Women’s Posture – Part 1
View from front and back (check for symmetry):Head straight
Hips and shoulders level
Hands parallel to each other
Knees over middle toes
View from side (check alignment):
Ankle, knee, hip, shoulder and ear line up
Chest up, shoulders back, head erect
Slight bend in knees and elbows (i.e., unlocked)
Natural arch in lower back
Here are two simple tests you can perform on your female clients to check their postural alignment:
Have your client stand with her back about two inches away from a wall. While keeping her feet flat on the floor and hip width apart, she should lean back towards the wall (see Figure 4). If her shoulder blades and buttocks touch the wall simultaneously, then she is in complete alignment. However, if one side of her body touches the wall before the other or her shoulders touch the wall before her butt does, then she has an imbalance.
While standing against the wall (make sure her heels, butt, upper back and head are touching the wall), ask you to try to slide her hand between the wall and the small of her back (see Figure 5). If her hand gets caught between her back and the wall, then she has a normal lumbar (lordotic) curvature. If she can barely get her fingers through, then she does not have enough of a curve in her lower back. If her entire hand slides through, she has too much lumbar curvature.
Posture Related Problems for Women
Women tend to experience several posture related problems. Although many people think large breasts are enviable, many problems exist for large breasted women: shoulder and back strain, headaches, sagging, sore shoulders and poor posture. Breasts encourage the shoulders to round forward. The bigger/heavier the breasts, the greater the rounding that occurs. Unfortunately, as the shoulder girdle migrates forward, the head is also pulled forward, resulting in a forward head syndrome and a kyphotic posture. It is this kyphotic or hunchback posture that encourages slouching, especially in taller, well endowed women. It is interesting to note that the current trend of breast augmentation surgery is causing a slew of lower back patients because their back muscles are not strong enough to counter the extra weight of the chest implants. As a result, these women develop poor posture and experience unnecessary pain (as you will read later, it is important to stretch the tight chest muscles and strengthen the weak back muscles in your exercise program to achieve/restore proper balance.) Breasts appear larger with good posture! Read that sentence again. Therefore, your clients should try to improve their posture first before ever considering any kind of surgery!
Another condition common to women is osteoporosis. Due to a reduction in physical activity and subsequent loss of muscle, a decrease in bone mass and fragility occurs, causing skeletal disfigurations. According to Sinaki, kyphotic postural change is the most physically disfiguring and psychologically damaging effect of osteoporosis and can contribute to an increment in vertebral fractures and the risk of falling. Unfortunately, it has been found that many females lose their ability to extend the thoracic spine and develop kyphosis at a relatively young age (starting as early as 22 years old.) This is yet another reason to exercise on a regular basis (particularly weight bearing exercises) and pay close attention to posture.
Since women are designed with wider hips (causing something called a greater Q-angle between the hips and legs when compared to men) to facilitate the child-bearing process. The pelvis will undergo anterior (forward) pelvic tilt if an imbalance exists between the hip flexors and the lower abdominals. This is quite common since the hip flexors (in particular, the psoas muscle) tend to be the tightest muscles in the human body and are much stronger than the often weak lower abdominal muscles. As a result, the pelvis tilts forward, causing a hyperlordotic posture (or too much arch in the lower back) and a distended abdomen. Inevitably, this will eventually lead to lower back problems and may also cause pain to occur in the hip, knees, ankles and feet. Although posture does naturally change during pregnancy, a forward pelvic tilt will not make childbirth easy!
Women make this problem worse by wearing high heeled shoes, which causes further anterior pelvic tilt and will also tighten and excessively shorten the calves. Women who wear heels often tend to lean forward when squatting. This will lead to problems when picking up a heavy object from the ground because the greater you lean forward when squatting or bending, the greater the strain on your lower back. In this situation, the calves must be stretched often (remember to warm up first, though). In addition to the dangers of high heels, it has also been postulated that constrictive clothing such as tight collars, belts, girdles and garters could adversely affect the spine and compress the abdomen, producing a multitude of symptoms. It is far better to activate your deep abdominal wall naturally. Thus, the first step towards obtaining a flat stomach and reducing joint discomfort should be to improve your posture.
In order for your female clients to improve their posture, they must first become aware of it and any bad habits they may have developed. So suggest your clients check their posture, no matter if they are sitting, standing or lying down, every 20 to 30 minutes (a watch can be set, if necessary). They could get into the habit of checking and correcting their posture when the phone rings, when receiving or sending email, during commercials or even when they are just talking to someone face to face. For example, it is common to lean on one side or stand with most of your weight on one leg. Your clients can correct this problem by distributing their weight evenly between both legs and standing tall. Simply visualize being pulled up by your head to help straighten out!
Your clients must be patient in their quest for improved posture. To your nervous system, it takes approximately 300 repetitions to form a new skill. However, it takes more than 5,000 repetitions to reformulate a skill. In other words, it takes a long time to break bad habits! Eventually, though, you can transform old posture but only with lots of practice!
Stay tuned for Part 2 of this series, which will show several strengthening and stretching exercises to improve posture and increase flexibility in your female clients. Part 2 will also address the psychological and social aspects of posture.
How Young Athletes Learn
How Young Athletes Learn
In all the industry banter about how best to develop biomotor abilities, we often overlook two specific aspects of youth athlete development that are quite paramount to the potential success rate of a youngster in sport: visual training and learning.
Although often overlooked from a training and development standpoint, the need for good and even specified vision in sport is paramount. At virtually every little league baseball game, you will undoubtedly hear the mantra that has become so synonymous with coaching younger athletes in vision-based sports: “Keep your eye on the ball!” What does it mean to keep your eye on the ball? How do you keep your eye on the ball? Is specified vision a trainable commodity?
Having worked the past few months with a legendary baseball coach, vision training expert and member of Illinois’ Baseball Hall of Fame, I can tell you that vision training should be a component of the development programs produced for young athletes. Pardon the pun, but all of my work with this vision training specialist has really served to open my eyes!
The eye itself has a primary goal of shaping incoming stimulus into something that can be used by the brain. Simple visual patterns can be detected and converted to useable neural signals more quickly than complex visual patterns, the difference in processing time being between 80 milliseconds for simple images versus 260 milliseconds for complex images. Quite obviously, the difference in processing time affects reaction time, which in turn can drastically affect sport performance. An example of this would be the relatively simple visual nature of a fastball versus the more complex visual image of a curve ball. Many baseball players, including Major Leaguers, can hit a fastball better than a curve ball – and this reality is directly proportionate to the visual complexity difference between those two pitches.
Within the context of sport, vision can be defined as reactive (the eyes will tell the athlete what they see) or inhibitory (the athlete tells the eyes what to look for). Vision is also thought of as learned. The latter point is a significant issue with regards to this article. While of course much of visual ability has a hereditary component, a great deal of research has shown that there exists a strong learning component to vision as well. In fact, vision training is not unlike strength training in many ways. While playing football will certainly increase your strength, adjunct and specific strength training will increase your strength even more and contribute to you becoming a better football player. Vision training can be looked at in the same way. Specified visual skills can be improved through isolating and training them separately. This is especially rewarding when an athlete has reached a limiting developmental threshold, the point at which playing the sport will no longer lead to specified visual improvements.
Visual Sport Skills
Acuity – Defined as the sharpness of a visual image. Static acuity refers to the ability to see while stationary (as in golf). Dynamic acuity refers to the ability to see while the athlete, or the perceived object, is moving. Tracking ability (i.e. “locating” a fly ball) and reaction time (i.e. committing to swinging at a pitch) are both aided by good acuity.
Accommodation – Defined as the ability to change focus rapidly from one point to another. This is crucial in “quick” sports such as basketball, in which the athlete must be able to focus on the ball, teammates, opponents and the basket at the same time.
Central Field Awareness – Defined as the ability see what is directly in front. This can also be likened to “fixation.” A tennis player, for example, will shift focus from near to far within the central field and concurrently be able to fixate on the ball and subsequently where they hit the ball.
Eye Tracking – Defined as the ability to follow the path of the moving object. While tracking particularly fast objects (such as tennis serves and baseball pitches), the eye goes through an involuntary, jerky movement known as a saccade.
Eye-Hand-Foot Coordination – Defined as the ability of the visual system to guide the motor system efficiently.
Another consideration we often overlook when working with pre-adolescent and adolescent clients is how they learn.
Developing a young athlete is not based solely on a given conditioning coach’s understanding of scientifically valid measures of motor stimulus, strength training or flexibility exercises. In fact, it could be argued that given all of the critical information contained in this textbook on exercise selection, methodology and sensitive period development, successful coaches will be the ones who can teach and relay information to young athletes well, more so than the coach who merely reads and digests the scientific information offered via clinical research.
The science of developing an athlete, then, is centered in the particular technical information associated with pediatric exercise science whereas the art of developing a young athlete is based on a coach’s ability to teach.
There are several styles of coaching that do not adequately serve to aid in a young athlete developing skill, yet they are nonetheless common amongst North American coaches and trainers.
An example of this would be the “Command Coach.” Command coaches presume that the young athlete is a submissive receiver of instruction. The instructions given and information offered moves in one direction only: from the coach to the athlete. Coaches who display this habit believe that coaching success is based on how well the athlete can reproduce the skills as taught or demonstrated by the coach.
There are also various misappropriations relating to how young athletes actually learn. These include the following:
Mirrors – Many coaches believe that young athletes will learn by merely reflecting the actions and nature of their coach. In this example, the coach or trainer is the most important figure in the relationship in that the athlete is a reflection of him or her.
Empty Buckets – Many coaches make the mistake of assuming that young athletes are akin to an empty bucket in that their heads will fill up with the information the coach or trainer offers.
Sponges – Much like the “Empty Bucket” notion, very often a coach or trainer will make the assumption that as he delivers information, a given young athlete will soak it up unreservedly.
Unfortunately, optimal learning does not occur in any of these ways. These aforementioned theories fail on several levels, which include the following:
Individual differences among athletes’ learning styles are not addressed.
Varying levels of physical maturity and prior athletic experiences are not considered.
They do not account for the needs or interests of each individual athlete.
They fail to recognize that “cognitive processes are important in learning physical skills.”
Recently, researchers have underscored the significance of both perception and decision-making as it relates to information processing and skill development. The focus has been on “how individuals learn to interpret information in the environment and use this to make effective decisions about movement execution.” There appears to be three chronological phases in performance or execution: Perceiving, Deciding and Acting.
The Perceiving Phase
During this phase, an athlete is attempting to establish what is happening and distinguish what information is applicable or valid. For example, a basketball player just received the ball and must now decipher a series of factors including the position of both teammates and opponents on the court, the player’s own position as it relates to the rest of the players as well as the basket and the stage of the game in relation to the score. Proficient players are able to sort through the key information quickly and separate it from other stimulus.
The Deciding Phase
This phase involves the athlete deducing the most appropriate path of action to take. In the case of our basketball player, that would include the decision to pass, dribble or shoot and which pass, dribble or shooting action would be the most suitable given the situation. Clearly, proficient athletes are more effective and decisive decision makers.
The Acting Phase
Neural signals are sent that enlist muscles to carry out the desired task with suitable timing and adroitness. Although this execution phase is clearly important to sporting success, it must be understood that it alone is not responsible for on-field accomplishment. The two preceding phases serve essentially to set up this final stage, a fact that is often ignored by coaches and trainers who maintain misappropriated beliefs regarding how athletes learn.
These three phases are co-dependent and take place in a rapid sequential manner.
Hierarchy of Progression – Part 1
When it comes to planning progressions for clients, many fitness professionals have adopted the methodology of periodization to progress their clients through the macrocycles (a duration of training lasting approximately 10 to 12 months). If the training plans are less concerned with long term planning, then the alternative routes taken are probably linear progression style based on the initial assessments. Also gaining popularity is the whole muscle confusion ideology, and training resembles some type of organized chaos.
None of these styles are wrong, considering the second priority of a fee-for-service training professional should be client satisfaction (assuming injury prevention always comes first). However, some type of progression must take place when training a client. The primary reason for training is the adaptations to progressive overload (“…progressively placing greater-than-normal demands on the body…” according to Baechle). Truth be told, progressing a client can be tricky. We commonly see steps skipped, and professionals mistakenly neglect the suggested first priority as they want to use the “sexy” training to impress the client. Unfortunately, understanding the risk involved with such errors, training professionals must acknowledge the great responsibility afforded to them and maintain a sound progressive plan. Many errors are made right at the start of the training plans.
First, where to start with the client…
It should be assumed that most of the population is going to have some adapted dysfunction. As a professional, a trainer understands that any dysfunction is going to be systemic throughout the entire kinetic chain (defined as the working relationship of the neuromuscularskeletal system as it experiences tensile or compression forces through initial “links” of the body, resulting in subsequent actions throughout the connecting links). To neglect this is only going to set both the trainer and the client up for failure in their coinciding goals. If dysfunction is found, restoring function will have to be the focus of the training plan. It is known that forces are transmitted throughout the entire kinetic chain, and a chain is only as strong as its weakest link. Therefore, prior to blindly attempting to strengthen the kinetic chain that possibly has weak links, it makes sense to address the weak links, re-educate kinematic sequencing (defined by Siff as the proper sequential involvement of muscles producing the motor force) and then move to strengthening the kinetic chain. To find this dysfunction as soon as possible, no steps in the INITIAL assessment can be skipped. (“Initial” is emphasized because assessing is an on-going process that never ends.) A client/athlete comes to you and says she’s been doing cleans, box jumps and other forms of power training with her last trainer because her goal was, and is, to improve her vertical. You can’t just follow suit and assume those exercises are suitable for her at the present time. Through a proper movement analysis, you may find that she can’t load properly in a bodyweight squat. Trainers will many times find themselves in that tough position when they have to tell the athletes that training has to be taken back to building the proper foundation, and all of that “fun stuff” will have to be put on hold. It’s tough because the majority of influence is persuading the athlete to seek the aggressive training to keep up with the competition. Fortunately, we know better than that and will provide the athlete with the scientific reasoning to justify our position.
Much of a client’s dysfunction will surface through the detailed movement analysis. An ideal movement analysis begins with uniplanar (not combining movements through two or more planes) and combines primary movements (squat, lower extremity shift (loading one leg more than the other), core extension, core rotation, upper extremity push/pull and reach), leads into a multiplanar analysis, progresses based on the surfacing dysfunction and then is reduced to isolate the dysfunction. It is common for trainers to consume valuable time assessing isolated function before assessing primary movements in a triplanar fashion. For example, why test supported open chain hamstring flexibility before you test unsupported bending and extending in all three bases (feet 24 to 36 inches apart in the following stances: stagger stance or one foot in front of the other, parallel stance and open hip or L-stance)? You should get more feedback from the latter and then decide to reduce the assessment to a more isolated fashion, if you see the need, such as the supported open chain hamstring stretch. If not, you just saved time. Remember, it is out of the scope of the trainer to diagnose, but it is within reason to hypothesize a correlation of dysfunctional activity.
To this point in working with your client, whether or not you’ve witnessed dysfunction, what hierarchy of priorities do you follow?
Sound functional training principles should be based on Newton’s three laws of motion. The three laws of motion can be translated into the utilization of their respective movement drivers (facilitators of all human movement): gravity, “realistic” force reactions and momentum.
Law 1: Every object in a state of uniform motion tends to remain in that state of motion unless an external force is applied to it.
We all know that gravity is a constant pulling force, or pushing force (whichever you prefer). As seen through the human life cycle, we have to learn to resist the force of gravity in order to achieve and maintain an upright posture. While in our upright posture, we learn efficiency to stay upright by aligning our centers of gravity (COG). As we get older, we have a harder time resisting gravity, and we lose that perfect upright posture, as seen in the elder who is slumped over with protracted shoulders and an excessive kyphotic thoracic spinal curvature (and, of course, this is also in part to the loss of hydration in the nuclei of intervertebral discs). This maladapted posture is also becoming an epidemic in younger individuals due to the plastic changes (biological changes exploiting the plasticity property within myofascia to provide an undesired alternative for stability due to a long-endured static position) that have resulted from sitting and slouching too long and often (common with the computer operator). Once we submit to the force of gravity, we would fall to a supported position (the floor, chair, etc). So in training, first, you want to know if your client can safely and effectively resist gravity. This can be partially assessed in the postural assessment.
Next, for training purposes, we’re going to skip Law 2 and go to Law 3.
Law 3: For every action, there is an equal and opposite reaction.
Realistic Force Reactions
A force reaction occurs when an individual applies a force into an object, and in turn, that object returns or absorbs the force. For example, jumping on a court flooring or ground will likely match the force transfer, allowing acceleration off the ground. Jumping on a soft mat or in sand will result in the loss of some force and a sub-optimal vertical. The most prevalent force reaction we use to drive movement is ground force reaction. Much of the equipment found in the conventional training environment causes the use of “unrealistic” force reactions, such as the bench press. The force reactions to drive the bench press push are derived from the contact points at the posterior shoulder girdles and at the SI joint. However, the same pushing motion in a realistic activity, such as pushing a car or a football offensive lineman push, the force reaction is going to come from the ground. The bench press does not utilize the proper kinematic sequence of force transfer through the legs and core as a realistic push requires. Therefore, the improperly trained sequence theoretically puts the athlete at a higher risk of injury. So after assessing the ability to resist gravity, you want to know if improper sequencing is putting your client at further risk of injury. Training with unrealistic force reactions could have re-educated the kinematic sequencing, which would make the subject appear strong, yet it actually put the subject at greater risk of injury. Beyond testing for this through questionnaire and observation, trainers can use palpations on their clients to determine activation of muscles, such as the glute/hamstring and glute/erector tests. The term “realistic force reactions” is used in place of ground force reactions because, circumstantially, there will be objects available that can provide reactionary forces to assist in the force transmission process. Again, most gym equipment does not provide realistic or ground force reactions. Doing a dumbbell row with a hand and knee up on the bench may not be the best way to do the exercise, but the bench can arguably provide realistic reactionary forces.
Law 2: The relationship between an object’s mass (m), its acceleration (a) and the applied force (F) is F = ma. Acceleration and force are vectors (as indicated by their symbols being displayed in slant bold font). In this law, the direction of the force vector is the same as the direction of the acceleration vector.
Finally, you want to know how safely, effectively and efficiently the client can move away from her center of gravity (COG), decelerate into the transition points (the point at agonist/antagonist reversal) and accelerate towards the re-alignment of the centers of gravity. We, as humans, like to be efficient. Therefore, we like to use momentum. We use it in ambulation, running, swinging, throwing, weightlifting and more. Though we use momentum everyday, training using momentum is saved for the more advanced phases. Just as you’ve probably learned to train deceleration before acceleration, but train stability before deceleration and train flexibility as you train stability, acceleration/momentum is for the advanced phases. Momentum facilitates movement through the initial generation and acceleration of the motor force. For example, a fMRI (functional MRI) will reveal the inactivity of the “working muscles” in the swing phase of ambulation. That’s due to the facilitation of movement through momentum.
Now knowing the facilitators/drivers of human movement, in the next article, we’ll move on to the application in a training progression.
All human movement is patterned and organized. It has predictable, repeatable elements such as those we see in gait. This article defines and describes three movement patterns essential to bipedal stance and locomotion that can contribute to assessment and program design in the fitness setting.
To illustrate this topic, I’m going to start with a little story about movement patterns I wrote some years ago.1
What do they mean when they say “it’s all in your head”?
A friend broke her ankle and spent the required time with cast and crutches. Her fracture healed in due time: the bones had knitted, the swelling was gone. But she continued to limp. They said, “Just walk normally,” but she couldn’t so they said, “It’s all in your head. “Let me try to understand this,” she said. “What are the possibilities?”
- It’s my imagination and I’m just not thinking the right thoughts.
- I’m doing this to myself—punishing myself for getting injured, or malingering to avoid my responsibilities, or to get sympathy.
- Something is seriously wrong and they’re not telling me.
- None of the above.
“But if I’m not limping because I want to or need to, why am I limping? It’s all in my head, isn’t it?”
How can we explain this phenomenon? My friend’s habit of limping is a movement pattern. These patterns are stored in the central nervous system, so the problem really is in her head (and spine). But it’s not about being crazy or imagining things. By having pain or even fearing pain we construct adaptive patterns so that when we move, it hurts less. In this way, we teach the nervous system a different way of moving (e.g., limping), which the CNS remembers even when the reason for limping is gone.
The CNS is goal oriented. It is designed to answer a need: the mover’s intention. Whenever we want to do something, the CNS is there for us directing our muscles and joints. However, if there is a barrier, such as pain, the CNS fulfills our intention by choosing alternative muscle use. Unfortunately, the pattern is not necessarily efficient, normal or pain-free, but it keeps us on our feet. My friend may have limped but she got around, all because of this goal-oriented aspect of the CNS. To change the limp she had to change the pattern by working with a therapist or trainer who could assess the situation and guide her toward normal function.
In the fitness setting we work with sedentary people who have not had to use their bodies very much. People sit too much because they cannot stand comfortably. They cannot stand comfortably because they have poor hip muscle function. Clients who are unstable on their feet will lift and tighten their shoulders, because their lower body support is insufficient. These behaviors are a product of poor movement patterns that cannot be corrected with strength training alone.
Many clients just want to lose weight; others want to tone and shape. Few are aware how the form of their bodies is a factor of how they use them.
Even in exercise, form follows function – and movement patterns are about function. Thus movement patterns have an impact on the body shape.
What is a Movement Pattern?
A movement pattern is a specific sequence of muscle activation. Any movement can be described as a pattern, normal or abnormal. For example, in normal shoulder abduction (lateral arm raise), the supraspinatus initiates the movement and the deltoid completes the arm raise to 90 degrees. If deltoid/supraspinatus is not fully active, some other muscle, such as the ipsilateral upper trapezius, will perform the movement. This is a dysfunctional, poor or abnormal pattern. The optimal pattern would use a clear initiation and follow through by the supraspinatus/deltoid with no lifting of the shoulder or other additional action.
As shown in the limping story, any pattern is developed through habitual use and stored in the CNS as a model. Practicing poor muscle activation results in a poor pattern in the CNS; a good pattern results in a good model. The CNS does not evaluate; it only stores. Unless there is some effort to change a dysfunctional pattern, it will continue to be used. In shoulder abduction, for example, coaching the client not to use the upper trapezius doesn’t work because she doesn’t have a choice. The CNS chooses whatever path is available. If the deltoid isn’t up to the job, some other muscle group will be used.
What is Normal in a Pattern?
There is a rather large gap in the literature regarding what is normal in a movement pattern. We are used to judging movement by joint range of motion but this is not enough to determine if the pattern is functional. Specific, correct muscles must also participate. “Function is not limited to passive joint mobility but implies also active, i.e., muscular activity and, of course, the central nervous regulation of motion producing the movement patterns.”
Dr. Vladimir Janda (1928-2002), a Czechoslovakian physiotherapist and physiatrist, pursued the question “What is normal in a movement?” Physical therapist, Irmgard Bartenieff (1900-1981) wrote in 1970 that among the various movement and rehabilitation disciplines, she found no one set of terms for defining that which is “normal.” About the same time, Janda was developing his view of the motor system as a whole and the importance of recognizing the role of central nervous regulation in movement patterning. Part of his research involved establishing the norms for certain movement sequences using EMG technology and then working out ways of recognizing, facilitating and reinforcing efficient patterns of movement in the clinic.
Janda discovered that people would use “trick” movements to accomplish a given movement when the proper muscle groups were not functioning. Bartenieff called this “muscling through” the movement. Neither Janda nor Bartenieff thought it acceptable to merely reproduce the gross features of the desired movement; how the movement was done was important. It had to be performed with the correct muscles working in the right sequence.
Three Patterns of the First Order
Janda identified three “first order” patterns: shoulder abduction, hip abduction and hip extension. These patterns occur in the three dimensional, proximal joints of the limbs. I will describe each pattern and how it presents in the fitness setting.
Shoulder Abduction (lateral arm raise)
The movement is a lateral arm raise to 90 degrees with elbow flexed (to eliminate the biceps brachii) and the palm faces the floor. Client may be seated or standing.
What to look for in a normal pattern:
- Recruitment in the deltoid/supraspinatus muscles
- Ease of movement in the arm raise: no stiffness, halting or apparent heaviness
- No involvement of ipsilateral upper trapezius
- No lateral shift in the torso away from the movement (i.e., leaning left to raise the right arm)
If the pattern is poor, the client may be overusing the upper trapezius as a substitute and have done so for some time. This overuse creates tightness and soreness in that muscle, a common complaint. The problem is not improved with resisted lateral arm lifts because it is not a question of weakness but one of available resources (muscles) by the CNS. When shoulder abduction is poor there may also be problems in the joints and limb segments distal to the shoulder such as tennis elbow or carpal tunnel syndrome. Overuse of the upper trapezius may also be a contributing factor in headaches. Any of these problems may have an impact on the client’s fitness commitment/regime/program as well as ADL.
When the pattern is normal, avoid loading to the maximum in resistance work. The long hand-to-shoulder lever is very sensitive to too much weight.
The client will be forced to recruit muscles other than deltoid/supraspinatus compromising the pattern. Instead, use a lighter weight with many repetitions to improve strength and maintain a good pattern. For improved muscle definition, coach your client to lift distally (from the hands) rather than proximally (from the shoulders). When fatigue sets in or the form deteriorates, rest or change the exercise.
The movement is a lateral leg raise from a side-lying position. The top hip is being tested and must be extended 10 to 15 degrees; the bottom hip/knee are flexed. To test, raise the leg no higher than the hip.
If tight hip flexors restrict hip extension, this will compromise the test position. Stretch them in advance of the test.
What to look for in a normal pattern:
- Active recruitment of the gluteus medius/minimus
- Ease in the leg raise with no appearance of effort, heaviness or strain
- Leg remains in the same plane throughout the lifting/lowering movement (i.e., no hip flexion occurs)
- No activity in the quadratus lumborum
- No raising of the pelvis toward the ribs
If the pattern is poor, the client may substitute the quadratus lumborum, the tensor fasciae latae, rectus femoris, iliopsoas or abdominals to raise the leg. Remember, the CNS is goal-oriented and intention-driven. It only wants to do our bidding. However, these substitutions create their own problems. A poor hip abduction pattern, over time, will produce lumbar strain, sacroiliac, knee or ankle pain. These stressed areas will be overused to supply the stability that should come from the hip abductors.
When the pattern is normal, clients will be able to stand on one foot easily with eyes open or closed and will improve their endurance in standing, walking and running, weight-shifting and changing levels (using stairs, crouching). In many clients, improving hip abduction is also a saddle-bag solution. When the gluteus medius and minimus are working properly, the shape above and below the greater trochanter becomes more defined.
A side-leg raise with the hip in extension may be used to keep the hip abductors working well. The leg raise should be slow, the foot should be relaxed and there should be a rest between each raise. Do not add ankle weights. The extended hip/knee provides adequate resistance. When fatigue sets in or the form deteriorates, change sides. Forcing the movement will encourage substitutions and a poor pattern. Hip abduction resistance machines used in a seated position do not improve the pattern because the flexed hip position recruits an insufficient number of abductor fibers.
The movement is a prone thigh raise to about 15 degrees of hip extension with knee flexed and ASIS on the mat.
What to look for in a normal pattern:
- Recruitment of gluteus maximus
- No rotation in the pelvis to either side
- No initiation of movement from the back extensors
If the pattern is poor, recruitment will be absent or insufficient in the prime mover, in which case the client will find the thigh/leg too heavy to raise or will hyperextend the lumbar spine as a substitute. The client may experience lumbar strain as well as difficulty using stairs or inclines.
When the pattern is normal, the gluteus maximus will have a rounded shape, even at rest, and will quickly contract on demand. The leg weighs 22 to 25 percent of the body weight and needs these large muscles to lift such weight and to transport the body against gravity; the leg provides its own resistance. Do not use ankle weights. A prone thigh raise is a useful exercise to maintain active use of the gluteus maximus. The thigh raise should be slow, the foot should be relaxed and there should be a rest between each raise. When fatigue sets in or the form deteriorates, change sides. Forcing the movement will encourage substitutions and a poor pattern.
Patterns in the Fitness Setting
A faulty pattern is not a question of isolated muscle weakness that can be corrected by strengthening. It is a choice made by the CNS as a result of poor usage, trauma or injury and insufficient variety of movement, or as Chaitow says, “overuse, misuse or abuse.” The result is abnormal muscle activation/recruitment and/or impairment of tissue. Attempting to improve a poor pattern through resistance training only teaches the CNS new ways of getting around the problem.
In most cases, poor patterning doesn’t mean people are not moving, but they will have difficulty in performance, reduced endurance and adaptability to change; they will fatigue quickly and the form of the movement will deteriorate early in the movement trial. What is interesting is how effective the CNS is in finding substitutes for poor patterns.
Working with Patterns in the Training Setting
An understanding of these patterns and their roles in basic body movement enhances fitness assessment and program design. Review your anatomy. Then practice looking at the patterns on a partner. There are only a few muscles involved in these patterns but their use is specific and precise. Working with patterns demonstrates their importance in the hierarchy of change and their inter-relationships within the body. If the client cannot stand and walk well (based on good hip abduction and extension), the upper body will not be free to use weights and sports equipment efficiently. Upper body movement is facilitated with support from the lower. Support from the lower comes from good grounding and the sense of security that comes from good hip patterns.
Good patterns support the body and its activities from simple walking and standing to high jumping, skating or pitching a baseball. Good patterns are the basis of excellent performance because they provide optimal use of the body as a bipedal organism in gravity. Pattern observation is part of a good assessment and will help plan an effective training strategy. Listen to your clients and to their comments about low back, sacroiliac or shoulder pain. Poor patterns may be the source.
When patterns are corrected, the trainer can observe the difference in ease and accuracy of the tested movement. The client experiences a lighter limb, a quicker response to a movement intention, less binding and restriction across the joint. Standing and walking become more comfortable. Working with these three first-order patterns also teaches the trainer to recognize patterning in all movement. Good patterns form the basis of a successful training strategy.
This article is for information and should not be considered a training vehicle. Patterns and the process of altering patterns are best learned in a hands-on setting.
Core Stability in Cycling and Runnings
The core is where the most of the body’s power is derived. It provides the foundation for all movements of the arms and legs. The core must be strong, have dynamic flexibility and function synergistically in its movements in order to achieve maximum performance. Motion of the human body is not isolated to one muscle or tissue moving in one specific direction. Rather, it is a complex event involving agonists and antagonist structures that work together to create changes in position and/or location, and to stabilize the body in all three directional planes. Regardless of what sport one plays, it is essential to have core strength and trunk stability to maximize performance and prevent injury.
What Makes Up the Core
The foundation of the core is much more than the abdominal muscles. It includes muscles deep within the torso, from the pelvis up to the neck and shoulders. The core includes the following structures:
- Multifidus – Deep spinal muscles that run segmentally from the neck (C2) to the sacrum. They produce extension and, to a lesser degree, rotation and lateral flexion forces that provide stability to joints at individual levels of the spine.
- Interspinales, Intertransversarii, Rotatores – Deep structures that attach directly to the spinal column. These are very important for rotatory motion and lateral stability.
- External Obliques – Abdominal muscles that attach at the lower ribs, pelvis and abdominal fascia.
- Internal Obliques – Abdominal muscles that attach at the lower ribs, rectus sheath, pelvis and thoracolumbar fascia.
- Transversus Abdominis – Abdominal muscles that attach at the lower ribs, pelvis and thoracolumbar fascia and rectus sheath.
These abdominal muscles work together to transmit a compressive force and act to increase intra-abdominal pressure that stabilizes the lumbar spine. They also work individually to perform trunk rotation, while the internal and external obliques on the same side can work synergistically to laterally flex the spine.
- Rectus Abdominis – Abdominal muscle that attaches at the fifth through seventh ribs, the lower sternum and the front of the pubic bone. This muscle flexes the spine, compresses the internal organs of the abdomen and transmits forces laterally from the obliques. It is a common fallacy that the upper and lower rectus are isolated differently. Training the rectus can be done with one exercise.
- Erector Spinae – Help to counterbalance all the forces involved in spinal flexion. They begin as the sacrospinalis tendon that attaches at the sacrum and ilium. This tendon then gives rise to different muscles that run up the spine and obliquely to attach at lateral parts of the vertebrae and the ribs. In the cervical region, these muscles attach at the base of the skull.
- Quadratus Lumborum – Attaches at the twelfth rib and the upper four lumbar vertebrae and the pelvis. It stabilizes the lumbar spine in all planes of motion, stabilizes the twelfth rib and the attachment of the diaphragm during respiration and laterally flexes the trunk.
- Latissimus Dorsi – This is the largest spinal stabilizer. It attaches via the thoracolumbar fascia to the lumbar vertebrae, sacrum and pelvis and runs upward to the humerus. It assists in lumbar extension and stabilization and also performs pulling motions through the arms.
- Thoracolumbar Fascia – Connects the latissimus dorsi, gluteal muscles, internal obliques and transverse abdominis, supplies tensile support to the lumbar spine and is used for load transfer throughout the lumbar and thoracic regions.
- Abdominal Fascia – Connects to the obliques and rectus abdominis and to the pectoralis major. Fascial connections that cross the midline transmit forces to the muscles of the opposite side of the body.
Training the Core
The common myth is that training the core simply involves sit ups and back extensions. An efficient core routine consists of multiplanar movements. As the body moves, the center of gravity changes, and forces exerted by and on the body’s tissues are constantly changing. Dynamic stabilization must be included to increase proprioception and stability in the trunk as well as in the rest of the body. This allows the parts of the body to react efficiently to external forces and stresses such as gravity, changes in terrain and carrying loads. It also allows the body to react to internal forces exerted by other muscles.
Dynamic stability is best achieved through training in functionally practical positions that mimic activities or movements in one’s particular sport or in life as a whole. With this in mind, one can conclude that most core training that is done while sitting or lying down and limiting pelvic movement has little functional value.
Medicine balls, balance boards and stability balls are great tools for core training and should be integrated into every program. Core exercises should include strengthening as well as challenges such as standing one-legged and/or two-legged on stable and unstable surfaces, reacting to external forces such as a partner’s light push or the catching and throwing of a medicine ball and moving the joints of the body through all planes of motion. (For examples of all of these exercises, please see the PTN Exercise Library.)
The goal of functional core training is to develop in the core a system of efficient automatic responses to work as a stable base from which to generate optimal force and motion.
Postural Distortion and Biomechanical Dysfunction
Consider how the chronic shortening of just one muscle, which happens to be a core muscle, can impede performance and cause imbalances that lead to injuries.
The rectus abdominis is a good example of an overworked muscle. As this muscle is overworked, the other core muscles are often ignored. Crunches, leg raises and exercises using abdominal machines all work only in the sagittal plane, therefore limiting any benefit to muscles that produce hip and trunk flexion. (Note that repetitive trunk flexion places increased injury-causing stress on the intervertebral discs of the lumbar spine). Therefore, it is imperative to train the core in a multiplanar fashion, especially in the transverse plane, in order to create stabilization in the trunk and in effect more optimal posture, strength and motion in the entire body.
The following is a common example of the result of overworking the rectus abdominis. A tight rectus abdominis, when creating tension or pull on its upper and lower attachments including the anterior pelvis, anterior ribs and inferior sternum, produces a flexion force in the trunk.
This has consequences beyond the immediate structures affected. The consequences include a chain of effects that begin with shortening and tightening of the pectoral muscles. These muscles will exert an inferior tension on the clavicle, superior ribs and the anterior scapula and will assist in internally rotating the humerus.
The force of gravity also contributes to the internal rotation of the glenohumeral (i.e., shoulder joint) as the trunk flexes forward. Internal rotation of the humerus tensions and lengthens the external rotators of the shoulder that, in combination with the tension exerted on the anterior scapula by the pecs, will bring the scapula into protraction, lengthening and weakening the middle and lower trapezius and rhomboid muscles. (Note that a tight latissimus dorsi can also be a primary contributor to internal rotation of the humerus.) The internally rotated humerus and protracted scapula will place the rotator cuff muscles at a biomechanical disadvantage in dynamically stabilizing the glenohumeral joint. The rotator cuff will not function effectively, increasing the risk of injury.
The reaction at the cervical spine is two fold. The lower segments of the cervical spine follow the forward and downward movement of the trunk, and they themselves flex, causing lengthening and weakening of the deep cervical flexor muscles. (This can also stress the outer layer of the intervertebral discs, which over time may lead to injury.)
Naturally, if the lower cervical spine flexes forward, the head will follow, and if this force is not countered, gravity will cause the head to fall forward. In order to prevent this from happening, tension will develop in the cervical extensors, including the upper trapezius, splenius, semispinalis, spinalis and sub-occipital groups that attach to the base of the skull. The upper cervical segments including the base of the skull are extended, shortening the sub-occipital muscles. This extension will allow the skull to remain somewhat level as it rests on the atlas (i.e., the uppermost cervical vertebra).
The over working of the upper trapezius muscle and lengthening and weakening of the middle and lower trapezius and the rhomboids will also contribute to early elevation of the scapula with shoulder motion. This will worsen the position of the glenohumeral joint and will further stress the rotator cuff.
The example I have illustrated has been limited to the rectus abdominis. It is important to understand that single muscles are rarely the isolated culprits in postural distortions and biomechanical dysfunction. (An exception would be an acute specific muscle injury that has not healed correctly and has caused compensatory overloading in other areas.) Because muscles act synergistically and as agonists and antagonists, there is usually more than one contributor. There are also connections between muscles through tough fascial connective tissue, which help to transmit forces between tissues. These cases of dysfunction can be rooted in other parts of the body, as the musculoskeletal system functions as a whole.
Not only will these faulty positions and compensatory biomechanics cause an athlete to move inefficiently. Over time, they may lead to degenerative processes in the soft tissues and joints that will lead to further injury and impairment.
The neurological system also adapts to these changes, applying muscle memory, as it controls the musculature. Training this system is essential in developing healthy neurological pathways and muscle firing patterns. This is achieved through the methods mentioned above such as using medicine balls, balance boards and stability balls and challenging the neuromuscular system.
Any of the muscles mentioned above may be the source of dysfunctional patterns, but it will most likely be a combination of them that will be the cause. It is important to follow the entire kinetic chain when assessing and treating these conditions.
Most cyclists focus on their hamstrings, quadriceps and gluteal muscles and forget about the importance of core stability. Consider how many hours a cyclist spends bent over in a flexed position on the aero bars, with no rotational or side bending motions. A strong core is needed to counter balance these forces.
With a focus on the core, a cyclist can generate more power and can sustain a higher level of intensity for longer periods. A stronger core also means less stress on the primary muscle movers and a delay in the build up of lactic acid. Even minor changes such as brake position can affect core stability. If the brake handle position is too low, the cyclist is forced to reach too far forward with his forearms. This reaching position forces the cyclist to raise his head, forcing the pelvic girdle posterior. This position can cause a restriction in several key muscles in the core, thus reducing performance. The ideal position for the forearms is to have the elbows bent and the forearms flattened out. In this position, the cyclist head drops into a more comfortable aerodynamic position, and the pelvis tilts forward. In this position, the cyclist is able to use all the core muscles with improved efficiency.
Now consider how a shortened rectus abdominis affects a triathlete’s performance during running. Although opinions about the “ideal running form” vary greatly, most authorities will agree that the less energy expended, the more effective and efficient the running style will be.
|Common Running Recommendations||How a Shortened Rectus Abdominis Affects Your Running|
|Run upright. Your back should be straight, roughly at a 90 degree angle to the ground.||A shortened rectus abdominis will pull the runner’s posture forward, causing a braking action that reduces running economy.|
|Look straight ahead. Your eyes should be focused straight down the road on a point moving about 10 meters in front of you. This helps to keep you in a straight line.||As the rectus is shortened, it pulls the chest forward, allowing gravity to pull the head down. In order to look straight ahead as instructed, the athlete wastes a considerable amount of force in trying to overcome the contracted rectus abdominis.|
|Swing your arms naturally. The angle at the elbow between your upper and lower arms should be about 90 degrees. Your hands should be loosely cupped, about belly level.||As the shoulders move forward, a shortened rectus abdominis causes the arms to rotate internally. This makes keeping your arms relaxed at the recommended 90 degree angle much more difficult, reducing running economy.|
When performing a biomechanical analysis, it is very common to see numerous imbalances of which the athlete is completely unaware. By video taping an athlete during activity, the practitioner can show and explain what is happening and then correct it.
When analyzing a runner, some of the most common biomechanical faults looked for are:
- Over-pronation (rolling in as arches collapse) in the feet. This can cause a series of biomechanical imbalances from the foot up to the cervical spine.
- Excessive hip adduction, due to tight hip adductors. This can cause increased load in the lateral tissues such as the iliotibial band, tensor fascia lata and gluteus medius.
- Lack of trunk rotation, due to restrictions in trunk rotators or shoulder extensors. This can cause overload in the hip musculature, spinal joints and other trunk rotators.
- Lack of hip extension, which is caused by tight hip flexors restricting extension and weak gluteal muscles. This causes the extensors and rotators of the lumbar spine to become overloaded in order to compensate for the lack of hip extension.
- Lack of shoulder extension, which is caused by restrictions in anterior shoulder muscles or poor trunk rotation.
Educating yourself on how the core works will help to avoid injury, improve your athletic performance and increase training efficiency. Far too often, people read the most popular book or take advice from someone who they think knows more than they do. This cookie cutter approach does not take into account a person’s specific needs and goals. In my opinion, anyone who participates in any sport or activity should have a professional evaluate them for any weaknesses or poor movement patterns. I can’t tell you how many patients have told me, “It just started hurting. I never did anything to it.” A simple evaluation can save you from repetitive stress injuries.
Defining the Hips
What constitutes the hip structure? I think of the hips as more of a region than an anatomical place on the body. However, to define the “hips” as an osseous structure, it would consist of the interplay between the head of the femur with the acetabulum of the pelvis, along with its surrounding joint capsule and ligaments that support this synovial ball and socket joint. It is essential to understand that the head of the femur is oriented with the acetabulum in three planes, and for this reason, the hip is a major transmitter of rotational forces from top to bottom, and vice versa. We must keep in mind, however, that the meeting of these structures is part of a larger picture, because what happens distally affects proximally (just as what happens on one side of the body affects the other). The muscles attaching the pelvis to the femur are some of the strongest and most powerful of the body and include the deep rotators of the hip, the adductors, rectus femoris, hamstrings and gluteus complex, consisting of the glut maximus, medius, minimus and the TFL. If observed together, these muscles angle in just about every direction, with none being purely horizontal or vertical. If looked at in an integrated fashion, with the idea that muscles work together to transmit and utilize energy efficiently, we begin to grasp how dominant the rotational forces are that affect the body and how important it becomes to train the body to handle these rotational forces.
Traditionally, we have thought of muscle and muscle function in an isolated manner and described it as if the body were lifeless on a table. Perhaps this is because in the 18th and 19th centuries, when Man was learning about the body by dissecting cadavers (likely stolen), experiments were performed in an effort to discover the function of the muscle and bone. The beginning and ends of a muscle were hooked up to electrodes (i.e,. the hamstrings) and turned on, resulting in muscle shortening (knee flexion). This description is the one primarily taught in anatomy books and is an isolated interpretation of muscle action. What is not taken into consideration is the way in which gravity and ground reaction, which is the force exerted on the body by the ground, affect the body. With the infusion of gravity and ground reaction that lengthen fascially connected structures, suddenly muscles don’t act upon the body to generate a movement (i.e., hamstrings performing knee flexion). Instead, the muscle responds to forces presented upon it by lengthening of muscle and energy absorption, such as the quads slowing knee flexion or hamstrings slowing hip flexion and knee extension. With this paradigm of thought, “stretching and strengthening” become synonymous, as strength becomes the body’s ability to lengthen, transfer and utilize energy with control and efficiency. To understand that muscles work together in an integrated fashion, battling gravity and ground reaction to keep upright and moving is an important step in our understanding of human motion.
This last point is critical to the understanding of movement, biomechanics and “function.” Muscles must first decelerate motion in all three planes (also described as absorbing energy, eccentrically loading, pronating or lengthening) before accelerating (also described as utilizing energy, concentrically lengthening, supinating or exploding). If looked at traditionally, then the gluteus complex either extends and/or abducts the hip, which in isolation is true. However, in this interpretation, it describes the muscle as first shortened before lengthening. Yet if looked at in integration, the role of the gluteus complex becomes far more complicated. We begin to understand that the gluteus complex has many different jobs, depending on where the femur is in relation to the pelvis. To better understand the role of the glut complex in relation to the hip, an understanding of its action in gait is necessary.
During the swing phase of the right leg and until heel strike, the right glut complex works to decelerate hip flexion in the sagittal plane, adduction in the frontal plane and internal rotation (IR) in the transverse plane. It is important to recognize that the right glut complex slows adduction/IR of the right swinging leg, because at toe off, the right “hip” is relatively abducted and externally rotated on the femur, which means that during swing, the femur is going to adduct and internally rotate on the pelvis. From heel strike of the right foot until midstance, the right glut complex slows the pelvis on the femur adduction and IR. For example, as the left leg is swinging, the right glut complex is stabilizing the hip in the frontal plane by controlling the left pelvis dropping inferiorly (pelvic on femoral adduction) in the transverse plane by slowing IR as the pelvis migrates forward over the femur. Once at midstance, the glut complex (along with other muscles including the opposite quadratus lumborum) assists to stabilize the lumbo-pelvic complex. It is extremely important to discern that the glut complex’s integrated function has little to do with hip extension in gait. Hip extension in gait is primarily accomplished from the body’s momentum of traveling forward over the foot and its reaction to gravity and ground reaction. During the propulsive phase of gait, the glut complex externally rotates the hip and propels the body forward, in conjunction with the calf.
In order to fully incorporate the way in which we look at, train and rehabilitate the body, being cognizant of the relationships that exist between structures is essential. If we can understand that structure feeds function, then we can begin to enhance the ability of one part by creating a chain reaction to indirectly affect the other. For example, in function if one demonstrates decreased hip extension, he will often demonstrate decreased dorsiflexion and often ipsilateral shoulder flexion, unless compensated for somewhere else in the kinetic chain (such as the lumbar spine). The hip flexors, what Physical Therapist Gary Gray calls the front butt, are eccentrically loaded (slowing hip extension) while the plantar flexors slow dorsiflexion. In other terms, when the hip is extending, if looked at from the ground up with the eccentric load first, the calf is also slowing hip extension because the soleus is slowing the tibia moving anterior over the talus, allowing the femur to move faster and further anterior than the tibia. Also, based on the proximal attachment points of the gastrocnemius (the posterior femoral condyles), when eccentrically loaded it assists to achieve full knee extension by slowing the femur moving over the tibia and pulling the distal end of the femur into a relatively posterior position on the tibia, which arthrokinematically is what happens between the femur and tibia during knee extension. This action further extends the hip by allowing the pelvis to continue to move forward faster than the femur.
As we can see, the body is an amazingly complicated machine. When we study movement, there are obvious relationships that become apparent. However, there are even more relationships that only make themselves known when we continue to study, watch and think about motion, muscle function and the body in general. This understanding allows us to further serve our patients/clients, which is the essential element. In further discussions, we will take a look at more of these relationships of human motion, as well as demonstrate different ways in which to train in an integrated fashion, utilizing gravity, ground reaction and creativity.
Atkins vs. South Beach vs. Metabolic Typing
As personal trainers working in the health club environment or in private studios, our clients often ask us questions about nutrition. Regardless of whether or not you provide your clients with nutritional counseling, in my opinion, it is absolutely necessary that we all have at least a fundamental understanding of the common diets our clients are experimenting with. As we all know, knowledge is power and transferring that knowledge to your clients in the form of verbal or written exchange will separate you from the average personal trainer who provides the generic advice of “exercise more and eat less.”
The following is an excerpt from my book The No Diet, Diet! and has been written to provide an overview of the two most common diets in America: the Atkins Diet and the South Beach Diet. I compare these diets to a third program, the Metabolic Typing Diet, which is not as well known.
After careful review and study of the South Beach Diet, Atkins Diet and Metabolic Typing Diet, the similarities and differences are summarized in this article. The South Beach and Atkins programs have many similarities. The similarities between these two programs are as follows:
- Cardiologists created each of the diets.
- Both authors advocate the consumption of artificial sweeteners.
- Neither program addresses the emotional component of eating or provides additional help through certified coaches or advisors. (Dr. Mercola states that emotional eating is the most important factor of dieting. To read more on this, visit www.mercola.com.)
- Neither program talks about food quality or food sources (i.e., organic, free range, processed meats, etc.)
- Both programs are marketed as a “lose weight quickly” diet.
- Both programs advocate eating fish without any mention of potential mercury and other heavy metal contamination.
- Both programs suggest eating whole grains, without mentioning that 50 to 60 percent of all white skin people are intolerant to gluten, a protein found in all grain products.
- Both programs support drinking pasteurized milk, which has many health risks that are often unknown by the general public. For example, pasteurized dairy products often exacerbate food intolerances.
- Both programs progress you through different “phases.”
- Both programs have specific meal plans for the initial phase.
- Both programs suggest that you will drop weight in the first two weeks.
- Neither program is tailored to the individual. Both are under the “one size fits all” model of dieting.
The main differences between South Beach and Atkins are:
- South Beach states that saturated fats are harmful. Atkins advocates large quantities of saturated fats.
- Atkins advocates counting carbohydrates, which is actually “net carbs,” defined as the number of carbohydrates minus the fiber content. South Beach does not have you count calories, carbs or anything else.
- The health benefits of Atkins are said to be reducing the risk of heart disease, controlling and preventing diabetes and lowering high blood pressure. The South Beach diet claims to improve cardiovascular health.
- The meal plans between the two diets are different. This is based on each author’s opinions about which foods will and will not help the dieter lose weight.
The Metabolic Typing Diet is different from South Beach and Atkins. Here is a summary of the key differences between Metabolic Typing (MT) and the other two programs:
- MT is a customized approach to nutrition. The individual’s “metabolic type,” which can be defined as his/her own nutritional needs, is determined through a comprehensive series of questions. The answers to these questions determine how food behaves in the body and then suggests the foods that are specifically going to support the individual’s requirements. Both Atkins and South Beach can be classified as a “one size fits all” approach, as it does not have any system of analysis for identifying one’s individual needs. These are books that anyone can read and then implement without any regard for an individual’s genetics, physical characteristics, activity levels or personality traits, all of which have a major influence on how the body converts food to energy.
- Unlike diets such as the Blood Type Diet, MT looks at the entire system, which is composed of 10 fundamental control systems including the Autonomic Nervous System, CarboOxidative, LiopOxidative, Electrolyte, Acid/Alkaline, Endocrine Type, Blood Type, Constitutional Type and Prostaglandin Balance. Therefore, Blood Type only accounts for a single, fixed variable, whereas MT is much more comprehensive and can offer clearly defined, specific and reliable test results.
- Atkins and South Beach do not address the quality of foods. For example, there is no mention of avoiding fish due to the high levels of known mercury and heavy metal contamination. Secondly, no comparison is made between free range, organic food and commercially processed food. Conversely, MT specifically suggests going out of your way to buy free range, organic food whenever possible and avoiding high quantities of mercury contaminated fish.
- Atkins has a university that offers courses on cooking, shopping and other areas of food. South Beach also has a web site that offers limited online support for dieters. Metabolic Typing has a very comprehensive certification program consisting of three intense levels. This program trains health care professionals such as doctors, nutritionists, chiropractors, C.H.E.K. Practitioners and personal trainers how to administer the questionnaires and thus be able to coach clients towards their goals using the comprehensive approaches that are outlined in the book The Metabolic Typing Diet by Wolcott and the Intermediate Level MT Certification Manual.
- The South Beach Diet and the Atkins Diet were both founded by cardiologists. Each program is based on one doctor’s opinion of how everyone should eat. MT is a comprehensive compilation of over 70 years of clinical research by many different individuals, including medical researchers, physicians, biochemists, dentists, physiologists, nutritionists and psychologists. The following doctors are the main contributors of what is now known as Metabolic Typing: Dr. George Watson, Dr. William Donald Kelley, Dr. Royal Lee, Dr. Weston Price, Dr. Francis Pottenger, Dr. Melvin Page, Dr. Roger Williams, Dr. Emanuel Revici and Dr. Henry Bieler. Many of these individuals are giants in their fields and world renowned in their respective scientific and clinical disciplines. Now compare this list to the two doctors who created South Beach and Atkins. Which do you think is more researched and reliable?
- South Beach and Atkins are marketed as quick, easy approaches to lose weight within the first two weeks. MT is designed as a health program, not a weight loss program. The program describes weight loss as a benefit of becoming healthy, but losing weight is NOT the primary focus. William Wolcott, the author and founder of MT, states that the program is NOT designed as a quick fix but as a permanent way of life by knowing how to listen to the body’s unique individual needs.
Conclusions and Suggestions
Based on the information and research available on these three diets, as well as the nature of the typical personal trainer/client relationship, I have found the following guidelines to be helpful when coaching clients on nutrition:
- When your client asks you about Atkins or South Beach, let them know some of the information you know to be true about these diets. Try to customize the information as much as possible to your client. For example, only emphasize certain points based on your client’s current level of understanding, his/her personality and motivation to learn.
- One of the major points I always make while working with a client is to point out that ANY diet he/she chooses will typically not yield long term results, unless it is customized. The problem with most diets is that they are cookie cutter and do not take into account biochemical individuality, which is the concept of no one diet working for everyone.
- I will gently suggest the client investigate Metabolic Typing or some version of customized nutrition.
Following these basic guidelines ensures your client is well informed about these diets and yet not “oversold,” which maintains your professionalism and gives you an opportunity to educate, motivate and inspire your clients to make healthier food choices.
The research is in. Without a shadow of a doubt, whole grains are far superior with respect to disease prevention and weight management than their refined counterparts. The list of reasons why is long, but here are the Coles Notes:
- More vitamins and minerals including selenium, vitamin E and magnesium.
- More phytochemicals, which wage war against disease-causing free radicals.
- More appetite-quelling, heart-protective fiber.
- A lower glycemic index, which reduces blood sugar spikes and, hence, diabetes risk.
And now the cat is out of the bag, and everyone seems to be hopping on the “whole grain” bandwagon as the media exalts their nutrition virtues and the Atkins craze becomes a thing of the past. Thing is, much of what health savvy individuals are consuming is brown rice, oats and whole wheat. This is coming at the expense of the wide array of other whole grains that are begging for some masticating attention. So in the name of culinary diversity, here are five lesser utilized whole grains that have the goods to fight disease, boost training results and re-stimulate a bored palate.
I’D: Although almost always consider a grain, quinoa (pronounced “keen-wa”) is actually a seed gleaned from a plant related to spinach and grown almost exclusively in the South American Andes. Unlike most crops, it thrives in drought conditions at altitude. It is most often sold in its beige form, but red and black quinoa is also sporadically available.
Nutrition Advantage: The Incan empires often looked to quinoa, which they called “the mother of all grains,” as a means to keep army personnel strong and energetic. That is because they knew what we are just beginning to appreciate: quinoa is a nutrition powerhouse. Unlike most other grains, this ancient grain boasts all the essential amino acids (including lysine, which often has a poor showing in plant-based foods), making it a complete source of protein. Read: it’s ideal for post-workout recovery. A one cup serving also supplies laudable amounts of fiber, folate, zinc, iron, manganese, phosphorus and magnesium. Magnesium is a crucial component of hundreds of biochemical reactions including normal muscle and nerve function, heart rhythm regulation, bone strengthening and immune system support. US Department of Agriculture scientists reported in the American Journal of Clinical Nutrition that subjects who had poor magnesium status were more likely to be inflicted with heart arrhythmias and poor blood glucose control. It’s likely that reliance on a fast food, convenience-fare diet (not that atypical these days) would come up short in magnesium. Lacking any gluten, quinoa can be enjoyed by those who are sensitive (i.e., Celiac disease) to this protein. If it wasn’t for a lack of vitamin C, quinoa just may be the perfect shipwrecked food.
In The Kitchen: Quinoa has a nutty, palate-pleasing taste and cooks up in only 10 to 15 minutes. Much faster than brown rice. Use a 2:1 water to grain ratio and take it off the heat when the water has soaked in and the germ unfolds like a little white tail. To intensify the flavor, try toasting quinoa in a skillet for a couple minutes over medium heat till darkened prior to boiling and add spices such as turmeric or chili powder to the cooking water. It is also best to rinse quinoa well before cooking to remove any remnants of a bitter coating called saponin.
I’D: Not all of the 60 or so species of the amaranth plant are cultivated to be eaten. Certain varieties appear as weeds, while others are used for ornamental purposes and have vibrant, kaleidoscope leaves. The seeds are diminutive oval shaped with a creamy complexion. Amaranth was a dietary staple of the Aztecs, believing it possessed supernatural powers even incorporating it into religious ceremonies. In fact, the emperor Montezuma collected it as a tax. In similar vein to quinoa, Amaranth grows in poor climatic conditions such as drought.
Nutrition Advantage: Amaranth contains an unusually good quality protein for a plant source, similar to that of buckwheat and quinoa. It also dishes out worthy amounts of iron, magnesium, calcium, copper and manganese. Giving your diet the roughage treatment, this Aztec go-to whole grain has among the highest fiber levels (more than quinoa) of any of the grains, with nine grams in one half cup uncooked. It is recommended that women and men consume 25 and 38 grams of fiber daily, respectively. All indications are that most of the population is coming well short of this. Looking up, amaranth leaves are an outstanding source of vitamin K with well over a days requirement of this bone strengthening, blood clotting vitamin in just one cup of raw leaves. Like quinoa, amaranth is a gluten-free grain.
In The Kitchen: Amaranth’s earthy flavor becomes more pleasing when toasted prior to cooking. Toast in a nonstick skillet for roughly four minutes and then add one cup of grain for each two and a half cups of boiling water, cover, reduce heat and simmer for about 20 minutes. Strongly consider adding aromatics to the cooking liquid such as ginger, herbs and spices. Make it into a breakfast cereal by using apple slices, cinnamon and nutmeg while cooking and topping with nuts and fresh berries. Amaranth flour is commonly available but needs to be mixed with other flours for baking yeast breads, as it contains no gluten. One part amaranth flour to three to four parts wheat or other grain flours is a good bet. For pancakes, only amaranth flour can be used.
I’D: Native to North America, wild rice is a seed of an aquatic grass traditionally harvested by Native people of the northern Midwest. These days, most wild rice is commercially grown and is also cultivated in areas of Africa, Southeast Asia and Southern China.
Nutrition Advantage: In addition to plenty of complex carbohydrates to help replenish muscle energy stores following a stiff workout, wild rice contains the most folate of the rice varieties. Folate is a B vitamin that, on top of helping prevent birth defects, lowers levels of homocysteine, a protein that has been linked to heart disease and cognitive decline. Adults with low levels of folate in their blood, according to researchers at the University of York in England, are 40 percent more likely to suffer from depression than those with normal stores of this B vitamin. Further, a 2007 study in the journal Circulation concluded that folate is effective at preventing strokes. Wild rice is a safe food for those allergic to gluten.
In the Kitchen: Cooked wild rice has a rich nutty smoky flavor and chew texture. The hand harvested, organically grown varieties possess the best, most complex flavors. It should be rinsed prior to cooking, which removes unwanted particles such as hulls or storage debris. For each one cup of wild rice, use roughly three cups of water and don’t expect quick results. It takes about 45 to 60 minutes for wild rice to fully cook (indicated by when the kernels begin to burst). Good things come to those who wait. Again, any sort of flavoring agents such as spices, walnuts and dried cranberries can be tossed with wild rice. Wild rice has a longer shelf life than most grains because it is dried and slightly fermented.
I’D: Ranking fourth behind wheat, rice and corn in terms of overall world cultivation, much of today’s barley is used for livestock feed, to make the sweetener malt syrup or fermented to produce beer. That’s too bad because as a whole food, it’s exceptionally nutritious.
Nutrition Advantage: Like oats, barely contains a soluble fiber called beta-glucan, which is a non-starch polysaccharide that reduces blood sugar spikes and binds up cholesterol, preventing its absorption. Thus, many studies have demonstrated that higher intakes of beta-glucan can reduce overall and LDL (“bad”) cholesterol levels offering protection against heart disease. It just happens that barley contains more of this cholesterol buster than oats. Plus, it trumps other whole grains with respect to selenium. It seems selenium has the ability to fend off cancer, preserve muscle strength and prevent cognitive decline. It does all this as part of proteins known as selenoproteins, which serve many vital functions such as regulating thyroid hormone activity and acting as a defense against oxidative stress induced cellular damage.
Although most barely available commercially is pearled or pot (scotch), hulled barley has only the outer husk (hull) removed and is the most nutritious form of barley, since the bran and germ are left intact. Its superior nutrient content such as more iron, thiamin and fiber makes it worth hunting down. You can tell the difference between pearled barely and “whole” barely by its lighter color and smaller size. All barely contains a small amount of gluten, so those who are sensitive need to experiment with tolerance.
In The Kitchen: Barley is an excellent addition to soups, salads, casseroles and stews. On its own, barley cooks about as fast as a tortoise with nowhere to be. Add one cup of barely to two and a half cups of boiling water, reduce heat, cover and simmer for 50 to 100 minutes. Hulled barely will need the longest to cook thoroughly. Because of it’s drawn out cooking time, it is best to rustle up big batches at a time.
I’D: Buckwheat is a seed of a plant native to northern Europe and Asia that is related to rhubarb. In Japan, buckwheat is ground into flour to make very nutritious soba noodles. Bees are particularly fond of buckwheat flowers and hence buckwheat honey that is fairly common in North America. Buckwheat groats, also called kasha, is whole grain buckwheat in which only an inedible hull is removed from the kernel.
Nutrition Advantage: Like amaranth and quinoa, buckwheat is free of gluten and contains a significant amount of the amino acid lysine, making it a fairly complete protein that will help repair and build lean body mass. There are also several valuable nutrients such as magnesium, B vitamins, copper, manganese, selenium and phosphorus. Buckwheat is also pumped full of antioxidant phytochemicals including rutin, which is not found in other whole grains. Rutin is thought to improve circulation and prevent LDL cholesterol from clogging up blood vessels. A Canadian study found that buckwheat extract was effective at lowering blood glucose in diabetic rats. The researchers surmise that the compound chiro-inositol, which is found in substantial amounts in kasha, functions to regulate blood sugar.
In the Kitchen: With a 15 minute simmer time, buckwheat is quick-cooking and versatile. It can be used in pilafs, salads, stuffings, stir fries and soups or in replace of a portion of meat in burgers and meatloaf. If you find the taste a little too overpowering on its own, try mixing some buckwheat in with other grains like rice or quinoa when serving as a side dish. On the stovetop, add one cup of buckwheat to two cups of boiling water, cover, reduce heat and simmer for roughly 15 minutes.
Glycemic Index and Youths
The glycemic index was brought to us by the pioneering work of Dr. David Wolever and Dr. David Jenkins in the early 1980s, finally giving a reliable and accurate measurement of blood glucose. The GI is simply a ranking of carbohydrate foods, according to their immediate influence on blood glucose levels after eating. Although its original conception was as a tool for helping type 2 diabetics control their blood sugar levels, the GI has become credible in achieving optimal health for both adults and children.
The “obesity epidemic” among children has been described as a “public health time bomb” by the Chief Medical Officer in the UK. Worldwide, there are reportedly 20 million children under the age of five who are overweight, and in the UK alone, 10 percent of six year olds and 17 percent of 15 year olds are classed as clinically obese (1). This is worrying for many reasons: it’s one thing when an adult is overweight and later develops type 2 diabetes and implicated CV disease, but when children as young as age 10 are showing signs of atherosclerosis and type 2 diabetes, it is another thing entirely. Clearly, being obese or overweight is a major issue, not least because there is a knock on effect into adulthood (i,e,. obese children are more likely to become obese adults). But it’s not just the effect on children’s physical appearance that is causing concern among health professionals. Children’s mental and emotional health also seems to be adversely affected by poor nutrition, with ADHD, dyspraxia and mental health issues becoming more evident among children.
So what’s changed in the last 20 to 30 years to adversely affect the physical, emotional and mental well being of children? Dietary fat has taken a bad rap over the last few decades. At one time, it was a taboo word, with many health professionals advocating removing it from the diet entirely. It seems, though, that fat and carbohydrate have a reciprocal relationship in the diet. That is, if you remove one, you tend to eat more of the other. So by removing fat, people started to eat more carbohydrates, the kind of carbohydrates like chips, fries, processed cereals and white breads that became more abundant in the supermarkets. It was around this time that the obesity epidemic really took off. Many schools had vending machines offering fizzy drinks and canteens serving up chicken nuggets and fries. It appears that the kind of carbohydrate your child eats affects health rather than all carbohydrates, per se.
Each time your child eats a high GI carbohydrate, he will almost instantly experience soaring blood sugar levels, which, if done habitually, can damage nerves and blood vessels as well as increasing the likelihood of type 2 diabetes. To cope with the rise in blood sugar, the pancreas excretes insulin, a powerful hormone that regulates blood sugar levels by aiding transport into working muscles for use as energy or to the liver where it is stored as glycogen or converted to fat. You may be surprised at some of the high GI foods that cause such a rise in blood sugar: bagels, white bread, frosted cereals and instant porridge: all interestingly often heralded as low fat healthy choices!
The problem is that many of these refined, simple carbohydrates have been stripped of their wholesome goodness in their processing, making them act in a similar fashion to pure sugar from the throat downwards. Insulin acts fast and deals with the rapid rise in blood sugar, though the peaks known as hyperglycemia are often accompanied by a subsequent rebound hypoglycaemia whereby blood sugars crash to low levels.
This is a concern for numerous reasons, including the potential impact on a child’s behavior. It has long been considered that a constant, even supply of blood sugar ensures optimum functioning of the brain. The brain is a hugely sugar-dependent organ and relies on a stable supply to function correctly. Research conducted at Swansea University found that these peaks and troughs experienced by consuming high GI carbohydrates are associated with poor memory, attention and concentration (2). A study conducted by Northumbria University showed the importance of feeding your child a low GI breakfast (3). They had two groups of children between six and 11 years old and fed them either chocolate rice cereal, which rapidly elevated blood sugar levels after consumption, or a starchy all-bran breakfast cereal that released the energy much more slowly. Hourly memory and attention tests were then administered thereafter, and researchers found that although both groups, as expected, declined in performance, the group that consumed the starchy breakfast fared much better in the subsequent tests than their counterparts.
Secondly, consuming a diet rich in high GI carbohydrates can also affect a child’s overall eating habits and weight. Research conducted by David Ludwig and colleagues looked at a group of 12 obese boys (4). On three separate days, the boys were given three breakfasts with identical calorie densities. On the first day, it was instant porridge, the second it was steel-cut oat porridge, and on the final day, it was a vegetable omelette and fruit. After each breakfast, the boys were allowed to freely graze on a snack platter. Shockingly, researchers found that the boys consumed an average of 600 to 700 calories more during the immediate hours following the high GI instant porridge compared to the other two lower GI breakfasts, suggesting that low GI foods are more satiating and keep your child fuller for longer. As expected, after the boys consumed the high GI instant porridge, there was a subsequent rise and fall in blood sugar.
Interestingly, from a behavioral standpoint, the rebound crash in blood sugar coincided with a surge in the hormone adrenaline, usually associated with times of stress. Adrenaline implicated in the “fight or flight” state may well cause children to appear hyperactive, anxious or aggressive. Further research conducted on children found that administering a low fat, calorie restricted diet was less successful (to the tune of seven pounds in four months) compared to the low GI, no restriction diet (5). The take home message here is, due to the satiating effects of low GI foods, children will naturally eat less and feel hungry less often when consuming low GI foods whenever they want. This also has implications for avoiding any eating disorders as children can freely consume healthy foods with no limitations, unlike many popular diets seen in the media.
By consuming a diet rich in low GI foods such as pulses wholegrains, fruits and vegetables, children are more able to control their appetite and ultimately bodyweight. It appears that cognitive performance in children is also associated with the type of carbohydrate they habitually consume. So not all carbohydrates are the same, and as such, the right kind of carbohydrates (low GI) should form the foundations for a healthy, balanced and nutritious diet for mental, emotional and physical well being.
In the world of endurance, it seems that you cannot discuss fitness without discussing VO2 max. Ask any endurance athlete about it, and you will hear epic stories with names like Indurain, LeMond and Armstrong. Many of you, however, may find yourselves wondering what exactly VO2 max is and why is it so important. To better understand this concept, let’s take a little trip back to school, specifically back to physiology class. According to the Essentials of Strength Training and Conditioning textbook, VO2 max is the maximum amount of oxygen in milliliters one can use in one minute per kilogram of body weight (ml/kg/min). In other words, maximal oxygen uptake (VO2 max) is the greatest amount of oxygen that can be used at the cellular level for the entire body. VO2 max has been found to correlate well with an individual’s degree of physical conditioning and has been accepted as an index of total body fitness. Numerous studies show that one can increase his/her VO2 max by working out at an intensity that raises the heart rate to between 65 and 85 percent of its maximum, for at least 20 minutes, three to five times per week. The estimated mean value of VO2 max for male athletes is about 3.5 liters/minute and for female athletes is about 2.7 liters/minute.
Now that we know what VO2 is, we can now answer the question, “Why is it so important?” For the endurance athlete, VO2 has long been considered the Holy Grail of fitness. The common rationale is the better one can utilize oxygen, the higher the level one can perform in endurance events. Is this, however, really the case?
Although VO2 max is an important component of any endurance program, I have both good and bad news for those of us who have may not have chosen the right parents! The bad news is that according to Exercise Physiologist Neal Henderson, Coordinator of Sport Science at the Boulder Center for Sports Medicine in Colorado, VO2 is approximately 80 percent genetic. Other estimates put this number anywhere between 30 to 60 percent. Whatever the number is, one thing is certain; there is a genetic ceiling for VO2. The good news is that VO2 is trainable. Unfortunately, if Neal Henderson’s 80 percent estimate is correct, and your VO2 is, for example, at 45ml/kg-/min (average), your best may only be 52 ml/kg-/min after a 20 percent gain (52 ml/kg-/min is considered to be good or just above average).
To put this into perspective, Lance Armstrong checks in at about 84ml/kg-/min, while cross country skier Bjorn Daehlie measured at an astounding 96 ml/kg/min. The highest VO2 max ever recorded in a lab was 300 ml/kg/min! This, of course, did not belong to a human but rather a pronghorn antelope. How they got the antelope to run on the treadmill I’ll never know, but I promise I’m not making this up. Thoroughbred horses have a VO2 max of around 180 ml/kg/min, and Siberian dogs running in the Iditarod Trail Sled Dog Race sled race have VO2 values as high as 240 ml/kg/min. To add even more perspective, Olympic marathon winners and elite runners like Jeff Galloway, Alberto Salazar and Frank Shorter check in among the low to mid 70s.
The good news is, like the previously mentioned runners, although you may be at your genetic potential, there are many factors besides VO2 max that can also influence your success in endurance performance. Improving efficiency and economy of movement as well as raising your anaerobic threshold (AT) can lead to performance enhancements in the absence of increases in VO2. These three components can all be addressed through a functional strength training program. Now let’s take a closer look at each of these components.
Continuing on in our physiology lesson, now would be a good time to talk about lactate threshold (LT) and its relationship to VO2. Dr. Stephen Seiler of Masters Athlete Physiology and Performance says, “For the endurance athlete, a high VO2 max is like having an invitation to the big dance but having an invitation to the dance does not ensure you will dance with the prettiest girl.” If you want to dance with that girl, you are going to have to work on your LT! (And you thought it was big guns and washboard abs that attracted the girls.) LT, as pointed out in one of my previous articles (see Lactic Acid; The Good, The Bad, and The Ugly), is the point where the body produces more lactic acid than it can clear. Training LT will result in a decrease in lactate production at any given exercise intensity. Untrained individuals usually reach the LT at about 60 percent of VO2 max. This means that even if my VO2 is 70 ml/kg/min, which is an elite level, I can only use 60 percent of it, or 42 ml/kg/min (average), before my LT shuts me down. With training, however, LT can increase from 60 percent to above 70 percent or even higher. Elite endurance athletes typically have an LT at or above 80 percent of VO2 max. Although most endurance athletes usually train LT in the pool, on the bike or during the run, we have several protocols in the gym designed specifically to improve LT. Furthermore, because specificity of movement is very important when training LT, these protocols address both the lower and upper body (see Table 1 below).
|Speed Squats||20||20 reps in less than 20 seconds to parallel|
|Lunges||20 (10 per side)||Alternate legs, knee just off ground|
|Box shuffle/split jump||20 (10 per side)||Use 9” box|
|Squat jumps||10||Squat to parallel and no rest between jumps|
Complete entire circuit without resting in less than 1:30
Last but not least, we can now tackle efficiency and economy of movement. The difference between efficiency and economy in an exercise setting is that, for a given energy consumption, economy is measured as movement velocity, while efficiency is measured as mechanical power output. What does all that mean? It means that efficiency and economy can be just as important as VO2 or LT. To better understand this concept, just think of the last time you were out for a group ride. Was it easier to pull at the front or sit in? Sit in, of course! Why is that? Because sitting in allows for more efficient movement and less exertion, which in turn will allow you to be more economical. Think of every joint in a given movement as an opportunity to leak power. The more joints involved in a movement, the more opportunity there is to leak power. The more stable the joint, the less power that leaks. The less power that leaks, the more efficiency in a given activity.
So how do these concepts apply to strength training? Frequently, I am asked to watch someone run on the treadmill and look at his gait. Instead, I ask him to perform 10 anterior reaches on a single leg. If this is difficult, that tells me his hips are not as stable as they could be, and his gait could not possibly be as good as it should be. The same goes for the shoulder joint. If you cannot manage a set of t-stabilization push ups with good form, then your swim stroke is not as efficient and economical as it could be.
Now for all of you skeptics out there, all I ask is for you to just try it out. Perhaps before you go to test your VO2 (no fun, by any means), you might first try taking a look at your anterior reaches or t-stab push ups. These alternatives I have presented are not meant to point out your shortcomings or embarrass you but rather to empower you. Rather than whining about genetics (though I still do), try testing your limits in some of the ways mentioned earlier. I assure you that you will find what my most successful clients have found, that through a comprehensive functional strength training program, economy, efficiency and lactate threshold can be improved, making maximal VO2 less important.