Right Exercise, Wrong Dose

Lots of people think “I exercise”, yet they get frustrated at their progress. Much of that comes down to binary thinking: I exercise or I don’t. Whereas a much more useful way to think about it is “am I exercising enough?”

In a previous article I wrote, about exercise as medicine. Here are the Cliff’s notes:

• For a medication to work, it needs two things: be the right medication, and have the right dosage.
• The same is true for exercise. It needs to be the right type of exercise (strength training, cardio or stretching), and the right dosage.

 

When it comes to strength training, dosage consists of:

• The amount of weight you’re lifting or the amount of resistance that you’re using.
• The number of reps
• The number of weekly sets

 

In this article, we’ll cover the number of sets necessary to make progress for different goals. Keep in mind, for all of these conditions, the scientific research is not exactly there yet in terms of determining exact cutoffs for how many sets are effective, and how many aren’t. But it’s getting there. So think of these recommendations as guidelines and not strict cutoffs.

If you want help with your own fitness goals, and you just want a professional to design the right exercise program for you, just respond to this email with your fitness/health goal. Doing so doesn’t obligate you to anything. It just sets up a quick, 10-15-minute chat where we try to understand your current situation. There’s no pressure, sales pitch or obligation.

 

For Muscle Gain

When it comes to muscle gain (which I differentiate from strength gain. I’ll talk about strength separately in the next section), the “dosage” of strength training depends on a few different factors:

• Chronological age: contrary to popular belief, older people actually need more sets per muscle group – not less. Why? Because their body is more resistant to muscle-growing stimuli (like strength training, protein and testosterone). So they need a greater stimulus to elicit the same result. I cover this extensively in my article on strength training over 60.
• Training age: regardless of your chronological age, the longer you’ve been training, the more sets you need to do per muscle group.
• Proximity to muscular failure: some people have the ability to really suffer. Others don’t. The closer someone is able to come to muscular failure, the fewer sets they need.

 

Here are a few general guidelines:

• Adults under 60 who are beginners need 6-10 sets per muscle, per week to grow.
• Adults under 60 who are past the beginner stage need 8-12 sets per muscle, per week to grow.
• Adults over 60 who are beginners need 8-12 sets per muscle, per week to grow.
• Adults over 60 who are past the beginner stage need 10-14 sets per muscle, per week to grow.

 

However, I differentiate between progress and maintenance. In order to progress, you need these numbers of sets. Maintenance requires a lot less. About 50% fewer sets than it takes to make progress. That’s encouraging, because if you’re on vacation, or at a time when you can’t put in as much work, instead of doing, say, 3 days per week for 4 sets, you can either do:

• One day per week for 6 sets
• Two days per week for 3 sets
• Three days per week for 2 sets

 

And if you’re below even those thresholds for a long enough time (generally over 7-10 days), you start to regress. Then, it takes extra time just to regain lost progress. But if you can do even the bare minimum to maintain, at least when you return to the necessary number of weekly sets to progress, you’ll pick up where you left off. When you do the bare minimum to maintain, you’re pushing “pause” on your progress. When you don’t do the bare minimum to maintain, you’re losing progress. Then, when you return, you’re just catching up to where you were before the break.

 

For Muscle Strength

A lot of people equate muscle size with muscle strength, but they’re not the same thing. That’s why I separate them into two different sections. What’s the difference between the two? Muscle size is the physical volume of the muscle. Muscle strength is how much force a muscle can produce. They’re related, but not the same thing. You can gain strength without size (and in a lot of sports with weight classes, that’s the direct goal), but you can’t gain size without strength.

Case in point, as you’ll see in a future article, postmenopausal women can really only increase their muscle size by 2-7 pounds (which represents only about a 5-10% growth in muscle size), but they can increase their strength by over 100% (they can more than double it).

So here’s the breakdown:

• Untrained individuals (of all ages) need about 4-6 sets per muscle, per week to get stronger (there are greater benefits with more sets, up to about 10 sets/week).
• Intermediates (of all ages) need about 6-9 sets per muscle, per week to get stronger (there are greater benefits with more sets, up to about 12 sets/week).

And as with muscle mass, maintenance is much easier than progress. You can do about 50% fewer sets, and still maintain (but not progress).

 

For Osteoporosis/Osteopenia

When it comes to osteoporosis/osteopenia, we don’t think of it in terms of muscles, but more in terms of skeletal site (lumbar spine, femoral neck and total hip). Why? Because 2 different muscles may work the same skeletal site.

So for osteoporosis/osteopenia improvement, you need a minimum of 12 sets per skeletal site, per week to make progress. There are improvements up to 18 sets per week.

As with the previous 2 goals, maintenance requires a lot less than progress. To maintain your bone density, you just need 6-8 sets per skeletal site, per week. Below that, and you’re regressing (continuing to lose bone).

 

For Type 2 Diabetes

For type 2 diabetes, for the reduction of blood sugar levels, a diabetic needs to do 6-10 sets per muscle group, per week to see progress (although unlike the previous goals, where the weekly frequency didn’t matter, with diabetes, it does matter. A higher frequency is better. So if you’re doing 10 sets, it’s better to do 2 sets 5 times per week than 5 sets twice per week). There are likely greater improvements in blood sugar levels with a higher number of sets, up to about 14-15 sets per muscle group, per week. You want to cover these major muscles:

• Calves
• Quadriceps (front of the thighs)
• Hamstrings (back of the thighs)
• Glutes (butt muscles)
• Abdominal muscles
• Mid-back
• Chest
• Shoulders
• Biceps (front of the arm)
• Triceps (back of the arm)

 

If you think “those are a lot of muscles to cover”, don’t fret. Lots of exercises work 2-3 of these at the same time. For example, deadlifts work the hamstrings, glutes and lower back simultaneously. Pushups work the chest, shoulders and triceps simultaneously.

As with the other goals, maintenance requires only about half the sets it took to progress.

 

Osteoarthritis

As I talk about in my arthritis book, frequency also matters more than the weekly number of sets. So it’s better to do fewer sets more frequently, than more sets, less frequently.

For improvements in osteoarthritis, you need to do at least 2 sets per target muscle group per workout, with a minimum workout frequency of 3 times per week. There are greater improvements with a higher frequency.

Notice how I said, “per target muscle group”? That means that not all muscle groups need the same number of sets. If your osteoarthritis is in your knees, but your other joints are fine, you can do fewer sets for muscles not surrounding the knees. For example, you might do 10 weekly sets of knee extensions (which work the quads – the front of the thighs), but only 5 weekly sets of pushups (which work upper body muscles, unrelated to the knees).

This specific article is about strength training. In the first 3 goals/conditions we talk about in this article (muscle size, muscle strength and osteoporosis), strength training is basically the major intervention for those. For type 2 diabetes, strength training is more or less equally as effective as cardio. But for osteoarthritis, there are 3 other forms of exercise besides strength training that are quite potent for pain reduction (yes, cardio is one of them, but there are 2 others). Since this article is about strength training, I won’t go into the other 3.

The maintenance dose of strength training for osteoarthritis is unknown, since pain reduction seems to happen independently of improvements in strength. Research shows that pain is reduced regardless of whether you’re lifting light weights or heavy weights. Unlike the other health/fitness goals in this article, the amount of weight you’re lifting doesn’t seem to matter. Frequency appears to be the bigger lever to pull.

 

High Blood Pressure

As I talk about in my blood pressure book, for optimal reductions in blood pressure, you need to do about 6-10 sets per exercise per week to see modest reductions, with greater reductions coming from more sets (up to 15 sets per exercise, per week).

The cool thing about strength training (this hurts me to say) is that blood pressure reductions are maintained for a few months even if you stop strength training.

In one study, women (with an average age of 67) with high blood pressure who were previously sedentary did strength training for 14 weeks. Their blood pressure dropped by an average of 18/6 mmHg. Then, after 14 weeks of strength training, they stopped. Fourteen weeks after stopping, their blood pressure was maintained. So when it comes to hypertension, maintenance requires a lot less work than for the other goals/health conditions.

Now don’t get me wrong – even if blood pressure does stay lower for 3ish months afterwards, strength starts to fade within 7-10 days. If you wait long enough, blood pressure starts to rise again. But it’s nice to know that at least in this study, blood pressure stayed reduced for 3 or so months.

As with diabetes and osteoarthritis, there are indeed other effective exercise treatments besides strength training, but since this article is about the strength training dose required to improve these health conditions, I’ll leave it at that.

If all of this sounds too complicated for you, and you just want a professional to design the right exercise program for you, just respond to this email with your fitness/health goal. Doing so doesn’t obligate you to anything. It just sets up a quick, 10-15-minute chat where we try to understand your current situation. There’s no pressure, sales pitch or obligation.