There have been various recommendations over the years in our profession about the recommended number of repetitions and sets of exercises that patients should perform. To judge for yourself what numbers are best for those in your care, you need to consider several factors — not the least of which is the hectic, fast-paced lives many of your patients already have.
Determine the Goal(s)
People exercise for a variety of reasons. Some do it for enjoyment and relaxation, some for general fitness, and some to improve their appearance. And then there are the athletes, who are trying to excel at a sport or win a competition.
Chiropractors generally have a different approach. We want to help our patients regain an improved level of health. The forms of exercising that work best for body builders, football players, and other athletes are not necessarily ideal for patients. We need to keep this in mind when recommending rehabilitative exercises, especially when we are working with patients who are not used to exercising at all. Because of that, many doctors find that simpler is better. Since the goal is just to get a patient to do the exercise regularly, it’s advisable to keep instructions clear and easy to follow. All patients do a lot better when they know exactly what is expected, and they will tend to do only the minimum necessary.
It All Adds Up
The repetition number (“reps”) means the number of times a patient performs an exercise consecutively, without stopping. In most programs this number is usually somewhere between 5 and 20. “Sets” are a series of reps, defined by the rest period between (which varies from 30 seconds to several minutes). Set recommendations vary from 1 to 3 or 5, or occasionally more. The “total reps” of an exercise can be determined by multiplying the number of reps times the number of sets performed.
The reps and sets can vary, even when the total reps are the same. For example, total reps of 20 can be performed as 2 sets of 10 reps, or 4 sets of 5 reps, or 5 sets of 4 reps. Strength and conditioning specialists, working with exercise physiologists and coaches, have developed a tremendous variety of exercise routines. Some of these have been found to be useful for certain sports, and others have developed from muscle research. The variations are determined to some extent by the athlete’s goal—maximum strength, power, or endurance.
Of course, doing fewer repetitions and fewer sets takes less time, but we obviously want our patients to exercise at least enough to improve their condition. What does the research show?
Since 1962, most exercise recom-mendations have been based on the Berger method1, which consists of 3 sets of 6 repetitions, for 18 total repetitions. Because it was a scientifically based recommendation, as well as being pretty simple for patients to follow, the Berger method has been widely used right up to the present day. While many still believe it is an effective program, an even simpler and easier method has gained popularity lately.
The literature review by Drs. Carpinelli and Otto2 found that there is now a large volume of research which disputes the need for 3 sets of exercise. In fact, they state that, “One set of repetitions has been shown to be as effective as multiple sets, and more time efficient, for increasing muscular strength and hypertrophy in males and females of different ages, for a variety of muscle groups and using various types of exercise equipment.” The article concludes by recommending that by “employing a single-set protocol, individuals can achieve similar results in less time and with less work and a decreased potential for injury.” This has been strong enough evidence for many doctors to change their approach to exercise recommendation.
Less Is More
In many instances, having patients perform just one set of 8 to 12 repetitions of their recommended exercise(s) has proven successful. Since this is only 8 to 12 total repetitions, without the need for rest periods, it can be completed in much less time. Patients are more likely to become consistent with the recommended exercises when the time commitment is less. And this approach has been found to be just as good for getting rapid results.
In many cases, patients can be instructed to perform at least 8 repetitions of the exercise, but they should initially attempt 12. If 12 repetitions can be done fairly easily, have them increase the resistance slightly the next time. When using surgical tubing exercises, this means increasing the starting distance from the door in which the tubing is temporarily attached.
Instruct patients to do their exercises every day, at least initially. This gets them into the habit of doing an exercise, and brings about more rapid change and improvement. And since the patient is being asked for such a minimal time commitment, it’s difficult for him or her to say that there isn’t enough time to exercise on a daily basis
Faster Recovery, Happier Patients
Either the traditional, multi-set exercise program or the newer, single-set protocol can help patients regain muscle function and improve spinal support and posture. However, I find that patients are appreciative when I express an awareness of how busy their schedules are and minimize the time needed for exercising.
Patients are more likely to do the exercises you recommend when they fit into a busy schedule. With only 6 to 12 total repetitions, several exercises can be done in just five or ten minutes.3 This helps ensure acceptance of the entire treatment program, which can lead to rapid progress under your expert care.
Kim Christensen DC, DACRB, CCSP, CSCS, directs the Chiropractic Rehab & Wellness program at PeaceHealth Hospital in Longview, Washington. He is a popular speaker, and participates as a team physician and consultant to high school and university athletic programs. Dr. Christensen is currently a postgraduate faculty member of numerous chiropractic colleges and is the past-president of the American Chiropractic Association (ACA) Rehab Council.
He is a “Certified Strength and Conditioning Specialist,” certified by the National Strength and Conditioning Association. Dr. Christensen is the author of numerous publications and texts on musculoskeletal rehabilitation and nutrition. He can be reached at PeaceHealth Hospital by email at [email protected].
1. Berger RA. Effect of varied weight training programs on strength. Res Q 1962; 33:168-81.
2. Carpinelli RN, Otto RM. Strength training: single versus multiple sets. Sports Med 1998; 26(2):73-84.
3. Winett RA, Wojcik JR, Fox LD, Herbert WG, Blevins JS, Carpinelli RN. Effects of low volume resistance and cardiovascular training on strength and aerobic capacity in unfit men and women: a demonstration of a threshold model. J Behav Med 2003; 26(3):183-195.