Whether you are training for a marathon or your goal is to get out of a chair easier, it is common to hit a point where progress has slowed down or even halted prior to reaching your goals. The dreaded training plateau can be even more frustrating if you are struggling with pain, dizziness, or any other unwanted physical symptom. In these cases, finding ways to continue to challenge your body and get stronger can be extra tricky. Time to get creative! Understanding the different ways that you can approach strengthening is a key part to overcoming plateaus.
Why Do We Need to Get Stronger in the First Place?
The obvious reason is we need to be strong for life. Muscle mass is a big predictor of longevity, fall risk, and bone integrity. Maintaining good strength and functional movements can keep you independent and doing the things you love.
Something that may be less intuitive is that exercise itself changes the brain. Exercise increases brain-derived neurotrophic factor (BDNF). BDNF increases neuroplasticity through improving growth, health, and connectivity in the brain, especially in brain regions such as the motor cortex, hippocampus, and prefrontal cortex.
Movement is a powerful way to create neuroplasticity - for better or for worse. When you do a successful, pain-free movement, you can help wire that task for safety in your brain. On the contrary, if you try to do a movement, and it causes pain, the brain may link that action to danger. This in turn could lower your threshold for the brain sending you unpleasant sensations (central sensitization) next time you perform the movement. It could also change the way your body moves which could have long term implications with strength and pain. This is why finding ways to move symptom-free and gradually increasing your exposure in a perceived "safe" way is so important when you struggle with chronic symptoms. Enter, the FITT Principle.
What is the FITT Principle?
The FITT principle is a an acronym that can be used as a general set of how-to guidelines for improving your overall fitness level. It can be used to circumvent training plateaus so that you can continue to improve strength, endurance, and overall capacity for movement. The chronic pain paradox: Strengthening is good for pain management and injury prevention, but sometimes strengthening can continue to cause pain and injury. You may start to feel like you cannot tolerate beyond a certain range of motion and load without pain. This is where I often turn people towards exploring the FITT principle to get creative with training and out of old painful movement patterns.
Let's go over the following principles in detail with an example at the end of the article where I put all 4 principles into action. It should be noted that it is generally recommended to increase the difficulty of only one FITT category at a time to avoid overtraining or injury.
Frequency
"F" stands for frequency. This is how often you perform an activity. This can be frequency within the same day or refer to how many days/week you are training.
EXAMPLE 1: A real-life example of this is when I was early postpartum, I was trying to build up my push-up capacity to 100. I definitely couldn't do all 100 at once or even with a short breaks during one training session. So instead, I spread them out throughout the day working in 30-35 during the morning, then repeating this midday, and once more before bed. (Before you are too impressed, read on to see how else I modified for success).
EXAMPLE 2: Another common example of this is increasing the amount of days you perform an exercise per week. ie. going to the gym 3x/wk instead of twice.
EXAMPLE 3: Low back pain with long walks is a common problem I see with my clientele. Shorter durations with increased frequency can help overcome hurdles specially with chronic pain. More on this below. See "walking chart."
Intensity
"I" is for Intensity - how vigorous the effort is when you are performing an activity. We sometimes use an RPE (Rate of Perceived Exertion) Scale or Borg Scale to quantify this. The original Borg scale goes from 6-20 and is intended to correlate with your actual heartrate (6=60bpm=Easy, 13=130=Somewhat Hard. 20=200=Very Very Hard). Most people use a Modified Borg Scale which ranks difficulty easy to hard from 0-10.
Upping the difficulty of an exercise (increasing the speed on the treadmill or weight on your barbell) will increase intensity. Another great way to safely increase intensity is through Blood Flow Restriction Training. This technique uses a blood pressure cuff to slightly restrict the flow of blood to a limb to main the exercise feel much more difficult without actually moving a heavier load (weight). This can be a great option for people with chronic pain or joint instability to improve strength with less risk of injury or pain flare. It does not come without its own risks, however, and is suggested to be done only under direct supervision of trained professionals who understand the parameters, indications, and contraindications.
Another thing I want to point out is that many people try to get past training plateaus by increasing the intensity. This may very well help you, but another way to look at it is you can decrease the intensity to tolerate an activity better. Going back to the concept of neuroplasticity to create a positive imprint of an activity, you may need to decrease the load (weight) so that you can tolerate the activity first.
Time
"T" is for Time. Manipulating time of an activity can increase your overall tolerance of the activity. If you exercise 30 minutes a day 3x/wk and want to improve your overall fitness, you may try exercising 45 minutes a day 3/wk. Lowering the intensity but going for a longer time can help improve endurance and has cardiovascular benefits.
Type
The second "T" is for Type of training. Doing different types of exercises for the same muscle group can help work the muscle at different lengths and positions which can help work around painful movements and improve strength and tolerance.
Example 1: Back to my push-ups postpartum. My goal was to achieve 100 push-ups in a row, but this wasn't achieved until months later. In fact, doing standard push-ups was out of the question initially due to abdominal weakness. So I modified the type of push-up to a wall push-up. Eventually, I progressed to countertop push-ups, and coffee-table height push-ups. This enabled me to eventually (9 months later) do standard floor push-ups without any injuries or pain-flares.
Example 2: If you are trying to improve standard forward lunges, you may find increased success by doing a variety of similar, but difference exercises including dynamic lunges, Bulgarian split squats, squats, and reverse and side lunges in addition to regular lunges.
Putting It All Together. Walking Grid Challenge:
When someone wants to improve the distance they can walk/hike/run, I've found using a walk/run calendar that manipulates different parts of the FITT principle on different days to be incredibly successful for achieving greater tolerance and decreasing pain and injury. It also keeps the activity fun and engaging. Here is a real-life example of a walking plan to get someone from walking 1-2 miles comfortably to 5 miles:
One way we manipulated Frequency was by walking a shorter distance multiple times throughout the day. Intensity was manipulated by interval training between slow and fast speeds. Type was manipulated by adding in exercises to cross train. Once a week, the client was told to try to keep walking for a total Time instead of focusing on pace or total distance.
Please keep in mind that the information presented are for education only. Do you have more questions about improving or tolerating exercise when dealing with chronic symptoms? I work one-on-one with clients creating specific plans for their individual needs. Book a free consultation here to see how I can help you.
Sources:
Dydyk AM, Givler A. Central Pain Syndrome. [Updated 2023 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553027/
Karanasios S, Lignos I, Kouvaras K, Moutzouri M, Gioftsos G. Low-Intensity Blood Flow Restriction Exercises Modulate Pain Sensitivity in Healthy Adults: A Systematic Review. Healthcare (Basel). 2023 Mar 2;11(5):726. doi: 10.3390/healthcare11050726. PMID: 36900731; PMCID: PMC10000465.
Robert W Morton, Lauren Colenso-Semple, Stuart M Phillips. Training for strength and hypertrophy: an evidence-based approach. Current Opinion in Physiology, Volume 10,2019, https://doi.org/10.1016/j.cophys.2019.04.006.
Srikanthan P, Karlamangla AS. Muscle mass index as a predictor of longevity in older adults. Am J Med. 2014 Jun;127(6):547-53. doi: 10.1016/j.amjmed.2014.02.007. Epub 2014 Feb 18. PMID: 24561114; PMCID: PMC4035379.
Zou Jianpeng , Hao Shijie. Exercise-induced neuroplasticity: a new perspective on rehabilitation for chronic low back pain. Frontiers in Molecular Neuroscience. https://www.frontiersin.org/journals/molecular-neuroscience/articles/10.3389/fnmol.2024.1407445
Dr. Stephanie House has over 15 years of experience in the health and wellness field and currently owns her own practice as a mind-body physical therapist in Charlottesville, VA.
She holds post doctoral certifications in vestibular therapy, dry needling, yoga therapy, and pregnancy and postpartum. With extensive continued study on topics such as mind-body medicine, integrative health, breathwork, and somatic therapy, Dr. House's extensive knowledge and comprehensive approach gets to the root of movement dysfunction and pain.
If you are ready to change the way you move and feel, work directly with Dr. House or join the House of Balance Newsletter.
"I don't heal or fix people. What I do is get your body and mind to an optimal place so you can start to heal yourself. We all have a greater capacity to heal than we are led to believe. With the appropriate input and support, our bodies can do amazing things." Stephanie House, PT, Founder
For specific questions or inquiries, reach out to Dr. House directly: info@houseofbalancept.com or visit her website: www.houseofbalancept.com
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