Exercise Prescription for Weakness

Question 1

What is needed in a strength program to make it optimal for a weak patient?

Answer 1

• Specificity
• High intensity
• Goes to failure
• Adequate frequency
• Adequate volume
• Appropriate rests
• Progressive

Question 2

Explain specificity

Answer 2

The changes in response to exercise training are very specific to the details of the program. Different people will flourish with different activities. The physiological adaptations that come from specific training are endurance (from increased capillary and mitochondria number, which both increase aerobic capacity) and heavy resistance (increased quality of contractile proteins (for hypertrophy)

Question 3

Explain high intensity

Answer 3

This is potentially the most important and is based on assessment. 85% of 1RM is optimal for strength, but you still see significant changes in 7-15RM. Untrained individuals need 8-12Rm, and intermediate to advanced training changes from 1-12Rm to 1-6RM. Most patients we will see will be untrained individuals, therefore 8-12RM is most commonly used – this will differ for athletes, where it will be closer to optimal

Question 4

Explain going to failure

Answer 4

10 reps is not 10RM (10RM would be inability to complete an 11th rep). You will still see changes if close but not to failure. This makes a program individualised to many health conditions where strength training needs to be modified

Question 5

Explain adequate frequency

Answer 5

2-3 times per week is often reported for beginners, but 3-4 is better for strength. 2 days is enough to maintain gains

Question 6

Explain adequate volume

Answer 6

Multiple sets are generally considered optimal for hypertrophy, and with more training, more stimulus is needed for maximal gains. In untrained subjects 1 set to failure is sufficient for significant gains, but three sets is better (this helps to individualise a program

Question 7

Explain appropriate rest

Answer 7

Patients need 1-3 days btw training the same muscle groups

Question 8

Explain progression

Answer 8

We need to progress at appropriate times – we assess when we need to progress, as it is often quicker in non-trained persons (2 for 2 rule – if patient can perform two extra reps on two sets with perfect form, then they can be progressed). The load is increased 2-10% with each progression

Question 9

When do we use strengthening clinically?

Answer 9

• Post-surgery
• In presence of pain
• Prevention of future injury
• Weakness in neurological conditions
• Strengthening after muscle strain
• Strengthening in the presence of disease
• Strengthening in people with respiratory conditions
• Strengthening in people with neurological conditions

Question 10

How do we know how to treat a condition with strengthening?

Answer 10

We review the available evidence (RCTs, systematic reviews, clinical guidelines) and make a decision based on clinical judgments of the evidence for the specific condition we are treating