Friday, February 28, 2014

FITNESS 50-PLUS: Rest and Recovery

Dear Friend,

Unfortunately, identifying the right balance of hard work and recovery is the most difficult part of serious fitness training. So it comes to no surprise that most of my clients are much more focused on the exercises I teach to help them reach their goals of rehabilitation, balance, weight management, health improvement, greater overall fitness etc. Paying attention to proper rest and recovery often is being neglected. I guess if one pays for training rest seems a waste. As a trainer and therapist it is my job to ensure that a client/patient is not sabotaging his/her own efforts of improvement and remind them that adequate rest and recovery are an essential part of any work out program and no less important than the exercise itself. Lack of rest in between exercises within a training session and too little or poor recovery on off days will compromise the success of training whether the goals pertain to rehabilitation, health maintenance, fitness or athletic performance and regardless of age. Rest and recovery will however increasingly gain greater relevance and importance as we age. Some of you might have watched the Winter Olympics in Sochi. Norway's Ole Einar Bjoerndalen (age 40) became the most decorated Winter Olympian of all times. He almost missed the team as he had dropped far down in World rankings in 2012 and only after changing his training and emphasizing rest and recovery did he become successful again. In today’s blog I want to help you better understand the role of rest and recovery and leave you with some tips on how you can maximize your rest and recovery periods to ensure training success.

The role of rest in between sets and different exercises within a training session

Rest in between sets and exercises depend on the intensity of a given exercise (number of reps and work load) the overall demand on the body and the goals of your training . If trying to improve muscular strength endurance/fatigue resistance you trainer will most likely chose light to moderate work loads, high number of repetitions and short (30 seconds or incomplete recovery) rest periods in between sets. If maximum strength is to be improved high to maximum work loads, low number of repetitions, and long rest periods (complete or nearly complete recovery) in between sets are the common choice. Improving aerobic cardio-vascular capacities requires you to train at or near the aerobe-anaerobe threshold for extended periods of time, while improvements of anaerobe capacities require a short high intensity stimulus like a sprint. Rest periods have to be far longer. And yes there are newer methods that have gained great popularity such as High Intensity Training (HIT) or High Intensity Interval Training (HIIT) mostly due to their high caloric expenditure and impact on VO2 that allow for very little or no rest in between exercises. These types of work-outs are typically shorter in total time (15-30 min) and require full recovery on off days to be successful.

Recovery in between training sessions - Super Compensation

Training success relies on the principle of “Super Compensation” which means that training is supposed to stimulate a response that improves the body’s readiness for the next training session and its demands. In order to accomplish “Super Compensation” the work-out has to provide a progressive overload challenging strength, balance, and/or aerobic/anaerobic capabilities etc. In order to ensure optimal results after each session, exercises, work loads, numbers of repetitions and rest in between sets and work outs have to be planned.

Super Compensation requires recovery. In order to improve performance, training has to be timed properly. The best time for the next training session is at the highest level of Super Compensation. Training prior to the climax of Super Compensation limits training results. Training prior to regeneration leads to overtraining and reduced performance. Waiting too long leads to maintenance without improvement. See graphs below for better understanding.

Super Compensation

Perfect timing leads to improvement

Overtraining - negative training

Symptoms of Overtraining may include but are not limited to:
  • Persistent muscle soreness
  • Persistent fatigue
  • Difficulty sleeping
  • Elevated resting heart rate
  • Reduced heart rate variability
  • Increased susceptibility to infections
  • Increased incidence of injuries
  • Irritability
  • Depression
  • Mental breakdown

Periodization - variable training intensities and training goals short-, medium- and long term

"Periodization is an organized approach to training that involves progressive cycling of various aspects of a training program during a specific period of time. Periodization is most widely used in resistance program design to avoid over-training and to systematically alternate high loads of training with decreased loading phases to improve components of muscular fitness (e.g. strength, strength-speed, and strength-endurance). This system of training is typically divided up into three types of cycles: microcycle, mesocycle, and macrocycle." (Frankel, C.C., & Kravitz, L. (2000). Periodization. IDEA Personal Trainer, 11 (1), 15-16)

Additional ways to maximize rest and recovery on training days and in between

Whether it is between interval bouts, immediately after an interval session, or the day following strenuous exercise, there is compelling research evidence that active recovery is superior to passive recovery (Del Coso et al., 2010). Here are some ways you can speed up and improve your recovery process.
  1. Post Exercise Nutrition Recovery has three goals, refueling glycogen storage by consuming complex carbohydrates (unprocessed, wholesome grains), offering protein for muscle repair and synthesis (first 45 minutes post exercise are key), and restoring fluid and electrolytes lost through sweat while exercising. Nutrition Recovery efforts should start within 45-60 minutes post exercise.
  2. Stretch your muscles and/or  perform Self Myofascial Release by using a foam roller.
  3. In addition an ice-cold full body plunge, contrast therapy by alternating hot and cold showers, and icing hard trained muscles right after working out can significantly reduce muscle soreness and inflammation and decrease the existing lactic acid build up, speeding up recovery.
  4. Ensure a good nights rest with plenty of hours and quality of sleep.
  5. Low intensity exercises such as walking or light weight lifting on the day following intensive work-outs will increase circulation and reduce lactic acid build up.
  6. A massage to help with myofascial release, circulation and relaxation can further promote recovery in the days following intense work out sessions.


Despite the fact that recovery is an under-researched topic and therefore not as well understood as other areas of training, we do know that it takes a well thought out training plan and active recovery strategies to speed up and maximize the recovery process, and optimize training results and performance in athletic endeavors as well as in activities of daily living.

I sincerely hope I was able to shed some light on rest and recovery and help you improve your current strategies after finishing your work outs. Please feel free to respond with any comments and questions you might have.

In good health,


Del Coso, J. et al. (2010). Restoration of blood pH between repeated bouts of high-intensity exercise: Effects of various active-recovery protocols. European Journal of Applied Physiology, 108, 523–532.

Frankel, C.C., & Kravitz, L. (2000). Periodization. IDEA Personal Trainer, 11 (1), 15-16

Monday, February 10, 2014

Exercising with advanced chronic kidney disease (CKD)

Dear Friend,

recently one of my long term clients and dear friends started dialysis after years of chronic kidney disease (CKD) as it moved from stage 3 to 4 and finally reached stage 5 which called for aggressive treatment and dialysis.

Today's blog is trying to provide some insights into exercising with advanced chronic kidney disease and dialysis.

Did you know that one in seven adult Americans suffers from chronic kidney disease?

The presence of CKD should be established through presence of kidney damage and level of kidney function measured by glomerular filtration rate (GFR). During stages 3 and 4 your kidneys are still able to remove some waste and excess fluids from your blood  and treatment is mostly focused on keeping your body nourished and treating other diseases contributing to the kidney disease. In addition your doctor will closely monitor kidney function to quickly intervene through medication and diet when necessary. Diet recommendations for patients wit CKD change with the amount of kidney function remaining, requiring adjustments in intake of protein, calories and other nutrients.

The most common causes of reaching the end-stage of this disease is diabetes mellitus. If diagnosed with diabetes make sure you watch your blood glucose levels and follow your treatment (insulin and other medications) strictly to prevent renal failure. Another cause for moving on to dialysis is hypertension as it damages the small blood vessels inside the kidneys. Controlling blood pressure by way of medication (often two different types) and reduced sodium intake is essential when trying to reduce the risk of further kidney damage.

Healthy kidneys produce the hormone erythropoietin also known as EPO which stimulates the bone marrow to make red blood cells, responsible for oxygen transport in the blood. Patients with chronic kidney disease do not produce enough EPO and often suffer from Anemia causing fatigue and paleness. Severe Anemia also places undue stress on the heart causing a greater risk for heart failure in patients with chronic kidney disease. Treatment options include EPO injections and iron supplements as EPO treatment is only successful if blood iron levels are sufficient.

Other problems caused by kidney disease effect bone health as phosphorous levels often increase and Calcium and Vitamin D levels decrease. Periodic bone density check ups are therefore warranted.

Knowing about the problems that chronic kidney disease can cause and being aware of possible other contributing diseases is helpful when starting and deciding on an exercise program. Many dialysis patients believe that they can't exercise any longer. The opposite is the truth. A regular exercise program has shown to be very beneficial to both, patients with chronic kidney disease even when undergoing dialysis. A regular exercise program yields the same benefits as it does for healthy individuals including but not limited to:
  • increased energy and endurance
  • improved physical function and activities of daily living
  • greater muscular strength and counterbalance dialysis associated muscular atrophy
  • lowering blood lipids
  • controlling blood pressure
  • improving insulin resistance
  • managing body weight
  • greater sleep quality
  • enhanced mental outlook
Exercising is extremely important for patients with CKD. Studies have shown that physically active individuals predialytic, on hemodialysis and after kidney transplant increase their overall quality of life and improve the outcome of renal disease.
Before starting any exercise program patients with CKD should consult with their physicians and discuss safe forms of exercise and possible risk factors and contra indications. Your nephrologist is aware how much, how often and what types of exercise are beneficial in your particular situation. In case a trainer or Physical Therapist is involved in your effort to exercise I strongly recommend a consult between the fitness expert and your physician ensuring successful and safe work-outs.

When starting an exercise program choose activities that are enjoyable as it increases the chances for better compliance. If you are a novice to exercising start out and progress work-outs slowly. Exercises that have proven to be of great benefit to patients include aerobic activities, such as walking, jogging, cycling, skiing, dancing and swimming. Try to work up slowly to 3-4 weekly sessions of 30 minutes or more. Chose a workout intensity that allows you to keep up a conversation without shortness of breath. Avoid exhaustion.

In addition to aerobic activities CDK patients should get involved in a regular resistance training program that helps increase lean muscle mass and strength. Work out loads should be light to moderate and focus on repetitions rather than load increases. Work-out intensities should be kept moderate to avoid excessive muscle soreness and fatigue. In order to be successful try two or three weekly sessions, strengthening all major muscle groups.

If exercising outdoors avoid the hottest hours of the day; avoid big meals right before exercising, and don't place your work-outs too close to bed time as it might interfere with the ability to go to sleep. Stop the work-out if you experience chest pain, excessive tiredness or shortness of breath. Do not exercise if you have a fever and changed your dialysis or medicine schedule before consulting with your nephrologist.

Conclusion: Not only can CDK patients exercise at any stage of the disease, it is encouraged and vital to the emotional and physical well-being, overall quality of life, and the outcome of the disease. The potential risk of physical activity can be reduced by medical evaluation, risk stratification, careful supervision, and education.

As always, your comments and questions are much appreciated.

In good health,

Physical Exercise in Patients with Severe Kidney Disease
G.C. Kosmadakis, A. Bevington,  A.C. Smith a E.L. Clapp, J.L. Viana, N.C. Bishop, J. Feehall