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Original papers

A comparison of two 3-week resistance training


programmes commonly used in short-term
military rehabilitation
Jakob Kristensen,1 S Burgess2
1
Academic Department for ABSTRACT extrapolating from repetition continuum tables it
Military Rehabilitation, Defence Introduction Resistance training is an important com- is evident that a 10RM load, as utilised by the
Medical Rehabilitation Centre
(DMRC), Headley Court, Surrey,
ponent of rehabilitation due to its ability to increase DAPRE protocol, corresponds to approximately
UK muscular strength and enhance functional ability. The 70% of 1RM11–14 and therefore is of sufficient
2
Complex Trauma Unit, DMRC, aim of this study was to assess the effects of two differ- intensity to induce improvements in maximal
Surrey, UK ent resistance-training programmes currently used in mili- strength. However, the two first sets of the DAPRE
tary rehabilitation. loading protocol merely employ a percentage of
Correspondence to
Dr Jakob Kristensen, MPhil, Method 27 male rehabilitation patients, serving with the the 10RM and consequently do not fall within the
CSCS, Higher Scientific Officer Armed Forces and suffering from a range of lower limb mus- intensity bracket needed to improve maximal
(HSO), Academic Department culoskeletal injuries were divided into two matched groups. strength. Thus, in effect the DAPRE system only
for Military Rehabilitation, Group 1 (n=14) performed the Daily Adjusted Progressive features two main work sets that fall within the
Defence Medical Rehabilitation
Centre, Headley Court, Epsom, Resistance Exercise (DAPRE), whereas Group 2 (n=13) required intensity range. Whilst strength increases
Surrey KT18 6JW, UK; performed the Functional Strength Training (FST). An 8 repe- have been observed with single and double set/low
jakob.kristensen711@mod.uk tition maximum (8RM) deadlift and countermovement verti- volume resistance training programmes it is
cal jump (CMVJ) test were used as Functional Assessment widely accepted that a multiple set approach to
Tests (FATs) and as measures of changes in strength and resistance training results in enhanced physiological
power, respectively. Both were conducted on admission and adaptations that is, increased strength and muscle
at discharge. mass.14–18 Another possible issue with the use of
Results Lower limb strength and power increased signifi- the DAPRE system is the fact that it is generally
cantly in both the DAPRE (p≤0.001/p≤0.001) and the FST used with resistance training machines rather than
(p≤0.001/0.001) groups. There was no significant differ- free weights. Evidence suggests that performing
ence between groups for either strength (p≥0.05) or power the same movement with free weights (FF) versus
(p≥0.05). fixed-form resistance machines (FX) leads to signifi-
Conclusions Short-term resistance training during cantly higher activation of stabiliser muscles19 20
rehabilitation can lead to gains in strength and power Enhanced activation of these is generally consid-
despite differences in programme design. However we con- ered to be beneficial in patients suffering from mus-
clude that three weeks of resistance training is insufficient culoskeletal injuries.1 2
duration to see significant differences between different In an attempt to overcome these problems an
training protocols. alternative resistance training programme, which
follows more recent guidelines for resistance pro-
gramme design1 9 14 has also been utilised at the
INTRODUCTION Defence Medical Rehabilitation Centre (DMRC).
Resistance training is an important component of This ‘functional strength training’ (FST) pro-
rehabilitation due to its ability to increase muscular gramme (Table 2) is based on the three powerlifts
strength and enhance functional ability.1–4 The resist- (squat, bench press, deadlift), while the remainder
ance training component of the military rehabilitation of the training volume is made up of functional
model has traditionally been administered using the exercises which are derivatives of the core lifts
Daily Adjusted Progressive Resistance Exercise (overhead squat, step-up, lunges, Romanian dead-
(DAPRE) protocol. This system was first developed by lifts, high-pulls). Patients typically perform 3–5
Knight in 19795 as an easy way of applying progres- exercises with each exercise comprising four sets of
sive overload to a resistance training programme in a 4–6 repetitions at 80–85% of 1RM. All four sets
rehabilitation setting (Table 1). for each exercise are completed before moving to
However, there are inherent concerns with the the next exercise. This programme is repeated three
use of the DAPRE protocol as a resistance training times per week and the training load increased
method. Evidence shows that resistance training weekly based on the ‘2 for 2’ rule described by
induces neural adaptations, both within the central Baechle et al.14
nervous system (CNS) and peripheral nervous The military currently only runs 3-week rehabili-
system (PNS).6 7 These neural adaptations result in tation courses at the DMRC; however there are
increased maximal strength and rate of force devel- no current studies investigating the magnitude of
opment (RFD) within the trained musculature. It is improvements seen in such a short timeframe.
widely accepted that loads above 70% of 1 Furthermore, no previous studies have investigated
To cite: Kristensen J, Repetition Maximum (1RM) are needed to elicit the effects of DAPRE versus functional resistance
Burgess S. J R Army Med neural or morphological adaptations in skeletal training methods on measures of strength and
Corps 2013;159:35–39. muscle in response to resistance exercise8–10 When power within a rehabilitation context. Based on the

Kristensen J, et al. J R Army Med Corps 2013;159:35–39. doi:10.1136/jramc-2013-000008 35


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Original papers

Table 1 DAPRE loading protocol as developed by Knight5 Table 3 Anthropometric characteristics of participants (mean
SET 1 2 3 4
values with standard deviation in brackets)
Group N Age (years) Height (cm) Weight (kg)
RESISTANCE 10 reps @ 50% of 6 reps @ Max Max reps @
10RM (established at 75% of reps @ adjusted weight DAPRE 14 30.7 (5.4) 177.2 (7.5) 82.6 (6.3)
baseline) 10RM 10RM (+2.5–5 kg)
FST 13 31 (6.5) 178.1 (4.8) 84.7 (6.5)
Rest between Sets: 3–5 mins.
Training frequency: Every day. RM, repetition maximum.

participants in the FST group only completed 7 resistance train-


current evidence in the literature we hypothesised that patients ing sessions.
in the FST group would exhibit significantly better improve-
ments in strength and power when compared to the DAPRE Statistics
group. The aim of this study was therefore to assess the effects A one-way analysis of variance (ANOVA) was used to assess
of two different resistance-training programmes currently used changes in response to the two resistance training programmes.
in military rehabilitation. Overall gains within groups was analysed with a paired t test.
The alpha level was at p≤0.05 for all analyses. All statistical ana-
lyses were carried out using SPSS V.16.0 (SPSS Inc. USA).
METHOD
Patients RESULTS
Twenty-seven participants were all admitted to the DMRC as Anthropometric results for the 27 male rehabilitation patients
part of ongoing rehabilitation for a range of heterogenous lower that participated in this study can be seen in Table 3. Values
limb musculoskeletal injuries, including anterior compartment given were those on admission, prior to commencement of the
syndrome, anterior knee pain (AKP) and patella/meniscus disor- exercise-based rehabilitation programme.
ders were divided into two groups. All patients were matched The within-groups results showed that lower limb power
for age, height, weight and gender. (CMVJ score) increased significantly in both the DAPRE
( p≤0.01) and the FST ( p≤0.001) groups at discharge. The mag-
nitude of improvements in CMJ were higher in the FST group
Design and there was less dispersion in the overall data. Nevertheless,
The overall design was considered a service evaluation in which no significant difference was observed between the two pro-
a matched-groups analysis of successive cohorts was utilised. grammes in terms of improvements in lower-body power
Group 1 performed the DAPRE protocol while Group 2 per- ( p≥0.05) (Figure 1).
formed the functional strength training programme (FST). Similarly, lower limb strength (DL score) increased signifi-
Lower body strength was assessed in both groups at admission cantly in both the DAPRE ( p≤0.001) and the FST ( p≤0.001)
and discharge using the 8-RM deadlift. Evidence suggests that groups at discharge. The relative magnitude of improvement in
the deadlift, due to its muscle recruitment pattern may be an the two intervention groups is presented in Figure 2. No signifi-
effective closed kinetic chain (CKC) exercise to employ in lower cant difference was observed when comparing the effects of the
limb rehabilitation.21 Due to the untrained nature of the two different resistance training protocols on lower body
patients a trap-bar was used for ease of execution. Lower body strength development.
power was assessed in the same testing sessions using the
counter-movement vertical jump (CMVJ). This test has served DISCUSSION
as the field test of choice in determining lower body power for The results of the present service evaluation indicate that during
decades,1 9 14 and has been validated accordingly.22 a 3-week rehabilitation programme the DAPRE and FST resist-
Due to the increased training frequency advocated by the ance training programmes are equally effective at improving
DAPRE protocol, participants in this group completed 13 resist- measures of lower limb strength and power in a group of
ance training sessions during their admission period, whereas patients suffering from a range of lower limb musculoskeletal

Table 2 Example of a functional strength training session (X denotes as explosively as possible)


Exercise Loading Tempo Rest Progression Frequency

Back Squat 4 sets 40X 3–5 mins Add 2,5–5 kg 3× per week
4–6 reps 2 for 2 rule
8RM (85% 1RM)
Bench Press 4 sets 40X 3–5 mins Add 2,5–5 kg 3× per week
4–6 reps 2 for 2 rule
8RM (85% 1RM)
Trap Bar Deadlift 4 sets 40X 3–5 mins Add 2,5–5 kg 3× per week
4–6 reps 2 for 2 Rule
8RM (85% 1RM)
Dumbbell Lunge 4 sets 40X 3–5 mins Add 2,5–5 kg 3× per week
4–6 reps 2 for 2 rule
8RM (85% 1RM)
RM, repetition maximum.

36 Kristensen J, et al. J R Army Med Corps 2013;159:35–39. doi:10.1136/jramc-2013-000008


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Original papers

Figure 1 Increases in Power (CMVJ)


in response to the two training
protocols. Error bars represent
standard error of mean (SEM).

injuries.. However, use of the FST programme appears to be suggests that improvements in lower body strength and power
associated with a lower variability in the training outcome. The are achievable in as little as three weeks. A large body of evi-
DAPRE programme was characterised by a very large variation dence suggests that the majority of these short-term improve-
in the results i.e. responders vs. non-responders, whereas all ments are due to neural adaptations,1 6 7 9 10 however,
subjects in the FST showed improvements in muscle strength emerging evidence does suggest that significant increases in
and power. muscle cross-sectional area (CSA) can be observed in as little as
Although no significant differences were observed in the 3 weeks.23 Because we did not assess possible muscle hyper-
present study between the DAPRE and FST resistance training trophy through Magnetic Resonance Imaging (MRI) or ultra-
programmes the relative improvements were of a greater magni- sound, we cannot rule out that morphological adaptations
tude in the FST group. It is possible that these differences could contributed to the increased muscle strength observed in
have reached statistical significance with a greater sample size or response to either training programme.
if the resistance training programme would have been extended Due to its reliance on compound multi-joint movements
beyond the 3-week mark, as evidence suggests that strength and coupled with a high-intensity loading protocol, the FST pro-
power continue to develop and reach higher magnitudes after gramme was considered more stressful to the neuromuscular,
6–10 weeks of continued resistance training.1 9 10 Thus, the fact endocrine and immune system than the lower-intensity
that the DMRC currently only runs 3-week rehabilitation weight-machine-centred DAPRE programme and thus, was only
courses, due to logistical constraints, may limit the benefits of performed 3 days a week. There is general agreement in
the resistance training programmes. However, the present study the literature that resistance training sessions which are

Figure 2 Increases in deadlift


strength in response to the two
training protocols. Error bars represent
standard error of mean (SEM).

Kristensen J, et al. J R Army Med Corps 2013;159:35–39. doi:10.1136/jramc-2013-000008 37


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Original papers

associated with a high overall body stress necessitate a reduced FST training programme is used in intermediate-stage rehabilita-
training frequency1 9 10 14 18 It is therefore worth noting tion due to its time effectiveness and lower variability in training
that due to the increased frequency of the DAPRE programme outcome.
(13 vs 7 sessions), participants in the DAPRE programme com-
pleted a much higher training volume but failed to see a con- Competing interests None.
comitant increase in strength and power when compared to the Provenance and peer review Not commissioned; externally peer reviewed.
FST group. It is plausible that the higher training intensity in
the FST group off-set the reduced training volume and led REFERENCES
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Kristensen J, et al. J R Army Med Corps 2013;159:35–39. doi:10.1136/jramc-2013-000008 39


Downloaded from http://jramc.bmj.com/ on April 30, 2017 - Published by group.bmj.com

A comparison of two 3-week resistance


training programmes commonly used in
short-term military rehabilitation
Jakob Kristensen and S Burgess

J R Army Med Corps 2013 159: 35-39


doi: 10.1136/jramc-2013-000008

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