achieve this effect we need different types of resisted exercises. Let me explain that to you. So, the first condition is to increase muscle power.

To increase muscle power

To increase muscle power, the type of exercise we need is high-resistance, low-repetition exercises.

So, suppose you want to increase the muscle power of your biceps by using dumbbells, you will need to use a slightly higher weight. You’ll need to use a weight of 2.5 kg or 3 kg, and the repetitions should be low. Because the higher your weight, the lower the repetitions. This principle improves our muscle power.

Increase muscle endurance

Now, the second condition is to increase muscle endurance. For this, we need low-resistance, high-repetition exercises. Means, let’s say, I want to increase my entire body’s endurance. Then I’d prefer aerobics. Because the exercises in aerobics are low-resistance and the repetitions are high.

For hypertophy of muscle

Now we know that high resistance exercises is to increase the muscle power, low resistance high repetition exercises increases our body’s endurance.

But, when we need to increase the muscle enudrance?

A 2021 systematic review found no significant difference in muscle hypertrophy between high, moderate, and low resistance training. This suggesting that total volume and effort may matter as much as the specific load chosen¹.

Now, let’s try to understand how the different resisting forces are provided.

Different ways of applying resistance

Resistance by physiotherapist

So, the first is the resistance force provided by the therapist.

Let me clarify this for you with an example. Let’s say I’m treating a hemiplegia patient and I need to gain strength in their biceps. I’ll instruct them to “Flex their elbow” against their flexion motion I’ll apply a little resistance here with my hand, and I’ll tell the patient to flex their elbow against the resistance of my hand.

So, I’m applying an external force, one therapist is applying external force to gain muscle strength in the biceps.

Resistance by patient himself

Another is that it can be given by the patient. It can be a weight and pulley circuit, a spring, an elastic band, and finally, water. Let’s try to understand each one step by step.

Own-Limb and bodyweight resistance

Suppose the patient can perform a resistance exercise by applying their own force to resist their movement. Here’s an example. Let’s say I want to strengthen the quadriceps muscle of this leg.

So what I’ll do is, in this high sitting position, I’ll resist this leg with my opposite leg. With my opposite leg, I’ll press this leg down, and this leg whose quadriceps muscle I want to strengthen, I’ll try to straighten the knee upward against that resisting force. So, there’s resistance, and my quadriceps muscle will strengthen.

The second example is this push-up. See, push-ups are a great example. In push-ups we’re pushing up our body weight against gravity. So, this is also a resistance exercise by the patient himself.

External weight

Now, the third one is resistance by using external weight. There are many options here, like dumbbells, a weighted cuff, or you can use a medicine ball. We usually use a weighted cuff in our clinic. It comes in different weights: 1.5 kg or 2 kg. So you can do this exercise using a weighted cuff.

The short clip above is a postoperative total knee replacement surgery case. She is performing resisted knee extension using a weight cuff after 2 weeks post-surgery.

Weight and pulley circuit

The fourth type of resistance, or option, is a weighted pulley circuit. Look at the diagram of the weight and pulley. Three pulleys are attached to the circuit, and a weight is hanging at the end.

A rope is passing through this pulley. One end of this rope will be tied around the patient’s ankle, around the lower leg. And our aim here is to strengthen the quadriceps muscle in this leg.

Using this pulley, we’ll place a weight here, and the other weight is suspended at the other end. So, when we ask the patient to extend their knee, they’ll have to actually lift the weight using this rope. This will provide resistance, strengthening the quadriceps.

This is a kind of weight and pulley circuit that you might see in a physiotherapy department.

Springs and resistance bands

The fifth resistance option is a spring and resistance band. You’ll find springs in physiotherapy units at major colleges or large physiotherapy centers. We often use resistance bands in our clinics.

TheraBands is a popular company that manufactures resistance bands. So, here I’m using this resistance band to strengthen my shoulder blades. With this same Theraband, I’m performing shoulder external rotation motions. This strengthens my shoulder external rotators.

This clinical use is well supported by recent evidence. A 2025 systematic review analysed 25 randomized controlled trials involving 1,318 older adults.

They found that elastic band resistance training significantly improved lower-limb strength, chair-stand performance, and balance measures compared to controls.²

There’s a subcategory within resistance exercise called progressive resistance exercise.

Progressive resistance exercise

Progressive resistance exercise involves gradually increasing resistance in a progressive manner. If the muscle is weak, we’ll use less resistance. As the muscle builds strength, we’ll increase the resistance. This is called progressive resistance exercise.

This concept was first introduced by DeLorme in 1945, then refined with Watkins in 1948 into the three-set protocol described below. The original aim was to use progressive resistance exercises to restore muscle power after injury.

So, there are three different techniques for performing progressive resistance exercises.

1. The first technique is called the DeLorme and Watkins technique.
2. The second technique is called the Oxford technique.
3. And the third technique is called the McQueen technique.

These three techniques are slightly different, and we can select one of these techniques based on the patient’s needs, muscle strength, weakness, and injury. So, let me explain in detail what these three techniques involve.

DeLorme and Watkins technique

So, first, we’ll go over the DeLorme and Watkins technique. In this, we’ll start with 10 reps with half of the 10 repetition maximum.

What is this repetition maximum?

10 repetition maximum means the weight we can lift 10 times and no more than 10 times. Let’s say I give you a 3 kg dumbbell. With a 3 kg dumbbell, you can only do elbow flexion a maximum of 10 times. This is 3kg weight is your 10 repetition maximum.

It can be different for a different individual. For a bodybuilder, it could be 5 kg and for a thin and a weaker person or an older person, it could be 1.5 kg. So, we have to find out these 10 RM to follow all our techniques.

Once we find out our 10 repetition maximum, what will we do next in DeLorme Watkins technique?

We’ll start with 10 lifts with half of the 10 RM.
Then we’ll progress to 10 lifts with another half of the 10 RM.
Then, in the third lift, we’ll do 10 lifts with full 10 RM.

So, let’s take an example: your patient’s 10 RM is 3 kg.

So, we’ll do 10 lifts in the first set with 1.5 kg.
Then we’ll add another 1.5 kg, and in the third set, we’ll ask the patient to lift a full 3 kg.
So, we’ll do 30 lifts four times weekly. You have four days in a week. So, we’ll pick any four days and ask them to apply this technique on each day.
Then progress to a new 10 RM once weekly. After one week, you’ll again select their 10 RM and repeat this technique.

So, in the first week, let’s say their 10 RM was 3 kg. By the next week, with continued exercise, let’s say it reaches 4 kg. So, during this time, you’ll repeat the same technique with 4 kg 10 RM.

Oxford Technique

In the Oxford Technique, you perform:

10 lifts with half of 10 RM in the first set.
10 lifts with half of 10 RM minus 1 pound in the second set. The weights here are calculated in pounds.
10 lifts with half of 10 RM minus 2 pounds in the third set.

Similarly, for the next sets, you perform -3 pounds, -4 pounds, and so on, until you reach the final repetition of -9 pounds. So, in a way, you’re lifting 10 times a day, and you’re doing 10 repetitions in each set. So, you’re doing 100 lifts a day. So, you’re doing 100 lifts five times weekly, and you’re measuring 10 RM daily, and you’re progressing.

McQueen technique

In this, the first set will be 10 lifts with 10 RM.
The second set will be the same, 10 lifts with 10 RM.
The third will be the same, and the fourth will be 10 lifts with 10 RM.

So, here you have to progress from 10 RM only. So, in one day you have 40 lifts total. And you have to do it three times weekly. You can do it on every other day, like on Monday, then on Wednesday, then on Friday. And here, every one to two weeks, you have to find out a new 10 RM and progress with it.

Effect of resisted exercises

Now finally, let’s try to understand the effects and use of resisted exercise.

1. So the first thing is to regain muscle strength of the weak muscle.
2. Second, increasing blood flow during exercise helps repair and hypertrophy the affected muscles. This means that the increased blood flow during exercise both repairs and hypertrophies the affected muscles. A general rise in blood pressure is seen.
3. Heat production due to muscular activity. Heat in our body or particular muscles increases due to muscle activity. If you have fair skin, your skin vasodilates and turns pink.

Understanding these dosing principles and delivery methods allows a therapist to select the right resistance technique for each patient’s stage of recovery, strength level, and rehabilitation goals.

Together with the site’s coverage of eccentric and concentric muscle work, this forms the foundation of a complete exercise therapy program — the accompanying BPT exercise therapy notes PDF is also useful for exam revision.

Sunit. S. Ekka

The author is a physiotherapist who has been practising for the last 17 years. He holds a Bachelor's in Physiotherapy (BPT) from SVNIRTAR (Swami Vivekananda National Institute of Rehabilitation and Research), one of the prestigious physiotherapy schools in India.

Whatever he learns dealing with his patient, he shares it with the world through blogs and e-books. He also owns a YouTube channel, "Sunit Physiotherapist" with over 8 lakh active subscribers. Here, he shares everything he gets to learn serving the patient.