Medical-Fitness Technician
Certification Course
Part D: Medical-Fitness Training (LM:35-38)
Certification Course
Part D: Medical-Fitness Training (LM:35-38)
Learning Module 38:
Strength Training
Strength Training
Study the Learning Module and take the Quiz.
Leraning Objectives
- Know how to do and instruct the 4 Strength Training Exercises.
- Understand the relationship between intensity and duration regarding timed rep counts.
- Know how to apply the Strength Training Protocol.
- Know how to log and track Strength Training Sessions.
- Understand the wide variability of Strength Training Goals.
Introduction
A set of muscle-specific strength training exercises should be part of every daily exercise routine. Strength training exercises are mainly used to condition the muscles for greater strength and endurance (stamina), but strength training exercises also help condition the bones and joints, and if done in a series (circuit training) during which the heart rate is adequately elevated and maintained, the exercises also serve to help condition the heart, lungs, and blood vessels.
Exercises to develop muscle strength and endurance are considered more anaerobic than aerobic, but both fuel systems are involved in the production of ATP for the working muscles. Higher intensity exercises use higher proportions of ATP supplied through anaerobic pathways, and therefore can not be sustained for more than 1-2 minutes between recovery times.
Strength training exercises are specific functional body movements involving a variety of muscle groups. These exercises utilize the "overload principle" to develop and condition the muscles. Overloading a muscle is accomplished by forcing it to do a greater amount of work than it is accustomed to doing, but without overdoing it. This limited and targeted demand on the muscles stimulates physiological adaptations resulting in muscle development and conditioning, as well as general improvements in health and fitness.
Overloaded muscles can not sustain continually repeated contractions for more than 1 to 2 minutes, depending on the type, size, condition, and function of the muscle, as well as the amount that it is overloaded and the speed at which it is demanded to work. Therefore, the intensity of these anaerobic strength training exercises is higher and the duration is shorter than aerobic exercises.
One of the primary goals of Medical-Fitness Training is to achieve and maintain an optimal level of Functional Muscular Capacity. The ideal strength training exercises for conditioning muscles for both strength and endurance are calisthenics, which use the individual's body weight as the resistance to different muscle contractions.
Calisthenics also provide the health and training benefits of:
For most individuals, functional capacity of muscle groups is best developed by frequently overloading the specific muscles for a short duration, but with appropriately-adjusted high intensity.
Exercises to develop muscle strength and endurance are considered more anaerobic than aerobic, but both fuel systems are involved in the production of ATP for the working muscles. Higher intensity exercises use higher proportions of ATP supplied through anaerobic pathways, and therefore can not be sustained for more than 1-2 minutes between recovery times.
Strength training exercises are specific functional body movements involving a variety of muscle groups. These exercises utilize the "overload principle" to develop and condition the muscles. Overloading a muscle is accomplished by forcing it to do a greater amount of work than it is accustomed to doing, but without overdoing it. This limited and targeted demand on the muscles stimulates physiological adaptations resulting in muscle development and conditioning, as well as general improvements in health and fitness.
Overloaded muscles can not sustain continually repeated contractions for more than 1 to 2 minutes, depending on the type, size, condition, and function of the muscle, as well as the amount that it is overloaded and the speed at which it is demanded to work. Therefore, the intensity of these anaerobic strength training exercises is higher and the duration is shorter than aerobic exercises.
One of the primary goals of Medical-Fitness Training is to achieve and maintain an optimal level of Functional Muscular Capacity. The ideal strength training exercises for conditioning muscles for both strength and endurance are calisthenics, which use the individual's body weight as the resistance to different muscle contractions.
Calisthenics also provide the health and training benefits of:
- 1) Improving joint health and flexibility,
- 2) Not requiring special equipment, and
- 3) Measuring muscle function in relation to body weight and composition.
For most individuals, functional capacity of muscle groups is best developed by frequently overloading the specific muscles for a short duration, but with appropriately-adjusted high intensity.
Review the 4 Strength Training Exercises used in Medical-Fitness Training:
1) Squats, 2) Leg-Raises, 3) Push-Ups, 4) Inverted Rows
1) Squats, 2) Leg-Raises, 3) Push-Ups, 4) Inverted Rows
1. Timed Rep Counts & Fitness Levels
Functional Muscular Capacity progression in Medical-Fitness Training is demonstrated by increasing repetitions (reps) of full muscular contraction for a standardized movement in a set period of time. In other words, with higher levels of fitness more work can be accomplished in the same amount of time.
Functional Muscular Capacity progression in Medical-Fitness Training is demonstrated by increasing repetitions (reps) of full muscular contraction for a standardized movement in a set period of time. In other words, with higher levels of fitness more work can be accomplished in the same amount of time.
2. Obesity Precaution
If a person's fitness level as scored by their Medical-Fitness Assessment is extremely low (< 20%) due to being obese, they should limit their Medical-Fitness Training to walking as described in the previous Learning Module (37). Strength Training is much less productive for weight-loss purposes for individuals that are stage 2 & 3 obese (BMI > 35). Also, obese individuals are much more injury-prone when participating in calisthenic exercises.
Specific strength training exercises can be added to an obese person's Aerobic Fitness Training Program as soon as they lose enough fat weight (BMI < 35) and score 20% or higher on the Calisthenic Movement Chart shown above.
Certified Medical-Fitness Technicians should refer their obese clients to a certified Medical-Nutrition Technician or Therapeutic Lifestyle Coach to help their client achieve a threshold weight-loss goal before engaging in strength training using calisthenic exercises. Working as a team for the client using both nutrition and fitness modalities helps ensure both quicker results and longer-term success.
If a person's fitness level as scored by their Medical-Fitness Assessment is extremely low (< 20%) due to being obese, they should limit their Medical-Fitness Training to walking as described in the previous Learning Module (37). Strength Training is much less productive for weight-loss purposes for individuals that are stage 2 & 3 obese (BMI > 35). Also, obese individuals are much more injury-prone when participating in calisthenic exercises.
Specific strength training exercises can be added to an obese person's Aerobic Fitness Training Program as soon as they lose enough fat weight (BMI < 35) and score 20% or higher on the Calisthenic Movement Chart shown above.
Certified Medical-Fitness Technicians should refer their obese clients to a certified Medical-Nutrition Technician or Therapeutic Lifestyle Coach to help their client achieve a threshold weight-loss goal before engaging in strength training using calisthenic exercises. Working as a team for the client using both nutrition and fitness modalities helps ensure both quicker results and longer-term success.
3. Anaerobic Training Protocol
Follow the instructions below to develop your Strength Training Program:
Follow the instructions below for each Strength Training exercise:
Follow the instructions below to develop your Strength Training Program:
- Be prepared to do the Strength Training exercises immediately after each 10-minute Aerobic Training session.
- The exercise order is: Squats (2min), Leg-Raises (1min), Push-Ups (30sec), and Inverted Rows (30sec).
- Use the Timer feature of your smartphone’s clock to set the following timers for each exercise:
- Set and save a timer of 2:02 minutes for the Squat exercise.
- Set and save a timer of 1:02 minutes for the Leg-Raise exercise.
- Set and save a timer of 0:32 seconds for both the Push-Up exercise and the Inverted Row exercise.
- The additional 2 seconds are to transition into position from starting the timer to starting the exercise.
Follow the instructions below for each Strength Training exercise:
- Do a brief dynamic warm-up before each exercise (i.e., a few slow reps of the specific exercise).
- When you are ready, start the Timer and immediately get into position for the exercise.
- Do as many repetitions of the exercise as possible until the timer sounds.
- Pace your movements so that you can continue throughout the full exercise time with minimal breaks to rest your muscles.
- Try to maintain an exercise intensity that results in muscle fatigue, as well as increased heart and respiration rates, by the end of the timed exercise.
- After the exercise, while you are still recovering, immediately start preparing for the next exercise in the series.
- As soon as you have "caught your breath" (within 30-60 seconds), start the next exercise.
- Log your Strength Training sessions using the form linked below.
Points to remember as you start training:
- During the first few weeks, you will probably have more time for the exercise than you have muscle strength and endurance.
- Try not to "break form." Always use proper technique while performing each repetition. This is for both proper muscle development and prevention of muscle or joint injury.
- Concentrate on the form of your movement more than the speed of your movement, especially during the first few days or until you have developed "neuromuscular coordination" for the movement.
- Neuromuscular Coordination (aka: “motor control” or “muscle memory”) is the ability of the nervous system to efficiently recruit a muscle or a group of muscles in order to perform a specific movement or complex task unconsciously.
- If your muscles start to "burn," you may want to pause for a moment and "shake it off," but resume as soon as possible. This may help reduce DOMS (Delayed Onset Muscle Soreness).
- As your fitness improves, you will be able to cruise through each exercise at faster speeds for higher rep counts, and any delayed onset muscle soreness that you may experience during the first few weeks should subside dramatically.
- You should be able to recover from each exercise very quickly, but take the time you need. As you get more fit, your recovery times between exercises will shorten.
- For added training benefits, do NOT let your heart and respiration rate return completely to normal before continuing with the next exercise. Each exercise focuses on different muscle groups, so you should be able to do your strength training exercises consecutively. This will extend the aerobic training benefits from 10 minutes to a full 15 minutes (50% increase) per session, while squeezing in a significant amount of strength training exercises for a high-efficiency work-out.
- If the series of Strength Training exercises is not convenient for you to do following a 10-minute Aerobic session, you may do multiple rounds of the Strength Training exercises separately or after a different Aerobic Training session on the same day.
Logging Instructions:
- Print a Strength Training Log sheet for every 4 weeks of training.
- Write your Name and the START Date for the next 4 weeks of log entries.
- Column 1 is the Week # of your continuous Strength Training Program.
- Column 2 is the Day of each week: Sn (Sun), M (Mon), T (Tues), W (Wed), Th (Thurs), F (Fri), St (Sat)
- Record the Reps of each Exercise for each Session every Day.
- The "a" Column under each Session is for the number of Squat reps for that Session.
- The "b" Column under each Session is for the number of Leg-Raise reps for that Session.
- The "c" Column under each Session is for the number of Push-Up reps for that Session.
- The "d" Column under each Session is for the number of Inverted Row reps for that Session.
- Add and Record the Total Reps of each Exercise for each Day.
- The "A" Column under Daily Totals is for the total number of Squat reps for that Day.
- The "B" Column under Daily Totals is for the total number of Leg-Raise reps for that Day.
- The "C" Column under Daily Totals is for the total number of Push-Up reps for that Day.
- The "D" Column under Daily Totals is for the total number of Inverted Row reps for that Day.
- Weekly Totals are for adding the daily Total Reps of each Exercise for all the Days of that Week.
- 4-Week Totals are for adding the weekly Total Reps of each Exercise for the previous 4 Weeks.
- Be sure to indicate if a Session was NOT done, so you will know it was not logged accordingly.
- You may want to indicate the reasons for missed Sessions and missed Days (dentist, travel, sick, etc.)
- Be sure to indicate which day is your REST Day. (You may want to note your recreational activity for that day.)
- Progression Summary is a brief statement that describes your improvement in Functional Muscular Capacity over the 4 weeks and from start-to-current or from current-to-goal.
4. Muscle Conditioning
Conditioning: Muscle conditioning occurs independent of hypertrophy (increasing muscle size). Conditioning improves muscle functionality by developing muscle density and tone and increasing muscle strength and endurance.
Agonists are the primary muscles involved in the power-phase of each strength training exercise by a concentric (shortening) contraction. The agonist muscles are also actively involved during the reverse movement by an eccentric (lengthening) contraction as the body moves back to its starting position in a controlled manner. This would be the downward movement of the squat, leg-raise, push-up, and inverted row. Both types of contraction are important for proper muscle conditioning.
The muscles that the strength training exercises mainly target are listed below:
Squats - Leg Extension
Leg-Raises - Thigh & Trunk Flexion
Push-Ups - Arm Extension
Inverted Rows - Arm Flexion
Conditioning: Muscle conditioning occurs independent of hypertrophy (increasing muscle size). Conditioning improves muscle functionality by developing muscle density and tone and increasing muscle strength and endurance.
Agonists are the primary muscles involved in the power-phase of each strength training exercise by a concentric (shortening) contraction. The agonist muscles are also actively involved during the reverse movement by an eccentric (lengthening) contraction as the body moves back to its starting position in a controlled manner. This would be the downward movement of the squat, leg-raise, push-up, and inverted row. Both types of contraction are important for proper muscle conditioning.
The muscles that the strength training exercises mainly target are listed below:
Squats - Leg Extension
- Gluteus Maximus, Medius, and Minimus (buttocks) - thigh extension
- Quadriceps Femoris (front of the thigh) - lower-leg extension (and thigh extension by Rectus Femoris)
Leg-Raises - Thigh & Trunk Flexion
- Iliopsoas (Iliacus, Psoas Major & Minor) (anterior hip) - thigh flexion
- Rectus Abdominis (anterior abdomen) - trunk flexion
Push-Ups - Arm Extension
- Pectoralis Major & Minor (anterior chest) - arm extension
- Triceps Brachii (posterior arm) - arm and forearm extension
- Anterior Deltoid (anterior shoulder) - arm extension
- Abdominals (anterior and lateral trunk) - stabilizes the trunk in the plank position
Inverted Rows - Arm Flexion
- Latissimus Dorsi (upper back and side of trunk) - arm flexion
- Biceps Brachii (anterior arm) - arm and forearm flexion
- Trapezius & Rhomboids (upper back) - stabilizes the trunk and shoulders in the suspended position)
Synergists are additional muscles involved in each movement which serve as body and joint stabilizers and assist in the coordination of the movement and the balance of the body.
Antagonists are muscles that are opposite to each agonist muscle that are intentional relaxed by neuron signals to stretch and allow the movement to be done with minimal local tissue resistance.
Hypertrophy: Muscular hypertrophy refers to an increase in muscle mass. This usually manifests as an increase in both muscle size and strength. Muscle hypertrophy occurs as a result of strength training such as weight lifting, including body weight calisthenics. However, the rate and degree of hypertrophy is highly variable depending on the muscle type, nutritional status, sleep pattern and quality, and various hormone levels, especially testosterone. Also, the size of one muscle does not necessarily correspond proportionally to the strength of that muscle as compared to other muscles of the same person or the same muscle of other persons.
5. DOMS – Delayed Onset Muscle Soreness
DOMS is that uncomfortable (but also strangely satisfying) "sting" that you get in your muscles 1-3 days after a more intense training session than usual. It can range from being mildly noticeable to so severe that you have difficulty moving the effected body parts for the next few days, generally peaking on day 2.
Despite much research into this phenomenon, DOMS is still a mystery. The exact cause or mechanism for the symptoms is not known. There are several theories that attempt to explain the pain. These include; the build-up of lactic acid in the muscles following exercise, muscle damage, connective tissue damage, muscle spasm, inflammation, and enzyme activity, or perhaps a combination of them all. Some people report experiencing DOMS more severely when practicing intermittent fasting or dieting at a significant caloric deficit.
The one consistency about DOMS is that it happens following more intense and often prolonged exercise, especially when the person doing the exercise is not used to that activity or level of intensity. The severity and occurrence of DOMS decreases over time as the person becomes accustomed to their regular exercise routine, and their body has adapted in response to their training.
There is an ongoing debate in the field of medical-fitness about whether DOMS is a sign of a productive workout or just an unnecessary inconvenience and annoyance. While DOMS is certainly a sign that a workout was intense, when it comes to building muscle, there is not convincing evidence that it indicates greater results in strength, or that hypertrophy gains are sure to come.
In fact, there are some good reasons to be wary of DOMS. Some of these include:
Unfortunately, there are no reliable methods to treat or prevent DOMS, except by less intense or shortened exercise sessions, especially when involving muscle groups that have not been properly and gradually conditioned. The popular methods that are being advocated to avoid or reduce DOMS, but which have unreliable, if any, effects, include:
DOMS is that uncomfortable (but also strangely satisfying) "sting" that you get in your muscles 1-3 days after a more intense training session than usual. It can range from being mildly noticeable to so severe that you have difficulty moving the effected body parts for the next few days, generally peaking on day 2.
Despite much research into this phenomenon, DOMS is still a mystery. The exact cause or mechanism for the symptoms is not known. There are several theories that attempt to explain the pain. These include; the build-up of lactic acid in the muscles following exercise, muscle damage, connective tissue damage, muscle spasm, inflammation, and enzyme activity, or perhaps a combination of them all. Some people report experiencing DOMS more severely when practicing intermittent fasting or dieting at a significant caloric deficit.
The one consistency about DOMS is that it happens following more intense and often prolonged exercise, especially when the person doing the exercise is not used to that activity or level of intensity. The severity and occurrence of DOMS decreases over time as the person becomes accustomed to their regular exercise routine, and their body has adapted in response to their training.
There is an ongoing debate in the field of medical-fitness about whether DOMS is a sign of a productive workout or just an unnecessary inconvenience and annoyance. While DOMS is certainly a sign that a workout was intense, when it comes to building muscle, there is not convincing evidence that it indicates greater results in strength, or that hypertrophy gains are sure to come.
In fact, there are some good reasons to be wary of DOMS. Some of these include:
- Severe DOMS can completely disrupt or greatly interfere with a strict or progressive training program schedule.
- Frequent episodes of DOMS probably indicate that the intensity of the workouts are too high and should be adjusted.
- An episode of DOMS may indicate inflammation in the body due to a deficiency in nutrition and/or recovery time.
- DOMS due to excessive physiological stress from overtraining is counter-productive to health and fitness goals.
Unfortunately, there are no reliable methods to treat or prevent DOMS, except by less intense or shortened exercise sessions, especially when involving muscle groups that have not been properly and gradually conditioned. The popular methods that are being advocated to avoid or reduce DOMS, but which have unreliable, if any, effects, include:
- Massage: A 2005 study found that a 10-minute massage 3 hours after exercise reduced the severity of DOMS by 30%, but it did not significantly improve muscle recovery time or range of motion.
- Foam Rollers: A 2019 meta-analysis of pre- and/or post- foam rolling practices showed "minimal, negligible, and trivial" results at best for muscle warm-ups, muscle performance, and muscle recovery.
- Cold Water Immersion: A 2012 review found that cold water immersion might delay DOMS, and a 2016 study found that cold water immersion may have reduced DOMS the following day, but it did not have a significant overall effect on muscle soreness.
- Stretching: A 2011 review found that stretching before and after exercise resulted in very minor reductions in DOMS, ranging from half a point to 4 points on a 100-point scale.
6. Pre- and Post- Exercise Stretching
Although most health and fitness instructors and athletic trainers promote pre- and post- exercise stretching, there is insufficient uniformity of methods and application to validate the claims of benefit, especially given the considerable time investment and complexity of recommended stretching techniques. There is also a considerable amount of research showing increases in injury inducement and performance impairment, even when the stretching routines are done properly.
The often touted "known great benefits" of stretching, such as: improving posture, flexibility, and range-of-motion, and reducing risk of injury are all made without solid scientific evidence. In fact, there is evidence to the contrary. The recommendation to "save some time after your work-out to do 'some static stretches' is particularly unwarranted. Far greater benefits would be realized if stretching time was used to extend the exercise time -- not cut it short.
Dynamic Stretches are not really "stretches" at all, but rather brief muscle- and joint- specific movements identical to and immediately preceding the next exercise. This practice does seem to have "warm-up" benefits, including: circulation and motor-neuron activation and psychological preparation. Dynamic stretches are free, quick, simple, practical, and self-administered. They pose no risk of injury. They avoid any false sense of safegaurd against injury, and they avoid all pretense of performance enhancement or health benefit.
Physical Therapy: An individualized stretching program, both passive and active, by a Physical Therapist and for a documented abnormality of pain, decreased range of motion, misalignment, or sports injury rehabilitation, and having clear, measurable therapeutic parameters is the only appropriate use of "stretching" in which the investment of time and money is worth the effort. "Stretching" of muscles, tendons, ligaments, and other connective tissues, IF medically indicated, is best deferred to a trained and licensed Physical Therapist.
Although most health and fitness instructors and athletic trainers promote pre- and post- exercise stretching, there is insufficient uniformity of methods and application to validate the claims of benefit, especially given the considerable time investment and complexity of recommended stretching techniques. There is also a considerable amount of research showing increases in injury inducement and performance impairment, even when the stretching routines are done properly.
The often touted "known great benefits" of stretching, such as: improving posture, flexibility, and range-of-motion, and reducing risk of injury are all made without solid scientific evidence. In fact, there is evidence to the contrary. The recommendation to "save some time after your work-out to do 'some static stretches' is particularly unwarranted. Far greater benefits would be realized if stretching time was used to extend the exercise time -- not cut it short.
Dynamic Stretches are not really "stretches" at all, but rather brief muscle- and joint- specific movements identical to and immediately preceding the next exercise. This practice does seem to have "warm-up" benefits, including: circulation and motor-neuron activation and psychological preparation. Dynamic stretches are free, quick, simple, practical, and self-administered. They pose no risk of injury. They avoid any false sense of safegaurd against injury, and they avoid all pretense of performance enhancement or health benefit.
Physical Therapy: An individualized stretching program, both passive and active, by a Physical Therapist and for a documented abnormality of pain, decreased range of motion, misalignment, or sports injury rehabilitation, and having clear, measurable therapeutic parameters is the only appropriate use of "stretching" in which the investment of time and money is worth the effort. "Stretching" of muscles, tendons, ligaments, and other connective tissues, IF medically indicated, is best deferred to a trained and licensed Physical Therapist.
7. Strength Training Goals
Medical-Fitness Training for improving functional muscular capacity is based on the individual's Medical-Fitness Assessment and always coincides with the individual's aerobic training program, which focuses on improving cardio-pulmonary-vascular fitness to increase aerobic capacity, assist with weight management, and prevent/reverse chronic disease.
Whereas aerobic training has both health promotion and chronic disease prevention/reversal benefits, strength training is more focused on functional capacity regarding "activities of daily living" for a higher quality of life, especially into the later years. Of course, younger adults who participate in regular strength training and have developed a significant muscle capacity reserve (muscle fitness scores > 100%) have placed themselves in a much better position to enjoy a higher quality of life throughout their lifespan.
Although the Medical-Fitness Assessment uses standardized timed rep counts to determine muscle fitness levels, personal goals in this area can vary widely without significantly affecting the persons general health and longevity. The fitness scale for interpreting a person's level of fitness was developed to establish a reasonably attainable goal of 100% (or higher) for most individuals up to about age 70, provided they have also trained to achieve and maintain a healthy body weight and composition.
Medical-Fitness Training for improving functional muscular capacity is based on the individual's Medical-Fitness Assessment and always coincides with the individual's aerobic training program, which focuses on improving cardio-pulmonary-vascular fitness to increase aerobic capacity, assist with weight management, and prevent/reverse chronic disease.
Whereas aerobic training has both health promotion and chronic disease prevention/reversal benefits, strength training is more focused on functional capacity regarding "activities of daily living" for a higher quality of life, especially into the later years. Of course, younger adults who participate in regular strength training and have developed a significant muscle capacity reserve (muscle fitness scores > 100%) have placed themselves in a much better position to enjoy a higher quality of life throughout their lifespan.
Although the Medical-Fitness Assessment uses standardized timed rep counts to determine muscle fitness levels, personal goals in this area can vary widely without significantly affecting the persons general health and longevity. The fitness scale for interpreting a person's level of fitness was developed to establish a reasonably attainable goal of 100% (or higher) for most individuals up to about age 70, provided they have also trained to achieve and maintain a healthy body weight and composition.