Navigating exercise can be difficult. The fact of the matter is: not all exercise is the same. What I mean by that is that the type of exercise you do now can impact your future self for the better, but also for the worst. I see too many patients in my clinic who struggle with finding that balance of exercise and are looking for the right guidance to understand when too much is too much, and when enough is not enough. I want to help you understand these differences in exercise so that your future self thanks you for taking the right steps today to create a healthier and pain-free tomorrow.
When you hear the word “exercise” what do you think of? Hour-long misery sessions at the gym lifting too-heavy weights to too loud music? Maybe you think of going out for a seven-mile run followed by a twenty mile bike ride and a one mile swim. I find that a lot of people are either in the “cardio” camp or the “weight lifting” camp. There is a propensity to stick to what we know and what we are good at.
I want you to take every misconception you have about exercise and throw it out the window. Let’s start from scratch. You need to know the basics of exercise and the goals or outcomes to be able to determine what is best for you and your lifestyle.
I like to think of exercise in three general classes: rehabilitation, maintenance and progression.
Rehabilitation is a phase for pre-existing injury or a chronic muscle, nerve, tendon or joint problem. For example, if you have trouble raising your arm overhead because it causes shoulder pain, there is a movement problem that needs to be corrected. Persistent pain with motion is not normal. It should be evaluated by a medical professional. More often than not, you will need to be re-trained to establish proper movement patterns with the help of either a physical or occupational therapist.
Furthermore, rehabilitation is broken down into 4 Stages:
Rest
Repair
Strength
Function
Rest refers to protection of the injury. You need to allow damaged tissue to begin the first phase of tissue healing so as to not harm the damaged tissue further. You can learn more about this in my Tissue Injury Cycle article. An example is if you have shoulder pain either at rest or with just lifting your arm against gravity, then you should stay away from activities loading the shoulder joint under more tension, like an overhead dumbbell press.
Repair occurs shortly after injury to the damaged tissue, usually in about a week or so after injury. This phase focuses on recovering *pain free* range of motion and stability of the injured area. Keeping with the shoulder as our example, you should look to restore full range of motion around the joint in addition to light weighted activity in the repair phase. All motions at this phase should be essentially pain free, and should focus mostly on the mobility of the joint, rather than the strength of the joint.
Strength should only come once a joint restores full *pain free* range of motion. This is the critical phase since it is where we reintroduce weight training in a controlled capacity. The idea is to create better lifting patterns with a lower weight so when we reach the last phase in rehabilitation, we can progress back to a normal state. Old lifting habits will need to be left at the door, especially if that is what caused the injury in the first place. Most of this phase focuses on a combination of training our stabilizer muscles in addition to our bigger muscle groups. Learning when and how to activate the right muscles at the right time is a huge preventative measure for future injury.
Function is taking all of that knowledge you learned in the first three phases of rehabilitation and applying it to every day exercise. Keep in mind, if it is a fifty pound dumbbell or a fifty pound bag of mulch you are squatting down to pick up, fifty pounds is…fifty pounds is…fifty pounds. Catch my drift? Proper lifting technique applies to more than just the gym, it applies to life.
Maintenance is a phase of exercise that most people jump in and out of. It is the port key to progression on one end, but detraining on the other end. In and of itself, I would not classify a certain exercise as maintenance, but rather the frequency and intensity of exercise that determines if you are maintaining the status quo, or progressing your health and physique. Let’s compare a week of maintenance exercise to progression exercise
Maintenance Week | Progression Week |
Day 1: Upper body push/pull @ 50% max effort | Day 1: Upper body push/pull @ 80% max effort |
Day 2: Lower body @ 75% max effort | Day 2: Lower body @ 75% max effort |
Day 3: Cardio at 25% max effort x 45 mins | Day 3: Cardio at 50% max effort x 45 mins |
Day 4: Upper body push/pull @ 75% max effort | Day 4: Upper body push/pull @ 75% max effort |
Day 5: Lower body @ 50% max effort | Day 5: Lower body @ 80% max effort |
Day 6: Cardio at 50% max effort x 45 mins | Day 6: Cardio at 75% max effort x 45 mins |
Day 7: Off day | Day 7: Off day |
You may have noticed in this example that there are no differences in the amount of days spent lifting or time spent on cardio. The difference is the intensity at which the lifting and cardio is happening. Variation in intensity can make a difference in whether your training program has you maintaining what you’ve got, or progressing toward a future goal.
Progression is ultimately our goal with an exercise program. However, this is what can get us into trouble. Let’s picture this - you are driving your car, but you are always driving at 100mph. That means there is more wear and tear happening to the vehicle. The tires will go bald quicker, the oil will need more frequent changes, the engine will get overheated, and the transmission can’t handle high speeds like that forever. Our bodies wear down, too. Have you ever looked at a picture of yourself, and then looked at a picture of yourself from 10 years ago? You are not the same person you were back then. So, why shouldn’t your training reflect that?
Let’s go back to our car example. If you took a 2022 Corvette and put it against a 1965 Corvette, slammed on the gas pedal, and drag raced down the street, I’m guessing the performance will be quite different between the two cars. This is of course assuming there were no rebuilds on the 1965 ‘vette’s engine. My guess would be the performance will be far superior with the newer vehicle. An older car needs to be maintained, warmed up, and THEN it will stand up to the performance.
My point is, progression is part of our equation, but not our whole equation. To have success in progression phases, we need to understand that some days our training will require just rehab, and some days will be more maintenance days.
I cannot stress enough that EVERYONE needs a combination of exercise that focuses on rehab, maintenance, and progression – regardless of age, gender, ethnicity, and previous training history.
So how do I know when I am ready to change from rehab to maintenance to progression?
The short answer is, there is no right answer. Each day will be different based on how your body is responding to a new exercise program. It is very dependent on the individual.
Ask yourself: Do I have any joints that hurt when I move them? If so, is it only with certain activities or is it starting to affect my day to day as well (i.e. house work, work, etc.)?
If you have a painful joint and it is starting to interfere with practically any use or movement of that joint, you need to look at being in a rehab phase for that specific joint.
If there is mild pain while lifting, then you may be okay just dropping to the maintenance phase by decreasing the weights or repetitions until the exercise you are performing is essentially pain-free.
This does not mean your whole exercise regimen needs to stop. Let us revisit our shoulder example. If you cannot perform overhead presses, that does not mean you can’t squat or perform lunges. You can still be in a progression phase for certain joints or body parts that are otherwise healthy.
Is this change in exercise from rehab to maintenance to progression linear?
No. Think of this model as a three-circle venn diagram. The idea should be that each body part will be in its own class and it may vary day to day, week to week, month to month, and so on.
For example, in a single training week, you may develop a program to rehabilitate some nagging shoulder stiffness and pain, but maintain your bicep, tricep, chest and back strength in addition to a day where you can really progress your leg strength. Just remember - injury does not mean you have to STOP exercise, it just means you have to MODIFY your exercise.
I am not reaching my goal on my timeline if I don’t push myself hard all of the time, what do you have to say about that?
Goals are interesting things. They are what motivate us to make a change to be better. I recommend really looking at your goal and understanding if it fits your lifestyle. Most goals with exercise are to change body composition to look better, lose weight, or gain muscle. It may be to win a competition such as Bodybuilding/Physique Competition or competing in a Marathon. Those goals require hard training. They require you to push yourself. And yes, they put you at higher risk for overtraining and injury if you do not give yourself enough time to train appropriately.
I always tell people if your goal is to complete a task or a competition, then understand you may run into injury and it will always be your decision if you push past it, or are forced to stop if the extent of injury is too much (i.e the difference between patellar tendinitis versus an ACL tear in a runner).
If you aren’t concerned with meeting a deadline, or a short-term goal which I define as training for 1 day of success (i.e. a race or competition) then you should look at exercise as a journey. Each day you get to get up and train for life. If your goal is to be able to get up from a chair and walk a mile without pain at ninety years old, or to lift your kids out of their car seats with no pain, then your goals are longer term. Just understand that yes, this does take time, and yes, you may not meet your “deadline” in a year. But each day you choose to train and take care of your body is one day more you will be able to do most things well into your ‘Golden Years’.
The great thing about changing your mindset from short-term goals to long-term goals with exercise is that you actually want to work out. It becomes a habit rather than a chore. It takes the stress away from disappointing injury or ultimately not reaching your goal. And if you did reach your goal, then usually you are left looking for another, bigger and better goal that may end up being your demise.
Luckily, as a society, our mindset is changing. The 1990’s and 2000’s were about being skinny for women and ripped with muscle for men. And if you did not fit into either of those categories, then what was the point in trying. Or, men and women would go to extremes with crazy exercise and diet programs that just are not sustainable.
The current climate is about promoting health first, not body image. I think this is a tremendous improvement. By putting our health first, we can reach those goals of feeling and looking better, while being able to stay mobile and active into our later years. When you stop comparing your looks to others and just focus on how you feel and what you do to help yourself, the stress and the angst of diet and exercise just melt away – trust me.
In my closing thoughts, I want to recap that exercise is important and that most of us struggle with how, what, and when to perform exercise. Each day we wake up and decide what we want to do, and sometimes this is limited by time, experience, access to space or equipment for exercise, and injury status. Most of us struggle understanding the difference in exercise and when we should be pushing hard, or backing off. The basic principle is that exercise is a journey, and you should feel invigorated, not inept by it.
Day by day and body part by body part will determine the intensity, frequency, and load of your exercise. There should be a good mixture of cross training (i.e. cardio, weights, bodyweight, stretching, and rest days, too) to have you looking, feeling, and moving your best not just now, but over your lifetime.
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