Lesson 15: Miscellaneous Topics

Table of Contents

Introduction

At this point I have gone over all of the basics of the physiology, health benefits, guidelines, and practical knowledge to create and follow an effective exercise program. In this lesson I will go over a variety of additional brief topics. These include:

  • how to maintain progress when you are unable to train
  • what to do if you are injured
  • special considerations for pediatric, elderly, and pregnant populations
  • nutrition geared towards exercise
  • warming-up and cooling-down for exercise sessions
  • additional exercises geared towards athleticism, conditioning, and mobility
  • individual variation in response to exercise programs

How to maintain progress if you have to cut back on training time

This can occur for several different reasons. If your gym is closed (due to a pandemic or other reasons), then you can create and follow a home-based workout routine as shown in Lesson 13.  However, sometimes life gets in the way and you may have to cut back on the time you can spend training. The question then becomes how much can you cut back on training without losing progress? A recent narrative review addresses this specific concern, though the authors were only able to find a small number of studies(Spiering, 2021):

  • Regarding aerobic training, the data indicates keeping exercise intensity high is imperative. Volume can be decreased by a factor of 1/3 if frequency is kept the same. It’s unclear how much frequency can be decreased, but going down to 2 sessions weekly seems effective for keeping shorter duration cardiovascular fitness levels intact if volume is not decreased each session.
  • Regarding resistance training, you can likely maintain maximum strength as well as muscular hypertrophy by training one day per week as long as you keep training volume and exercise intensity high. Alternatively, you can keep the training frequency the same and do 1 set per exercise. For the elderly it may be more important to keep training frequency at 2 sessions weekly with ≥2 sets per exercise.

Overall, it appears you can significantly decrease your weekly volume and maintain your current level of progress if you keep the intensity high.

What to do if you are injured

Depending on the type of injury you may need to see a healthcare provider and get medical clearance before you can feel confident you can safely train again. This is especially applicable to any health issues involving chest pain or the heart as well as any musculoskeletal issues where you hear or feel a pop, see significant bruising, or find yourself with limited range of motion.

  • With issues related to chest pain or the heart it is likely best to stop all physical activity until you are medically cleared.
  • For serious musculoskeletal issues, you may be able to still train the body parts that are not affected by the injury. For example, if you develop a serious knee injury you may still be able to do some upper body exercises such as lat pulldowns, machine chest press, etc.

If you suffer a more minor injury, such as a pulled muscle or an ankle sprain, but you don’t feel or hear a pop and you don’t see significant bruising, you can likely rehab this on your own.

  • You should expect the swelling and pain to worsen the first 24 hours or so. Taking NSAIDs such as Naproxen, if they are safe for you to take, on a regular basis for the first couple of days may decrease the swelling and pain. This will allow you to work on increasing the mobility of the affected joint.
  • It is important to work on range of motion from the start and keep working on it. If you just rest the injured body part and don’t move it then it will get more stiff and it will take longer to recover. This goes again the standard RICE (rest-ice-compression-elevation) mantra but real world experience indicates working on mobility and range of motion is key. When working on range of motion this should NOT be significantly painful. Simply move the injured joint or muscle back and forth through its range of motion as much as possible to the point of starting to feel pain (to a pain scale of no more than 2-3/10). Do this sporadically throughout the day as it is healing.
  • If after the first 72-96 hours the injury is not gradually improving then it may be more severe and you may want to consider seeing a healthcare provider.
  • While you are rehabbing the injury you can still train the rest of your body, just be careful not to put your body in any positions or do any exercises that will cause more pain and worsen the injury.

Note: While beyond the scope of this course as the research is still in the relatively early stages and there are some concerns regarding safety, blood-flow restriction training, where you purposefully apply occlusion to a limb such that venous blood flow is interrupted, seems to allow you to train with very light weights and still develop hypertrophy benefits. This could be a viable training method in particular for people with injuries to the limbs that prevent them from using heavier weights, as well as immobilization injuries that prevent any movement at all for some period of time.(Hughes, 2017)

There are some safety concerns and from what I’ve read I cannot guarantee this will be a safe method to use over longer time periods or even in the short term for people with certain medical conditions. Additionally, most people are not going to purchase the equipment necessary to use this approach effectively. Therefore, I will not discuss blood-flow restriction training in more detail.

However, for those who are interested and would like further reading:

  • Click here for a review article that discusses the various safety concerns.
  • Click here for a practical guide regarding how to incorporate blood-flow restriction training.
  • Click here for additional considerations of methodology, application, and safety.

Special considerations for pediatric populations

For a long time there have been many concerns of children and adolescents engaging in strength training and specifically weight training activities. However, recent research indicates these concerns are largely unfounded.(Yavuz, 2021) There seem to be no significant concerns of a negative impact on growth, and multiple studies have found the injury rate for children engaged in resistance training to be very low, though appropriate supervision is important.(Myers, 2017; Wang, 2022) As discussed in Lesson 3, there are many physiologic benefits of resistance training at all ages. Contrary to popular belief, in addition to these other benefits it is even possible for prepubertal children to attain small increases in skeletal muscle hypertrophy and other fitness measures with consistent training.(Legerlotz, 2016; Sánchez Pastor, 2023)

Additionally, various types of training in both children and adolescents (traditional resistance training, plyometrics, more power-based movements) can all be an effective part of an athletic training program, though younger children should prioritize general strength and balance training prior to engaging in more stressful plyometric or power-based exercises.(Behm, 2017; McQuilliam, 2020; França, 2023) Reviews of large numbers of studies indicate many different training protocols can be effective in children and adolescents, though loads ≥80% of their one-repetition maximum (“1RM”) are still likely best for strength gains.(Lesinski, 2016; Peitz, 2018)

However, this research does not negate the benefit of aerobic training. Aerobic training still has health benefits independent of resistance training. There is some thought that combined resistance and aerobic exercise (“CRAE”), where both modalities are done in one session, may increase adherence, though more research is needed to evaluate this hypothesis.(Headid, 2021) As one example of how to combine exercise styles, a recent study found a high-intensity interval training (“HIIT”) workout using body weight exercises yielded benefits for various aspects of fitness that exceeded those seen from HIIT with just running; the image below shows the intervention that was done(Li, 2023):

Reproduced from: Li Z, Liu Y, Han X, Zhou Z. Effects of running-based versus body-weight-based high-intensity interval training on physical fitness in healthy adolescents. Front Physiol. 2023 Mar 10;14:1060216. doi: 10.3389/fphys.2023.1060216. PMID: 36969578; PMCID: PMC10036788.

A position stand by the National Strength and Conditioning Association on long-term athletic development indicates that(Lloyd, 2016):

  • Children who are old enough to follow directions in organized sport (usually age 6-7) can start resistance training.
  • Children can typically recover faster from high-intensity exercise than adults.
  • Early sports specialization should be avoided due to an increased risk of injury and suboptimal athletic development.
    • There is some controversy about this point given the lack of strong evidence supporting some of the theorized negative effects of early sports specialization. If interested, particularly if you know of a child who is going to specialize in sports early and want to help mitigate the potential negative effects, please consider reading this document for further information.(Mosher, 2022)
  • There seems to be a higher risk of injury if:
    • youth participate in more hours of sports practice per week than their number of years in age
      • Regardless of age youth should not participate in more than 16 hours of weekly training volume.
    • if the ratio of organized sports to free play is >2:1
    • when youth train >8 months in a year for a single sport
  • Injury risk is highest around the time of the adolescent growth spurt, particularly in the lower limbs. It is worth considering decreasing the training stress or spending more time working on stability during this time to help decrease the risk of injury. Taking height measurements every 3 months and plotting a growth curve will make it more obvious when height velocity increases.

The American Academy of Pediatrics published a report in 2020 also promoting resistance training for children and adolescents. They mention(Stricker, 2020):

  • Children recover more quickly from fatigue so may need less rest between sets than older individuals.
  • 1RM testing can be safe if done with qualified professionals and established testing protocols.
  • There does not seem to be a significant interference effect with concurrent training.
  • Injury rates in youth resistance training with proper supervision are lower than other sports and general recess at school.
  • Youth should fully rest 1-2 days weekly.
  • It is important to use (potentially modified) equipment that is an appropriate size for children.
  • If youth have hypertension or an uncontrolled seizure disorder they should consult a specialist prior to engaging in resistance training.
  • Additionally, medical contraindications to resistance training include:
    • hypertrophic obstructive cardiomyopathy
    • pulmonary hypertension
    • Marfan syndrome
    • prior use of anthracyclines (a class of chemotherapy drugs)
  • Youth can start body weight exercises at age 5.
  • General guidelines for programming:
    • Begin with 1-2 sets of 8-12 reps with <60% 1RM.
    • Increase the weight in 5-10% increments and work to 2-4 sets of 6-12 reps with ≤80% 1RM.
    • Periodically phase in <6 reps of >80% 1RM.
    • Use a full range of motion with all exercises.
    • Start with multi-joint compound exercises and progress to single-joint exercises.
    • Include a dynamic warm-up.

Separately, a 2021 consensus statement was published with recommendations on youth participation in ultra-endurance running events, concluding that(Scheer, 2021):

  • there is generally a lack of data on long-term outcomes regarding the impact on various body systems
  • the events that do include younger runners generally do not report more injuries among them than older runners
  • runners age <12 or who are prepubertal are highest risk, age 12-15 are medium risk, and age 16-18 are lowest risk for unhealthy outcomes
  • the authors ultimately recommend anyone can participate in the lower risk events (<50 kilometers, minimal changes in surface and elevation, no weather extremes, good medical support/hydration/nutrition available)
  • for medium and higher risk events (longer distances, more changes in surfaces/elevation, more weather extremes, more remote with less nutrition/hydration available, higher amounts of weight that need to be carried) it is more important to evaluate things on a case-by-case basis

A 2021 review highlighted how children (prior to undergoing puberty) and adults differ with respect to endurance exercise, noting that(Skinner, 2021):

  • Children have less glycogen and lower rates of glycogen utilization.
    • This leads to lower maximal lactate values and limits a child’s ability to exercise at high intensities for an extended period of time.
  • Children also have a greater surface-to-mass ratio, generate more heat per kilogram of body weight during exercise, start to sweat at higher body temperatures, sweat at a slower rate, and lose less heat via evaporation compared to adults, while also taking more exercise sessions in a hot climate to acclimatize to the heat.
    • Thus, children have fewer problems in a neutral environment but are not able to tolerate exercise as well in hot or cold environments.
    • This is particularly true if there is high humidity in hot environments that would further decrease sweat production.
  • Collectively, these factors lead to children naturally exercising at high-intensity in spurts while avoiding prolonged endurance activities.

Summary of considerations for pediatric populations

Overall, it is clear that children and adolescents can engage in a variety of different muscle-strengthening activities productively as long as they follow sensible programs and utilize good technique. Adequate supervision is important. Prioritizing exercises and programs that the children find fun and enjoyable will likely be the most helpful in fostering healthy exercise habits long-term. For child athletes it is worth building up a general base of strength prior to focusing on more explosive and plyometric-based movements. Additionally, child athletes should not engage in greater activity amounts than those listed above. It also seems youth can engage in prolonged endurance events, though it is important that the youth indicate they want to do this and the overall risks need to be considered on a case-by-case basis (regarding the individual and race conditions).

Tip: With the above guidelines it should be clear that children can follow routines similar to the ones listed in the last two lessons, assuming they have adequate equipment that is appropriately sized. This latter part may be quite challenging; most leg press machines for example will simply not fit a child.

Additionally, a 45 pound barbell may be much too heavy. Thankfully there are still several options for children:

  • All sorts of body weight exercises are viable. Many children can hold small dumbbells for additional weight. Wearing a backpack for further weight is reasonable.
  • In a regular commercial gym… well to be honest most children will not be allowed to workout in a regular commercial gym. Thus, performing modifications of the home-based workout programs in Lesson 13 will be easiest.
  • Youth-sized equipment can be purchased. Some examples:
    • A play set for age 3-5 (prior to graduating to using real weights).
    • Barbells made for children. Here is one option; it weighs 5 pounds and can only accommodate a maximum weight of 50 added pound. However, as a typical olympic style barbell is 45 pounds, children can train with this one until they can comfortably lift 45 pounds and then graduate to a full olympic barbell.
      • Do note that a typical olympic barbell is longer than this junior version.
      • Also note that if you are purchasing equipment from scratch and want to train at home you will need to additionally purchase weight plates and spring collars to hold the plates on the barbell. A kid’s squat rack may also be helpful.
        • There are many types of weight plates out there. For the bar listed above you will want plates that have a hole with a 2 inch diameter in the center. These would be olympic plates, not standard plates. Bumper plates would be ok as well but they are more expensive and this bar is not supposed to be dropped, which defeats the purpose of getting bumper plates.
        • The sleeves on the end of the bar are 3.75 inches. Thus, you will want to ensure the plates you purchase are less than 1 inch thick to make sure they can fit on the bar with the collars on the end. If you purchase four 10 pound plates, two 5 pound plates, and two 2.5 pound plates, you will be able to use 5 pound increments from 5-45 pounds, assuming they will fit on the sleeves.
    • A cheaper option than the olympic barbell shown above would be a standard barbell. This barbell for example weighs ~16 pounds with a maximum weight capacity of ~250 pounds. If you go with this option then you will need to purchase standard plates with a 1 inch diameter hole in the center and you will need to get spring collars designed for a standard barbell (such as these).
  • You can also make equipment for children. For example, sandbags are great as they can be used in a lot of ways with a low risk of injury. Just purchase sand (or soil), fill up a backpack or duffel bag (you can place the sand/soil in a trash bag and put this in the backpack or duffel bag), and then you can use that for exercises.

Ultimately if a child wants to workout it may be best to show them a variety of exercises they can perform, let them choose which they want to do, and help them make a program with those exercises. Start with light weight, always emphasize good technique, and use linear progression to increase the weight slowly.

Special considerations for elderly populations

Much of what was discussed in Lessons 3-6 applies to elderly populations; I specifically included literature pertaining to elderly populations in those lessons. Nonetheless, I wanted to emphasize a few points when considering training programs for elderly populations. The following sections provide a summary of some of the most relevant points in the 2019 National Strength and Conditioning Association’s position statement on resistance training for older adults.

Of note, there are not many well-controlled trials involving individuals >80 years of age, however the literature that does exist as recently reviewed indicates that there are significant benefits when following the standard physical activity guidelines regarding aerobic activity (discussed in Lesson 3 of this course), still some benefits when doing less than the minimum recommended in those guidelines, and that incorporating resistance training 1-2 times weekly is also beneficial.(Carrick-Ranson, 2022)

Safety considerations

  • Resistance training is safe when done appropriately. It should be done concurrently with aerobic training.
  • Absolute contraindications include:
    • unstable coronary heart disease (“CHD”), decompensated heart failure, uncontrolled arrhythmias, severe & symptomatic aortic stenosis or dissection, acute myocarditis, endocarditis, pericarditis
    • severe pulmonary hypertension
    • uncontrolled hypertension (>180/110 mmHg)
    • Marfan syndrome
    • People with active proliferative retinopathy or moderate or worse nonproliferative diabetic retinopathy should not lift >80% of their 1RM.
  • Relative contraindications (should consult a physician prior to beginning resistance training) include:
    • major risk factors for CHD
    • diabetes
    • blood pressure >160/100
    • functional capacity <4 metabolic equivalents
    • musculoskeletal limitations
    • the presence of pacemakers or defibrillators

Programming variables

  • Sets: 1 for beginners or older adults with frailty, up to 3 sets if healthy
  • Repetitions: 10-15 for beginners and progress to 8-12
  • Intensity: begin as tolerated and progress to 70-85% of 1RM
  • Exercise selection: 8-10 different exercises
  • Modality: free weight or machine-based (ideally free weight based on abilities)
    • Remember, free weights will aid balance and bone mineral density more than machines.
  • Frequency: 2-3 nonconsecutive days per muscle group per week
  • Rest between sets: 1.5-3 minutes as tolerated for symptom control
    • If any abnormal symptoms develop during a set then you should consider stopping your workout and seeing your healthcare provider if this is new and/or concerning. Otherwise at least rest long enough for the symptoms to disappear prior to performing the next set.
  • Power training: 40-60% of 1RM
    • It is important to perform reps with these lighter weights as quickly as possible on the concentric phase to aid power development.
  • Functional movements: include exercises to mimic tasks of daily living
    • This can include standing up from a chair, balancing on one leg, picking up objects and walking with them, and really anything else you can think of that may mimic every day life in some capacity.

Note: Individuals with slow walking speed (<0.8 meters/second (m/s)) seem to benefit from any physical activity, while individuals with a walking speed of 0.8-1.4 m/s and especially >1.4 m/s will need increasingly higher levels of training stimulus and task-specific movements to yield increasing benefits.(Brahms, 2021) Thus, particularly for elderly individual who can walk faster, consider performing increasingly complex functional movements and balance tasks to derive additional benefits.

Additional considerations for elderly with frailty

  • Start at 20-30% of your 1RM and progress to 80% of your 1RM.
  • Include power exercises with 30-60% of your 1RM.
  • Include functional exercises that simulate activities of daily living.
  • When strength and balance improve you can begin endurance training. Start with 5-10 minutes and progress to 15-30. Build up to an intensity of 12-14 on the Borg RPE scale of 6-20.
  • Include balance training with exercises such as line walking, tandem foot standing, and standing on one leg.
  • Gradually increase the volume, intensity, and complexity of exercises.
  • Make sure you to do these various activities with a setup such that there is minimal risk of falling.

Considerations of comorbidities

  • Mobility limitations: Consider seated exercises and limiting the range of motion to a pain-free range where the movement you do perform is with good form.
  • Mild cognitive impairment: Select simple exercises; extra instruction and demonstration may be required.
  • Diabetes: Monitor blood glucose before and after training and additionally consider specific diabetes comorbidities (ie, feet numbness will worsen proprioception/balance).
  • Osteoporosis: Begin at lower intensity, train balance safely (to minimize the risk of falling), use caution with bending and twisting movements, and include postural exercises such as spinal extension.
  • Joint pain or limited range of motion due to arthritis: Limit exercises to ranges of motion that can be done without pain. Consider setting up the machines if possible to restrict the range of motion to a pain-free range.
  • Poor vision or balance: Consider weight machines.

Summary of considerations for elderly populations

Overall, elderly individuals can engage in resistance training and expect excellent health benefits similar to younger individuals. Other than the safety concerns with medical comorbidities mentioned above, most of the training philosophies that apply to younger individuals are still applicable. Modifications may need to be made to ensure good form can be utilized, and if this means shortening the range of motion that is ok. Power exercises done with lighter loads as quickly as possible can be done as warm-up sets for heavier sets. As long as safety is prioritized most elderly individuals will be able to train effectively.

Tip: Elderly individuals can follow pretty much all of the programs in the last two lessons if modifications are made according to the above. Elderly individuals can take longer to recover so I would start working out only 2 or at most 3 days a week. I would also start with only 1 set of each exercise not including warm-up sets. Aim for 10-15 reps during this set. Use linear progression and then when progress stalls consider adding in a second set.

Thus, initially, a full body program may include:

  • Squats: 1*10-15
  • Deadlifts: 1*10-15
  • Leg press: 1*10-15
  • Bench press: 1*10-15
  • Incline dumbbell bench press: 1*10-15
  • Lat pulldowns: 1*10-15
  • Seated rows: 1*10-15
  • Farmer’s walks: hold a dumbbell in each arm and walk as far as you can in 1 minute. If you have no difficulty holding the dumbbells this entire time then increase the weight. When the weight becomes too heavy and you have to let go before 1 minute, then keep using the same weight and try to beat the time each session. Increase the weight when you can hold them for 1 minute.
  • One-legged stands: stand on one leg for 1 minute and try to minimize the number of times the opposite leg touches the ground. Then repeat with the opposite leg.
  • Walk for distance: sit in a chair or on a bench, stand up, walk a certain distance come back, sit down, and repeat for 2 full minutes. Try to beat the total distance each session.

This is 10 exercises with 1 set each. Alterations can be made as needed. Once linear progression ends you can consider adding a “power” set with lighter weight where you attempt to do 5 reps as fast as possible (only the concentric phase is as fast as possible, the eccentric phase should still be controlled). Do this “power” set before doing the more difficult set. When you begin doing multiple sets per session you can do them in a circuit.

Special considerations for pregnant populations

As discussed in Lesson 3, exercise during pregnancy confers ample health benefits both for the pregnant individual and the growing child. When determining how to exercise while pregnant, there are several considerations:

  • Is it safe to exercise for any given medical condition?
  • How to safely exercise during pregnancy?
  • How much exercise should a pregnant woman perform?

There are several review articles, guidelines, and commentaries that address these questions; I will summarize them here.(Meah, 2020; Carmichael, 2021; Ferrari, 2021; Yang, 2021; Hassan, 2022; Hayman, 2023)

Contraindications to exercising while pregnant

In 2020, the American College of Obstetricians and Gynecologists (ACOG) published guidance regarding physical activity and exercise during pregnancy and the postpartum period.

They suggest the following warning signs that a pregnant individual should stop exercising:

  • vaginal bleeding
  • abdominal pain
  • regular painful contractions
  • amniotic fluid leakage
  • dyspnea before exertion
  • dizziness
  • headache
  • chest pain
  • muscle weakness affecting balance
  • calf pain or swelling

They do not actually list absolute or relative contraindications in that document. There is an earlier 2015 document where contraindications are stated, but 2020 document cited above replaced that one and does not list any, though it does state “There are few maternal medical conditions in which aerobic exercise is absolutely contraindicated.”

So what are these contraindications? A recent document summarized various guidelines from around the world that list contraindications and also described the evidence base that does or does not provide support for these recommendations.(Meah, 2020) I have summarized the authors’ recommendations in the table below; please refer to their full document for a discussion of the evidence for further reading if desired.

a table listing contraindications to exercising while pregnant

How to exercise safely during pregnancy

Per the ACOG document linked above the following exercise types have been studied extensively in pregnancy and are known to be safe:

  • walking
  • stationary cycling
  • aerobic exercises
  • dancing
  • resistance exercises (with lighter weights)
  • stretching exercises
  • hydrotherapy and water aerobics

The various documents cited above indicate the following safety aspects of exercising while pregnant:

  • The supine position (lying on your back) after 20 weeks of gestation may decrease venous return to the heart (due to aortocaval compression from the uterus). Thus, this should be avoided.
    • However, as indicated in one of the more recent reviews above not everyone agrees exercise in the supine position is always unsafe.(Hayman, 2023)
  • There are different upper limits of intensity indicated in the cited documents, but all agree that you should not exceed 90% of your maximum heart rate. Some advise not exceeding 80% but for people who are regular exercisers going up to 90% does not seem to negatively impact the fetal heart rate.
  • Maintaining good hydration is important.
  • Avoid exercise modalities with a high risk of abdominal trauma (ie, some contact sports) or falling.
  • Exercising in a thermoneutral environment to prevent overheating is important.
  • Adequate nutrition for sessions >45 minutes in length is important to prevent low blood glucose.
  • There is sparse literature of the Valsalva maneuver during resistance training while pregnant, to be safe this should be minimized.
    • The Valsalva maneuver was described in Lesson 9. Briefly, this describes attempting to breathe out against a closed glottis. This is commonly done while having a bowel movement. It is natural to do this with resistance training as this increases your intra-abdominal pressure to provide further stability and increased force transmission. You can avoid using the Valsalva maneuver by breathing regularly throughout each repetition; this will be easier with relatively lighter weights.
  • Due to the physiologic changes during pregnancy it may be more difficult to catch your breath, particularly as pregnancy progresses. You may find that you need to decrease the overall intensity to account for this.
  • Due to hormonal changes of pregnancy your joints can become more lax. Thus, it may be safer to avoid explosive and jerky movements.

There are a number of musculoskeletal conditions that can present in the prenatal, pregnancy, and postpartum periods, some of which will impact your physical activity and may be amenable to physical therapy of some sort; you can read about some of these conditions here if curious.(Borowski, 2021)

How much exercise to perform while pregnant

The ACOG document linked above suggests:

  • Aiming for 20-30 minutes of moderate-intensity exercise daily or at least most days of the week.
  • Moderate-intensity exercise corresponds to a 13-14 on a 20-point RPE scale (somewhat hard); a person should still be able to carry a conversation at this intensity.

There is not much specific guidance beyond that. For the reasons listed in Lesson 3 regular exercise seems beneficial and there is no indication that the general physical activity guidelines should not be followed as long as the considerations regarding safety listed above are kept in mind. A compilation of 13 guidelines indicates that most guidelines suggest(Yang, 2021):

  • Aim for at least 150 minutes of moderate-intensity exercise weekly spread over at least 3 weekly sessions in 30-60 minute increments.
  • It is preferable to be active on most, and even better on all, days of the week.
  • Another recent guideline compilation also suggests including muscle-strengthening, including pelvic floor exercises, at least two days a week.(Hayman, 2023)

ACOG additionally recommends that pelvic floor and abdominal strengthening exercises can be started in the immediate postpartum period. This includes “abdominal vacuums” where you try to draw in your waist in as much as possible. Together this can help recovery of the various core/pelvic muscles and decrease the risk of diastasis recti (a separation of the abdominal muscles, commonly seen as a gap down the midline of the abdomen). Lastly, the authors note that regular aerobic training while lactating will not negatively impact milk production if adequate hydration is maintained.

Summary of considerations for pregnant populations

Overall many forms of exercise are safe during pregnancy. There are absolute and relative contraindications that should be kept in mind, and it is always safest to discuss this with your own obstetric care provider if you are unsure what you should or should not do. The general physical activity guidelines can mostly be followed, though heavy resistance training with extensive use of the Valsalva maneuver and high-intensity training where your heart rate increases beyond 90% of its maximum value should not be performed, though we need more research in elite athletes who are accustomed to training in this way. Once you determine a method of exercise that is suitable you can gradually progress with it as tolerated as long as you keep the safety considerations listed above in mind. Ultimately you can feel confident this will benefit not only your health but your child’s health as well.

Nutrition and hydration when exercising regularly

As I have a nutrition and weight management course on this site, I am not going to go into this in detail here. However, there are some additional considerations when exercising for prolonged periods of time. I will summarize relevant key points from the course as well as additional separate guidance documents here.(Thomas, 2016; Kerksick, 2018; Schroeder, 2021)

However, prior to discussing guidance from the above documents, one thing I do want to highlight is the concept of relative energy deficiency in sport (“RED-S”) and low energy availability (“LEA”).(Charlton, 2022) The former is a newer term (first described in 2014) that expanded the “female athlete triad” and extends to males. Over time RED-S contributes to various physiological and psychological co-morbidities, such as:

  • mental health problems (depression, anxiety, impaired judgement, poor concentration)
  • abnormal hormone levels (decreased insulin, leptin, thyroid, growth hormone, IGF-1, testosterone, and estrogen, while also having increased cortisol)
  • poorer bone health (decreased bone mineral density, increased stress fractures)
  • injury risk

LEA is thought to be the underlying mechanism of RED-S, and while LEA may differ between people, it is generally assumed that individuals with energy availability < 30 kcal/kg (calories/kilogram) of fat free mass are at risk of LEA. Energy availability is defined as energy intake – exercise energy expenditure. See the next box for an example. Unfortunately, there is no great diagnostic tool for LEA (which various between people likely based on gender/genetics/activity levels) and RED-S, but any time health problems emerge or a decrease in overall performance occurs this should be a consideration.

Example: Let’s assume you weigh 75 kg (165 pounds), you have a body fat percentage = 20%, and you perform enough exercise to burn 500 calories daily. Therefore:

  • Your fat free mass = 75 kg * 0.80 = 60 kg (132 pounds).
  • If you need an energy availability of at least 30 kcal/kg of fat free mass to help prevent LEA and RED-S, then you need an energy availability = 30 * 60 = 1,800 calories.
  • Since you expend 500 calories daily with exercise, you need to consume 1,800 + 500 = 2,300 calories daily to help prevent LEA and RED-S.

Keep in mind this would be a minimum to aim for and for reasons discussed in my nutrition and weight management course it can be quite difficult to accurately estimate both caloric intake and caloric expenditure. Thus, it may be safer to aim for an energy availability of at least 35 kcal/kg of fat free mass daily in case you are estimating incorrectly (in this example this would lead to 35 * 60 + 500 = 2,600 calories per day).

Standard recommendations for nutrition in the context of exercising regularly

  • If you do not have a lot of excess body fat to lose then aim for at least 1.3 grams of protein per kilogram (g/kg) of body weight daily. This equals ~0.6 grams per pound (g/lb). If you are purposefully losing weight then increasing protein intake to 1.6-2.2 g/kg (0.7-1 g/lb) will be more beneficial.
    • If you do have a significant amount of excess body fat to lose then this protein recommendation may be too high. In that case aim for 30-40 grams in each of 3-4 meals throughout the day while working to lose the excess body fat.
    • These recommendations assume you do not have any medical contraindications that would make consuming this much protein harmful (ie, chronic kidney disease).
    • Additionally, if all of your protein will come from plant sources then aiming for the higher side of the recommendations will potentially optimize results, though this is not necessary to make steady progress.(Kerksick, 2021)
  • Fat intake should be at least 20% of your daily calories; if you go under this occasionally that is ok but you should not go under this chronically. Polyunsaturated fatty acids and monounsaturated fatty acids should be prioritized. Saturated fatty acids should be <10% of your daily intake. Trans fatty acids should be avoided (particularly from industrial sources).
  • Several servings each of fruits, vegetables, and whole grains should be included in your daily nutrition. Additional carbohydrates can come from refined grains if needed, particularly if you are doing a lot of exercise and need to consume more carbohydrates for energy.
  • You should aim for at least 14 grams of fiber for every 1,000 calories you consume; however if you are consuming 30-40 grams of fiber you do not need to go above this if it will cause gastrointestinal distress or prove difficult.
  • If you are engaging in a heavy training load then consider taking a multivitamin daily.

Fluid replacement

  • Different people sweat at different rates. To determine how much you sweat, weigh yourself naked prior to exercising, then again after exercising (after drying yourself off).
    • The difference added to the amount of liquid you consumed during the session will equal how much fluid you lost in sweat (assuming you did not use bathroom between your initial and final weight).
    • Then in the future you can plan to drink that amount for that time frame to help ensure you do not become dehydrated.
    • Example: if you weigh 150.0 pounds before a session starts, you drink 240 milliliters (~8 ounces, this equals 0.5 pounds) during the session, and after the session you weigh 149.0 pounds, then:
      • 150 (starting weight) – 149.0 (final weight) = 1.0 (difference in weight)
      • 1.0 (difference in weight) + 0.5 (fluid consumed) = 1.5
      • Thus, you lost 1.5 pounds of sweat.
      • In the future instead of aiming to drink 8 ounces you can aim to drink 24 ounces.
  • Additionally, as people lose sodium in sweat you may want to ingest 300-600 milligrams of sodium per hour of exercise.

Peri-workout nutrition

  • Eating carbohydrates alone prior to exercise may cause premature fatigue towards the end of a session. If so, consider consuming carbohydrates with a source of protein (if this does not cause gastrointestinal distress) or periodically consuming carbohydrates during longer training sessions.
  • Drinking liquids with calories or eating during a training session is unlikely to be helpful if your training session is <60 minutes in duration.
  • However, for sessions >60 minutes, consider drinking a solution with glucose and electrolytes in it.
  • Additionally, for high intensity sessions >90 minutes, consider consuming 30-60 grams of carbohydrates per hour in an electrolyte solution.
  • If you are going to workout twice in one day, consume fast digesting carbohydrates right after the first workout to help resynthesize glycogen for the second workout. This is more important if the two sessions are within 8 hours of each other. You may need to consume ~1 gram of carbohydrate per kilogram of body weight per hour to maximize glycogen resynthesis in the first few hours (~0.45 g/lb of body weight).
  • If you are eating high quality protein spaced throughout the day (ie, 20-30 grams in 4 meals or 30-40 grams in 3 meals) then the benefit of consuming protein directly after a workout will likely not be very significant. If your protein intake is on the lower side, or if you are only eating protein in 2 meals daily, then it will likely be more helpful to consume protein directly after a workout. There is no need to consume carbohydrates directly after a workout unless you are purposefully trying to replenish glycogen stores as quickly as possible.

Specifically regarding aerobic training, recommendations were recently summarized in the following figure.(Rothschild, 2020) “Starting muscle glycogen” refers to if you are beginning in a state of glycogen depletion, normal levels, or maximal levels, which will depend on activity over the last 8 hours or so as well as whether you are typically in a caloric deficit and/or following a low carbohydrate diet. In the figure “g” = grams.

Reproduced from: Rothschild JA, Kilding AE, Plews DJ. What Should I Eat before Exercise? Pre-Exercise Nutrition and the Response to Endurance Exercise: Current Prospective and Future Directions. Nutrients. 2020 Nov 12;12(11):3473. doi: 10.3390/nu12113473. PMID: 33198277; PMCID: PMC7696145.

Note: Recently ketogenic diets have become more popular, and while they can be helpful for appetite suppression, they are generally not ideal for exercise performance. There is some indication they may be helpful for fat free mass retention when losing weight in endurance athletes, which is good, but they can hinder endurance performance at higher intensities.(Moreno-Villanueva, 2021) Additionally, when attempting to gain weight, it can be more difficult to build skeletal muscle mass(Vargas, 2018), and other evidence indicates there can be difficulty retaining lean body mass while losing weight unless your protein intake is elevated at ~1.7 grams per kilogram per day.(Ashtary-Larky, 2021; Coleman, 2021) Thus, for exercise-related purposes, I recommend not using a ketogenic diet.

High level sports competition

In 2021 a thorough review with up-to-date recommendations for high level sports nutrition, particularly revolving around competitions, was published and is available for free if interested. I will not discuss it in detail, but I have included two of the figures here regarding a general overview and also regarding carbohydrate consumption prior to and during an event. You can look through the document for more details regarding specific topics if curious.(Burke, 2021) an image showing recommendations for carbohydrate consumption before and during an event

Warming-up and cooling-down

I’ve spent a lot of time discussing what to do during actual exercise sessions but I haven’t actually discussed what the research suggests regarding warming-up and cooling-down. I will discuss those topics here.

Warming-up

Many studies have been conducted to evaluate the impact of warming up on a variety of different measures of performance. There is a significant amount of variability in the studies, and thus synthesizing all of the literature and determining conclusive outcomes is challenging. Nonetheless, a few review articles have attempted to do this in various ways. Of note, almost of this research pertains to athletic training literature:

  • A 2015 systematic review on the effects of static stretching found that static stretching may decrease the risk of an acute muscle injury but will also likely decrease performance to a small degree.(Behm, 2015)
  • Also in 2015 a systematic review evaluating upper body warm-up studies ultimately found that performing static stretching for <60 seconds can aid flexibility while performing high-load dynamic warm-ups can enhance performance.(McCrary, 2015)
  • A 2018 systematic review evaluating various methods of warming up for explosive efforts in team sports led to the following recommendations(Silva, 2018):
    • An initial warm-up should include 10-15 minutes of progressive intensity (~50-90% of maximum heart rate) activity and end in maximum-intensity sprints to induce a post-activation potentiation effect (this is discussed further below).
    • After this initial warm-up it is useful to wear heated garments and then do a 2 minute additional warm-up with explosive tasks if there will be a 15 minute break prior to beginning the sporting activities.
    • During a half-time session it is helpful to wear a heated garment and then perform a 5 minute warm-up prior to the second half.
  • A 2019 review on warming up for sports performance concluded that(Gil, 2019):
    • Static stretches may be helpful if performed for 10 seconds per stretch, <30 seconds per target muscle, and not at maximum intensity.
    • You can follow this with dynamic stretching for <30 seconds per stretch and <7 minutes total duration.
    • It is important to try to keep the muscles warm.
  • In a 2019 review the authors concluded the more recent literature suggests that short duration (<60 seconds) static stretching as part of a full warm-up routine will have at most a small detrimental impact on performance while it may aid flexibility and decrease the risk of injury.(Chaabene, 2019)

More recently, a 2021 systematic review compiled the literature looking specifically at the acute impact of various warm-up protocols on resistance training.(Ribeiro, 2021)

  • The research indicates there is typically no significant benefit to adding a general warm-up (ie, using the elliptical for 5 minutes) to a specific warm-up (ie, doing specific warm-up sets)
    • One exception is if a general warm-up is needed to raise your body temperature.
  • There was a benefit seen to doing either a high load with a low velocity or a low load with a high velocity for the warm-up sets, with a post-activation potentiation effect seen when doing higher load sets prior to the working sets.
    • Post-activation potentiation refers to the phenomenon that when performing a near maximal load on a rep as quickly as possible, after a couple of minutes of rest there is a performance benefit for explosive movements using a lighter load. This can also occur with lighter movements done explosively.
      • This is thought to be due to changes in neuromuscular activation as well as calcium content within the muscle after the heavier loaded movement is performed.
      • This can be useful for athletic performances and various competitions but has little relevance for training for general health.

Cooling down

Many studies have also evaluated different methods of cooling down after performing various athletic activities. This body of literature was recently reviewed, and collectively indicates(Van Hooren, 2018):

  • Acute studies:
    • An active cool-down does not seem to help:
      • delayed onset muscular soreness (“DOMS”) or perceived muscular stiffness
      • the removal of lactate from muscle tissue
      • indicators of muscle damage
      • recovery of neuromuscular function or contractile properties
      • a return of various hormones to baseline levels
    • An active cool-down does seem to:
      • accelerate the removal of lactate from blood and the return of blood pH to normal
        • however, this quickens the process by <2 hours
      • diminish the decrease in immune cells that occurs with exercise
        • this potential benefit only lasts for 2 hours
      • lead to a faster return of the cardiovascular and respiratory systems to normal
        • however, it is not clear if this helps with post-exercise fainting or other cardiovascular complications
      • help subjective markers of recovery for many people
        • additionally, many people perceive a benefit to cooling down, though it’s unclear if this is due to a placebo effect
    • Chronic studies:
      • an active cool-down does not seem to help injury rates
      • an active cool-down does seem to benefit the anaerobic lactate threshold, though it’s possible this is due to extra training volume that occurs when regularly including a cool-down
      • NSAIDs, cold water immersion, and antioxidants all seem to attenuate adaptations – these thus have negative effects
      • Static stretching does not reduce DOMS though foam rolling can (foam rolling can additionally help with perceived stiffness and range of motion the next day)

Other reviews do find that some post-workout protocols can help alleviate DOMS but this does not seem to contribute to recovery of performance and in some cases (ie, cold water immersion) may attenuate adaptations.(Dupuy, 2018; Fares, 2021; Nahon, 2021; Petersen, 2021) Thus, you can consider using various methods to aid recovery if you feel this improves your quality of life, aids consistency with your workouts, allows you to perform better if you train or exercise several times in one day, or simply feels good, but there does not seem to be any significant advantage when doing so regarding long-term performance benefits.

Summary and recommendations

More research is needed to better determine ideal warm-up and cool-down protocols, if ideal protocols even exist. Nonetheless, I recommend:

  • Perform a general full body warm-up as needed to bring up your core temperature if the environment is on the chilly side.
  • Static and dynamic stretching are not necessary, though if you have the time and would like to perform them you can do both. I would keep static stretching holds to <30 seconds and perform dynamic stretching movements after the static stretching. You can just focus on the key muscles/joints you will be using. If you are doing a full body workout, you can stretch everything or prioritize any muscles you feel are tight or stiff.
  • For aerobic training workouts:
    • Warming-up:
      • No warm-up is needed for light-intensity sessions.
      • For higher-intensity sessions I would warm-up with light-intensity activity for at least 1-2 minutes and then gradually increase the intensity until you are at your desired intensity level. This may take 5 minutes in total.
    • Cooling-down:
      • For light-intensity and higher-intensity sessions I would decrease the intensity to the lowest setting possible (on an elliptical, exercise bike, or equivalent) or keep moving slowly (ie, slowly jog or walk if you were previously jogging) until your heart rate and breathing rate noticeably come down. This should only take 1-2 minutes.
        • The research above indicates it’s not clear this will help post-exercise fainting but the research also doesn’t definitively state it will not and anecdotally as some people do faint shortly after stopping more vigorous activity, including a 1-2 minute cool down to potentially prevent this is worth considering.
  • For resistance training workouts:
    • Warming-up:
      • I would just warm-up with the actual lifts you are planning to do. Examples:
        • Starting with a medium rep set: if you plan to lift 100 pounds for your first set to 10 reps or so, you can do 45×10, 75×10, 95×3, and then start with 100 pounds.
          • You can experiment with doing 120 x 1 prior to the first set of 100 pounds to obtain a post-activation potentiation effect. This is optional.
        • Starting with a low rep set: if you plan to lift 100 pounds for your first set to 3 reps or so, you can do 45×10, 65×3, 80×2, 90×1, and then do your first set with 100 pounds.
    • Cooling-down:
      • There is no need to perform any type of cool-down after resistance training if you follow a reasonable program; certain active recovery protocols (ie, many light reps) may help decrease DOMS but with a well-designed program DOMS should be minimal.
  • For resistance training followed by aerobic training workouts:
    • In this case your body is already fairly warmed-up. Thus, even if you are doing high-intensity aerobic activity you should be able to gradually increase the intensity from low to high over 2 minutes.
    • The considerations for cooling-down are the same as those described for aerobic training workouts above.
  • For aerobic training followed by resistance training workouts:
    • As discussed in Lesson 8 this may be less optimal than performing resistance training first.
    • You can warm-up and cool-down similarly to how you would for distinct aerobic training and resistance training sessions as described above.

Athletic/conditioning/mobility exercises

There are a number of exercises that I have not discussed in this course. This course was primarily dedicated to health promotion, and thus I did not place a strong emphasis on competitive events (ie, running a marathon, competing in a powerlifting contest, etc) or specifically training for athletics. However, training for general athleticism can certainly be health-promoting as well. Almost all of the exercises I listed in Lessons 9-12 were options for specific muscle groups or movement patterns. These can fit nicely into the workout programs discussed in Lessons 13 and 14. However, there are several exercises that do not fit well into those specific categories.

Here I will highlight some of these additional exercises that do not fit neatly into the prior lessons. First I will list exercises that must be performed in an explosive manner (as quickly as possible) to be practical. This is ideal for increasing power production and overall athleticism. I will then list a handful of exercises useful for mobility and general conditioning. Lastly, I will briefly discuss how these can be incorporated into the prior training programs.

Note: You do not need to perform any of these exercises. I am including these for further information if desired.

Explosive lifts

  • Snatch – the bar goes from the ground to overhead in one fluid movement, the bar is “caught” overhead with the arms fully extended
  • Power snatch – “power” versions mean the lifter stays above parallel when squatting down to catch the weight, otherwise this is similar to the snatch
  • Hang power snatch – “hang” means you start from a standing position as opposed to the bar beginning on the floor, you can dip down prior to the explosive movement upward, otherwise this is similar to the snatch
  • Block snatch pull – “block” means the bar starts in an elevated position (typically on blocks in a weightlifting gym), otherwise this is similar to the snatch
  • Dumbbell power snatch – this is an easier version of the lift than the barbell variations
  • Clean and jerk – the bar goes from the ground to your shoulders in one fluid movement (this is the clean), then you stand up fully, then from a standing position you dip down and explosively jerk the barbell upward such that you are able to fully extended your arms to catch the barbell at the top in one fluid movement (contrast this to the push press below)
  • Hang clean pull – start from a hang position and explode the bar upward as high as possible without rotating your arms underneath to catch the barbell
  • Below knee hang clean pull – start from a hang position and dip down prior to performing the hang clean pull
  • Dumbbell hang power clean and jerk – this is an easier version of the lift than the barbell variations
  • Hang jump shrug – you essentially perform a weighted jump while shrugging upwards, you can perform this with dumbbells
  • Push press – this is similar to a standing shoulder press with additional leg drive, the difference between this and a jerk is with the push press you are actively pushing the bar upwards with your arms throughout the movement while with the jerk you are actually pushing your body underneath the bar while the bar is still moving upwards such that when the bar stops moving upwards you catch it with your arms at full extension

General tips for technique and safety:

Many of these are complex movements that take a lot of practice, typically with good coaching, to master. There are lots of tutorials on YouTube; click here for a good channel – the top two links are guides for the clean and the snatch. However, the easiest versions from a technical perspective that work different movement patterns are likely the hang clean pull and the push press.

Hang clean pull:

  • Think of this like a vertical jump but you are putting all of your force into the barbell to move it upward.
  • Start slightly bent over the bar and then explode upward by extending your hips, knees, and toes while also shrugging your shoulders upward at the top.
  • You can choose whether or not to pull the bar upwards with your arms.
  • You can choose whether or not to dip downward at the start prior to exploding upward.

Push press:

  • You can start in a similar position to a standing shoulder press, squat down slightly similar to when you perform a vertical jump, and use leg drive to push the bar as high off your shoulders as you can. At the same time push upward on the bar with your arms. Then attempt to bring the bar back down to your shoulders in control.
  • Alternatively, if you have the mobility to use a clean grip such that you start with your hands on the bar similar to the video above, then you can do this instead. This will force you to initiate the movement solely with leg drive prior to your hands catching the the bar on the way up and engaging your shoulders and triceps to complete the press.

Mobility exercises

  • Overhead squat  – many people lack the mobility to perform this, consider starting with a broomstick and progressing to an empty barbell, this may be easier if you elevate your heels
  • Sots press – similar to overhead squats some will lack the shoulder mobility to perform this, if this causes any pain then you likely should not perform this exercise, start with a broomstick if possible before progressing to an empty barbell
  • Dumbbell windmill – do these slowly to maintain full control of the weight
  • Turkish get-up – here you start lying on the ground with the weight extended in one arm and progress to a standing position without bending your arm, this can also be done with a dumbbell, start with the lightest weight and make sure there is space around you in case you lose your balance and need to drop the dumbbell or kettlebell

General tips for technique and safety:

  • The technique for these lifts is fairly self-explanatory.
  • There are safety concerns if you lose balance with the overhead squats or Sots presses; ideally you will be in a safety rack of some sort so if you lose balance and drop the bar it will land on the rack instead of your body.
  • It’s very important to start with light weight with these exercises. Many people will not be able to perform them.
  • If you attempt these exercises and cannot perform them, try to identify what aspect of your flexibility or mobility is limiting you. Then you can specifically work on this.
  • In general, doing exercises that push you to the limit of your mobility is a good method to increase your mobility, but you need to do this sensibly. Until you can perform these with consistent, good technique, you should keep the weight light and the reps slow. If you develop any pain when attempting these exercises then either take a break from them and work more on flexibility and mobility by stretching the relevant body parts & joint positions or give up on these specific exercises.
  • You can progressively overload these exercises if desired but the main point is to be able to develop the ability to do them easily. Once you can perform them easily with light weight you will get some benefit from going heavier but not to the same degree as developing the ability to do them in the first place.

Conditioning exercises

  • Kettlebell swing – this can also be done with a dumbbell of with a loaded backpack or duffel bag, when doing these you should focus on moving the weight by extending your hips (as opposed to raising your arms), these should be done explosively
  • Farmer’s walk – if you have heavy enough dumbbells or kettlebells this is an excellent exercise to work on core strength, grip strength, and conditioning; simply walk as far as possible until you can no longer hold the weights
  • Dumbbell thruster – for a general warm-up without cardio equipment this will be an easy way to raise your heart rate, use light weight on this and focus on conditioning rather than trying to focus on strength development with this exercise

General tips for technique and safety:

  • There are no significant safety concerns with these exercises as long as you do not hit yourself with a dumbbell when doing the thrusters and make sure to not drop a weight on your feet when doing Farmer’s walks.

Plyometric exercises

There are a large variety of different types of plyometric exercises, both for the upper and lower body. Click here for a list of several different types. I will not go through specific ones in detail. The general goal of these exercise is to minimize the ground (or implement) contact time. This helps to train the stretch reflex and will aid your overall agility/quickness/speed/power/athleticism. Notice in that list that they are listed from lower- to higher-intensity; it is very important to start with lower-intensity options and slowly build up to higher-intensity. I recommend not performing any high-intensity plyometrics until you have been engaging in resistance training for several months; this will help ensure you have enough muscular strength and conditioning to be able to handle higher-intensity plyometric exercises with minimal injury risk.

The key when performing these is to move through each rep as quickly as possible while maintaining good control of your body.

How to include these exercises in your exercise program

Explosive lifts:

  • These are good exercises to use for power development.
  • Thus, keep the weight light enough that you can move the weight pretty fast; there is no need to max out on these lifts.
    • You can max out if you want to but I recommend you do not do this unless you are confident you have developed good technique.
    • You can get the power benefits without mastering the technique since the weight will be light enough to help prevent technical errors from proving too problematic. Nonetheless, if you identify technique flaws you should strive to correct these.
  • In general when working on power development lower rep sets are key so you can keep the speed of each rep high. I would consider doing 3-5 sets of 3-5 reps for each exercise you want to include. Since the weight is light you will not need to rest very long between sets.
  • You can include these exercises on any workout day (ie, a full body day, an upper body day, a lower body day, etc). In general I advise performing these at the beginning of your workout when you are fresh. Then you will not have any fatigue that limits your explosiveness and this can prove to be a good general warm-up for the remainder of your lifting.
  • You can perform these movements 1-3 days a week (2 sessions is likely superior to 1).
  • You do not need to add weight each session. Simply add weight when you believe you can do so without the rep speed becoming noticeably slower. The primary goal here is to lift a decent amount of weight very quickly (recall the force-velocity curve from Lesson 1 that showed what allows for optimal power); going heavier and having to slow down the rep speed defeats the purpose.

Mobility exercises:

  • These can be done as part of a general warm-up or after a training session.
  • If you want to become proficient with these then it is important to include these with high frequency. For example, if you want to improve with overhead squats then performing one set every workout is a good idea. A high training frequency is key for improving mobility and maintaining any results you obtain.
  • When you can perform these lifts easily and consistently with light weight, then you can gradually start increasing the weight. Keep the progression slow; if you are close to the limit of your mobility with light weight then going too heavy too quickly will increase the risk of an injury.
  • Again, the goal here is not to lift a massive amount of weight, rather it is to work on general balance and mobility.
  • You can mix in higher rep sets with lower rep sets (lower reps when you are using weight that is challenging, higher reps when the weight is relatively light). In general though I favor lower rep sets for these (ie, 3-5 reps) as it will be a lot easier to focus on maintaining good technique for 3-5 reps than ≥10.
    • An exception would be if using an empty bar is challenging in the 3-5 rep range. Then keep using an empty bar until you can perform at least 12 reps or so prior to increasing the weight.

Conditoning exercises:

  • The dumbbell thrusters are a good warm-up exercise. You can also do them in place of some of the aerobic training you would otherwise perform if desired.
  • Kettlebell swings are a great exercise for conditioning and working on hip extension.
    • If you have a heavy enough kettlebell where you struggle to perform these for 10-15 good reps, then you can actually use these to increase lower body power. Unlike the explosive lifts above, while this is explosive, this particular lift uses the stretch reflex very significantly. Given this and the very short durtion of the concentric portion of each rep (assuming you are doing them explosively), I would keep the rep range to ≥10. You can perform 2-3 sets prior to the more standard lifting sets.
    • If you do not have a heavy enough kettlebell where this is challenging after only a handful of reps, then you can still use this for general conditioning. This can be a good warm-up exercise or done in place of some of the aerobic training.
  • Farmer’s walks are ideally done with heavy dumbbells or kettlebells such that you will not be able to hold onto them for a very long time.
    • If you have access to heavy enough options where it is challenging to hold them for >60 seconds then you can perform 1-3 sets where you hold onto them and walk as far as possible.
      • If you only have lighter options available then you can consider wrapping a washcloth or hand towel around the handles to make them thicker (this makes it harder to hold on).
        • Alternatively you can perform 1 long set of >60 seconds duration.
    • People typically do these at the end of a lifting session as it will be harder to grip things well after doing this.
    • As long as you are allowed to drop the weights and it is safe to do so you can perform Farmer’s walks to failure. Otherwise set the weight down slowly just before you would otherwise drop it.

Plyometric exercises:

  • Start with low-intensity options and stay at low intensity for several weeks prior to progressing. Take several weeks each time you increase the intensity and do not use high-intensity options until you have been training for at least several months; I advise waiting until linear progression begins to slow down prior to performing high-intensity options.
  • In general for lower-intensity options I would consider performing 2-3 sets of 5-10 reps per exercise. For higher-intensity options I would consider 3-5 sets of 3-5 reps per exercise.
  • It is likely best to do these when fresh prior to heavy lifting. You can do plyometric exercises 1-3 days a week (2 is likely better than 1).
  • Regarding the lower body, consider starting with 30-60 foot contacts weekly and progress to 100-200 foot contacts weekly.
    • If you work up to including 5 exercises with 3 sets of 5 reps on 2 days a week, then this comes to 5*3*5*2 = 150 foot contacts a week.
  • In general there is no need to overload the plyometric exercises with additional weight, but if you get to the point where you can perform the high intensity options regularly without issue and you would like to add weight, consider doing so in light increments and stop doing so if the speed of the reps or the transition period between the eccentric and concentric phases noticeably slow down.

Individual variability in responses to exercise programs

Throughout this entire course I have attempted to provide an evidence-based framework upon which to construct an exercise program. I have cited many systematic reviews and meta-analyses to indicate what combination of training parameters seem to work best. However, it is critically important to understand that a meta-analysis does not indicate what is best for every individual person. A systematic review and meta-analysis is constructed as follows:

  1. Generate a research question with specific criteria (ie, studies of at least 2 months duration) and perform a search to find all studies that meet these criteria.
  2. Glance or read through all of the studies to determine if they meet the specific criteria and provide sufficient data to address the research question.
  3. Convert all of the results of each study into a similar metric (ie, standard mean difference between a control and intervention group). Of note, each study’s result represents an average of all of the individual participants of the study.
  4. Combine all of the results, generally in a weighted average with larger studies carrying more weight.
  5. Determine if this weighted average result is statistically significant and publish the result.

Thus, almost all meta-analyses represent an “average of averages”. This does not in any way capture the individual variability between two individuals. Yet, there is significant research suggesting that individual variability does exist in the response to different exercise programs:

  • One recent analysis found that baseline gene expression differences strongly predicted the overall hypertrophy response to a resistance training program among elderly participants.(Lavin, 2021)
  • Differences have also been seen with cardiometabolic outcomes, though the individual variability to resistance training seemed relatively small compared to the natural fluctuation in cardiometabolic markers over time.(Ahtiainen, 2020)
  • Within an individual person there can be differences between hypertrophy and strength outcomes with higher or lower training frequencies.(Damas, 2019) In this study using leg extensions some subjects had better results with:
    • high frequency for both hypertrophy and strength
    • low frequency for both hypertrophy and strength
    • high frequency for hypertrophy and low frequency for strength
    • low frequency for hypertrophy and high frequency for strength
  • A brief editorial highlighted individual variability seen in response to aerobic training, noting that it seems people who do not respond well may need higher training volumes and/or intensity of training to observe an increased benefit.(Tanaka, 2018)
  • A systematic review and meta-analysis evaluating underlying genes of phenotypic differences with exercise interventions found that these genes explained 10% of differences in power outcomes, 44% of differences in aerobic outcomes, and 72% of differences in strength outcomes.(Chung, 2021)
  • As discussed in the nutrition and weight management course on this site, there are variable compensatory mechanisms the body undergoes when trying to lose weight with caloric restriction. This also extends to exercise in general.(Drenowatz, 2016; Verboven, 2021)

At this point the underlying molecular mechanisms governing these differences in responses are not well understood. Some hypotheses regarding hypertrophy are shown in this figure:

An image showing some of the hypoethical molecular underpinnings of variable repsonses to resistance training
Reproduced from: Joanisse S, Lim C, McKendry J, Mcleod JC, Stokes T, Phillips SM. Recent advances in understanding resistance exercise training-induced skeletal muscle hypertrophy in humans. F1000Res. 2020 Feb 24;9:F1000 Faculty Rev-141. doi: 10.12688/f1000research.21588.1. PMID: 32148775; PMCID: PMC7043134.

However, there are a large amount of training variables and potential influencing factors that impact the internal load your body experiences with training.(Gronwald, 2020) This “internal load” describes the actual physiologic impact the exercise session provides. Two people may run the same pace but one may be at 90% of their maximum heart rate while the other is at 80%; this would yield different internal loads. One person may run at 80% of their maximum heart rate on two separate occasions but the RPE may differ depending on their acute nutritional state; this would also yield different internal loads. Using an autoregulated approach helps to account for this with resistance training, but as discussed previously everyone cannot apply this equally well.

Many studies are not able to account for all of these variables to help ensure the actual internal load experienced by the participants is consistent between individuals. Until we can do that effectively it is unclear to what degree individual variability can be attributed to underlying genetic differences compared to other factors within one’s control. For example, a recent MA of resistance training trials in people aged 60 years and older found inter-individual variability in response to programs was not actually present, rather it seems other factors causing variability (ie, random variation or nutrition/sleep differences) accounted for varying responses.(Kelley, 2023)

Additionally, much of this literature does not properly consider the inherent variability within a control group.(Bonafiglia, 2022) We need to develop a better understanding of the underlying factors outside of one’s control that govern individual variability and test performance while developing practical testing to determine where along a spectrum of these factors any given person falls. Only then will be in a place to prescribe optimized individual exercise programs with an anticipated range of results. Until then, trial and error to find what works best for any given individual is key.

Importantly, when people who do not respond well to a protocol and then utilize a different protocol, they frequently do respond much better.(Pickering, 2019) This is true for both resistance training and aerobic training and generally occurs with an increase in the exercise stimulus (by increasing frequency, intensity, duration, volume, or some other relevant metric).(Bell, 2022; Bonafiglia, 2022; Reuter, 2023) Thus, it’s likely that very few people, if any, are true non-responders to exercise. Rather, some people may just have more difficulty finding a suitable program, or may need to perform a higher volume or intensity of work to see significant benefits.

Tip: Not everyone is destined to become a world-class athlete, but that does not mean exercise is pointless! There are tons of health benefits from performing exercise regardless if you are a higher or lower responder to an exercise program. Importantly, since many people respond differently to different training parameters, if you go through a period of training where you do not seem to obtain many results this is not a reason to give up. Rather, this is why it is very important to track your workouts; you can look through your training history and continue to incorporate the parameters that have typically worked better for you in the past.

A key takeaway here is that there is not an “optimal” exercise program given the variability in responses between individuals. It is more ideal to:

  • develop some sort of plan meeting general guidelines you can stick to and will work with your schedule
  • stick to the plan for at least 1-2 months
  • track progress objectively
  • make adjustments accordingly, which may include altering:
    • resistance training volume, frequency, rep ranges, rep tempo, exercise selection, proximity to failure, etc
    • aerobic training duration, modality, ratio of moderate-intensity to higher-intensity aerobic training, etc
    • increasing caloric intake
    • optimizing sleep and decreasing overall stress levels

Ultimately, it is very important to track progress as objectively as possible. That way you will be able to identify when progress stalls and will know when to make adjustments. Over longer periods of time you will learn what training parameters allow you to make better progress and can tailor your own exercise program accordingly.

Conclusion

In this lesson I have gone over a variety of miscellaneous topics that can be pertinent in various situations. I’ve discussed:

  • considerations when you have to scale back the training due to time constraints or injury
  • specific programming characteristics for pediatric, elderly, and pregnant populations
  • nutrition to help optimize physical performance and overall results
  • what to do when warming-up and cooling-down
  • how to incorporate various athletic, conditioning, and mobility exercises
  • considerations of individual variability in response to an exercise program

You are now done with all of the lessons in this exercise course and should have a good understanding of how to generate and perform an effective exercise program.

Click here to proceed to the conclusion of this course

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