Abstract:
A method of assessing a subject comprising exercising said subject on an exercise apparatus for exercising muscle groups said exercise apparatus including: support means ( 13 ) for supporting the subject&#39;s body in a desired exercising attitude; force application means ( 11 ) for applying a continuous or variable force to a part of the subject&#39;s body whereby one or more of the large muscle groups may be employed to resist said force; positioning means adapted for contact by another part of the subject&#39;s body for assisting the patient to position and maintain said part of the body in a substantially stationary position by limiting movement of said other part; and—at least one strain gauge ( 45 ) associated with said force application means ( 11 ) wherein said at least one strain gauge ( 45 ) provides a measurement of the resistance exerted by said patient against said continuous or variable force whereby said measurement is electronically distributed to interested parties.

Description:
FIELD AND BACKGROUND OF THE INVENTION  
       [0001]     This invention relates to a method for assessing subjects, in particular to assessing subjects using an exercise apparatus.  
         [0002]     This invention has particular but not exclusive application to exercise apparatus which exercises at least some of the major muscle groups of the user&#39;s upper or lower body simultaneously and that as a consequence the user is encouraged to perform a valsalva manoeuvre and for illustrative purposes reference will be made to such application. However in addition, it is believed the method of the present invention may employ an exercise apparatus such as that used to strengthen the cardiovascular system of the human body and/or selected muscles; to enhance the lymphatic and nerve systems; to correct neurological, muscular and vascular abnormalities; to treat medical disorders including Multiple Sclerosis and Chronic Fatigue Syndrome, and for minimising abnormalities in bodily fluid flow and a general loss of mobility and strength exhibited by persons confined to weightless environments such as astronauts and bedrest patients in post-operative situations.  
         [0003]     Subjects may be assessed for a variety of reasons and the assessment may involve one or more professionals having an interest in the assessment of the subject. For example, in the measurement of the physical development of a patient suffering from a neurological, muscular or vascular abnormality physicians and therapists may wish to access measurements of patient performance in order to manage the treatment of the patient. Also in the recovery from injury a patient&#39;s therapists and physicians may wish to monitor the patient&#39;s physical recovery. Lawyers, insurance companies and government departments that may be associated with a claim for compensation resulting from the injury may wish to review the physical recovery of a patient.  
         [0004]     The management of an athlete may be enhanced if all stakeholders, including the athlete, coaches, team management and the athlete&#39;s medical advisors have access to the measurement of the athlete&#39;s performance during a training program or the sports season.  
         [0005]     Generally anyone involved in a fitness or training program will benefit from all stakeholders being able to access the performance of the subject. For example, the subject themselves, the operator of the training facility, the trainer and the subject&#39;s medical practitioner.  
       SUMMARY OF THE INVENTION  
       [0006]     The present invention aims to provide a method for assessing and monitoring a subject in a manner that enables stakeholders, such as a medical professional, to reliably assess the subject&#39;s condition with reference to previous assessment(s) or against population, performance or recovery norms, or at least alleviate one or more of the aforementioned disadvantages.  
         [0007]     With the foregoing in view, this invention in one aspect resides broadly in a method of assessing a subject comprising exercising said subject on an exercise apparatus for exercising muscle groups said exercise apparatus including: 
        support means for supporting the subject&#39;s body in a desired exercising attitude;     force application means for applying a continuous or variable force to a part of the subject&#39;s body whereby one or more of the large muscle groups may be employed to resist said force;     positioning means adapted for contact by another part of the subject&#39;s body for assisting the patient to position and maintain said part of the body in a substantially stationary position by limiting movement of said other part; and     at least one strain gauge associated with said force application means wherein said at least one strain gauge provides a measurement of the resistance exerted by said patient against said continuous or variable force whereby said measurement is electronically distributed to interested parties.        
 
         [0012]     In a preferred embodiment the at least one strain gauge outputs said measurement to a recording or processing means. It is preferred that the at least one strain gauge is in the form of one or more load cells. Preferably the recording or processing means is a computing device that can display a comparison of the output resistive force against previous results from the subject or against population norms. In this way the improvement or otherwise of a subject may be determined by a comparison against previous results. By making comparisons against population, performance or recovery norms the status of a subject may be determined. This is particularly advantageous in patients suffering from degenerative diseases such as multiple sclerosis or patient in post-surgery rehabilitation.  
         [0013]     The measurements and comparisons obtained are distributed to stakeholders by electronic means such as on a network, by e-mail or be made accessible on a dedicated site on the internet or provide to the patient as a measure of their progress. Interested parties may include the patient, the patient&#39;s carer or guardian, a physician, a therapist, a coach, a trainer, a lawyer, an insurance company, government department or the like.  
         [0014]     In a further preferred embodiment the subject may be video taped during the measurement of performance so that the interested party can be provided with visual feedback as well as the measured data. The video recording of the patient may also be distributed electronically to the stakeholders.  
         [0015]     Preferably the exercise apparatus also includes control means for controlling the application of said force whereby, whilst the user is resisting said force, the magnitude of said force may be progressively increased. The magnitude of the force may be a maximal, or sub-maximal force. Furthermore, it is preferred that the magnitude of the force which may be applied to the user&#39;s body is a maximal force such that in order to resist said force the user must perform a valsalva manoeuvre.  
         [0016]     The force may be applied concentrically, isometrically, eccentrically or isotonically. The force may be applied to specific areas of the subject whereby groups of muscles, in particular large muscle groups, are exercised and measured.  
         [0017]     The force applied by the force application means may be gravitational. For example the apparatus may include a plurality of weights which may be selectively used conjunctively in order to increase the magnitude of the force applied to the user&#39;s body. Alternatively the apparatus may include a heavy mass and wherein the magnitude of the force applied to the user&#39;s body may be varied by selectively repositioning of all or some of the mass.  
         [0018]     However in other embodiments a machine such as a ram or a winch may be used to apply a force to the user&#39;s body and wherein the machine may be mechanically, electrically or hydraulically driven.  
         [0019]     Alternatively the force may be applied by having the subject strain against a fixed member.  
         [0020]     The support means may include a support assembly for supporting a user in a selected attitude. In one embodiment the support assembly may be adapted to support the user in a substantially recumbent position and may include a platform for supporting the user&#39;s back, head and shoulders in a substantially horizontal attitude. Furthermore, the angle of inclination to the horizontal may be variable and the platform may be padded.  
         [0021]     In an alternative embodiment the support assembly may be adapted to support a user in a seated attitude and may include a platform on which the user may sit and possibly a back support to support the user&#39;s back. The support assembly may also include support means for supporting the user&#39;s legs, arms and hands including handles which the user may grasp.  
         [0022]     In yet another embodiment the support assembly may be adapted to support the user&#39;s body in an upstanding position, such as a forwardly inclined position, and wherein the support assembly may include a platform upon which the user may stand and foot support means for supporting the user&#39;s feet. For example, the foot support means may include one or more foot blocks upon which the user may rest their feet and wherein both the inclination of the blocks and their location relative to the force application means may be variable. The foot support means may also permit movement of the user&#39;s feet whilst the user is also resisting forces applied to the user&#39;s body by the force application means. Furthermore, movement of the foot support means may be automated and may be controlled by the control means. Other positioning may be in the form of a squatting position with exerciser&#39;s feet on the floor and the exerciser attempting isometrically to stand/straighten up while a waist band connected to a pulley resist such movement. This band which is connected via a pulley to a hydraulic fore in a resistive eccentric exercise mode, pulls the exerciser further into a squat position which the exerciser resists. Various bands around the upper and lower extremities can be used to isolate specific muscles or muscle groups to exercise said muscles isometrically or resistively and eccentrically.  
         [0023]     The positioning means preferably prevents the user from straightening certain parts of their body and thus assist the user in maintaining a preferred exercising attitude. The positioning means may therefore prevent certain injuries which might otherwise occur if the user were lock his or her skeletal frame in a position so as to resist forces applied to the user&#39;s body by the force application means.  
         [0024]     The control means may include a trigger or the like which controls the release of gravitational forces. Alternatively, the control means may control the operation of a motor or such like used to drive the force application means. For example, the control means may control the speed at which a motor may operate, the pressure applied to working fluids or the operation of mechanical means used to drive machines adapted to apply compressive or tension forces on the user.  
         [0025]     Preferably the control means permits either the user, or persons assisting the user, to regulate, increase or decrease the force applied by the force application means.  
         [0026]     The exercise apparatus may further include termination means operable by a user, or a person assisting the user, for terminating the application of forces applied to the user. For example, the termination means may include a switch which terminates or reverses the operation of any motors.  
         [0027]     The exercise apparatus may also be provided with safety means which prevents the continued application of forces to the user&#39;s body should the user be unable to continue resisting the application of the forces or which enables a user to safely disengage his or her body from the portion of the exercise apparatus through which the forces are applied to his or her body. For example, the apparatus may include stops which limit the operation of the machines in the event that a user ceases resisting the forces applied to his or her body by the apparatus.  
         [0028]     Preferably the magnitude of the force applied to the user&#39;s body is progressively increased whereby in order to resist the force, the user is compelled to perform a valsalva manoeuvre, namely to close the glottis and all abdominal orifices thereby closing the thoraco-abdominal cavity resulting in a temporary cessation of breathing, a decrease in the flow of blood from the heart to the lungs and from the lungs to the heart and whereby the resulting rise in pressure in the thoraco-abdominal cavity causes blood to be forced into the vertebral venous plexus thereby raising the pressure of the cerebrospinal fluid.  
         [0029]     It is also preferred that the user is positioned or supported by the support assembly in a supine position, ie. the user&#39;s head is lower than the user&#39;s trunk, or horizontal. When in such a position, it is believed that greater pressure is exerted on the thoraco-abdominal and cranial systems than would exist if the user were horizontal or supported in a position whereby the user&#39;s head was elevated above the user&#39;s hips. The increase in pressure is believed to effect the arterial, venous, lymph, cerebrospinal and nervous systems.  
         [0030]     Multiple sclerosis may be described as a gradual demyelination of cells in the central nervous system (the brain and spinal cord). The myelin sheath which protects the spinal cord often becomes damaged and inflamed and wherein the resulting scar tissue (sclerosis) prevents nerve signals travelling to and from the brain. Often more than one area of the central nervous system is usually affected, hence the name multiple sclerosis.  
         [0031]     Persons who are afflicted with multiple sclerosis may experience difficulties with balance, sight, speech, limb movement and certain body functions. The type and degree of disability depends on the parts of the nervous system which are affected.  
         [0032]     It is also noted that the degree of disability which persons suffer may vary considerably and may be dependent upon emotional and physical factors such as increased stress levels, physical exercise, foods and a lack of sleep.  
         [0033]     Information on exercise activity is monitored by the load cell and recorded directly on a software base. A visual screen allows the exerciser to monitor his/her progress. Every person has an individual method of exercising. By monitoring this activity concentrically, isometrically, eccentrically and isotonically an individual&#39;s progress can be accurately assessed in terms of rehabilitation. This allows changes to be made in exercise activity calculated by levels of progress. Further assessments as to levels of recovery and fitness to return to work duties can more accurately be made. Unsatisfactory progress can highlight unsuccessful surgical procedures, injury misdiagnosis or other psychosocial factors limiting patient progress.  
         [0034]     Patient compliance or non-compliance is calculated by comparing exercise activity with normal recovery activity levels. Fine tuning an athlete&#39;s strength performance is achieved by the establishment of their individual database and assessing their progress. Different muscle groups may be targeted depending on the sport.  
         [0035]     In a preferred embodiment of the present invention the evaluation software consists of a data and video acquisition module that reads the input and video data from multiple sources. Source  1  is an “S” beam load cell that records the foot-plate and cable forces. Source  2  consists of two multi directional force plates. Source  3  are two single force plates that measure total force when applied in a lateral direction. Two video cameras record all movements. The video and input data are synchronised and then displayed. Three additional computations are made from the video capture.  
         [0036]     Computation  1  measures the angle of any component on the video. Example would be the angle of the knee during a cable squat. Computation  2  takes a minimum of three video points and calculates the acceleration between those points and computation  3  calculates the time interval between two points. A center of Gravity display shows balance and can be used for proprioceptive re-training. The video is dynamic, therefore ultraslow motion is obtained without having to stop the current video while it is playing. All data and video can be displayed in either viewing area. This allows for the viewing of different information for one user or the comparison of one individual with a second individual. All information is stored for recall. Stored information can be printed in one of two ways. The first is a 16-panel printout of the entire exercise from start to finish. The second prints eight images and three pieces of associated information. This second printing function is matrix based and allows for multiple pieces of information to be displayed simultaneously.  
         [0037]     In one embodiment the load cell or strain guage is located upon a brace against which the subject presses to resist the force. Where the force application means is a fixed member the load cell may preferably be located on such a brace. In this embodiment the subject can be set in a 90° squat by positioning the fixed bar relative to the brace, in the case of the squat being a floor. This allows the assessment of a 1 repetition max to be measured and compared to a population with minimal bias in the testing protocol.  
         [0038]     In another embodiment the weight of the subject may provide the force application means and a multiplicity of load cells may record the weight transfer of the subject, allowing the subjects balance to be measured. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0039]     In order that this invention may be more readily understood and put into practical effect, reference will now be made to the accompanying drawings which illustrate a typical embodiment of the invention and wherein:  
         [0040]      FIG. 1  is an end view of exercise apparatus for use in accordance with the method of the present invention;  
         [0041]      FIG. 2  is a side view of the exercise apparatus illustrated in  FIG. 1 ;  
         [0042]      FIG. 3  is an end view of another exercise apparatus for use in accordance with the method of the present invention;  
         [0043]      FIG. 4  is a side view of the exercise apparatus illustrated in  FIG. 3 ;  
         [0044]      FIG. 5  is a front view of yet another exercise apparatus for use in accordance with the method of the present invention;  
         [0045]      FIG. 6  is a side view of the exercise apparatus illustrated in  FIG. 5 ;  
         [0046]      FIG. 7  is a schematic illustration of a hydraulic circuit;  
         [0047]      FIG. 8  is a front view of the exercise apparatus illustrated in  FIG. 5 ;  
         [0048]      FIG. 9  is a digital photograph of an apparatus used in the method of the present invention; and  
         [0049]      FIG. 10  is a digital photograph of a further apparatus for use in the method of the present invention.  
         [0050]      FIG. 11  is a printout of one form of readout from the method of the present invention.  
         [0051]      FIG. 12  is another printout of readout from the method of the present invention. 
     
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0052]      FIGS. 1 and 2  illustrate an exercise apparatus  10  including application means  11  for applying a force to a users body  12  maintained in a force opposing attitude by support means  13  including a support assembly  14  supporting the users head  15  and trunk  16  in a supine position and bearing means  17  against which the users feet  18  abut.  
         [0053]     The application means  11  includes a vertically orientated hydraulic ram  19  having a lower end  20  coupled to the bearing means  17  and an upper end, not shown, which is retained within a cylindrical housing  21 .  
         [0054]     The housing  21  depends from a pair of opposing, horizontally disposed, frame members  22  each having opposing ends  23  which are each releasably pinned to a respective upstanding frame member  24  having a plurality of apertures  25  formed therein along an upper portion thereof using pins  26 . The upstanding frame members  24  are each supported by a bracing assembly  27  and a rectangular frame assembly or base  28 .  
         [0055]     The lower end  20  of the ram  19  is coupled to a pair of opposing, horizontally disposed, frame members  29  each having opposing ends  30  which may be selectively pinned to respective frame members  24  using pins  31 .  
         [0056]     The housing  21  includes an inlet port  32  and an outlet port  33  each fluidly connected to a fluid container  34  by respective inlet and outlet pressure hoses  35  and  36  respectively. The application means further includes a hydraulic pressure motor  37 , mounted on and operatively connected to the fluid container  34  whereby in use the motor  37  drives the fluid contained in the container  34  through hose  35  into an upper chamber of the housing  21  resulting in downward movement of the ram  19 . The motor  37  is actuated by an on/off switch not shown and wherein the pressure under which the fluid is delivered to the ram  19  is controlled by control means comprising a pressure regulator assembly  38  having a control lever  39  and a pressure gauge  39   a.    
         [0057]     The bearing means  17  includes a base plate  40  which is supported by a frame assembly  41  slidably mounted on upstanding frame members  24  and wherein the frame assembly  41  is provided with roller assemblies  42 ,  43  and  44  which bear against front, side and rear faces of each frame member  24  respectively. The bearing means  17  further includes a load cell assembly  45  having a digital display  46  and wherein the load cell assembly  45  is located intermediate and is operatively connected to the frame assembly  41  and the frame members  29 .  
         [0058]     The support assembly  14  includes a padded platform  50  supported by a rectangular frame assembly  51  comprising a pair of opposing longitudinal frame members  52  and a pair of opposing transverse frame members  53 . Each longitudinal frame member  52  includes an aperture  54  formed partway along the length thereof and wherein the fame assembly  51  may be supported in an inclined attitude by a pair of pins  55  each of which extend through respective aligned apertures  56 , formed in the frame members  24  near the lower end thereof, and apertures  54 .  
         [0059]     The exercise apparatus also includes positioning means including a padded, horizontally disposed, frame member  57  which is supported by a pair of vertically orientated frame members  58  which extend downwardly from the base plate  40 . The frame member  57  is locatable behind a user&#39;s knee joints and wherein in use the frame member prevents the user from straightening their legs and thus assists the user to maintain a preferred exercising attitude. The positioning means may therefore prevent certain injuries which might otherwise occur if the user were to lock his or her skeletal frame in a position so as to resist forces applied to the user&#39;s body by the force application means.  
         [0060]      FIGS. 3 and 4  illustrate an exercise apparatus  70  including application means  71  for applying a force to a user&#39;s body  12  maintained in a force opposing attitude by support means  72  including a support assembly  73  supporting the user&#39;s body in an upstanding, forwardly inclined position.  
         [0061]     The application means  71  includes a vertically orientated hydraulic ram  74  having an upper end  75  and a lower end, not shown, which is retained within a cylindrical housing  76 . The housing  76  is coupled to a ram mounting assembly  77  comprising a pair of opposing, horizontally disposed, frame members  78  each having opposing ends  79  which are releasably pinned to a respective upstanding frame member  80 , having a plurality of apertures  81  formed therein along an upper portion thereof, using pins  82 .  
         [0062]     The upstanding frame members  80  extend upwardly from a base comprising a rectangular frame assembly  83  and are each supported by a respective bracing assembly  84 . Each bracing assembly  84  includes a horizontally disposed frame member  85 , which extends outwardly from frame member  80 , having a remote end  86  which is supported by an upstanding frame member  87 , and wherein the frame member  85  supports an inclined frame member  88  having an upper end  89  which is attached to the upper end  90  of the frame member  80 . The upper ends  90  of the frame members  80  are further connected to an intermediate frame member  91 .  
         [0063]     The upper end  75  of the ram  74  is coupled to a pair of opposing, horizontally disposed, frame members  92  which are slidably mounted on frame members  80  and wherein the ends  93  of each frame member  92  include roller assemblies  94  and  95  which bear against an internal face and either a forward or rear face of a frame  80 . The opposing ends  93  of each frame member  92  may also be selectively pinned to respective frame members  80  using pins  96 .  
         [0064]     The housing  76  includes an inlet port  100  and an outlet port  101  each fluidly connected to a fluid container  102  by respective inlet and outlet pressure hoses  103  and  104  respectively. The application means  71  further includes a hydraulic pressure motor  105 , mounted on and operatively connected to the fluid container  102  whereby in use the motor  105  drives the fluid contained in the container  102  through hose  103  into an upper chamber of the housing  76  resulting in a downward movement of the ram  74 . The motor  105  is actuated by an on/off switch, not shown, and wherein the pressure under which the fluid is delivered to the ram  74  is controlled by control means comprising a pressure regulator assembly  106  having a control lever  108  and a pressure gauge  109 .  
         [0065]     The user  12  is supported by a support assembly  73  which includes a pair of foot supports  110  each mounted, one behind the other, on opposing longitudinal frame members  111  of the base assembly  83 . Each foot rest  110  includes a foot plate  112  having a lower transverse edge hingedly connected to a base plate  113  which is supported at each end by opposing longitudinal frame members  111 . Each foot plate  112  is supported in an inclined position by inclined bracing members located at opposing ends thereof and which are selectively pinned thereto.  
         [0066]     The exercise apparatus also includes positioning means including a pair of handles  115  each mounted on a respective end  86  of a respective frame member  85 . The positioning means prevents the user from straightening certain parts of their body and thus assists the user to maintain a preferred exercising attitude. The positioning means may therefore prevent certain injuries which might otherwise occur if the user were lock his or her skeletal frame in a position so as to resist forces applied to the user&#39;s body by the force application means.  
         [0067]     The user  12  is provided with a harness or belt  120  which may be worn about the user&#39;s trunk  121 . A hook  122  is used to releasably connect the harness  120  to an end  123  of a cable  124 . The opposing end  125  of the cable  124  includes an eye which is adapted to engage a hook  126  extending upwardly from a load cell  127  mounted on frame members  92 . The load cell  127  includes a digital display  128 .  
         [0068]     The cable  124  is supported by a lower pulley assembly  130  including a pulley wheel  131  rotatably mounted on a shaft  132  mounted intermediate the lower portions of frame members  80 . The cable  124  is also supported by an upper pulley assembly  133  including a pulley wheel  134  rotatably mounted on a shaft  135  suspended from frame member  91 .  
         [0069]      FIGS. 5 and 6  illustrate an exercise apparatus  210  including application means  211  for applying a force to a user&#39;s body  12  which is maintained in a force opposing attitude by support means  213  including a user support assembly  214  supporting the users head  15  and trunk  16  in a supine position and bearing means  217  against which the user&#39;s feet  18  abut.  
         [0070]     The application means  211  includes a vertically orientated hydraulic ram  219  having a lower end  220  coupled to the bearing means  217  and an upper end, not shown, which is retained within a cylindrical housing  221 .  
         [0071]     The housing  221  depends from a pair of opposing, horizontally disposed, frame members  222  each having opposing ends  223  which are each releasably pinned to a respective upstanding frame member  224  having a plurality of apertures  225  formed therein along an upper portion thereof using pins.  
         [0072]     As previously mentioned, the lower end  220  of the ram assembly  219  is operatively coupled to bearing means  217  having mounting means  229  associated with opposite ends thereof. The mounting means  229  includes rollers which permit sliding movement of the mountings  229  relative to respective upstanding guide frame members. The mountings  229  may be selectively pinned to respective frame members  224  using pins which are also locatable within selected apertures  231  extending upwardly along the length of the guide frame members  209 .  
         [0073]     The housing  221  includes an inlet port and an outlet port each fluidly connected to a fluid container by respective inlet and outlet pressure hoses respectively. The application means  211  further includes a hydraulic pressure motor, operatively connected to the fluid container and whereby in use the motor supplies the fluid contained in the container, via the inlet hose to an upper chamber of the housing  221  thereby resulting in downward movement of the ram  219 . The motor is preferably actuated by an on/off switch and wherein the pressure under which the fluid is delivered to the ram assembly  219  is preferably controlled by control means comprising a pressure regulator assembly.  
         [0074]     The bearing means  217  includes a base plate  240  which is supported by plate support means  241  attached to said mountings  229  and which as a consequence may move in a generally vertical direction relative to the guide frame members  209 .  
         [0075]     The bearing means  217  also includes a bar  245  which depends from the base plate  240  and which is detachably mounted thereto. The bar may provide a user supported by said user support assembly  213  with something to grip with his or her hands and wherein the configuration is such that a user may use his or her arms to resist forces applied to the user&#39;s body by the application means  211 , see  FIG. 8 .  
         [0076]     The user support assembly  214  includes a padded platform or cushion  250  supported by a rectangular frame assembly  251  comprising a pair of opposing longitudinal frame members  252  and a pair of opposing transverse frame members  253 . The ends  252   a  of each longitudinal frame member  252  include an aperture  254  formed therein and wherein the fame assembly  251  may be releasably secured to upstanding frame members  235 , each having a plurality of apertures  256  formed therein, by extending pins through respective pairs of aligned apertures  254  and  256 .  
         [0077]     It will be appreciated that the construction of the user support assembly and the application means enables the user to selectively position the height of the user support assembly and the application means above the floor to suit his or her body dimensions. It will also be appreciated that the construction of the user support assembly also permits the user to selectively arrange the frame assembly  250  such that the user will be supported in a position wherein his or her head lies below, level with or above their hips.  
         [0078]     The exercise apparatus  210  is also provided with a second user support assembly  273  which is adapted to support a user&#39;s body in a generally upstanding, forwardly inclined position. The user support assembly  273  includes a pair of foot supports  310  arranged side by side and slidably mounted on respective guide assemblies or rails mounted on a base frame assembly of the exercise apparatus  210 . Each foot support is attached to a respective hydraulic ram assembly  180  and  181  and wherein the hydraulic circuit is illustrated schematically in  FIG. 7  and wherein the hydraulic circuit is adapted to provide resistance to the sliding movement of the user&#39;s back and forth. In particular, when the ram  182  moves in the direction of arrow  183 , fluid is discharged from the cylinder  184  into cylinder  185  by way of connecting hose  186 . The hose  186  is punctuated by two valve assemblies  187  which provide resistance to the flow of fluid through the hose  186 .  
         [0079]     Similarly, the fluid retained behind the piston  188  contained within cylinder  181  is discharged therefrom into cylinder  182 , behind the piston  189 , via a connecting hose  190 , which is in fluid connection with a reservoir  192 .  
         [0080]     It will be appreciated that the converse applies when the user&#39;s feet change direction and the ram  191  is driven in the direction of arrow  183 .  
         [0081]     It is believed that repeated movement of the user&#39;s legs in a forward and backward direction, when engaging respective supports  310 , will enhance the user&#39;s proprioceptive ability.  
         [0082]     The user support assembly  273  further includes a pair of handles  315  each mounted on a respective end  286  of a respective frame member  285 .  
         [0083]     The user  12  is provided with a harness or belt  320  which may be worn about the user&#39;s trunk  121 . A hook is used to releasably connect the harness  320  to an end  323  of a cable  324 . The opposing end  325  of the cable  324  is operatively connected to the application means  211 . The cable is supported intermediate its two ends by a lower pulley assembly  330 , and two upper pulley assemblies  331  and  332 .  
         [0084]     In the case of the apparatus illustrated in  FIGS. 1 and 2 , in use, a user is positioned on the padded platform  50  such that the user&#39;s head is lower than the user&#39;s trunk and wherein the user&#39;s outstretched legs extend upwardly in the direction of the ram  19 .  
         [0085]     Depending upon the length of the user&#39;s legs, the height of the ram assembly is adjusted such that, when the ram  19  is in a fully retracted position relative to the housing  21 , the user&#39;s feet abut the base plate  40  when the user&#39;s legs are at least partially bent at the knee joint. Preferably during use, the padded platform  57  prevents straightening of the user&#39;s legs.  
         [0086]     Having located the ram assembly relative to the user&#39;s body  12 , pins  26  may be extended through aligned apertures  23   a  and  25  so as to secure frame members  22  to upstanding frame members  24 . It should be noted that the bearing assembly is free to travel along the length of the frame members  24  and that pins  31  have been temporarily discarded.  
         [0087]     An assistant/trainer may then actuate the hydraulic motor  37  so as to drive fluid contained in the container  34  into the housing  21  via hose  35 . The resulting hydraulic pressure within the housing  21  drives the ram  19  and the bearing plate  40  coupled thereto in a downward direction.  
         [0088]     In use, the user is required to resist the downward movement of the bearing plate  40  with his or her legs with an equal and opposite force. The pressure at which the fluid is delivered to the housing  21 , and hence the force exerted on the user, is increased using the pressure regulator assembly  38  until the situation exists whereby in order to resist the force applied to his or her body the user is required to perform a Valsalva manoeuvre.  
         [0089]     It will be appreciated that such a situation cannot be maintained indefinitely and the resistance of large forces can only be brief and intense.  
         [0090]     Eventually the user will be unable to resist the forces applied to his or her body and as a consequence will be forced to retract his or her legs. The bearing plate however is prevented from crushing the user&#39;s body by the length of the ram  19 .  
         [0091]     With regard to exercise apparatus  70 , a user may be positioned thereon in an upstanding, forwardly inclined, attitude such that the user&#39;s feet are each positioned on a respective inclined footrest  110  and wherein the user&#39;s hands are used to grip respective handles  115 .  
         [0092]     The user is also provided with a harness or belt  120  which he or she may wear about their waist.  
         [0093]     The height of the ram assembly is adjusted such that when the ram is fully extended, there is little or no slack in the cable  124 .  
         [0094]     Having located the ram assembly relative to the user&#39;s body  12 , pins  82  may be extended through aligned apertures  81  and  82   a  so as to secure frame members  78  to upstanding frame members  80 .  
         [0095]     It should be noted that frame members  92  are free to travel along the length of frame members  81  and that the pins  96  have been temporarily discarded.  
         [0096]     An assistant/trainer may the actuate the hydraulic motor  105  so as to drive fluid contained in container  102  into the housing  76  via hose  103 . The resulting hydraulic pressure within the housing  76  drives the ram  74  in a downward direction. The movement of the ram  74  applies a tension force to the cable  124  which tends to pull the user backward. In use, the user  12  is required to resist the tension force by pulling on the cable with an equal and opposite force.  
         [0097]     The pressure at which the fluid is delivered to the housing  76 , and hence the force exerted on the user, is increased using the pressure regulator assembly  106  until the situation exists whereby in order to resist the force applied to his or her body, the user is required to perform a Valsalva manoeuvre.  
         [0098]     In use, the maximum force resisted by the user is measured by the load cell  45  or  127  and is displayed on the digital display  46  or  128 .  
         [0099]     It will be appreciated that the exercise apparatus  10  and  70  may be used to strengthen the vascular system of the body as opposed to peripheral muscular pumping. Increasing the body&#39;s ability to resist forces applied thereto (eccentric strength) enables a rapid increase in the amount of weight the body can lift (concentric strength). Furthermore, experiments have shown that the concentric upper limits of the human body can be increased towards the limit which a person can support eccentrically. It has also been observed that even after 12 to 18 months of non-activity a user&#39;s strength remains the same as previously attained levels of strength.  
         [0100]     It will also be appreciated that by inserting pins  31  through aligned apertures  29   a  and  25 , so as to secure frame members  29  to frame members  24 , the force exerted by a user on the fixed base plate  40  may also be measured using the load cell  45 .  
         [0101]     Similarly, by inserting pins  96  through aligned apertures  96   a  and  81 , the user may exert a tension force may on the fixed frame members  92  and wherein the force may be measured by the load cell  127 .  
         [0102]     It will be appreciated that the exercise apparatus illustrated in  FIGS. 5 and 6  is in essence a combination of the respective apparatus illustrated in  FIGS. 1 and 2  and  3  and  4  and wherein the respective components of the apparatus  210  will operate in a similar manner to the apparatus  10  and  70 .  
         [0103]      FIG. 9  shows an exercise apparatus  200  having a support assembly  214  for supporting the users head  215  and trunk  216  in a supine position. The exercise apparatus  200  also has a bearing means  217  against which the users feet  218  abut. A strain gauge  220  associated with a vertically oriented hydraulic ram  221  measures the resistive force applied by the users feet  18  against the force exerted by the hydraulic ram  221 . The strain gauge  220  directs an output to a computer  230 . The computer  230  distributes the measurement of resistance to interested parties in real time or in delay. The measurement may be distributed by the computer  230  via the internet and may include comparative or associated data that may provide context and meaning to the results of the strain gauge measurement.  
         [0104]      FIG. 10  shows an exercise apparatus  300  having a support assembly  314  for supporting the users head  315  and trunk  316  in a supine position. The exercise apparatus  300  also has a bearing means  317  against which the users feet  318  abut. A strain gauge  320  associated with a vertically oriented hydraulic ram  321  measures the resistive force applied by the users feet  18  against the force exerted by the hydraulic ram  321 . The strain gauge  320  directs an output to a computer  330 . The computer  330  distributes the measurement of resistance to interested parties in real time or in delay. The measurement may be distributed by the computer  330  via the internet and may include comparative or associated data that may provide context and meaning to the results of the strain gauge measurement.  
         [0105]      FIG. 11  shows a readout from a subject performing a concentric LR. The readout facility allows a stakeholder to compare each 0.25 sec of exercise effort. Comparisons can be made within session to session and exerciser to exerciser. Moment of maximum effort can be recorded coincidently with video tape recorded. Specific exercise joint angle can be measured at time of this effort.  
         [0106]      FIG. 12  shows a readout from a subject performing a leg press. The readout allows the moment of maximum effort to be recorded coincidently with the video tape record. Specific exercise joint angle can be measured at time of this effort. The graph indicates the readout facility to compare each 0.25 sec of exercise effort. Comparisons can be made within session, session to session or person to person.  
         [0107]     It will of course be realised that while the above has been given by way of illustrative example of this invention, all such and other modifications and variations thereto as would be apparent to persons skilled in the art are deemed to fall within the broad scope and ambit of this invention as is herein set forth in the appended claims.