Ten patients were referred to the laboratory with a possible diagnosis of having OTS. Based on the criteria used in the consensus statement of the ECSS,1 the decision was made to perform a double maximum test with these athletes. One of the criteria to define an athlete as OTS is that recovery from the status will take months, or even years.1 2 In the present study, an arbitrary cutoff of 1 year was used. Those patients who needed more than 1 year for recovery were retrospectively diagnosed with OTS, the others with NFO. There seemed to be a good distinction between the patient groups based on this criterion, as the OTS patient with the shortest recovery time (1) experienced underperformance and other symptoms for 2 years, whereas the NFO patient with the longest recovery time (10) had NFO for 8 months. In addition, although subjective, there seemed to be a good parallel with the severity of the symptoms.
Limitation of the Study. One potential limit of the present study undoubtedly regards the limited number of subjects involved in the study and the operating loss of the control group. Unfortunately, too many participants of the latter did not satisfy the requirements during the study, thus impeding a comparative statistical approach. Further studies are therefore needed to confirm our conclusions, in particular with a larger sample and control group.
Founder Ken Hutchins' SuperSlow has been 'managed' by unscrupulous business partners, into a commercial entity bearing little resemblance to his original intention, (& no involvement with Mr Hutchins himself, nor any of his original associates). The -real- SS was revolutionary for its time, but Hutchins' new textbook, "The Renaissance of Exercise, a Vitruvian Adventure", is the result of his ongoing refinements over the past 18 years. Rather than pay over a $150 for the supposed historic value of a slim, soft-cover, dog-eared $10 book & it's relatively primitive ideas, get the new hard-cover textbook./It seems that one of the main criticisms os The Manual is "too much information". True, for a casual reader.The fact is, ANY exercise protocol is simple enough to write up on one or two pages: How many sets. How many reps. How many exercises. How often. About 10 exercise technique descriptions: Done. It's the precise whys, hows, & special cases that take a book to fulfill.
Exercise was defined as planned, structured activities, for instance going for walks, skiing, swimming and doing sports, but also as unplanned activities that the participants experienced as exercise. The participants were asked to fill in exercise logs immediately after each exercise session they performed throughout the year and send them to the research center either in prepaid envelopes monthly, or to use internet-based forms following each exercise session . Exercise frequency was calculated as the mean number of sessions reported per week during the year. To assess intensity of exercise the participants reported their subjective RPE on a Borg scale ranging from 6 to 20 . The participants were asked to report the mean intensity level during the exercise session. Ratings from 6 to 10 were classified as low intensity, 11 to 14 as moderate intensity, and 15 to 20 as high intensity. Duration of exercise was measured with a 4-point scale: less than 15 min, 15–29 min, 30 min to 1 h, and more than 1 h. Less than 15 min and 15–29 min was combined due to a low response rate on these response options (1.1 and 8.7% of the total number of exercise sessions, respectively).
Use your toilet time wisely. Take advantage of that toilet time by doing some kegels. Kegels are the muscles used to stop the flow of urination, so practice clenching those muscles the next time you're doing your business. Both men and women can do kegels, which will not only help guard against incontinence, but may also improve bedroom endurance, if you catch my drift.
All six MMB pioneers expected near magical effects from the regular non-exhausting practice of their exercise regimes. This promised a lifetime of optimal health, beauty, and strength for the body and mind. Further, expected benefits include improved quality and efficacy of daily activities, looking and feeling good, making life itself easier and more pleasurable with a disappearance or reduction of symptoms while improving postures. This leads to increased self-esteem, reduced health costs, and the expectation of a longer and high-quality life. It is interesting to note that all six MMB pioneers enjoyed long and fruitful lives that reflect this philosophical model within real life examples: Checkley died in 1925 at 78; Müller in 1938 at 72; Alexander in 1955 at 86; Randell in 1974 at 99; Pilates in 1967 at 87; and Morris in 1980 at 89.
I have used the standard protocol (10 seconds plus or minus two for both concentric and eccentric contractions) of this method, although sometimes I prefer going a bit faster such as 4/4, 6/6 or 8/8 seconds respectively. It is not easy and even a bit painful to do a single set of each exercise and "inroad" the muscles. Moving from machine to machine between exercises with no rest, one experiences tremendous cardio-respiratory workload (experiences counterpulsation due to very large venous return to the heart) and some feel extreme fatigue when finished. A workout can last as little as 10-12 minutes, based on 5 basic compound exercises (ie: ankle raise, trunk extension, squat, shoulder or chest press, pulldowns), and personally, I found I needed 2 workouts/week in order to achieve the strength gains I desired. Some think only one session per week is needed and I believe this is a personal and time management choice.
Tracing the origins of Western MMB training suggests that the regular practice of movement-harmonizing exercises was embedded in ancient Greek culture.1 Herodotis. The history of Herodotus. New York (NY): Appleman and Company; 1885. [Google Scholar] Calisthenics in Greek means strength and beauty, a combination highlighted in Greek mythology and everyday life. This philosophy engendered sporting activities that were practiced to facilitate self-empowerment and prepare for events such as the Olympic Games or military actions.2 The Atlantic [Internet]. Cheever DW. The Gymnasium (1859). 2015 Aug 30 [cited 2015 Aug 30]. Available from: http://www.theatlantic.com/magazine/archive/1859/05/the-gymnasium/305407/. [Google Scholar] Today, Calisthenics refers to full-body movement exercises benefiting the body and mind by employing functional motions such as bending, stretching, twisting, kicking, jumping, push-ups, sit-ups, and squats.3 Greek Calisthenics Movement [Internet]. History. 2015 Jun 25 [cited 2015 Aug 30]. Available from: http://calisthenics.gr/en/index.html. [Google Scholar]
15. Make sure you get a good night's sleep, especially on the day you've worked out. This is crucial! Repair takes place during deep sleep. Your body normally gets a few deep sleep cycles during the night. If your alarm clock cuts short or eliminates one of these cycles, it's not a good thing. On your exercise day, you'll need to get a bit more sleep than usual; plan for it! Go to sleep a little earlier. Don't worry, after an intense workout you'll have no trouble falling asleep.
^ Jump up to: a b Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M, Mead GE (September 2013). "Exercise for depression". Cochrane Database Syst. Rev. 9 (9): CD004366. doi:10.1002/14651858.CD004366.pub6. PMID 24026850. Exercise is moderately more effective than a control intervention for reducing symptoms of depression, but analysis of methodologically robust trials only shows a smaller effect in favour of exercise. When compared to psychological or pharmacological therapies, exercise appears to be no more effective, though this conclusion is based on a few small trials.
One almost overall finding, at least in endurance and strengthendurance athletes having OTS, is a diminished maximal lactate concentration, whereas submaximal values remain unchanged or slightly reduced.10 12 This is confirmed in the present study where OTS patients did not reach maximal lactate concentrations above 8 mmol l−1. Two out of the four NFO patients did not reach [La]max of 8 mmol l−1 at the first exercise test either (for one patient [La]max was missing). Thus, although low [La]max has frequently been described as a diagnostic marker for OTS, from these results, it does not seem sensitive enough to distinguish OTS from NFO.
The participants completed in total 69 492 exercise logs (33 608 HIIT group) during the year, of which 39 075 were received in prepaid envelopes and 30 417 in internet-based forms. Both groups performed 2.2 ± 1.3 exercise sessions per week. Almost 80% of the sessions in the MCT group were actually performed with moderate intensity (11–14 on the Borg scale), while almost 60% of the sessions in the HIIT group were performed with high intensity (≥15 on the Borg scale) (Fig. 2). In the MCT group, women had a significantly higher proportion of sessions with moderate intensity compared to men (81.7% vs. 74.9%, p < 0.01). In the HIIT group, men had a higher proportion of sessions with high intensity compared to women (63.7% vs. 52.3%, p < 0.01) (Fig. 2). In the MCT group, 9.6, 43 and 47.4% of the sessions had a duration of < 30 min, 30 min to 1 h, and more than 1 h, respectively. The corresponding percentages in the HIIT group were 10.1, 45 and 44.9%.
The MMB exercises are not pathology orientated or sport specific, rather all exercises are recommended for everybody, whether they are injured, healthy, or a competitive athlete; the ability to perform the exercises represents the normal. The exercises and sequence do not change, besides the difficulty levels which are adjusted according to the individual level of practice. The MMB progressions occur when the exercises become easier and eventually autonomous and harmonious, ensuring the short- and long-term benefits of practice. Harmonious breathing and relaxation techniques are employed in every exercise repetition. Furthermore, there is the recommendation to train daily in relaxed environments, with abundant fresh air and appropriate sunlight levels and to bath regularly. Studio training is recommended for beginners, people with ailments or performing athletes.
First, a disclaimer: I have no financial stake in the sale of any of the other books mentioned below in my review of "Superslow: The Ultimate Exercise Protocol". I'm just interested in promoting safe, logical, scientifically sound methods for people that care about being in good physical condition without any unnecessary risks or wasted time. Any other books or authors mentioned are merely for the purpose of expanding the information available regarding the history (and refinements) of High Intensity Training (HIT) since Arthur Jones first began to popularize the method in the early 1970's.
As you strengthen your abs, it's vital to tone the back of the body as well. Lie on your back with your knees bent and your feet hip-width apart. Keep your arms at your sides and raise your hips without arching your back. Tighten the muscles of your buttocks and hamstrings, and hold for five breaths. Lower down one vertebra at a time to the floor if you're stopping here, or go on to the advanced posture.
This is what you should be doing before exercise to raise your heart rate and body temperature in preparation for the workout. During this type of warm-up, you moving through stretches and light exercises without stopping (as opposed to a passive stretches, which are held in place, like you do in a cool-down). This helps increase mobility and range of motion so you can get deeper into exercises. Here are five great dynamic warm-up stretches to try.
Brooke has integrated the fundamentals of breathing, core stabilization and pelvic floor awareness into a safe method that enables women to not only gain strength and stability during pregnancy but also prepares them for a healthier delivery and postpartum period. As a pelvic floor physical therapist, I wish more fitness professionals had the knowledge and expertise that Brooke brings to the industry. I always feel very comfortable referring my patients to Brooke because I know that her methods are safe and align with the physical therapy model of functional stability, posture and strength.
The Bloom Method is for every woman preparing for pregnancy, currently expecting, or even years postnatal. A variation of our techniques can be beneficial to everyone regardless of your fitness level or the vision you have for your birth. The Bloom Method is here to support each of you during your life-altering experience while providing you with simple and effective techniques that you can apply to your life no matter what your day to day looks like. We make it easy and doable for you, so that you can focus on being a mother, a friend, a partner and anything else life demands of you. We’ve got you’re back and your core for that matter, trust us, after all, this entire mehthod was created with you in mind.
This move is sure to get your heart racing in no time. Master a basic lunge before progressing to this version. With right foot ahead of left foot and core tight, drop into a low lunge, bending both knees to 90 degrees. Now jump up, switching feet in middair so you land with left foot ahead of right foot and immediately drop into a low lunge on the other side.
This move works best if you use a low bench. With the low bench at your right side, start with knees slightly bent and hips back. Shift weight to left foot then jump over the bench first with right foot, allowing the left foot to follow. Land lightly on right foot first then left foot. Reverse the move, starting with left foot, to return to starting position.
Doonya describes itself as “your at-home solution for fun dance-fitness!” Bring the energy and dance of Bollywood straight to your living room with this cardio workout. With loads of energy, Doonya co-founders Kajal Desai and Priya Pandya give you a taste of their high-powered dance routines with this four-minute video that’ll leave you sweating in no time. You’ll definitely need some coordination to complete this routine, but it’s great for beginners.
After trying many different workout "schemes" with limited success, I bought this book and began doing Super Slow workouts. I'm now working out 6 times a month, spending less than 30 minutes in the gym for each workout, and I'm stronger than I've ever been. I've never experienced progress like this before. At 45 years old, my leg press has gone from 400 to 820 lbs. in a couple of months. The workouts aren't easy, but they're over quickly, and I'm able to spend more time with my family without feeling like I'm compromisng my health and fitness.
Given that "Superslow" is long out-of-print and much more research and refinement has occurred since the early 1990's I am hesitant to recommend it to anyone other than hardcore collectors of bodybuilding or exercise related ephemera. Ken Hutchins recently updated the entire Superslow manual and further elaborated on many more topics by publishing "The Renaissance of Exercise: A Vitruvian Adventure Volume I" (2011) which is only available via mail-order and not in retail stores. It doesn't even have an ISBN number inside. But "The Renaissance of Exercise" will give you the majority of chapters from the original SuperSlow technical manual in a much more durable hardcover textbook format. It is 320 pages of no-holds-barred Ken Hutchins simply telling the truth about what he has learned after 35 years spent rigorously studying exercise. Considering current prices of some used copies of "Superslow" for sale here on Amazon you might as well spend the $150 with the folks at RenEx and you'll get _WAY_ more for your money. You can also read some of those chapters/articles for free on the RenEx website or at Hutchins' website called SuperSlow Research Zone.
SOURCES: Liz Neporent, video creator; president, Wellness 360 corporate wellness consulting firm, New York. Wendy Glenna, American Council on Exercise-certified fitness instructor; physical education teacher; fitness video reviewer, Collage Video, Minneapolis, Minn. Paula Zurowski, ACE-certified personal trainer; fitness video reviewer, Richmond, Calif.
You’ll begin the program with a full-body training split, meaning you’ll train all major bodyparts in each workout (as opposed to “splitting up” your training). Train three days this first week, performing just one exercise per bodypart in each session. It’s important that you have a day of rest between each workout to allow your body to recover; this makes training Monday, Wednesday and Friday—with Saturday and Sunday being rest days—a good approach.
You’re only a week into the program, yet you’ll begin to train different bodyparts on different days with a two-day training split (meaning the entire body is trained over the course of two days, rather than one as in the first week). You’ll train a total of four days this week; the split includes two upper-body days (Monday and Thursday) and two lower-body days (Tuesday and Friday), and each bodypart is trained twice. Wednesday, Saturday and Sunday will be your recovery days.
Around 1900, Tasmanian-born Australian professional reciter and theatrical producer Frederick Alexander developed a novel methodology to harmonize full-body functional movements. As a child, Alexander suffered respiratory ailments, leading to the initial purpose of developing the method – to normalize his personal voice function in order to materialize a stage performance dream. In 1902, Alexander established the Sydney Dramatic and Operatic Conservatorium and in 1904, moved to London to spread his teaching method. During the first years, Alexander focused on teaching ‘full chest breathing’ techniques mainly to stage artists and people with breathing pathologies.19 Staring J. Frederick Matthias Alexander 1869-1955. The Origins and History of the Alexander Technique. A medical historical analysis of F.M. Alexander’s life, work, technique, and writings. Nijmegen: Radboud Universiteit; 2005. [Google Scholar] However, he soon discovered that retrieving the natural ‘conscious control’ via mindful postures and movements resulted in benefits not only for the vocal health and performance but also the health and performance of the whole body and mind.20 Alexander FM. Man's supreme inheritance. London: Methuen; 1910. [Google Scholar] This holistic evolvement transformed the newly formed ‘Alexander Technique’ into a general remedy and preventative tool suitable for all populations. Alexander explained in his 1910 book ‘Man’s Supreme Inheritance:’20 Alexander FM. Man's supreme inheritance. London: Methuen; 1910. [Google Scholar]
Jump up ^ Magnoni, L. J; Crespo, D; Ibarz, A; Blasco, J; Fernández-Borràs, J; Planas, J. V (2013). "Effects of sustained swimming on the red and white muscle transcriptome of rainbow trout (Oncorhynchus mykiss) fed a carbohydrate-rich diet". Comparative Biochemistry and Physiology Part A: Molecular & Integrative Physiology. 166 (3): 510–21. doi:10.1016/j.cbpa.2013.08.005. PMID 23968867.
Selection bias may limit generalizability to other populations of older adults since the included participants in the Generation 100 study were healthier, more educated and more physically active than nonparticipants . However, our study population was diverse and included both healthy as well as older adults with comorbidities, and both inactive and very active older adults were included. The findings in the present study are based on a very large data material, and represent the most comprehensive data material on exercise patterns among older adults to date.
Target your glutes and core muscles with bridges. Lie on your back with your knees bent, feet flat on the floor, and your arms by your sides. Inhale, then exhale as you engage your core muscles and slowly raise your hips and lower back off of the floor. Lift yourself until your shoulders and knees form a straight line, and keep your arms flat on the floor to keep your balance.
Jump up ^ Petersen RC, Lopez O, Armstrong MJ, Getchius T, Ganguli M, Gloss D, Gronseth GS, Marson D, Pringsheim T, Day GS, Sager M, Stevens J, Rae-Grant A (January 2018). "Practice guideline update summary: Mild cognitive impairment – Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology". Neurology. Special article. 90 (3): 1–10. doi:10.1212/WNL.0000000000004826. PMID 29282327. Lay summary – Exercise may improve thinking ability and memory (27 December 2017). In patients with MCI, exercise training (6 months) is likely to improve cognitive measures and cognitive training may improve cognitive measures. ... Clinicians should recommend regular exercise (Level B). ... Recommendation
One of the most recognized MMB pioneers was Joseph Hubertus Pilates, born near Dusseldorf in Germany to a prize-winning gymnastics father and naturopath mother. According to Pilates historians’, he was a bullied child who suffered asthma and a weak body that he overcame as a teenager by learning anatomy from medical books and the practice of sports such as wrestling and gymnastics. During this process, he developed a model body, which was even displayed in anatomy classes.39,40 Balanced Body, Inc. [Internet]. Origins of Pilates. 2015 Aug 30 [cited 2015 Aug 30]. Available from: https://www.pilates.com/BBAPP/V/pilates/origins-of-pilates.html.
Jump up ^ Gallaugher, P. E; Thorarensen, H; Kiessling, A; Farrell, A. P (2001). "Effects of high intensity exercise training on cardiovascular function, oxygen uptake, internal oxygen transport and osmotic balance in chinook salmon (Oncorhynchus tshawytscha) during critical speed swimming". The Journal of Experimental Biology. 204 (Pt 16): 2861–72. PMID 11683441.
Super setting means pairing two exercises and doing them back-to-back, explains Lefkowith. There are a few ways to do these: You could save time by working two different muscle groups (like arms and legs) so you don’t need to rest in between exercises, because one muscle group is recovering while the other is working. Or, you could do two exercises that work the same area to completely fatigue one muscle group. Another option is to pair “push” and “pull” movements—for example, a push-up and a pull-up. “Super sets can be helpful if you are short on time and still want to focus on building strength,” explains says Lefkowith. And because you’re doing movements paired together, you’re likely to raise your heart rate, too.
The split jerk is a very powerful and fast move. HOW TO DO IT: The bar starts in the front rack position with your feet hip-width apart. Take a big breath to tighten your core, then dip straight down just a few inches to get more power. Next, drive the bar up overhead while splitting your legs into a lunge position. The goal is to get under the bar as fast as possible while driving the bar up overhead. MUSCLES USED: Glutes, quads, hamstrings, calves, core, shoulders, back and triceps.
Shapiro recommends elevated quadrupled shoulder adduction for a total body workout. “Start on the floor on all fours with your knees on the ground shoulder width apart and hands on the ground shoulder width apart. Make sure your knees are in line with your hips and wrists in-line with your shoulders. Tuck your toes towards your body and straighten out your back to have a neutral posture,” he explains. “Here’s the fun part: now lift your knees off the ground just two to four inches. You should feel your arms, shoulders, core, quads, and legs shaking.” And for the finale? Utilize the back—begin by pushing your upper back to the sky, separating your shoulder blades. Immediately push your chest down to pinch your shoulder blades together to target the upper back muscle groups that include the rhomboids and lower traps.
This is also the point at which exercise becomes more critical. Bone and muscle mass peak at the end of your 20s. Unchecked, sarcopenia, or muscle loss, can claim up to 50 percent of an inactive adult’s muscle tissue by the time he or she reaches 70, according to a 2014 Johns Hopkins University study. Your VO2 max — a measure of how much oxygen your body can process — declines similarly, dropping about 10 percent per decade after around age 30 in healthy sedentary adults of both sexes.
Rest-Pause Sets. The body is an amazing machine, with the right amount of rest it can surprise us with its tenacity. With a weight near your 3 or 5 rep maximum, perform as many reps as possible, then re-rack. Rest for 10 to 15 seconds, then grab it again and go at it. Make sure to keep correct form, and go/rest until you can't budge the bar. Make sure to only do this once.
How much time are you willing to devote (realistically) to working out? – Another question that being brutally honest with yourself is necessary. Pretending you will devote 2 hours to working out every day isn’t practical unless you do that in some form NOW. Most people can’t keep up a two hour a day workout program unless they are professional fitness trainers or competitors. Exercise videos come in all lengths and intensity levels. Some are very short; others may be 60-90 minutes long. Knowing how much time you have to devote to working out will help you choose an exercise video that provides what you need in the time frame you have available. This will also encourage you to continue using it.
Perception of effort, defined as “the conscious sensation of how hard, heavy, and strenuous exercise is” [23, 24], was measured during the incremental test (at the end of each minute) and during the time to exhaustion tests (at the end of the warm-up and every 30 s) using the 15 points RPE scale (Borg 1998). Standardized instructions for the scale were given to each subject before the warm-up. Briefly, subjects were asked to rate how hard they were driving their leg during the exercise (leg RPE [8, 24, 25]). Subjects were also asked to not use this rating as an expression of leg muscle pain (i.e., the intensity of hurt that a subject feels in his quadriceps muscles only).
What Does the Workout Focus on? – This goes along with matching the exercise video to what you want to work on in your fitness goals. Make sure the exercise video you choose will help you reach the fitness goals you have. For example, if one of your goals is to work on getting flatter abs and there is not an abs exercise on the whole video, this is a major fitness goal that goes untouched. With the variety of exercise videos on the market today, you will be able to find an exercise video that helps you reach your goals.
In line with the previous literature, our study showed that walking was the most common exercise type among older adults [24, 25]. This result is not surprising as walking is among the most cost effective and accessible means of exercise . In addition, walking has been identified as a relatively safe exercise alternative to older adults . We found that walking was the most common exercise type in both training groups. However, the MCT group had a higher proportion of walking sessions than the HIIT group, while the HIIT group had a higher proportion of sessions with for instance jogging and cycling. This might indicate that some older adults in the HIIT group feel that it is easier to achieve a high-intensity level when performing jogging and cycling compared to walking. Absolute workload at a given intensity varies greatly among individuals with different levels of cardiorespiratory fitness (CRF) , so that e.g. walking at 5 km/h corresponds to moderate intensity for an individual with relatively high CRF level, while the same speed exhibits near-maximal intensity for an individual with low CRF. Therefore, the type of exercise an individual need to perform in order to achieve a feeling of high intensity varies from one individual to another . Since ageing often results in CRF decline , it is likely that many older adults will reach a feeling of high-intensity when walking. However, those with a high CRF level might need to perform other exercise types, for instance jogging and cycling, to reach the same intensity level during their workout session.
HIIT stands for high-intensity interval training. “This refers to tough quick, intense bursts of exercise, followed by short recovery periods. This type of training gets and keeps your heart rate up,” explains Laferrara, while also (typically) decreasing the overall amount of time you spend training. This workout is great for burning fat because the intense intervals help kick-start the process known as excess post-exercise oxygen consumption (AKA the “afterburn effect”), which helps you burn more calories even after you stop working out as your body has to work harder and take in more oxygen to return to its resting state.
During the time to exhaustion tests, all perceptual and physiological measurements increased over time. The increase in heart rate is similar to a previous study using the same exercise on a different ergometer . Furthermore, these authors demonstrated that the respiratory system is not a limiting factor for this exercise. Despite we did not measure the maximum heart rate of our subjects via a typical whole-body incremental test (e.g. cycling), it is clear that a heart rate of ~ 130 beats/min is faraway of the maximum heart rate capacity of our subjects. Therefore, taking all together, these results confirm that high intensity OLDE performed until exhaustion is not limited by the cardiorespiratory system.
Behind the seemingly uniform acute hormonal response to exercise, explaining the disturbance to the neuroendocrine system caused by OTS is not that simple. There are several similarities with other intensive and chronic stress situations. There is compelling evidence for the involvement of HPA axis abnormalities in chronic stress situations such as post-traumatic stress disorder17 and depression25 and probably also during NFO and OTS. In chronic stress situations, the number of ACTH and cortisol secretion pulses is increased, which is also reflected in elevated urinary cortisol production.25
The main strength of this study is the large data material on exercise patterns. Most research on exercise pattern has used a cross-sectional design whereas we followed older adults over a one-year period and collected data from each exercise session they performed. Furthermore, this is the first study to assess differences in exercise patterns between older adults instructed to follow MCT versus HIIT.
Rotator cuff impingement syndrome (RCIS) is a multifactored disease that can lead to functional limitations and an inability to participate in work, leisure, and sporting activities. This syndrome can be caused by many factors, such as weakness of the rotator cuff and periscapular muscles, decreased pectoral and rotator cuff muscle flexibility, abnormal motion patterns, extrinsic factors (eg, vibration exposure, use of hand tools, work-station height), and trauma. Kuhn provided a valuable synopsis of randomized controlled clinical trials in which the benefit of exercise for individuals with RCIS was examined. Substantial evidence1 exists to support the use of exercise for the management of this patient population. In addition, manual therapy has been shown1 to augment the effectiveness of exercise. However, we believe it is premature to label the proposed rehabilitation protocol as a criterion standard because of the lack of specific exercise descriptions, variability in the exercise programs, and inability to separate the effects of specific exercises on the measured outcomes that Kuhn noted. Furthermore, because RCIS is multifactored, use of the same exercise protocol to treat everyone with RCIS might not be the best standard of care.
A Polar (www.polar.fi) heart rate monitor (belt and watch) is used to measure heart rate continuously. A transmitter belt is fastened around the chest while the watch is held by a nearby observer. If at any time during the experiment the heart rate exceeds the predetermined ceiling (85% of age-predicted max heart rate) the experiment should be stopped immediately.