It’s the start of a new year, and for many, this means new resolutions and plans. A lot of us will have new year goals that are related to health and fitness. Surveys show that getting active and in shape, along with losing weight, are some of the top goals people have for new year’s resolutions (1). Unfortunately, research shows that over 50% of individuals who commence a fitness program will cease completing it after 6 months (2, 3). Furthermore, when looking at new year’s resolutions specifically, studies show less than 25% of people commit to the resolutions for >30days, with an accomplishment percentage of only 8% (4).
This blog will look to touch on some evidence-based recommendations from an exercise and injury prevention perspective that will help you achieve your goals in 2020.
The first component of successfully achieving any goal is the process of goal setting. Without setting specific goals and targets, you’re setting yourself up to fail, and the research supports this. Individuals who set goals have better outcomes on their fitness programmes than those in control groups (5). Goal setting has been recommended as a critical step in athletic & sporting populations (6).
Recommendations for goal setting:
Set specific and measurable goals.
Have a range of goals including short-term and longer-term goals (3).
Set goals that are personalized and important to you as they will be more effective (3).
Make some of your goals realistic and achievable, as goal achievement is a critical step for motivation and adherence (3, 6).
Getting feedback on goal progress is important and aids success in achieving outcomes (3).
Under take regular self-monitoring and re-evaluation of current progress (3).
Having a regular “exercise leader” to touch base with assists motivation (this could include a physiotherapist, personal trainer, group class trainer/leader etc) (5).
Delving more into goal setting, it has been shown that setting process goals provides better outcomes at 3 and 6 months than outcome goals, performance goals, or control groups (5). For example, an outcome goal refers to the end point of an event, like losing 8kgs in weight. A process goal refers to the method or process and individual wants to engage in to achieve the goal, for example, wanting to keep your exercising heart rate above 140bpm for 20mins of the session. It has been found that the process goals increase the motivation and persistence with exercise programs (5).
As mentioned previously, one of the biggest issues with a health and fitness goal is the ability to adhere to and achieve the goal (2, 4, 7). Poor adherence to exercise or rehabilitation can significantly affect the outcomes (8). There are a number of factors causing individuals to drop out of exercise programs, include a lack of time, failure to achieve the goal, a lack of improvement, motivation (or lack of), difficulty with performing exercises and technique, fear of injury, lack of interest, fatigue, work schedules, and more (8, 9, 10). Factors such as poorer mental health, low social support, high number of perceived barries, and pain during exercise are associated with poorer adherence to exercise programmes (8).
How can adherence be improved? The recommendation is to identify the potential barriers which may impact on your ability to complete the program as desired. This may affect your goal acheivement (8). Utilize strategies such as setting realistic expectations, settings short and long term goals, ensuring social support (consider group-based exercise), and having a health professional overseeing the program (e.g. physio, personal trainer etc) (5, 8). Furthermore, it is recommended to choose a type of exercise that you have enjoyment or preference for, as this will increase adherence (11). If you are an exercise or health professional, work with your patients to help them set goals, and identify any potential barriers which may impair their ability to successfully achieve their goals (8).
Once you’ve started exercising in progression towards your goals, the next big consideration is ensuring you don’t increase your training load too quickly. Changes, especially spikes in activity, are linked with injury in team sport athletes and runners (12, 13). Confused? Let’s break this down…
What is load:
“The sport and non-sport burden (single or multiple physiological, psychological or mechanical stressors) as a stimulus that is applied to a human biological system (including subcellular elements, a single cell, tissues, one or multiple organ systems, or the individual). Load can be applied to the individual human biological system over varying time periods (seconds, minutes, hours to days, weeks, months and years) and with varying magnitude (ie, duration, frequency and intensity).” (13).
Still confused? In simple terms, load refers to the amount of demand placed on a system. For example, this could be the amount of kilometres run, the number of squat repetitions completed, the amount of time swimming, the amount of weight lifted.. and so on. Each of these activities places stress on tissues and systems of the body.
The use of loading is an important factor for improving strength, fitness, and performance (13). As illustrated by the figure below (see figure-2), exercise load causes a short term reduction in capacity, with the body then adapting, and super-compensating to improve capacity. Subsequent bouts of activity interspersed with adequate recovery will continue to lead to increased capacity.
The next figure (see figure-3) shows how inadequate recovery and/or excessive loading can lead to maladaptation, and therefore reduced ability to accept load. This can increase the risk or susceptibility to injury.
When broken down further, studies demonstrate that the total amount of activity (e.g. absolute load) may not be the primary problem. It has been found in a number of studies that higher activity levels (training load) may actually be protective from injuries, likely due to well developed physical qualities/capacity (13, 14, 15). The factor more likely to increase risk of injury is the change in load, especially rapid increases in activity relative to what the athlete/individual is prepared for (13). Periods of deloading, where there is a lack of activity, followed by a return to training, is also high risk of injury. For example, this could include after you have been unwell and had time off training, or during the offseason for your chosen sport. These changes in activity are often considered “training load errors” (14).
The graph above (see figure-4) demonstrates a model where there is a proposed “sweet spot” where load isn’t too high, but also isn’t too low. The model utilizes the acute chronic workload ratio (ACWR), which compares an acute period of activity/load (usually 1 week) to a chronic period of loading (usually rolling average of 4 weeks). If the ratio is between 0.8 and 1.3, this is typically the “sweet” spot where injury risk is the lowest (approximately 5% risk or less). This model, which is based upon evidence in team sports, highlights that consistent increases / maintenance of load is crucial, with a systematic progression to higher loads important to prevent fatigue/overload (and subsequent high AWCR). The model illustrates that high load (load spike) and deloading can both cause increased injury risk. Small and progressive increases in load have been recommended, with a goal of reaching high training and activity levels over time. This allows time for recovery and adaptation, where the athlete is able to increase their fitness/capacity, also avoiding periods of overload (e.g. entering the “danger zone”, see figure-4) (13, 15, 16).
Important to note this data is from cricket fast bowlers, however the model and principle is useful to use in other settings/populations. Furthermore, the theory of not over or underloading should be utilized and adapted for most athletes/sports and individuals aiming to increase physical activity levels (13, 15, 16).
The recommendation of 10% increase in activity/load per week is often given, and has been used in some literature (17). Studies on runners show that increases above 30% per week had greater injury risk than ~20% increases (18). Furthermore, training load data showed that a change from <10% to >15% per week increased injury likelihood from 7.5% to 21% (15). Based upon this data, my recommendation would be to initially stick to changes between 10-15% per week, however individuals may vary and consultation with a physiotherapist (or other exercise & health professional) should be considered.
Regular monitoring of training activity levels is important, along with assessing for potential indicators of overtraining/overload. Consider monitoring your own muscle soreness, sleep, fatigue levels, and potentially the session rate of perceived exertion (RPE) (RPE x session duration). Significant spikes in these measures are potential indications of overload, and a deload session could be recommended (19).
Along with injuries, studies show that high load and low load both increase the risk of illness in national level, sub-elite and recreational athletes compared to moderate loads. However, elite level athletes (e.g. medal winning) may be able to cope with high loads without the increased illness risk (20) (see figure-6).
Take home messages about load: Whilst the model (ACWR) above is complex, the messaging and methodology behind it is useful when considering your activity levels. Look to progressively increase your activity levels, avoiding periods where your current week of activity is significantly higher than your previous weeks, thus avoiding a load spike. Gradual progression, with a goal of achieving high levels of activity is recommended.
With any health and fitness goal, my recommendation is to consider inclusion of an individually prescribed strength and conditioning program. There are numerous studies available demonstrating the significant positive effects of strength training. These benefits are diverse, and include impacts on the musculoskeletal system (increased muscle mass and strength, improved bone and joint health etc), improvements on the nervous system (reduced pain, improved muscle activation, improved movement control), benefits on mental health, it is hugely significant for chronic disease management, and much more. The figure below (see figure-7) displays some of these benefits visually.
When considering our new years resolutions or fitness goals, strength training also has a massive role to play. Studies show that completing resistance type training helps to maintain muscle mass during weight loss (21, 23, 24), also showing improved fat loss compared to dieting only (24, 25).
Strength training has also shown to improve running performance (26), cycling endurance performance (26, 27), and is recommended for swimmers for injury prevention and performance (28, 29). Furthermore, strength training has significant evidence to show a strong injury prevention benefit, especially for muscle injuries.
Furthermore, weights training is safe and effective in adolescents. For more information on this form of training in this population, have a read of a recent blog post I’ve written: https://www.kywynne.com/post/weight-training-for-youth-athletes.
Finally, it is important to consider not only your strength, but the control of movement. Studies have shown that movement and control assessments are key factors in injury prevention for lower limb injuries (30, 31). Movement assessments are typically common for activities such as running, jumping, and exercise technique.
It is also important to consider sleep, and stress. Both are important in training success, but also in injury risk. I have written previous blog posts on these areas for those interested in read further:
In summary, I would recommend utilizing the motivation of a new year to set achievable and measurable goals, both for the short and long term. Consider an exercise modality that you enjoy, and potentially utilize group training or an exercise leader (e.g. personal trainer) to assist with adherence. Look at what barriers you may have that will affect your ability to stick to your goals, and put strategies in place to prevent them impacting. Be mindful of your training load, and avoid significant spikes in activity. Finally, consider working with an appropriately qualified health professional to monitor training load, assess your movement, and set a strength & conditioning program.
Best of luck with your new years goals! Please feel free to share this with anyone you think it may benefit.
Ky Wynne, DPT, APAM, BExSci
Resources:
Consensus Statement on Load: https://bjsm.bmj.com/content/50/17/1030.short
Paper on the Acute Chronic Workload Ratio (ACWR): https://bjsm.bmj.com/content/50/5/273.short
Mick Hughes blogs on load:
Running blogs:
Brad Beer’s blog on running mistakes and loading: https://www.physio-network.com/5-running-mistakes-to-avoid/
Blog on load and running progressions (Brad Beer): https://www.pogophysio.com.au/blog/the-10-rule-does-it-hold-true/
Tom Goon’s blog on running injury prevention research: https://www.running-physio.com/skimpyresearch/
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