7 Principles of Exercise and Sport

Training
When you approach your multisport training, the best way to answer your questions is to better
understand the principles behind the work you are putting in to improve. These are seven basic
principles of exercise or sport training you will want to keep in mind:

Individuality
Everyone is different and responds differently to training. Some people are able to handle higher
volumes of training while others may respond better to higher intensities. This is based on a
combination of factors like genetic ability, predominance of muscle fiber types, other factors in your
life, chronological or athletic age, and mental state.

Specificity
Improving your ability in a sport is very specific. If you want to be a great pitcher, running laps will
help your overall conditioning but won’t develop your skills at throwing or the power and muscular
endurance required to throw a fastball fifty times in a game. Swimming will help improve your
aerobic endurance but won’t develop tissue resiliency and muscular endurance for your running
legs.

Progression
To reach the roof of your ability, you have to climb the first flight of stairs before you can exit the 20th
floor and stare out over the landscape. You can view this from both a technical skills standpoint as
well as from an effort/distance standpoint. In order to swim the 500 freestyle, you need to be able to
maintain your body position and breathing pattern well enough to complete the distance. In order to
swim the 500 freestyle, you also need to build your muscular endurance well enough to repeat the
necessary motions enough times to finish.

Overload
To increase strength and endurance, you need to add new resistance or time/intensity to your
efforts. This principle works in concert with progression. To run a 10-kilometer race, athletes need to
build up distance over repeated sessions in a reasonable manner in order to improve muscle
adaptation as well as improve soft tissue strength/resiliency. Any demanding exercise attempted too
soon risks injury. The same principle holds true for strength and power exercises.

Adaptation
Over time the body becomes accustomed to exercising at a given level. This adaptation results in
improved efficiency, less effort and less muscle breakdown at that level. That is why the first time
you ran two miles you were sore after, but now it’s just a warm up for your main workout. This is why
you need to change the stimulus via higher intensity or longer duration in order to continue
improvements. The same holds true for adapting to lesser amounts of exercise.

Recovery
The body cannot repair itself without rest and time to recover. Both short periods like hours between
multiple sessions in a day and longer periods like days or weeks to recover from a long season are
necessary to ensure your body does not suffer from exhaustion or overuse injuries. Motivated
athletes often neglect this. At the basic level, the more you train the more sleep your body needs,
despite the adaptations you have made to said training.

Reversibility
If you discontinue application of a particular exercise like running five miles or bench pressing 150
pounds 10 times, you will lose the ability to successfully complete that exercise. Your muscles will
atrophy and the cellular adaptations like increased capillaries (blood flow to the muscles) and
mitochondria density will reverse. You can slow this rate of loss substantially by conducting a
maintenance/reduced program of training during periods where life gets in the way, and is why just
about all sports coaches ask their athletes to stay active in the offseason.

The principles of specificity, progression, overload, adaptation, and reversibility are why practicing
frequently and consistently are so important if you want to improve your performance. Missed
sessions cannot really be made up within the context of a single season. They are lost opportunities
for improvement. Skipping your long ride on weekend A means you can’t or shouldn’t go as far as
originally planned on weekend B (progression & overload). Skipping your Monday swim means your
swimming skills and muscles won’t be honed or stressed that day (specificity). Missing a week due
to a vacation sets you back more than one week (adaptation and reversibility). Apply these principles
to your training to get a better understanding of your body and how to achieve success.

Role of Environmental Interventions in

Injury Control and Prevention
Topic:

 child
 wounds and injuries
 fire - disasters
 fire - physical phenomenon
 injury prevention
 prevention
 home modification
Issue Section:

PREVENTION
CAUSAL MODEL OF INJURIES

Injuries result from transfer of energy to a human host. In the epidemiologic model of
infectious disease, microbes are the “agents” of infection. Similarly, in the
epidemiologic model of traumatic injury, energy is the “agent” of injury (figure 1).
This model provides a good basis for understanding the role of the environment in the
causal pathway for injuries.

Transfer of energy to the host is the final step in the causal pathway for injuries, but
many factors influence the nature of this exchange and its consequences. Energy that
causes injuries can be in several forms, including kinetic, chemical, or thermal. For
example, kinetic energy causes motor-vehicle-related injuries, and thermal energy
causes burns. Lack of metabolic energy that occurs through external forces, such as
during drowning or suffocation, can also be included in the definition of injuries.
Energy can be transferred to a human host through vehicles (inanimate objects such as
motor vehicles) or vectors (animate objects such as another human). Some injuries
require both a vehicle and a vector, such as a gunshot wound that requires a firearm
and ammunition (vehicles) and someone to shoot it (vector).

The potential for energy transfer exists just about everywhere, but certain
environmental characteristics increase the potential for injury. If these characteristics
can be understood, we may be able to modify the environment to remove or reduce
energy transfer. Since humans have designed and constructed most of our
environments, it is a logical but often forgotten premise that we can modify this
environment to be safer.

The environment is a complex interaction of physical, social, economic, cultural, and

demographic features. In this article, we focus primarily on the physical environment.
Other articles in this volume of Epidemiologic Reviews address social, economic, and
cultural components of the environment. Injury prevention strategies aimed at
changing the physical environment are among the most successful injury control
interventions. However, successful interventions must always consider the entire
causal pathway; thus, the best approaches are multifaceted. This article describes
some of the reasons for the success of environmental approaches and provides some
examples that describe the many ways that the environment can be modified. We have
concentrated on the epidemiologic and public health literature, but further evidence
can be found in the engineering, policy, economic, and legal literature. Many more
environmental approaches have been implemented than have been evaluated, and we
also identify some promising areas of future impact. This article also discusses the
difficulty in conducting research evaluations of environmental modifications.

CLASSIFICATION OF THE PHYSICAL ENVIRONMENT

The physical environment, and changes within the environment, can be categorized as
natural or man-made. For example, weather-related injuries, such as those associated
with tornadoes, floods, and extreme temperatures, are related to global climate trends,
which are part of the natural environment. The roadway and buildings are examples of
the man-made environment.

Although our ability to manipulate the natural environment may be limited,

understanding the relation between the natural environment and injury risk may
suggest important avenues for intervention. Often, the man-made environment can be
modified to reduce injury risks inherent in the natural environment. For example,
persons in mobile homes are at extremely high risk of injury during tornadoes, yet
mobile homes are often found in areas frequently affected by tornadoes (1, 2).
Tornado-related deaths and injuries can thus be reduced through interventions
focusing on the natural environment, such as careful urban planning and land use
policies that consider environmental risks, and those focusing on the man-made
environment, such as improving the structures built in tornado-prone areas. However,
interventions that incorporate land use policies are rare in disaster planning.

Changes in the physical environment related to the risk of injury can be intentional or
unintentional. Many examples of intentional modifications implemented to reduce
injuries are described in this article and include changes to roadways, businesses, and
residences. Unintended changes in the environment can lead to increased or reduced
injury risk. The increasing number of sport utility vehicles on the roadway may lead
to increased injury severity and fatality rates because larger cars cause more damage
when crashing with smaller cars (3, 4). In contrast, several elements of the
socioeconomic and demographic environment contributed to reduced violent crime
rates in the late 1990s. These elements include a smaller proportion of the population
between the ages of 15 and 39 years, a group that tends to have the highest criminal
perpetration rates, and a strong economy.

HISTORY OF THE PUBLIC HEALTH APPROACH TO ENVIRONMENTAL

INTERVENTION

Dr. Hugh DeHaven first recognized the potential to modify the environment to
prevent injury (5). His early research in the 1940s examined the causal pathway for
injuries from falls and from airplane crashes (6, 7). He identified the thresholds of
injury based on the height of the fall and also recognized that the configuration of an
airplane cockpit influences the potential for injury in a crash. Researchers such as Drs.
John Stapp and William Haddon measured the human body’s tolerance for brief
exchanges of mechanical energy, such as that sustained in a motor vehicle crash, and
found that the physical environment can be modified to greatly enhance the
survivability of a crash (8).

Before this groundbreaking work, injury control research had focused on identifying
behavioral risk factors associated with the host (5, 9). Therefore, the responsibility for
injury prevention rested largely on the individual person. Dr. Haddon argued that no
matter how resilient the human host becomes, both physically and through education,
he or she will not be able to overcome injury risks inherent in the environment.
However, modifying the environment requires not only an understanding of how the
environment can be changed to reduce injury risk but also action by decision makers,
such as government officials, who can initiate large-scale change. Efforts to modify
the environment are thus multifaceted and often expensive.
Although sometimes difficult and expensive to implement, environmental
modifications have been among the most effective approaches to preventing injuries,
for two reasons. First, environmental modifications are usually passive to the persons
in the environment (10, 11). A passive intervention does not require specific activity
by the host for the intervention to work. For example, an air bag is passive; once it is
installed in the car, the driver does not need to activate it to be protected while
driving. In contrast, a seat belt is an active intervention because the driver must buckle
it to receive its protective effects.

Second, environmental modifications often protect many persons. Although changes

in the environment may be difficult to implement, all those who interact with the
changed environment will benefit from the injury-reducing modifications. For
example, changes in roadways, described in more detail later in this article, protect all
drivers.

As introduced by Dr. Haddon (5, 10) and discussed by Runyan in this volume (12),
the Haddon Matrix divides injuries into three phases: pre-event, event, and post-event.
The following sections provide examples of environmental interventions to reduce
injuries in each of these phases.

ENVIRONMENTAL STRATEGIES TO REDUCE INJURIES IN THE PRE-

EVENT PHASE

Interventions in the pre-event phase aim to prevent transfer of energy to the host. Such
primary prevention interventions can often be very effective because they protect the
host from energy exposure. They do not depend on host resilience or other factors that
can increase the potential for injury given an energy transfer. Environmental strategies
in the pre-event phase are the most promising of injury prevention approaches.

Modification of the roadway environment

The number of motor vehicle miles (1 mile = 1.61 km) traveled in the United States
increased from approximately 206 billion in 1930 to over 2,467 billion in 1996 (13)
(figure 2). In addition to this increase in exposure, factors such as increased
congestion on roadways, increasing numbers of licensed teenaged drivers, increased
alcohol consumption, increased speed capabilities of cars, and generally increased
speed limits would all seem to predict an increase in the rate of motor-vehicle-related
deaths per million miles traveled (14).

However, the fatality rate per 100 million vehicle miles traveled decreased from 16.0
in 1930 to 1.5 in 2000 (figure 2) (13). The National Highway Traffic Safety
Administration and the US Federal Highway Administration estimated that between
1966 and 1990, 243,000 lives were saved as a result of highway, traffic, and motor
vehicle safety programs (13). Although many factors contributed to the decline in
motor-vehicle-related fatality rates, one major factor has been changes in the roadway
environment.

With increased urbanization and reliance on cars came a shift from two-lane rural
roads to interstate freeways. Although vehicle volume and speed are highest on
interstates, the number of crashes per mile traveled is the lowest for all types of
roadways. This lower crash rate is largely due to road modifications mandated by the
Federal Highway Traffic Safety Act of 1966, implemented after growing concern over
traffic fatalities (14).

Safety features built into interstate roads are numerous. Divided highways separate
traffic flow in different directions, avoiding lane crossings and reducing the risk of
head-on crashes. Curves are graded to reduce the risk of cars running off the road.
Skid-resistant surfaces have been developed to reduce loss of traction while braking.
Lighted signage has been added to increase visibility and reduce distraction. On- and
off-ramps help control the integration of slow-speed with high-speed traffic. The top
half of figure 3 shows a rural roadway that has not incorporated environmental safety
features, whereas the bottom half of figure 3 shows an interstate roadway that has
been modified with the roadway improvements described above. These roadway
modifications are so effective because they protect all road users, regardless of their
level of training, risk-taking behavior, experience, or other risk-related behaviors.
Modifications to reduce violence in the workplace

Homicide is the second leading cause of traumatic death in the workplace, following
transportation-related deaths (15). Approximately 40 percent of all workplace
homicides occur in the retail industry, and these events decreased 46 percent between
1994 and 1999 (15). The majority of workplace homicides are robbery related (16).

The environmentally based approach called Crime Prevention Through Environmental

Design (CPTED) originated in the 1970s to reduce robberies and associated violence.
CPTED aims to modify the work environment to reduce vulnerability to crime,
allowing businesses direct control of the environment rather than relying on indirect
control of criminal behavior (17, 18). If robberies can be prevented, then the injuries
and deaths that occur during robberies will also be prevented.

The CPTED model identifies four elements for environmental modification: natural
surveillance, access control, territoriality, and activity support. Natural surveillance
includes internal and external lighting—and visibility into the store—and placement
of the cash register. Access control includes such factors as number of entrances, door
type and placement, and design of the internal environment to control customer
movement. Territoriality addresses the location of the store within the community,
traffic flow surrounding the store, signs and advertisements for the store, and design
issues that empower the employees over the customers (such as bulletproof barriers).
Activity support includes efforts to increase the presence of legitimate customers and
encourages both increased business and good customer behavior. Figure 4 depicts one
store environment that does not follow CPTED principles (top), which is in contrast to
a store environment that does (bottom).

Published evaluations of the CPTED approach indicate that it is successful in reducing

robberies (19). Robberies of businesses that introduced the CTPED approach
decreased 30–84 percent compared with control stores (19–21). In addition, four
studies evaluated a series of Florida ordinances that required security measures such
as limited cash in registers, increased lighting and visibility, staffing and hour
changes, and employee training (22–25). These ordinances led to robbery decreases of
12–65 percent, with only one study not observing a significant decrease. Evaluations
of the CPTED approach that examined injury and homicide as an outcome generally
found decreases in assaultive injury to employees but did not find decreases in
homicides (19, 26). The two studies examining homicides had insufficient power and
did not control for background crime rates; thus, these findings are not conclusive
(19). Other positive outcomes included reductions in monetary losses and increases in
perpetrator apprehension (19).

Although the evidence consistently shows success of this approach, the

methodological approaches used in the evaluations are weak. Most studies involved
pre- and postintervention comparisons without a control group, and many had small
sample sizes (19). Perhaps the most serious methodological concern is that most
studies did not measure compliance with the program, so a direct connection to
implementing the program cannot be made.

The CPTED approach can be applied in many settings, including hospitals, schools,
and even residences (19). However, the effectiveness of this approach has not been
evaluated outside of the retail industry. Research also suggests that the CPTED model
might be more effective if integrated with administrative and behavioral approaches.
One recent case-control study found that among a series of environmental
characteristics examined, only access control and lighting were effective in reducing
the risk of all types of workplace homicide (27). However, combinations of
administrative approaches, which included reducing exposure during late night hours,
did lead to a reduced homicide risk.

Modifications to protect the child pedestrian

Each year in the United States, approximately 850 children under the age of 15 years
are killed and another 30,000 injured in pedestrian collisions (28). Children less than
age 15 years represented 23 percent of the population but 30 percent of the nonfatal
pedestrian injuries and 11 percent of the pedestrian fatalities in 1998 (refer to the
following Internet Web site: www.cdc.gov/ncipc/factsheets/pedes.htm).
Most educational programs that train children to cross streets have demonstrated
limited success in reducing pedestrian injury (29). The main reason suggested for
these results is that children, especially young children, are not cognitively ready to
handle the complex traffic environment. Challenges for children include difficulty
seeing and processing traffic patterns, judging speed of vehicles, prioritizing street-
crossing activities, and choosing an adequate gap in traffic to cross the road
(28, 30, 31). Changing children’s behavior is difficult.

However, many environmental risk factors for pedestrian injuries have been
documented, including high traffic volume, a large number of parked cars, multiple
lanes of traffic, higher speed limits, decreased visibility, and poor maintenance of
street signage (29, 32–35). Population-based environmental risks include a high
population density, household crowding, lack of play areas, and a large proportion of
multiple-family dwellings (29, 32–34). Existing studies show that children are often
hit by cars when they dart out into the street (36) and that toddlers are often hit in
driveways (34).

These findings suggest that environmental approaches that separate children from the
traffic environment and slow traffic in places where children might be in the street
would be effective. For example, using fences to physically separate children from
driveways was associated with a threefold decrease in driveway-related child
pedestrian injuries in New Zealand (37). However, some approaches to accomplish
this goal have been controversial. Marked crosswalks, although designed to protect
pedestrians, have been shown to actually increase the risk of pedestrian injury and
may present a false sense of security (29, 33, 35).

One approach that has garnered increasing international attention is “traffic calming.”
The tenet of traffic calming is that each environment presents specific risks for road
users, and these risks should be identified and addressed locally. Implementing traffic
calming measures begins by identifying the nature and extent of local traffic problems
and then using a “toolbox” of mostly physical measures to address the specific
problems (38). These tools include traffic circles and roundabouts, speed humps,
chicanes, modifications of street width, barriers, street closures, as well as many
others (38). Figure 5 depicts a three-way intersection in which a traffic roundabout
was introduced to control traffic flow.

Preston (39) reviewed 19 evaluations of traffic-calming interventions and found that

injury reductions ranged from 14 percent to 85 percent. Elvik (40) conducted a meta-
analysis of 33 traffic-calming evaluations and found that injuries decreased an average
of 15 percent overall and 25 percent on residential roads. Because of the wide
variation in traffic speed, traffic volume, and roadway design of communities, each
circumstance must be reviewed independently before choosing the best combination
of approaches. Recognition of this variation keeps traffic calming from being a “one
size fits all” approach and may be one reason behind its success.

Home modifications to reduce falls in the elderly

Falls are a significant health concern for the elderly because of their frequency and the
potential for serious consequences. Falls account for approximately 25 percent of
injury deaths among those over age 65 years, and 34 percent of injury deaths among
those aged 85 years or older, usually as a result of complications from hip fractures
(41). Falls are also a major cause of disability and loss of independence in the elderly
(42, 43). Twenty-five percent of the elderly who sustain hip fractures die within 6
months of the injury, and more than 50 percent of community-dwelling older adults
who survive hip fractures are discharged to nursing homes and require rehabilitation
for more than a year (44).

The home environment has been identified as a potential contributor to as many as 50

percent of falls occurring to the elderly (45–49). Furthermore, research indicates that
the majority of homes in which the elderly live have at least one, and usually more,
environmental hazard (50–52). These hazards include obstructed pathways, loose
throw rugs, poorly maintained stairways, poor lighting and visibility, hard surfaces on
which to fall, and lack of safety devices such as grab bars. As residents age, problems
with vision, balance, chronic conditions, and side effects of medication may hinder
their ability to negotiate these home hazards. Thus, the causal pathway for falls often
involves the interaction of predisposing factors with precipitating factors in a person’s
environment (53).

These risk factors suggest that modifying the home environment would be a
successful approach to reducing falls and related consequences. However, research
identifying specific household risk factors and falls is inconsistent. Some research
successfully links home hazards with fall incidence (45, 47, 49), but the specific
hazards that are mediated are not consistent among studies. Other research shows no
association between specific risk factors and falls (48). This research does illustrate
that falls are often the result of multiple factors, and it is difficult to identify which of
these factors are most successfully amenable to intervention.

Since the relation between specific home hazards and fall risk is not completely clear,
it is no surprise that evaluations of interventions to modify the home environment are
also inconsistent. In two randomized controlled trials that examined home
modification in the absence of other approaches, Cummings et al. (54) found an
overall decrease in fall risk, especially among those with a history of falling, when
modifications such as nonslip bath mats, lighting at night, and stair rails were
recommended by an occupational therapist. However, Stevens et al. (55) found no
decrease in falls compared with a control group. Gillespie et al. (56) conducted a
Cochrane Library review of randomized controlled trials of interventions to prevent
falls in the elderly. They concluded that home modification in the absence of other
intervention approaches may be effective for persons with a history of falling but is
likely to be most effective when integrated into a multifaceted intervention program
that also focuses on medications, exercise, and nutritional status. This conclusion was
supported by Day et al. (57), who evaluated group-based exercise, home hazard
management, and vision improvement in reducing falls among over 1,000
independently living elderly. The group that received all three interventions
experienced a 14 percent reduction in the annual fall rate, which far surpassed the rate
for any of the interventions individually.
ENVIRONMENTAL STRATEGIES TO REDUCE INJURIES IN THE EVENT
PHASE

In the event phase, prevention aims to reduce the amount of energy transferred to the
host when an energy-producing event is present, thereby reducing the severity of
injury or eliminating injury altogether. Although energy transfers causing injury often
occur in milliseconds, effective environmental approaches have been developed to
reduce the amount of energy transferred to the host once an injury risk factor is
present.

Home modifications to reduce fire-related deaths and injuries

Fires and burns are the seventh leading cause of injury death in the United States (41).
In 2001, exclusive of the terrorist attacks of September 11, 2001, residential fires
comprised only 23 percent of reported fires annually but were responsible for 83
percent of the civilian deaths, 77 percent of the civilian injuries, and 53 percent of the
property loss associated with fires (58). Fire kills across the lifespan; the rates for
children aged less than 5 years and adults aged more than 64 years are two to six
times higher than those for other age groups (59).

The home environment can be modified in many ways to reduce injuries and deaths
from fires. Modifications include installing smoke alarms and sprinkler systems, fire
extinguishers, and devices such as rope ladders to enable escape from a burning
residence. Of these measures, the smoke alarm has been the most frequent subject of
research.

In North Carolina, Runyan et al. (60) estimated that residents of homes without a
smoke alarm have 3.4 times (95 percent confidence interval: 2.1, 5.6) the risk of fire
death as residents of homes with a smoke alarm. Hall (61) reported that smoke
detectors cut the risk of dying in a home fire by about 40 percent in the United States,
with 0.57 deaths per 100 home fires with alarms compared with 1.03 deaths per 100
home fires without alarms. The National Fire Protection Association estimated that
75–80 percent of the fires that would have grown large enough to be reported in the
absence of alarms are not reported when alarms are present because people do not
need fire department aid (61).

Although evidence suggests that smoke alarms are highly effective, their use is not
universal even after nearly three decades of availability. This is an excellent example
of how behavioral or regulatory approaches are sometimes necessary to require the
use of existing interventions that change the physical environment. Although
approximately 88 percent of homes have at least one installed smoke alarm, the
alarms are not functional in about one quarter to one third of them (62–64). Even
fewer homes meet the National Fire Protection Association code requirement of at
least one working alarm per floor and near each sleeping area (61). In a survey
conducted by the Consumer Product Safety Commission, 55 percent of
nonfunctioning alarms did not have batteries, 25 percent had dead batteries, and 15
percent had disconnected batteries (62).

Two recent systematic reviews of interventions to promote smoke alarms (65, 66)
found few published controlled evaluations of alarm promotion programs, and most of
these evaluated educational approaches to increase use. DiGuiseppi and Higgins (65)
pooled results from 10 randomized trials on smoke alarm ownership and concluded
that educational programs to promote smoke alarm installation and maintenance had
only modest effects on increasing smoke alarm ownership or functionality.
Educational programs in clinical settings and those that combined education with
discounted alarms showed slightly higher gains in ownership and function. Warda et
al. (66) reviewed 10 interventions that aimed to increase smoke alarm use and
function, some that overlapped with the studies that DiGuiseppi and Higgins
evaluated, and again concluded that educational programs had a modest, if any, effect.

Studies that evaluated the incidence of fires and fire-related injuries following smoke
alarm giveaway programs have had inconsistent results. Three studies found decreases
in fire-related injuries (62, 67, 68), but the study with the greatest validity found no
decrease (69).
Few evaluations of other environmental approaches to reduce fire-related deaths exist.
On the basis of evidence in industrial settings from the Federal Emergency
Management Agency, the Council on Scientific Affairs of the American Medical
Association recommended widespread installation of residential sprinkler systems
(70). However, the role of these systems in dousing fires and saving lives has not been
documented. Although sprinklers would require very little maintenance, the ability of
owners to change sprinkler heads is not known and, as suggested by the lack of
maintenance of smoke alarms, may be poor. Although the cost of installing, and even
more so retrofitting, sprinklers is high, better technology is reducing these costs.

ENVIRONMENTAL STRATEGIES TO REDUCE INJURIES IN THE POST-

EVENT PHASE

Post-event intervention aims to reduce the consequences of an injury-producing event

after energy transfer has occurred. This goal can be accomplished by reducing the
time between injury and medical treatment, improving medical treatment,
implementing effective rehabilitation to reduce physical impairment and disability, or
providing services, such as mental health services, to reduce trauma following the
event.

Environmental modifications that affect the post-event period are usually

implemented before the event, but they act after the injury to reduce negative
sequelae. Post-event environmental modifications are often part of a cycle in which
knowledge gained from an event can be applied to reduce consequences of a similar
event in the future. This cycle requires that post-event consequences be examined and
that knowledge from this examination be applied during the next event. Therefore,
many post-event environmental modifications involve a complex interaction between
the physical and socioeconomic environments.

Modifications to the delivery of emergency and trauma care

Improvements in emergency medical response and trauma care have had a major
impact in the field of injury control. Identifying the relation between time to definitive
treatment following an injury and the outcome of that injury has led to development of
coordinated trauma care from the prehospital through the rehabilitative phases (13).
Implementation of trauma systems has mainly involved changes in the social
environment, which have included better coordination between agencies, triage and
transport protocols, assignment of treatment levels to trauma centers, and improved
training and certification at all levels of emergency care delivery.

Early evaluations of trauma systems focused on the number of deaths that could be
prevented, and estimates were in the range of 20–40 percent (13, 71, 72). These
studies had many methodological flaws including lack of appropriate comparison
groups, failure to control for confounding, and small samples without identification of
a base population (73). However, studies adopting better methodologies and using
population-based approaches have also reported significant reductions in fatalities
(74, 75). These findings have led an increasing number of US states to implement
coordinated trauma systems, yet there are still important gaps in knowledge regarding
the effectiveness of trauma systems, especially with regard to prehospital care and
long-term outcomes (13). These knowledge gaps were most recently reviewed in
the Journal of Trauma (1999, volume 47) and are not discussed in detail here.

Coordinated trauma care has also led to changes in the physical environment that have
contributed to increased survival and recovery from an injury. The major goal of these
changes is to reduce the time between an injury and definitive medical care, and they
include an increase in the number and quality of emergency medical vehicles,
improved emergency communication systems (such as “911” telephone response), and
improved medical equipment for treating trauma. Few evaluations of these changes to
the physical environment have been published in the medical literature. One
evaluation of the 911 emergency telephone number found that incorporating the
single-use three-digit number was a more efficient and successful way to activate the
emergency medical system than the previous multiple seven-digit numbers (76).

The use of helicopters to transport critically ill patients is one example of an

intervention in the physical environment. Many communities use helicopters to reduce
transportation time, especially in rural areas or areas that present challenges to ground
transportation, such as dense urban freeways. Because helicopter crews often include
highly trained medical personnel, their use also brings critical care to the patient in the
field. Evaluations of helicopter use have had mixed results. While some studies have
found improved survival with helicopter transport (77–82), others have reported no
benefit (83–85) and some have found that the benefits are limited to a very small
proportion of patients transported in the helicopter (86, 87). Studies in rural settings
tended to find more favorable outcomes, and studies that did find an effect often
attributed it to the presence of medical personnel on the flight crew rather than a
decrease in transport time (80, 81). Studies evaluating helicopter use are difficult to
compare because they apply different criteria for determining appropriate use and
identification of survival potential, use different control groups (and often no control
groups), and use different types of transport, including on-scene-to-hospital and
hospital-to-hospital.

The environment and disaster response

The area of disaster response provides a good example of how the environment is
related to the post-event phase. Natural disasters throughout the world have caused an
average of 3 million deaths each year for the past 20 years, and many more injuries
(88). Natural disasters that require international assistance occur almost every week.
Man-made disasters, such as industrial incidents, refugee crises, and terrorism add to
this toll. Because of increasing population densities, development and transportation
of toxic and hazardous materials, and increasing globalization, the death rate from
disasters will likely grow in the future (88–90).

Following a disaster, emergency responders must be able to quickly initiate search

and rescue activities, provide medical care, and provide food and shelter to affected
populations (90). Disaster response is influenced by both the natural and man-made
environments. Weather-related events such as tornadoes, hurricanes, and extreme
temperatures hinder the ability of rescue teams to access injured persons. Hurricanes,
earthquakes, and erupting volcanoes can lead to secondary natural phenomena such as
floods and landslides, and these events also hinder rescue efforts. In addition to
hindering rescue efforts, unfavorable elements in the natural environment can reduce
the ability of response agencies to provide clean water, food, and shelter to disaster
survivors (91). Improvements in search and rescue equipment and technology have
helped overcome these problems, but many developing countries, which tend to be
disproportionately impacted by disasters, do not have access to these advances.

The man-made environment is also related to post-event recovery. For example,

building integrity is an important component in earthquake response. Buildings that
collapse cause increased death and injury and are more difficult to negotiate during
search and rescue activities. Collapsed buildings are also much more difficult to
reconstruct following a disaster. Engineering research has clearly documented that
wood-framed buildings are less likely to collapse during an earthquake (92). Buildings
with heavy roofs and less-stable walls, such as mud houses with adobe roofs that are
found throughout the developing world, are extremely susceptible to collapse. The
United States and Japan have both implemented sophisticated seismically sound
buildings in earthquake-prone areas, but, again, developing countries rarely have the
resources to do so.

The man-made environment includes all of the necessary communication and

transportation infrastructures necessary to respond to a disaster. The New York
Times reported widespread radio and communications failures with firefighter’s
equipment during the response to the terrorist attacks on September 11, 2001 (93).
Because of these malfunctions, many firefighters did not hear orders to evacuate the
second World Trade Center tower, leading to many preventable deaths. Failed
bridges, roadways, traffic control systems, and energy sources are routinely identified
as hindrances to emergency response (90, 91). Thus, infrastructure planning is a
promising area for environmental intervention in disaster response.
UNINTENDED CONSEQUENCES OF ENVIRONMENTAL CHANGE

Changes in the environment, whether intentional or unintentional, can lead to

increased injury risk. Sometimes this risk can be due to unintended consequences of
an environmental change implemented to reduce injury risk.

One example of this phenomenon is the air bag. As with most of the modifications to
the vehicle interior, design specifications were based on the size of the average male
(94). An increasing number of air-bag-related injuries to children and small adults
brought attention to air bag design beginning in the early 1990s (95). The first cases
indicated that the problem was largely associated with unrestrained children or infants
seated improperly in the front seat while in rear-facing infant seats (96). However,
further research indicated that older children adequately restrained in the front seat
were still at high risk of fatality from air-bag-induced injuries, even in low-speed
collisions (97). Analysis of several years of data indicates that children under the age
of 10 years who are in the right front passenger seat have a 21 percent increased risk
of fatality when an air bag is present (98).

Since then, federal agencies, including the National Transportation Safety Board and
the National Highway Traffic Safety Administration, have recommended that infant
car seats and children under age 12 years always be placed in the back seat in cars
equipped with passenger-side air bags (99). Many agencies have supported broad
public campaigns to promote this message. In addition, engineers are working to
improve the air bag to reduce these unintended consequences. Current technology
includes the “smart” air bag, which deploys in response to the passenger’s height and
weight (100, 101). Note that, although the air bag poses a real injury risk to children
who are inappropriately seated in front, many more children are killed each year
because they are not adequately restrained.

The environment can also change in predictable ways that unintentionally lead to
injury risk. Vulnerability to disasters is one example. In the United States, deaths,
injuries, and financial losses from disasters have increased dramatically over the last
several decades (90). However, the frequency of large-scale disasters has not
increased.

One reason for the increased vulnerability involves population shifts to vulnerable
areas. Currently, 80 percent of the Florida population lives within 35 km of the
coastline, and these areas are highly vulnerable to hurricanes (90). Another example is
California, which saw its population grow from 10 million in 1950 to 33 million in
1990 and become increasingly concentrated in metropolitan areas (90). Most of this
population is at risk of earthquakes. Although population shifts do not change the
natural environment, they lead to changes in the built environment in these areas. In
addition to the increased number of persons at risk, the environment shifts toward
larger buildings, increased population density, and increasingly complex
transportation, communication, and service infrastructures.

The environment is also sometimes modified intentionally in ways that increase injury
risk. One example is the end of the required 55 mile-per-hour speed limit. This speed
limit was imposed not to reduce injuries but to increase fuel efficiency during the
petroleum crisis (4). The federal speed limit requirement on rural interstates was
increased to 65 miles per hour in 1987; in response, many states and municipalities
increased their speed limits. Although evidence is conflicting, most indicates that
higher speed limits led to increased crashes and associated deaths and injuries
(4, 102, 103).

EPIDEMIOLOGIC STUDIES OF THE ENVIRONMENT

The epidemiologic literature evaluating environmental interventions is very scant

compared with the variety of interventions implemented. With notable exceptions,
most evaluations of environmental interventions use weak, often quasi-experimental
designs, often without a control group, and underuse analytic techniques. Many
factors have contributed to the lack of stronger research designs. Inadequate funding
has prohibited use of randomized controlled trials and prospective studies in many
settings. In addition, randomized designs are often infeasible or unethical to
implement when interventions focus on environmental change. Many of the
evaluations were conducted prior to the widespread use of personal computers, and
advanced, straightforward statistical software was not available. Finally, the
multidisciplinary nature of the field of injury control has led to a literature spread
across many fields; each uses its own approach to research. Comparing findings in
this broad field is difficult.

Considering these hindrances to research, it is not surprising that many of the existing
evaluations use ecologic study designs and rely on retrospective, secondary data. In
addition, many of the analytic approaches include only a pre- to postintervention
comparison with no control group, and they often fail to control for known
confounding factors. The early evaluations of roadway changes are predominantly
ecologic, and it is difficult to draw causal connections from them. These studies often
do not control for heterogeneity of the regions being studied (such as variance in
baseline fatality rates in different states) or attempt to control for simultaneous
interventions that might influence injury rates. A large body of economic research has
evaluated roadway and motor vehicle safety features, but this research fails to
consider many of the confounding factors that affect both crash incidence and injury
severity (4).

Several randomized controlled studies have been conducted in the home setting, but
many have insufficient power to detect differences. Existing literature suggests that
home modification may be effective as part of a multifaceted intervention approach,
but very large sample sizes are required to detect the role of individual components of
an intervention program.

Despite these weaknesses, some very promising approaches exist. A larger funding
base will increase opportunities to conduct randomized controlled trials, and they will
offer the best assessments of effectiveness. Certain study designs are also well suited
to study the environment. One example is the “case-site, control-site” study design, a
variant of the traditional case-control approach. This design has been used widely in
studying pedestrian injuries (29, 33, 104). The “case” in this study design is a child
pedestrian collision, and characteristics of both the child and the location are
incorporated. Controls are chosen from locations where children were not hit, and
they are usually selected through a stratified random sampling scheme that controls
for environmental factors not under investigation. This design is especially useful for
environmental research.

The case-crossover design is also a promising approach to studying the environment.

In this design, cases serve as their own controls, and thus many confounding factors
will be inherently matched (105). This design is especially helpful when many
confounders are unknown, often the case with environmental influences. One example
of the case-crossover design examined cellular telephone use and driving crash risk
(106). In this study, cases were 699 drivers with cellular phones who were in crashes
causing substantial property damage. Phone records for the day of the crash were
compared with those from a week prior to the crash. Therefore, subjects served as
their own controls during a time period prior to the outcome event. Investigators
found a fourfold increase in crash risk when the phone was being used.

Stronger analytic strategies are also underused in some environmental studies. Use of
interrupted time-series modeling is rare, even when prolonged baseline and follow-up
data are available. Time-series analyses may be particularly important in
environmental evaluations because ecologic study designs are so often used, and
interrupted time-series models are one of the best approaches to control for
confounding effects by using ecologic data (107). This design would have been
particularly helpful for the series of evaluations of Florida ordinances to reduce
robberies and related injury. These studies used ecologic study designs to compare the
rate of robberies and homicides before and after implementing the ordinances (22–
24). However, they did not control for expected changes in violent crime, which were
generally decreasing during the study period. Thus, the effects of the program could
be overestimated, and this bias could have been controlled by using an interrupted
time- series design.
Hierarchic modeling is a promising strategy to control for clustering of events. By
introducing a random-effects term into the intercept of a model, units in which events
cluster can be controlled and examined (105). This approach would be appropriate for
studies comparing crash rates by state because states, each with their own laws and
enforcement strategies, have different factors predicting crash rates. This approach
would also be helpful in studies evaluating robbery-prevention programs because
individual stores have different risk factors for robbery.

Evaluation research on environmental modifications has improved greatly since the

early ecologic studies of the roadway to the randomized controlled trials of fall
prevention programs in the home. There is great promise for the future, and better
evaluations of environmental approaches will help guide decisions about the use of
scarce prevention resources.

CONCLUSION

The injury prevention examples described in this article demonstrate that modifying
the environment may require large-scale change involving many stakeholders.
Bringing together all of the stakeholders around an environmental intervention will
usually require integration with behavioral and regulatory interventions.

For example, successful modification of the roadway and vehicle environments

required collaboration of legislators, urban planners, city councils, law enforcement,
automobile manufacturers, engineers, and health professionals, among others.
Prevention efforts focusing on the seat belt required engineering, education, and
legislative approaches. Legislation was required first to get seat belts installed in cars
and then to get drivers and passengers to wear them. Doing so required education of
legislators to understand the scope of the problem and the promise of reducing it.
Thus, it can be argued that environmental change does not occur without some
underlying change in knowledge, attitudes, culture, or beliefs in the persons or groups
that can institute environmental changes.
The causal pathway of most injuries is complex. Preventing injury events and
reducing the severity of injuries requires coordinated effort and multifaceted
approaches. Changing the environment remains one of the most promising approaches
to reducing injuries, but environmental approaches will be effective only if they are
designed and implemented with a full understanding of the complex and changing
nature of the environment. This understanding will depend on increased funding of
robust evaluative research.

NTEGRATION OF STRENGTH AND CONDITIONING

PRINCIPLES INTO A REHABILITATION PROGRAM
Michael P. Reiman, PT, DPT, OCS, SCS, ATC, FAAOMPT, CSCS1 and Daniel S. Lorenz, DPT, PT,
ATC/L, CSCS2

Author information Copyright and License information Disclaimer

This article has been cited by other articles in PMC.

Abstract
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Background and Purpose

Strength and conditioning is traditionally thought to exist only in the training of the healthy
athlete, while rehabilitation is for the athlete who has been injured. Once the athlete completes
their post-injury rehabilitation with the athletic trainer and/or sports physical therapist, they often
then move onto the strength and conditioning coaches to resume their “weight room workouts”
and re-integration with the team. The strength and conditioning coach, in consultation with the
athletic trainer and/or sports physical therapist, uses an understanding of the proper technique
and application of several types of exercise to develop a program to ready the rehabilitating
athlete for competition.
Evidence supporting the implementation of strength and conditioning principles into such a
program is currently sparse.1–6 Several authors have investigated both conservative1–4,6 as well as
post-surgical interventions.5 While each of these studies have integrated specific strength and
conditioning concepts, none have employed the entire spectrum of strength and conditioning as it
applies to the rehabilitating athlete. The purpose of this clinical commentary, therefore, is to
describe these strength and conditioning principles, and provide a suggested implementation of
their use throughout the entire rehabilitation process, not just during the return to sport phase.

Assessment of the Athlete and the Post-Injury Training Program

Proper implementation of a post-injury training program requires assessment of the rehabilitating
athlete, their sport, and the defined training program principles themselves (Figure 1). Periodic
re-assessment of the athlete, as well as the program and its outcomes can provide the sports
physical therapist the necessary information required to manipulate the various training program
variables to achieve the desired goals. Specific training principles (Table 1) should be addressed
when designing the athlete's program. The sports physical therapist should consider the phase of
rehabilitation that the rehabilitating athlete is in when implementing such a program. The
specific program parameters of strength, power, endurance, and hypertrophy must also be
carefully considered and targeted when planning the program.

Figure 1.

Program Design for the Rehabilitation Athlete.

Table 1.
Training Program Design Principles.18,22,23,60,64
 Principle Definition

Individuality Treating the athlete as an individual and designing their training program specifically for
them. Several factors should be considered when designing a resistance training
program, including age, sex, medical history, previous training background, injury history,
overall health, training goals, motivation, and any healing restraints related to the injury
or surgery.

Progressive overload States that in order to continue making gains in an exercise program, stress to the
system must be progressively overloaded as it becomes capable of producing greater
force, power, or endurance. The principle of specificity states that the body makes gains
from exercise and training according to the manner in which the body trains. The way
the athlete trains is how he or she will function.

Specificity When developing a training program using this principle, one should consider the
following:

• Energy-source specificity: training the correct energy system

• Muscle action specificity: gains in strength are in part specific to the type of muscle
action used in training (e.g., isometric, concentric/eccentric, isokinetic).

• Muscle group specificity: training the muscle group(s) and joint(s) that are involved in
the sport.
 Principle Definition

• Velocity specificity: training gains are specific to the velocities at which exercises are
performed. Exercise selection and order of performance specificity

Volume and Intensity Volume relates to the total amount of weight lifted in a training session. Intensity (or
load) is the amount of weight assigned to an exercise set. Volume and intensity are
inversely proportional.

Frequency The number of training sessions per specific time-frame (typically enumerated on a
weekly basis).

Rest period The length of time for recovery between sets and exercises. Rest period is dependent on
the sport the athlete is participating in, the training goal(s) (strength, power, endurance,
hypertrophy), load lifted, and the training status of the athlete.

Type of resistance The primary types of resistance available to the athlete are: free weight and elastic
resistance (which affords multi-planar, whole body patterns of movement resistance
training), machine resistance (provides increased stabilization for isolated muscle
strengthening), aquatic resistance (provides multi-planar resistance with fluid
resistance/assistance dependent on positioning), and isokinetic resistance (provides
accommodating resistance with large amounts of reliable and valid data).

Variation/Periodization The planned manipulation of training variables (load, sets, and repetitions) in order to
maximize training adaptations and to prevent the onset of overtraining syndrome.18
 Principle Definition

▪ Linear/classical Linear: This model is characterized by high initial training volume and low intensity. As
training progresses, volume decreases and intensity gradually increases based on
changing exercise volume and load across several predictable mesocycles. The program
over a 12-month period is referred to as a macrocycle, and two subdivisions are the
mesocycle (3-4 months) and the microcycle (1-4 weeks).

▪ Non- Non-linear periodization (NP) is based on the concept that volume and load are altered
linear/undulating more frequently (daily, weekly, biweekly) in order to allow the neuromuscular system
more frequent periods of recovery. Phases are much shorter providing more frequent
changes in stimuli, which may be highly conducive to strength gains. 18

▪ Reverse Reverse: this model is the inverse of the linear model in which intensity is initially at its
highest and volume at its lowest.

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The requirements or demands of any given sport must be ascertained in order to determine how
to properly manipulate the training variables throughout the program. For example, training for a
football lineman in the latter phases of rehabilitation should emphasize explosive power in
activities performed that last 7-10 seconds with 20-60 seconds of recovery time to best replicate
the demands of the sport.7,8 In the earlier phases of rehabilitation it may be necessary to correct
specific impairments, such as muscle imbalances, that may contribute to injury.9–12The inability
of a rehabilitating athlete to perform a specific task can be identified using various measures
(self-report, impairment based, bio-psycho-social, and/or performance based measures). An
individual's ability to properly function occurs along a continuum, and therefore should include
these multiple measures.13,14 The assessment continuum should include a subjective report of
functional ability, observation and examination of impairments, and functional performance
testing as appropriate. Functional performance testing has previously been defined as using a
variety of physical skills and tests to determine (1) one's ability to participate at the desired level
in sport, occupation, recreation, or to return to participation in a safe and timely manner without
functional limitations and (2) one's ability to move through as many as three planes of
movement. Functional performance is assessed using nontraditional (e.g. beyond manual muscle
and range-of-motion) testing that provides qualitative and quantitative information related to
specialized motions involved in sport, exercise, and occupations.13 The comprehensive
assessment approach can be utilized to not only assess the rehabilitating athlete and their sport
demands, but the success of the implemented program as well. If specific program parameter(s)
(e.g. functional movement, strength, power, endurance, and/or hypertrophy) are determined to be
deficient in the rehabilitating athlete during testing, the program can be modified to correct these
deficiencies. Limitations demonstrated in fundamental movement patterns15,16 would require
amelioration prior to placing emphasis on power training. Since it has recently been suggested
that assessment of an individual's overall functional ability is multifactorial14complete description
of functional assessment is beyond the scope of this clinical commentary. For additional
suggestions on the implementation of the assessment of the athlete, the reader is referred
elsewhere.13–17

Traditional Training Program Parameters

Specifically training a muscle or group of muscles to achieve the desired goals of increased
strength, power, endurance, and hypertrophy is paramount. The reader is advised to consult other
sources18–20 for detailed information on training of these parameters, as it is also beyond the scope
of this commentary to do so. General parameters will be discussed here.
Training for muscle performance including strength, power, and endurance, requires different
program design and does necessitates variability in exercise prescription (Table 2). Strength
training typically involves a load/ intensity of 80-100% of the maximum amount of weight that
the individual can lift one repetition (1 RM), utilizing approximately 1 to 6 repetitions.18–23 Power
training, on the other hand, requires a primary component of velocity of movement. Therefore,
since velocity is inversely proportional to the amount of load lifted, the load will have to be
relatively lighter than loads utilized in strength training in order to accomplish the necessary
velocity. Power training though does require a foundation of strength.

Table 2.
Repetition Maximum Continuum.18,19,21–23

Primary Parameter Trained Repetition Range

Strength and Power 0-6

High Intensity Endurance much greater than Strength and Power 6-12
 Primary Parameter Trained Repetition Range

Low Intensity Endurance greater than High Intensity Endurance 12-20

Low Intensity Endurance 20-30

While strength and power training can require similar components of training, endurance training
is fairly unique. Endurance training can involve many methods (circuit training, etc.) but the
common theme is high repetitions with lighter loads.18–23 The relative work to rest ratio is the
lowest amongst the primary three parameters of muscle performance. Endurance training can be
a method to achieve hypertrophy training since moderate loads and repetition range of 8-12 is
suggested for hypertrophy training.18,22,23

Phases of Injury Rehabilitation

Regardless of the type or region of injury, basic phases of rehabilitation have been described in
the literature.3–5,24–34 Dependent on the injury status, whether surgery was involved, and the
restrictions associated with the recovery, the duration of these phases will differ. There are some
common characteristics, goals, precautions and criteria for progression to the subsequent phase.
Described below and in Table 4 is a general outline of the various phases of rehabilitation based
on multiple previous protocols, literature sources,3–5,24–34 as well as opinions of the authors.
Criteria for progression, goals of each phase, and characteristics of each phase therefore are the
authors' opinions based upon available protocols and past literature.

Table 4.
Utilization of Non-Linear Periodization in Different Phases of Rehabilitation.

Training Emphasis Non-Linear Parameter Trained Training with Team

Periodization
Phase

Phase I ▪ Low intensity I. Setting I. Monday: Endurance I. Cardiovascular (CV)

Immediate endurance of stabilizing foundation with Wednesday: endurance training
 Training Emphasis Non-Linear Parameter Trained Training with Team
Periodization
Phase

Rehabilitation muscles emphasis on Hypertrophy Friday: (e.g stationary bike

muscle Strength for injured UE or
endurance trunk, Upper body
ergometer (UBE) for
injured LE or trunk)

▪ Training of joint above II. Weight room

and/or below for stability training of non-
and endurance injured areas with
protection of injured
area

III. Lower-level sport

related skills of non-
injured areas (e.g. free
throws or ball tossing
for injured LE; ball
passing drills for
soccer player with
injured UE)

Phase II ▪ Low to high intensity I. Emphasis on I. Monday: Hypertrophy I. Weight room

Intermediate endurance of stabilizing increasing Wednesday: Strength training of non-
Rehabilitation muscles (dependent on muscle size and Friday: Hypertrophy injured areas;
 Training Emphasis Non-Linear Parameter Trained Training with Team
Periodization
Phase

their specific function) continued continue CV

strength training endurance,
progressing to long
duration/lower
intensity interval CV
activity (bike, UBE,
etc)

▪ Progression from low to II. Strength gain II. Monday: Strength II. Interval CV activity
high intensity strength emphasis prior to Wednesday: Endurance increasing in intensity
for muscles responsible transition to Friday: Strength (decreasing duration)
for movement of power training with emphasis on
affected area (dependent energy system most
on contraindications and relevant to athlete's
precautions, etc.) sport.

III. Sport related skills

as prior; initiation of
sport related skills of
injured area (patterns
of movement, low-
intensity drills, etc.)

Phase III ▪ Continued endurance I. Strength gain I. Monday: Strength I. Interval training
 Training Emphasis Non-Linear Parameter Trained Training with Team
Periodization
Phase

Advanced emphasis for stabilizing emphasis prior to Wednesday: Endurance emphasis on proper
Rehabilitation muscles transition to Friday: Strength energy system and
power training incorporating total
(short duration body movement
emphasis) patterns

▪ High intensity II. Begin II. Monday: Strength II. Sport related skills
strengthening transition to Wednesday: Power – progressed to game
progressing power Friday: Strength intensity as per
athlete readiness and
tolerance

▪ Low to high intensity

power progression of
movement muscles
(dependent on
precautions, etc.)

Phase IV ▪ Continued as in phase I. Continued I. Monday: Power I. Sport related skills

Return to III; with increased progression of Wednesday: at game intensity
Function emphasis on clients' strength and Strength/Hypertrophy progressed to normal
functional requirements power phase Friday: Power practice and
(i.e. power for jumping eventually return to
athletes; endurance for game competition.
 Training Emphasis Non-Linear Parameter Trained Training with Team
Periodization
Phase

long distance running

athletes, etc.)

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Phase I, Immediate rehabilitation: Characterized by tissue and/or joint inflammation and pain,
disuse, detraining, loss of muscle performance, potential immobilization (dependent on injury),
and initiation of tissue repair and/or regeneration. The primary goals to be addressed during this
phase are protection of the integrity of the involved tissue, restoration of range-of-motion (ROM)
within restrictions; diminishment of pain and inflammation, and prevention of muscular
inhibition. Major criteria for progression to Phase II include: minimal pain with all phase I
exercises, ROM≥75% of non-involved (NI) side, and proper muscle firing patterns for initial
exercises.
Phase II, Intermediate rehabilitation: Characterized by continuation of tissue repair and/or
regeneration, increased use of involved body part or region, decreased inflammation, and
improved muscle performance. The primary goals to be addressed during phase II include:
continued protection of involved tissue(s) or structures and restoration of function of the
involved body part or region. Criteria for progression to Phase III include: close to full
ROM/muscle length/joint play, and 60% strength of primary involved musculature when
compared to the uninjured side.
Phase III, Advanced rehabilitation: Characterized by restoring normal joint kinematics, ROM,
and continued improvement of muscle performance. The primary goals to be addressed during
this phase are restoration of muscular endurance and strength, cardiovascular endurance, and
neuromuscular control/ balance/proprioception. Criteria for progression to phase IV include:
strength > 70-80% of non-involved (NI) side and demonstration of initial agility drills with
proper form (e.g. avoidance of medial collapse35 of bilateral lower extremities, coordinated and
symmetrical movement of all extremities, controlled movement of entire body).
Phase IV: Return to function: Characterized by activities that focus on returning the athlete to
full function. The primary goals to be addressed during this phase are successful return to
previous functional level in the athlete's preferred activity, and prevention of re-injury.

Designing a Training Program with Consideration for the Injured Athlete Needs Analysis
of Training Program
In order to properly design a patient and sports specific rehabilitation program, a needs
analysis should be performed.36 Performing a comprehensive analysis (Recall Figure 1),
investigating such factors as the physiological and biomechanical requirements of a sport is
required when designing the program. Components of a needs analysis include a general
biomechanical analysis of the sport which rehabilitating athlete participates in, an analysis of the
energy sources utilized in the sport, and an analysis of the common injury sites and patterns for
the sport.36Furthermore, an appropriate physiological analysis allows the clinician to devise a
program that addresses specific strength, range of motion, flexibility, power, endurance, and
speed requirements for any given sport. For example, an American football player needs more
muscle size and strength than a cross-country athlete or a soccer player. Only by addressing these
requirements specifically will an athlete be successful in returning to their sport or activity. Next,
a biomechanical analysis is required to choose training activities that develop the athlete in a
manner most specific to the sport. Specificity of training is a foundation of both functional and
resistance training programs.18 It is the authors opinion that the sports physical therapist should
be well-versed on injury patterns that are present in the sport in which the rehabilitating athlete is
participating to ensure that prevention strategies are included. For example, female soccer and
basketball players have demonstrated a higher risk for anterior cruciate ligament ruptures than
athletes who participate in other sports.37–41 Likewise, American football lineman and gymnasts
are at an increased risk for spondylolysis and spondylolisthesis compared to athletes in other
sports.42–45 Each of these examples shows how training programs for the rehabilitating athlete
should be specifically designed to accommodate each individual athlete's needs to maximize
performance and avoid subsequent injury. The reader is directed to Table 5 for an illustration of
these concepts.

Table 5.
Needs Analysis Comparison for a Male Football Player versus Female Soccer Player Recovering
from ACL Reconstruction Surgery.

SPORT Football Soccer

Biomechanical Analysis - Multi-directional, multi-joint, - Multi-directional movements with varying

explosive movements that vary with degrees of intensity, often requiring
position simulataneous manipulation of a ball

- Requires multiple stops/starts - Eye-foot coordination

- Asymmetry of stance and kick leg

 SPORT Football Soccer

Energy requirements Primarily ATP Primarily aerobic

Physiological Analysis

- Maximal power and strength, - strength, endurance, flexibility, balance

flexibility, balance

- One game per week - Possibly several games in a week

- Environmental acclimatization - Female athlete triad considerations

- Environmental acclimatization

Injury patterns - Soft tissue injuries including - Females have high risk of ACL injury in soccer
ligament sprains, muscle strains

- Soft tissue injuries including sprains and strains

-Increased incidence of - Overuse tendinopathies

spondylolisthesis in linemen
 SPORT Football Soccer

-Concussion - Spondylolysis

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Assessment of Rehabilitating Athlete's Strengths and Weaknesses

Assessment of each rehabilitating athlete's strengths and weaknesses can be a complex
undertaking. As previously mentioned, proper assessment of an athlete's functional capacity is
multi-factorial, involving multiple variables.14Along with the assessment of the rehabilitating
athlete's strengths and weaknesses, knowledge of their training history/status, injury
history/status, and basic physical characteristics is warranted. Training status may depend on
numerous factors, including length of time playing the sport, length of time specializing in the
sport (or position within a sport), and the level of competition at which the athlete is accustomed
to participating.

Training Program Design Principles

Once the clinician has determined the rehabilitating athlete's needs, the next step in designing the
rehabilitation program is manipulation of the program principles. As previously mentioned, it is
beyond the scope of this article to discuss all the necessities of program design; however some
discussion of these principles is warranted especially in light of the paucity of literature
regarding their implementation in the rehabilitating athlete The program principles of interest to
the sports physical therapist for manipulation include: exercise selection, training equipment
availability, training frequency, exercise order, rest interval and resistance/training load.

Exercise Selection
Exercise selection is a critical program principle for which the clinician should account. Multi-
joint exercises are exercises that involve many muscle groups in one exercise.18 Examples of
multi-joint exercises include squats, deadlifts, cleans, bench presses, and push jerks. Typically,
these exercises are done first in the training session because they are the most fatiguing, but also
because they are recommended most for increasing muscle and bone strength.18 The other type of
exercise is known as supplementary, or isolation exercises. Examples of isolation exercises
include front raises, lateral raises, and knee extensions. Since these isolation exercises are
primarily single joint-single plane exercises, they are a good choice for the untrained or
inexperienced athlete.18 Ultimately, though, the experienced athlete will require several multi-
joint exercises in their program in order to be successful.
Progression to multi-joint exercises involves more instruction and greater time to practice in
order for the athlete to establish the necessary coordination to properly execute the exercise
safely and effectively. Performing large muscle mass, multi-joint exercises early in the workout
has been shown to produce significant elevations in anabolic hormones.46–48 This type of an
anabolic response may potentially expose smaller muscles (such as those in the affected area) to
a greater anabolic response than that resulting from only performing small muscle exercises.47,48

Availability of Training Equipment

A lack of certain equipment necessitates changes or does not allow the performance of some
exercises.36 In the context of free weights, lack of floor or ceiling space may hamper lifts that
could involve dropped weights or pushing weights overhead. For example, many Olympic lifts
performed overhead (i.e. snatch, jerks) are performed with bumper plates that bounce on the
ground to promote athlete safety if a lift is missed, or if maximal lifts are attempted. In any of
these cases, the bar is often dropped to the floor where it bounces and could potentially injure
others. Some machines may not be multi-dimensional enough to be sport-specific for the
rehabilitating athlete,36 so the clinician will need to supplement training programs with
appropriate exercises. For example, when the rehabilitating athlete needs to perform a chest press
motion, it may be more appropriate to use the dumbbell or barbell bench press than a weight
machine. These lifts, although utilizing the same musculature, require the athlete to make
adjustments to complete the lift given that the axis of movement is not fixed and may follow an
unpredictable course compared to a seated chest press using a weight machine which only has
one axis of movement.

Training Frequency
Training frequency ultimately depends on the volume and load of exercises, the type of
movement (multi vs. single joint) that prevails throughout the workout, the training level of the
athlete, the goals of training, and the health status of the athlete.36 Traditionally, resistance
training on alternating days is encouraged in the early stages of training to ensure recovery,36 but
frequency may increase with increased training experience. Previous authors have demonstrated
insignificant differences in strength gains observed between training 1, 2, 3, or 5 days per week
if the volume was kept constant.18 When near maximal resistances are used, more recovery time
is advocated.18,19,22,23
The sports physical therapist must also consider other concurrent training in which the athlete is
involved. A young pitcher may not only be in season, but may also be working with a pitching
coach once or twice a week in addition to resistance training. The frequency of training may
need to be reduced to accommodate the athlete's schedule of training in order to ensure that
proper rest and recovery is achieved. Similarly, an increase in training frequency may be
warranted if the athlete appears to be reaching a plateau or making minimal gains in one or more
of the training parameters (e.g. strength, power, endurance).

Exercise Order
The ability to perform the desired load and volume of each exercise is dependent on proper order
of exercise.36 Proper coordination of the integration of multi-joint and isolated strengthening
exercises requires careful planning on part of the sports physical therapist. Each individual
athletes physical condition, as well as the their particular strengths and weaknesses will require
consideration when designing the training program.36 Various methods of utilization of exercise
order will be described.
Because multi-joint exercises require the most coordination, skill, and proper levels of energy, it
is encouraged that they are performed first in the training session. For example, the bench press
should be performed prior to tricep extensions. Since multi-joint lifts are the most fatiguing, the
athlete is unlikely to obtain the maximum benefit of these exercises if the smaller muscle groups
are fatigued from previous exercises. Pre-exhaustion is a training technique is a training
technique in which a muscle is fatigued in a single-joint, isolated movement prior to performing
a multi-joint exercise involving the same muscle.36 An example of pre-exhaustion training is
performing leg curls or leg extensions prior to a back squat or deadlift. The sports physical
therapist may utilize this technique if they feel that the multi-joint movements are not completely
developing the muscles in question or to help alleviate the effects of training boredom. To the
author's knowledge, no studies exist utilizing pre-exhaustion as a training technique.
There are various methods of pairing exercises to challenge the athlete, alleviate boredom, and
emphasize muscle endurance and hypertrophy. Super setting involves alternating agonists and
antagonists with minimal rests between exercises. For example, a bench press followed by a
seated row or a bicep curl followed by a triceps pushdown would be examples of super
sets. Compound setting is performing two different exercises of the same muscle group in
alternating fashion with little to no rest between exercises. Anterior lunges followed by squats or
barbell bicep curls followed by alternating dumbbell curls are both examples of compound
setting. Athletes in poor physical condition may find super setting, compound setting, or pre-
exhaustion techniques too strenuous in the early stages of training.36
Other methods to manipulate exercise order are to have an athlete perform upper and lower body
exercises in an alternating fashion. The clinician can also have the athlete perform upper body
push and lower body pull exercises alternatively, or vice versa. Lastly, the athlete can perform a
“push-pull” routine. Here, the athlete can perform a front squat followed by a deadlift. Push-pull
may involve agonists and antagonists, but may also include an upper body “push” exercise
coupled with a lower body “pull”, or vice versa. Collectively, these methods allow more
exercises to be completed within a session and allow greater intensity of each exercise due to
extended recovery of the each muscle group being worked. Plus, these methods help promote
balance and symmetry of agonist-antagonist training.

Rest Period & Resistance/Training Load

Manipulation of all of the above training variables are applicable to the rehabilitating athlete, but
it will require the sports physical therapist to design athlete specific programs, keeping the above
principles in mind. Regardless of injury, it is advised that the athlete have at least 24 hours of
recovery between sessions, and 48 hours in between sessions working the same muscle
group.18,21,22 For a rehabilitating athlete who is seen only 1-2 times per week, a total body routine
is advocated to maximize training balance. If training is done 4-5 days per week, a split routine is
advocated by the authors of this review to allow proper recovery between muscle groups used.
Regarding the athlete who is rehabilitating 3-5 days per week, the authors suggest activities on
“off days” might include flexibility training, yoga, balance and proprioceptive exercises, or
core/abdominal training.
Determining the training load and rest ratios requires careful consideration of the rehabilitating
athlete's sport and the body part or region to be trained. For example, muscles of the trunk are
primarily slow twitch, type I muscle fibers49–51 that necessitate high repetition, low load
endurance based training. Other, more explosive muscles that are prime movers, utilized in
jumping (e.g. quadriceps and gastrocnemius) require strength based training programs,
progressing to lower loads at explosive speeds, and plyometric type training for development of
power.
Training load is usually determined with 1 RM testing in strength and conditioning. The use of 1
RM testing is often disadvantageous for the rehabilitating athlete as it requires a systematic
progressive increase in maximum load lifting capability. Although this method is the most
advantageous and accurate method of determining 1 RM, the use of estimating 1 RM and
training load charts is advisable for these athletes. Other methods for determining training load
include the DeLorme technique, the Daily Adjusted Progressive Resistance Exercise (DAPRE)
technique, the OMNI-RES, or the Oddvar Holten method.52–55 These tables are intended to be
used as a guide until the athlete has developed the neuromuscular capabilities that will allow
them to safely and effectively test with heavier loads to more accurately determine their 1
RM.18 The use of such tables is but one method of determining load, as other methods have
proven effective.55 Training volume is typically prescribed in terms of the number of repetitions
per set, number of sets per session, and the number of sessions per week.56 The importance of
training volume for maximal strength and hypertrophy gains during early phases of resistance
training has previously been demonstrated.57–59 Untrained, normal individuals were shown to
experience maximal strength gains with a mean training intensity of ≈12 RM, while trained
individuals demonstrated these gains with a mean training intensity of ≈8 RM.59
The length of the rest period is dependent on the training goal, the relative load lifted, the sport in
which the athlete participates, and the training status of the athlete. The rest period is a primary
determinant of the overall intensity of a workout, as rest period length is strongly related to the
load lifted.18,21,60 The rest period length not only determines how much of the adenosine
triphosphate-phosphocreatine (ATP-PCr) energy source is recovered,60but also how high post
exercise lactate concentrations become in the blood.47,61–63
Other training principles were outlined and defined in Table 1. Additionally, Tables 2 and
and33 provided descriptions of training load and rest period suggestions. Utilization of concepts
and suggestions given in these tables, as well as the outline provided in Figure 1 will provide the
sports physical therapist the necessary framework to design a proper training program for the
rehabilitating athlete. Integration of these principles into a specific program is the next step.

Table 3.
Rest Period Continuum.18,19,21–23,63

Primary Parameter Trained Rest Period

Muscular Power 5-8 minutes

Primary Parameter Trained Rest Period

Maximal Muscular Strength 3-5 minutes

Muscular Hypertrophy 1-2 minutes

Muscular Endurance 30-60 seconds

Integration of Training Principles and Parameters into a Rehabilitation Program for the
Injured Athlete
The previous sections offered suggestions regarding multiple parameters and the opportunities
for their manipulation of these training principles for the rehabilitating athlete, based on current
evidence and principles used with normal (uninjured) athletes. Additionally, Table 1 defines
periodization, as well as the difference between linear and non-linear periodization. The
rehabilitating athlete may need to be considered similar to the untrained category initially with
respect to the injured body part. Therefore, as outlined in Table 4 the initial non-linear
periodization phase for the injured body part or region should be an emphasis on higher
repetitions and muscle endurance/hypertrophy with a later initiation of strength-based training.
As the patient progresses further in their rehabilitation, additional progression into more
aggressive strength training and power training should be incorporated. Unlike linear
periodization, where the emphasis is on only one parameter (endurance, hypertrophy, strength,
endurance), non-linear periodization allows the clinician the ability to train more than one of
these parameters at a time, while still emphasizing one of them in a particular phase. Although
the literature is lacking regarding the utilization of types of periodization with the rehabilitating
athlete, the opinion of the authors of this review is that the non-linear form of periodization
would most likely fit the rehab process in most instances. Additionally, it is the authors'
suggestion that the rehabilitating athlete continue with some form of training with their
team. Table 4 also offers ideas on how to integrate the rehabilitating athlete into team training
components. This is a general framework upon which the reader can build and individualize a
program specific to the needs of each rehabilitating athlete.
As an alternative to non-linear periodization previously described, a rehabilitation program could
be constructed using short duration linear periodization. Utilizing a short duration linear program
would require initial emphasis on high volume and low intensity (endurance and/or hypertrophy
phase). Progression into the strength/power phase and eventually to the power phase at end stage
rehabilitation would then occur. Once again, the authors of this commentary assert that non-
linear periodization may prove to be a more advantageous method of program design for the
rehabilitating athlete as it affords implementation of multiple variables into the different phases
throughout the rehab program.
Go to:

CONCLUSION
Strength and conditioning principles and training parameters are a necessary component of the
decision making and tailoring of any rehabilitation program. This is especially important in the
rehabilitation and full return to function of an injured athlete. The sports physical therapist
implementing such programs should be cognizant of each the components and variables for the
rehabilitation program of an athlete. Currently the literature has little to offer regarding of the
integration of strength and conditioning concepts into the rehabilitation of the injured athlete.
The benefit of integration of these training principles during the rehabilitation of an injured
athlete, although intuitive for best practice, remains elusive. Future studies should investigate the
extent of the relationship between strength and conditioning principles and their integration into
a rehabilitation program for the rehabilitating athlete. Determining how integral a role these
training principles play for athletic rehabilitation is long overdue
Water aerobics (waterobics, aquatic fitness, aquafitness, aquafit) is the performance of
aerobic exercise in fairly shallow water such as in a swimming pool. Done mostly
vertically and without swimming typically in waist deep or deeper water, it is a type of
resistance training.

Cycling, also called biking or bicycling, is the use

of bicycles for transport, recreation, exercise or sport.[1] People engaged in cycling are referred to as
"cyclists",[2] "bikers",[3] or less commonly, as "bicyclists".[4] Apart from two-wheeled bicycles, "cycling"
also includes the riding of unicycles, tricycles, quadracycles, recumbent and similar human-powered
vehicles (HPVs).
Bicycles were introduced in the 19th century and now number approximately one billion
worldwide.[5] They are the principal means of transportation in many parts of the world.
Cycling is widely regarded as a very effective and efficient mode of transportation[6][7] optimal for short
to moderate distances.
Bicycles provide numerous benefits in comparison with motor vehicles, including the sustained
physical exercise involved in cycling, easier parking, increased maneuverability, and access to
roads, bike paths and rural trails. Cycling also offers a reduced consumption of fossil fuels,
less air or noise pollution, and much reduced traffic congestion. These lead to less financial cost to
the user as well as to society at large (negligible damage to roads, less road area required).By fitting
bicycle racks on the front of buses, transit agencies can significantly increase the areas they can
serve.[8]
Among the disadvantages of cycling are the requirement of bicycles (excepting tricycles or
quadracycles) to be balanced by the rider in order to remain upright, the reduced protection in
crashes in comparison to motor vehicles,[9] often longer travel time (except in densely populated
areas), vulnerability to weather conditions, difficulty in transporting passengers, and the fact that a
basic level of fitness is required for cycling moderate to long distances.
 Walking (also known as ambulation) is one of the main gaits of locomotion among legged animals.
Walking is typically slower than running and other gaits. Walking is defined by an 'inverted
pendulum' gait in which the body vaults over the stiff limb or limbs with each step. This applies
regardless of the unusable number of limbs—even arthropods, with six, eight, or more limbs, walk.

Contents

 1Difference from running

 2Health benefits
 3Origins
 4Variants
 5Biomechanics
 6A leisure activity
o 6.1Walkability
 7In robotics
 8In child amputees
 9Animals
o 9.1Horses
o 9.2Elephants
o 9.3Walking fish
 10See also
 11References
 12External links

Difference from running[edit]

Main article: Running

See also: Jogging

Racewalkers at the World Cup Trials in 1987

The word walk is descended from the Old English wealcan "to roll". In humans and other bipeds,
walking is generally distinguished from running in that only one foot at a time leaves contact with the
ground and there is a period of double-support. In contrast, running begins when both feet are off the
ground with each step. This distinction has the status of a formal requirement in competitive
walking events. For quadrupedal species, there are numerous gaits which may be termed walking or
running, and distinctions based upon the presence or absence of a suspended phase or the number
of feet in contact any time do not yield mechanically correct classification.[1] The most effective
method to distinguish walking from running is to measure the height of a person's centre of
mass using motion capture or a force plate at midstance. During walking, the centre of mass
reaches a maximum height at midstance, while during running, it is then at a minimum. This
distinction, however, only holds true for locomotion over level or approximately level ground. For
walking up grades above 10%, this distinction no longer holds for some individuals. Definitions
based on the percentage of the stride during which a foot is in contact with the ground (averaged
across all feet) of greater than 50% contact corresponds well with identification of 'inverted
pendulum' mechanics and are indicative of walking for animals with any number of limbs, although
this definition is incomplete.[1] Running humans and animals may have contact periods greater than
50% of a gait cycle when rounding corners, running uphill or carrying loads.
Speed is another factor that distinguishes walking from running. Although walking speeds can vary
greatly depending on many factors such as height, weight, age, terrain, surface, load, culture, effort,
and fitness, the average human walking speed at crosswalks is about 5.0 kilometres per hour
(km/h), or about 1.4 meters per second (m/s), or about 3.1 miles per hour (mph). Specific studies
have found pedestrian walking speeds at crosswalks ranging from 4.51 kilometres per hour
(2.80 mph) to 4.75 kilometres per hour (2.95 mph) for older individuals and from 5.32 kilometres per
hour (3.31 mph) to 5.43 kilometres per hour (3.37 mph) for younger individuals;[2][3] a brisk walking
speed can be around 6.5 kilometres per hour (4.0 mph).[4] Champion racewalkers can average more
than 14 kilometres per hour (8.7 mph) over a distance of 20 kilometres (12 mi).
An average human child achieves independent walking ability at around 11 months old.[5]

Health benefits[edit]
Main article: Physical exercise

Regular, brisk exercise of any kind can improve confidence, stamina, energy, weight control and life
expectancy and reduce stress.[6] It can also reduce the risk of coronary heart
disease, strokes, diabetes, high blood pressure, bowel cancer and osteoporosis.[6] Scientific studies
have also shown that walking, besides its physical benefits, is also beneficial for the mind,
improving memory skills, learning ability, concentration and abstract reasoning,[6] as well as
ameliorating spirits.[clarification needed] Sustained walking sessions for a minimum period of thirty to sixty
minutes a day, five days a week, with the correct walking posture,[7] reduce health risks and have
various overall health benefits, such as reducing the chances of cancer, type 2 diabetes, heart
disease, anxiety disorder and depression.[8] Life expectancy is also increased even for individuals
suffering from obesity or high blood pressure. Walking also improves bone health, especially
strengthening the hip bone, and lowering the harmful low-density lipoprotein (LDL) cholesterol, and
raising the useful high-density lipoprotein (HDL) cholesterol.[6] Studies have found that walking may
also help prevent dementia and Alzheimer's.[9]
The Centers for Disease Control and Prevention's fact sheet on the "Relationship of Walking to
Mortality Among U.S. Adults with Diabetes" states that those with diabetes who walked for 2 or more
hours a week lowered their mortality rate from all causes by 39 per cent. Women who took 4,500
steps to 7,500 steps a day seemed to have fewer premature deaths compared to those who only
took 2,700 steps a day.[10] "Walking lengthened the life of people with diabetes regardless of age,
sex, race, body mass index, length of time since diagnosis, and presence of complications or
functional limitations."[11] It has been suggested that there is a relationship between the speed of
walking and health, and that the best results are obtained with a speed of more than 2.5 mph
(4 km/h).[12]
Governments now recognize the benefits of walking for mental and physical health and are actively
encouraging it. This growing emphasis on walking has arisen because people walk less nowadays
than previously. In the UK, a Department of Transport report[13] found that between 1995/97 and
2005 the average number of walk trips per person fell by 16%, from 292 to 245 per year. Many
professionals in local authorities and the NHS are employed to halt this decline by ensuring that the
built environment allows people to walk and that there are walking opportunities available to them.
Professionals working to encourage walking come mainly from six sectors: health, transport,
environment, schools, sport and recreation, and urban design.
One programme to encourage walking is "The Walking the Way to Health Initiative", organized by
the British walkers association The Ramblers, which is the largest volunteer led walking scheme in
the United Kingdom. Volunteers are trained to lead free Health Walks from community venues such
as libraries and doctors' surgeries. The scheme has trained over 35,000 volunteers and have over
500 schemes operating across the UK, with thousands of people walking every week.[14] A new
organization called "Walk England" launched a web site in June 2008 to provide these professionals
with evidence, advice and examples of success stories of how to encourage communities to walk
more. The site has a social networking aspect to allow professionals and the public to ask questions,
post news and events and communicate with others in their area about walking, as well as a "walk
now" option to find out what walks are available in each region. Similar organizations exist in other
countries and recently a "Walking Summit" was held in the United States. This "assembl[ed] thought-
leaders and influencers from business, urban planning and real estate, [along with] physicians and
public health officials", and others, to discuss how to make American cities and communities places
where "people can and want to walk".[15]

Origins[edit]

A walking hamster.

It is theorized that "walking" among tetrapods originated underwater with air-breathing fish that could
"walk" underwater, giving rise (potentially with vertebrates like Tiktaalik)[16] to the plethora of land-
dwelling life that walk on four or two limbs.[17] While terrestrial tetrapodsare theorised to have a single
origin, arthropods and their relatives are thought to have independently evolved walking several
times, specifically in insects, myriapods, chelicerates, tardigrades, onychophorans,
and crustaceans.[18] Little skates, members of the demersalfish community, can propel themselves by
pushing off the ocean floor with their pelvic fins, using neural mechanisms which evolved as early as
420 million years ago, before vertebrates set foot on land.,[19][20]
Judging from footprints discovered on a former shore in Kenya, it is thought possible that ancestors
of modern humans were walking in ways very similar to the present activity as many as 1.5 million
years ago.[21][22]
Variants[edit]

Nordic walkers

 Scrambling is a method of ascending a hill or mountain that involves using both hands, because
of the steepness of the terrain.[23] Of necessity it will be a slow and careful form of walking and
with possibly of occasional brief, easy rock climbing. Some scrambling takes place on narrow
exposed ridges where more attention to balance will be required than in normal walking.
 Snow shoeing – A snowshoe is footwear for walking over the snow. Snowshoes work by
distributing the weight of the person over a larger area so that the person's foot does not sink
completely into the snow, a quality called "flotation". It is often said by snowshoers that if you
can walk, you can snowshoe. This is true in optimal conditions, but snowshoeing properly
requires some slight adjustments to walking. The method of walking is to lift the shoes slightly
and slide the inner edges over each other, thus avoiding the unnatural and fatiguing "straddle-
gait" that would otherwise be necessary. A snowshoer must be willing to roll his or her feet
slightly as well. An exaggerated stride works best when starting out, particularly with larger or
traditional shoes.
 Beach walking is a sport that is based on walk on the sand of the beach. Beach walking can be
developed on compact sand or non-compact sand. There are beach walking competitions on
non-compact sand. And there are world records of beach walking on non-compact sand in
Multiday distances. Beach walking has a specific technique of walk.
 Nordic walking is a physical activity and a sport, which is performed with specially
designed walking poles similar to ski poles. Compared to regular walking, Nordic walking (also
called pole walking) involves applying force to the poles with each stride. Nordic walkers use
more of their entire body (with greater intensity) and receive fitness building stimulation not
present in normal walking for the chest, lats, triceps, biceps, shoulder, abdominals, spinal and
other core muscles that may result in significant increases in heart rate at a given pace.[24] Nordic
walking has been estimated as producing up to a 46% increase in energy consumption,
compared to walking without poles.[25][26]
 Pedestrianism is a sport that developed during the late eighteenth and nineteenth centuries, and
was a popular spectator sport in the British Isles. By the end of the 18th century, and especially
with the growth of the popular press, feats of foot travel over great distances (similar to a
modern ultramarathon) gained attention, and were labeled "pedestrianism". Interest in the sport,
and the wagering which accompanied it, spread to the United States, Canada, and Australia in
the 19th century. By the end of the 19th century, Pedestrianism was largely displaced by the rise
in modern spectator sports and by controversy involving rules, which limited its appeal as a
source of wagering and led to its inclusion in the amateur athletics movement. Pedestrianism
was first codified in the last half of the 19th century, evolving into what would
become racewalking, By the mid 19th century, competitors were often expected to extend their
legs straight at least once in their stride, and obey what was called the "fair heel and toe" rule.
This rule, the source of modern racewalking, was a vague commandment that the toe of one
foot could not leave the ground before the heel of the next foot touched down. This said, rules
were customary and changed with competition. Racers were usually allowed to jog in order to
 fend off cramps, and it was distance, not code, which determined gait for longer races.
Newspaper reports suggest that "trotting" was common in events.[27]
 Power walking or speed walking is the act of walking with a speed at the upper end of the
natural range for walking gait, typically 7 to 9 km/h (4.5 to 5.5 mph). To qualify as power walking
as opposed to jogging or running, at least one foot must be in contact with the ground at all
times (see also fitwalking).
 Racewalking is a long-distance athletic event. Although it is a foot race, it is different
from running in that one foot must appear to be in contact with the ground at all times. Stride
length is reduced, so to achieve competitive speeds, racewalkers must attain cadence rates
comparable to those achieved by Olympic 800-meter runners,[28] and they must do so for hours
at a time since the Olympic events are the 20 km (12.4 mi) race walk (men and women) and 50
km (31 mi) race walk (men only), and 50-mile (80.5 km)events are also held. See
also pedestrianism above.
 Afghan walking: The Afghan Walk is a rhythmic breathing technique synchronized with walking.
It was born in the 1980s on the basis of the observations made by the Frenchman Édouard G.
Stiegler, during his contacts with Afghan caravaners, capable of making walks of more than
60 km per day for dozens of days.[citation needed]

Biomechanics[edit]

Human Walking Cycle

Human walking is accomplished with a strategy called the double pendulum. During forward motion,
the leg that leaves the ground swings forward from the hip. This sweep is the first pendulum. Then
the leg strikes the ground with the heel and rolls through to the toe in a motion described as an
inverted pendulum. The motion of the two legs is coordinated so that one foot or the other is always
in contact with the ground. The process of walking recovers approximately sixty per cent of the
energy used due to pendulum dynamics and ground reaction force.[29][30]
Walking differs from a running gait in a number of ways. The most obvious is that during walking one
leg always stays on the ground while the other is swinging. In running there is typically
a ballistic phase where the runner is airborne with both feet in the air (for bipedals).
Another difference concerns the movement of the centre of mass of the body. In walking the body
"vaults" over the leg on the ground, raising the centre of mass to its highest point as the leg passes
the vertical, and dropping it to the lowest as the legs are spread apart. Essentially kinetic energy of
forward motion is constantly being traded for a rise in potential energy. This is reversed in running
where the centre of mass is at its lowest as the leg is vertical. This is because the impact of landing
from the ballistic phase is absorbed by bending the leg and consequently storing energy
in muscles and tendons. In running there is a conversion between kinetic, potential, and elastic
energy.
There is an absolute limit on an individual's speed of walking (without special techniques such as
those employed in speed walking) due to the upwards acceleration of the centre of mass during a
stride – if it's greater than the acceleration due to gravity the person will become airborne as they
vault over the leg on the ground. Typically however, animals switch to a run at a lower speed than
this due to energy efficiencies.
Based on the 2D inverted pendulum model of walking, there are at least five physical constraints that
place fundamental limits on walking like an inverted pendulum.[31] These constraints are: take-off
constraint, sliding constraint, fall-back constraint, steady-state constraint, high step-frequency
constraint.

A leisure activity[edit]

Hiking with full packs.

Main article: Hiking

Many people enjoy walking as a recreation in the mainly urban modern world, and it is one of the
best forms of exercise.[32] For some, walking is a way to enjoy nature and the outdoors; and for
others the physical, sporting and endurance aspect is more important.
There are a variety of different kinds of walking, including bushwalking, racewalking, beach
walking, hillwalking, volksmarching, Nordic walking, trekking, dog walking and hiking. Some people
prefer to walk indoors on a treadmill, or in a gym, and fitness walkers and others may use
a pedometer to count their steps. Hiking is the usual word used in Canada, the United States
and South Africa for long vigorous walks; similar walks are called tramps in New Zealand, or hill
walking or just walking in Australia, the UK and the Irish Republic. Australians also bushwalk. In
English-speaking parts of North America the term walking is used for short walks, especially in towns
and cities. Snow shoeing is walking in snow; a slightly different gait is required compared with
regular walking.
In terms of tourism the possibilities range from guided walking tours in cities, to
organized trekking holidays in the Himalayas. In the UK the term walking tour also refers to a multi-
day walk or hike undertaken by a group or individual. Well-organized systems of trails exist in many
other European counties, as well as Canada, United States, New Zealand, and Nepal. Systems of
lengthy waymarked walking trails now stretch
across Europe from Norway to Turkey, Portugal to Cyprus.[33] Many also walk the traditional pilgrim
routes, of which the most famous is El Camino de Santiago, The Way of St. James.
Numerous walking festivals and other walking events take place each year in many countries. The
world's largest multi-day walking event is the International Four Days Marches Nijmegen in
the Netherlands. The "Vierdaagse" (Dutch for "Four day Event") is an annual walk that has taken
place since 1909; it has been based at Nijmegen since 1916. Depending on age group and
category, walkers have to walk 30, 40 or 50 kilometers each day for four days.[citation needed] Originally a
military event with a few civilians, it now is a mainly civilian event. Numbers have risen in recent
years, with over 40,000 now taking part, including about 5,000 military personnel.[citation needed] Due to
crowds on the route, since 2004 the organizers have limited the number of participants. In the U.S.,
there is the annual Labor Day walk on Mackinac Bridge, Michigan, which draws over 60,000
participants; it is the largest single-day walking event;[citation needed] while the Chesapeake Bay
Bridge Walk in Maryland draws over 50,000 participants each year.[citation needed]There are also various
walks organised as charity events, with walkers sponsored for a specific cause. These walks range
in length from two miles (3 km) or five km to 50 miles (80 km). The MS Challenge Walk is an 80 km
or 50-mile walk which raises money to fight multiple sclerosis, while walkers in the Oxfam Trailwalker
cover 100 km or 60 miles.
In Britain, The Ramblers, a registered charity, is the largest organisation that looks after the interests
of walkers, with some 100,000 members.[34] Its "Get Walking Keep Walking" project provides free
route guides, led walks, as well as information for people new to walking.[35] The Long Distance
Walkers Association in the UK is for the more energetic walker, and organizes lengthy challenge
hikes of 20 or even 50 miles (30 to 80 km) or more in a day. The LDWA's annual "Hundred" event,
entailing walking 100 miles or 160 km in 48 hours, takes place each British Spring Bank
Holiday weekend.[36]

Walkability[edit]
Main article: Walkability

Gauchetière Street, Montreal, Quebec, Canada

There has been a recent focus among urban planners in some communities to create pedestrian-
friendly areas and roads, allowing commuting, shopping and recreation to be done on foot. The
concept of walkability has arisen as a measure of the degree to which an area is friendly to walking.
Some communities are at least partially car-free, making them particularly supportive of walking and
other modes of transportation. In the United States, the active living network is an example of a
concerted effort to develop communities more friendly to walking and other physical activities.
An example of such efforts to make urban development more pedestrian friendly is the pedestrian
village. This is a compact, pedestrian-oriented neighborhood or town, with a mixed-use village
center, that follows the tenets of New Pedestrianism.[37][38] Shared-use lanes for pedestrians and
those using bicycles, Segways, wheelchairs, and other small rolling conveyances that do not
use internal combustion engines. Generally, these lanes are in front of the houses and businesses,
and streets for motor vehicles are always at the rear. Some pedestrian villages might be nearly car-
free with cars either hidden below the buildings or on the periphery of the village. Venice, Italy is
 essentially a pedestrian village with canals. The canal district in Venice, California, on the other
hand, combines the front lane/rear street approach with canals and walkways, or just
walkways.[37][39][40]
Walking is also considered to be a clear example of a sustainable mode of transport, especially
suited for urban use and/or relatively shorter distances. Non-motorised transport modes such as
walking, but also cycling, small-wheeled transport (skates, skateboards, push scooters and hand
carts) or wheelchair travel are often key elements of successfully encouraging clean urban
transport.[41] A large variety of case studies and good practices (from European cities and some
worldwide examples) that promote and stimulate walking as a means of transportation in cities can
be found at Eltis, Europe's portal for local transport.[42]
The development of specific rights of way with appropriate infrastructure can promote increased
participation and enjoyment of walking. Examples of types of investment include pedestrian malls,
and foreshoreways such as oceanways and also river walks.
The first purpose-built pedestrian street in Europe is the Lijnbaan in Rotterdam, opened in 1953. The
first pedestrianised shopping centre in the United Kingdom was in Stevenagein 1959. A large
number of European towns and cities have made part of their centres car-free since the early 1960s.
These are often accompanied by car parks on the edge of the pedestrianised zone, and, in the
larger cases, park and ride schemes. Central Copenhagen is one of the largest and oldest: It was
converted from car traffic into pedestrian zone in 1962.

Weight training is a common type of strength training for developing the strength and size
of skeletal muscles[1]. It utilizes the force of gravity in the form of weighted bars, dumbbells or weight
stacks in order to oppose the force generated by muscle through concentric or eccentric contraction.
Weight training uses a variety of specialized equipment to target specific muscle groups and types of
movement.
Sports where strength training is central
are bodybuilding, weightlifting, powerlifting, strongman, highland games, hammer throw, shot
put, discus throw, and javelin throw. Many other sports use strength training as part of their training
regimen, notably: American football, baseball, basketball, football, hockey, lacrosse, mixed martial
arts, rowing, rugby league, rugby union, track and field, boxing and wrestling.

Contents

 1History
 2Basic principles
 3Safety
o 3.1Maintaining proper form
o 3.2Stretching and warm-up
o 3.3Breathing
o 3.4Hydration
o 3.5Avoiding pain
o 3.6Other precautions
 4Equipment
 5Types of exercises
o 5.1Isolation exercises versus compound exercises
o 5.2Free weights versus weight machines
 o 5.3Push-pull workout
o 5.4Isotonic and plyometric exercises
 6Health benefits
 7Weight training and other types of strength training
o 7.1Weight training and bodybuilding
o 7.2Complex training
o 7.3Ballistic training
o 7.4Contrast loading
o 7.5Weight training versus isometric training
 8See also
 9References
 10Bibliography

History[edit]

An early plate-loading barbell and kettlebell

The genealogy of lifting can be traced back to the beginning of recorded history[2] where humanity's
fascination with physical abilities can be found among numerous ancient writings. In many
prehistoric tribes, they would have a big rock they would try to lift, and the first one to lift it would
inscribe their name into the stone. Such rocks have been found
in Greek and Scottish castles.[3] Progressive resistance training dates back at least to Ancient
Greece, when legend has it that wrestler Milo of Croton trained by carrying a newborn calf on his
back every day until it was fully grown. Another Greek, the physician Galen, described strength
training exercises using the halteres (an early form of dumbbell) in the 2nd century.
Ancient Greek sculptures also depict lifting feats. The weights were generally stones, but later gave
way to dumbbells. The dumbbell was joined by the barbell in the later half of the 19th century. Early
barbells had hollow globes that could be filled with sand or lead shot, but by the end of the century
these were replaced by the plate-loading barbell commonly used today.[4]
Another early device was the Indian club, which came from ancient India where it was called the
"mugdar" or ''gada''. It subsequently became popular during the 19th century, and has recently made
a comeback in the form of the clubbell.
Weightlifting was first introduced in the Olympics in the 1896 Athens Olympic games as a part of
track and field, and was officially recognized as its own event in 1914.[1]
The 1960s saw the gradual introduction of exercise machines into the still-rare strength
training gyms of the time. Weight training became increasingly popular in the 1970s, following the
release of the bodybuilding movie Pumping Iron, and the subsequent popularity of Arnold
Schwarzenegger. Since the late 1990s increasing numbers of women have taken up weight training,
influenced by programs like Body for Life; currently nearly one in five U.S. women engage in weight
training on a regular basis.[5]

Basic principles[edit]
Main article: Strength training

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A woman doing weight training at a health club with her coach standing behind her.

The basic principles of weight training are essentially identical to those of strength training, and
involve a manipulation of the number of repetitions (reps), sets, tempo, exercise types, and weight
moved to cause desired increases in strength, endurance, and size. The specific combinations of
reps, sets, exercises, and weights depends on the aims of the individual performing the exercise.
In addition to the basic principles of strength training, a further consideration added by weight
training is the equipment used[1]. Types of equipment include barbells, dumbbells, kettlebells, pulleys
and stacks in the form of weight machines, and the body's own weight in the case of chin-
ups and push-ups. Different types of weights will give different types of resistance, and often the
same absolute weight can have different relative weights depending on the type of equipment used.
For example, lifting 10 kilograms using a dumbbell sometimes requires more force than moving 10
kilograms on a weight stack if certain pulley arrangements are used. In other cases, the weight stack
may require more force than the equivalent dumbbell weight due to additional torque or resistance in
the machine. Additionally, although they may display the same weight stack, different machines may
be heavier or lighter depending on the number of pulleys and their arrangements.
Weight training also requires the use of proper or 'good form', performing the movements with the
appropriate muscle group, and not transferring the weight to different body parts in order to move
greater weight (called 'cheating'). Failure to use good form during a training set can result in injury or
a failure to meet training goals. If the desired muscle group is not challenged sufficiently, the
threshold of overload is never reached and the muscle does not gain in strength. At a particularly
advanced level; however, "cheating" can be used to break through strength plateaus and encourage
neurological and muscular adaptation.
Safety[edit]
Weight training is a safe form of exercise when the movements are controlled and carefully defined.
However, as with any form of exercise, improper execution and the failure to take appropriate
precautions can result in injury.

Maintaining proper form[edit]

A dumbbell half-squat.[6]

Maintaining proper form is one of the many steps in order to perfectly perform a certain technique.
Correct form in weight training improves strength, muscle tone, and maintaining a healthy weight.
Proper form will prevent any strains or fractures.[7] When the exercise becomes difficult towards the
end of a set, there is a temptation to cheat, i.e., to use poor form to recruit other muscle groups to
assist the effort. Avoid heavy weight and keep the number of repetitions to a minimum. This may
shift the effort to weaker muscles that cannot handle the weight. For example, the squat and
the deadlift are used to exercise the largest muscles in the body—the leg and buttock muscles—so
they require substantial weight. Beginners are tempted to round their back while performing these
exercises. The relaxation of the spinal erectors which allows the lower back to round can cause
shearing in the vertebrae of the lumbar spine, potentially damaging the spinal discs.

Stretching and warm-up[edit]

Weight trainers commonly spend 5 to 20 minutes warming up their muscles before starting a
workout.[citation needed] It is common to stretch the entire body to increase overall flexibility; however,
many people stretch just the area being worked that day. The main reason for warming up is injury
prevention. Warming up increases blood flow and flexibility, which lessens the chance of a muscle
pull or joint pain.
Warm up sets are also important. When properly warmed up the lifter will have more strength and
stamina since the blood has begun to flow to the muscle groups.[8]

Breathing[edit]
In weight training, as with most forms of exercise, there is a tendency for the breathing pattern to
deepen. This helps to meet increased oxygen requirements. Holding the breath or breathing
shallowly is avoided because it may lead to a lack of oxygen, passing out, or an excessive build up
of blood pressure. Generally, the recommended breathing technique is to inhale when lowering the
weight (the eccentric portion) and exhale when lifting the weight (the concentric portion). However,
the reverse, inhaling when lifting and exhaling when lowering, may also be recommended. Some
researchers state that there is little difference between the two techniques in terms of their influence
on heart rate and blood pressure.[9] It may also be recommended that a weight lifter simply breathes
in a manner which feels appropriate.
Deep breathing may be specifically recommended for the lifting of heavy weights because it helps to
generate intra-abdominal pressure which can help to strengthen the posture of the lifter, and
especially their core.[10]
In particular situations, a coach may advise performing the valsalva maneuver during exercises
which place a load on the spine. The vasalva maneuver consists of closing the windpipe and
clenching the abdominal muscles as if exhaling, and is performed naturally and unconsciously by
most people when applying great force. It serves to stiffen the abdomen and torso and assist the
back muscles and spine in supporting the heavy weight. Although it briefly increases blood pressure,
its is still recommended by weightlifting experts such as Rippetoe since the risk of a stroke by
aneurysm is far lower than the risk of an orthopedic injury caused by inadequate rigidity of the
torso.[11] Some medical experts warn that the mechanism of building "high levels of intra-abdominal
pressure (IAP)...produced by breath holding using the Valsava maneuver", to "ensure spine stiffness
and stability during these extraordinary demands", "should be considered only for extreme weight-
lifting challenges — not for rehabilitation exercise".[12]

Hydration[edit]
As with other sports, weight trainers should avoid dehydration throughout the workout by drinking
sufficient water. This is particularly true in hot environments, or for those older than 65.[13][14][15][16][17]
Some athletic trainers advise athletes to drink about 7 imperial fluid ounces (200 mL) every 15
minutes while exercising, and about 80 imperial fluid ounces (2.3 L) throughout the day.[18]
However, a much more accurate determination of how much fluid is necessary can be made by
performing appropriate weight measurements before and after a typical exercise session, to
determine how much fluid is lost during the workout. The greatest source of fluid loss during exercise
is through perspiration, but as long as your fluid intake is roughly equivalent to your rate of
perspiration, hydration levels will be maintained.[15]
Under most circumstances, sports drinks do not offer a physiological benefit over water during
weight training.[19] However, high-intensity exercise for a continuous duration of at least one hour may
require the replenishment of electrolytes which a sports drink may provide.[20] [21] 'Sports drinks' that
contain simple carbohydrates & water do not cause ill effects, but are most likely unnecessary for the
average trainee.
Insufficient hydration may cause lethargy, soreness or muscle cramps.[22] The urine of well-hydrated
persons should be nearly colorless, while an intense yellow color is normally a sign of insufficient
hydration.[22]

Avoiding pain[edit]
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An exercise should be halted if marked or sudden pain is felt, to prevent further injury. However, not
all discomfort indicates injury. Weight training exercises are brief but very intense, and many people
are unaccustomed to this level of effort. The expression "no pain, no gain" refers to working through
the discomfort expected from such vigorous effort, rather than to willfully ignore extreme pain, which
may indicate serious soft tissue injuries. The focus must be proper form, not the amount of weight
lifted.[23]
Discomfort can arise from other factors. Individuals who perform large numbers of repetitions, sets,
and exercises for each muscle group may experience a burning sensation in their muscles. These
individuals may also experience a swelling sensation in their muscles from increased blood flow also
known as edema (the "pump"). True muscle fatigue is experienced as loss of power in muscles due
to a lack of ATP, the energy used by our body, or a marked and uncontrollable loss of strength in a
muscle, arising from the nervous system (motor unit) rather than from the muscle fibers
themselves[23]. Extreme neural fatigue can be experienced as temporary muscle failure. Some weight
training programs, such as Metabolic Resistance Training, actively seek temporary muscle failure;
evidence to support this type of training is mixed at best.[24] Irrespective of their program, however,
most athletes engaged in high-intensity weight training will experience muscle failure during their
regimens.
Beginners are advised to build up slowly to a weight training program. Untrained individuals may
have some muscles that are comparatively stronger than others; nevertheless, an injury can result if
(in a particular exercise) the primary muscle is stronger than its stabilizing muscles. Building up
slowly allows muscles time to develop appropriate strengths relative to each other. This can also
help to minimize delayed onset muscle soreness. A sudden start to an intense program can cause
significant muscular soreness. Unexercised muscles contain cross-linkages that are torn during
intense exercise. A regimen of flexibility exercises should be implemented before and after workouts.
Since weight training puts great strain on the muscles, it is necessary to warm-up properly. Kinetic
stretching before a workout and static stretching after are a key part of flexibility and injury
prevention.

Other precautions[edit]
Anyone beginning an intensive physical training program is typically advised to consult a physician,
because of possible undetected heart or other conditions for which such activity is contraindicated.
Exercises like the bench press or the squat in which a failed lift can potentially result in the lifter
becoming trapped under the weight are normally performed inside a power rack or in the presence
of one or more spotters, who can safely re-rack the barbell if the weight trainer is unable to do so. In
addition to spotters, knowledge of proper form and the use of safety bars can go a long way to keep
a lifter from suffering injury due to a failed repetition.

Equipment[edit]
Main article: Exercise equipment

Weight training usually requires different types of equipment, most

commonly dumbbells, barbells, weight plates, and weight machines. Various combinations
of specific exercises, machines, dumbbells, and barbells allow trainees to exercise body parts in
numerous ways.
A lifting strap.

A lifting belt.

Other types of equipment include:

 Lifting straps, which allow more weight to be lifted by transferring the load to the wrists and
avoiding limitations in forearm muscles and grip strength
 Weightlifting belts, which are meant to brace the core through intra-abdominal pressure.
Controversy exists regarding the safety of these devices[24] and their proper use is often
misunderstood.
 Weighted clothing, bags of sand, lead shot, or other materials that are strapped to wrists, ankles,
torso or other body parts to increase the amount of work required by muscles
 Gloves can improve grip, prevent the formation of calluses on the hands, relieve pressure on the
wrists, and provide support.[25]
 Chalk (MgCO3), which dries out sweaty hands, improving grip
 Wrist and knee wraps
 Shoes, which have a flat, rigid sole to provide a sturdy base of support, and may feature a raised
heel of varying height (usually 0.5" or 0.75") to accommodate a lifter's biomechanics for more
efficient squats, deadlifts, overhead presses, and Olympic lifts.

Types of exercises[edit]
See also: List of weight training exercises
Isolation exercises versus compound exercises[edit]
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The leg extension is an isolation exercise.

An isolation exercise is one where the movement is restricted to one joint only. For example,
the leg extension is an isolation exercise for the quadriceps. Specialized types of equipment are
used to ensure that other muscle groups are only minimally involved—they just help the individual
maintain a stable posture—and movement occurs only around the knee joint. Isolation exercises
involve machines, dumbbells, barbells (free weights), and pulley machines. Pulley machines and
free weights can be used when combined with special/proper positions and joint bracing.
Compound exercises work several muscle groups at once, and include movement around two or
more joints. For example, in the leg press, movement occurs around the hip, knee and ankle joints.
This exercise is primarily used to develop the quadriceps, but it also involves the hamstrings, glutes
and calves. Compound exercises are generally similar to the ways that people naturally push, pull
and lift objects, whereas isolation exercises often feel a little unnatural.
Each type of exercise has its uses. Compound exercises build the basic strength that is needed to
perform everyday pushing, pulling and lifting activities. Isolation exercises are useful for "rounding
out" a routine, by directly exercising muscle groups that cannot be fully exercised in the compound
exercises.
The type of exercise performed also depends on the individual's goals. Those who seek to increase
their performance in sports would focus mostly on compound exercises, with isolation exercises
being used to strengthen just those muscles that are holding the athlete back. Similarly,
a powerlifter would focus on the specific compound exercises that are performed at powerlifting
competitions. However, those who seek to improve the look of their body without necessarily
maximizing their strength gains (including bodybuilders) would put more of an emphasis on isolation
exercises. Both types of athletes, however, generally make use of both compound and isolation
exercises[26].
Free weights versus weight machines[edit]

Exercise balls allow a wider range of free weight exercises to be performed. They are also known as Swiss
balls, stability balls, fitness balls, gym balls, sports balls, therapy balls or body balls. They are sometimes
confused with medicine balls.

Free weights include dumbbells, barbells, medicine balls, sandbells, and kettlebells. Unlike weight
machines, they do not constrain users to specific, fixed movements, and therefore require more
effort from the individual's stabilizer muscles. It is often argued that free weight exercises are
superior for precisely this reason. For example, they are recommended for golf players, since golf is
a unilateral exercise that can break body balances, requiring exercises to keep the balance in
muscles.[27]

The weight stack from a cable machine.

Some free weight exercises can be performed while sitting or lying on an exercise ball.
There are a number of weight machines that are commonly found in neighborhood gyms.
The Smith machine is a barbell that is constrained to vertical movement. The cable machine consists
of two weight stacks separated by 2.5 metres, with cables running through adjustable pulleys (that
can be fixed at any height so as to select different amounts of weight) to various types of handles.
There are also exercise-specific weight machines such as the leg press. A multigym includes a
variety of exercise-specific mechanisms in one apparatus.
One limitation of many free weight exercises and exercise machines is that the muscle is working
maximally against gravity during only a small portion of the lift. Some exercise-specific machines
feature an oval cam (first introduced by Nautilus) which varies the resistance, so that the resistance,
and the muscle force required, remains constant throughout the full range of motion of the exercise.
Push-pull workout[edit]
A push–pull workout is a method of arranging a weight training routine so that exercises alternate
between push motions and pull motions.[28] A push–pull superset is two complementary segments
(one pull/one push) done back-to-back. An example is bench press (push) / bent-over row (pull).
Another push–pull technique is to arrange workout routines so that one day involves only push
(usually chest, shoulders and triceps) exercises, and an alternate day only pull (usually back and
biceps) exercises so the body can get adequate rest.[29]

Isotonic and plyometric exercises[edit]

These terms combine the prefix iso- (meaning "same") with tonic ("strength") and plio- ("more")
with metric ("distance"). In "isotonic" exercises the force applied to the muscle does not change
(while the length of the muscle decreases or increases) while in "plyometric" exercises the length of
the muscle stretches and contracts rapidly to increase the power output of a muscle.
Weight training is primarily an isotonic form of exercise, as the force produced by the muscle to
push or pull weighted objects should not change (though in practice the force produced does
decrease as muscles fatigue). Any object can be used for weight training, but dumbbells, barbells,
and other specialised equipment are normally used because they can be adjusted to specific
weights and are easily gripped. Many exercises are not strictly isotonic because the force on the
muscle varies as the joint moves through its range of motion. Movements can become easier or
harder depending on the angle of muscular force relative to gravity; for example, a standard biceps
curl becomes easier as the hand approaches the shoulder as more of the load is taken by the
structure of the elbow. Originating from Nautilus, Inc., some machines use a logarithmic-
spiral cam to keep resistance constant irrespective of the joint angle.
Plyometrics exploit the stretch-shortening cycle of muscles to enhance the myotatic (stretch) reflex.
This involves rapid alternation of lengthening and shortening of muscle fibers against resistance.
The resistance involved is often a weighted object such as a medicine ball or sandbag, but can also
be the body itself as in jumping exercises or the body with a weight vest that allows movement with
resistance. Plyometrics is used to develop explosive speed, and focuses on maximal power instead
of maximal strength by compressing the force of muscular contraction into as short a period as
possible, and may be used to improve the effectiveness of a boxer's punch, or to increase the
vertical jumping ability of a basketball player. Care must be taken when performing plyometric
exercises because they inflict greater stress upon the involved joints and tendons than other forms
of exercise.

Health benefits[edit]
Benefits of weight training include increased strength, muscle mass, endurance, bone and bone
mineral density, insulin sensitivity, GLUT 4 density, HDL cholesterol, improved cardiovascular health
and appearance, and decreased body fat, blood pressure, LDL cholesterol and triglycerides.[30]
The body's basal metabolic rate increases with increases in muscle mass, which promotes long-
term fat loss and helps dieters avoid yo-yo dieting.[31] Moreover, intense workouts
elevate metabolism for several hours following the workout, which also promotes fat loss.[32]
Weight training also provides functional benefits. Stronger muscles improve posture, provide better
support for joints, and reduce the risk of injury from everyday activities. Olderpeople who take up
weight training can prevent some of the loss of muscle tissue that normally accompanies aging—and
even regain some functional strength—and by doing so, become less frail.[33] They may be able to
avoid some types of physical disability. Weight-bearing exercise also helps to
prevent osteoporosis.[34] The benefits of weight training for older people have been confirmed by
studies of people who began engaging in it even in their eighties and nineties.
For many people in rehabilitation or with an acquired disability, such as following stroke or
orthopaedic surgery, strength training for weak muscles is a key factor to optimise recovery.[35] For
people with such a health condition, their strength training is likely to need to be designed by an
appropriate health professional, such as a physiotherapist.
Stronger muscles improve performance in a variety of sports. Sport-specific training routines are
used by many competitors. These often specify that the speed of muscle contraction during weight
training should be the same as that of the particular sport. Sport-specific training routines also often
include variations to both free weight and machine movements that may not be common for
traditional weightlifting.
Though weight training can stimulate the cardiovascular system, many exercise physiologists, based
on their observation of maximal oxygen uptake, argue that aerobics training is a better
cardiovascular stimulus. Central catheter monitoring during resistance training reveals
increased cardiac output, suggesting that strength training shows potential for cardiovascular
exercise. However, a 2007 meta-analysis found that, though aerobic training is an effective therapy
for heart failure patients, combined aerobic and strength training is ineffective; "the favorable
antiremodeling role of aerobic exercise was not confirmed when this mode of exercise was
combined with strength training".[36]
One side-effect of any intense exercise is increased levels
of dopamine, serotonin and norepinephrine, which can help to improve mood and counter feelings
of depression.[37]
Weight training has also been shown to benefit dieters as it inhibits lean body mass loss (as
opposed to fat loss) when under a caloric deficit. Weight training also strengthens bones, helping to
prevent bone loss and osteoporosis. By increasing muscular strength and improving balance, weight
training can also reduce falls by elderly persons. Weight training is also attracting attention for the
benefits it can have on the brain, and in older adults, a 2017 meta analysis found that it was effective
in improving cognitive performance.[38]

Weight training and other types of strength training[edit]

The benefits of weight training overall are comparable to most other types of strength training:
increased muscle, tendon and ligament strength, bone density, flexibility, tone, metabolic rate, and
postural support. This type of training will also help prevent injury for athletes. There are benefits and
limitations to weight training as compared to other types of strength training. Contrary to popular
belief, weight training can be beneficial for both men and women.

Weight training and bodybuilding[edit]

Although weight training is similar to bodybuilding, they have different objectives. Bodybuilders use
weight training to develop their muscles for size, shape, and symmetry regardless of any increase in
strength for competition in bodybuilding contests; they train to maximize their muscular size and
develop extremely low levels of body fat. In contrast, many weight trainers train to improve their
strength and anaerobic endurance while not giving special attention to reducing body fat far below
normal.
The bodybuilding community has been the source of many weight training principles, techniques,
vocabulary, and customs. Weight training does allow tremendous flexibility in exercises and weights
which can allow bodybuilders to target specific muscles and muscle groups, as well as attain specific
goals. Not all bodybuilding is undertaken to compete in bodybuilding contests and, in fact, the vast
majority of bodybuilders never compete, but bodybuild for their own personal reasons.
Complex training[edit]
In complex training, weight training is typically combined with plyometric exercises in an alternating
sequence. Ideally, the weight lifting exercise and the plyometric exercise should move through
similar ranges of movement i.e. a back squat at 85-95% 1RM followed by a vertical jump. An
advantage of this form of training is that it allows the intense activation of the nervous system and
increased muscle fibre recruitment from the weight lifting exercise to be utilized in the subsequent
plyometric exercise; thereby improving the power with which it can be performed. Over a period of
training, this may enhance the athlete's ability to apply power.[39] The plyometric exercise may be
replaced with a sports specific action. The intention being to utilize the neural and muscular
activation from the heavy lift in the sports specific action, in order to be able to perform it more
powerfully. Over a period of training this may enhance the athlete's ability to perform that sports
specific action more powerfully, without a precursory heavy lift being required.

Ballistic training[edit]
Ballistic training incorporates weight training in such a way that the acceleration phase of the
movement is maximized and the deceleration phase minimized; thereby increasing the power of the
movement overall. For example, throwing a weight or jumping whilst holding a weight. This can be
contrasted with a standard weight lifting exercise where there is a distinct deceleration phase at the
end of the repetition which stops the weight from moving.[40]

Contrast loading[edit]
Contrast loading is the alternation of heavy and light loads. Considered as sets, the heavy load is
performed at about 85-95% 1 repetition max; the light load should be considerably lighter at about
30-60% 1RM. Both sets should be performed fast with the lighter set being performed as fast as
possible. The joints should not be locked as this inhibits muscle fibre recruitment and reduces the
speed at which the exercise can be performed. The lighter set may be a loaded plyometric exercise
such as loaded squat jumps or jumps with a trap bar.
Similarly to complex training, contrast loading relies upon the enhanced activation of the nervous
system and increased muscle fibre recruitment from the heavy set, to allow the lighter set to be
performed more powerfully.[41] Such a physiological effect is commonly referred to as post-activation
potentiation, or the PAP effect. Contrast loading can effectively demonstrate the PAP effect: if a light
weight is lifted, and then a heavy weight is lifted, and then the same light weight is lifted again, then
the light weight will feel lighter the second time it has been lifted. This is due to the enhanced PAP
effect which occurs as a result of the heavy lift being utilised in the subsequent lighter lift; thus
making the weight feel lighter and allowing the lift to be performed more powerfully.

Weight training versus isometric training[edit]

See also: Isometric exercise § Comparison with dynamic exercises

Isometric exercise provides a maximum amount of resistance based on the force output of the
muscle, or muscles pitted against one another. This maximum force maximally strengthens the
muscles over all of the joint angles at which the isometric exercise occurs. By comparison, weight
training also strengthens the muscle throughout the range of motion the joint is trained in, but only
maximally at one angle, causing a lesser increase in physical strength at other angles from the initial
through terminating joint angle as compared with isometric exercise. In addition, the risk of injury
from weights used in weight training is greater than with isometric exercise (no weights), and the risk
of asymmetric training is also greater than with isometric exercise of identical opposing muscles.
 Stretching is a form of physical exercise in which a specific muscle or tendon (or muscle group) is
deliberately flexed or stretched in order to improve the muscle's felt elasticity and achieve
comfortable muscle tone.[1] The result is a feeling of increased muscle control, flexibility, and range of
motion. Stretching is also used therapeutically to alleviate cramps.[2]

A stretching Siberian tiger

In its most basic form, stretching is a natural and instinctive activity; it is performed by humans and
many other animals. It can be accompanied by yawning. Stretching often occurs instinctively after
waking from sleep, after long periods of inactivity, or after exiting confined spaces and areas.
Increasing flexibility through stretching is one of the basic tenets of physical fitness. It is common for
athletes to stretch before (for warming up) and after exercise in an attempt to reduce risk of injury
and increase performance.[3]:42
Stretching can be dangerous when performed incorrectly. There are many techniques for stretching
in general, but depending on which muscle group is being stretched, some techniques may be
ineffective or detrimental, even to the point of causing hypermobility, instability, or permanent
damage to the tendons, ligaments, and muscle fiber.[4] The physiological nature of stretching and
theories about the effect of various techniques are therefore subject to heavy inquiry.
Although static stretching is part of some warm-up routines, a study in 2013 indicated that it
weakens muscles. For this reason, an active dynamic warm-up is recommended before exercise in
place of static stretching.[5]

Contents

 1Physiology
 2Types of stretches
o 2.1Dynamic stretching
 o 2.2Static stretching
 3Effectiveness
 4Stretching tools
 5References
 6Further reading

Physiology[edit]
Studies have shed light on the function, in stretching, of a large protein within the myofibrils of
skeletal muscles named titin.[6] A study performed by Magid and Law demonstrated that the origin of
passive muscle tension (which occurs during stretching) is actually within the myofibrils, not
extracellularly as had previously been supposed.[7] Due to neurological safeguards against injury
such as the Golgi tendon reflex, it is normally impossible for adults to stretch most muscle groups to
their fullest length without training due to the activation of muscle antagonists as the muscle reaches
the limit of its normal range of motion.[4]

Types of stretches[edit]

Football player Luis Suárez stretching prior to a match.

Martin Brodeurstretching on the Devils' bench during warmups.

Assisted stretching may be performed when the athlete is unable to stretch optimally independently. For
example, during cramping of the hamstrings, assistance in stretching out the muscles may help.

Stretches can be either static or dynamic, where static stretches are performed while stationary and
dynamic stretches involve movement of the muscle during the stretch. Stretches can also
be active or passive, where active stretches use internal forces generated by the body to perform a
stretch and passive stretches involve forces from external objects or people to facilitate the stretch.
Stretches can involve both passive and active components.[8]

Dynamic stretching[edit]
Dynamic stretching is a movement based stretch aimed on increasing blood flow throughout the
body while also loosing up the muscle fibers. Standard dynamic stretches typically involve slow and
controlled active contraction of muscles. An example of such a dynamic stretch are lunges. Another
form of dynamic stretching is ballistic stretching, which is an active stretch that involves bouncing or
swinging back and forth at a high speed in order to take a muscle beyond its typical range of motion
using momentum. Ballistic stretching may cause damage to the joints.[8]

Static stretching[edit]
The simplest static stretches are static-passive stretches, which bring the joint to its end range of
motion and hold it there using external forces. There are more advanced forms of static stretching,
such as proprioceptive neuromuscular facilitation (PNF), which involves both active muscle
contractions and passive external forces.[3]:42[9] PNF stretching may involve contracting either the
antagonist muscles, agonist muscles, or both (CRAC).[10]

Effectiveness[edit]

A roller derby athlete stretching

Although many people engage in stretching before or after exercise, the medical evidence has
shown this has no meaningful benefit in preventing muscle soreness.[11]
Stretching does not appear to reduce the risk of injury during exercises, except perhaps for
runners.[12] There is some evidence that pre-exercise stretching may increase athletes' range of
movement.[12][13]
There are different positives and negatives for the two main types of stretching: static and dynamic.
Static stretching is better at creating a more intense stretch because it is able to isolate a muscle
group better[citation needed]. But this intense of a stretch may hinder one's athletic performance because
the muscle is being over stretched while held in this position and, once the tension is released, the
muscle will tend to tighten up and may actually become weaker than it was previously[citation needed]. Also,
the longer the duration of static stretching, the more exhausted the muscle becomes. This type of
stretching has been shown to have negative results on athletic performance within the categories of
power and speed[citation needed].
Dynamic stretching, because it is movement-based, may not isolate the muscle group as well or
have as intense of a stretch, but it is better at increasing the circulation of blood flow throughout the
body, which in turn increases the amount of oxygen able to be used for an athletic performance. This
type of stretching has shown better results on athletic performances of power and speed, when
compared to static stretching[citation needed].
However, both of these types of stretching have been shown to have a positive impact on flexibility
over time by increasing muscle and joint elasticity, thus increasing the depth and range of motion an
athlete is able to reach.[1] This is evident in the experiment "Acute effects of duration on sprint
performance of adolescent football players." In this experiment, football players were put through
different stretching durations of static and dynamic stretching to test their effects. They were tested
on maximum sprinting ability and overall change in flexibility. Both static and dynamic stretching had
a positive impact on flexibility but, whereas dynamic stretching had no impact on sprint times, static
stretching had a negative result, worsening the time the participants were able to sprint the distance
in. While the duration of stretching for dynamic had no impact on the overall results, the longer the
stretch was held for static, the worse the results got, showing that the longer the duration of
stretching held, the weaker the muscle became.[citation needed]

RELAXATION

the feeling of being relaxed:

I go fishing for relaxation.

a pleasant activity that makes you become calm and less worried: