Can resistive training improve offloading?

Resistive Training for Improved Offloading

Resistive training can significantly improve offloading by increasing muscle strength and endurance, which optimizes performance of tasks that specifically load muscles such as stair-climbing and sit-to-stand movements. 1

Benefits of Resistive Training for Offloading

• Resistive training increases muscle force and mass compared to no exercise training, which can improve the ability to perform weight-bearing activities 1
• Gains in quadriceps muscle strength specifically optimize performance of tasks that load these muscles, such as stair-climbing and sit-to-stand movements 1
• Resistive training elicits a reduced cardiorespiratory response compared to endurance exercise, making it more tolerable for individuals with limited exercise capacity 1
• Strength training through resistive exercises increases gait speed and muscular strength in the hemiparetic leg, improving functional mobility and walking 1

Optimal Training Parameters

• For older adults and those with cardiac conditions, the American Heart Association recommends 10-15 repetitions at lower resistance levels (40-60% of one-repetition maximum) 1, 2
• The American College of Sports Medicine recommends 1-3 sets of 8-12 repetitions performed 2-3 days per week for developing muscular strength and endurance 1
• Initial loads should be equivalent to either 60-70% of the one-repetition maximum or a load that causes fatigue after 8-12 repetitions 1
• Exercise dosage must progressively increase over time (overload principle) to facilitate improvements in muscular strength and endurance 1

Implementation Strategies

• Include 8-10 different exercises that train the major muscle groups in each workout session 3
• Focus particularly on lower extremity exercises such as leg extensions, leg curls, and leg press 1
• For upper extremity, include bench press, lateral pulldowns, biceps curl, and triceps extension 1
• Overload can be achieved by increasing resistance/weight, increasing repetitions per set, increasing sets per exercise, or decreasing rest periods between sets 1, 4

Special Considerations

• Knee extensors are the most important muscle group on the hemiparetic leg that predicts gait speed; therefore, interventions targeting increased gait speed should focus on strengthening the knee extensors 1
• Resistance training can be performed using free weights, elastic bands, or repetitive isolated muscle training 1
• The upper body should not be neglected as many activities of daily living require arm work 1
• Combining constant-load/interval and strength training improves outcomes (exercise capacity and muscle strength) to a greater degree than either strategy alone 1

Common Pitfalls to Avoid

• Using exclusively one repetition range limits overall development - combining different loading schemes may provide optimal results 2
• Neglecting progressive overload principles will stall adaptations regardless of repetition range 2, 4
• Improper technique at heavy loads increases injury risk - prioritize form over weight 2
• Breath-holding and straining (Valsalva maneuver) should be avoided by exhaling during the contraction phase and inhaling during the relaxation phase 2

Long-term Considerations

• Benefits obtained from exercise training may not be sustained if exercise is stopped; therefore, continued activity is recommended for an indefinite period 1
• Single-set programs are less time-consuming and more cost-efficient, which generally translates into improved program compliance 3
• For individuals with chronic diseases, range of motion for some exercises may need to be limited with lighter weights and more repetitions 3