Pump Up The Volume!

It still frustrates me how little most physios know about exercise, with many not knowing how to progress or regress it, or what parameters are more important to adjust and monitor. That's if they bother to adjust and monitor anything at all.

In this blog, I want to discuss the two most important parameters of exercise; INTENSITY and VOLUME. I want to highlight why these are so important for physios to consider and monitor during their patient's rehab.

The volume of an exercise gives you a way to quantify the amount of work done. In its simplest form volume can be worked out for resistance exercise as the load x sets x reps or time x distance for cardio exercise.

The intensity of an exercise is an individual's internal subjective rating of how hard or effortful an exercise feels. This is usually done using rate of perceived exertion (RPE) scales such as the Borg Scale ranging from 6-20 to coincide with heart rate, or the more common modified Borg scale ranging from 1-10 with 10 being maximal effort.

An Example

So let's say you're doing a 10kg dumbbell shoulder press, for 3 sets, and you do 10 reps per set. This gives you a volume for this exercise of 300 (10kg x 3 sets x 10 reps). Now let's say we found that hard an gave it a score of 8/10. This gives us a total volume for this exercise of 2400.

We can also add the volume of each exercise to others in a session to give us the total session volume. So let's say we also did some lateral shoulder raises with 5kg dumbbells, for 3 sets, and did 8 reps each time and it was also hard at 8/10 RPE. This gives this exercise a volume of 960 (5kg x 3 set x 8 reps x 8 RPE). And a session volume of 3360

Unaware

However, not many physios measure or record the volume or intensity of rehab for patients, and as a consequence, many are unaware if they are progressing or regressing.

Usually, the most common way physios and patients gauge if they are progressing or not with rehab is if they feel less pain when doing an exercise or task. Now, of course, these are useful things to monitor and check, but in my experience, they are not always the most accurate or fastest occurring.

As for many things that hurt or have been injured, it takes time for pain and functional improvements to become apparent and noticeable. This can mean patients often become demoralised and disheartened, thinking their rehab isn't helping or working when in fact it is.

If more were to record and monitor the volume of their rehab they would see the progress in their numbers a lot sooner than they feel improvements in their pain or function.

This can potentially help motivate more patients and help with rehab adherence. Personally I think the volume of work done during rehab can be a far more sensitive measure in the early stages of rehab, not to mention helping patients to focus less on pain.

Volume > Load

Many think that increasing the load of an exercise is a good sign and measure of its progress or success, and it can be. However, many tend to focus on the load of an exercise too much and try to progress it too fast and too soon at the expense of volume.

Let me explain using a very simple example.

Let's say we have done that 10kg shoulder press as mentioned above doing 3 sets of 10 reps at an RPE of 8 giving me a volume of 2400. But in the next session, we want to progress so we go and grab the 12kg dumbbells.

However, as the load is heavier we find that we can only do 8 reps per set compared to the 10 reps before at the same level of RPE at 8. This gives our 2nd session a volume of 2304 (12kg x 3 sets x 8 reps x 8 RPE) which is actually lower than the previous session's volume!

Ok, so it's only a small difference of just 4%, which isn't much in the grand scheme of things in this example. However, we would probably have been better to stick with our original 10kg weights and just added a few more reps or even an extra set. Both of these options would have increased the volume of the exercise, whereas increasing the load reduced it slightly.

This is a situation I commonly see in rehab and training, increasing the load too quickly and sacrificing the volume. This mistake is also made when we underestimate the effects of fatigue and try to do too many reps in one set.

Volume > Fatigue

Let me demonstrate this by using the same 10kg shoulder press as an example again. Let's say we are fired up and feeling good at the start so we do 15 reps in the first set. Great, that's progress, right?

Well, hold on, because when we come to do our 2nd set we are fatigued and so can now only do 6 reps, and only 3 reps on the 3rd set. This gives the total number of reps for this 10kg shoulder press now at 24 compared to 30 we did last time. This is a 20% drop in volume and a big deal. Had we just paced things a little better we could have got more work done.

Again most physios and most patients will not recognise this reduction of volume and think that because they have done more reps on one set, or are using heavier loads they are progressing when in fact they could be regressing.

The lesson here is don't let your ego to progress the load or number of reps in one set come at the expense of the total volume of work done. Often pacing and spreading the effort more evenly over a session is beneficial.

Summary

I hope I have demonstrated how recording or monitoring the volume and RPE of exercise can be very helpful. This helps avoid sacrificing volume by increasing the load or number of reps in the first set too soon. Don't let your ego or eagerness harm your exercise progression.

I urge more physios and patients to record their exercise volume and RPE during their rehab more as it can show progress before changes in pain, strength, or function are noticed. You can download and use my very simple old skool paper exercise log that I use to do this for many of my patients here.

As always thanks for reading, and remember to pump up that volume...

Adam