Exercise Prescription Revision

Training Age and Experience

- Training age: this refers to the number of years a person has been exercising
regularly immediately prior to your assessment. The greater the training age
is, the more advanced their exercise prescription can be.
- Training experience: this refers to the overall history of exercise. This takes
into account not only the number of years of training experience, but also their
level of training based off the activities they have participated in. Different
exercises/hobbies require different neurological demands, therefore programs
will vary depending on history e.g. a program for a gymnast will be vastly
different to that of an endurance runner as gymnastics has greater
neurological demand.
- The greater the persons training experience in both years and complexity, the
more frequently you will need to modify their program, and the more
advanced your initial prescription will be.

Needs Analysis
One of the most important skills in exercise prescription is for the EP to be able to
perform an assessment of the clients’ needs and what their current abilities are. The
difference between the 2 forms the basis for the client exercise program.
It is very easy to underestimate client needs. Some of the factors that are not
considered include:
- Current loading exposure: it is a common mistake to underload a client due to
poor understanding/consideration of current lifestyle habits/commitments. E.g.
a post-natal mother will often be prescribed weights between 2 – 3kgs despite
being accustomed to holding her baby (>6kgs) for prolonged periods of time.
- Environmental conditions: each sport/activity has a different surrounding e.g.
a surfers environment is much more unstable compared to a sprinters track,
therefore the demand for stability is of greater importance when prescribing
exercise to a surfer.
- Physical contact: different sports/jobs require different levels of contact, if any
at all, therefore strength and power will be vastly different between different
athletes e.g. a rugby player would require much more strength/power
compared to a basket baller, whereas a tradesman would require greater
strength compared to an office worker.

Movement Patterns
All sport, work and daily activities can be broken down into 7 key movement patterns:
1. Knee dominant movements such as the squat
2. Hip dominant movements such as the deadlift
3. Upper body press/push in both vertical and horizontal planes such as the
military press and push-ups, respectively
4. Upper body pull in both vertical and horizontal planes such as the lat-
pulldown and seated cable row, respectively
5. Lunging
6. Twisting movements including anti-rotary movements such as Russian twists
and pallof presses
7. Gait patterns such as walking and running

Sets and Repetitions

The set and repetition ranges prescribed in any exercise program should reflect the
goals of the overall program itself e.g. some programs are strength-based whereas
others are focused more so on hypertrophy and growth.

Muscle Fibre Type

- Fast twitch muscles require heavier loads, but lower repetition ranges
- Slow twitch muscles require lighter loads, but with greater repetition ranges

In general, the major muscles of the body are as follows:

Pectorals: fast twitch dominant
Triceps: fast twitch dominant
Biceps: fast twitch dominant
Deltoids: mixed - slow twitch dominant
Abdominals: slightly slow twitch dominant 
Trapezius: slow twitch dominant
Spinal erectors: slow twitch dominant
Glutes: mixture of both fibre types
Hamstrings: mixture of both fibre types
Quadriceps: mixture of both fibre types
Calves: slow twitch

Tempo
This is an important factor when it comes to exercise prescription as it allows for the
program to be tailored to help the client meet their desired goals and needs e.g.
strength, hypertrophy, power etc. it is commonly written as a 4-digit number e.g.
3210.
- First number: refers to the eccentric or lengthening phase of the exercise
- Second number: refers to the pause time at the end of the eccentric phase
- Third number: refers to the concentric phase of the exercise
- Fourth number: refers to the pause at the end of the concentric phase

Number of Exercises
Typical whole-body programs will consist of between 8 – 12 exercise however it is
important to consider other factors such as:
 - Training goals: the number of sets and repetitions should reflect the training
goals, as shown in the tables above.
- Available time: you need to consider how much time your client is willing/able
to commit to exercising. Be mindful of other commitments e.g. family and
work schedules
- Exercise modality/modalities: incorporating a combination of aerobic and
resistance training into one session will require a lower number of exercises.
On the other hand, focusing solely on one modality per session will allow for
more exercises in a strength program, or longer aerobic training sessions
- Training experience and age: more advanced clients will require a greater
number of exercises, load and/or repetitions in order for further adaptations to
occur. On the other hand, a novice client will adapt with lower intensities and
fewer exercises
- Neurological fatigue: it is important that motor control stays below the
neurological threshold, however at the same time, the program needs to have
enough loading to ensure that the body ill be appropriately challenged, and
will adapt accordingly.

Order of Exercises
Movement preparation exercises should be performed prior to strengthening
exercises. These include:
- Stretching/release of over-active muscles. Be mindful that too much
stretching prior strength training can lead to injury due to a reduction in the
number of cross-bridge attachments. Pressure-point release is useful.
- Activation drills to ‘wake-up’ muscles that tend to switch off or become
inhibited e.g. glutes when seated
- Mobility drills
It is always recommended to start with complex exercises that are the most
neurologically demanding and recruit multiple major muscle groups e.g. deadlifts,
squats, lunges etc. Finish with isolated exercise e.g. curls.

Injury
- In the initial stages of rehabilitation where the inflammatory process is active,
the intensity of the exercise should be no greater than 60%.
- A higher repetition and lower intensity approach enables adequate blood
supply to provide the necessary oxygen and nutrients to aid in tissue healing.
- This also ensures that there is no disruption to the integrity of the damaged
tissue

Basic Periodisation
- The type of periodised model used should reflect the S&C training age of the athlete
and not their competition age or rank. These generally entail little variation and
relatively flat workloads with the main emphasis being on the logical and therefore
potentiated progression of biomotors (e.g. strength endurance, strength and power).
As an example of this basic strategy, the athlete essentially completes a
hypertrophy/strength endurance phase for 4 microcycles (or 1 mesocycle), a strength
phase for 4 microcycles, and then a power phase for 4 microcycles. Each phase
(dependent on the prescribed volume loads) may be further separated by an
unloading week, as may also happen after the power phase and before the
competition. In addition, heavy and light days may still be prescribed. This strategy,
considered appropriate for athletes with an S&C age of zero, introduces them to S&C
(i.e., the merits of and the required discipline) and periodization (i.e., the need to
systematically alter the emphasized biomotors and a quality over quantity approach)
and enables them to get a ‘‘feel’’ for gym-based training interventions and developing
their associated technique. As a final note on this basic model (which is applicable to
all models), to ensure the athlete gets the most out of each phase, the S&C coach
should ensure that they are technically sound to perform the exercise of each phase
before progressing onto it. For example, power cleans and snatches may be part of
the power phase; however, the athlete should start practicing and developing them in
the strength endurance phase to ensure effective training by the time they are called
into use.

Exercise Progression
It is important to be able to distinguish between:
- Exercise progression: modifying an exercise to make it progressively harder
for the client. E.g. progressing the glute bridge to the glute bridge with leg lift
exercise.
- Exercise program progression: this involves modifying the initial program by
changing the exercises so that incorporates more functional movement
patterns. E.g. the glute bridge would be a good starting point in order for
clients with low back pain to develop lumbopelvic stability and strength,
however progressing the exercise with increases in volume and/or intensity
does not allow for functional adaptations to occur as it does not allow for hip
loading during a weight-bearing position. This skill would be better progressed
through a deadlift movement pattern as it closely replicates the demands
associated with common lifting tasks.

Periodisation
This is an essential part of training for athletes to ensure that they are in peak
condition for competition
- Exercise programs are designed in 3 – 4 phases (macrocycles) in which the
focus of the program will differ with each phase e.g. strength, power and
endurance. The latter the phase, the more specific the training program is to
the client’s goals.
- Each phase has both a progressive increase in intensity as well as a
deloading component to prevent neurological fatigue.

Linear Periodisation
- This is the traditional mode of periodisation in which the intensity of the
exercise program increases linearly throughout each phase (image above). At
the start of each mesocycle, the intensity is modified through reductions in
repetition range and increases in %RM.

Undulating Periodisation
- This involves the manipulation of repetition ranges each exercise session.
- The theory that underpins this style centres around the concept that the body
adapts faster to repetition ranges when compared to the actual exercises
performed. As a result, the rep ranges are changed more frequently than the
exercises themselves.

Application of Periodisation to Rehabilitation Programs

The typical phases used in a rehab setting include:
- Stabilisation: correct the injury and injury-related deficits. This may
incorporate mobility, motor control, postural control and proprioception
exercises.
- Strengthening: this builds on the previous phase by continuing to develop
stability and strength specific to the clients needs. This involves introducing
complex exercises using multiple muscle groups.
- Power: the primary goal is to develop power relative to the clients needs. The
end of this phase should mark the return to normal function.

Calculating the intensity of sessions

- Desired training effects will only occur when appropriate adjustments to load
are made throughout the duration of each phase of periodisation.
- It also allows for the monitoring of fatigue, which will assist in determining
when the program will need to be modified.
- Training load is a function of volume, frequency and intensity (%RM). A
change in any one of these variables will require subsequent alterations in the
other two.

Internal Load
- This refers to the effect that the exercise is having internally on your client,
and provides assurance that they are not overtraining. Measurable variables
include:
- Heart rate
- RPE
- Heart rate variability
- Questionnaires
- VO2max