Orthopaedic Exercise: What Type of Workout Program is Best for Me?

Crossfit – Zumba – Tai Bo – Insanity – PX90 – walking – running – swimming – biking – powerlifting – Olympic lifting – yoga – golf – tennis – basketball… So many options! How can you decide what is the optimal workout program for you?

From an orthopaedic perspective, the primary endpoint when treating patients is always optimizing function. This is a good criteria for evaluating a workout program. What type of exercise will allow me to optimize my function, perform my activities of daily living most efficiently, and maximize my daily quality of life? While improving your appearance is a motivating factor for most, functional improvement should always be the bottom line. Functional expectations are obviously highly variable. The 17-year-old football player, the 45-year-old business person, and the 73-year-old grandmother will have divergent goals and physical limitations. The exercise program they choose needs to respect these differences. There is no cookie-cutter approach which works for everyone, but there are common themes that each should employ in their plan.

Musculoskeletal function is determined by joint flexibility, muscular strength, muscular endurance, and neurological function. An optimal workout program should balance each of these facets of function. Flexibility is key for muscular function. By pre-stretching before loading a muscle, the load to failure is increased by 50%.   This means a muscle can absorb 50% more load prior to failure. Consequently, stretching joints before exercise significantly decreases the risk of muscle strain/injury. Stretching also maximizes the functional range over which your joints operate effectively, allowing you to perform tasks which a stiff joint precludes. Muscular strength is maximized by progressive loading over time, leading to adaptive gains in motor strength and increased ability to perform functional tasks. Weight training is the key here. Strength training ( weights, machines, or free body) improves athletic performance in athletes, decreases age- related atrophy and the associated dysfunction in adults, and combats osteoporosis in the elderly. It should be a part of every fitness program. Muscular endurance is enhanced with aerobic exercise which maintains your target heart rate (age dependent) for 20 minutes a minimum of 3 times/week. The minimum goal is improvement in cardiovascular function, which not only improves functional ability (quality of life), but also burns excess calories and likely increases longevity. Neurologic function is impacted by nutrition and environmental factors (vitamin B intake – good, smoking – bad), and may be optimized with proprioception (balance) drills and sports which require coordination of multiple muscle groups to achieve the given goal (tennis/basketball/etc).

The mitigating factor in choosing which specific type of exercise best suits your needs is your underlying medical status. Age, history of trauma, underlying medical disease, and genetic factors (height, weight, joint alignment) influence your exercise prescription. If you are under age 30, ideal body weight, and have no joints affected by cartilage wear (arthritis), then almost anything is appropriate – you are blessed! On the other hand, if you are like most of us, then your workout program will be modified by your physical weak points. If you have arthritic knees or hips, then the aerobic aspect of your workout should be low impact – swimming/elliptical machine/cycling – to protect your affected joints. The strength portion should avoid abusing these weak points by inappropriate loading (box jumps, full squats, lunges, etc) in favor of controlled loading over a safe range of motion (quarter/half squats, no loading in hyperflexion, etc). If you have an arthritic AC joint (shoulder) or cervical disc disease (neck), your strength training should be controlled and slow, avoiding end range loading of the affected joint. Explosive lifts – power cleans, snatches, etc – are a bad idea here. The bottom line is that there is a level of physiologic stress (exercise) which is good for each of us, no matter what our physical limitations may be. Running a marathon may overload your physiologic capacity to the point where you are hospitalized for dehydration (bad!), but chronic bedrest will lead to weight gain, osteoporosis, joint stiffness, and muscular atrophy (also bad!). The ideal level is different for each individual, and your workout should be tailored to your specific needs. Arthritic knees or obesity may not allow you to run a marathon, but they won’t prevent you from walking in a pool or doing water aerobics.

So for your ideal exercise program, remember the key ingredients – stretch/strength/endurance/balance – modified by your individual limitations, and never give up. One more thing – HAVE FUN! You’ve got to find something you enjoy or you won’t do it for very long.   God bless.

“Do you not know that in a race all the runners run, but only one receives the prize? So run that you may obtain it.” 1 Corinthians 9:24-25