{
  "resourceType": "ActivityDefinition",
  "id": "heavy-slow-resistance-achilles",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/heavy-slow-resistance-achilles",
  "version": "1",
  "name": "HeavySlowResistanceAchilles",
  "title": "Heavy Slow Resistance (HSR) for Achilles Tendinopathy",
  "status": "draft",
  "experimental": true,
  "description": "Progressive heavy resistance training including seated calf raise (bent knee), standing barbell calf raise (straight knee), and leg press calf raise (straight knee). 6 seconds per rep. 12-week progression from 3×15 to 4×6 with increasing load. Equivalent clinical outcomes to Alfredson with superior compliance (92% vs 78%) and patient satisfaction (100% vs 0% at 12 weeks).",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: intermediate"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "heavy-slow-resistance-achilles",
          "display": "Heavy Slow Resistance (HSR) for Achilles Tendinopathy"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "ankle",
          "display": "Ankle"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "70258002",
          "display": "Structure of ankle joint"
        }
      ],
      "text": "Ankle"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "12-week progression: Wk1 3×15, Wk2-3 3×12, Wk4-5 4×10, Wk6-8 4×8, Wk9-12 4×6. 6 seconds per rep. 3 exercises per session [Beyer 2015]"
    }
  ],
  "usage": "Evidence: strong. Both HSR and eccentric reduce tendon thickness and neovascularization. HSR shows greater collagen turnover evidence and may be more likely to produce tendon adaptation [Malliaras 2013]",
  "note": [
    {
      "text": "Long line through the calf — slow tempo loads the tendon",
      "authorString": "focus:internal"
    },
    {
      "text": "Take three slow seconds up, three slow seconds down",
      "authorString": "focus:external"
    },
    {
      "text": "Drop the heel below the platform on each rep",
      "authorString": "focus:external"
    },
    {
      "text": "Bar settles evenly across both shoulders",
      "authorString": "focus:tactile"
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "label": "kisner-therapeutic-2017",
      "citation": "Kisner C, Colby LA, Borstad J. (2017). Therapeutic Exercise: Foundations and Techniques"
    },
    {
      "type": "citation",
      "label": "acsm-guidelines-2021",
      "citation": "American College of Sports Medicine. (2021). ACSM's Guidelines for Exercise Testing and Prescription",
      "document": {
        "url": "https://doi.org/10.4135/9781412994149.n165"
      }
    },
    {
      "type": "citation",
      "label": "beyer-hsr-vs-eccentric-2015",
      "citation": "Beyer R, Kongsgaard M, Hougs Kjær B, Øhlenschlæger T, Kjær M, Magnusson SP. (2015). HSR vs Eccentric Training for Achilles Tendinopathy: RCT",
      "document": {
        "url": "https://doi.org/10.1007/s00167-009-1006-7"
      }
    },
    {
      "type": "citation",
      "label": "malliaras-tendinopathy-loading-2013",
      "citation": "Malliaras P, Barton CJ, Reeves ND, Langberg H. (2013). Achilles and Patellar Tendinopathy Loading Programmes: Systematic Review",
      "document": {
        "url": "https://doi.org/10.1007/s40279-013-0019-z"
      }
    },
    {
      "type": "citation",
      "label": "martin-achilles-cpg-2018",
      "citation": "Martin RL, Chimenti R, Cuddeford T, et al.. (2018). Achilles Tendinopathy CPG Revision 2018",
      "document": {
        "url": "https://doi.org/10.2519/jospt.2018.0302"
      }
    },
    {
      "type": "citation",
      "label": "wilson-achilles-exercise-review-2018",
      "citation": "Wilson F, Walshe M, O'Dwyer T, Bennett K, Malone J, Bleakley C. (2018). Exercise, Orthoses and Splinting for Achilles Tendinopathy",
      "document": {
        "url": "https://doi.org/10.1136/bjsports-2017-098913"
      }
    },
    {
      "type": "predecessor",
      "label": "Build calf endurance with bilateral bodyweight heel raises before heavy loaded HSR (HSR's stated bilateral regression).",
      "display": "Heel Raise (Calf Raise)",
      "resource": "ActivityDefinition/heel-raise"
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Gastrocnemius"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "35616000"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Soleus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "78376008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Tibialis Posterior"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "74318005"
          }
        }
      ]
    }
  ]
}