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Select the right type of exercise for your client

This is an excerpt from Laboratory Assessment and Exercise Prescription With HKPropel Online Video-Loose-Leaf Edition by Jeffrey M. Janot & Nicholas M. Beltz.

Core endurance exercises can either be static (isometric) or dynamic in nature. A typical program for a client may include both static and dynamic exercises to address any type of occupational, recreational, or sport movement demands that they may have in their everyday life. Ratamess and colleagues (2009) recommend including exercises that involve multi- and single-joint movements in a muscular endurance program. This recommendation is also supported by others (Garber et al. 2011; Gibson, Wagner, and Heyward 2019; Magyari 2018). Ultimately, the choice of exercise will be dictated by the program goals and needs of the client.

Static core exercises are done to build endurance of the spine stabilizer (core) musculature while simultaneously restricting movement in the spine (McGill 2015). This type of training is very important for learning spine stiffening technique (i.e., abdominal bracing in neutral spine position) to protect the spine during dynamic movement and to decrease external loading of the spine during exercise while building greater endurance capacity. These two factors are especially critical for those clients with a history of past or current low back issues and poor core stability. According to McGill (2015), proper curl-up (anterior stabilizers; rectus abdominis), side bridge variations (lateral stabilizers; quadratus lumborum, obliques, transverse abdominis), and bird dog variations (posterior stabilizers; back extensors) are three exercises that should be at the center of any core endurance program addressing all spine stabilizers. Other static exercises for the core are reverse glute and other body bridges, front plank, stir the pot, and dead bug variations, among others. Remember, these exercises should be done with as limited spine motion as possible. A final piece regarding static core exercises is the length of time each isometric contraction is held. McGill (2015) recommends no more than 7 or 8 s of contraction hold per exercise followed by a short rest period (~5 s). This contraction can be repeated for as often as is required to attain the overall volume goal for a particular exercise. For example, if you want a client to perform two sets of the bird dog and front plank exercises for 1 min each set, then both exercises should be broken up into multiple repetitions of  7 or 8 s holds that equal the total volume goal. Thus, continuous plank or other isometric holds for minutes on end should not be recommended!

Dynamic core exercises can include multidirectional movements involving rotation in the transverse plane, flexion and extension in the sagittal plane, abduction and adduction in the frontal plane, or in a diagonal pattern (Magyari 2018; McGill 2015). Modalities that can be used are cable machines with a weight stack to perform horizontal cable chops and high to low or low to high cable chops; medicine balls to perform rotational throws, slams, reverse throws, and presses; and dynamic balance exercises with a focus on core stability. Also, “anti-movement” exercises for the core such as “anti-rotation,” “anti-lateral flexion,” and “anti-extension” Pallof-type presses and cable walkouts can be done using cables or bands.

Additionally, performing these and other resistance training exercises utilizing an unstable surface (e.g., stability ball, foam pad, BOSU, etc.) or modality (e.g., TRX training) can provide both a dynamic core and balance challenge for the client (Behm and Colado 2012; Behm and Sanchez 2013; Behm et al. 2015; Janot et al. 2013; Magyari 2018). However, if greater force or power production is the goal, it is recommended that a more stable surface is used during exercise (Behm and Anderson 2006). Also, employing unstable surfaces during exercise leads to greater co-contraction of the spine stabilizing muscles, which equally increases the stress or load on the spine (McGill 2015). Therefore, unstable surfaces for certain clients should be prescribed cautiously, and that client should be carefully assessed first, especially if low back health is an issue.

Finally, velocity of contraction during muscular endurance training can vary along a large continuum of tempos and still be effective. It is generally recommended that moderate to faster velocities (i.e., a ratio of 2 s during concentric movement and 2 s during eccentric movement or less) of contraction per repetition be performed during muscular endurance training (Ratamess et al. 2009). With that said, it is imperative that form is never sacrificed for greater velocity; thus, beginners should perform at the tempo at which they can best maintain technique and form during exercise.

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