Email a Link to this Page

High Intensity Strength Conditioning and
Its Application to Medical Conditions

The real pioneer in high intensity strengthening is Arthur Jones, the person who designed and developed Nautilus equipment. Mr. Jones’s early writings contain discussions about intensity, or what he sometimes called "outright hard work.." This form of strengthening was enhanced in the 70's by Mike Mentzer, 1979 Mr. Universe. I believe his writings, which emphasized the principles of high intensity exercise and the philosophy of exercise as a whole, did more to provide "sanity" to bodybuilders and the field as a whole. I have taken these same principles used by body builders and introduced them to the arena of strengthening for individuals with medical problems.

The principles of high intensity training (HIT) were formulated and directed to individuals who were interested in "body building" for competition. This form of exercise is not taught in the schools of physical therapy or medical schools. Prior to the 70's, primarily high volume exercise, meaning high numbers of repetitions, multiple sets and with gradual weight increase was used. This was called the DeLorme Method , introduced in the 40's by Dr. Delorme. This continued for 3 decades until men like Jones and Mentzer started experimenting with fewer repetitions, slow movement, and no unloading of the targeted muscles to complete muscle fatigue. The results showed greater strength in less time.

Only recently has this form of strengthening for individuals over 50 years of age, with or without medical problems, been targeted for functional strength. This has come about because of two primary reasons:

The introduction of exercise equipment in the 90's that allows full range of motion, variable resistance, minimal friction, and adjustments for proper and safe positioning and alignment. Prior to the 90's most all exercise in the gym was with "free weights." Some equipment existed, but with high friction, minimal settings for alignment, and poor stabilization of the trunk.
The development of a protocol for training that incorporates total control of the person being exercised. Specifically, the SuperSlow protocol introduced in the 80's by Ken Hutchins through an osteoporosis study at the University of Florida. This certified program for high intensity strengthening contains all the safeguards to train more fragile individuals with complicated diagnoses.

Force = Mass x Acceleration

It is well known that the greater the force, the greater the chance of injury. With the SuperSlow Protocol of training, the movement is so slow that acceleration is almost dropped from the equation. What about mass? By going slow thru the arc of motion, momentum is eliminated , thus the weight an individual moves is actually less. Combined together, force is obviously decreased, thereby lessening the chance of injury.

HIT could just as well be called low force exercise to better accommodate the medical community, however nowhere in the literature do we read about low force exercise. The term High Intensity Training has been written about, studied, and practiced for the last 25 years.

Intensity of an exercise is directly proportional to the weight lifted, and indirectly proportional to time or repetitions. Thus, the heavier the weight and shorter the time under load, the higher the intensity. In exercise physiology, a term is often used is called One Repetition Maximum (1RM) which is the amount of weight the selected muscle, or muscle group, can lift through one repetition. In high intensity exercise the weight used is 80-90% of 1RM, with only one set.

In high intensity strengthening, it is necessary and very important to work the muscle to complete momentary fatigue with good form. This means the targeted muscles are worked to the point where there is no movement possible with maximum exertion. This fatigue (inroad) must occur with specific parameters of time or repetitions. I much prefer time as the quantitative measure as it can be more precise than reps, and easier to determine when to add, subtract, or maintain the weight lifted. Accordingly, all of the criteria for changing weights will be determined at the time the muscle(s) inroads. Increase weight the next session if time is over 2 minutes under load. Decrease the weight if unable to reach 1 minute 20 seconds. Maintain the same weight if between 1:20 and 1:59. Stop the exercise if not inroaded by 2:20.

Range of motion of each repetition should be as great as possible. If the movement resulting from muscular contraction is less than full-range, the entire length of the muscle will not be involved in the work. As you begin to fatigue, range of motion will decrease. In fact, at the very end of the exercise the range will be short as you reach momentary fatigue. This is acceptable.
Speed of movement should be slow, steady and continuous through out the arc. The motion should be under control at all times.
Momentum should be eliminated.
Form perfect.
Never holding your breath, face relaxed.
The velocity should range from 15 to 20 seconds per repetition. This would equate to 7-10 seconds thru the concentric (positive) motion, and 7-10 seconds thru the eccentric (negative) phase of the repetition. This slow movement eliminates momentum, produces excellent control, maintains form, and fatigues the targeted muscles quickly.

The Journal of Sports Medicine and Physical Fitness published a study by Wayne Wescott, PhD, that showed this method of going slow resulted in 50% greater increase in strength compared with regular, faster, and momentum- aided weight training.

High Intensity strengthening requires rest between workout sessions. Muscles stimulated to total momentary fatigue require a time for repair and additional time for growth. If you stimulate a muscle that has been fatigued before it has a chance to hypertrophy, or grow, you interrupt the biological mechanism the stimulus produced, thereby retarding the growth you attempted to get by stressing the muscle to total fatigue. The minimum time between workouts is 72 hours, 2 sessions per week. This gives the fibers time to heal and grow.

Machines Versus Free Weights

"Selectorized" machines (those that you pin the selected weight, and adjust the seat, back, and arms to position, align, and stabilize) are much better adapted to working with individuals with any form of medical problems. You can limit range of motion of any joint by pinning the weight up or down. Weights can be as light as 8 ounces. These specific requirements to stabilize are just not as easy to do with a bar bell. Dumbbells can be used for upper extremities.

Stumbling Can Be Good

I stumbled on the SuperSlow protocol by accident in the fall of 1998. I was intrigued enough to go back to Orlando, Florida and talk with Mr. Hutchins. I liked what I saw in the protocol, and proceeded to complete the Level I and II certification. I was very aware of the fact that in many instances we in physical medicine were not aggressive in our rehabilitation, especially with post surgery back patients. It appeared to me that this protocol was the safest avenue to introduce high intensity strengthening into the medical arena. It has proven to be true.

Since February 1999, I have specialized in "aggressive rehabilitation" using high intensity strengthening with the SuperSlow protocol for training. My study group has consisted of personally evaluating 1625 individuals to qualify them for the program. With the help of three certified trainers, these individuals have accumulated 40,501 sessions of exercise on 14 different exercise machines. The diagnosis pool has included degenerative discs, herniations, degenerative joints, multiple sclerosis, Parkinson’s Syndrome, rheumatoid arthritis, cancer, fibromyalgia, diabetes, cardiac issues, hypertension, and the list goes on. Post surgery strengthening has included low back fusions, laminectomies, total hip, knee, and shoulder replacements.

One particular diagnosis that I feel this program is too aggressive for is Chronic Fatigue Syndrome. I’ve had two individuals with this syndrome, and I was not able to formulate an exercise plan that did not result in exacerbating symptoms. One criteria is required of all candidates for high intensity strengthening. They must be stabilized in their condition, including medication. No joint swelling, acute pain, muscle spasm. Another principle of this program is to strengthen the entire body, targeting the specific area, but including upper and lower extremities, core musculature, and low back.

Can High Intensity Strengthening Be Dangerous?

It certainly can if not used properly. There are aspects of HIT that include negatives, static contractions, breakdowns, etc., that if not performed correctly can cause injury. These are occasionally used, and only with trainers who are certified, and students who perform the repetitions perfectly e.g. slow, controlled, proper breathing, etc. Knowledge of the equipment and its proper adjustments, and an understanding of the SuperSlow protocol keeps this form of strengthening safe.

Conclusion

I am completely aware that what has been accomplished in my exercise studio over the past five years could not be classified as a "study" as it relates to academia. What I have accomplished is taking the knowledge I accrued over 40 years of private physical therapy practice and introduced the concept of high intensity strengthening into my practice in 1999. I had no idea as to what the outcome would be. Thanks to a few physicians who trusted me in this vision, I was able to specialize in this form of "rehabilitation" while foregoing 90% of traditional physical therapy. After 5 years, the results have exceeded what I suspected, and the referring physicians have been equally awed. Speed of results and safety of the protocol have been beyond expectations.

Medicine has advanced considerably over the past 10 years and it is vital that physical therapists, physicians, and others in the physical medicine field stay abreast of the changes. Continued use of high intensity-low force strengthening can be a vital aspect of a treatment plan when applied appropriately and with adequate knowledge of the protocol.