Rationale for interval training

Interval Training Program Guide

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The premise of interval training is that an individual can produce a greater amount of work in a training session if the training bouts are spaced between periods of lower intensity work. Usually these active recovery (AR) periods are between 30 seconds and one minute in duration (see Chapter 4).

Key Points on Active Recovery Exercises

• lower intensity cardiovascular activity, e.g. walking;

• musculoskeletal endurance (MSE) work, e.g. exercises to improve local endurance of muscles NOT used in the cardiovascular stations.

Progression from Interval to Continuous CV Work

In this context continuous can mean that the AR is removed, or that the subject participates in one mode, e.g. rowing or cycling for the entire overload section. The goal is to progress participants from interval to continuous training as their fitness improves. The duration of the active recovery sections must be either reduced or maintained. Aerobic activity can be altered either through increased durations of CV work or through an increase in intensity. This will depend on an individual's risk stratification and rehabilitation goals.

Why Circuits?

Circuits (circuits in this context do not refer to circuit training) have become the most popular mode of delivery in cardiac rehabilitation because they can be designed without a large amount of equipment. A further advantage is that circuits offer variety, and each station can be adapted to allow for individual ability, thus allowing progression both within and between stations. In addition, they provide motor skills development and include more functional-type exercise. Furthermore, circuits are an opportunity for social interaction amongst participants and, because the exercise leader is not required to exercise, he or she is free to move around participants and to provide individual coaching and correction. Finally, depending on the type of circuits created, they can be used as a model for home-based exercise. Home-based exercise circuits can be delivered as a video or using copies of the stations on the Physiotools package (2005) with a created handout of individual exercises.

Factors to Consider in Circuit Design

Careful planning and preparation, knowing in advance the limitations on room size, equipment available, number of participants, etc. will all help make the circuit design work in practice. In general the circuit must follow in a logical sequence with an easy-to-follow plan. This becomes more important especially with larger groups and with participants of different levels of exercise ability, for example, from very deconditioned to above average fitness.

Most circuits include 8 to 12 exercise stations. Your circuit needs to have a sufficient number of stations to accommodate all the participants, along with sufficient trained staff to supervise those exercising. Current Association of Chartered Physiotherapists in Cardiac Rehabilitation (ACPICR, 2003) guidelines recommend a staff-to-patient ratio of 1:5. You need to pre-plan how staff will monitor stations effectively, e.g. take responsibility for three or four stations, or responsibility for four or five people moving round the entire circuit. If you are planning to use exercise equipment you will have to make sure there is enough available to prevent queuing as participants wait for equipment to become available. Above all you need to ensure that the circuit consists of adequate aerobic-type exercises (see Table 5.1) and includes different ways of adjusting the exercise intensity (see Table 5.2) without introducing high-impact moves.

Table 5.1. Examples of aerobic exercise

Leg Pattern

Arm Pattern

Knee lifts Toe taps behind Toe taps to side Knee bends Back heel lifts

Three steps forwards and back Side lunges Heel digs to front March

Two steps to side and back

Step kicks

Toe taps to front

Elbow bends Double punch forwards Side arm raises Butterfly (pectoral) Criss-cross to front Arm raise above head Hand push-downs Reach pull back Forward elbow circles Low swing behind back Diagonal arm reaches Forward arm swing

Table 5.2. Methods of altering intensity of an aerobic exercise

Range of movement (e.g. step height, step length)

Speed of movement

Length of levers (upper limb)

Unilateral / bilateral movement

Plane of movement (above/below chest height)

Change load (hold light hand dumbbells)

Change exercise duration

Choice and Arrangement of Stations

In order to maximise the desirable physiological effect, the majority of the exercises should be aerobic in nature. Aerobic exercises involve rhythmic movement of large muscle groups involving the whole body. Variations in the starting position of an upper body exercise can have a significant effect on rate pressure product (RPP). For example, elbow flexion and extension performed with the arms by the side are easier than when the arms are held at shoulder level, which is easier than when the arms are held high above the head.

When selecting individual exercises, it is essential to ensure there is a balance of exercise on different muscle groups, and that consecutive exercises do not result in overusing any one muscle group (e.g. step-ups followed by cycling will result in excessive quadriceps work).

Active recovery stations, by their very nature, need to be evenly spaced amongst the aerobic stations and not next to one another. AR exercise involves a muscle to exert sub-maximal forces against a resistance over an extended period of time and differs from strength. Musculoskeletal endurance (MSE) is best developed by using lighter weights and with a greater number of repetitions (Pollock, et al., 1998). As a rule for muscular endurance, select resistances that allow more than 16 repetitions to be performed without inducing fatigue (i.e. RPE less than 15). AR are generally used to increase endurance of specific muscle groups, e.g. quadriceps, and are of a lower intensity, i.e. 60% HRmax. If muscular endurance exercises are chosen, then they should target muscles not used extensively in the CV component (see Table 5.3 for some examples).

A useful website resource for theraband (http://www.thera-bandacademy. com) provides a database of exercises using elastic bands and allows you to create a printed handout.

Table S.3. Examples of muscular endurance exercises

Muscle/group

Gastrocnemius Gluteals

Upper trapezius and deltoid Lateral dorsi and rhomboids Triceps

Gluteal medius and minimus Biceps

Lateral rotator cuff Quadriceps, hamstrings and gluteal maximus Pectorals and triceps

Exercise

Standing single calf raises

Standing single hip extension

Upright row holding weighted pole

Seated row with elastic band

Standing press backs or seated dips

Standing hip abduction

Bicep curls holding dumbbells

Seated shoulder rotations with elastic band

Wallslides

Chest press (band around back under arms)

Station 1 _k Station 2

Station 3 1

Station 4

Station10

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Getting Started With Dumbbells

Getting Started With Dumbbells

The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.

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