Resistance Training

Introduction:

Resistance type training builds muscle, maintains strength, increases strength, and increases the body’s resting metabolic rate. Resistance exercise is used to focus on muscle toning and building. This type of exercise has the greatest overall ability to improve the shape of the body, as well as establish overall body symmetry and form. The following information includes initiation of resistance exercise in apparently healthy adults, in those with health conditions, and evidence based research on resistance training and muscular hypertrophy. Also see the section on aerobic exercise.

Starting resistance exercise in apparently healthy adults and older adults:

According to the American College of Sports Medicine (ACSM) and the American Heart Association (AHA), in addition to aerobic activity performed for a minimum of 30 minutes 5 days per week, adults and older adults should also perform muscle-training exercises 2-3 days each week using a variety of exercises (8-10 exercises involving the major muscle groups). For each exercise, 10-15 repetitions are recommended to improve strength. Daily balance and flexibility training exercises are also recommended as part of the overall program. (6)

 

World Health Organization statement on exercise:

According to the World Health Organization, the most benefit from physical activity is achieved with at least 2.5 hours of aerobic exercise of moderate intensity per week and by performing resistance exercises for muscle strengthening. Increased intensity, frequency and duration of exercise is associated with increased added health benefits. Regular exercise is recommended for not only all healthy individuals, but also those suffering from obesity, diabetes, hypertension, atherosclerotic cardiovascular disease, and cancer. (13)

 

Resistance training in those with health conditions or in chronically ill patients:

Exercise testing:

Exercise cardiac stress testing should be conducted in individuals who have suspected or known coronary artery disease, typical and atypical angina or have had prior heart attack. In healthy people, without symptoms, those with multiple heart risk factors(high cholesterol, high blood pressure, family history, obese, diabetes mellitus) or concurrent chronic diseases or those in a high-risk occupation for example pilots, firefighters, law enforcement officers, and transit operators should undergo exercise stress testing. Stress testing is also recommend for men over age 40 and women over age 50 who have been inactive but plan to start vigorous exercise. Evaluation of exercise capacity in patients with heart disease involving one or more of the valves of the heart (patient’s whose heart valve does not open fully), those with heart rhythm disorders, and those with pacemakers is also necessary. (15)

Formal clinical cardiopulmonary exercise testing using a treadmill or cycle ergometer and the more basic 6 minute walk test may be used to determine baseline exercise capacity before and after medications, surgery, and pulmonary or cardiac rehab programs. These tests may be used as a basic evaluation of exercise capacity, safety and guidelines in patients with coronary heart disease, shortness of breath with/without exertion, lung/heart transplantation, poor exercise tolerance, lung resection, pulmonary hypertension, chronic bronchitis, asthma, interstitial lung disease, heart failure, COPD, cystic fibrosis, peripheral vascular disease, fibromyalgia, advanced age, patients with pulmonary vascular disorders, and for predicting mortality in cardiac patients.

Clinical cardiopulmonary exercise testing may yield detailed diagnostic information important to the patient’s ideal care. This testing may provide valuable diagnostic data for a patient’s poor exercise capacity, assist evaluation of disease conditions, and safely evaluate the patient’s ability to start and continue an exercise program. Monitors uptake of oxygen, EKG, blood pressure, ventilation, and perceived exertion using a treadmill or cycle ergometer (10). A motivated patient interested in improving their health status despite chronic disease conditions will greatly benefit from a referral for cardiopulmonary exercise testing.

Exercise testing will be able to evaluate a patient’s response to exercise while taking medications. An example includes medications such as beta blockers, including labetalol, which decrease heart rate and blood pressure during rest and exercise. Beta blockers will also increase baseline exercise capacity in patients with pre-existing angina and will either decrease exercise capacity or have no effect on those patients without angina. (15)

The 6 minute walk test is a simple test using an area for the patient to walk such as a hallway to determine the distance traveled in 6 minutes. The patient is instructed to walk as far as possible at their desired intensity without jogging. The items required include a timer, cones to mark turnarounds, lap counter, and safety equipment such as defibrillator, crash cart, emergency personnel, oxygen, and chair in the walking area. However, thousands of subjects in several studies have previously performed the test without adverse events. It is contraindicated in those with myocardial infarction or unstable angina within the past month, heart rate over 120 and blood pressure of 180/100. (10,11)

Incorporate balance exercise in aerobic activity which may help prevent older adults from falling. Among older adults living in the community, a moderate to high-intensity balance exercise program is the most effective in preventing falls. Among older adults who needed extra care living in institutional settings, exercise along with multifactorial interventions are recommended. At a minimum, older adults need at least 50 hours of exercise to prevent falls. (14)

Once exercise testing is complete and physician feels it safe to proceed, adults with cardiovascular disease should perform muscle-training exercises 2-3 days each week using a variety of exercises (8-10 exercises involving the major muscle groups). For each exercise, 1 set of 8-15 repetitions (may increase to more than 1 set) is recommended to improve strength. Additionally, flexibility exercises performed at least 2 or 3 days each week are recommended. (6)

 

Resistance training and cholesterol:

Resistance training may help reduce cholesterol. Overweight hypercholesterolemic men with serum cholesterol >200 mg/dl were randomly divided into 3 groups (placebo (n = 9), soy (n = 9) or whey (n = 10) supplementation) and participated in supervised resistance training for 12 weeks. Total serum cholesterol decreased significantly (average=5.8%) for all groups (mean reduction = 12.6 mg/dL), with no differences among groups. Specifically, total cholesterol reduction was 10.4 mg/dL for placebo, 11.2 mg/dL for soy, and 15.9 mg/dL for whey. Participation in a 12 week resistance exercise training program significantly reduced serum cholesterol, increased strength, and improved body composition in overweight, hypercholesterolemic men. Whey protein improved cholesterol a small amount more than placebo or soy protein but additional added benefit from protein (soy or whey) supplementation was not otherwise seen in this study group. (2)

 

Exercise and Asthma:

The National Heart, Lung, and Blood Institute (NHLBI) published guidelines on exercise induced asthma or bronchospasm (EIB). In adults and children with asthma, taking inhaled short and long acting beta2-agonists (such as albuterol, salmeterol, formoterol) before vigorous activity or exercise may prevent EIB, exercise induced asthma, in about 80% of patients. The benefits of treatment may last for 2-3 hours for short  action beta agonist or up to 12 hours if long action beta agonists are used. Additionally, a warm-up period prior to exercise is associated with a lessen degree of EIB. In cold weather, a mask or scarf over the mouth may lessen the effects of cold-induced EIB. Children suffering from EIB should not be excluded from sports and other activities but teachers and coaches should be notified that the child suffers from EIB and may need inhaled medication prior to participation. If symptoms of EIB occur during usual non-vigorous play activities, this may an sign of poorly managed or persistent asthma and long-term treatment may be necessary. Appropriate long-term management may reduce EIB. (16)

 

Medication influence on exercise:

The influence of medications on exercise was described by Gauer, RL and O’Connor, FG with Department of Family Medicine Uniformed Services University of the Health Sciences, in the article“How To Write An Exercise Prescription.” Accessed 3/8/2013. (15)

Beta Blockers with examples including Lopressor and Toprol XL( metoprolol), Coreg (carvedilol), Tenormin (atenolol), Bystolic (bisoprolol), reduce heart rate and blood pressure during both rest and exercise. Beta blockers will increase baseline exercise capacity in patients with pre-existing angina and will either decrease or have no affect on those patients without angina.

Calcium channel blockers, including Adalat and Procardia (nifedipine), Cardizem (dilitiazem), and Calan (verapamil), will increase baseline exercise capacity in patients with pre-existing angina and have no effect on those patients without angina. During rest and exercise, nifedipine increases heart rate and decreases blood pressure. Dilitiazem and verapamil decrease both heart rate and blood pressure during rest and exercise.

Nitrate medications or nitroglycerin increase heart rate and blood pressure during rest and exercise. They will increase baseline exercise capacity in patients with pre-existing angina and have no effect on those patients without angina. In patients with CHF, nitrates will increase or have no affect on baseline exercise capacity.

Diuretics, which increase the production of urine, do not effect exercise capacity except potentially in patients with congestive heart failure by relieving edema in the lungs. Heart rate during rest and exercise is not affected. Blood pressure may decrease or remain unaffected with use of diuretics.

Bronchodilators, including methylxanthines such as theophylline, sympathomimetic agents (such as ephedra, pseudoephedrine, amphetamines and methamphetamines), cromolyn sodium, and corticosteroids such as prednisone or methylprednisolone increase exercise capacity in patients with limited bronchospasm. During rest and exercise, methylxanthines and sympathomimetic agents increase or have no effect on heart rate and blood pressure. Sympathomimetic agents may also increase blood pressure during rest and exercise. Cromolyn sodium and corticosteroids have no effect on either heart rate or blood pressure during rest and exercise.

Hyperlipidemic agents with the exception of clofibrate and nicotinic acid (also known as niacin), have no effect on heart rate or blood pressure. In patients with prior heart attack, clofibrate and dextrothyroxine may increase arrhythmias and angina. If you are taking dextrothyroxine, it is advisable to discontinue it because it was pulled from the market due to cardiac adverse effects. During rest and exercise, dextrothyroxine may increase heart rate and blood pressure and worsen myocardial ischemia. Probucol is a cholesterol lowering agent which decreases LDL but it is advisable to discontinue since it may also lower HDL. Blood pressure is decreased by use of nicotinic acid (Niacin) and use of probucol may decrease heart rate (QT interval lengthens). During rest and exercise, nicotine increases blood pressure and either increases or has no effect on heart rate.

Antihistamines such as Benadryl (diphenhydramine), Claritin (loratadine), Zyrtec (cetirizine), commonly used to treat an allergic reaction, have no effect on heart rate and blood pressure during rest and exercise. They also have no effect on exercise capacity. Cold medicine with sympathomimetic agents may increase heart rate or blood pressure during rest and exercise.

Levothyroxine or brand name Synthroid, a thyroid medication, increases heart rate and blood pressure during rest and exercise. It has no effect on exercise capacity except if a patient has angina, it may become worse.

Alcohol, has no effect on heart rate but chronic use of alcohol increases blood pressure during rest and exercise. Alcohol has no effect on exercise capacity.

Hypoglycemic (low blood sugar) agents, including insulin and oral agents have no effect on heart rate and blood pressure during rest and exercise. They also have no effect on exercise capacity.

 

Exercise prescription for serious illnesses:

A prominent credible source for exercise prescription is Thompson et al, American College of Sports Medicine’s (ACSM’s) Guidelines for Exercise Testing and Prescription. (17) Another older but valuable source is Gauer, RL and O’Connor, FG with Department of Family Medicine Uniformed Services University of the Health Sciences, “How To Write An Exercise Prescription.” (15) This can be accessed at: http://www.move.va.gov/download/Resources/CHPPM_How_To_Write_And_Exercise_Prescription.pdf

 

The American College of Sports Medicine Training Guidelines for Muscular Fitness:

Emphasizes development of strength, hypertrophy, power and endurance through progressive resistance training. (18):

Large muscle groups before small: As a rule, large muscle group exercises should be performed before small muscle group exercises. Also, multiple-joint exercises should be performed before single-joint exercises.

Novice and untrained individuals: Untrained individuals with no resistance training experience or who have not trained for several years (novice) should exercise with a repetition rage of an 8-12 repetition maximum (RM) 2-3 days per week. RM is the maximum number of repetitions that can be done at a given amount of resistance. For instance, a 6 RM is the weight which a person can lift a maximum of 6 times.

After 6 months of training: Individuals with approximately 6 months of consistent resistance training experience (intermediate) and individuals with years of  experience (advanced) are advised to use a loading range from 1-12 RM in periodized fashion leading to an emphasis on heavy loading of 1-6 RM using 3 to 5-min rest periods between sets 3-4 days per week for intermediate training, and 4-5 days per week for advanced training.

Contraction velocity and load: Weight should be lifted at a moderate contraction velocity. When training at a specific RM load, it is advised that 2-10% increase in load be applied once the individual can perform the current workload for 1 to 2 repetitions over the goal.

Progression for hypertrophy training: Progression in power training entails two general loading strategies: 1) strength training and 2) use of light loads (0-60% of 1 RM for lower body exercises; 30-60% of 1 RM for upper body exercises) performed at a fast contraction velocity with 3-5 min of rest between sets for multiple sets per exercise (3 to 5 sets). This exercise selection and frequency are recommended for hypertrophy training, with emphasis on 6-12 RM and 1- to 2-min rest periods between sets.

 

Principles of Resistance Training:

1. If beginner, exercises for upper body may be grouped in one day and lower body exercises may be grouped on another day. For Intermediate or Advanced (consistent training for 8 week or more) Combine 1 major and 2 minor muscle groups with each workout. There are many combinations:

Major Muscle Groups: chest, back, legs, exclude calves

Minor Muscle Groups: triceps, biceps, calves, shoulders, abs, low back

Day 1: Chest, triceps, abs

Day 2: Back, shoulders, low back

Day 3 Legs, calves, biceps

Or

Day 1: Back, triceps, abs

Day 2: Legs, shoulders, low back

Day 3 Chest, biceps, calves

2. Create a 3 workout cycle and follow in sequence.
3. Start with the 3 major muscle group exercises and then on to the 2 minor muscle group exercises.
4. Pick 3 exercises for each major muscle group and 2 for each minor muscle group.
5. Use moderate, (not all out intensity) and increase weight with each set: 18 reps, increase weight, 15 reps then increase, 12 reps then increase, then finally 10 reps with highest weight. More benefit is achieved as conditioning occurs. Increase weight further as the muscles grow stronger and adapt to lighter weight.
6. Consistency is the key and the process of building muscle mass is cumulative. Try not to miss more than 1 day of exercise at a time.
7. Wait 1 min between sets and do multiple sets with each exercise.
8. For every 2-3 days of strenuous exercise, or if soreness and fatigue occurs, do aerobic-type exercise only for that day or take a day of rest.
9. Use different exercises to target different parts of each muscle to fully work each muscle.
10. Drink 8-16 ounces of H20 30 min prior to working out, and an additional liter of water throughout the workout.
11. Eat 1-2 hours before exercise to have any recent food fully digested in order to use this energy to fuel the workout. Eating too soon before exercise (under 45 min before a workout) may result in indigestion.
12. Take a protein supplement with 15 -30 grams of protein within 15 minute of finishing your workout to repair muscle tissue. Eat a meal within 1-2 hours after resistance training to help repair muscle and replace carbohydrates.
13. Include low fat protein (milk/yogurt/cheese, beans, chicken, lean beef, egg whites, whey protein) to keep amino acid levels within the blood for consistent building and maintaining muscle while losing weight.
14. Keep carbohydrates low in the form of whole vegetables mainly, either fresh or cooked. Limit flour, pretzels, pasta, rice, and sugar.
15. Include carbohydrates mainly for breakfast and lunch. Reduce for the later parts of the day.
16. Try to work out at the same time each day. After a daily workout schedule is established, your body adjusts to anticipate exercise at the same time each day.
17. Stretch the muscles being trained a few times during each workout and at the end of each workout.
18. Most modern gyms have a cable machine circuit which is simple to use and trains each muscle group as you proceed with each machine. This can usually be completed within 30 minutes. This circuit may be divided into a lower body and upper body regimen with more sets per exercise. This may then be completed on 2 separate workout days. The circuit may then be used to work each body part more thoroughly with more sets per muscle group instead of only one set.
19. Many gyms come with a free personal trainer for several sessions. Take advantage of this service for establishing a resistance training routine.

 

Sample Resistance Training Schedules

Beginner-(2 sets for all body parts)

Intermediate to Advanced-(6-12 sets major groups, 4-10 minor groups) 

 

Sample Beginner Resistance Training Program: Include aerobic exercise for 10-45 min. Stretch in between exercises. May substitute resistance bands for dumbbells. Adapt these exercises to available equipment. Perform 2 sets for each exercise. After 8 weeks, advance to Intermediate workout.

 

Sample Intermediate Resistance Training Program: Include aerobic exercise for 10-45 min. Stretch in between exercises. Adapt the exercises to available equipment. Perform 3-4 sets for each exercise. After 3-6 months, proceed to Advanced workout. 

 

Sample Advanced Resistance Training Program: Include aerobic exercise for 10-45 min. Stretch in between exercises. Adapt the exercises to available equipment. Perform 4-6 sets for each exercise. Change workouts every 8 weeks.

Maximizing hypertrophy:

Higher volume, multiple-set programs are recommended for maximizing hypertrophy. The following principles apply when the focus is on building of muscle as opposed to muscle toning.

• Research shows that moderate intensity resistance training working up to a large volume of sets between 4 and 12 repetitions increases the degree of muscular hypertrophy.
• Proper form in the effective range of motion of the joints must be used.
• The repetition maximum should be reached on the final set of each exercise only.
• Forcing maximum effort on every set with a large amount of weight will overstress the joints and skeletal muscles to the point of over training or injury.
• Adequate rest should be practiced with a day off from training at least every 3rd to 4th day of training. Overtraining results in tendonitis, excessive soreness and/or fatigue.
• Exercises should include those which recruit a large number of muscle groups simultaneously.
• Adequate caloric intake 1-3 hours before training will establish adequate energy levels to power the workout.
• A protein supplement within 30 minutes following completion of the training will aide in recovery and muscle growth.
• 8 hours or more of sleep per night is required to establish muscle repair, recovery and growth.
• Workouts should focus on a different set of muscle groups on each day of the training cycle. All muscle groups should be trained in succession in a symmetrical fashion. Muscle groups should not be skipped, or favored by training certain muscle groups more than others.

 

 

Endurance training:

For endurance training, light to moderate loads (40-60% of 1 RM) with high repetitions (>15) using short rest periods (<90 seconds) is recommended.

 

 

Resistance training programs should be individualized:

All recommendations are dependent and should be tailored to an individual’s needs, goals, training status and physical capacity.

 

 

Types of resistance exercises:

Emphasis should be placed on multiple-joint exercises involving the total body.

 

 

Local muscular endurance training:

For local muscular endurance training, it is recommended that light to moderate loads (40-60% of 1 RM) be performed for high repetitions (>15) using short rest periods (<90 s).

 

 

Training guidelines for emphasizing muscular hypertrophy:

Ideal repetitions maximum for muscular hypertrophy of the thighs:

A study evaluated the response  of 21 sessions of squat training for the resulting enlargement in muscle size. Body weight, thigh girth, net thigh girth, and quadriceps (is a large muscle group that includes the four prevailing muscles on the front of the thigh) and hamstring thickness. Ultrasound was used to measure muscle size in 4 groups of 38 men of 21.1 years of age. The groups performed 4 sets of multiple repetitions maximum (RM): group I, 3-5 RM; group II, 13-15 RM; and group III, 23-25 RM. A control (C) group did not perform physical training. Results found that body weight and hamstring thickness were similar in all groups after training. However, thigh girth was greater in groups II (mean:1.42) and III (1.35) than in group C (0.24). Net thigh girth was greater in groups II (1.33) and III (1.40) than in group C (0.10). Quadriceps femoris thickness was greater in all 3 training groups (I, 0.61; II, 0.43; III, 0.55) than in group C (0.05). The study found that 4 sets of squats done with the subject’s maximum amount of weight able to be lifted in a variable range of 13-25 times all resulted in enlargement of the thigh muscles. (3)

 

 

Training techniques for muscular hypertrophy:

According to an article by Schoenfeld, B.J. in the Journal of Strength and Conditioning Research. a muscle hypertrophy (increase in muscle size) oriented program should consists of a repetition range of 6-12 reps per set with rest intervals of 60-90 seconds between sets. Exercises should be varied in a multidirectional, multi-angled fashion to guarantee optimal stimulation of all muscles. In the context of a split training routine, multiple sets should be used to heighten the anabolic response. At least some of the sets should be carried out to the point of concentric muscular failure. Concentric repetitions (the goal of this type of contraction is to produce enough force to move the weight) should be performed at fast to moderate speeds (1-3) seconds while eccentric repetitions (the body resists a change in movement but does not produce enough force to move the object in a concentric direction) should be performed at slightly slower speeds (2-4 seconds). Training should be performed in parts so that the hypertrophy phase ends in an optimal performance capacity of muscle tissue post training period. (4)

 

 

Number of sets for muscular hypertrophy:

Krieger studied the effects of single to multiple sets per exercise on muscle hypertrophy (enlargement in muscle size) Results of the study found that multiple sets per exercise were associated with significantly greater modifications in muscle size during resistance programs. Specifically, multiple sets had 40% greater hypertrophy-related effect sizes than a single set. Also, there was a trend toward dose effects (i.e., increasing muscle size with increasing number of sets). Findings from this study suggest that performing a minimum of 2-3 sets per exercise and possibly, 4-6 sets would be more effective in achieving maximal hypertrophy in both trained and untrained subjects. (5)

 

 

Resistance training in the morning verses the evening:

The effects of time-of-day-specific strength training on muscle hypertrophy (muscle enlargement) and maximal strength in men was examined by Sedliak M et al. Subjects were randomized to either a morning training group or an afternoon training group. The groups trained for 10 weeks with training times between 07:00 and 09:00 hours and 17:00 and 19:00 hours in the morning group and the afternoon group respectively. Cross-sectional areas and volume of the quadriceps femoris (is a large muscle group that includes the four prevailing muscles on the front of the thigh) were obtained by magnetic resonance imaging at weeks 0, 10, and 20. Maximum voluntary isometric strength during unilateral knee extensions and the half squat one repetition maximum were tested at weeks 0, 10, and 20. A control group did not train but was tested at all occasions. The entire 20-week training period resulted in significant increases in maximum voluntary contraction and 1 repetition maximum (1RM) in both training groups. In this study, the magnitude of muscular hypertrophy and strength did not statistically differ between the morning or afternoon group. (7)

 

 

Muscular hypertrophy in young versus older men and women:

The effect of age on the magnitude of hypertrophy response was examined in 9 young (22-31 yr, 5 male and 4 female) and 8 old (62-72 yr, 4 male and 4 female) subjects. Muscle hypertrophy is an increase in the size of a muscle through an increase in the size of cells. Muscle in the thigh and upper arm were examined before and after 3 months of progressive resistance training by magnetic resonance imaging (MRI). Strength was determined by 3-repetition-maximum (3RM) testing. Results showed that an average increase in muscle cross-sectional areas (CSA) were lower in the older group for elbow flexors (22% in young, 9% in old, p < .05) and knee flexors (8% vs 1% in old, p < 0.01), but not for knee extensors (4% vs 6% in old). Mean increases in specific tension (ratio of 3RM strength to CSA) were similar in young (21%) and old groups (19%) for elbow flexors and knee extensors (38% vs 32 % in old), but were greater in the older group for knee flexors (28% vs 64% in old, p < 0.02). In conclusion, aging can reduce the effect of hypertrophic muscle response to resistance training, but the older subjects are able to continue to develop increase in strength and muscle size despite aging. (8)

Elderly women are able to increase muscle strength significantly. A 12-week resistance training program was developed for 27 healthy elderly women (mean age 69) to determine if increases in muscle strength is associated with changes in cross-sectional fiber area of the vastus lateralis muscle (located on the outer side of the thigh). Thirteen women were put on seven exercises that stressed primary muscle groups of the lower extremities, while 6 control subjects were assigned no exercise. Compared to baseline values, increases in muscle strength and type II muscle fibers among the exercisers were significant (28-115% and 21%, respectively). However, no significant change in strength or type II fiber area was observed in the controls. No significant changes in type I fiber area were found in either group. The authors concluded that despite an average age of 69 years old, resistance training in elderly women increased muscle strength. (9)

 

 

Power lifting by strongman competitors:

Training practices of 167 strongman competitors who perform feats of strength were reviewed from a 65-item online survey. Among the participants, 65.8% performed back squats, 88% performed conventional deadlift, 85% incorporated some form of periodization in their training, 74% included hypertrophy training, 97% included maximal strength training, 90% included power training, 59.9% performed speed repetitions with submaximal loads in the squat, 61.1% performed deadlift, 54% incorporated lower body plyometrics, and 88% performed Olympic lifts as part of their training. Additionally, 56 and 38% of the strongman competitors used elastic bands and chains in their training, respectively. These findings show that strongman competitors use a variety of strength and conditioning practices that are focused on increasing muscular size, and the development of strength and power. (12)

 

 

 

 

Assessment and Plan: Resistance Training

• Exercise cardiac stress testing should be conducted prior to exercising in individuals who have suspected or known coronary artery disease, typical and atypical angina or have had prior heart attack. In healthy people, without symptoms, those with multiple heart risk factors(high cholesterol, high blood pressure, family history, obese, diabetes mellitus) or concurrent chronic diseases or those in a high-risk occupation for example pilots, firefighters, law enforcement officers, and transit operators should undergo exercise stress testing. Stress testing is also recommend for men over age 40 and women over age 50 who have been inactive but plan to start vigorous exercise. Evaluation of exercise capacity in patients with heart disease involving one or more of the valves of the heart (patient’s whose heart valve does not open fully), those with heart rhythm disorders, and those with pacemakers is also necessary.

 

• Formal clinical cardiopulmonary exercise testing using a treadmill or cycle ergometer and the more basic 6 minute walk test to determine baseline exercise capacity before and after medications, surgery, and pulmonary or cardiac rehab programs.

 

• Consider a pulmonary or cardiac rehab program for related diseases with functional impairment due to these diseases.

 

• Counsel physically active patients regarding the influence of medications upon exercise.

 

• According to the American College of Sports Medicine Training Guidelines for Muscular Fitness, higher volume, multiple-set programs are recommended for maximizing hypertrophy. Intensity of 0-60% of 1 RM for lower body exercises and 30-60% of 1 RM for upper body exercises should be emphasized with a 6-12 RM and 1- to 2-min rest periods between sets. The study be Krieger found that multiple sets had 40% greater hypertrophy-related effect sizes than a single set. The muscular response to training in elderly men and women may be less than younger individuals, but are still able to develop muscular fitness, strength and hypertrophy despite aging.

 

• For muscular endurance training, light to moderate loads (40-60% of 1 RM) with high repetitions (>15) using short rest periods (<90 seconds) is recommended.

 

• Training in the morning or evening results in similar benefit in muscular fitness.

 

• For supplements to enhance athletic performance see the athletic performance section.

 

 

 

 

References:

1.Walter R. Thompson, American College of Sports Medicine, Neil F. Gordon, Linda S. Pescatello ACSM’s Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins, Feb 1, 2009.

 

2.Denysschen CA, Burton HW, Horvath PJ, Leddy JJ, Browne RW. Resistance training with soy vs whey protein supplements in hyperlipidemic males. J Int Soc Sports Nutr. 2009 Mar 11;6:8. http://www.ncbi.nlm.nih.gov/pubmed/19284589

 

3.Weiss LW, Coney HD, Clark FC. Gross measures of exercise-induced muscular hypertrophy. J Orthop Sports Phys Ther. 2000 Mar;30(3):143-8. http://www.ncbi.nlm.nih.gov/pubmed/10721510

 

4.Schoenfeld, B.J. The mechanisms of muscle hypertrophy and their application to resistance training. Journal of Strength and Conditioning Research. 2010; 24(10): 2857-2872. http://img2.tapuz.co.il/forums/1_158907702.pdf

 

5.Krieger JW. Single vs. multiple sets of resistance exercise for muscle hypertrophy: a meta-analysis. J Strength Cond Res. 2010 Apr;24(4):1150-9. http://www.ncbi.nlm.nih.gov/pubmed/20300012

 

6.Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007 Aug;39(8):1435-45.

http://circ.ahajournals.org/content/116/9/1094.full.pdf

 

7.Sedliak M, Finni T, Cheng S, Lind M, Häkkinen K. Effect of time-of-day-specific strength training on muscular hypertrophy in men. J Strength Cond Res. 2009 Dec;23(9):2451-7. http://www.ncbi.nlm.nih.gov/pubmed/19910830

 

8.Welle S, Totterman S, Thornton C. Effect of age on muscle hypertrophy induced by resistance training. J Gerontol A Biol Sci Med Sci. 1996 Nov;51(6):M270-5. http://www.ncbi.nlm.nih.gov/pubmed/8914498

 

9.Charette SL, McEvoy L, Pyka G, Snow-Harter C, Guido D, Wiswell RA, Marcus R. Muscle hypertrophy response to resistance training in older women. J Appl Physiol. 1991 May;70(5):1912-6. http://www.ncbi.nlm.nih.gov/pubmed/1864770

 

10.Sumer S Choudhary and Sanjiw Choudhary. Exercise testing in assessment and management of patients in clinical practice-present situation. Lung India. 2008 Jul-Sep; 25(3): 111–117. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2822334/

 

11.Crapo, Robert et al. ATS Statement: Guidelines for the Six-Minute Walk Test, developed by the ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. March 2002. http://www.thoracic.org/statements/resources/pfet/sixminute.pdf

 

12.Winwood PW, Keogh JW, Harris NK. The strength and conditioning practices of strongman competitors. J Strength Cond Res. 2011 Nov;25(11):3118-28. http://www.ncbi.nlm.nih.gov/pubmed/21993033

 

13.Mendes R, Sousa N, Barata JL. [Physical activity and public health: recommendations for exercise prescription]. [Article in Portuguese]. Acta Med Port. 2011 Nov-Dec;24(6):1025-30. Epub 2012 Feb 20. http://www.ncbi.nlm.nih.gov/pubmed/22713198

 

14.Shubert TE. Evidence-based exercise prescription for balance and falls prevention: a current review of the literature. J Geriatr Phys Ther. 2011 Jul-Sep;34(3):100-8. http://www.ncbi.nlm.nih.gov/pubmed/22267151

 

15.Gauer RL, O’Connor FG. Department of Family Medicine Uniformed Services University of the Health Sciences. How To Write And Exercise Prescription. http://www.move.va.gov/download/Resources/CHPPM_How_To_Write_And_Exercise_Prescription.pdf

16.National Heart, Lung, and Blood Institute (NHLBI). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: NHLBI; August 2007. http://www.ncbi.nlm.nih.gov/books/NBK7232/pdf/TOC.pdf

 

17.Thompsonet al, American College of Sports Medicine’s (ACSM’s) Guidelines for Exercise Testing and Prescription.

 

18.American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009 Mar;41(3):687-708. http://www.ncbi.nlm.nih.gov/pubmed/19204579