Introduction

The main difference between Power Training vs Strength Training is, that

strength refers to the ability to overcome resistance, while power refers to the
ability to overcome resistance in the shortest period of time.

What is Strength?

 The definition of strength is the ability to exert force (measured in

Newtons) in order to overcome the resistance.
 The formula for force says force is equal to mass (m) multiplied
by acceleration (a). Force is measured in Newtons (N), mass in kilograms
(kg), and acceleration in meters per second squared ( m/s2 )

What is Power?

 The definition of power (measured in Watts) is the ability to exert force

in the shortest period of time.
 The physical formula of power is Power = Force multiplied by velocity
or Power = Work / time [1]

Strength Training

What is Strength Training?

 Strength training trains the ability to overcome resistance where you

focus on moving as much weight as possible for the given number of
repetition.,
 The focus is on moving the weight from point A to point B. [1]
 Strength training isn’t just for those in search of bulked-up muscles. It
also boosts the strength needed for daily tasks. Just about any activity
becomes easier with stronger muscles. So does any sport you enjoy. [2]

Power Training
Power Training focusses on overcoming resistance but also focusses on the
ability to overcome the resistance in the shortest period of time. Simply put,
 Power = Force x Velocity, which means power can be improved by increasing
force or velocity, or using a mixed-methods approach. To maximize power
development, a combination of unloaded (e.g., 0% 1 RM) and loaded (e.g., up
to 90% 1 RM) exercises can be used, and enhance program variety. This
enables clients to operate throughout the entire power continuum (0 to 90%
1RM) to maximize power output. However, when trying to increase power,
encourage clients to move as fast as possible, but always with control. [3]

 Typically the resistance is lower and the movement velocity is higher in

power training (Progressive resistance exercises are a form of power training).
[1]

 Examples of strength exercises you can adapt into power exercises (by
making the concentric contraction — the part where you raise the weight
against gravity — fast and powerful, but preserve the slow, steady pace on the
eccentric contraction eg when lowering the weight back to the starting
position)include: squats, lunges, overhead presses, biceps curls, dips,
overhead triceps extension, push-ups, bench presses — and many more.
 Optimal power reflects how quickly you can exert force to produce the
desired movement. Eg. Faced with a four-lane intersection, you may have
enough strength to walk across the street. But it’s power, not just strength,
that can get you across all four lanes of traffic before the light changes.
Likewise, power can prevent falls by helping you react swiftly if you start to
trip or lose your balance. [2]

What adaptations occur in Power Training vs Strength Training?

Power is the ability to overcome resistance in the shortest period of time

leading to the ability to produce higher velocities against a given load.

The neurological adaptations are higher firing frequency and a stronger

activation of the high threshold motor units.

Power Training can potentially lead to a shift in the muscle fiber type

spectrum towards a higher percentage of fast twitch fibers.

Strength training is the ability to exert force in order to overcome resistance,

therefore your strength training efforts lead to a higher recruitment of muscle
fibers and a stronger synchronization of muscle fibers.[1]
Clinical Application

As we age, muscle power ebbs even more swiftly than strength does. Exercises
that can produce gains in power become especially important later in life.
Physiotherapists are now combining the swift or high-velocity moves of power
training with more deliberate and slow strength-training exercises to reap the
benefits of both activities [2]

Studies show improved physical performance in Older Adults  undertaking

progressive resistance training (power training) that incorporates rapid rate-
of-force development movements. In healthy older adults it results in
significant gains in muscle  strength, muscle power, and physical performance.
Such improvements could prolong functional independence and improve
the quality of life [4].

Power training is recommended over conventional strength/resistance

training with considerations to gait biomechanics. Progression models in
resistance training for healthy adults in order to stimulate further adaptation
toward specific training goals.The Amercian college of sports concluding that:
"Progression in power training entails two general loading strategies: 1)
strength training and 2) use of light loads (0-60% of 1 RM for lower body
exercises; 30-60% of 1 RM for upper body exercises) performed at a fast
contraction velocity with 3-5 min of rest between sets for multiple sets per
exercise (three to five sets). It is also recommended that emphasis be placed
on multiple-joint exercises especially those involving the total body. For local
muscular endurance training, it is recommended that light to moderate loads
(40-60% of 1 RM) be performed for high repetitions (>15) using short rest
periods (<90 s). In the interpretation of this position stand as with prior ones,
recommendations should be applied in context and should be contingent upon
an individual's target goals, physical capacity, and training status". [5]

A 2017 study into the effects of low load high velocity exercises (power
training) on diabetic type 2  people found that only 6 weeks of low-load high-
velocity resistance exercises improved muscle strength, power output, and
functional capacity in. In addition, physical activity intervention composed by
low-intensity walking, dancing classes and stretching exercises did not induce
any changes in the strength, power, and functional capacity. [6]

Research in 2016 into power training helps in muscle strength

in stroke patients. Stroke causes loss of power which has negative
implications for functional capacity and work ability.  For the paretic leg,
 power training showed higher values of muscle activity and altered
neuromuscular activity resulting in functional gains. [7]

Sports Training

It is clear from the research that high-velocity, low-load training (ie Power
Training) is related to an ability to produce force quickly and has implications
for activities of daily living as well as athletic endeavors.

 High velocity exercise results in specific high velocity adaptations and

should be employed when attempting to increase high speed movements.
 Sports that require athletes to sprint faster or jump higher may benefit
from assisted training that mimics sport specific movement speeds.
 Since maximizing speed is one of the most desired goals for fitness and
performance, implementing innovative over-speed methods within a training
program can aid in maximizing performance.
 In addition, short duration training is effective for the acute adaptation
of neural factors, which results in an acute increase in performance in the
absence of muscular hypertrophy. [8]
Practical Assessment and Treatment of
Cervicogenic Headaches
An online course by Ari Kaplan

Learn more on this topic

Related articles
Strength Training in Neurological Rehabilitation - Physiopedia Strength
Training in Evidence Paresis (muscle weakness) is a is a key physical impairment in
neurological conditions limiting mobility.[1] Resistance training has been found to
improve muscle strength[2] and functional performance when added to functional
exercises.[3] A systematic review by Kjølhede in 2012 reported strong evidence
regarding progressive resistance training on muscle strength for people with Multiple
Sclerosis (MS).[4] A more recent study by Patrocinio de Oliveira and colleagues found
that patients with MS had improved knee extensor 1 repetition maximum, Timed 8-Foot
Up and Go, Chair Stand Test following progressive resistance training and eccentric
strength-enhanced training.[5] However, the authors note that eccentric strength-
enhanced training appeared to improve the transfer of strength adaptations to
functional tests.[5] Progressive resistance exercises are also strongly recommended by
the Australian Stroke Foundation guidelines (2017) and the AHA guidelines (2010), but
the optimal strengthening approach is still unknown.[1] Different systematic reviews[4]
[6][7][8][9] demonstrated improvement in strength following resistance training, but
showed limited impact on walking parameters.[10] A recent randomised controlled trial
by Kanegusuku and colleagues found that progressive resistance training can
specifically improve cardiovascular autonomic dysfunction in patients with Parkinson's.
[11] Williams et al[10] investigated task specificity of strength training for walking in
neurological conditionsfandound quadriceps and hamstrings exercises to be the most
commonly used exercises in neurological rehabilitation. Biomechanics of Gait A good
understanding of gait parameters is needed to prescribe proper exercises for walking.
Muscle recruitment and speed influence walking mechanics across hip, knee and ankle
joints.[12] In older adults, it has been found that a lower walking speeds reduce gait
quality.[13] A minimal level of strength is required in all muscles to generate power for
walking, however, not all muscles are recruited equally. Three key events are important
for power generation during the walking cycle: Hip extensor power generation at Initial
Contact Ankle plantar flexion power generation at push-off (terminal stance) Hip flexor
power generation at toe-off to accelerate the leg through the swing phase At the knee
joint, muscles generate force for power absorption: Knee extensors at terminal stance
Knee flexors at terminal swing to decelerated the leg. At the stance phase, the main
power is generated at the ankle, when the plantar flexor generates power at terminal
stance for push off. A study analysed the power generated at the ankle joint and found
that Achilles tendon produced the highest peak of force.[14] Stance phase makes up
about 0.6 seconds of the gait cycle. Push off represents about 0.15 seconds- this is when
the achilles tendon is producing most of the power. Strength training can increase the
muscle-tendon strength but not the power needed for the push off. Is It Just About
Strength? Strength training trains the ability to overcome resistance where you focus on
moving as much weight as possible for the given number of repetition.[15] Progressive
Resistance Exercises (PRE) is a form of power training. Power Training focusses on
overcoming resistance but also focusses on the ability to overcome the resistance in the
shortest period of time[15]. PRE are considered the best method for improving force
production and muscle hypertrophy. Changing resistance constantly is the key to
improve strength[1]. Heavy resistance training improves strength whereas ballistic
(lighter loads and high repetitions) training improves power generation[1]. Speed is
another factor that influences gait mechanics as muscle power generation during
walking occurs at high angular velocities. Applying the principals of ballistic training at
a targeted speed at the ankle joint can be the key to improve walking [1]. A 2017
study[16] evaluated the effect of functional high-velocity resistance training (power-
training) to improve muscle strength and walking capacity of children with Cerebral
Palsy. Significant improvement was reported in the muscle power sprint test, 1-minute
walk test (1MWT), 10-m shuttle run test (SRT), gross motor function, isometric strength
of lower-limb muscles and dynamic ankle plantar flexor strength reflecting
improvement on walking capacity. Seated leg press was performed with and without a
jump in a single testing session by Williams[17]. A 70% increase in concentric velocity
was reported in the ballistic exercise condition. [18] In Williams et al systematic
review[10], most studies did not include exercises relating to all three main power
events important for walking. Instead, strength testing and strengthening exercises
were prioritised for the knee extensors and flexors, despite their minor role in normal
gait cycle. Clinical Applications Considerations for exercise prescriptions: Power
training is recommended over conventional strength/resistance training with
considerations to gait biomechanics. Exercises should be performed with speed Exercise
has to be specific to the muscles that generate the power (ankle plantar flexor). If the
patient is unable to isolate the right muscle, apply some modifications to allow for
proper performance. Task specificity principals based on ACSM guidelines[19]: Role of
the muscle Action of the muscle Type of contraction Active range and segmental
alignment Load Speed of movement Progression Principals: Progressive muscle
overload Greater intensity Periodisation Increasing total repetition & training volume
Increasing the speed of movement Reduce rest Hypertrophy Muscle Endurance Sports
application In neurological conditions, proximal compensations greater forces were
observed in the hip flexors and extensors.[20] Power training can reverse these
proximal compensations.[21] Despite being highly important for standing up from a
chair and stairs,[22] quadriceps strengthening is not the key for better walking.
Example exercises To improve walking and gait focus on ballistic or fast exercises, and
particularly target the calf because it is so important for walking. For example, if you
have no resources or are in a home environment, it would be better to do a quick 'calf
drop' exercise rather than a controlled calf raise – i.e. raise up onto the toes and then
quickly drop down and push up again. Or with access to a mini-trampet the exercise
could involve bouncing between alternate heel raises demonstrated in the video below.
Additional ideas for appropriate exercises. Strength Training -
Physiopedia Introduction Strength training (also known as resistance exercise)
increases muscle strength by making muscles work against a weight or force. Resistance
exercise is an anaerobic exercise.[1] Different forms of strength training include using
free weights, weight machines, resistance bands and your own body weight. A beginner
needs to train two or three times per week to gain the maximum benefit. Client should
complete a pre-participation health screening and consult with professionals eg doctor,
exercise physiologist, physiotherapist or registered exercise professional, before
starting a new fitness program. Participant should rest each muscle group for at least 48
hours to maximise gains in strength and size. Vary workouts to help client push past a
training plateau[2] Examples Of Strength Training Different types of strength training
include: Free weights – classic strength training tools such as dumbbells, barbells and
kettlebells. Medicine balls or sand bags – weighted balls or bags. Weight machines –
devices that have adjustable seats with handles attached either to weights or hydraulics.
Resistance bands – these provide resistance when stretched. They are portable and can
be adapted to most workouts. The bands provide continuous resistance throughout a
movement. Suspension equipment – a training tool that uses gravity and the user's
body weight to complete various exercises. Body weight – can be used for squats, push-
ups and chin-ups (convenient, especially when travelling or at work)[2]. Repetition
Maximum for Weight Training A repetition maximum (RM) is the most weight a person
can lift for a defined number of exercise movements. Eg a 10RM would be the heaviest
weight a person could lift for 10 consecutive exercise repetitions. RM is a good measure
of a persons current strength level. One Repetition Maximum (1RM) is defined as the
maximal weight an individual can lift for only one repetition with correct technique.
The 1RM test is most commonly used by strength and conditioning coaches to assess
strength capacities, strength imbalances, and to evaluate the effectiveness of training
programmes[1] By establishing 1RM and tracking it, you are able to observe a persons
progress. It is a precise measure, so it can help judge how effective the program is.[3] It
can be either calculated directly using maximal testing or indirectly using submaximal
estimation methods. There are many different formulas to estimate your 1RM, all with
slightly different calculations. The most popular (and proven accurate1) one is the
Brzycki formula from Matt Brzycki: weight / ( 1.0278 – 0.0278 × reps ) If you just
managed to lift 100 kg for five reps, you’d calculate your 1RM like this[4]: 100 /
( 1.0278 - 0.0278 × 5 ) = 112.5 kg How to Safely Test 1RM While 1RM is a very useful
tool, it does have limitations. Measuring your 1RM is not simply a matter of grabbing
the biggest weight and getting a person to perform a rep. By definition, you will be
stressing this muscle to its maximum and placing person at risk of an injury if you don't
do it correctly. You need to prepare to do it properly.eg Choose which move you are
going to test (squat, bench press, etc.). Person warms up with light cardio activity and
dynamic stretching for at least 15 to 30 minutes. Person performs 6 to 10 reps of chosen
move using a weight that's about half of what you think their max will be. Then allow a
rest for at least one to two minutes. Increase the weight up to 80% of what you think
max might be. person performs three reps, then rests for at least one minute. Add
weight in approximately 10% increments and person attempts a single rep each time,
resting for at least one to two minutes in between each attempt. The maximum weight
successfully lifted, with good form and technique, is 1RM[3]. Designing a Strength
Program It is important to pay attention to safety and form in order to reduce the risk
of injury. A typical beginner’s strength training program involves: Warming up before
resistance training eg  walking, cycling or rowing for 5 minutes begin with 8 to 10
exercises that work the major muscle groups of the body and are performed two to three
times per week. Beginning with one set of each exercise, comprising as few as eight
repetitions (reps), no more than twice per week. Gradually increase to two to three sets
for each exercise – comprising eight to 12 reps, every second or third day. Once person
can comfortably complete 12 reps of an exercise, progress further. The principles of
strength training involve manipulation of the number of repetitions (reps), sets, tempo,
exercises and force to overload a group of muscles and produce the desired change in
strength, endurance, size or shape. Specific combinations of reps, sets, exercises,
resistance and force will determine the type of muscle development achieved. General
guidelines, using the RM range, include: Muscle power: 1 – 6 RM per set, performed
explosively. Muscle strength/power: 3 – 12 RM per set, fast or controlled. Muscle
strength/size: 6 – 20 RM per set, controlled. Muscle endurance: 15 – 20 or more RM
per set, controlled[2]. Effects of Strength Training Strength training stimulates a variety
of positive neuromuscular adaptations that enhance both physical and mental health.
Physical and mental health benefits that can be achieved through resistance training
include: Improved muscle strength and tone. Maintaining flexibility, mobility and
balance, which can help maintain independence in ageing. Weight management and
increased muscle-to-fat ratio – might be even more beneficial than aerobic exercise for
fat loss.[1] May help reduce or prevent cognitive decline in older people. Greater
stamina – as you grow stronger, you won’t get tired as easily. Prevention or control of
chronic diseases such as diabetes, coronary artery disease, arthritis, back
pain, depression and obesity. Pain management. Improved posture. Decreased risk of
injury. Increased bone density and strength and reduced risk of osteoporosis. Improved
sense of wellbeing – resistance training may boost self-confidence, improve body image
and mood. Improved sleep and avoidance of insomnia[2]. Increased blood glucose
utilization Reduced resting blood pressure Improved blood lipid profiles Increased
gastrointestinal transit speed [5] Strength Exercises and Chronic Diseases People with
Chronic disease can all benefit from exercise eg diabetes, asthma, metabolic syndrome,
cardiovascular disease, low back pain, arthritis , joint pain, depression, (COPD).
Strength training can improve muscle strength and endurance, make it easier to do
daily activities, slow disease-related declines in muscle strength, and provide stability to
joints. Obesity Sedentary living leads to muscle loss, metabolic slowdown, and fat gain.
Presently, almost 70% of American adults are overfat and at increased risk for chronic
diseases and other health problems. Regular endurance exercise is performed by less
than 5% of the adult population (USA). Strength training provides a practical way for
combating obesity and for eliciting physiological and psychological improvements that
positively impact quality of life. Basic and brief strength training sessions have proved
to be effective for rebuilding muscle, recharging metabolism, reducing fat, and
enhancing a variety of health and fitness factors[6] Cardiovascular Disease (CVD) The
magnitude of resistance exercise-induced reductions in SBP (5–6 mmHg) and DBP (3–
4 mmHg) are associated with an 18% reduction of major cardiovascular events (Blood
Pressure Lowering Treatment Trialists Collaboration, 2014) Mcleod et al, 2019
recommended low-to moderate intensity resistance exercise training(RET) (30–69% of
1RM) is safe and effective even in individuals with CVD or at risk for developing CVD.
[7] A comprehensive resistance-training program of 8 to 10 exercises for 20 to 30
minutes with an intensity of ≈50±10% of 1 RM with a minimum of 2 days per week and,
if time permits, progress to 3 days per week is recommended. Exercise need to be done
at a comfortably hard level (13 to 15 on the RPE [rating of perceived exertion]) and
without valsalva maneuver. Progession of exercise can be done by increasing 5 % of
weight if the participant can comfortably lift the weight for up to 12 to 15 repetitions. If
the participant cannot complete the minimum number of repetitions (8 or 10) using
good technique, the weight should be reduced.[8] (According to the AHA) Type 2
Diabetes American Diabetes Association, 2014 has reported lifestyle modifications (i.e
diet and exercise) were associated with a greater reduction on glycemic control than
medication with more emphasis on aerobic exercise training. However there are other
studies showing benefits of resistance exercise on glycemic control. There is a
contradictory result showing the level of intensity of resistance exercises in glycemic
control. But the study done by Mcleod et al. 2019, recommends the inclusion of general
whole-body resistance exercises twice in week in routine without worrying about
exercise intensity.[7] Cancer There is a role for resistance exercise in reducing cancer
risk, cancer recurrence, cancer mortality, and improving prognosis during adjuvant
therapies. In breast[9] and prostate cancer, resistance exercise has been apparent.
Further work needs to be done to address the optimal dose, intensity, and mechanisms
specific to resistance exercise-induced benefits to cancer.[7] Strength and the Older
Population With an increase in age, there comes various co-morbidities and frailty.
Frailty, sarcopenia and osteoporosis are most common conditions which cause a decline
in physical mobility and increased risk of falls.[1] Resistance exercises can play a vital
role in the improvement of functional mobility. Resistance exercise is a potent stimulus
for muscle hypertrophy and increasing bone density which is affected by sarcopenia and
osteoporosis. Resistance exercise incorporated with combined exercise training
( balance exercise, aerobic exercises) has shown to be the best strategy for improvement
in functional mobility in older adults. [10] Recent evidence shows that the
recommended amounts of protein may be too low for elderly people and improved
protein intake combined with strength exercises are hugely beneficial.[11]. See Muscle
Function and Protein See: Age and Exercise; Physical Activity in Ageing and Falls;
Muscle Function: Effects of Aging Resources (2014) ACSM's guideline for exercise
testing and prescription. Resistance Exercise in Individuals With and Without
Cardiovascular Disease-American Heart Association Effects of weight-lifting or
resistance exercise on breast cancer-related lymphedema: A systematic review Related
Pages Comparison between the DeLorme and Oxford Principles of Strength Training
Strength Training versus Power Training Strength and Conditioning Strength training
in prepubescents Neuromuscular Adaptations to Exercise -
Physiopedia Introduction Regular exercise is an effective way to maintain health. It
also results in various physiological adaptations in the neuromuscular, cardiovascular
and respiratory systems of the human body. These adaptations can improve physical
performance.[1] Adaptation to Exercise: The Overload Principle The overload principle
is responsible for the improvement in exercise as well as the adaptation to exercise. The
muscular system can be mechanically or metabolically overloaded. These mechanisms
result in specific and different adaptations that enhances performance.[1] The
magnitude of these adaptations are dependent on:[1] The type of exercise The intensity
of exercise The frequency of exercise The duration of exercise There is also emerging
evidence for other factors also playing a role such as:[2] The initial level of fitness
Genetic influences which determine the body's responsiveness (responders and non-
responders) to given training interventions The mode of exercise (e.g. strength training
or endurance training) influences the type and magnitude of adaptation in the
neuromuscular system. For example if endurance training (high repetition, low load
contractions) is undertaken the muscular system will undergo specific changes that
targets aerobic metabolism and improved fatigue resistance. Strength training (low
repetitions with high load contractions), in contrast, will cause muscle adaptations such
as increased myofibrillar protein synthesis. As a result muscle size, strength and power
may increase and improve.[1] Another principle to consider is specificity. The type of
exercise performed is important to consider within the context of training. The
principle of specificity states that only the system or body part repeatedly stressed will
adapt to chronic overload. Thus, "specific exercise elicits specific adaptations creating
specific training effects."[3] [4] Adaptations to High-Resistance Strength Training
Progressive resistance training refers to any type of training that aims to increase
muscle strength, power and size through muscular contraction. This mode of exercise
relies on the overload principle where strength is improved and muscle growth
stimulated by exercising/working a muscle close to its maximal force generating
capacity. A typical programme might involve 6-8 repetitions of lifting and lowering a
weight, with these sets being repeated 3-4 times and using loads that which are equal to
approximately 70-80% of maximum weight that can be lifted once (1-RM).[1] [5] Neural
Adaptations Increased central drive (from the higher centers of the brain) after
resistance training is partly responsible for the increase in strength[6] Increased Motor
Unit (MU) synchronization (several MU's firing at similar times)[7] Decrease in the
force threshold at which Motor Units are recruited[8] Increased Motor Unit firing
rate[9] Decrease in the level of co-activation of antagonist muscles after training[10]
[11] Muscular Adaptations Skeletal muscle will adapt to mechanical overload by
increasing in muscle size. With resistance training various signaling mechanisms are
activated and these initiate the creation of new proteins and the enlargement of muscle
fibre and muscle cell size leading to hypertrophy with little evidence showing an
increase in the number of muscle fibres (hyperplasia) taking place.[1][12]Various
adaptations include: Increase in the cross sectional area of the muscle[13] Changes in
muscle architecture[13] Ultrasound studies have shown changes in the angle of fiber
pennation (the angle at which fibres are aligned in regards to their insertion to the
aponeuroses of the muscle). This will affect force output by determining the
physiological cross sectional area (where the cross-section area is determined
perpendicular to the line of pull of the muscle fibres).[13] Hypertrophy of fibre types at
cellular level, especially in Type II fibres:[13] Research shows a decrease in the number
of Type IIx fibres, together with an increase in Type IIa fibres[13] Fast twitch muscle
fibres are inherently stronger (greater force per unit area) and have a high speed of
shortening, therefore "a given enlargement of a fast twitch fibre should have a
proportionately greater effect on strength and power than the same growth of a slow
twitch fibre."[13] Muscle Protein Synthesis It is well-known that muscle is sensitive to
training loads. The muscular system is a dynamic system with proteins being
synthesised and degraded. For muscle growth the balance between protein synthesis
and degrading needs to be changed. This can occur by either increasing the synthesis
rate or decreasing the rate of degrading or a combination of both.[1] Important findings
to know about human muscle protein turnover: Muscle protein synthesis is ~ 0.04% per
hour in the fasted state[14] Exercise and feeding stimulate muscle myofibrillar protein
synthesis[14] Following resistance training muscle protein synthesis increases 2x - 5x
post exercise[14] Increases in protein synthesis occur 1 - 2 hours post exercise, but in
the fed state it can remain increased for 48 - 72 hours[15] An elevated protein
breakdown accompanies this increase in protein synthesis post exercise[16] In a fed
state, protein synthesis is greater than protein breakdown, resulting in a net gain of
protein[16] The accumulated effect of this process over multiple exercise bouts leads to
a net gain in protein and therefore muscle growth.[1] The above mentioned findings
clearly shows that adaptations to muscle are dependent on nutrition availability. The
protein synthesis and breakdown response post exercise can be adjusted by altering the
availability of certain nutrients. Both, resistance training and amino acid ingestion
increases protein synthesis[1]. When these two factors are combined it has an even
bigger effect.[17] The consumption of protein post exercise does the following:
Promotes protein synthesis[17] Suppresses protein breakdown[17] With the
suppression of protein breakdown post exercise in the fed state, there is also an increase
in insulin levels which further aids this suppression of protein breakdown. It is
therefore important to maintain adequate nutrition to maximise the benefits of
resistance training.[18] Satellite Cells Satellite cells are specialised muscle stem cells
located in a niche between the basal lamina and the sarcolemma of a muscle fibre. They
aid in the growth and repair of all skeletal muscle. These cells are activated by muscle
damage and/or sufficient exercise. Once these cells are activated they proliferate
differentiate and fuse to an existing myofibre, and in this way forming new contractile
proteins and repair damage.[1] Resistance training results in an increase in the number
of satellite cells within four days of training[19]. With continued resistance training
over an extended period of time satellite cell numbers can increase by ~30% and can
furthermore remain elevated even if training is stopped.[20] Another important role of
satellite cells is the donation of their nuclei to act as post-mitotic nuclei in the growing
muscle fibre.[1] Adaptations to Endurance Training Endurance training is focused on
increasing muscle fatigue resistance for exercise of longer duration.[1] Fatigue is
defined as: "a loss in the capacity for developing force and/or velocity of a muscle,
resulting from muscular activity under load and which is reversible by rest."[21]
Performance in endurance activities is dependent on the body's ability to produce
sufficient ATP through aerobic respiration. This process requires the neuromuscular,
cardiovascular and respiratory systems to interact. The focus will be more on the local
adaptations that happens in skeletal muscle for the purpose of this page. Essentially,
endurance training and activity enhances the oxidative capacity and metabolic
efficiency of skeletal muscle. The adaptations that it achieves this through are: oxygen
utilisation (mitochondrial adaptations), oxygen delivery (angiogenesis) and local
substrate availability.[1] [22] Mitochondrial Adaptations (Oxygen Utilisation)
Mitochondria are the "powerhouse" of the cell. These organelles generate the majority
of the cell's supply of ATP through aerobic respiration.[1] Endurance training can:
increase the volume and number of mitochondria and the magnitude of these changes
are dependent on the frequency and intensity of training[23] With the increased
number and size of mitochondria, the proportion of pyruvate formed during glycolysis
passing into the mitochondria for oxidative phosphorylation is increased with less used
for the production of lactate and its byproducts. As a result the exercise intensity, which
can be sustained through relying on aerobic metabolism, is higher.[1] Angiogenesis
(Oxygen Delivery) The network of capillaries adjacent to the muscle fibres is
responsibly for the diffusive exchange of gasses, substrates and metabolites between the
circulation and the working muscle fibres. Endurance training results in: the growth of
new capillaries (process of angiogenesis), with an increase of ~20% being present after
8 weeks of training in both Type I and Type II fibres[24] Substrate Utilisation During
submaximal exercise the main fuel sources are carbohydrates (mainly muscle glycogen)
and fats (local and circulating fatty acids).[1] Endurance training leads to a key
adaptation in substrate utilisation: for a given level of submaximal exercise the
contribution of fatty acid oxidation to the total energy requirement increases with a
marked increase in the muscle's ability to utilise intramuscular triglycerides as the
primary fuel source.[25] Training results in more glycogen being stored in muscle
fibres, in form of granules, this leads to a greater number of intramuscular lipid
droplets being in contact with the mitochondria[26] Endurance athletes rely on on
improved fatty acid oxidation as it conserves muscle glycogen stores (these are more
needed during exercise of high intensity)[1] Neural Adaptations With endurance
training the following adaptations occur in the neural system: Motor unit discharge rate
decreases[9] Slower rate of decline in Motor unit conduction velocity during sustained
contractions is found after endurance training[27] Decrease in Motor unit recruitment
thresholds[1] Comparison of Neuromuscular Adaptations to Strength and Endurance
Training Variable Strength Training Endurance Training Muscle fibre size increase no
change Number of muscle fibres no change no change Movement speed increase no
change Strength increase no change Aerobic capacity no change increase Anaerobic
capacity increase no change Capillary density no change or decrease increase
Mitochondrial density decrease increase Type II muscle fibre subtype conversion almost
all to Type IIa with sprint interval majority to Type IIa Strength Training in Spinal
Cord Injury - Physiopedia Introduction Poor strength is the first impairment
considered by most physiotherapists in relation to spinal cord injury, and can be both
neurally induced or occur in neurally intact muscles. with motor tasks often limited by
the strength of completely paralysed, partially paralysed or non-paralysed muscles. 
Loss of strength in neurally intact muscles, particulary during the acute phase of spinal
cord injury can have a significant impact on function, and tends to occur as a result of
disuse atrophy or insufficient strength for the demands of novel functional tasks ie.
transfers, wheelchair mobility etc. Paralysis (complete disruption to descending motor
pathways) or partial paralysis (particla disruption to descending mootor pathways)
result in neurally induced weakness or loss of strength. Strength training, also referred
to as resistance training can be thought of as voluntary activation of the muscles against
resistance, and refers to any form of exercise where you lift or pull against resistance,
which can can take the form of body weight, free weights, machine resistance,
powerbands, or any other external form of resistance. Strength training can elicit
numerous positive benefits on your health and well being, not only increasing strength
but increased bone, muscle, tendon, and ligament strength and toughness which can
reduce the occurrence of sarcopenia, which is the age-related decline in muscle, and
decrease the risk of osteoporosis, improved joint function, increased bone density,
increased metabolism, increased fitness [1], improved cardiac function, and has been
linked to decreased pain, stress and depression, often resulting in reduced potential for
injury. Regular strength training has also been linked to decreased risk of
cardiovascular disease through decreased body fat, decreased blood pressure, improve
cholesterol profile, and lower the stress placed on the heart while lifting a particular
load. In individuals with a spinal cord injury these benefits can have a positive impact
on quality of life and often result in making activities of daily living more efficient e.g.
transfers etc. Strength training programmes progressively increasing the force output of
the muscle through incremental increases in resistance / weight and should always use
uses a range of exercises (push, pull, upper body, lower body, trunk etc.) and types
of equipment to target specific muscles or groups of muscles. Strength training is
primarily an anaerobic activity, although some proponents have adapted it to provide
the benefits of aerobic exercise through circuit training or high intensity interval
training. Physiotherapy treatment is directed at neurally intact muscles and in those
areas with only partial paralysis, as the muscle with paralysis has complete disruption
of the descending motor pathways and can not be improved with strength training.
voluntary strength of paralysed muscle can not be improved with strength training.
Definition According to the Oxford Dictionary of Sport Science and Medicine, strength
training are any exercises performed specifically to develop strength, which involves
weight training using progressive resistance exercises incorporating a repetition
maximum that ensures overload of the muscle. [2] Assessment of Strength An
assessment of muscle strength is typically performed as part of a patient's objective
assessment to assist the physiotherapist's clinical reasoning and enable them to reason
an appropriate point to begin strengthening rehabilitation from. Muscle strength can be
assessed by a number of methods: manually, functionally or mechanically including the
following; [3] Manual Muscle Test Manual Muscle Testing (MMT) is a standardized set
of assessments that measure muscle strength and functionagainst specific criteria and is
commonly used in clinical practice by physiotherapists to measure strength in
individuals with a spinal cord injury. During manual muscle testing, each muscle group
is tested bilaterally. There are a number manual muscle testing systems available, the
most well known of which are the Medical Research Council Scale (also known as the
Oxford Scale), Daniels and Worthingham and Kendall and McCreary. Despite some of
the inherent problems of manual muscle tests, they are still useful for broadly
identifying neurological weakness and detecting marked neurological deterioration or
improvement. This is particularly important for individuals with an acute spinal cord
injury when it is important to monitor the effects of interventions such as surgical
decompressions, although it can be less sensitive at detecting changes in strength with
grades 3+, 4 and 4+/5, where hand held myometry more sensitive. Manual muscle tests
are also useful because the results are readily interpretable by all, including patients.
Manual muslce testing has adequate to excellent psychometric properties in patients
with spinal cord injury, including excellent interrater reliability (ICC = 0.94) and
convergent validity and is easily integrated into clinical practice. [4] The following links
demonstrate Manual Muscle Testing of specific joints and movements: Upper
Extremities Lower Extremities Shoulder Flexion Hip Flexion Shoulder Extension Hip
Extension Shoulder Abduction Hip Abduction Shoulder Horizontal Adduction Hip
Adduction Scapula Elevation Hip External Rotation Scapular Retraction/ Adduction
Hip Internal Rotation Elbow Flexion Knee Flexion Elbow Extension Knee Extension
Wrist Flexion Plantarflexion Wrist Extension Dorsiflexion Ankle Eversion Ankle
Inversion One Repitition Maximum One Repetition Maximum (1 RM), refers to the
maximum weight a patient can lift through an entire range of motion against gravity,
and can be used to determine muscle strength for muscle groups with Grade ⅘ or
greater strength. Testing for 1RM involves adjusting the weight until it can be lifted but
not more than once, ensuring sufficient rest between each attempt to avoid fatigue. In
muscles with Grade ⅗ strength, a ‘Modified’ 1 RM can be used by moving the weight
horizontally, instead of lifting a weight against gravity, often with the limbsupported
using slideboards or overhead suspension Hand Held Myometer Myometers,
predominantly small, portable handheld devices, either mechanical or electronic, can be
used to test for isometric strength providing a measures of force, rather than torque.
While it provides an objective, quantifiable method of measuring muscle strength, this
does not necessarily reflect function. It may superior to manual muscle testing for
detection of mild to moderate weakness and changes in muscle strength, particulalry in
the upper limb. It also eliminates potential bias from the evaluator for various age
groups and gender.Examiner may have difficulty stabilizing muscle or joint for strong
individuals. While it can be difficult to utilise with a stronger individual, particularaly
when testing the larger lower limb muscles, they can be useful for testing strength in
individuals on bed rest and is primarily utilised in strength testing for upper limb in
spinal cord injury. There are some limitations for use with individuals with a spinal
crod injury due to inability to use with muscle grades <3/5.[4] Hand held myometry has
Low to High Inter-rater reliability (ICC=0.21-0.89), variability may be due to the lack of
standardization for starting position and for muscles tested, while Intra-rater reliability
is High (ICC=0.93-0.99). Validity was Low to High for individuals with paraplegia
(Spearman’s r=0.26-0.67) and Moderate to High for individuals with tetraplegia
(Spearman’s r=0.50-0.95). [5] Isokinetic Dynamometer Isokinetic Dynamometer is less
commonly used in cilnical practice but has the advantage of using a ratio scale for
measurement, measuring torque during dynamic (concentric or eccentric) contractions
at a constant angular velocity. Equipment is both expensive to buy initially, is more
complex to adjust when testing multiple muscle groups, and not appropriate for those
with profound weakness or those restricted to bedrest. Response to Strength Training
Exercise Prescription The basic principles of strength training involve a manipulation of
the number of repetitions, sets, tempo, exercises and force to cause desired changes in
strength, endurance or size by overloading of a group of muscles. The specific
combinations of reps, sets, exercises, resistance and force depend on the purpose of the
individual performing the exercise: to gain size and strength multiple (4+) sets with
fewer reps must be performed using more force.[24] A wide spectrum of regimens can
be adopted to achieve different results, but the classic formula recommended by the
American College of Sports Medicine reads as follows: Overload To stimulate increased
strength, the muscle must work harder than it has previously worked, workloads should
be at a higher level than normally encountered. As the muscle adapts to a particular
workload, the individual should progress to a higher load, as such as the muscle
becomes stronger the load has be be increased progressively over time to stimulate
further strength increases. This should be monitored carefully to ensure the loads are
not too high for the muscle to cope with, thus increasing the risk for overtraining and
overuse injuries, particularly in an individual with a spinal cord injury who rely on the
upper limb for mobility, and have less opportunity to rest the upper limb following
strength training. Frequency Refers to the number of training sessions per unit of time,
typically over a week. The rate of recovery from a strength training session appears to
be limited by the rate f recovery of the muscle cell, which typically takes longer than 24
hours and therefore training the same muscle two days in a row intensely with
resistance is not recommend. Training a muscle before it has recovered can increase the
risk of overtraining, while training too infrequent can result in under training and may
fail to produce an optimal training response. In line with the new Spinal Cord Injury
Exercise Guidelines to improve strength, adults with a spinal cord injury should engage
in; Strength Exercises for each major functioning muscle group 2 times per week
Intensity Refers to the amount of resistance or load being lifted. Recommendations use
a percentage of one repetition maximum. Modifying the load, number of repetitions,
speed of repitions, and rest between sets are ways of modifying the intensity of strength
training. In line with the new Spinal Cord Injury Exercise Guidelines to improve
strength, adults with a spinal cord injury should engage in; Strength Exercises for each
major functioning muscle group, at a Moderate-Vigorous Intensity Volume Refers to the
total amount of work performed during a strength training session. It can be thought of
as the product of Number of Reps x Number of Sets x Number of Exercises x Load.
Volume of training over a week can be taught of as the number of training sessions x the
amount of work done in those sessions. In line with the new Spinal Cord Injury Exercise
Guidelines to improve strength, adults with a spinal cord injury should engage in at
least; 3 Sets of Strength Exercises for each major functioning muscle group 2 times per
week Specificity Adaptations that take place as a result of training are directly related to
the type of training undertaken and are specific to the way the training is performed.
The more specific the exercise the better transference into performance improvement in
the area you are trying to improve. So when strength training with an individual with a
spinal cord injury around specific functional tasks e.g transfers, then it is best done as
far as possible within the context of that specific motor task. Low repetition training ( <
5 Reps ) with high loads causes large increase in strength but minimal increase in
muscle size. Moderate repetition training ( 6 - 15 Reps ) produces the greatest increase
in muscle size but lower levels of maximal strength than low repetition training. High
repetition training ( 15 - 30 Reps ) results in less maximal strength than lower
repetition training but produces greater muscular endurance. Resources Physical
Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) Physical
Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) is a self-
report physical activity measure for individuals with spinal cord injury. It aims to
measure type, frequency, duration, and intensity of physical activity performed by
individuials with a spinal cord injury who use a wheelchair as their primary mode of
mobility. ProACTIVE SCI Toolkit The ProACTIVE SCI Toolkit, from SCI Action Canada,
is designed to help physiotherapists work with individuals with a spinal cord injury to
be physically active outside of the clinic. It's a step-by-step resource that uses three
overarching strategies including education, referral, and prescription to develop
tailored strategies that work for both the physiotherapist and the individual with a
spinal crod injury. Active Living Leaders Active Living Leaders is comprised of a series
of peer-mentor training videos with a goal of helping people who would like to use the
latest physical activity knowledge, sport resources, and transformational leadership
principles to inform and motivate adults living with a spinal cord injury to lead more
active lives. SCI-U Physical Activity Course for Individuals with Spinal Cord Injury SCI-
U Physical Activity Course is a collection of modularized training sessions.  It includes
Modules on Living an Active Life, Ways to Get Fit, Overcoming Barriers and Reaching
Your Goal. SCI Action Canada Knowledge Mobilization Training Series SCI Action
Canada's Knowledge Mobilization Training Series (KMTS) is a collection of modularized
training sessions, with the goal of advancing physical activity knowledge and
participation among individuals living with spinal cord injury. It includes Modules on
the Physical Activity Guidelines and Physical Activity Planning. Muscle Strength of
the Ankle - Physiopedia Definition / Description Muscle strength is the amount of
force a muscle can generate. It is different from the muscle power which is the rate at
which the muscle can work effectively. The ability to generate force is necessary for all
types of movement. Regaining strength bilaterally is accepted clinical practice and is
thought to be important for the prevention of ligamentous injuries at the ankle.
Characteristics Muscle fiber cross-sectional area (CSA) is positively related to maximal
force production.  The arrangement of fibers according to their angle of
pennation,muscle length, joint angle, and contraction velocity can alter the expression
of muscular strength. Force generation is further dependent upon motor unit activation
according to the size principle. [1] Adaptations to resistance training enable greater
force generation through numerous neuromuscular mechanisms. Muscle strength may
increase significantly within the first week of training, and long-term strength
enhancement manifests itself through enhanced neural function, changes in muscle
architecture, increased muscle CSA and possible adaptations to increased metabolites,
for increased strength. The magnitude of strength enhancement is dependent on the
type of program used and the careful prescription of muscle actions, intensity, exercise
selection and order,volume, frequency and rest periods between sets.[1] Physical
Therapy Management Once ROM is achieved and swelling and pain are controlled, the
patient is ready to progress to the strengthening phase of rehabilitation.[2][3][4]  It is
essential to strengthen the weakened muscles for a rapid recovery and it is a preventive
measure against re-injury. All muscles of the ankle should be targeted, including the
peroneal muscles.[2][5][3][4][6] Performing exercises bilaterally is thought to be
important for the prevention of ligamentous injuries at the ankle. [2] Continual
monitoring of strength is important. Isokinetic strength testing is an accepted method
of assessing ankle strength.[2][6] Also used is a hand-held dynamometry for consistent
monitoring of strength performance.[7][2] It is important to understand that each
rehabilitation program must be individualized [2]  The use of mental practice during
the treatment might be a useful adjunct to treatment options aimed at increasing
muscle strength. [8]  Strengthening begins with isometric exercises and progresses to
dynamic resistance exercises.[2][4] Isometric Strength Training [2] Resistance is given
by an immovable object (wall or floor), The contra-lateral foot or manual resistance by
the physiotherapist. Strengthening can be accomplished in a pain-free range of motion.
Frequency: Hold muscle contraction for 5–10 s. 5–10 repetitions per direction, 3–5
times /day. Plantar flexion Procedure: Push foot downward (away from the head)
Dorsiflexion Procedure: Pull foot upward (toward the head) Inversion Procedure: Push
foot inward (toward the mid-line of the body) Eversion Procedure: Push foot outward
(away from the mid-line of the body) Isotonic Strength Training [2][3][5] Resistance is
given by the contralateral foot, rubber tubing, weights or the physiotherapist.
Strengthening can be accomplished in full range of motion and includes concentric and
eccentric contractions first in non-weight-bearing position, later in a weight-bearing
position  Frequency: Maintain muscle contraction for 4–10 s for concentric and
eccentric components. 2 sets of 10 repetitions per direction, 3–5 /day Plantar flexion
Procedure: Push foot downward (away from the head) Dorsiflexion Procedure: Pull foot
upward (toward the head) Inversion Procedure: Push foot inward (toward the mid-line
of the body) Eversion Procedure: Push foot outward (away from the mid-line of the
body) Toe curls and marble pick-ups[2] Strengthening can be accomplished throughout
the day at work or at home Frequency: 2 sets of 10 repetitions, 3–5 / day Procedure:
Place foot on a towel. Curl toes, moving the towel toward the body. Use toes to pick up
marbles or other small objects. Toe raises, heel walks, toe walks[2] Strengthening can
 be accomplished using the body as resistance in a weight-bearing position Frequency: 3
sets of 10 repetitions; progress walking as tolerated Procedure: Lift the body by rising
up on the toes Walk forward and backward on the toes and heels It is also important to
provide home exercises for the patient, this will improve his rehabilitation. The
exercises shown here above can be given as home exercises.[5][3][2] (grade of evidence
=B) As the patient achieves full weight bearing without pain, Proprioceptive training is
initiated for the recovery of balance and postural control. [2][3] (grade of evidence =A)
References
1. ↑ Jump up to:1.0 1.1 1.2 1.3 Christian Bosse Power Training vs Strength Training –
what is the difference between Strength Training and Power
Training?  Available from: https://christianbosse.com/power-training-vs-
strength-training-what-is-the-difference/  (last accessed 6.2.2020)
2. ↑ Jump up to:2.0 2.1 2.2 Harvard medical School Power training provides special
benefits for muscles and function  Available
from:https://www.health.harvard.edu/blog/power-training-provides-special-
benefits-for-muscles-and-function-201304226097  ( last accessed 6.2.20)
3. Jump up↑ Ace fitness 5 exercises to increase your clients
power Available from:https://www.acefitness.org/education-and-
resources/professional/expert-articles/6941/five-exercises-to-help-your-
clients-develop-power  (last accessed 7.2.2020)
4. Jump up↑ Henwood TR, Taaffe DR. Improved physical performance in
older adults undertaking a short-term programme of high-velocity resistance
training. Gerontology. 2005;51(2):108-15. Available
from:https://www.karger.com/Article/Abstract/82195  (last accessed
6.2.2020)
5. Jump up↑ American College of Sports Medicine. American College of
Sports Medicine position stand. Progression models in resistance training for
healthy adults.  Medicine and science in sports and exercise. 2009
Mar;41(3):687. Available
from:https://www.ncbi.nlm.nih.gov/pubmed/19204579  (last accessed
7.2.2020)
6. Jump up↑ Celes R, Bottaro M, Cadore E, Dullius J, Schwartz F, Luzine
F. Low-load high-velocity resistance exercises improve strength and
functional capacity in diabetic patients.  European journal of translational
myology. 2017 Jun 24;27(2). Available
from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505086/  (last
accessed 6.2.2020)
7. Jump up↑ Vinstrup J, Calatayud J, Jakobsen MD, Sundstrup E,
Andersen LL. Focusing on increasing velocity during heavy resistance knee
flexion exercise boosts hamstring muscle activity in chronic stroke
patients. Neurology research international.
2016;2016.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976165/ Availab
 le from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976165/  (last
accessed 6.2.2020)
8. Jump up↑ Anthony, Chantel & Brown, Lee. (2017). HIGH VELOCITY
TRAINING.  ACSM web. Available
from:https://www.researchgate.net/publication/313752954_HIGH_VELOCI
TY_TRAINING  (last accessed 6.2.2020)