The Exercise Spectrum
A question I get quite often as a Physical Therapist is, “How often should I do exercises?”. As is the case with most questions pertaining to health and wellness, the answer is: “It depends!”. Of course, follow the instructions of your Physical Therapist, but here is a little snapshot of the factors we consider when deciding how to answer this highly individual question.
Let’s review some different types of exercises, and there is a nifty chart at the bottom to help tie this together.
Neuromuscular re-education: These are what our patients refer to as the “boring exercises”. The goal of these movements is to reinforce a pattern or to get under-utilized muscles to “kick on”. While these may look really easy, they can be the hardest to perform correctly, using the correct muscles. Many deep core, shoulder stability, and foot stability exercises fall under this category. Getting really good at these foundational exercises help those muscles to do their job when we need them most- while swimming, biking, running, working, etc. While you may be given a prescribed amount of these exercises to complete, it is really important to do every single repetition correctly. This means taking breaks if you find yourself compensating or too tired to complete them correctly. Complete them often in lower repetition amounts to further reinforce muscle sequencing.
Rehabilitation: This is where most Physical Therapy exercises land. The resistance is light (body weight, light dumbells, theraband), and therefore the stress on the tissues is relatively low. Of course, how stressful these exercises are to the body is dependent upon stage of the recovery and the tissue it is intended to strengthen or lengthen, in the case of mobility exercises. While mobility exercises can be completed multiple times per day, exercises to strengthen injured tissue need to be utilized with more care. The majority of these exercises can be completed daily without jeopardizing recovery.
Strength: Some of these exercises may look like rehabilitation exercises, except that the difficulty or the load (weight, resistance, etc.) is much higher. These are intended to sufficiently stress the tissue to facilitate improved strength and output from the muscle. Therefore, they are often incorporated toward the end of a rehabilitation program.These may result in soreness for the next 24-48 hours, classically known as DOMS, or Delayed Onset Muscle Soreness. More recovery is needed, and it is sufficient to complete these 3-4 times per week. The repetition range is typically 2-3 sets of 8-12 reps with 30-90 seconds rest. As with all exercises, performing each repetition correctly is key, so that means be diligent and taking breaks if your form is compromised. No cheating!
Endurance: The key difference with this category is the number of repetitions performed. The exercises may be very similar to those discussed previously, but the patient/athlete is now able to complete more consecutive repetitions without form breakdown. The type of exercise will be very dependent on the sport or activity that the patient/client wants the exercise to translate to. This may even mean holding a certain position or posture for an extended period of time, progressing to longer and longer to meet the demands of sport. Endurance can only be improved once the strength and muscle sequencing required is in place. These exercises may be completed 3-4x per week or daily, depending on the goals of the patient/client.
Power: Power is defined as “The rate of work done per unit of time”. Thus, there is a speed component to how power exercises are performed. Power can be improved by lifting heavy loads quickly. Plyometrics, or jumping exercises, also fall into this category. These are the most stressful exercises included in this list, and need to be treated as such. Guidance regarding heavy and Olympic lifts is key to receive maximum benefit and avoid injury. At Precision we refer clients to strength coaches to help with this. The repetition range, generally speaking, can be 3-5 sets of 4-6 repetitions with plenty of rest (2-5 mins) in between sets. Because these exercises rely on a different energy system than those described above, more rest is needed to successfully complete the prescribed workout. Examples of power exercises are squats, deadlifts, bench press, and Olympic lifts such as the clean, clean and jerk, and snatch. For the endurance athlete population, these types of workouts are reserved to early or in-between season training due to the amount of stress placed on the body. When incorporated properly, power training can significantly improve performance of endurance events. These should only be completed once the athlete is pain-free and has mastered all other levels of exercise.
Exercise is very dependent upon an individual’s needs and demands of sport, but I hope that this clarifies different types and progression of exercise.
Keep going, you got this!
Kacy Seynders, PT, DPT