New research finds that decreasing the number of sets can be just as efficacious while improving patient compliance

Over the years, chiropractors have received conflicting information about the number of repetitions and sets of exercises patients should perform. There is still some controversy (even among exercise scientists) regarding this issue. Based on recent research by Carpinelli and Otto,¹ which has attempted to provide answers, some professionals have changed the recommendations. To determine what numbers are best for your patients, several factors must be considered as to the reasons for exercise—fun or relaxation, general fitness, appearance improvement, or athletic competitions.

All Intents and Purposes
The chiropractor’s purpose is usually different: we are trying to help our patients regain an improved level of health. This means that the best form of exercising for body builders, football players, and other athletes is not necessarily best for patients. We need to keep this in mind when recommending rehabilitation exercises, especially when working with patients not used to exercise. For this reason, many doctors find that simpler is better. Since the goal is just to get a patient to do the exercise regularly, instructions should be clear and easy to follow. All patients improve when they know exactly what is expected. But remember, most tend to do only the minimum necessary.

The repetition (reps) number means the number of times a patient performs an exercise consecutively without stopping. This is usually somewhere between five and 20 in most programs. Sets are a series of reps and are defined by the rest period between, which can vary from 30 seconds to several minutes. Set recommendations are from one, three or five (occasionally more). The total reps of an exercise can be determined by multiplying the number of reps times the number of sets performed.

The repetitions and sets can be different, even when the total reps are the same. For instance, total reps of 20 can be performed as two sets of 10 reps, or four sets of five reps, or five sets of four reps.

Strength and conditioning specialists with exercise physiologists and coaches have developed a variety of exercise routines. Some are useful only for certain sports, while others have developed from muscle research. The variations are determined to some extent by the athlete’s goal—maximum strength, power, or endurance.

Naturally, doing fewer repetitions and fewer sets will take less time, but obviously we want our patients to exercise at least enough to improve their condition.

Figure 1. Wall squats with ball.

Since 1962, most exercise recommendations have been based on the Berger method,² which consists of three sets of six repetitions, for 18 total repetitions. Since it was a scientifically based recommendation, as well as simple for patients to follow, the Berger method has been widely used up to the present day. While many still believe it is an effective program, an even easier method has recently gained popularity.

Carpinelli and Otto¹ found a large volume of research that disputes the need for three sets of exercise. In fact, they state that “[o]ne set of repetitions has been shown to be as effective as multiple sets, and more time efficient, for increasing muscular strength and hypertrophy in males and females of different ages, for a variety of muscle groups, and using various types of exercise equipment.”

The article recommends by “employing a single-set protocol, individuals can achieve similar results in less time and with less work and a decreased potential for injury.” This has been strong evidence for many doctors to change their approach to exercise recommendations.

Figure 2. Trunk extension.

Less Time, More Consistency
Having patients perform just one set of eight to 12 repetitions of recommended exercise(s) has proven successful in many instances. Since this is only eight to 12 total repetitions, and includes no rest periods, it can be completed in much less time. Patients are more likely to become consistent with the recommended exercises when the time commitment is less.

In many cases, patients can be instructed to perform at least eight repetitions of the exercise, but they should try for 12. If 12 repetitions can be done fairly easily, have them increase the resistance slightly the next time. When using surgical tubing exercises, increase the starting distance from the door.

Instructions should include performing the exercise every day—at least initially. This gets the patient into the habit of exercising and brings rapid change and improvement. Since the time commitment is minimal, patients are less likely to use the “not enough time” factor as an excuse for noncompliance.

Figure 3. Lunges

Both the traditional, multi-set exercise program and the newer, single-set protocol can help patients regain muscle function and improve spinal support and posture. I find that patients are appreciative when I express an awareness of how busy their schedules are and can minimize the time needed for exercising.

Patients are more likely to do the exercises when they fit into their busy schedule. With only eight to 12 total repetitions, several exercises can be done in just 5 or 10 minutes. This helps ensure acceptance of the entire treatment program, which can lead to rapid progress. CP

Kim D. Christensen, DC, CCSP, DACRB, CSCS, founded the SportsMedicine & Rehab Clinics of Washington. He is currently a postgraduate faculty member of numerous chiropractic colleges, president of the American Chiropractic Association (ACA) Rehab Council, and a lecturer and author. Christensen can be reached at Chiropractic Rehabilitation Consulting, 18604 NW 64th Ave, Ridgefield, WA 98642, or via email: kimdchris tensen@hotmail.com.

References
1. Carpinelli RN, Otto RM. Strength training: single versus multiple sets. Sports Med. 1998;26(2):73–84.
2. Berger RA. Effect of varied weight training programs on strength. Res Q. 1962;33:168–81.