Earlier this summer my friend and fellow PT and strength training junkie Scotty Butcher tagged me in a brilliant presentation for Ignite Physio where he discussed the value of strength training post rehabilitation to transition from PPLOF (piss poor level of function) to OLOF (optimal level of function).
As someone who’s a physio, strength coach and powerlifter and has seen, worked with, and/or learned from people who have squatted over a grand to people who can barely out of their own chair it got me thinking. For the regular person who’s not a competitive athlete and just wants to look good, feel good, and be healthy … how much strength is enough? How much cardiovascular fitness is enough? At what point does trying to improve those areas become detrimental to health and cross-over into high performance athletics? That is the topic of today’s article.
Disclaimer: Since many studies on strength use grip strength as a primary measure (which is linked to mortality) I will discuss this topic from a philosophical and opinion based perspective than with specific data as most people, outside of a physio clinic or performance centre, can’t measure their grip strength on a whim. Same goes for cardiovascular fitness.
I’m going to look at this topic from two perspectives
Perspective #1: We should just let people do the activities they want and live their life that way
There’s a lot to be said for this especially given the rates of obesity and inactivity in the developed world. A common saying is “the best form of activity is the one you’ll do and stick to.”
From a compliance perspective – yes it’s important that people enjoy the activities that they are doing. Not everyone enjoys running or slugging weights around as much as you do. It is what it is. As much as people like to knock CrossFit – it’s helped excite a bunch of people to get physically active.
My only concerns with this perspective are two fold
Concern 1 – In some regions, especially here in Canada where it seems to be either cold and snowy or stinking hot all year, many activities that people enjoy (i.e. certain sports, walking, gardening) just don’t get done. What good is an activity if you’re not doing it most of the year?
Concern 2 – Are these activities enough to build both strength, cardiovascular fitness, lean body mass, and bone density to a point that
- People can take part in more strenuous activities without any major issues
- These attributes are built enough and maintained enough to the point where they won’t sink to a harmful level with age and
- Supply a reserve of ability for after the activity is done
Explaining these points in more detail, and again using Canadian examples, look at the person who just walks and does things around the house … and then has a heartattack during the first major snowfall of the winter while shovelling snow. Those activities that the person took part in did not prepare them enough for the demands of a more physically demanding (yet essential) task nor did it give them a reserve of ability for afterwards as it was a beyond “max effort” task.
In addition – some research have questioned where low intensity activities such as walking can provide enough of a stimulus to maintain health, especially through the aging process.
As such, while it’s important that people pick activities they enjoy, there needs to be enough of a stimulus to promote health and to enable more strenuous essential activities to be done while still maintaining a reserve of physical functioning afterwards.
Perspective #2: We should turn all our physical therapy or personal training clients into powerlifters, endurance athletes or functional fitness freaks
As my friend Nick Tumminello said (paraphrased) we do tend to train our clients based on our specific biases – whether it’s cardio, bodybuilding, powerlifting, kettlebells, crossfit or the like.
While all of these activities, when programmed properly, can have great benefits on physical function my concerns are twofold.
First of all … these activities carry a higher health risk than just training for general health.
My friend Stan Efferding has said “if you want to be healthy don’t compete.” While strength sports such as bodybuilding, powerlifting, strongman, and crossfit do have an injury rate comparable to (or slightly less than) those of non-contact sports an injury rate ranging from 1 every 10 years to over 1 per year is a lot for someone who’s not pursuing highly competitive athletics. In addition there are the other health risks involved from carrying too much bodyweight; which includes too much fat and too much muscle; which include OA, insulin sensitivity, high blood pressure, and sleep apnea.
Endurance sports, while widely considered to be healthier than strength sports, actually have a much higher rate of injury. In a recent paper recreational runners are less likely to develop knee OA than the sedentary population – however competitive runners are more likely to develop knee OA. In addition – the relationship between cardiovascular fitness and health is not 100% linear. High performance endurance athletes can have higher mortality and adaptations of the heart that can predispose them to further issues.
Secondly … training like a high-level athlete can become very burdensome from a time, effort and money perspective. Many high-level athletes train, eat, sleep and recover like it’s their job. Eating 6 meals a day, being in bed by 10 every night, and training 8-10+ hours a week doesn’t seem like the lifestyle most people want to live when their goal is just to be healthy.
As such – training like a competitive athlete isn’t the answer either.
Well what is the answer?
It’s tough to give specifics without understanding a person’s goals, general health, and demands of their life.
A good general guideline for what I consider to be “sufficient” strength and cardiovascular fitness is for people to ….
1) Be able to do physically demanding activities such as factory and farm work, help move furniture, and be able to play some sports with coworkers/kids … without these tasks being a “max effort” or causing such fatigue or muscle soreness that they can’t be performed consistently.
2) Have appropriate levels of bone density and lean body mass
…all throughout the lifespan. Some may argue with me – but that’s my standard.
For most people who are healthy and already eat & train well – 2-3 days a week of some well designed strength training & a bit of HIIT training – as well as some leisure walks or bike rides a week should have the desired effect without being burdensome or counterproductive to health.
I hope this article provided some useful food for thought on making the distinction between optimal health and optimal athletic performance. As always – thanks for reading.
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