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Short vs Long rest periods for Muscle Growth

Reference: Schoenfield et. al. (2016) Longer Interset Rest Periods Enhance Muscle Strength and Hypertrophy in Resistance Trained Men.

 

Information on the study:

 

  • Trainees with at least 6 months resistance training experience were split into 2 groups

 

  • Both groups performed 7 compound lifts, for 3 sets of 8-12 reps, 3x per week, for 8 weeks

 

  • 1 group rested for 1 minute between sets, while the other rested for 3 minutes between sets

 

 

  • It was found that the longer rest group saw superior gains in all muscle groups when compared to the shorter rest group.

 

  • This supports the idea that longer rest periods are superior for hypertrophy

 

 

Application to real world:

  • With longer rest periods come longer overall sessions durations, unless you cut overall volume.
  • Overall volume has been shown to be a significant factor in muscle hypertrophy
  • Therefore, it may be worth only applying these long rest periods if you have the extra time free in your schedule to allow you to do so.

Is scale weight an accurate way to track progress?

When people embark on a fitness journey, whether that be to lose body fat or gain muscle mass, the common tool to track their progress people use is how much the number on the scales changes over time. However, is this the most accurate way to track progress towards body composition goals? Just like most questions relating to health and fitness, the answer is- it depends.

 

The first thing to remember is that scale weight is the total weight of all the tissues in your body and not just muscle and fat. Therefore, it is not the most accurate measurement when it comes to measuring body composition. Other methods include skin fold callipers, a cheap tool which measures body fat percentage. However, despite its low cost, the skill needed to take an accurate measurement makes this a fairly inaccessible method of measuring body composition. The gold standard of body composition measurement in a DEXA Scanner. Although, this is a very expensive piece of equipment, only really seen in medical facilities due to its use in also identifying bone density and helping diagnose patients with osteoporosis. Due to other methods being inaccessible, scales are by far the most common tool used by the general population to assess progress in their body composition goals, so what can be done to ensure you are getting the most reliable and accurate changes to body fat and muscle as you can with scales?

 

Any tool is only effective when you know how to use it and scales are no different. Weighing yourself on Monday at 7am and then again on Sunday at 8pm will not give an accurate measurement for how your weight has changed over the course of the week, due to factors that will be discussed in this article. Therefore, if you are to use scales accurately, I would recommend taking daily measurements, first thing in the morning each day and then calculating the mean average each week and compare each week’s average from the last, to get a more accurate measurement of how much your weight is changing due to changes to fat or muscle tissue.

 

So, what factors can influence the weight on the scales besides from muscle and fat tissue? Firstly, there’s water retention. The amount of water our bodies hold will hold will change throughout the day, as well as day by day. Reasons for this include carbohydrate and sodium intake, which cause our bodies to hold more water- not add on fat tissue (a common misconception in, the case of carbohydrates, spread by the misinformed and keto zealots). Therefore, if your diet is more heavily carbohydrate based for a few days, then you may add some weight. However, this will be due to the added water retention from an increased intake of carbohydrates, not an added amount of fat tissue.

 

Next, there’s the amount of food you are currently digesting. First thing in the morning, is when you have the least food in your digestive system as it will have been 9-10 hours since your last meal. Therefore, food being digested cannot influence your scale weight, unlike if you weighed yourself shortly after a meal.

 

Besides from keeping these variables at bay, what else can be done to improve the reliability and accuracy of scales measuring body composition? Firstly, you could also use a measuring tape and measure your Hip to Waist Ratio. This is productive because most people hold the majority of fat around their Waist area. Therefore, if you are trying to gain muscle mass and you put yourself in a calorie surplus and put on weight, you may believe you are getting closer to your goal. However, if you take measurements are realise your Waist measurement is increasing at a faster rate than your Hips, then this indicates you are putting on fat faster than muscle mass. This information can then lead to you making productive changes to your training and/or nutrition.

 

Next, it’s important to ensure you are setting yourself up for success. One way to do this is to ensure you are consuming enough protein and tracking it. Ensuring adequate protein intake with a suitable resistance training programme and sleep will ensure that any weight loss will not be due to loss of muscle mass. Alternatively, when gaining muscle, will ensure you are adding as much muscle mass as you can in the calorie surplus you are in.

 

In conclusion, scales are far from perfect when it comes to measuring body composition goals. However, with the correct information, it can be a very useful tool to help you stay on track when pursuing your goals.

 

How often should you change exercises?

The Study:

‘Kassiano et. al. (2022) Does Varying Resistance Exercises Promote Superior Muscle Hypertrophy And Strength Gains? A systemic review J Strength Cond Res.

 

What is the study is about?

 

It’s a review that tries to find evidence for how often exercises should change in an exercise programme in order to maximise results.

 

Results of the study:

 

  • Changing exercises too frequently seems to be less effective for muscle growth compared to sticking with the same exercises for an extended period of time.

 

  • Furthermore, there’s evidence supporting that less frequent exercise variation may promote greater long term muscle growth as a result of differences in regional hypertrophy

 

  • However, each exercise stresses specific ranges of a muscle. Therefore it might be beneficial to switch exercises every so often.

 

  • The general recommendation for how often you should change exercises looks to be in the region of every 4-6 weeks. Certain factors may change this though, such as enjoyment of a programme, linked to adherence.

 

Application to clients:

 

  • My recommendation would be to generally follow these guidelines with the exception of a couple of reasons: Firstly, if the client gets bored of certain exercises. Secondly, if the clients goals change. But if your goal is to become better at certain lifts then its likely that you will require those lifts throughout your macrocycle.

 

Principles of Training – Individualisation

Each and every one of us is physically and mentally different. This is why, when it comes to training, everyone’s approach needs to be bespoke to them, if it’s going to be optimal.

 

One of these factors will be their starting point, in terms of ability, in their fitness journey. For example, if two people come to a personal trainer saying they wish to build better whole-body strength, then both will be assessed to see where their starting point is at. If it becomes clear one athlete has a proportionately stronger upper body than their lower body, and the other person vice versa then despite the same goal, their programmes will look different. The first person will need a more lower body focussed approach whereas the other person would need the opposite, this is an example of applying the principle of individualisation.

 

Another key factor to consider is lifestyle variations. Everyone has a life outside of the gym, all of which will include factors which influence their performance inside the gym. Therefore, this needs to be considered when programming. To give another example, imagine someone wants to become generally fitter all round. If they’re a labourer then you need to consider that their job is very taxing, therefore workload needs to be managed more carefully as to avoid overtraining and injury.

 

 

Next, there’s anatomical variants between each individual which can affect performance in the gym. For example, someone with a larger rib cage convexity, steeper sternum angle and short limbs is going to have a better chance at being better at the Bench Press compared to someone with a smaller ribcage, flatter sternum angle and long limbs, due to the first person having a shorter range of motion to achieve a full repetition and the line of pull on the pecs from insertion to origin. Another way in which anatomical differences influence training, can be down to active range. Everyone’s active range for a given movement is different. A common example would be overhead mobility. If someone cannot lift their hands directly above their heads (180 degrees of shoulder flexion) then trying to perform an overhead press is going to take them out of their active range and they will lean back to achieve the overhead position. This person will be putting a lot of stress on joint structures outside of this range and also increase the risk of injury when lifting outside of it. Therefore, consider this individual difference and give them an exercise that challenges them in their active range, for instance an incline press, set to a height whereby they are working in the active range that they can achieve.

 

Next, there’s two factors that link together. These are tolerance to training loads and responsiveness to training load. One’s tolerance to training load is going to help you in the initial phase of deciding things like how frequently they should train and how demanding each session should be. Their responsiveness to training will link closely with progressive overload. So, someone who responds very quickly to training will need to increase their training load more frequently than a slow responder. It’s important however that progressive overload is applied correctly to both people to prevent any from overtraining or undertraining.

 

Finally, the psychology behind training must also be taken into consideration. As with most things, intrinsic motivation is the key to long term adherence and this is achieved when someone feels competent, so the training programme must not feel too difficult for the participant. They also need relatedness, this comes from good relationships attached with the activity. Therefore, having great rapport with your PT, or attending the gym with a friend is a great idea. It’s also a reason why exercise groups with a more ‘community feel’ are more popular, the biggest example of this being the rapid growth of CrossFit over the past 10-15 years. Also, the participant must feel like they have autonomy, this can come via a number of ways such as having the freedom to train when they want, as well as being able to have a say in what they do during sessions (if they want that).

 

Overall, there’s many factors here to consider, it’s important to manage them all carefully, in order to ensure you are getting the most out of your training.

Principles of Training: Reversibility

The principles of training are factors that should be applied to any training programme to ensure optimal adaptations. These principles include: Progressive Overload, Reversibility, Specificity, Individualisation and Periodization. To delve deeper into each of these, I will be writing an in-depth article on each, with this one discussing Reversibility.

 

It’s at this time of year where the majority of people go on their holiday and take a break from everything in life, including training. Alternatively, many people may have to cease training due to other reasons such as work and family commitments or injury. Depending on the amount of time taken off, one can experience reversibility.

 

Reversibility can be defined as the loss of fitness and/or performance adaptations via the withdrawal of tissue loading (which we get from training). Each adaptation takes a different amount of time to fade. For example, aerobic capacity and muscle elasticity have been shown to decrease after just 5 days of inactivity. However, strength has been shown to only decrease by 10% after 8 weeks without training. It’s important to note that other factors will also play a significant role in how quickly an adaptation is lost when training is stopped. These include the individual’s genetics, as well as nutrition. For example, if two bodybuilders were to stop training and one continued to consume a high protein diet and maintenance calories and the other who consumed inadequate amount of protein and ate below their maintenance calories, the latter is expected to experience a greater degree of reversibility.

 

Once someone experiences this, upon their return to training they are expected to experience a reduction in performance levels across the board. Also, lower recovery levels between sessions, susceptibility to DOMS (Delayed Onset Muscle Soreness) and increased risk of injury are expected- especially if the reason for cessation of training is due to an injury.

What can someone do to try and minimise the effects of the issues mentioned above? Upon returning to training after a break, what many people try and do is go and train extra hard, and twice as much in an attempt to make up for lost time. Unfortunately, our bodies do not work like that and this approach will only result in overtraining. This is because our bodies can only adapt to a given amount of a stimulus at one time and after a period of detraining, this size of the stimulus needed for maximal adaption actually decreases. Therefore, the best approach when returning to training is to decrease the FIT principles from FITT (Frequency, Intensity, Time) in order to moderate size of the stimulus on the body.

 

Frequency refers to the number of sessions per week that is being carried out, if you were training over 3 times per week prior to taking time off, it may be wise to decrease frequency by up to 50% and then gradually build back up. For example, if you originally trained 4 times per week and then took an 8-12 week break, you may train twice on your first week back, 3 times on your second and be back up to 4 sessions per week by your third week back into full training.

 

Intensity refers to how vigorous a session is. Therefore, if you went through a block of training whereby a number of your lifts were at 80% of your 1 rep max, then it may be sensible to decrease this load to 60% of your 1 rep max and increase it by 5% each week until you are back at 80%.

 

Time refers to the duration of each training session. This concept is best applied to cardiovascular exercise. Simply put, if you were running for 45 minutes each session prior to taking time away from training. You would look at decreasing this amount, depending on how much time you had away from exercise. Typically, you may decrease to 25 minutes if you took a month off, and then increase the duration by 5 minutes each week until you were back at 45 minutes.

 

All these precautions are necessary to try and reduce the risk of injury and to make sure the body can adequately recover between sessions instead of experiencing burnout and having to take more time away from training. It’s also worth noting that the stimulus needed to maintain performance is significantly less than what is needed to improve. Therefore, performance will not continue decrease, even on much smaller training loads whilst building back up.

 

The effect of volume on muscle growth

The effect of volume on muscle growth

 

The study: Schoenfeld, B. J., Contreras, B., Krieger, J., Grgic, J., Delcastillo, K., Belliard, R., & Alto, A. (2019). Resistance training volume enhances muscle hypertrophy but not strength in trained men. Medicine and science in sports and exercise51(1), 94

 

 

  • 45 men with an average lifting experience of 4.4 years of lifting performed the same exercises in the 8-12 rep range, 3x per week for 8 weeks

 

 

  • The men were split into 3 groups. One performed each exercise for 1 set per session, one group for 3 sets per session and 1one group for 5 sets per session

 

 

  • The results found a dose-response-relationship between sets performed and change in muscle thickness (muscle hypertrophy)

 

  • This was still the case with extremely high volumes up to 45 sets.

 

Summary and application:

 

  • In summary, the study supports the idea that higher volume results in increased hypertrophy even up to very high levels of volume (45 sets on a muscle group per week)
  • This information is applicable to the general population who may be experiencing plateaus in their training, which could be down to them not increasing their volume for a prolonged period of time.
  • How can you increase volume without spending vast amounts of time in the gym? Methods include drop sets, rest-pause sets and giant sets.

Exercise Selection and Goals

One aspect of programme design that many people are confused over is how to decide what exercises to add to their programme. There can be many misconceptions about regarding this, such as ‘machines are less functional than dumbbells’, causing many people to stray from using machines. However, ‘functional’ has become an ambiguous term in fitness, so it’s worth applying its original definition of ‘designed to be practical and useful’. Therefore, if an exercise is practical and useful to that individual then it is, by definition, functional.

 

How do we decide what is practical and useful for an individual? Well, there is several factors to consider. One of which, is their goals, as different goals will require different exercises, we apply the concept of specificity to choose the most optimal exercises. Not to mention a form of assessment and screening of an individual to determine what they a lacking in terms of mobility, strength and stability.

 

Hypertrophy:

 

If someone’s only goal is to build or retain muscle, then exercise selection can make a significant difference to the end result. For an exercise to be effective for this goal, the limiting factor in the exercise has to be the targeted muscle tissue. In other words, the reason you fail to do another rep must be due to fatigue felt in the muscle you are trying to work, and not another reason such as a loss of balance.

 

To achieve this, exercises that have high external stability will deliver better results. Exercises that have high external stability require less stabilisation from the person performing the exercise (internal stability), therefore muscular fatigue is much more likely to be the reason for failure as opposed to a breakdown in technique, thus making it superior for hypertrophy.

 

However, there is a caveat to this- Stability drives output. Therefore, if someone is lacking stability at a joint then this can limit long term hypertrophy of the muscles attached. For instance, someone with average mobility at the hip could get significant results in hamstring hypertrophy using a Barbell Romanian Deadlift or a Squat up to a point. However, form may start to breakdown once using a certain load which would express the underlying lack of stability within the hip.

 

 

Therefore, the use of exercises with a higher internal stability can be implemented in their programme, to improve performance and further drive hypertrophy. To go back to the hamstring hypertrophy example, the person may add a single leg Romanian Deadlift variations and progressions to their programming to help improve stability at the hip and further help increase load and drive hypertrophy when performing Barbell Romanian Deadlifts.

 

Strength:

If the goal is strength, then the focus shifts away from muscle tissue and towards the movement itself. What movements do you want to get stronger in and why? Often this goal is adopted by athletes as their sports will have specific movements to get stronger in, which will help advance them in their sports.

 

The most obvious example would be powerlifting. Powerlifting involves lifting the most amount of weight for 1 rep each of the Bench Press, Deadlift and Back Squat. Therefore, when putting together a powerlifting programme we apply the concept of specificity and base the programme around the 3 main lifts mentioned, accompanied by accessory movements to assist the improvement in performance of the competition lifts. However even with strength if an individual is lacking adequate hip stability and they are aiming to achieve absolute strength on the said lift then spending time on one leg within their program will help further drive the adaptations required to exert force on their lifts.

 

Alternatively, athletes of other sports are going to select resistance exercises which complement the movements that they complete in their sport. For example, many sports involve running. Therefore, for many of these athletes, performing front foot elevated split squats may be beneficial. This is because this exercise shares many similarities to the skill of running. Both are uni-lateral, internally stable skills, involve flexion and extension of the hip and knee as well as plantar flexion and dorsi flexion at the ankle it will also train the athlete to keep their centre of mass balanced as fatigue can kick in during long distances and heel strikes can get heavier towards the latter stages of a race. Building strength in this movement can allow the athlete to apply more force at a given effort when performing the sport.

 

This can aid in the development of running economy- a reduction in the amount of energy expended at a given speed. In terms of transfer to performance, this can help the athlete run faster, for longer without form breaking down and thus reduce the risk of injuries.

 

 

Overall, it is crucial to truly analyse your goals because many people wish to simultaneously achieve improved strength and hypertrophy, which is very achievable for everyone except very advanced lifters. The importance of each goal is going to play a role in which exercises are selected, so it is important to have this established before forming the programme.

 

With anyone we work with here at Soma Fitness, we run them through a full assessment to determine where the starting point of the program is. This is highly beneficial as if you don’t pick certain aspects up and run with a cookie cutter program you will be leaving a lot on the table in terms of the progression of your results. If someone cannot get into certain positions and we then go and load them in those positions, it’s a quick way to set yourself up for injuries which will then hinder your overall progression towards your goals.

Should you track your nutritional intake?

Firstly, I would like to say if you’re serious about driving fat loss or muscle hypertrophy then absolutely yes you will have more chance of success in the initial phases at least if you are tracking your consumption. If you have long term success tracking calories and macronutrients, then you will know how effective it is in dialling in on your goals. However, from personal experience of managing my own and clients, nutrition, tracking calories and micronutrients day by day there can be some flaws to this method to help one stay on track with your nutrition.

 

The first, and main, reason I am not a supporter of tracking in the long term is that it requires a lot of time which many people often cannot fit into a busy schedule. For example, many people at work 9-5, have children to look after around that, as well as trying to make time for exercise and a healthy social life. If you are already stuck for time, the last thing you need is to be compelled to open up an app and make a diary entry every single time you eat.

 

Secondly, along with time, there are certain times where it’s simply inconvenient. If you are enjoying a few drinks at the weekend with your friends, not many people want to open MyFitnessPal every time someone gets another round in. Not only that, you’re probably going to forget to do so after the 6th!

 

Thirdly, it’s unnecessarily complex. Many apps will have you tracking calories, carbohydrates, protein and fats and lead you to believe that you need to hit each to the exact figure recommended. In reality, for anyone with body composition goals (building muscle and/or lose fat), carbohydrates and fats consumed do not significantly influence one’s results. As long as you hit your daily calorie target within 100kcal and have at least 2.2g protein per kg of bodyweight, then grams of carbohydrates and fats consumed simply does not matter (for body composition, for overall health it can but that’s a topic for a different blog).

 

These reasons are often the cause of many people giving up on tracking their nutrition. This in turn gives them a sense of failure and exhaustion towards making healthy nutritional choices, sending many back to previous bad habits

 

 

 

Aside from the impractical element of tracking, there’s the inaccuracy that often comes with it. Unless you are weighing every single food and drink that enters your body to the gram then you are not going to be 100% accurate. This is a big issue with more calorie dense foods. For instance, ‘A splash of olive oil’ is a subjective term. To some, this could mean 15ml and for some it could be 50ml. The difference in calories for this 123kcal vs 410kcal. This difference of almost 300kcal is enough to tip someone from a small calorie deficit back to their maintenance, without realising. Learning the skills of how to track and be accurate with is something that requires an element of coaching in itself and we have recently begun to provide out clients with guides on how to track using my fitness pal which is probably the most user-friendly app.

 

Lastly, another reason I do not like the tracking method is that it does not take into account micronutrients. These essential vitamins and minerals make a huge difference to overall health, helping you stay clear of chronic diseases. However, on tracking apps, 500kcal from a small pizza is the same as 500kcal from a chicken breast and vegetables.

 

So how do you ensure you’re making the correct nutritional choices for your goals?

 

Personally, I find that the most effective method for this is to plan ahead. Organising your nutrition on a Sunday for example, or whenever you get time, formulate yourself a meal plan for the week ahead. Plan out what you are going to eat and when, use tracking devices and labels to help you calculate protein and calories, forget about carbohydrates and fats if a change in body composition is your goal as a beginner if you are new to tracking keep it as simple as you can. Also, plan each day to have at least 5 different portions of fruit and vegetables to ensure you are consuming all the micronutrients you need.

 

If you keep note of how many calories and protein meals you often consume contains, then a few weeks in, you will have a menu of all of your meals with the portion sizes for each meal and you can continue adding meals to your plan for the week, as protein and calories will already by noted, saving you a lot of time in the long run. If you want to smash your goals this method of creating your menu based on your protein and calorie requirements will in the initial phases be a little bit of work and planning however after a good 4 weeks of doing so you will have all the tools required for you to keep your nutrition consistent which in the world of weight loss or building a physique is the most important driver in which will determine lasting success.

 

As for going out socialising, 100% accuracy cannot be achieved. However, knowing how many calories are in 1 glass of your chosen drink, and knowing roughly how much you drink will be much better than failing to track at all. If you know that you will be going out over the weekend you can then reduce calories in the week to make up for it. (Check out our blog on calorie banking for more on this).

 

Similar to training, planning ahead often yields much more effective results than being reactive day to day.

Understanding Fat

Why we need Fat in our diet:

Fuel Source

Protection of Vital Organs

Cell membrane constituents

Precursors of bile, hormones and steroids

Fat soluble vitamin intake

 

Types of Fat:

Monounsaturated fats: Sources include avocado’s, olive oil, and almonds.

Polyunsaturated fat: Sources include flaxseed oil, walnuts and salmon.

Saturated Fats: Sources include animal fats, butter, coconut oil

Trans fats: Sources include bakery goods, fried foods, dough of frozen pizzas and most processed foods. These are fats we should try and limit in our dietary intake.

 

How much we need:

Upwards of 20% of our daily intake of calories from fats is considered healthy, just as long as it’s not so much to the point where we do not consume enough protein.

 

Also, it’s important to consider that Fat is very calorie dense (9kcal per gram of fat compared to 4kcal per gram of carbohydrate and protein). Therefore, when amount taken in isn’t monitored then it is easier to end up in a calorie surplus and put on weight.

Importance of Resistance Training for Elderly Populations

 

What is Resistance Training?

Resistance Training can be defined as a form of exercise, whereby external weights provide progressive overload to skeletal muscles in order to make them stronger and often result in hypertrophy (growth in overall size of muscle cells) (Alix-Fages et. al, 2022; Phillips and Winett, 2010), which can lead to several benefits.

 

Benefits:

Less chance of falls and subsequent physical inactivity:

Araujo et. al (2022) found that middle aged or older people who could not stand on one leg for more than 10 seconds were more likely to die in the next seven years, compared to people who could. Why could this be the case?

 

People with less balance can be more prone falls. When in older age, this is more likely to lead to serious injury to lower bone density. If this results in a hip fracture, then there is no guarantee they will reach pre-injury level of recovery, leaving a lack of mobility and pain. With many people, this can result in them stopping activities which they used to enjoy, such as regular walks, and meeting up with friends to do things. This decrease in physical activity and increase in isolation can further accelerate the negative effects of the fall such as increased risk of depression and heart disease from being physically inactive

 

Reduce risk of chronic diseases and keeping one’s independence:

Furthermore, regular resistance training (2-3 sessions per week) has been shown to reduce the risk of chronic diseases such as osteoporosis, heart disease, arthritis and type 2 diabetes. (Fragala et. al, 2019),  as well as being important in managing sarcopenia (the gradual loss in muscle mass due to age). Avoiding these chronic diseases can help people keep their independence in their old age, thus increasing their quality of life. For example, if someone can avoid osteoporosis and arthritis, then they can move with much more ease. This allows them the ability to complete activities such as playing with grandchildren and climbing stairs.

 

The snowball effect of being able to do these things can also have a positive effect on one’s mental health as they will be able to live with more confidence, less anxiety and more social interactions instead of potential isolation due to lack of mobility.

 

Seeing these benefits first hand:

As a personal trainer, one of the main protocols I take when working with older clients is to incorporate exercises which improve their balance and stability into their training programme, at a level suited to them. This can start off as simple as dowel assisted front foot elevated split squat, progressing all the way to unassisted single leg Romanian deadlifts. When performed consistently and accompanied by adequate nutrition, results are seen quickly so never think that it’s too late to start resistance training.

 

Reference List:

  • Alix-Fages, C., Del Vecchio, A., Baz-Valle, E., Santos-Concejero, J., & Balsalobre-Fernández, C. (2022). The role of the neural stimulus in regulating skeletal muscle hypertrophy. European Journal of Applied Physiology, 1-18.
  • AraujoCG, de Souza e Silva CG, Laukkanen JA, et al, Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals British Journal of Sports Medicine Published Online First: 21 June 2022. doi:1136/bjsports-2021-105360
  • Fragala, Maren S.1; Cadore, Eduardo L.2; Dorgo, Sandor3; Izquierdo, Mikel4; Kraemer, William J.5; Peterson, Mark D.6; Ryan, Eric D.7Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association, Journal of Strength and Conditioning Research: August 2019 – Volume 33 – Issue 8 – p 2019-2052 doi: 10.1519/JSC.0000000000003230
  • Phillips, S. M., & Winett, R. A. (2010). Uncomplicated resistance training and health-related outcomes: evidence for a public health mandate. Current sports medicine reports9(4), 208.
  • Zhang, J., Ang, M. L., & Kwek, E. B. (2015). Who Will Walk Again? Effects of Rehabilitation on the Ambulatory Status in Elderly Patients Undergoing Hemiarthroplasty for Femoral Neck Fracture. Geriatric orthopaedic surgery & rehabilitation6(3), 168–172. https://doi.org/10.1177/2151458515583111