APTA s Combined Sections Meeting, 2019 Science Meets Practice: Do We Need to Fail to Succeed? Speakers:

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1 APTA s Combined Sections Meeting, 2019 Science Meets Practice: Do We Need to Fail to Succeed? Speakers: Scot Morrison, PT, DPT Board Certified Orthopaedic Clinical Specialist Certified Strength & Conditioning Specialist Owner/Operator, Physio Praxis, Portland, OR Daniel W. Safford, PT, DPT, MAT Board Certified Orthopaedic Clinical Specialist Certified Strength & Conditioning Specialist Lead Therapist, Good Shepherd Penn Partners, Glenside, PA Research Physical Therapist, Arcadia University Shoulder Research Center, Glenside, PA Moderator: Marisa Pontillo, PT, PhD, DPT Board Certified Sports Clinical Specialist Sports Team Leader, GSPP Penn Therapy at Penn Sports Medicine Center, Philadelphia, PA Scientific Consultant, Penn Orthopedics/University of Pennsylvania Athletics, Philadelphia, PA Chair of the Shoulder SIG of the American Academy of Sports Physical Therapy Outline: High intensity training regimes that emphasize loading to failure as necessary to maximize adaptation and lower opportunity cost are supported by a compelling body of evidence. However, arguments against the necessity of training to failure raise concerns about suboptimal performance outcomes and unwanted side effects such as extended recovery. Loading without failure may be a more advantageous approach to training and rehabilitating athletes. Evidence regarding these two loading schemes will be examined and debated through a clinical lens to determine which approach should be used to achieve desired clinical and performance outcomes. A focus of this session will be the consideration of physiological responses and the optimal application of these approaches in the athletic population. Objectives: Following this session, attendees will be able to: 1. Discuss the current state of the evidence on training to failure versus non-failure. 2. Accurately identify the exercise parameters necessary for optimal outcomes for both loading approaches. 3. Understand the physiological effects and benefits of training to failure versus nonfailure in the athletic population.

2 4. Critically evaluate the clinical feasibility of failure and non-failure training, and conceptually apply these schemes to improve rehabilitation and performance in athletes. Timetable: 00:00-00:05 Overview of session format 00:06-00:30 Platforms 00:30 00:50 Moderator led Q&A; cases 00:50-01:15 Dialogue #1: The case for non-failure training in athletes 01:15-01:45 Dialogue #2: The case for failure training in athletes 01:45-02:00 Moderator led Q&A/Summary of session

3 Fail to Succeed: The case for non-failure training in athletes Daniel W. Safford, PT, DPT, MAT Board Certified Orthopaedic Clinical Specialist Certified Strength & Conditioning Specialist Lead Therapist, Good Shepherd Penn Partners, Glenside, PA Research Physical Therapist, Arcadia University Shoulder Research Center, Glenside, PA 1. Variability and clarification of failure-related terms a. Repetition failure, momentary failure, fatigue, non-failure Strength & performance outcomes of non-failure training in comparison to failure a. Relatively equivocal Possible mechanisms of action for adaptation in non-failure training a. Neural i. Recruitment patterns b. Hormonal c. Tissue stress 4. Physiological effects of non-failure training a. Positive muscle protein synthesis b. Decreased hormonal response c. Decreased tissue damage 5. Recovery required for non-failure training a. Less than failure training 8-11 b. Allows for increased training volume & higher intensity training i. May allow for indirectly improved outcomes 6. Implications for injury a. May reduce overuse or overtraining injuries 7. Parameters for application a. Type of exercise and contraction b. Intensity c. Frequency d. Volume and rest 8. Considerations within athlete macrocycle periodization Summary, conclusions, and questions References: 1. Davies T, Orr R, Halaki M, et al. Effect of Training Leading to Repetition Failure on Muscular Strength: A Systematic Review and Meta-Analysis. Sports Med 2016;46(4): doi: /s Steele J, Fisher J, Giessing J, et al. Clarity in reporting terminology and definitions of set endpoints in resistance training. Muscle Nerve 2017;56(3): doi: /mus.25557

4 3. Sampson JA, Groeller H. Is repetition failure critical for the development of muscle hypertrophy and strength? Scandinavian journal of medicine & science in sports 2016;26(4): doi: /sms [published Online First: 2015/03/27] 4. Izquierdo M, Ibanez J, Gonzalez-Badillo JJ, et al. Differential effects of strength training leading to failure versus not to failure on hormonal responses, strength, and muscle power gains. Journal of applied physiology (Bethesda, Md : 1985) 2006;100(5): doi: /japplphysiol [published Online First: 2006/01/18] 5. Nobrega SR, Ugrinowitsch C, Pintanel L, et al. Effect of Resistance Training to Muscle Failure vs. Volitional Interruption at High- and Low-Intensities on Muscle Mass and Strength. Journal of strength and conditioning research 2018;32(1): doi: /jsc [published Online First: 2017/12/01] 6. Dankel SJ, Counts BR, Barnett BE, et al. Muscle adaptations following 21 consecutive days of strength test familiarization compared with traditional training. Muscle Nerve 2017;56(2): doi: /mus [published Online First: 2016/11/23] 7. Spangenburg EE, Le Roith D, Ward CW, et al. A functional insulin-like growth factor receptor is not necessary for load-induced skeletal muscle hypertrophy. The Journal of physiology 2008;586(1): doi: /jphysiol [published Online First: 2007/11/03] 8. Gonzalez-Badillo JJ, Rodriguez-Rosell D, Sanchez-Medina L, et al. Short-term Recovery Following Resistance Exercise Leading or not to Failure. International journal of sports medicine 2016;37(4): doi: /s [published Online First: 2015/12/17] 9. Moran-Navarro R, Perez CE, Mora-Rodriguez R, et al. Time course of recovery following resistance training leading or not to failure. European journal of applied physiology 2017;117(12): doi: /s [published Online First: 2017/10/02] 10. Parraga-Montilla JA, Garcia-Ramos A, Castano-Zambudio A, et al. Acute and Delayed Effects of a Resistance Training Session Leading to Muscular Failure on Mechanical, Metabolic, and Perceptual Responses. Journal of strength and conditioning research 2018 doi: /jsc [published Online First: 2018/06/29] 11. Pareja-Blanco F, Rodriguez-Rosell D, Aagaard P, et al. Time Course of Recovery From Resistance Exercise With Different Set Configurations. Journal of strength and conditioning research 2018 doi: /jsc Ralston GW, Kilgore L, Wyatt FB, et al. The Effect of Weekly Set Volume on Strength Gain: A Meta-Analysis. Sports Med 2017;47(12): doi: /s [published Online First: 2017/07/30] 13. Grgic J, Schoenfeld BJ, Davies TB, et al. Effect of Resistance Training Frequency on Gains in Muscular Strength: A Systematic Review and Meta-Analysis. Sports Med 2018;48(5): doi: /s x [published Online First: 2018/02/23] 14. Sarabia JM, Moya-Ramon M, Hernandez-Davo JL, et al. The effects of training with loads that maximise power output and individualised repetitions vs. traditional power training. PloS one 2017;12(10):e doi: /journal.pone [published Online First: 2017/10/21]

5 Fail to Succeed: The case for failure training in athletes Scot Morrison, PT, DPT Board Certified Orthopaedic Clinical Specialist Certified Strength & Conditioning Specialist Owner/Operator, Physio Praxis, Portland, OR 1. Underloading: a current issue in rehabilitation 2. ExRx History a. Early Pioneers 1-3 b. Strength & Conditioning 4-6 c. Bodybuilding & Mike Mentzer 3. An argument for a consistent anchor 7 4. Review of current body of literature on training to failure a. Intensity based 8-13 b. Volume based 10, Rating of perceived exertion and discomfort 8,13,14,17,25,26 6. Searching for optimal in the face of reality. a. Optimal loading 27 b. Heuristics & decision making c. Optimal, sloptimal and satificing d. 7. Practical responses to theoretical issues a. Recovery. A systemic vs isolated issue. b. Injury. Looking at the bigger picture. 8. Practical conclusions a. When to include training to failure b. How to include training to failure 9. Summary, conclusions & questions References: 1. DELORME TL, WATKINS AL. Technics of progressive resistance exercise. Archives of Physical Medicine and Rehabilitation. 1948;29(5): Knight KL. Knee rehabilitation by the daily adjustable progressive resistive exercise technique. Am J Sports Med. 1979;7(6): doi: / HELLEBRANDT FA, HOUTZ SJ. Mechanisms of muscle training in man: experimental demonstration of the overload principle. Phys Ther Rev. 1956;36(6):

6 4. Stone MH, Moir G, Glaister M, Sanders R. How much strength is necessary? Physical Therapy in Sport. 2002;3(2): doi: /ptsp Stone MH, O'Bryant HS, Schilling BK, et al. Periodization: Effects Of Manipulating Volume And Intensity. Part 1. Strength & Conditioning Journal. 1999;21(2): Stone MH, O'Bryant HS, Schilling BK, et al. Periodization: Effects of Manipulating Volume and Intensity. Part 2. Strength & Conditioning Journal. 1999;21(3): Steele J, Fisher J, Giessing J, Gentil P. Clarity in Reporting Terminology and Definitions of Set End Points in Resistance Training. Muscle Nerve. January 2017:1-26. doi: /mus Fisher JP, Ironside M, Steele J. Heavier- and lighter-load resistance training to momentary failure produce similar increases in strength with differing degrees of discomfort. Muscle Nerve. December 2016:1-26. doi: /mus Fisher J, Steele J, Smith D. High- and Low-Load Resistance Training: Interpretation and Practical Application of Current Research Findings. Sports Med. July 2016:1-8. doi: /s Steele J, Fisher JP, Assunção AR, Bottaro M, Gentil P. The role of volume-load in strength and absolute endurance adaptations in adolescent s performing high- or low-load resistance training. Appl Physiol Nutr Metab. October 2016:apnm doi: /apnm Fisher J, Steele J, Bruce-Low S, Smith D. Evidence-based resistance training recommendations. Med Sport Izquierdo M. Differential effects of strength training leading to failure versus not to failure on hormonal responses, strength, and muscle power gains. Journal of Applied Physiology. 2006;100(5): doi: /japplphysiol Sampson JA, Groeller H. Is repetition failure critical for the development of muscle hypertrophy and strength? Scandinavian Journal of Medicine & Science in Sports. March 2015:n/a n/a. doi: /sms Fisher JP, Blossom D, Steele J. A comparison of volume equated knee extensions to failure, or not to failure, upon rating of perceived exertion and strength adaptations. Applied Physiology Fisher J, Steele J. Questioning the Resistance/Aerobic Training Dichotomy: A Commentary on Physiological Adaptations Determined by Effort Rather than Exercise Modality. J Hum Kinet. 2014;44(1):1-7. doi: /hukin Fisher J, Steele J, McKinnon P, McKinnon S. Strength Gains as a Result of Brief, Infrequent Resistance Exercise in Older Adults. Journal of Sports Medicine. 2014;2014(1):1-7. doi: /2014/

7 17. A comparison of low volume high-intensity-training and high volume traditional resistance training methods on muscular performance, body composition, and subjective assessments of training. Biol Sport. 2016;33(3): doi: / Figueiredo VC, de Salles BF, Trajano GS. Volume for Muscle Hypertrophy and Health Outcomes: The Most Effective Variable in Resistance Training. Sports Med. 2017;48(3):1-7. doi: /s Low-load resistance training promotes muscular adaptation regardless of vascular occlusion, load, or volume. Eur J Appl Physiol. 2015;115(7): doi: /s TAN B. Manipulating Resistance Training Program Variables to Optimize Maximum Strength in Men: A Review. Journal of Strength and Conditioning Research. 1999;13(3): Willardson JM. The application of training to failure in periodized multiple-set resistance exercise programs. Journal of Strength and Conditioning Research. 2007;21(2): doi: /r SANBORN K, BOROS R, HRUBY J, et al. Short-Term Performance Effects of Weight Training With Multiple Sets Not to Failure vs. a Single Set to Failure in Women. Journal of Strength and Conditioning Research. 2000;14(3): Schoenfeld BJ. Is There a Minimum Intensity Threshold for Resistance Training-Induced Hypertrophic Adaptations? Sports Med. August doi: /s z. 24. Davies T, Orr R, Halaki M, Hackett D. Effect of Training Leading to Repetition Failure on Muscular Strength: A Systematic Review and Meta-Analysis. Sports Med. 2015;46(4): doi: /s Steele J, Fisher J, McKinnon S, McKinnon P. Differentiation between perceived effort and discomfort during resistance training in older adults:reliability of trainee ratings of effort and discomfort,and reliability and validity of trainer ratings of trainee effort. Journal of Trainology. 2016;6(1):1-8. doi: /trainology.6.1_ Relationship Between the Rating of Perceived Exertion Scale and the Load Intensity of Resistance Training. June 2018: Glasgow P, Phillips N, Bleakley C. Optimal loading: key variables and mechanisms. British Journal of Sports Medicine. 2015;49(5): doi: /bjsports Mousavi S, Gigerenzer G. Heuristics are Tools for Uncertainty. Homo Oeconomicus. 2017;34(4): doi: /s z. 29. Javanovic M. Uncertainty, Heuristics and Injury Prediction. February 2017:1-7.

8 30. Gigerenzer G, Brighton H. Homo Heuristicus: Why Biased Minds Make Better Inferences. Topics in Cognitive Science. 2009;1(1): doi: /j x.