There has been conflicting information over the years regarding the recommended number of repetitions and sets of exercises patients should perform. To judge for yourself what numbers are best for those in your care, you need to consider several factors - especially the hectic, fast-paced lives many of your patients lead.
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.
We chiropractors generally employ a different approach. We want to help our patients achieve 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 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 a good idea to provide clear and easy-to-follow instructions. All patients do better when they know exactly what is expected, and they will tend to do only the minimum necessary.
Adding Up the Numbers
The repetition number ("reps") means the number of times a patient performs an exercise consecutively, without stopping. In most programs, this number usually is somewhere between one 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 one to three to five, and 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 two sets of 10 reps, four sets of five reps or five sets of four 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 of 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?
Established Guidelines Disputed
Since 1962, most exercise recommendations have been based on the Berger method.1 This method consists of three sets of six repetitions (18 total repetitions). Because it is 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's an effective program, an even simpler and easier method has gained popularity lately.
A literature review by Drs. Carpinelli and Otto2 found there is now a large volume of research that disputes the need for three sets of exercise. In fact, they state, "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.
Success in Less Time
In many instances, having patients perform just one set of eight to 12 repetitions of their recommended exercise(s) has proven successful. Since this is only eight 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. This approach has been found to be just as effective in getting rapid results. In the very early stages of recovery, as few as three repetitions can be helpful.
In many cases, patients can be instructed to perform at least eight repetitions of the exercise, but they should initially attempt 12. If that number of repetitions can be done fairly easily, have patients slightly increase resistance the next time. When using surgical tubing exercises, this means increasing the starting distance from the door to which the tubing temporarily is 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. Since the patient is being asked for such a minimal time commitment, it's difficult for them to say 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 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 the exercises fit into their busy schedule. With only eight to 12 total repetitions, several exercises can be done in just five or 10 minutes.3 This helps ensure acceptance of the entire treatment program, which can lead to rapid progress under your expert care. Patients also benefit from written and visual demonstration of the exercises you are recommending they perform.
- Berger RA. Effect of varied weight training programs on strength. Res Q 1962;33:168-81.
- Carpinelli RN, Otto RM. Strength training: single versus multiple sets. Sports Med 1998;26(2):73-84.
- 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):183-95.
Click here for previous articles by Kim Christensen, DC, DACRB, CCSP, CSCS.