Positive Health Online

The Health Survey for England report on physical activity levels indicates that 37 per cent of males and 25 per cent of females within the UK participates in regular physical activity.[1] Having witnessed thousands of members performing an array of exercises within health and fitness clubs, I must question the relative quality of those exercise movements that are being performed. For instance, from my experiences within a health club, it was not uncommon for me to technically correct anywhere between 30-40 members within a one hour period at peak times, most of whom were performing free-weight and resistance exercises with improper technique. Additionally, I had consulted many clients and members who presented signs and symptoms of over-training and even those who I deemed as 'under-training'. Without the coaching from a skilled, highly trained fitness professional any single exercise can produce directly the opposite result to that with which it is promoted, often creating a greater imbalance within the human body.

A Holistic Model for Optimum Training and Conditioning

Consider for a moment that a human is a physical, mental, spiritual and emotional being – it is logical that for any stressor that bombards the body, at any given moment in time, it will challenge the relative homeostasis of each of these elements. Stressors reach our bodies in many forms, such as nutrition, electromagnetic, chemical and thermal to psychic and physical movement.[2] These stressors are vital to the integrity of our physiological systems that control our body. The quality and dosage of any such stressor that reaches our body is of absolute importance – too much and the body may not be able to tolerate the imposed demand; too little and the body would not deem a physiological adaptation in preparation for the future exposure to such a stressor. For example, it is accepted that regular physical activity will promote a healthier mind and body, just as the exposure to bacteria and viruses strengthens the immune system. However, understanding the adaptations that take place during any training and conditioning programme, the body will eventually plateau in response to a particular stressor and should the stressor remain constant, then the body will no longer continue to adapt, resulting in reduced levels of strength and stamina.[3,4] As a species we are designed to eat, move, sleep, reproduce and essentially survive within the confines of planet Earth. Fortunately, there are still many indigenous civilizations within the world that survive in conditions synonymous to those that our ancestors experienced. If you refer to the excellent research of Dr Weston A Price,[5] you will actually discover that ALL of these cultures live with an abundance of health, fitness and vitality free from common Westernized diseases, such as heart disease, diabetes and cancer. More to the point, they have to move to survive. They require a healthy, strong body for hunting, farming and fishing, playing and surviving the array of climates. When did you last see an indigenous Eskimo bench pressing 200lbs to strengthen the chest and arms in preparation for hunting? We live in a society which is accustomed to many luxuries and conveniences of travel, medicine, information technology and health clubs – yet looking around we have the highest incidences of health problems in the history of mankind despite great efforts from the government, pharmaceutical and medical worlds.[6,7]

"A conditioning program is only as effective as the initial assessment."
Paul Chek.[8]

My holistic health and performance clinic revolves around a triad of health matters, which integrate mind, body and nutrition techniques. I typically invest anywhere between two and four hours initially with a new client, evaluating and assessing their unique body, mind and diet. I take the time to individually review each and every client's personal objectives, needs, strengths and areas for development. Having worked in the industry for over eight years I have experienced, and still continue to witness, Palaeolithic methods of assessing new health club members that may take a gym instructor anywhere between five to 20 minutes to complete. Secondary to this, it is common for instructors to utilize a 'one-size-fits-all' approach in designing a programme. This allopathic approach is synonymous to that of seeking advice from a medically trained professional who 'treats the disease that has the person, over the person that has the disease'. We must seek out the aetiology of any form of health dysfunction rather than just attempting to treat or condition the area or symptoms of particular concern to the client or practitioner. For example, what good is an abdominal exercise to increase muscle tone and reduce tummy size without equally considering the implications of appropriate nutrition, medical history, posture, muscle balance of the trunk and related musculature, and the functional requirements of the trunk muscles.

It is essential that we, as health practitioners, understand that an exercise stressor stimulates the human body on all levels (cellular, tissue, organ and systemic) through which the body is highly sensitive and highly dependent upon their integrated manner of functioning. The type, strength and dosage of an exercise stressor control the degree to which each physiological system is stimulated. For example, 45 minutes of running at 70 per cent VO2Max will impose a greater demand upon the cardiovascular, pulmonary and respiratory systems versus 20 minutes maximal strength training which imposes a greater demand on the muscular, nervous and endocrine systems.[3,4] For a training response and adaptation to be successful, it is important that we consider the principles of functional training and effective programme design.

In summary, the holistic model presented within this article revolves around the key considerations that:

• The human body is composed of a number of physiological systems that function in a highly integrated fashion, each of which is challenged when exposed to a host of stressors;
• The human body needs exposure to an array of stressors of sufficient quantity and quality in order for adaptations to take place for a healthier body and mind;
• Each individual patient or client presents a range of unique goals, needs; strengths and areas for development, all of which should be determined by employing a thorough means of assessment of the systems to be treated or conditioned.

Functional Training Considerations

The term 'functional training' has permeated the health and fitness industry over the past five years and often resembles techniques using equipment such as Swiss balls, balance boards and medicine balls. By definition it refers to the training techniques that will prove most useful for transference to an individual's daily activity or sport requirements. For example, if we consider one of the most frequently performed movements executed by all able-bodied persons on a day-to-day basis, it would have to be the squat movement.

Consequently, it becomes essential that training and conditioning programmes incorporate this fundamental movement pattern to ensure sufficient strength, stability and flexibility to the tissues involved in the performance of a squat. The squat is an excellent choice of exercise for developing strength in the erector spinae, gluts, hamstrings and quadriceps, gastrocnemius and soleus muscles. However, it is the performance of sound squat technique that ultimately determines the success of tissue adaptation on a neuromuscular, endocrine and vascular level. Recalling that each individual is highly unique, then only following an initial assessment of muscle length-tension relationships, joint range of movement, muscle strength assessment and technique analysis, can a squat be coached with optimum results in mind.

Programme Design Considerations

My approach to optimum training and conditioning involves the periodization of training cycles to progressively condition an individual to peak health and performance. I seek to customize each of my client's physical programmes, as I would an elite level athlete's programme, taking into account each component from Table 1. Harnessing the holistic model that has been outlined within the article, and following a thorough examination of each new client (components 1-4 of Table 1), I would next be in a position to be able to design a specific programme in accordance with both my findings and the individual client's personal goal(s) and objective(s).

The 'movement patterns' component of programme design refers to the functional requirements of a conditioning programme. For example, a fire-fighter will have a different movement pattern profile to a professional basketball player (refer to Table 2). The demands of each role place varying physical and mental stressors upon their body which need to be determined prior to the commencement of any form of optimum conditioning programme. Here we are presented with situations whereby exercise can further imbalance the human body if a thorough examination does not take place during the initial stages and the balance of exercise stressors are not considered.

Within my clinic I initiate any conditioning programme with exercises that serve to restore balance and function to the musculo-skeletal system utilizing an 'isolate-to-integrate' principle of training. This method enables a practitioner to isolate a specific muscle or muscle group to aid in strengthening it in alliance with other muscles within its peripheral force-couple relationship. For instance, the extensor chain mechanism of the body integrates the cervical, thoracic and lumbar extensors, together with the gluteus maximus and hamstrings muscle groups.9 However, if the hamstrings are not firing with sufficient strength or even at the correct time, then the other muscles of the extensor mechanism are being overloaded unnecessarily. In order of restoring balance, the hamstrings can be isolated (e.g. hamstring curl) until sufficient neuromuscular strength is achieved to progressively re-integrate into a full extensor chain exercise (e.g. back extension).

Metabolic Components

The metabolic demands component of programme design refers to the physiological systems that are engaged during the client's daily activities. With varying modalities and structures of training and conditioning, each can either support or impede optimum health and/or performance for a client. It becomes critical, therefore, that a fitness professional and/or health professional understand the principles behind effective and optimum programme design techniques.

In essence, the metabolic profile can be determined by considering which energy systems are prevalent in the client's daily activities and/or sport. This information will also indicate the degrees to which each physiological system will be stimulated (e.g. cardiovascular, muscular and endocrine). For an average person who works in an office environment, the prevalent energy system that is employed for general day-to-day activities (walking, driving, eating and sleeping) is the oxidative (aerobic) energy system. At times when speed or intensity is raised in performing daily movement (e.g. running for the bus, walking up six flights of stairs), the glycolytic and phosphagen (anaerobic) energy systems are engaged. Exercise physiology texts highlight that during any given movement each of the energy systems are engaged, the degree to which is dictated by the intensity of that movement.[4]

Depending upon the findings presented within my initial assessment, I determine the starting point of a metabolic conditioning programme and aim to train each client across the complete spectrum of metabolic conditioning (i.e. oxidative, slow glycolysis, fast glycolysis and the phosphagen energy systems) investing more time in the zones applicable to their daily movements and metabolic demands.

Customizing a Programme

Once we have an understanding of the client's movement patterns and metabolic demands, we can ascertain a clearer picture of potential imbalances to the human body. Additionally, we also become more knowledgeable in customizing a programme in accordance with the specific demands imposed upon that client's body on a fairly regular basis. All in all, each individual client must have a well-rounded programme consisting of multi-joint, multi-plane exercises that serve to strengthen their body with loads and movements synonymous to those involved in their job, and additionally any sporting activities that they participate within. The reader is referred to texts on programme design and periodization for a more in-depth discussion on the appropriate selection of repetitions, sets, rest, rate and exercise selection.[3,10]

Injury risk can be determined by taking note of the client's medical history and the most common movement patterns performed regularly. I frequently assess clients who illustrate a significant muscle imbalance, elicited by the repetitive nature of daily movements and sitting postures. For example, it is common knowledge that most people have or have had some form of injury to the lower back. Consequently, most, if not all, conditioning programmes should take this factor into consideration. Once a practitioner understands the client's injury history, the potential movements that may cause future injury and the aetiology behind potential injury risks, effective prehabilitation exercises can be incorporated within a training programme to reduce the level of risk of potential injury.

In conclusion, a fitness and/or health practitioner should be vigilant of the injury risk and aim to seek a relative balance of exercises and movement patterns. For example, in general, those who spend a lot of time in a seated position at work, in the car and at home need to be performing a relative amount of extension movements (e.g. scapula adduction, neck extension and thoracic extension). I educate all my clients that of the 168-hours in each week we need to consider how much time they are spending in certain postures, stances and/or movement patterns. This again proves vital in the holistic model for exercise selection and programme design with regards to achieving balance and optimum training and conditioning responses.

Summary

This article is intended to enlighten all therapists involved in human health, as to the importance of holistic exercise techniques and the methodology behind the structure of an exercise programme. Certainly if exercise is to be a recommendation within a therapist's treatment, it is important to recognize and identify fitness professionals who represent such a holistic model presented herein.

References

1. Prior G. Health Survey for England. Chapter 5. www.archive.official-documents.co.uk/document/doh/survey98/hse-05.htm 1998.
2. Chek P. Holistic Approach To Training. CHEK Institute. USA. www.chekinstitute.com/articles.cfm?select=41 2004.
3. Baechle TR and Earle RW. Essentials of Strength Training & Conditioning. Human Kinetics. Hong Kong. ISBN 0-7360-0089-5. 2000.
4. McArdle WD, Katch FI and Katch VL. Exercise Physiology. Fifth Edition. Lippincott Williams and Wilkins. USA. ISBN 0-7817-2544-5. 2001.
5. Price WA. Nutrition and Physical Degeneration. Cancer Book House. USA. ISBN 0-9167-6400-1. 1997.
6. Rivera R and Deutsch RD. Your Hidden Food Allergies Are Making You Fat. Second Edition. Prima Publishing. USA. ISBN 0-7615-3760-0. 2002.
7. Day P. Health Wars. Credence Publications. UK. ISBN 0-9535012-7-2. 2001.
8. Chek P. Scientific Core Conditioning. Video Series. CHEK Institute. USA. 1995.
9. Chek P. Scientific Back Conditioning. Video Series. CHEK Institute. USA. 1995.
10. Bompa T. Periodization – Theory & Methodology of Training. Fourth Edition. Human Kinetics. USA. ISBN 0-88011-851-2. 1999.