Paradigm Shift For Exercise

Discussion in 'Chit Chat' started by Brass, Sep 4, 2012.

  1. Brass


    I don't know anything about this guy, but the material seems interesting enough.


    by M. Doug McGuff, M.D.

    For the past three decades the medical community has largely recommended aerobic exercise to patients as a means of improving their health. This emphasis on steady-state activity was largely based on the work of Kenneth Cooper, M.D. and a multitude of studies showing positive cardiovascular outcomes when performing aerobic exercise. Running, Jogging, and aerobic dance became national fads. Thirty years later, many of us are finding that the exercise rage that we helped create may have done more to destroy America's knees than it did to save America's hearts.

    We must understand that aerobics is a word made up to describe a particular exercise philosophy. The word aerobic describes the subsegment of metabolism that involves the Krebs cycle and respiratory chain, which requires oxygen to function. During low level physical exertion, energy demands are met primarily by this metabolic pathway. At higher levels of exertion, other metabolic pathways predominate. The research that has been performed in the past has operated on the assumption that exercising to produce aerobic metabolic adaptations is most desirable. Measuring how aerobic a particular exercise is largely determined through V02max testing (maximal oxygen uptake). When exercise showed improvement in cardiovascular outcomes the link between aerobic metabolic conditioning and cardiovascular health was established. It then became a forgone conclusion that exercise that did not rely predominantly on the aerobic metabolic system would have no effect on cardiovascular health. Thirty years later, the literature is suggesting that we were wrong.

    The Best Kind of Exercise

    A review of the more recent literature seems to suggest that resistance training may be the best way to train the cardiovascular system. If you think about it, this makes sense. The only way we can get at the cardiac or vascular system is by performing mechanical work with the muscles. It only makes sense that the higher the intensity and quality of the muscular work, the greater will be the effect on those systems that must support the muscular work. If you think of exercise in biological terms, you will note that exercise is simply an irritative stimulus which acts upon the body (an organism); if the stimulus intensity is high enough, and the organism has the resources available (nutrition, rest) it will produce an adaptive response. By raising the stimulus intensity we can produce a more pronounced and well-preserved adaptive response.

    How do we know that resistance training produces a strong cardiovascular effect? Most of us have been told that high muscular tension increases peripheral vascular resistance and traps venous blood, which inhibits venous return. These supposed effects act to decrease cardiac output (or so we were told). If you think about it, these arguments make little sense. Venous return is largely dependent on muscle contraction to move blood centrally. Forceful muscle contractions should enhance, not inhibit cardiac return. Furthermore, the release of catecholamines during intense exercise causes gut vasoconstriction, but stimulates vasodilatation in the muscles, the net effect of which should be to decrease peripheral resistance. Decreased peripheral resistance combined with enhanced venous return should enhance cardiac output. Increased end-diastolic pressure should enhance coronary artery perfusion, making permissible meaningful exercise to even those with coronary artery narrowing. The argument seems logical, but until recently it has not been measured directly. An article from the June 1999 issue of the American Journal of Cardiology actually used right heart catheterization to measure hemodynamic changes during high intensity leg press exercise in patients with stable congestive heart failure. The measurements taken noted significant increases in heart rate, mean arterial blood pressure, diastolic pulmonary artery pressure and cardiac index. Furthermore, there was a significant decrease in peripheral vascular resistance, an increased cardiac work index and left ventricular stroke work index, suggesting enhanced left ventricular function.(1).

    The profound effect of resistance training on the cardiovascular system might make one worry that the demands are too great and resistance training may actually be dangerous to those with know or lurking cardiovascular disease. A review of the literature shows that we need not worry too much. A recent article in the March-April Journal of Cardiopulmonary Rehabilitation examined circuit weight training at varying levels of intensity in patients with CAD. They actually noted a lower rate-pressure product when compared to treadmill walking and no subject displayed any ST-segment depression or angina during circuit weight training.(2). This parallels my experience training patients with known CAD. Despite training these subjects at very high intensity, taking every set to muscular failure, we have never had a subject experience angina. This is even true for subjects who have angina climbing steps or walking uphill. I believe that the augmented venous return improves coronary perfusion and permits a more meaningful level of exertion in these patients. Resistance training has even been shown to be safe early after myocardial infarction (again, I believe for similar reasons). An article from the March-April Journal of Cardiopulmonary Rehabilitation looked at resistance training as early as 6 weeks post MI and compared it to more traditional aerobic-based rehab protocols. Amazingly, they noted "...30 of 42 subjects had one or more cardiovascular complication (arrhythmia, angina, ischemia, hypertension, hypotension) during the aerobic exercises as compared to only 1 subject with complications during resistive exercises". (3). Furthermore, it appears that we need not worry too much about the blood pressure response from resistance training. A meta-analysis from the March issue of Hypertension concluded that "progressive resistive exercise is efficacious for reducing resting systolic and diastolic blood pressure in adults." (4). Another article confirms that resistance training does not exacerbate exercise blood pressure. (5).

    Peripheral Effects
    Despite its profound effects on the cardiovascular system resistance training still has its major impacts through peripheral adaptations, mainly in terms of increased muscle strength. We have all told our patients that just performing activities of daily life (walking, taking the stairs, yard work) can preserve our cardiovascular health. Unfortunately, the age-related loss of muscle (sarcopenia) can undermine our ability to carry out those activities. Resistance training can prevent and even reverse sarcopenia.(6). Furthermore, as a muscle becomes stronger, fewer motor units will have to be recruited to perform a given task, thus reducing the demand on the cardiovascular system. Clearly, the best kind of exercise is the kind that will tax the musculature the most, this will create a powerful cardiovascular stimulus, while producing hemodynamic changes that minimize the risk of cardiac ischemia and also produce the most profound peripheral changes in the form of muscle strengthening.

    The Best Resistance Training
    The best resistance training would be high intensity but of low force so that the beneficial effects can be obtained without the risk of injury. Heightened intensity would also be helpful because the duration of the workout could be shortened and the recovery interval between sessions prolonged. A brief and infrequent exercise protocol would go a long way toward improving long-term compliance with an exercise program...
  2. Brass



    At my facility we use the SuperSlow™ protocol which involves lifting the resistance over a 10 second time span and lowering the resistance over a 10 second time span. The very slow lifting speed provides two beneficial effects. First, by moving so slowly the weight cannot get moving under its own momentum and this enhances muscular loading and intensifies the exercise. Secondly, the slow movement eliminates acceleration. Since force=mass x acceleration, we can greatly reduce the amount of force that the exercising subject will encounter. The SuperSlow™ protocol was originally devised for use with osteoporosis patients.(7). The protocol is so effective at raising intensity that we find workouts of about 12 minutes to be optimal and a recovery interval of 7 days to be optimal for most subjects. We have been able to double subjects strength in about 12-20 weeks. Recent research performed by Dr. Wayne Wescott compared the SuperSlow™ protocol to standard repetition speed resistance training and noted a 50% better strength gain in the SuperSlow™ group.(8). The researchers were so astounded that they later repeated the study and were able to reproduce the results.(9).

    So, it appears that exercise will make a paradigm shift in the new millennium. Aerobic exercise will fall into the background while resistance training takes center stage. If you want more information on these changes, consult your medline ( or feel free to contact me.

    1. Meyer, K. et al. Hemodynamic responses during leg press exercise in patients with chronic congestive heart failure. Am J Cardiol 1999 Jun1;83(11):1537-43.
    2. Degroot DW, et al. Circuit weight training in cardiac patients: determining optimal workloads for safety and energy expenditure. J Cardiopulm Rehabil. Mar-Apr;18(2):145-52.
    3. Daub WD, et al. Strength training early after myocardial infarction. J Cardiopulm Rehabil. 1996 Mar-Apr;16(2):100-8.
    4. Kelley GA, Kelley KS. Progressive resistance exercise and resting blood pressure: A meta-analysis of randomized controlled trials. Hypertension. 2000 Mar;35(3):838-43.
    5. Harris KA, Holly RG. Physiological response to circuit weight training in borderline hypertensive subjects. Med Sci Sports Exerc 1987 Jun;19(3):246-52.
    6. Rogers MA, Evans WJ. Changes in skeletal muscle with aging: effects of exercise training. Exerc Sport Sci Rev 1993;21:65-102.
    7. Hutchins, K. 1992. SuperSlow: The Ultimate Exercise Protocol. Media Support/SuperSlow Systems. Casselberry, Florida.
    8. Wescott, W. Exercise Speed and Strength Development. American Fitness Quarterly 13(3):20-21.
    9. Wescott, W. et al. Effects of regular and slow speed training on muscle strength. Master Trainer 9(4): 14-17.


    M. Doug McGuff, MD is a graduate of the University of Texas Medical School at San Antonio. Dr. McGuff completed his emergency medicine residency at the University of Arkansas for Medical Sciences where he served as Cheif Resident. Dr. McGuff is currently a partner in Blue Ridge Emergency Physicians, P.A. in Seneca, South Carolina. Dr. McGuff also owns Ultimate Exercise, a licensed SuperSlow(tm) facility that provides one-on-one exercise instruction in a clinically controlled environment.
  3. Brass


    Regarding the SuperSlow™ stuff:

    Superslow strength training: Does it work?
    Is superslow strength training more effective than regular strength training?

    from Edward R. Laskowski, M.D.
    Research hasn't shown superslow strength training to be superior to other forms of strength training. Still, superslow strength training is a reasonable tool if you want to vary your strength training routine.

    Superslow strength training is a strength training technique in which you lift and lower a weight more slowly than usual — about 10 seconds to lift the weight and another 10 seconds to lower the weight. The goal of superslow strength training is to limit momentum. This forces your muscles to work harder to lift the weight.

    Superslow strength training may help prevent boredom in your strength training routine while you challenge your muscles in a new and different way. If you try superslow strength training, start with a familiar strength training exercise and a weight that tires your muscles by 12 to 15 repetitions — which might be less weight than you usually use. As with any type of strength training, remember the importance of good form and proper technique.
  4. Eight


    12 minutes once a week? I like what I'm reading...
  5. thats no exercise routine thats my wife's sex life lol
  6. Brass


    Weight training is good for the heart and for the waistline

    Royal Oak, MI - Mild-to-moderate resistance training modifies cardiovascular risk factors and improves cardiac function and should become a part of the regular exercise and fitness regimen of not only healthy individuals but men with low-risk cardiovascular disease, according to an American Heart Association (AHA) Science Advisory appearing in the February 22, 2000 issue of Circulation [1]. The advisory dispels the myth that weight training is somehow bad for the heart, a long-held misconception, Dr Barry Franklin (William Beaumont Hospital) told heartwire.

    The AHA commissioned an expert panel of researchers to examine the role that resistance training plays in people with and without heart disease. The panel assessed weight training from three perspectives: rationale and benefits, safety, and prescription, and came up with several conclusions.


    Weight training lowers cholesterol levels, slightly decreases blood pressure (BP), reduces body weight and fat stores, and improves glucose metabolism and insulin sensitivity. And, in contrast to what many doctors tell their patients, regular weight training, over a period of months, improves cardiac function by reducing heart rate and BP responses during lifting of heavy loads.

    "Weight training makes the heart more efficient. Because the muscles are stronger, any given load now represents a lower percentage of one's maximum capacity. As a result, you have a lower heart rate, and lower blood pressure, and since those are the two primary factors that determine demands on the heart, you have lower cardiac demands. Stronger muscles translate into less effort to lift any given load," Franklin said.


    While the benefits of aerobic exercise have been touted for years, both in terms of cardiovascular fitness and weight management, it turns out that weight training also helps trim the waistline. It does this by maintaining or increasing lean body mass, something that aerobic exercise does not do. "The greater the lean body mass, the more calories burned over a 24-hour period. If we can maintain or enhance lean body mass as we age, that will increase basal metabolic rate, and thus have a favorable effect on reduction of body and fat stores long term," Franklin said.

    Results from weight training appear very rapidly. While it can take 3 to 6 months to experience a 20% improvement in aerobic fitness, the same duration of resistance training will achieve a 25 to 100% increase in muscle strength and endurance.


    Although the benefits of weight training are considerable for all individuals, seniors may stand to benefit the most from pumping iron. The AHA panel noted that weight training is extremely beneficial for older persons, (over the age of 70) because it promotes functional independence. It also increases bone density, an extremely important factor in the fight against osteoporosis.

    "The Framingham, Massachusetts study on heart disease showed that the average woman over the age of 65 cannot lift a 10-pound plate with one arm. So it goes to show how important weight training is, especially for older women, in terms of keeping them self-sufficient," noted Franklin.

    Weight training has been documented by a number of studies to be safe in healthy adults and in low-risk cardiac patients. The AHA advisory identifies low-risk cardiac patients as people who may have had MI, angioplasty or bypass surgery, but who have sustained minimal damage, with no ongoing angina or worrisome ventricular arrhythmias, no heart failure, and no uncontrolled hypertension. "We at Beaumont have been using weight training for over a decade with selected cardiac patients, with zero complications," Franklin emphasized.

    American Heart Association weighs in on pumping iron

    New York, NY - Pumping iron for 2 or 3 days a week strengthens the most important muscle of all - the heart, according to an American Heart Association (AHA) Science Advisory reported on March 21, 2000 in both the New York Times and the Washington Post. The advisory, appearing in the February 22, 2000 issue of Circulation, reported findings from a panel of cardiovascular experts selected by the heart association, reported the Times: "The panelists reviewed the results of experiments done by other researchers to see how lifting weights affected people with cardiovascular disease. The panel found that weight lifting could be beneficial to some patients who had had heart attacks."

    The panel concluded that weight training did not cause complications in healthy adults or people with minor damage to their hearts, the Times reported: "But the results were unclear for moderate or high-risk heart patients. For instance, the researchers did not recommend lifting weights if patients had unstable angina, uncontrolled high blood pressure, uncontrolled arrhythmia, or were suffering from heart failure." The AHA also recommended that cardiac patients with low-to-moderate risks first participate in aerobic exercise programs for at least 2 to 4 weeks.

    For men with what the advisory terms "low-risk cardiovascular disease," an appropriately prescribed and supervised weight training program can be particularly beneficial, "since many cardiac patients lack the physical strength and/or self-confidence to perform common activities of daily living," the Post reported. "For other groups of cardiac patients - including women and people with more severe disease - the AHA experts caution that more research is needed to determine the safety and effectiveness of resistance exercise."

    The researchers found that resistance training for 3 to 6 months could improve muscular strength and endurance in men and women by 25% to 100%, depending on the workout and the person's initial level of strength, the Times reported: "Conventional weight-training guidelines have suggested that surgical and heart attack patients avoid weight training for 4 to 6 months, but the panel wrote that many patients could perform low-weight activity equivalent to carrying up to 30 pounds, as early as 3 weeks after an acute heart attack." Mark L Fuerst


    There are still unanswered questions, however, over the safety of weight training for women, older patients with low aerobic fitness, and patients with severe LV dysfunction. The AHA advisory does not rule these groups out; it just says they may require more careful evaluation and initial monitoring. Women are on the list because there have been few, if any, randomized controlled trials about safety and efficacy of weight training in this population.

    Contraindications to weight training include unstable angina, uncontrolled hypertension (defined as systolic blood pressure >160 mm Hg and/or diastolic BP >100 mm Hg), uncontrolled dysrhythmias, recent history of congestive heart failure that has not been evaluated and effectively treated, severe stenotic or regurgitant valvular disease, and hypertrophic cardiomyopathy. "Those people shouldn't be pumping heavy iron," Franklin warned.


    Finally, people don't need to spend their lives at the gym, Franklin said. The AHA science advisory's prescription calls for a single set of 8 to 15 repetitions, using 8 to 10 different exercises, 2 to 3 days a week.

    "This recommendation does not hold for professional football and basketball players and elite athletes. This is for the average 45- or 50-year old, or 60-year-old who comes to you and asks to start a weight training program, who doesn't have all kinds of time, and who wants the most cost-effective prescription. This is it."


    A study in the March 1, 2000 issue of Hypertension [2] offers additional evidence in support of the AHA Science Advisory. A meta-analysis of 11 randomized controlled trials on the effects of weight training on resting systolic and diastolic BP found a 2% reduction in systolic BP and a 4% reduction in diastolic in individuals who regularly did progressive resistance training.

    "While such small reductions may do little in reducing cardiovascular disease morbidity and mortality, it has been shown that small reductions similar to these have resulted in a decreased risk for stroke and coronary heart disease. More importantly, it does not appear that progressive resistance exercise raises resting blood pressure," Drs George Kelley (Northern Illinois University) and Kristi Kelley write.

    "Site-specific exercise like weight training is important for everybody, but I'm biased in that it may be even more important for older populations, because we believe that a lot of the changes that are occurring in us as we age is the result of being inactive, not necessarily the aging process," George Kelley said in a heartwire interview. "We should make weight training part of our general fitness regimen, like brushing our teeth."

    Fran Lowry

    Cited sources

    1. Pollock ML, et al. Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription. Circulation 2000;101:828-833

    2. Kelley GA, Kelly KS. Progressive resistance exercise and resting blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2000;35:838
  7. Brass


    On volume:

    Number of Sets for Muscular Hypertrophy
    For muscle hypertrophy, 2-3 sets per exercise were more effective than 1 set, but there was no significant difference between 2-3 sets per exercise and 4-6 sets per exercise.

    Krieger JW (2010). Single vs. multiple sets of resistance exercise for muscle hypertrophy: a meta-analysis. J Strength Cond Res. 24(4):1150-9.


    Strength Dose-Response Curve

    Trained participants experience maximal strength gains training each muscle group 2 days per week with an average training intensity of 80% of their 1 RM, or approximately 8 RM. Four sets performed per muscle group elicited the most gains in both trained and untrained. Interestingly, only marginal benefits where observed between 2 and 4 sets per muscle group in trained individuals.

    Rhea warns their dose-response curves represent mean training levels and should not be construed as supporting training at a particular volume or intensity on a constant basis. Instead, effective programs should incorporate varied training doses (volume, frequency, and/or intensity) [particularly for trained individuals].


    Untrained participants (less than 1 year of consistent training) experience maximal strength gains with an average training intensity of 60% of their 1 RM or approximately a 12 RM, training each muscle group 3 days per week. Novices weight training 2 times per week may make approximately 80% of the strength gains as compared to training 3 times per week.

    Rhea et al (2003) suggested caution when prescribing multiple-set programs to those who have not been training consistently for at least 1 year. Adequate time is required to become accustomed to the stress of resistance exercise and avoid over-stress injuries in the early phases of training. Novice trainees may also lack the desire to commit to a training program requiring the additional time needed to perform multiple sets and thus reduce adherence to the exercise regimen.

    Braith RW, Graves JE, Pollock ML, Leggett SL, Carpenter DM, Colvin AB (1989). Comparison of 2 vs 3 days/week of variable resistance training during 10- and 18-week programs. Int J Sports Med. 10(6):450-4.

    Rhea MR, Alvar BA, Burkett LN, Ball SD (2003). A meta-analysis to determine the dose response for strength development. Med Sci Sports Exerc. 35(3):456-64.


    Single versus Multiple Sets
    Hass et. al. compared one and three sets in long-term recreational weightlifters and found no significant difference in strength and muscular development.

    Hass CJ, Garzarella L, de Hoyos D, Pollock ML (2000). Single versus multiple sets in long-term recreational weightlifters. Med Sci Sports Exerc. 32(1):235-42.

    Rhea et. al. also compared one and three sets in recreationally trained individuals for the Bench Press and Leg Press. A statistically significant difference in strength gains was found favoring 3 sets in the leg press (p < 0.05, effect size [ES] = 6.5). However, only a small but statistically insignificant difference in strength gain was found for the bench press (p = 0.07, ES = 2.3).

    Rhea MR, Alvar BA, Ball SD, Burkett LN (2002). 16(4):525-9. Three sets of weight training superior to 1 set with equal intensity for eliciting strength. J Strength Cond Res.

    Schlumberger found greater strength gains in women performing 3 sets versus a single set. Both training groups made significant strength improvements in leg extension (multiple-set group, 15%; single-set group, 6%; p 0.05). However, in the seated bench press only the 3-set group showed a significant increase in maximal strength (10%).

    Schlumberger A, Stec J, Schmidtbleicher D (2001). Single- vs. multiple-set strength training in women. J Strength Cond Res.15(3):284-9.

    Single-set programs for an initial short training period in untrained individuals result in similar strength gains as multiple-set programs. As progression occurs multiple-set programs were more effective.

    Wolfe BL, LeMura LM, Cole PJ (2004). Quantitative analysis of single- vs. multiple-set programs in resistance training. J Strength Cond Res.18(1):35-47.


    Rest Between Sets
    Ahtiainen et. al. compared 2 to 5 minute rest periods in previously strength-trained men. No significant difference in acute hormonal and neuromuscular responses or long-term training adaptations in muscle strength and mass were found.

    Ahtiainen JP, Pakarinen A, Alen M, Kraemer WJ, Häkkinen K (2005). Short vs. long rest period between the sets in hypertrophic resistance training: influence on muscle strength, size, and hormonal adaptations in trained men. J Strength Cond Res.19(3):572-82.

    3 minute rests between sets of bench press allowed for more repetition to be performed than rests of 2 or 1 minute.

    Willardson JM, Burkett LN (2006). The effect of rest interval length on bench press performance with heavy vs. light loads. J Strength Cond Res. 20(2):396-9.

    Squat strength gains were not significantly different between 2 minutes versus 4 minutes rest between sets.

    Willardson JM, Burkett LN (2008). The effect of different rest intervals between sets on volume components and strength gains. J Strength Cond Res. 22(1):146-52.


    Active Recovery
    Light activity between sets can improve recovery. In a study conducted at University of Kansas, subjects completed six sets of squats (85% 10RM) with 4 minute rest periods between sets. Rest periods consisted of either sitting quietly (passive recovery) or cycling at 25% or 50% of VO2max (active recovery). Blood lactate was significantly lower when cycling at 25% of VO2max compared to the other two types of rest periods. Following the initial workout, the 25% VO2 recovery group continued to perform more repetitions to exhaustion (65% if 10RM) compared to the other two recovery groups. Also see Dodd (1984).

    Corder K, Potteiger J , Nau K, Figoni S, Hershberger S (1998). Effects of active and passive recovery on lactate, RPE, and performance during resistance training. Medicine and Science in Sports and Exercise, 30(5), Supplement abstract 194.

    Corder KP, Potteiger JA, Nau KL, Figoni SE, Hershberger SL (2000). Effects of active and passive recovery conditions on blood lactate, rating of perceived exertion, and performance during resistance exercise. Journal of Strength and Conditioning Research, 14: 151-156.


    Varying Workloads
    Making workload alterations (8RM, 6RM, 4RM) every workout was more effective in eliciting strength gains than doing so every 4 weeks.

    Rhea MR, Ball SD, Phillips WT, Burkett LN (2002). A comparison of linear and daily undulating periodized programs with equated volume and intensity for strength. J Strength Cond Res. 16(2):250-5.

    Hunter et. al. compared variable resistant training (once-weekly training at 80%, 65%, and 50% 1RM) versus training 3 times a week at 80% 1RM in men and women over the age of 60. After 6 months both groups made similar strength and lean body mass gains. However the variable resistant training group reported lower perceived exertion during a carrying task.

    Hunter GR, Wetzstein CJ, McLafferty CL Jr, Zuckerman PA, Landers KA, Bamman MM (2001). High-resistance versus variable-resistance training in older adults. Med Sci Sports Exerc. 33(10):1759-64.
  8. Brass


  9. Interesting info. Good stuff.

    As far as the slow mo workouts, I saw that in magazines years ago. I always viewed it as just something to add variation once in awhile. I never thought of it as some kind of new best method.
    #10     Sep 7, 2012