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Tag: periodized resistance exercise

  • Strength Training and Intermittent Claudication

    Strength training increases walking tolerance in intermittent claudication patients: randomized trial. J Vasc Surg. 2010 Jan;51(1):89-95.  Ritti-Dias RM, Wolosker N, de Moraes Forjaz CL, Carvalho CR, Cucato GG, Leão PP, de Fátima Nunes Marucci M.

    Abstract
    OBJECTIVE:
    To analyze the effects of strength training (ST) in walking capacity in patients with intermittent claudication (IC) compared with walking training (WT) effects.
    METHODS:
    Thirty patients with IC were randomized into ST and WT. Both groups trained twice a week for 12 weeks at the same rate of perceived exertion. ST consisted of three sets of 10 repetitions of whole body exercises. WT consisted of 15 bouts of 2-minute walking. Before and after the training program walking capacity, peak VO(2), VO(2) at the first stage of treadmill test, ankle brachial index, ischemic window, and knee extension strength were measured.
    RESULTS:
    ST improved initial claudication distance (358 +/- 224 vs 504 +/- 276 meters; P < .01), total walking distance (618 +/- 282 to 775 +/- 334 meters; P < .01), VO(2) at the first stage of treadmill test (9.7 +/- 2.6 vs 8.1 +/- 1.7 mL.kg(-1).minute; P < .01), ischemic window (0.81 +/- 1.16 vs 0.43 +/- 0.47 mm Hg minute meters(-1); P = .04), and knee extension strength (19 +/- 9 vs 21 +/- 8 kg and 21 +/- 9 vs 23 +/- 9; P < .01). Strength increases correlated with the increase in initial claudication distance (r = 0.64; P = .01) and with the decrease in VO(2) measured at the first stage of the treadmill test (r = -0.52; P = .04 and r = -0.55; P = .03). Adaptations following ST were similar to the ones observed after WT; however, patients reported lower pain during ST than WT (P < .01).
    CONCLUSION:
    ST improves functional limitation similarly to WT but it produces lower pain, suggesting that this type of exercise could be useful and should be considered in patients with IC.

     My comments:

    If you just read the abstract you would come away from this study with the impression that strength training is just as good as treadmill training for intermittent claudication.
    The weight training group used an 8 machine exercise protocol based working the total body 3 sets of 10 reps each which is fine enough. However both the weight training program, and the walking program (2 minutes on, 2 minutes off, for 60 minutes, attempting to get claudication the last 30 seconds of each interval), which to me sounds a bit dubious and not optimal for either. In both groups they wanted 60 minutes of total workout time, with 30 minutes of that time being rest in both groups and exercise was done 2 days per week for 12 weeks. While both groups improved neither group improved that much on a percent basis. Pain free walking distance (PFWD) improved 41% in the strength group and 37% in the treadmill group, while maximum walking distance (MWD) improved 25% in the strength group and 37% in the treadmill group. If I do the match per week and per workout improvements were as follows:

    • Strength PFWD/week = 3.4%
    • Strength MWD/week =2.1%
    • Strength PFWD/workout = 1.7%
    • Strength MWD/workout = 1.0%
    • Treadmill PFWD/week = 3.1%
    • Treadmill MWD/week = 3.1%
    • Treadmill PFWD/workout = 1.5%
    • Treadmill MWD/workout = 1.5%

    So neither the strength nor treadmill increases in walking distance were anything close to the improvements seen in either conventional walk/passive rest or walk/active rest protocols of other studies. Also I don’t think it was a great idea for the authors to try and equate effort between strength and treadmill programs and they would have done better to just use the best strength training program they could (with intensity based on repetition maximums) and compared that to the best walking program, rather than make up their own for each. Still I think it’s good that they found strength training did help improve walking distance and for patients with peripheral neuropathy who are particularly weak I think it would be an especially important part of their treatment.  Also this study noted that the strength training group had 50% less pain, which sounds great, but when you look at the specific data that meant pain during exercise was a 1.5/10 during strength training vs. 3/10 during treadmill training, which isn’t of that much practical significance.  

    Thanks for reading my blog. If you have any questions or comments (even hostile ones) please don’t hesitate to ask/share. If you’re reading one of my older blogs, perhaps unrelated to neck or back pain, and it helps you, please remember SpineFit Yoga for you or someone you know in the future.

    Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.

  • Periodized Resistance Training Works Better than Aerobic Training for Chronic Low Back Pain

    A comparison of two forms of periodized exercise rehabilitation programs in the management of chronic nonspecific low-back pain. J Strength Cond Res. 2009 Mar;23(2):513-23. Kell RT, Asmundson GJ.

    From the study:

    Abstract
    The purpose of this study was to determine the influence of 2 different periodized exercise rehabilitation programs (resistance training [RT] and aerobic training [AT]) on musculoskeletal health, body composition, pain, disability, and quality of life (QOL) in chronic (>or=3 months; >or=3 d.wk) nonspecific low-back pain (CLBP) persons. Twenty-seven CLBP subjects were randomly assigned to 1 of 3 groups, 1) RT (n = 9), 2) AT (n = 9), or 3) control (C; n = 9). Subjects were tested at baseline and at weeks 8 and 16 of training. Intensity and volume were periodized in the training groups. Significance was set at p <or= 0.05. No significant differences were noted among the groups at baseline. The RT group significantly decreased body fat percent from baseline to week 8 and from baseline to week 16, whereas the AT group significantly decreased body fat percent and body mass from baseline to week 16. The RT group significantly improved most musculoskeletal fitness, pain, disability, and QOL outcomes from baseline to week 8, baseline to week 16, and weeks 8 to 16. However, the AT group showed significant improvements in flexibility from baseline to week 8 and in cardiorespiratory and peak leg power from baseline to week 8 and baseline to week 16. The AT groups showed no significant improvements in pain, disability, or QOL. The primary finding was that periodized RT was successful at improving many fitness, pain, disability, and QOL outcome measures, whereas AT was not. This study indicates that whole-body periodized RT can be used by training and conditioning personnel in the rehabilitation of those clients suffering with CLBP.

    Chad’s comments:

    This is another great study by the same authors as my prior blog, but was published two years earler using largely the same exercise program, focusing on total body strength rather than just core stabilization. Subjects also had chronic low back pain but were a little younger, averaging 35-40 years. Rather than compare to a control group that just stayed active, the other experimental group did periodized aerobic training. As the abstract states, group that lifted weights improved their low back disability scores and decreased pain considerably more than the aerobic and control group. Reading the entire did a good job in explaining their exercise selection and helps to dispel some of the errors you continue to hear from the biopsychosocial proponents, many of whom seem to think that all activity/exercise is of equal benefit or consequence to the spine. Rather, movements matter, postures matter, fitness matters, exercise selection matters, and so does your physical therapist if they are not keeping up with the latest in rehabilitation science.

    Thanks for reading my blog. If you have any questions or comments (even hostile ones) please don’t hesitate to ask/share. If you’re reading one of my older blogs, perhaps unrelated to neck or back pain, and it helps you, please remember SpineFit Yoga for you or someone you know in the future.

    Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.