Optimizing Your Exercise Routine

There isn’t a one-size-fits-all approach to optimizing exercise. Every person is unique and your current and past exercise habits, age, and health status all impact how you will respond to exercise. Your physical therapist has taken these factors into account, along with your goals, to design your personalized physical therapy program to address your pain. It is helpful to understand key concepts of exercise programming so you can perform exercises outside of the clinic during and after the completion of your plan of care.

Building Muscle and Strength

To induce muscle growth (known as hypertrophy), muscles need to be pushed beyond their current capacity. This overload is accomplished by progressively increasing the total mechanical tension. We can lift more weight or lift the same weight more times to accomplish this goal.

How much volume you should aim for largely depends on your training history. If you are new to the gym, I’d recommend a few sets of exercises per muscle group per week. As your body accommodates and delayed onset muscle soreness diminishes, you will need to ramp up quickly.

Rapid strength gains are common when you start exercising as your nervous system becomes more efficient. We recruit more motor units (connection points between the nerve and muscle), and they are better synchronized. Imagine 6 people trying to lift a large sectional. If they all lift at slightly different times, the task will be more challenging than if they all lift at once and sustain similar efforts. Adding two more people will make the task even easier. That’s roughly how the nervous system adapts to exercise.

Once you are past the beginner stage, research provides more guidance on how much exercise to perform. Research shows 12–20 sets per muscle group per week is likely the best range for most people. If you are a professional bodybuilder, you will likely exceed 20. If you are new to training, 12 may be too much. Some trial and error will be involved.

A quick caveat, 12–20 sets of any exercise intensity will be insufficient. The lifts need to stimulate hypertrophy by inducing overload. In other words, the reps matter, too.

For hypertrophy, your lifts should be close to failure. If you are stopping at 8 repetitions, your max out should be 10–11 reps. If you could crank out 20 but stop at 8, the load is too light. The rep range isn’t as important as the intensity and the number of sets.

If you love the burn that comes from lifting, choose higher rep ranges (>15). If not, aim for lower ranges (4–8). Heavy singles and doubles are inferior for muscle growth, will fatigue you more, and likely increase muscle soreness. If you are over the age of 59 or new to resistance training, you may respond better to light-load training (<50% of your 1 rep max).

Building Power

The most effective way to increase power is through quick movements, especially during the concentric phase of muscle contraction when the muscle shortens, such as the upward motion in a squat or the curling phase in a biceps curl. Aim to perform each rep in the gym as fast as possible, regardless of the weight, to stimulate as many motor units (the connection point between the nerve and the muscle) as possible. Rapid movement must occur during the concentric phase, while the lengthening portion (eccentric phase) should be controlled to maximize muscle strength and growth. When lifting very heavy weights, approaching your max lift, or lifting close to fatigue, you might not be able to move the weight quickly; however, that doesn’t mean power isn’t being trained. Still, try to contract the muscle and move the weight as quickly as possible.

For optimal power results, it’s recommended to slightly reduce the resistance, allowing you to move quickly. Studies indicate that peak power is generated around 70% of your 1 rep max. So, for instance, if your max squat is 300 pounds, moving as quickly as you can with 210 pounds will maximize your power output. Power training, similar to heavy strength training, is both safe and effective for older adults. If you have a stationary bike that measures power, you can experiment with the resistance until you find the ideal level for generating peak and sustained power, aiming to improve both.

It’s important to note that peak power cannot be sustained for long periods. Whether you’re cycling at peak power, performing max effort jump training, or sprinting, you’ll need long rest breaks. Similar to strength development, longer rest breaks ranging from 3–7 minutes between sets of exercise are necessary to allow your muscles to restore most of their ATP, the muscle’s energy source. While there are benefits to training in a fatigued state, training in a fresh state allows you to maximize peak results.

To measure your improvement, use the earlier tests, as power and strength are closely aligned. As your power improves, your strength will likely improve as well. While being more powerful won’t automatically translate to hitting a ball farther or running faster, it will provide the physical foundation necessary to improve those skills. Additionally, being more powerful contributes to overall health and longevity.

Building Cardiovascular Capacity

Cardiovascular capacity, often referred to as cardiovascular fitness or aerobic capacity, is a measure of the efficiency of the cardiovascular system in delivering oxygen to working muscles during prolonged physical activity. It reflects the body’s ability to take in, transport, and utilize oxygen to meet the energy demands of sustained exercise. The primary component of cardiovascular capacity is VO2 max (maximum oxygen consumption), which represents the maximum amount of oxygen the body can utilize during intense physical exertion.

Improving your VO2 max involves targeted cardiovascular training. Engage in aerobic exercises such as running, cycling, or swimming regularly to challenge your cardiovascular system and enhance its efficiency. Incorporate high-intensity interval training (HIIT) into your routine, alternating between short bursts of intense effort and periods of active recovery. This approach has been shown to effectively boost VO2 max. Consistency is key, so gradually increase the duration and intensity of your workouts over time. Additionally, consider cross-training to diversify your exercise routine and prevent plateaus. Incorporating strength training, flexibility exercises, and maintaining a healthy diet will further contribute to overall cardiovascular health, aiding in the improvement of your VO2 max.

Polarized training, widely favored by elite athletes, emphasizes spending the majority of aerobic training in low and moderate-intensity zones (1 and 2). Zone 2 training is the intensity level where you can hold a conversation but with a noticeable effort. Another test is you can talk but not sing. Zone 1 is typically at 50-60% of your max heart rate while zone two is around 60-70%. Your max heart rate is roughly calculated as your age subtracted from 220.

The physical activity guidelines state you should train about 150 minutes in zone 2 (moderate intensity) or 75 minutes in zones 3-5 (vigorous intensity) which is above 70% of your heart rate max about 6/10 on ratings of perceived exertion scale. A 1/10 is minimal effort and a 10/10 is maximal effort, such as a one-rep max lift or running until you can’t continue.

Improving Bone Health

Exercise, particularly high-intensity activity, offers a multitude of benefits beyond bone health, including improvements in strength, power, muscle mass, and cardiovascular capacity. The key is to push the body, forcing adaptation and stimulating growth in bone and muscle.

Simply put, if exercise is not challenging, it won’t drive the necessary adaptations. While any form of exercise benefits beginners, sustained progress requires pushing boundaries. This is true for bone just as it is for muscles and lungs. Diet alone is insufficient; the signal to use building blocks for bone and muscle comes from exercise.

The best ways to improve bone mineral density are heavy resistance training and impact activity. Research shows jumping, kickboxing, and stomping can all safely improve bone strength. Even in post-menopausal women over the age of 55 and with poor bone mineral density, heavy lifting and impact activity were safe and effective.

To get started, fundamental movements like squatting, lifting, pressing, and jumping can form the basis of an effective exercise routine. No need for fancy exercises or complex rep schemes. Comfortable exercises performed close to failure, with 8-10 sets per muscle group per week, can yield positive results. A sample routine includes squats, bench presses, lat pulldowns, lunges, deadlifts, overhead presses, seated rows, and calf raises. Gradually build up the resistance and incorporate impact activity.