Exercise Referral & Athletes Conditioning – Why they can be similar!
Physical Training can be defined as physical activity that places demands on the body in order to elicit a compensatory/adaptation reaction – Training Effect.
All training imposes stresses on the body that causes the body to react in order to cope with the demands imposed on it. If these stresses are too great then the body will be harmed and negative effects will occur, likewise if the stresses are too light then the body will see no reason to adapt and none or very little training response will occur. It is this balance that takes not just knowledge but experience to deliver effectively in a training program for an individual, and the stresses that can be imposed in a physical training program should have a direct negative correlation with the stresses that already exist in the individual’s day to day life.
There are many factors that need to be taken into account with an individual when programming a training regime for them. For example, recovery ability (sleep & diet), working hours, daily activity (at work, heavy labor, desk job, athletes etc), medical issues, medication (both prescribed and not), recreational activities (sports, sedentary, drinking, drugs etc). The more important the factor is to the individual and the more it causes stresses on the body day to day, the less stresses can be imposed during training without causing a negative effect. However it also has to be noted that the general physical preparedness and level that the individual is accustomed to training also is a factor in the programming of training.
There are two clear ends of this spectrum in physical training, you have a professional athlete at one end and an individual with medical problems (exercise referral client) at the other. Exercise Referral is when a client is referred by a medical professional onto a specifically designed exercise program that is usually run by local sports and fitness establishments by specially qualified fitness trainers. You would expect that a pro athlete would be in top physical condition and an exercise referral client (ERC) would struggle more with physical activity. However they both have daily factors that impact heavily on the body and it is of high importance in both cases to not cause harm to the body as this would have dramatic negative effects to either health or performance. So for this reason it is possible that a similar approach to training can be adopted for both. When I say this I am referring to the conditioning training of the athlete, not their sport specific skill training, as this is something quite separate.
Many strength and conditioning trainers will use very technical weight lifting movements with their athletes in order to try to improve strength, power, explosiveness, and speed. There are two main issues with this; some athletes would not have the skill level to perform the movement with enough force to create the desired training effect, and others may be very practiced and have a high skill level for the activities, they would also have a high level of physical preparedness, so the level that they would have to achieve to elicit a positive training effect would also be very high, and at this high level there is a greater chance of causing injury or adopting bad form, unnecessary wear and tear, and creating muscle imbalances. In comparison, standard weightlifting movements cannot usually be utilised effectively with an ERC due to the low skill level of the client they wouldn’t necessarily be able to train to a level that would cause the desired effect on the body due to the neuromuscular boundaries that would have to be over come first. This continues with both parties with the types of movements that are used, squats, bench press, chin ups, deadlifts, overhead lifts, weights rows, cleans, jerks, these are all big compound movements that are advisable in the most part for everyone, and I would actually say that they should be used with athletes in their off season to develop strength and work on specific muscle balance (with the exception of jerks as these are more of a specific movement for Olympic lifting rather than a strength movement, a standard push press would usually suffice), and also used with ERC at a low volume dependent on the medical conditions presented. However these exercises DO have a high stress level on the body so for an in-season athlete, a new to exercise person or an ERC there are better options to gain the same results. The reason for this is that most traditional weighted movements have three parts to the movement, the concentric phase, where the prime mover muscles are shortening under tension, the eccentric phase, where the prime mover muscles are lengthening under tension, and the point where the movement changes direction in between the concentric and eccentric phases. The concentric phase is usually the movement/muscle group that you are trying to train, whereas the eccentric and change phases are the ones that cause the most negative stresses on the body. The change of direction phase can be especially damaging to the joints and connective tissues and even more so the more dynamic the movement is. This said it is often dynamic weight movements like a clean and press and high rep speed sets of squats, jumps, pressups or deadlifts that are adopted by athletes for speed/power training. It is obvious that the aesthetics of the movement are being focused on, as they appear fast and powerful rather than the actual training effect of the exercise. And this concept carries over to the ERC or new exerciser as they often do not have the joint stability, muscular control or connective tissue strength to cope with such demands on the body, especially those with joint and muscular conditions this concern in emphasised.
So it is the concentric phase that we need to focus on, as it is this that can create the positive training effect that we are looking for with minimal negative effects (as I have mentioned above, for an athlete they may need more specific strength training in the off season, however I am talking in relation to the in-season conditioning). Also cyclic movements can be beneficial, these are movements that are continuous motions, most standard cardiovascular training involve cyclic movements, such as running, cycling, rowing etc, however these movements are not always ideal for the populations that we are discussing and the training effects that we are trying to elicit.
I will start with the ERC. There are many conditions that are included in the referral criteria, such as, arthritis, high blood pressure, angina, asthma, COPD, depression, diabetes, cystic fibrosis, obesity, fibromyalgia, and operation preparation and recovery. All of these conditions can be benefitted by physical activity, likewise they can be worsened by poor exercise advice and application. This is why it is of upmost importance to get the balance right. Obviously different conditions require different treatment as if is often a different training effect that is desired, however the principle is the same, minimise the negative, maximise the positive.
So I am going to focus on two conditions, arthritis and diabetes:
With arthritis the training is based on creating range of movement around the joints while at the same time minimising impact and strengthening the muscles in order to support the joints. Cyclic movements are often used to instigate the release on synovial fluid (lubricant) in the joint however it is still important to aim to increase strength, which traditional cyclic movements don’t do, and it is also important to keep the training time to a minimum as to cause a little wear and tear on the joints as possible, so it seems obvious to train both of these aspects at the same time. Exercises such as weighted sled drags, sled rows, prowler pushing (with legs & arms), and battle ropes, are all exercise that will have the desired effect of strength and movement and the intensity can be adjusted with both speed and weight with very little compromise on technique. In addition some range of movement exercise would be done on the affected areas, but these would be at are relatively low intensity and focusing on joint alignment and proper muscle activation.
With diabetes on the other hand the training is designed to have an effect on the blood sugar levels and insulin response. I must add at this point that this technique is only safe and effective on clients with type 2 diabetes that is controlled by diet or medication, but not insulin dependent type 1 clients, they would have to take other steps before getting to this point, and all clients would be required to undergo some base level cardio training prior to or alongside this technique as not to cause enlargement of the heart muscle and raise blood pressure. So again you are aiming to deplete the blood sugars in order to illicit an insulin response, it is simply trying to kick start the system into gear as it is not working properly. In order to do this the client needs to work at a reasonably high intensity for short amounts of time, but as I mentioned earlier this client is likely to have a low skill level, and low physical preparedness, so the exercises have to be as un-technical as possible to be able to perform them at a high intensity, and also an adequate amount of rest between exercises must be given in order to allow the body to recover and then work at a high enough intensity again. So again good exercise for this are sled drags, prowler pushing, battle ropes, light(ish) tyre flips, med ball slams, sledge hammers swings, and rope pulls, all weighted cyclic or concentric only movements. I would note that a sensible diet should be followed in order to have a maximum effect from this type of training. I have a client who was diagnosed with type 2 diabetes with a blood sugar reading of 13.5 (normal being less than 6.5), he trained with me using this training protocol for around 3-4months, he then had a re-test with his GP and his blood sugar levels had dropped to 6.5, he had also lost around 4-5 stone in weight, he did change his diet as well, although I would say it was still not perfect, but he did make big improvements.
So onto athletes, again I am going to use two examples that I have and some experience with; fighters (boxers/MMA) & rugby players:
So rugby players believe it or not need to be wrapped in cotton wool! This is because they experience so much trauma in their sport and in their skill training that the last thing a strength and conditioning coach wants to do is to cause further negative stresses on the body – unfortunately this is an aspect that is often overlooked and I see all sorts of damaging training being conducted by or on semi pro/pro players, such as Olympic lifting and circuits of high reps compound exercises and jumps. The training effect you are looking for is generally power, speed and/or muscular endurance, all of which can be achieved with the traditional techniques, however there is the negative impact as well, which as I already discussed is what we are trying to avoid! So again I am referring to IN-SEASON conditioning training for a rugby player, they should have developed all the strength that they are going to in the off season, so we are working now on maintenance and a bit of endurance (both physically and mentally!). Exercises that are perfect to this are prowler sprints and heavy weighted pushes, sled sprints and heavy drags, prowler ‘shot-guns’ (a push with the arms), sled rows, battle ropes, med ball slams, sledge hammer swings, tyre flips… this list looks similar doesn’t it! And that is the point, obviously the intensity, speed/weight will be higher than with the ERC’s, and the training effect that you are looking for is different, so application will differ too, but the considerations are the same, so you have concentric strength movements and cyclic conditioning movements.
Fighters are slightly different in the aspect that they are weight class competitors, so it is essential that their strength and conditioning does not have a negative effect on the weight of the athlete. There has been a longstanding misconception that lifting weight makes fighters slow, so there are many that don’t do much if any to assist their sport. There is a small bit of truth in this however it has been blown way out of context and proportion. If you train to be slow you will be slow, so if you lift weights controlled and slow then yes this could slow you down, for example, if you lift a weight that is heavy and you are lifting it as fast as you can then you are training your speed or acceleration through the movement, the addition of chains/bands are a great way of utilising this concept, however that is not really the point, just that it IS possible to weight train and not become slow, as long as you do it right, it can even increase your speed! So that is more the strength aspect of training. As far as conditioning goes this is where it is more important for fighters, this is because they often mix their skill training with training for conditioning, for example sparring in a fatigued state or pad work when fatigued, the coaches say that they have to do this so that they can practice the state of being in a fight, however I don’t think this works, for one they will be detraining their technique because as they tire their technique will drop off, they are then detraining their technique, this is obviously bad! Secondly it does not replicate a fight situation because in a fight there are other factors such as adrenalin that will be playing a big part that you don’t get in training. So what do they need to do about it? Simple really, separate the skill and the conditioning training, fighters need to be able to produce powerful movements repetitively (especially MMA where ground fighting is involved), this type of conditioning can be done by again using battle ropes, sledge hammers, med balls, sleds and prowlers, these would usually be done relatively light and fast and with very little rest for the duration of the session, again they are directly working on the muscular endurance of the athlete without compromising speed, weight gain, or technique.
So you can see that similar exercise can be utilised in different ways to elicit different training responses, but all with the underlying consideration of minimising the unnecessary stresses on the body, and as I mentioned at the beginning, the greater the existing/day to day stresses, medical conditions, contact sports etc, the more consideration needs to be given into the minimising of stresses during the strength and conditioning training. This does not mean that we don’t take these things into consideration for ALL clients, just that it is more imperative for some than others.
I would also like to add that this is just one aspect of the training for any population, on an individual basis there are many other aspects that may need to be covered, however for the consideration of limiting stresses, in my opinion, this is the most effective and versatile way to achieve a range of training effects for most populations.