Programming and Periodization

Basics of Periodization for the Physical Therapist

  • Presenter: Keelin Godsey, PT, DPT, OCS, CSCS, Kaiser Permanente Orthopaedic/Sports Rehabilitation Fellowship

Goals of the Presentation

  • History of Physical Therapy's famous 3 sets of 10

  • Learn different periodization models

  • Learn different programming models

  • Create a training program for improving strength, hypertrophy, and/or power

Understanding 3 Sets of 10

  • Introduced by Dr. Thomas DeLorme and Dr. Arthur L. Watkins in 1948

  • Focused on progression for injured WWII veterans and polio patients

  • Utilizes a 3 x 10 structure with progressively heavier loads:

    • 50% of 10RM

    • 75% of 10RM

    • 100% of 10RM

  • Initial suggestions included 70 to 100 repetitions in 7 to 10 sets, revised down to 20 to 30 repetitions for greater muscle hypertrophy.

Definition of Periodization

  • Simplified: Organization of training

  • Formally: Planned manipulation of training variables (volume, intensity, rest) aligned with predetermined training goals, using sequencing and variation.

  • Aims to produce specific physiological and performance adaptations while preventing overtraining.

Goals of Periodization

  • Optimize athlete performance at specific times

  • Maintain performance capacity throughout a season

  • Structure interventions for specific physiological and performance outcomes

  • Manage training stressors to mitigate overtraining risk

  • Promote long-term athletic development

  • Aid physical therapists in planning rehabilitation structured around patient goals

Key Concepts in Periodization

  • General Adaptation Syndrome (GAS)

  • Fitness-Fatigue Model

  • Stimulus-Fatigue-Recovery-Adaptation Theory (SFRA)

General Adaptation Syndrome (GAS)

  • Concept: Systems adapt to stressors encountered.

  • Phases of GAS:

    • Alarm/Reaction Phase:

      • Initial response involves fatigue, soreness, stiffness, reduced energy.

    • Resistance Phase:

      • Adaptation occurs, leading to less fatigue and return to or above baseline performance.

    • Supercompensation:

      • Enhanced performance capacity developed from the resistance phase adaptations.

    • Exhaustion:

      • Occurs if stressors surpass adaptation capacity, risking overtraining.

Understanding Performance Level Changes

  • Performance fluctuates intraday, interday, and in microcycles due to stressors.

  • Phases in performance response:

    1. Alarm Phase: Initial training recognition leads to fatigue and decreased performance.

    2. Resistance Phase: Adaptation occurs, performance returns to or exceeds baseline.

    3. Supercompensation Phase: Increments performance through adaptations.

    4. Overtraining Phase: Excessive stressors lead to performance suppression.

Fitness-Fatigue Theory

  • Views periodization as a balance of fitness and fatigue.

  • Preparedness results from fitness level and fatigue interaction. (

    • Optimize training by enhancing fitness while minimizing fatigue effects.

    • Exercise-specific fatigue impacts performance; allow recovery on different exercises.

  • Increased demands lead to neuromuscular adaptations alongside experienced fatigue.

Stimulus-Fatigue-Recovery-Adaptation Theory

  • Fatigue correlates with stimulus strength/duration.

  • Recovery allows performance/preparedness to enhance post-fatigue.

  • Delayed effects from loading determine recovery needs, while involution occurs with inactivity post recovery.

Cycle Breakdown

  • Multi-Year Preparation: 2-4 years (e.g. preparation for world championships).

  • Annual Training Plan: 1-year structured focus on performance.

    • Macrocycle: 12 weeks to 1 year focusing on specific goals.

    • Mesocycle: 2-8 weeks focusing on a specific skill or quality.

    • Microcycle: 1-2 weeks detailing precise goals.

    • Training Session: Individual workout day.

Methods of Periodization

  • Sequential:

    • Linear

    • Non-linear/undulating

  • Conjugate

  • Block

Linear Periodization

  • Gradually increases workload towards training goals in a linear structure.

  • Progresses from high volume/low intensity to low volume/high intensity.

  • Advantages: Predictable for beginners.

  • Disadvantages: Less effective for advanced athletes due to fatigue management issues.

Non-linear/Undulating Periodization

  • Adjusts volume/intensity between training sessions.

  • Benefits: More recovery and adaptability, effective for intermediate/advanced squatting.

  • Drawbacks: Not ideal for beginners and limited foundational strength development.

Conjugate Periodization

  • Known as the Westside Method; frequently alters training stresses.

  • Focus on maintaining multiple abilities with concentrated efforts.

  • Phases:

    • Accumulation: High load on major training focus; minor emphases.

    • Transmutation: Redistribute workloads and change emphasis.

    • Realization: Lower workloads to manage fatigue dissipation.

Block Periodization

  • Focuses on specific training abilities, using concentrated workloads.

  • Three Phases:

    1. Accumulation: Increases work capacity.

    2. Transmutation: Progress with increased loads on specific exercises.

    3. Realization: High specificity movement at significant loads.

Key Steps for Setting Up Training Programs

For Strength and Conditioning Specialists

  1. Determine long-term goals.

  2. Prioritize major objectives and assess last year's training plan.

  3. Identify preparatory, competitive phases.

  4. Establish mesocycle lengths and focuses.

  5. Construct microcycles including training/recovery plans.

  6. Design training day structure.

  7. Implement plan with ongoing monitoring.

For Physical Therapists

  1. Determine long-term rehabilitation goals.

  2. Prioritize primary impairments and assess patient history.

  3. Identify rehabilitation phases (e.g. healing, strengthening).

  4. Structure mesocycles for rehabilitation focuses.

  5. Construct microcycles for patient training frequency.

  6. Structure treatment session details.

  7. Implement plan of care with consistent monitoring.

Resistance Training Program Variables

  • **Exercise Selection: **

    • Type of contraction (eccentric, concentric, isometric).

    • Joint involvement (single vs multi-joint).

    • Equipment accessibility.

    • Open vs closed chain exercises.

    • Unilateral vs bilateral styles.

  • Workout Structure:

    • Order based on primary training goals.

    • Types: Total Body, Upper/Lower Splits, Muscle group splits.

Resistance Training Variables: Intensity and Volume

  • Intensity: Amount of weight lifted.

    • Untrained: > 45-50% of 1RM.

    • Advanced: > 80-85% of 1RM.

  • Volume: Total sets and repetitions.

    • Typical sets per exercise: 1-6.

  • Rest: Critical for metabolic and hormonal management.

  • Frequency: Number of training sessions per week.

Rehab Training Variable: Pain/Injury

  • Program must be modifiable as per patient feedback.

  • Autoregulation through Daily Adjusted Progressive Resistive Exercise (DARPE).

  • Focus on strength/power, strength/hypertrophy, hypertrophy zones.

  • Use of RPE as a reliable measure of exercise intensity in rehabilitation contexts.

Training for Hypertrophy

  • Involves muscle growth and allows for higher volume endurance training.

  • Uses lower loads to promote form development; suitable for those unable to handle high loads.

Training for Strength

  • Foundation for effective return-to-play programs.

  • Essential load intensity for strength adaptation.

  • Recommended: Multiple sets > 80% 1RM, optimum set numbers around 3-4 sets.

Training for Power

  • Power defined as the rate of work, linking force and velocity.

  • Critical for rehabilitation and sports performance.

  • Components: Muscular strength, rate of force development, maximum force at high velocities.

  • Peak power should be calibrated according to exercise types.

References

  • Various studies and resources supporting the concepts discussed in periodization and training for physical therapy.