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Maximizing Patient Outcomes with Periodized Exercise Plans

Table of Contents

Key Takeaways:
  • Premade or cookie cutter exercise programs are out of style and need to be replaced with thoughtfully designed and periodized programs
  • Periodization is simply defined as the planned manipulation of training variables.
  • A periodized plan consists of the four training variables: volume, frequency, movement variation, and intensity.
  • While the learning curve for writing a periodized program for patients with complex musculoskeletal issues can be long, ultimately learning the foundations will allow for better patient care and health outcomes

Bucking The System

At what point does an inside joke stop being inside? Likely when people outside of a group start to repeat that same thing. The classic physical therapy inside joke involves the idea that every single exercise in a plan of care be prescribed for 3 sets of 10 reps (3×10).

You really hate to see it: a stapled packet of multiple pages, poorly aligned from being copied excessively over years, the black and white figures on the sheet doing rubber band work, or interacting with a chair. You can barely even see them through the speckles on the sheet from what was probably dust particles from 10 years ago. That, or a handout made from a website where you act as a slave to whatever preloaded, non-sweat inducing exercises exist there.

What we hope to do here at Across The Continuum is get you to move away from the premade, cookie cutter handouts, and embrace individually crafted, specifically designed programs made for the human sitting in front of you. Its a tall order for a time crunched and likely burnt out physical therapist: taking the time to design a structured exercise plan. The only way to improve on something like the aforementioned program is to understand the basics of program building, and thats what we are going to get into right now.

Mount Periodization

Periodization in and of itself can be intimidating, especially if you’re new to the strength and conditioning world. From the outside it can look like a giant mountain we need to scale, and it certainly can be, but doesn’t need to be. Just like any arduous journey, taking the first few steps is all we need to do to get started.

Periodization is simply defined as the planned manipulation of training variables. With it, we can create a skeleton of what a training plan might look like going forward as far as you can want it to. There are nuances when the rubber meets the road regarding human responses to a plan, but a well periodized plan can be a theoretical road map guiding you and your patient in a desired direction.

The Four Training Variables

To create a periodized plan, you need to understand the four training variables: volume, frequency, movement variation, and intensity. Each training variable answers a question being asked by the program. In no specific order, lets go over all four in more depth:

First and most well know is volume. Volume answers the question of “how much?” This typically includes the number of sets and reps for a specific exercise. For example, the classic “3 sets of 10 reps” is a volume prescription. It’s all about quantifying the work done in a given session or movement. 3 sets of 10 is 30 repetitions of volume for a given prescription. We need not stop at reps and sets as volume can answer the question of how much in a few ways. It can also answer the question of how far (distance) and for what duration (time). All three are an aspect of how much the patient will be doing in the given periodization context.

Next we have frequency which answers the question of “how often (per time period)?” Typically, we look at a weekly timeframe, but you can insert any time period. For instance, if you plan to do “chest day” twice a week, that’s a frequency of two times per week.

Movement Variation answers the question of ” to what specific physical movement is the periodization being applied? Whether it’s a sumo deadlift or a conventional deadlift, a dumbbell bench press or a barbell bench press, this is where you apply the periodized elements to the physical movements involved.

Finally we have Intensity. This variable answers the question of “how difficult?” It deals with how close you are to failure during a specific exercise or movement. There are two types of intensity: subjective and objective. Subjective intensity is the athlete or patient’s perception of how challenging the exercise feels, which can be rated on a scale of 0 to 10. Objective intensity, on the other hand, is more specific, often measured by a repetition maximum (rep max) – the maximum weight lifted for a specific number of repetitions.

Subjective Intensity is versatile, as it allows for personal feedback on how the session felt, perceived fatigue, and more. On the other hand, objective intensity is primarily used when you have objective benchmarks like rep maxes. If you want to read more about objective and subjective intensity and using it in the clinic, check out our other article: How To Use Subjective Intensity As A Physical Therapist.

Putting It All Together

If you can grasp these four training variables and can apply them to create a periodized plan, you are going to be well on your way to completely turning your patient’s health outcomes around. If you are still having trouble grasping the idea of a periodized plan, check out one of our free guides that not only goes over these variables again, but has two 8 week examples of periodized plans: 8 Week Beginner Strength Program

Incorporating a well structured periodized plan into your patient care is a game-changer. Periodization may seem complex on the surface, and while it can be, with the right knowledge and approach it can also be a powerful tool in patient care.