Tendinopathy is a broadly defined as a painful condition occurring in and around tendons in response to overuse or under-preparation.
Resistance exercise has been shown to be effective for improving outcomes for these common tendon problems for athletes.
However, the effect of different resistance training dosing variables such as intensity, volume and frequency is not well understood.
Fortunately, a new largest-to-date meta-analysis of 110 studies across 5 common tendinopathies provides much needed insight.
How does training intensity, volume, and frequency influence tendinopathies?
What did the researchers do?
Researchers performed a systematic review with meta-analysis and meta-regression investigating the moderating effects of resistance exercise dosing variables, including intensity, volume, and frequency.
Training dose variables:
- Frequency - number of training sessions performed per week
- Volume - total number of sets and repetitions
- Intensity - bodyweight vs external load in absolute or relative terms
Outcomes of Interest:
- Disability
- Function
- Pain
- Range of motion for rotator cuff related shoulder pain (RCRSP)
- Physical function capacity
- Quality of life
Included in study:
- 110 studies were included across
- 148 treatments arms
- 3,953 participants
- 5 tendinopathy types
What did they report?
- Higher intensity resistance training had consistent evidence of greater pooled mean effect sizes comprising additional external resistance compared with body mass only.
- Less frequency had greater efficacy, implying benefits of adequate recovery, compared with higher frequencies of once or more per day.
- Training volume pooled mean effect sizes were minimal and inconsistent.
What does this mean?
- Higher intensity using external loads versus bodyweight alone appears to better.
- Frequencies spread across the week with off days appears to be better than every day or multiple times per day.
- Effect of volume was unclear, given that majority of studies used similar volume of 3x15.
Worth Noting Limitations
- Exercise dose across studies is poorly reported making firm conclusions challenging.
- Intensity was binary categorized as bodyweight or above bodyweight
- Muscle actions were not differentiated between eccentric, isometric, concentric.
Coach's Takeaway
- Use of external load greater than bodyweight should be prescribed for tendon pain, assuming pain is tolerated well.
- Use of less frequent but higher intensity sessions with adequate recovery between allows for greater stimuli-recovery-adaptation cycles compared to daily or multiple sessions per day.
- As intensity is progressed above bodyweight, start with a high-low or on-off cycle and adjust based response of the athlete.
