spot-reduce fat from around the abdomen and waist . Fat is lost only by expending more calories type of exercise) abdominal muscles, unlike most.

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10ABDOMINALSThe abdominal musclesŠrectus abdominus andthe internal and external obliquesŠare part of thegroup that form the trunk musculature. Weakabdominal muscles are a cause of bad posture andmay be a predisposing factor in chronic lower backpain. Strengthening these muscles will firm thewaistline, improve posture, and result in a trimmerappearance. However, abdominal exercises do notspot-reduce fat from around the abdomen andwaist. Fat is lost only by expending more caloriesthan are consumed.The sit-up is one of the most common exercisesfor abdominal strengthening and toning. The Bent-Leg Sit-up is popular because it does not causeexcessive stress on the lower back. Straight-LegSit-ups are not recommended and should be avoidedbecause they may cause undue strain on the lowerback. (Straight-Leg Sit-ups work the hip flexormuscle as opposed to the abdominals.)Many authorities agree that (depending on thetype of exercise) abdominal muscles, unlike mostother muscle groups, can be worked on a dailybasis. Weight-resistive abdominal exercises shouldusually be alternated with a day of rest. Rate ofprogress is an individual judgment, but in thebeginning it is best to proceed slowly.Abdominal exercises may be used for fullydefined muscular development or as a warm-uproutine for other exercises and sports. In a musculardevelopment routine, abdominal muscles arestrengthened by:1.increasing the number of repetitions per set2.increasing the number of sets3.progressively shortening the rest periods be-tween sets4.increasing the angle of the exercise5.strapping on leg weights for some exercises orholding a weight plate while performing otherexercises.Abdominal exercises are usually performed withhigher repetitions per set than are most weight-training exercises.118

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119Conditioning Exercises: AbdominalsABDOMINAL EXERCISE ROUTINEMuscleExerciseTitleWarm-up/Abdominals/Hip Flexors53Supine Leg RaiseAbdominals/Hip Flexors54Jackknife Sit-upAbdominals/Hip Flexors55Bent-Leg Sit-upUpper Abdominals/Hip Flexors56Bent-Knee CrunchAbdominals/Hip Flexors57Incline Bench Sit-up with VariationsAbdominals/Hip Flexors58Nautilus Abdominal ChairLower Abdominals59Vertical Bench Bent-Knee RaiseLower Abdominals/Hip Flexors60Vertical Bench Straight-Leg RaiseLower Abdominals/Hip Flexors61Incline Leg RaiseInternal/External Obliques62Side Bends with DumbbellInternal/External Obliques63Side Bends/Hyperextension BenchUpper Abdorninals/Hip Flexors64Straight-Leg Sit-up/HyperextensionBenchAbdorninals/Shoulder Extensors65Exercise WheelAlways do warm-up exercises before lifting weights.Start with a minimum of 8 repetitions with egixnn weight. !fo minimum of 8repetitions cannot be completed, the weight is too heavy for you and theresistance should be lowered until 8 repetitions can be completed.When 12 repetitions can be successfully completed, the weightshouldbeincreased by 5-10 pounds. When 12 repetitions can be completed with theincrease in pounds, the weight may be increased again.Work up to 15’20 repetitions per set for muscle maintenance, endurance, andtone.When performing exercises with free weights, it is recommended that 2-6sets for each particular muscle group be used.CAUTIONBeginners are encouraged to use free weights with a spotter present. Certainexercises will require a spotter regardless of skill level (e.g., squats).INCREASINGTHENUMBEROFREPETITIONS

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120RRDS Clinical Guide. Physical Fitness: A Guide for Individuals with Lower Limb LossEXERCISE 53. SUPINE LEG RAISEPURPOSEWarm-up and strength conditioning of the lower abdominal muscles and hip flexors.PROCEDUREnLie flat on your back with arms at sides and legs close together and straight out.nKeep the heels close together while raising the legs 3 to 6 inches off the floor.nTighten abdominal muscles and tilt pelvis to flatten the lower back against the floor.This will stabilize the pelvis and protect the back. Hold the legs in this position for afew seconds. Increase the time gradually, week by week.nFor beginners, three sets are suggested with a 30-second to 1-minute rest periodbetween each set.MODIFICATIONSThe prosthetic knee is locked in the straight position to prevent it from flexing. A personwith AK amputation who does not have a locking knee unit can support the prosthesisand prevent it from flexing by placing the sound limb underneath the prosthesis or bypressing the heels together.SKILL LEVELBeginner.CAUTIONThis exercise can be stressful tothe lower back. Omit if low backproblems are present.Linda Pedersen exercises with her above-knee quad socket, Mauch SNS Knee Unit,and Otto Bock SACH Foot.

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121Conditioning Exercises: AbdominalsEXERCISE 54. JACKKNIFE SIT-UP (ALSO KNOWN AS V-UP SIT-UP)PURPOSEStrengthens the upper and lower abdominal muscles and hip flexors.PROCEDUREnLie on the floor in a supine position with legs straight out in front and arms extendedbehind the head.nKeep the elbows and knees straight throughout the exercise.nSimultaneously bring legs and arms together in a position as close to a vertical positionas possible while bending from the waist.nLower the limbs to the supine position to complete each repetition.nDo not rest while in the supine position.nInhale as you lower the legs and arms to a supine position and exhale as you come upto a vertical position.MODIFICATIONSThe prosthetic knee should be locked in extension to prevent it from flexing. A flexiblebrim above-knee socket may help in flexing the hip further while reaching the verticalposition.SKILL LEVELAdvanced.CAUTIONMs. Pedersen keeps her back verystraight as she reaches the topposition because she has beenconditioning for many years. Be-ginners and those with chronicback pain should not attempt toreach as high, but only try to reachthe mid-calf, shins, or ankles. Startwith the Bent-Knee Crunch (Exer-cise 56) or the Nautilus AbdominalChair (Exercise 58) until you areready to do the Jackknife Sit-ups.As strength of the abdominal mus-cles is developed, there will be lessrisk of possible back injury in dailyactivities and other exercise rou-tines.

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122RRDS Clinical Guide. Physical Fitness: A Guide for Individuals with Lower Limb LossEXERCISE 55. BENT-LEG SIT-UPPURPOSEStrengthens the abdominal muscles and hip flexors.PROCEDUREnLie flat on your back with hands clasped behind your head.nBend the knees to about a 45-degree angle and have someone hold your feet to thefloor.nBend at the waist and bring your elbows up to your knees.nLower your body slowly and let your shoulders touch the mat.nExhale as you bring your body up and inhale as you lower it down.nRepeat the exercise without pausing in order to keep tension on the abdominal muscles.MODIFICATIONSFor the person with AK amputation, the suspension of the sockets must be good andtramlines low enough to allow adequate hip flexion. To work the oblique muscles, twistyour trunk as you raise it. Do not come up all the way if you are not able to complete atleast 15 repetitions. If you are a beginner, start by only raising your head to complete asit-up. If you can do that, raise your shoulders off the mat on the next set. Later, proceedto a half sit-up and then to a full sit-up as your strength increases.SKILL LEVELIntermediate.NOTEThe person with a unilateral amputation will experience greater tension on the sound limb asboth legs are held down.Bent-Leg Sit-ups are easier on the back than are Straight-Leg Sit-ups. They also allow forbetter isolation of the abdominal muscles because they do not require as much use of the hipflexor muscles. Many beginning exercisers use this type of sit-up at first, since climbing ontoand balancing on an incline bench is difficult for some people. However, the advantage of theIncline Bench Sit-up (Exercise 57) is that no partner is needed.

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125Conditioning Exercises: AbdominalsGreg Mannino does a half sit-up, demonstrating the appropriate position for a personwho has a back problem or is a beginner. (Notice that the low back remains incontact with the floor.)Samantha Ellis assists Mannino by holding his legs in place while hedoes a full sit-up.

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126RRDS Clinical Guide. Physical Fitness: A Guide for Individuals with Lower Limb LossEXERCISE 57. INCLINE BENCH SIT-UP WITH VARIATIONSPURPOSEDevelops and strengthens the upper abdominal muscles and hip flexors.PROCEDUREnAdjust the sit-up board to the desired height.nSit on the incline board and place your feet underneath the foot bar. Flex your knees toabout a 45-degree angle.nPlace your hands behind your head or across your chest (whichever is mostcomfortable) and tuck in your chin. (Hands behind the head is the most difficultposition.)nArms may be held in a variety of positions but must remain fixed during the exercise tokeep from swaying and to minimize excessive body movement. Concentrate on pullingup your body using only the abdominal muscles.nLie back flat on the bench to begin the sit-up.nBend at the waist and bring yourself to an upright position (45 degrees) until yourelbows are at about the same height as your knees. Slowly return to the startingposition.nRepeat the exercise without pauses in order to maintain tension on the abdominalmuscles. To keep tension on the abdominal muscles, do not come up too high or restyour back on the bench on the way down.VARIATIONSFor increased resistance, hold the weights behind your head or on your chest while doingsit-ups. To also work the oblique muscles, twist the upper body to each side, alternatingeach turn (i.e., center, left; center, right; center, left; etc.).MODIFICATIONSThe prosthesis should have good socket suspension; the AK prosthesis should have aflexible brim socket when possible. Before the legs are placed underneath the bar, positionthe prosthesis with your hands or get assistance getting on and off the incline bench.SKILL LEVELIntermediate.NOTEThe greater the angle of the bench, the more difficult the sit-up. Beginners should start withthe lowest angle. Two types of adjustable incline benches are shown. The incline benchshown in the first two photos supports the bent leg at a 45-degree angle. A more advancedincline bench with no bent-leg support is shown in the latter two photos.CAUTIONIf you have back problems, keep the lower back on the bench and raise your body no furtherthan a half sit-up. Raise the head and shoulders only as high as is comfortable.

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128onoSClinical Guide. Physical Fitness:A Guide for Individuals with Lower Limb LossEXERCISE 57, INCLINE BENCH Sff-UP WITH VARIATIONS (Continued)Linda Pedersen demonstrates asit-up on an incline bench with nobent-leg support. She is using theExoskeletal Quad Suction Socket,Mauch SNS Knee Unit, and OttoBookSACH Foot.AlbertRappoportdemonstrates an Incline Bench Sit-Up with the bench raised to itsmaximum position for greater difficulty.

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