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Weight bearing exercises such as running or weightlifting can help increase bone density and this reduces the risk that bones will break or fracture when under pressure.

https://orthoinfo.aaos.org/en/staying-healthy/exercise-and-bone-health

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Exercise and Bone Health - OrthoInfo - AAOS

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Most people are familiar with many of the benefits of exercise, such as reducing the risk for heart disease and stroke, and preventing obesity. Perhaps not as well understood is the importance of regular physical activity in building and maintaining healthy bones.

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Resistance and plyometric training can increase the strength of tendons & ligaments which connect bones together and bones to muscles, which needs to be done progressively to increase the potential resistance these can deal with.

https://www.trainingpeaks.com/blog/how-to-strengthen-tendons-ligaments/

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Strength training is usually associated with building muscle, but as an endurance athlete, you also need to build connective tissue strength. Your tendons, in particular, are responsible for transferring force generated by muscle contraction to bone to whatever you are trying to move or push against (like a weight, a pedal, or the ground). This movement of force creates an elastic recoil effect known as the stretch-shortening cycle (SSC) that helps you to run, jump, and make a variety of other movements. In this article, we'll discuss the importance of connective tissue, how to strengthen tendons and ligaments, and how that can help improve your athletic performance.

Why Tendon Health Matters

Tendons connect bone to muscle. They allow us to move our muscles, absorb impact, and transfer force. Ligaments connect bone to bone, keeping our joints stable and in place.

Tendons and ligaments provide an elastic recoil response that allows us to run, jump, and lift heavy things quickly. As we age, tendon elasticity decreases. Connective tissue injuries mostly occur for endurance athletes due to the repeated, forward and backward (sagittal plane) motions of running or pedaling. Sitting for hours at a desk further weakens tendons and ligaments. So how do you increase tendon elasticity?

Can You Strengthen Tendons?

The short answer is yes. But, when compared to changes in muscle tissue, which can take just days to improve, the tendon's structural tissue can take weeks or months to adapt. One study showed that it took two months before tendon stiffness improved, and this also included changes in collagen structure and synthesis. This is why tendon and ligament injuries take longer to heal - there is limited blood supply going to these connective tissues. Thus, it also takes more time for a tendon to adapt to training stress compared to muscles.

Tendon (and ligament) strength and tendon (and ligament) stiffness are often used interchangeably because an overly elastic (non-stiff) tendon is weaker and more susceptible to injury. Assuming sufficient strength to be injury resistant, there is still a range of stiffness/elasticity a given tendon can develop. The optimal stiffness for a given tendon will be determined by the forces it experiences, which is determined by its anatomical location and the specifics of the athlete's main sport. Having a well-balanced strength training program can keep these connective tissues appropriately "snappy" for a given sport. In addition to preventing injury this can lead to improved running economy through improvements in aspects of the stride cycle and improved efficiency in the pedal stroke for cyclists.

How to Strengthen Tendons and Ligaments With Connective Tissue Exercises

So how do we build strength in our connective tissues? There are many ways to strengthen tendons, but for the purpose of this article, we'll focus on doing so through strength training. This includes eccentric training, plyometrics, and isometric forces.

1. Eccentric Training

Eccentric training can be done with lighter weights or bodyweight where the high forces are generated through a lengthening (eccentric) contraction (such as landing on the floor from the top of a box jump into a deep squat or when you lower your heels back down after the raise in a slow and deliberate manner, that is an eccentric movement.) or with heavier weights and a focus on lowering them as slowly as possible.

Multiple studies have been done on eccentric training and tendon stiffness. These studies found that tendon stiffness does not change, or improves minimally, with body weight alone. Instead, weighted protocols on a single leg resulted in better improvement in tendon stiffness.

A few examples of eccentric training exercises that can help strengthen tendons and ligaments include:

Eccentric heel raises

Single-leg squats

Single-leg deadlifts

2. Plyometrics

Explosive movements like plyometrics - such as squat jumps, single leg hops, depth jumps, box jumps, and quick feet step-ups - may help build tendon strength and make your legs feel a little more snappy, as long as you don't overdo it.

Plyometrics use the tendon's recoil response to execute explosive movements. Take, for example, a single-leg jump. The Achilles tendon lengthens and then releases energy as it recoils or shortens. Over time, this action becomes more efficient.

Plyometrics should be phased in and applied gradually to one's strength training program. A 14-week study of plyometric training determined that, over time, there was less energy dissipating as heat and more energy being applied to the recoil of the tendon, allowing for an increase in the rate of our movements.

Examples of plyometric leg exercises that can reduce your risk of injury can be found here.

Plyometric training can have a significant impact on performance and injury resistance, but due to the high loads and sometimes complex movements associated with plyometric training, it is critical to develop a deliberate progression plan based on your sport and your experience with this type of training.

3. Isometric Training

Isometric contractions occur when the muscle is held in a constant or static position. Examples of isometric exercises include wall sits, calf holds, planks, or any position that you can maintain and hold for an extended time.

One study concluded that isometric training can provide short-term pain-relief benefits in the middle of the competitive season. Isometric training may also be beneficial at the beginning of a strength training program or rehab for improving stabilization. This would be very important before doing heavy resistance training as you need to know how to put your joints in a stable position. So while structurally heavy resistance training and eccentric exercises have been shown to be more effective in building overall tendon stiffness, isometric training can be more effective targeting the healthy fibers in a tendon with previous tendinopathy or that is otherwise painful so that it can begin to remodel itself and eventually reduce or eliminate pain

Endurance athletes should spend time year-round integrating strength training into their training program. This will help maintain or even increase the strength of your connective tissues, steadily improve your power output, and reduce injury risk without having to increase volume or intensity.

References

(2018, July 26). What are ligaments? Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK525790/

Finni, T. et al. (2012, October 18). Viewpoint: On the hysteresis in the human Achilles tendon. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23085961/

Fouré, A. et al. (2010, June 24). Plyometric training effects on Achilles tendon stiffness and dissipative properties. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20576842/

Kubo, K. et al. (2011, November 22). Time course of changes in the human Achilles tendon properties and metabolism during training and detraining in vivo. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22105708/

Lim, H.Y. & Wong, S.H. (2018, July 4). Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: A systematic review. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29972281/

Quinlan, J.I. et al. (2019, August 20). Tendon Adaptations to Eccentric Exercise and the Implications for Older Adults. Retrieved from ncbi.nlm.nih.gov/pmc/articles/PMC7739434/

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How to Strengthen Tendons and Ligaments With Strength Training

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Strength training is usually associated with building muscle, but as an endurance athlete, you also need to build connective tissue strength. Your tendons, in particular, are responsible for transferring force generated by muscle contraction to bone to whatever you are trying to move or push against (like a weight, a pedal, or the ground).

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Endurance, strength and weight bearing exercises increases bone density by stimulating bone cells to create more bone tissue which increases the density and also the strength of bones which can be further supported with nutrition and supplements.

https://www.nsca.com/education/articles/kinetic-select/resistance-training-adaptations-skeletal-changes

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The following is an exclusive excerpt from the book NSCA's Essentials of Personal Training, Second Edition, published by Human Kinetics. All text and images provided by Human Kinetics. NSCA's Essentials of Personal Training, Second Edition, is the authoritative text for personal trainers, health and fitness instructors, and other fitness professionals as well as the primary preparation source for those taking the National Strength and Conditioning Association Certified Personal Trainer® (NSCA-CPT®) exam. The book is available in bookstores everywhere, as well as online at the NSCA Store .
It is tempting to think of the skeletal system as an inert framework comprising simply a set of levers that muscles act upon to create movement. However, bone tissue is very much "alive" and is a dynamic tissue. In addition to its role in movement and protection, bone serves as a depot for important minerals, most notably calcium. Osteoporosis is the consequence of long-term net demineralization of bone. In recent years, resistance training has been studied for its possible influence on bone mineral density (BMD). Bone tissue is significantly affected by strain; that is, deformation (bending) of bone rapidly stimulates bone cells to begin activities that stimulate bone formation (6, 65). Therefore, it seems logical to examine the effects of resistance training on bone formation, especially in the context of osteoporosis. Because osteoporosis is mainly, though not exclusively, a condition associated with postmenopausal women, most research has focused on women. Specifically, researchers have focused on the effect of resistance training on the accumulation of bone tissue prior to menopause (peak bone mass is typically achieved prior to age 40 (6), as well as on the effect of resistance training on the decline in bone mass associated with aging and menopause. Menopause is particularly critical in the development of osteoporosis because hormones like estrogen, which facilitate bone formation, markedly decline after menopause. Accumulation of bone mass prior to menopause is considered important because the greater the bone mass prior to menopause, the less severe the consequences of loss of bone mass.

The research literature has shown quite clearly that, in cross-sectional studies, stronger women tend to have thicker and stronger bones. However, selection bias may influence such studies (3). Intervention studies are less clear as to whether resistance training programs result in increases in bone mass. Some of these studies show no significant effect of resistance training on bone tissue (10, 104), while others have shown that resistance training programs can positively affect bone tissue (87, 121). Differences between studies are influenced by factors such as length and characteristics (e.g., intensity, volume, type of exercises) of the training programs, small sample sizes, differences in the extent of bone demineralization prior to training, gender, and age. A recent meta-analysis has reported that high-intensity resistance training can significantly increase lumbar spine BMD but not BMD of the femoral neck in premenopausal women (89). Nonetheless, there is enough evidence in the literature to suggest that resistance training very likely has a positive effect on bone tissue (6). What has not been examined in depth is the effect of explosive and plyometric types of training on BMD. Both strain magnitude and strain rate affect the stimulus for bone formation (6), and these would be expected to be higher with explosive and plyometric training. In addition to the obvious effects of resistance training on muscle mass and strength, resistance training may lead to decreased risk for osteoporosis, fractures, and falls in later life.

# data[].attributes.attachment_link.authors[].name
NSCA’s Essentials of Personal Training Second Edition

# data[].attributes.attachment_link.description
Bone tissue is “alive” and is a dynamic tissue that can respond to resistance training. In addition to the obvious effects of resistance training on muscle mass and strength, resistance training may lead to decreased risk for osteoporosis, fractures, and falls in later life.

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Reduced Risk of Osteoporosis & Arthritis

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Reduced Risk of Osteoporosis & Arthritis

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Exercising regularly reduces the rate of bone loss and conserves bone tissue, lowering the risk of fractures, and it also helps reduce the risk of falling. It is also linked to strengthening bones & muscles around joints, as well as maintaining joint mobility and flexibility, which can help prevent joint injury and pain.

https://www.hopkinsarthritis.org/patient-corner/disease-management/role-of-exercise-in-arthritis-management

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Role of Exercise in Arthritis Management

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Resistance & weight bearing exercises continues can help to keep your bones strong. This makes them less likely to break. Also can increase sports performance as you are able to move heavier weights more effectively or increase strength/power behind movements.

https://theros.org.uk/information-and-support/bone-health/exercise-for-bones/

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Learn different weight bearing and muscle strengthening exercises to help keep your bones strong and healthy throughout life.

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Strength, plyometric and resistance training can cause hypertrophy, which is where micro-tears in the muscle fibres are caused by exercise and when these are repaired this causes them to become large to withstand greater resistance and stress.

https://www.bbc.co.uk/bitesize/guides/z8stfrd/revision/5

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When a person takes part in resistance exercises such as weight training, their muscle tissue is placed under stress. This causes micro-tears in the muscle fibres. The body responds by repairing the muscle fibres and making them larger.

When a muscle gets bigger, the process is called hypertrophy.

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Move on to Test

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Muscle hypertrophy - Muscular system - Eduqas - GCSE Physical Education Revision - Eduqas - BBC Bitesize

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1 2 3 4 5 Page 5of 5 When a person takes part in resistance exercises such as weight training, their muscle tissue is placed under stress. This causes micro-tears in the muscle fibres. The body responds by repairing the muscle fibres and making them larger.

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Exercise can help correct and improve posture through strengthening and stretching muscles in the back, shoulders, chest, legs, core and hips, which helps reduce slouching and improve balance, and has been found to improve spinal alignment. https://integrehab.com/blog/sports-performance/posture-exercise

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The Relationship Between Posture and Exercise | Integrated Rehab

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Posture and exercise have a symbiotic relationship, in which weak core muscles often cause slouching. Learn more about this pattern.

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Exercises that develop and engage skeletal muscles are also linked to prevent injuries as well, this is because exercise strengthens muscles which reduces the risks of strains, sprains and tears, but also to correct any imbalances which further prevents over-exertion and overuse injuries in skeletal muscles.

https://se-ortho.com/strength-training-reduce-sports-injuries/

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How Strength Training Can Help Reduce Sports Injuries | Southeast Orthopedic Specialists

# data[].attributes.attachment_link.description
Most athletes focus on aerobic exercise to build their endurance, but some athletes neglect an equally important area of exercise: strength training. Even for sports such as swimming or running in which packing on muscle mass is undesirable, strength training can be tremendously beneficial. One of the biggest benefits of […]

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Exercise can reduce fatigue as it increases oxygen and nutrient delivery to working muscles, improves muscular endurance and releases endorphins, therefore decreasing overall fatigue and increasing cognitive function.

https://www.vailhealth.org/news/how-exercise-can-help-combat-fatigue

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When hit with a bout of fatigue, it can be tempting to take a nap or give into a day of lounging. Counterintuitive as it may seem, getting up and participating in low- to moderate-intensity exercises when experiencing fatigue has been shown to help boost energy levels and reverse fatigue-related symptoms, according to multiple studies.

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Exercise increases flexibility by increasing blood circulation to muscles and joints to support them moving through a greater range of motion. This helps muscles work more effectively and reduces the risk of injury.

https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931

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Stretching: Focus on flexibility

You can stretch anytime, anywhere. Just follow these tips to do it safely and effectively.
By Mayo Clinic Staff
You know exercise is important, but what about stretching? Does stretching take a back seat to your exercise routine? Not so fast.

Stretching may help you improve your range of motion and decrease your risk of injury, among other benefits.

Understand why stretching can help and how to stretch correctly.

Benefits of stretching

Studies about the benefits of stretching have had mixed results. Some research shows that stretching doesn't reduce muscle soreness after exercise. Other studies show that lengthening the muscle and holding the stretch immediately before a sprint may slightly worsen performance.

However, research has shown that stretching can help improve flexibility, and, as a result, the range of motion of your joints.

Better flexibility may:

Improve your performance in physical activities

Decrease your risk of injuries

Help your joints move through their full range of motion

Increase muscle blood flow

Enable your muscles to work most effectively

Improve your ability to do daily activities

You may learn to enjoy the ritual of stretching before or after hitting the trail, ballet floor or soccer field.

Stretching essentials

Before you plunge into stretching, make sure you do it safely and effectively. While you can stretch anytime, anywhere, proper technique is key. Stretching incorrectly can actually do more harm than good.

Use these tips to keep stretching safe:

Don't consider stretching a warmup. You may hurt yourself if you stretch cold muscles. Before stretching, warm up with light walking, jogging or biking at low intensity for 5 to 10 minutes. Even better, stretch after your workout when your muscles are warm.

Consider skipping stretching before an intense activity, such as sprinting or track and field activities. Some research suggests that pre-event stretching may actually decrease performance. Research has also shown that stretching immediately before an event weakens hamstring strength.

Strive for symmetry. Everyone's genetics for flexibility are a bit different. Rather than striving for the flexibility of a dancer or gymnast, focus on having equal flexibility side to side (especially if you have a history of a previous injury). Flexibility that is not equal on both sides may be a risk factor for injury.

Focus on major muscle groups. Concentrate your stretches on major muscle groups such as your calves, thighs, hips, lower back, neck and shoulders. Make sure that you stretch both sides.

Also stretch muscles and joints that you routinely use or that you use in your activity.

Don't bounce. Stretch in a smooth movement, without bouncing. Bouncing as you stretch can injure your muscle and actually contribute to muscle tightness.

Hold your stretch. Breathe normally and hold each stretch for about 30 seconds; in problem areas, you may need to hold for around 60 seconds.

Don't aim for pain. Expect to feel tension while you're stretching, not pain. If it hurts, you've pushed too far. Back off to the point where you don't feel any pain, then hold the stretch.

Make stretches sport specific. Some evidence suggests that it's helpful to do stretches involving the muscles used most in your sport or activity. If you play soccer, for instance, stretch your hamstrings as you're more vulnerable to hamstring strains.

Keep up with your stretching. Stretching can be time-consuming. But you can achieve the most benefits by stretching regularly, at least two to three times a week. Even 5 to 10 minutes of stretching at a time can be helpful.

Skipping regular stretching means that you risk losing the potential benefits. For instance, if stretching helped you increase your range of motion, your range of motion may decrease again if you stop stretching.

Bring movement into your stretching. Gentle movements, such as those in tai chi, Pilates or yoga, can help you be more flexible in specific movements. These types of exercises can also help reduce falls in older adults.

Also, try performing a "dynamic warmup." A dynamic warmup involves performing movements similar to those in your specific sport or physical activity at a low level. Then you speed up gradually and add intensity as you warm up.

Some people may also choose to add foam rolling before working out along with a dynamic warmup.

Know when to exercise caution

If you have a chronic condition or an injury, you might need to adjust your stretching techniques. For example, if you already have a strained muscle, stretching it may cause further harm. Talk to your doctor or physical therapist about the most appropriate way to stretch if you have any health concerns.

Also remember that stretching doesn't mean you can't get injured. Stretching, for instance, won't prevent an overuse injury.

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Show references

1. Franklin BA, et al. Exercise prescription and guidance for adults. https://www.uptodate.com/contents/search. Accessed Oct. 21, 2021.

2. AskMayoExpert. Physical activity (adult). Mayo Clinic; 2020.

3. Physical Activity Guidelines for Americans. 2nd ed. U.S. Department of Health and Human Services. https://health.gov/our-work/physical-activity/current-guidelines. Accessed Oct. 21, 2021.

4. More MC. Physical activity and exercise in older adults. https://www.uptodate.com/contents/search. Accessed Oct. 21, 2021.

5. Madden CC, et al. Netter's Sports Medicine. 2nd ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Nov. 1, 2021.

6. Riebe D, et al., eds. ACSM's Guidelines for Exercise Testing and Prescription. 10th ed. Wolters Kluwer Health Lippincott Williams & Wilkins; 2018.

7. Anderson BL, et al. The acute effects of foam rolling and dynamic stretching on athletic performance: A critically appraised topic. Journal of Sport Rehabilitation. 2021; doi:10.1123/jsr.2020-0059.

8. Polero P, et al. Physical activity recommendations during COVID-19: Narrative review. International Journal of Environmental Research and Public Health. 2020; doi:10.3390/ijerph18010065.

9. Berg, K. Stretching fundamentals. In: Prescriptive Stretching. 2nd ed. Kindle edition. Human Kinetics; 2020.

10. Gordon BT, et al., eds. Flexibility assessments and exercise programming for apparently healthy participants. In: ACSM's Resources for the Exercise Physiologist. 3rd ed. Kindle Edition. Wolters Kluwer; 2022.

11. Behm DG. Does stretching affect performance? In: The Science and Physiology of Flexibility and Stretching. Kindle edition. Routledge; 2019.

See more In-depth

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Stretching is not a warm up! Find out why

# data[].attributes.attachment_link.description
Learn why stretching your muscles is an important part of your exercise routine and how to do it safely.

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Regular exercise helps strengthen the heart muscles, which could contribute to a lower resting heart rate which is best measured when you’re sitting or lying down, and you’re in a calm state.

https://www.healthline.com/health/athlete-heart-rate

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Endurance athletes often have a lower resting heart rate than others. Heart rate is measured in beats per minute (bpm). Your resting heart rate is best measured when you're sitting or lying down, and you're in a calm state.

The average resting heart rate is usually between bpm. But some athletes have resting heart rates as low as 30 to 40 bpm.

If you're an athlete or someone who exercises often, a lower resting heart rate isn't usually anything to be worried about, unless you're dizzy, tired, or ill. In fact, it typically means you're in good shape.

An athlete's resting heart rate may be considered low when compared to the general population. A young, healthy athlete may have a heart rate of 30 to 40 bpm.

That's likely because exercise strengthens the heart muscle. It allows it to pump a greater amount of blood with each heartbeat. More oxygen is also going to the muscles.

This means the heart beats fewer times per minute than it would in a nonathlete. However, an athlete's heart rate may go up to 180 bpm to 200 bpm during exercise.

Resting heart rates vary for everyone, including athletes. Some factors that could influence it include:

age

fitness level

amount of physical activity

air temperature (on hot or humid days, heart rate may increase)

emotion (stress, anxiety, and excitement can increase heart rate)

medication (beta blockers can slow heart rate, while some thyroid medications can increase it)

How low is too low?

An athlete's resting heart rate is usually only considered too low when they have other symptoms. These may include fatigue, dizziness, or weakness.

Symptoms such as these may indicate there's another issue. See a doctor if you experience these symptoms alongside a slow heart rate.

Athletic heart syndrome

Athletic heart syndrome is a heart condition that's usually harmless. It's typically seen in people who exercise for more than one hour each day. Athletes with a resting heart rate of 35 to 50 bpm may develop an arrhythmia, or irregular heart rhythm.

This may show up as abnormal on an electrocardiogram (ECG or EKG). Usually, there's no need to diagnose athletic heart syndrome because it doesn't present any health problems. But always let a doctor know if you:

experience chest pain

notice your heart rate seems irregular when measured

have fainted during exercise

Occasionally athletes do collapse due to a heart problem. But that's usually because of an underlying condition such as congenital heart disease, not athletic heart syndrome.

New research suggests that athletes with low resting heart rates may experience irregular heart patterns later in life. One found that lifelong endurance athletes had a higher incidence of later electronic pacemaker implantation.

Research is still ongoing on the long-term effects of endurance exercise. Researchers aren't recommending any changes to your athletic routine at this time. See a doctor if you're concerned about your low heart rate.

Well-trained athletes may have a resting heart rate between 30 and 40 bpm. But everyone's heart rate is different. There's no "ideal" resting heart rate, even though a lower resting heart rate may mean you're more fit.

You can measure your resting heart rate at home. Take your resting heart rate by checking your pulse first thing in the morning.

gently press the tips of your index and middle finger over the lateral part of your wrist, just below the thumb side of your hand

count the beats for a full minute (or count for 30 seconds and multiply by 2, or count for 10 seconds and multiply by 6)

Some athletes like to follow target-heart-rate training. This is based on your intensity level compared to your maximum heart rate.

Your maximum heart rate is considered the highest amount your heart can sustain during cardiovascular training. To calculate your maximum heart rate, subtract your age from 220.

Most athletes train at between 50 and 70 percent of their maximum heart rate. For example, if your maximum heart rate is 180 bpm, your target-training zone would be between 90 and 126 bpm. Use a heart rate monitor to keep track during exercise.

Going higher than your calculated maximum heart rate for long periods of time could be dangerous for your health. Always stop exercising if you feel lightheaded, dizzy, or ill.

Athletes often have a lower resting heart rate than others. If you exercise frequently and are reasonably fit, your heart rate may be lower than other people.

This isn't necessarily a bad thing. A low heart rate means your heart needs fewer beats to deliver the same amount of blood throughout your body.

Always seek medical care if you experience dizziness, chest pain, or fainting. Also see a doctor if you suspect your low heart rate is accompanied by other symptoms like fatigue or dizziness. They can assess your heart to confirm you can continue exercising.

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Why Do Athletes Have a Lower Resting Heart Rate?

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The average resting heart rate is usually between 60 and 80 beats per minute, but some athletes have resting heart rates considerably lower. We'll tell you more about resting heart rates, why athletes typically have lower resting heart rates, how to determine your own heart rate, how low is too low, and more.

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Cardiac hypertrophy is where the ventricle wall gets larger or thickens as a result of exercise, typically cardiovascular or endurance exercise as this gets the heart working harder and for longer periods of time.

https://www.bbc.co.uk/bitesize/guides/z367tyc/revision/2

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Long term effects of exercise on the body systems - Long and short term effects of exercise - Edexcel - GCSE Physical Education Revision - Edexcel - BBC Bitesize

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Learn about and revise long and short term effects of exercise with this BBC Bitesize GCSE PE (Edexcel) study guide.

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During exercise, your heart typically beats faster so that more blood gets out to your body. Your heart can also increase its stroke volume by pumping more forcefully or increasing the amount of blood that fills the left ventricle before it pumps.

https://myhealth.alberta.ca/health/pages/conditions.aspx?Hwid=tx4080abc

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NEW: Express access to COVID-19 vaccine record is now available.

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Cardiac output increases during exercise when your heart beats faster and pumps more blood out of the heart. During exercise, your cardiac output can increase to as much as 30 litres per minute, compared to about 5 litres per minute at rest.

https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=tx4080abc

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For the body to function properly, the heart needs to pump blood at a sufficient rate to maintain an adequate and continuous supply of oxygen and other nutrients to the brain and other vital organs. Cardiac output is the term that describes the amount of blood your heart pumps each minute. Doctors think about cardiac output in terms of the following equation:

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Being active lowers your blood pressure by reducing blood vessel stiffness so blood can flow more easily which keeps your heart and blood vessels in good shape, lowering your risk of heart disease and stroke.

https://www.bloodpressureuk.org/your-blood-pressure/how-to-lower-your-blood-pressure/healthy-living/exercise-physical-activity

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Whether you have high blood pressure or want to prevent it, it’s never too late to start. There’s lots of help available, and you don’t have to go the gym.

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Exercise reduces resting breathing rate by strengthening the muscles used for breathing, which means they need less oxygen to function. This improves your body's ability to use oxygen, and makes it easier to breathe.

https://www.asthmaandlung.org.uk/living-with/keeping-active/physical-activity

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Find out why exercise is good for your lung condition. We also have information about the different types of exercise you could do.

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Exercise improves lung capacity by strengthening the muscles around your lungs, increasing the number of capillaries in your lungs, and improving your body's ability to use oxygen.

https://www.lung.org/lung-health-diseases/wellness/exercise-and-lung-health

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You already know exercise is good for you. You probably think about the way it can boost your fitness, trim your waistline, strengthen you heart and even improve your mood. But did you know that exercise can also help keep your lungs healthy?

How Does Exercise Strengthen the Lungs?

When you are physically active, your heart and lungs work harder to supply the additional oxygen your muscles demand. Just like regular exercise makes your muscles stronger, it also makes your lungs and heart stronger. As your physical fitness improves, your body becomes more efficient at getting oxygen into the bloodstream and transporting it to the working muscles. That's one of the reasons that you are less likely to become short of breath during exercise over time.

Some types of exercise can also strengthen the muscles of the neck and chest, including the diaphragm and muscles between the ribs that work together to power inhaling and exhaling.

The Benefits of Exercise

Exercise has lots of benefits for everyone, whether you are young or old, slender or large, able-bodied or living with a chronic illness or disability. Physical activity can reduce your risk of serious illness, including heart disease, stroke, diabetes and some forms of cancer, including lung cancer. Being active can help you stay active, by strengthening bones, improving flexibility and agility, reducing weight gain and improving sleep. Regular exercise is good for your head too. It can reduce feelings of anxiety and depression, improve attention and memory, and reduce the risk of dementia, including Alzheimer's disease.

What Types of Exercise and How Much?

National guidelines recommend that all adults get 30 minutes of moderate physical activity five days a week. It doesn't have to be a formal exercise program to be beneficial. Some examples of moderate activity include walking briskly, recreational bicycling, gardening and vigorous housecleaning.

Both aerobic activities and muscle-strengthening activities can benefit your lungs. Aerobic activities like walking, running or jumping rope give your heart and lungs the kind of workout they need to function efficiently. Muscle-strengthening activities like weight-lifting or Pilates build core strength, improving your posture, and toning your breathing muscles. Breathing exercises in particular can strengthen your diaphragm and train your body to breathe more deeply and more effectively.

Some Things to Keep in Mind

Always talk to your doctor before you start or modify your exercise routine. This is especially important if you have an underlying health condition.

Avoid exercising outdoors when pollution levels are high. When the air is bad, walk indoors in a shopping mall or gym or use an exercise machine. Limit the amount of time your child spends playing outdoors if the air quality is unhealthy.

Exercising with Lung Disease

People living with lung disease can and should get regular exercise for all the same reasons as everyone else. Your lungs and heart stay stronger, you are better able to perform the tasks of daily living and you feel better in mind and body. But if you already are dealing shortness of breath, it can be intimidating to think about increasing your physical activity. It is important to work with your healthcare team to make a fitness plan that works for you.

To learn more about staying active with lung disease, check out the links below:

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Did you know that exercise can also help keep your lungs healthy? Just like regular exercise makes your muscles stronger, it also makes your lungs and heart stronger.

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Exercise, specifically cardiovascular, endurance and strength training will make the muscles around the lungs i.e. diaphragm and intercostal muscles stronger as they become adapted to training at higher intensities for more sustained periods.

https://www.physio-pedia.com/Respiratory_Muscle_Training

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Original Editor - Rachael Lowe

Respiratory Muscle Training (RMT) can be defined as a technique that aims to improve the function of the respiratory muscles through specific exercises. Inspiratory Muscle Training (IMT) in particular has been shown to increase inspiratory muscle strength, respiratory muscle function, and might help to reduce dyspnoea on exertion.

RMT is normally aimed at people who have respiratory conditions such as asthma, bronchitis, emphysema and COPD. However, many people adopt RMT as part of their sports training. It has also been found to be beneficial for individuals with other conditions, such as stroke/CVA, spinal cord injury , and Fontan physiology.

RMT may consist of Inspiratory Muscle Training (IMT) or Expiratory Muscle Training (EMT) or a combination of the two.

Respiratory muscles respond to training stimuli in the same manner as skeletal muscles i.e. by undergoing adaptations to their structure and function that are specific to the training stimulus.

Structural adaptations - changes in muscle fibre type, fibre cross-sectional area (hypertrophy) and muscle thickness have been demonstrated

Functional adaptations - improvements in strength, speed, power, endurance performance, peak inspiratory flow, maximal inspiratory and expiratory pressures have been demonstrated

There is evidence that RMT has many beneficial effects in healthy people and has been shown to improve athletic performance. Results of studies clearly indicate that IMT produces statistically significant improvements in performance but EMT does not. A more recent review has explored the use of RMT in hypoxic conditions. Hypoxic training has become more popular among athletes, but hypoxia related hyperventilation can have negative effects, including respiratory muscle fatigue during prolonged exercise. RMT was found to improve breathing patterns, make respiration more efficient, lower the perception of dyspnoea and improve performance in hypoxic conditions. An increase in inspiratory muscle strength, functional capacity, and quality of life in patients with heart failure occured after an isolated IMT.Another study indicated, that IMT promotes an increase of inspiratory muscle strength and diaphragmatic thickness in older adults.

The range of pathological conditions in which RMT has been implemented ranges from the obvious (e.g. COPD) to the unexpected (e.g. Diabetes, chronic kidney disease). The evidence for the use of RMT in these conditions varies widely from conditions where RMT is supported by systematic reviews and meta-analyses (e.g. COPD) to those where there is only theoretical rationale.

Effort related responses:

Breathing effort

Whole body effort

Metabolic related responses:

Respiratory muscle fatigue

Breathing pattern

Lactate turnover

Oxygen uptake kinetics

Maximal oxygen uptake

Maximum lactate threshold

1. Optimisation of blood flow distribution - when work of breathing increases, blood flow to the legs decreases. If the work of breathing is decreased, cardiac output reduces, thus blood flood to the legs can increase. It is believed that these changes can be explained by the metaboreflex. Every muscle, including respiratory muscles, have simple nerve endings. When metabolites accumulate, this stimulates these nerve fibres, which sends information to the cardiovascular control centres. This in turn triggers a reflex increase in sympathetic outflow, which causes limb and respiratory vasoconstriction. This reduces blood flow and increases blood pressure, thus explaining the changes in blood flow to the limbs. IMT is thought to affect this because training increases the intensity of inspiratory work required before the reflex is triggered. If the activation of this reflex is abolished or delayed, it is possible to maintain blood flow to the legs for longer, thus enhancing performance.

2. Attenuation of central fatigue - exercise adaptation improves cerebral oxygenation and positive improvement in central fatigue as shown in acute asthma. So exercise acclimatization protects against the development of central fatigue

3. Reduced sense of respiratory and peripheral effort - by manipulating the work of breathing (ie increasing resistance during training), exercise tolerance is affected. If the work of breathing is increased during training, exercise tolerance is also increased.

The force generated to overcome both frictional and static elastic forces that restrict lung expansion and gas flow through the lungs is defined as work of breathing.

There are three training principles that have been established for all skeletal muscles: overload, specificity and reversibility. These also apply to respiratory muscles.

Overload - to obtain a training response, muscles must be overloaded. Overload can be applied by altering duration, intensity or frequency. The accepted levels of duration, intensity and frequency used for IMT are:

intensity = 50-70 percent (typically yields failure within 30 breaths, or 2-3 mins)

duration = 30 breaths

frequency = twice daily

Specificity - the nature of the training response depends on the type of stimulus delivered. Muscles, including respiratory muscles, respond to strength training stimuli (high intensity, short duration) by improving strength and endurance training stimuli (low intensity, long duration) by improving endurance.

strength - respiratory muscles respond to high-load, low-frequency load with increased strength

endurance - endurance training can be achieved with low-load, high-frequency load. However, it is possible to improve endurance through strength training. Stronger muscles perform any given task at a lower percentage of their maximum capacity than weak muscles. Strong muscles are, therefore, able to sustain a given activity for longer periods

lung volume - respiratory muscle length is determined by lung volume, therefore IMT should be conducted over the greatest range of lung volume possible. Start as close as possible to residual volume (maximal exhalation) and end as close as possible to total lung capacity (maximal inhalation)

Reversibility

detraining - respiratory muscles respond in a similar way to other muscles when the training stimulus is removed. Most of the losses occur within 2-3 months of the cessation of training. Endurance is lost before strength. Short periods of detraining (1-2 months) can be accommodated without too much regression of functional gains.

maintenance - improvements in inspiratory muscle function can be sustained with training frequency reduced by as much as two thirds - ie 2 days per week in healthy adults and 3 days per week in patients with COPD

Training methods can be divided into two types: resistance training and endurance training. Resistance training is described as the most versatile due to the fact that it is the least time consuming and it results in a dual conditioning response (strength and endurance improvements).

Resistance training - inspiratory pressure threshold loading (IPTL) is by far the most commonly used, researched and validated method of RMT. Users breathe via a device (such as the Powerbreathe) that contains a pressure loaded inspiratory valve and an unloaded expiratory flap valve.

Endurance training - uses a technique called voluntary isocapnic hyperventilation (VIH) which requires people to maintain high levels of respiration for up to 40 mins. It utilises a hyperventilation method that employs a partial re-breathing circuit to prevent hypocapnia

RMT is indicated for anyone who is looking to improve exercise tolerance. This includes individuals with or without pathological processes, those who have dyspnoea and/or reduced exercise tolerance, as well as athletes/sports people. Research supports the use of IMT in certain classes of disease or conditions. These include: respiratory, cardiac and neuromuscular conditions, as well as around surgery and general ageing. A systematic review suggests that inspiratory muscle training is an effective post-operative treatment tool for patients undergoing cardiac surgery and there is strong evidence that this training improves inspiratory muscle strength, pulmonary function, and functional capacity and reduces patients' hospital stay.

Specific conditions where IMT has shown clinically significant benefits or there is a rationale for IMT based upon the presence of inspiratory muscle dysfunction and/or abnormal respiratory mechanics include: amyotrophic lateral sclerosis, ankylosing spondylosis, anorexia nervosa, arthritis, artificially ventilated patients, asthma, bronchiectasis, cancer, cerebral palsy, chronic heart failure, COPD, corticosteroid use, cystic fibrosis, diabetes, diaphragm paralysis, hypothyroidism, kyphoscoliosis, multiple sclerosis, muscular dystrophies, myasthenia gravis, obesity, obstructive sleep apnoea, Parkinson's, post-polio, pregnancy, pulmonary arterial hypertension, renal failure, sarcoidosis and interstitial lung disease, senescence, spinal cord injury, surgical patients (abdominal and thoracic) ventilator-induced myopathy and failure to wean, ventilatory failure (vulnerability to) vocal cord dysfunction and stridor. Some specific physiological indicators of inadequate respiratory muscle function:

Reduced respiratory muscle strength

Orthopnoea

Expiratory muscle flow limitation

Hyperventilation

Reduced respiratory system compliance

Elevated ratio of dead space to tidal volume

Tachypnoea

Hypoxaemia

Hypercapnia

Poor cough function

Inability to breathe without aid of mechanical ventilation

There have been no reports of adverse event following RMT, however there is a risk of barotrauma-related events. Accordingly, caution should be exercised in the following events:

History of spontaneous pneumothorax

Traumatic pneumothorax that has not fully healed

Burst eardrum or other conditions of the eardrum

Unstable asthma with an abnormally low perception of dyspnoea

Minimise hypercapnia in patients with coronary artery disease

May cause ear discomfort in people who have had a recent cold or sinusitis

Clinical judgement should be used in individuals who have experienced an acute exacerbation or chest infection

Individuals should be cautioned against sharing training equipment

Posture - has a role to play in obtaining optimal results. The ideal positions for foundation training are sitting or standing. Recumbent and semi-recumbent postures are known to impair respiratory muscle function and inspiratory muscle function is optimised in the upright position. Once foundation training is complete, training in functional positions can commence

Optimising breathing technique - choose the right training device, optimise the training stimulus it generates, use a good breathing technique (i.e. diaphragmatic breathing), use a good breathing pattern

Diaphragm breathing - disease related changes to the mechanics of breathing can lead to a reduction in diaphragm mobility. This, as well as exercise tolerance and breathing pattern, can be improved with a diaphragm breathing training program. Relearning normal efficient breathing strategies underpins Foundation IMT

Breathing pattern - breathing movements should take place over the largest range possible and maximise recruitment of the inspiratory musculature

Secretions - repeated deep inhalations against an inspiratory load have been found to have been twice as effective as standardised physiotherapy consisting of postural drainage and active cycle of breathing technique. Individuals, particularly patients with conditions such as bronchiectasis and bronchitis, may experience loosening of secretions following IMT. Accordingly, people need to be warned of this and advised on appropriate secretion clearance techniques.

Progress should be assessed by changes in:

1. Inspiratory muscle function - ensure that the training regime is stimulating adaptation in inspiratory musculature and that improvements in function are accommodated by increasing training intensity

2. Clinical outcomes that result from the former

Assessment of respiratory muscle function may utilise:

Maximal respiratory pressures (MIP) - provides a surrogate measure of strength and is the most widely used measure of IMT-induced changes in inspiratory muscle function. It is measured using a clinical apparatus against an occluded airway at a prescribed lung volume

Sniff inspiratory pressure - an alternative to MIP which measures the pressure in the nostril during a maximal sniff

Peak inspiratory flow rate - has been shown to improve in response to moderate IMT training. Requires a mechanical peak inspiratory flow meter

Inspiratory muscle endurance - there is no standard test for this, but the tests fall into two categories: hyperpnoea tests and inspiratory loaded breathing tests

The evaluation of clinical benefits will vary enormously between patient populations. The outcome measures selected need to be specific for the clinical population being addressed whilst also being sensitive to the effects of IMT.

IMT starts with Foundation training. Foundation training is underpinned by diaphragmatic breathing and a good breathing pattern. It takes place for 6 weeks prior to moving on to functional training.

Foundation training concepts:

Use a training load of 50-60%of MIP or set intensity to a 30 repetition maximum (30RM) - i.e. repetition failure occurs at 30 breaths, using a process of trial and error (repetition failure of the inspiratory muscles is an inability to achieve a satisfying breath)

Use stretching and warm-up to prepare for IMT.

Inhale against load with maximum effort (as fast as possible).

Breathe in and out as far as possible during each breath

Train twice per day - morning and evening not less than 6 hours apart

Increase the training load at least once per week

Progress the training by maintaining it at 50-60% of the new MIP or keeping the load at the new 30RM to account for improvement

Train to failure in a window between 25-35 breaths per session

Keep in mind that at certain times of day, other activities and health status may affect IMT because of residual fatigue

If you suspect that there is residual fatigue of the inspiratory muscles, take a day off

Keep an IMT diary

Progression - functional training can be initiated after 6 weeks of Foundation IMT. It should be undertaken at least 3 days per week and always in tandem with Foundation training which should be undertaken at least 3 days per week

Maintenance - maintenance training can be initiated after 12 weeks of IMT. Reduce frequency to once every other day

Pre-habilitation - implementing IMT prior to whole-body training has been shown to improve the outcome of the whole-body training and can therefore be considered effective rehabilitation

Incorporating into rehabilitation - can be done prior to, during or after a rehabilitation session

Warm up - 2 sets of 30 breaths at 40% MIP with 1 minute of rest between. It should be completed no more than 10 minutes before IMT training

Cool down - aids the clearing of metabolites to help with recovery and adaptation

Stretching - thoracic stretching will reduce any musculoskeletal resistance to inhalation and can result in improvements in chest wall expansion and functional residual capacity therefore increasing the effectiveness of RMT

The role of the respiratory muscles extends beyond their role in driving respiration. They are also a vital component of our postural control and core stabilisation. This non-respiratory function is pivotal to performance and injury prevention.

The non-respiratory roles of the respiratory muscles are often brought into conflict with their role in breathing. The external manifestation of this conflict is dyspnoea that is disproportionate to the ventilatory demand of activity. It can also compromise the effectiveness with which the respiratory muscles contribute to their non-respiratory core-stabilising functions.

The objective, therefore, of functional training is to also enhance the core stabilisation role of the respiratory muscles. In this way, the respiratory function of the respiratory muscles can be optimised to improve core stability. This is achieved by performing IMT in positions that challenge core stability. Two approaches can be taken in the selection of exercises for an individual:

1. Use a generic set of around 10 exercises that provides holistic benefits

2. Create a bespoke set of exercises specifically for the individual e.g. tasks that are particularly challenging for a patient, sporting positions or actions used by an athlete

1. Should be preceded by a 6 week period of Foundation IMT and development of good diaphragmatic breathing technique.

2. Ensure the individual has good technique and exercise form before adding any resistance

3. Start by performing each exercise with nothing more than a focus on maintaining, slow, deep diaphragmatic breathing throughout. Then add external resistance to inhalation using an inspiratory muscle training device (IMTD) set on its minimum load

4. Gradually increase the load on the IMTD over a period of a few weeks

5. Workouts should be preceded by stretching and mobilising exercises

6. An individual workout should consist of around 10 exercises

7. Exercises should be performed at least 3 times per week - Foundation IMT should be practised on the other days

Sample exercise videos can be viewed at Physiobreathe

1. Wu F, Liu Y, Ye G, Zhang Y. Respiratory muscle training improves strength and decreases the risk of respiratory complications in stroke survivors: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. 2020 Nov 1;101(11):1991-2001.

2. Wu FM, Opotowsky AR, Denhoff ER, Gongwer R, Gurvitz MZ, Landzberg MJ et al. A Pilot Study of Inspiratory Muscle Training to Improve Exercise Capacity in Patients with Fontan Physiology. Semin Thorac Cardiovasc Surg. 2018; 30(4):462-469.

3. Illi SK, Held U, Frank I, Spengler CM. Effect of respiratory muscle training on exercise performance in healthy individuals: a systematic review and meta-analysis. Sports Med. 2012 Aug 1;42(8):707-24.

4. Alvarez-Herms J, Julia-Sanchez S, Corbi F, Odriozola-Martinez A, Burtscher M. Putative role of respiratory muscle training to improve endurance in hypoxia: A review. Front Physiol. 2018; 9

5. Dipp T, Macagnan FE, Schardong J, Fernandes RO, Lemos LC, Plentz RD. Short period of high-intensity inspiratory muscle training improves inspiratory muscle strength in patients with chronic kidney disease on hemodialysis: a randomised controlled trial. Brazilian Journal of Physical Therapy. 2020 May 1;24(3):280-6.

6. McConnell, A. Inspiratory muscle training: history and putative mechanisms. Frontiers in Sport and Exercise Science and Medicine Seminar on inspiratory muscle training, Centre for Sports Medicine and Human Performance, Brunel University, April 2013

7. McConnell, A. Methods of respiratory muscle training. Chapter 5 in: Respiratory Muscle Training: Theory and Practice. Elsevier, 2013.

8. McConnell, A. Implementing respiratory muscle training. Chapter 6 in: Respiratory Muscle Training: Theory and Practice. Elsevier, 2013.

# data[].attributes.attachment_link.description
Original Editor - Rachael Lowe Respiratory Muscle Training (RMT) can be defined as a technique that aims to improve the function of the respiratory muscles through specific exercises. Inspiratory Muscle Training (IMT) in particular has been shown to increase inspiratory muscle strength, respiratory muscle function, and might help to reduce dyspnoea on exertion.

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As your physical fitness improves through cardiovascular and endurance training, your body becomes more efficient at getting oxygen into the bloodstream and transporting it to the working muscles.

https://www.lung.org/lung-health-diseases/wellness/exercise-and-lung-health

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You already know exercise is good for you. You probably think about the way it can boost your fitness, trim your waistline, strengthen you heart and even improve your mood. But did you know that exercise can also help keep your lungs healthy?

How Does Exercise Strengthen the Lungs?

When you are physically active, your heart and lungs work harder to supply the additional oxygen your muscles demand. Just like regular exercise makes your muscles stronger, it also makes your lungs and heart stronger. As your physical fitness improves, your body becomes more efficient at getting oxygen into the bloodstream and transporting it to the working muscles. That's one of the reasons that you are less likely to become short of breath during exercise over time.

Some types of exercise can also strengthen the muscles of the neck and chest, including the diaphragm and muscles between the ribs that work together to power inhaling and exhaling.

The Benefits of Exercise

Exercise has lots of benefits for everyone, whether you are young or old, slender or large, able-bodied or living with a chronic illness or disability. Physical activity can reduce your risk of serious illness, including heart disease, stroke, diabetes and some forms of cancer, including lung cancer. Being active can help you stay active, by strengthening bones, improving flexibility and agility, reducing weight gain and improving sleep. Regular exercise is good for your head too. It can reduce feelings of anxiety and depression, improve attention and memory, and reduce the risk of dementia, including Alzheimer's disease.

What Types of Exercise and How Much?

National guidelines recommend that all adults get 30 minutes of moderate physical activity five days a week. It doesn't have to be a formal exercise program to be beneficial. Some examples of moderate activity include walking briskly, recreational bicycling, gardening and vigorous housecleaning.

Both aerobic activities and muscle-strengthening activities can benefit your lungs. Aerobic activities like walking, running or jumping rope give your heart and lungs the kind of workout they need to function efficiently. Muscle-strengthening activities like weight-lifting or Pilates build core strength, improving your posture, and toning your breathing muscles. Breathing exercises in particular can strengthen your diaphragm and train your body to breathe more deeply and more effectively.

Some Things to Keep in Mind

Always talk to your doctor before you start or modify your exercise routine. This is especially important if you have an underlying health condition.

Avoid exercising outdoors when pollution levels are high. When the air is bad, walk indoors in a shopping mall or gym or use an exercise machine. Limit the amount of time your child spends playing outdoors if the air quality is unhealthy.

Exercising with Lung Disease

People living with lung disease can and should get regular exercise for all the same reasons as everyone else. Your lungs and heart stay stronger, you are better able to perform the tasks of daily living and you feel better in mind and body. But if you already are dealing shortness of breath, it can be intimidating to think about increasing your physical activity. It is important to work with your healthcare team to make a fitness plan that works for you.

To learn more about staying active with lung disease, check out the links below:

# data[].attributes.attachment_link.description
Did you know that exercise can also help keep your lungs healthy? Just like regular exercise makes your muscles stronger, it also makes your lungs and heart stronger.

# data[].attributes.body
During aerobic exercise, your heart and lungs work together pumps oxygenated blood to working muscles to help them burn fat and carbohydrate for fuel, which in turn enables you to perform for extended periods.

https://www.scienceinsport.com/sports-nutrition/aerobic-endurance-explained

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Join us as we discuss Aerobic Endurance, how to improve it and the benefits it can have on your overall health and training.