Laurie's Blogs.

Last week, we discussed the things you need to THINK about for progressing your patients with exercise therapies, and the questions you need to ask yourself about the patient (and owner).  This week, I want to talk about HOW to progress a patient.  More specifically, what components you can change in order to progress your patient?  Let’s dive in!

Last week’s blog can be found here:  https://www.fourleg.com/Blog?b=553 

Firstly, you need to ask yourself, what is my goal?  Do I need to build cardiovascular endurance?  Do I want to build strength? Power? Is my exercise goal to improve muscular endurance?  Balance? Technical difficulty?  Speed?  Am I trying to get this dog back to a sporting level of fitness? Or, are you just looking to improve lameness, weight bearing, and overall use of the limb?

Next, you need to take into account the current fitness level of the dog.  If your dog was healthy and athletic prior to requiring rehab, then you can likely progress these dogs faster and move them towards their sport-specific needs sooner than your couch-potato dog.  If your patient is the couch potato, then you need to consider that any exercise in your therapy sessions is also working to accomplish a certain amount of general conditioning as well.

Establishing your first exercise session is a bit of a guess and some trial and error.  As I said in the last blog, we tend to start most all of our dogs with 15 minutes in the UWT (if we are using the UWT).  Water height is dependent upon the acuity and condition being treated.  Initial speed should be dependent upon ‘best gait’… that where the dog looks best and moves as close to their ‘normal’ as possible.  If I am conducting a land exercise session, I test multiple exercises to see what the animal can do, which exercises are safe for the stage of healing, and which exercises will challenge the animal and push them towards the goal we are trying to achieve.  I like the owner to be there during that session to watch and see what I am seeing and learn how to do the exercise with their dog.  I come up with my home program based on these trial and error exercise sessions.

How can I progress an exercise session?

I have seven components at my disposal when it comes to exercise prescription:

Intensity

Exercise intensity refers to how much energy is expended when exercising. Perceived intensity varies with each subject.  Oxygen consumption (VO2) would be an objective measure, but that’s not very practical in a clinical setting.  I found the following article / table online however, which might have use clinically. 

(from Swanson et al 2019 - https://pubmed.ncbi.nlm.nih.gov/30693513/)

What should be noted in regards to intensity however, is that you increase intensity by increase one of the following parameters.

Duration

The amount of time spent participating in one session of physical activity is the "exercise duration." Fitness levels and goals determines the exercise duration for each workout. The intensity at which you work out also factors into duration.   So, if you want aerobic capacity and endurance, you exercise at a lower intensity for longer.  If you want to establish anaerobic power (i.e. for an agility dog or a flyball dog), then you incorporate interval training and bursts of speed within your exercise sessions.  In this scenario the duration of exercise is shorter, but the intensity (or bouts of intensity) is greater.

Resistance

Resistance training increases muscle strength by making your muscles work against a weight or force.  For dogs, this tends to be resistance using their own body weight  but could include using a weighted vest while doing exercises (i.e. push-ups) or regular activity (i.e. walking up a hill).  Other approaches might include puling against resistance or tug of war activities.  Here is where we want to create a little muscle fatigue in order to improve muscle strength as the body recovers from the bout of exercise.

Speed

Speed can be defined as the ability to move the body in one intended direction as fast as possible. Therefore, speed training is a type of exercise training designed around improving the ability to move the body in one direction as fast as possible.  High intensity interval training (HIIT) and/or sprint training targets the goal of speed acquisition.  This is easily done on a treadmill or in an UWT.  HIIT times will increase as the dog improves in capacity, but as a general rule, the low exertion sessions are longer than the high exertions interval times (i.e. starting with 20 seconds of high interval training followed by 2 minutes of low exertion exercise for recovery), repeated a few times in a session.  This can be done for any dog, but is very applicable to the canine athlete.  Of note, when training for speed, duration of exercise tends to be lower.

Repetitions and Sets

One repetition (Rep) is defined as one complete motion of an exercise.  One “Set” is a consecutive number of Reps without stopping.  Now, we have to go back to our goals when determining reps and sets.  Do you want muscular endurance?  Then you do a lower load with more repetitions (i.e. 12 – 20 reps of one or more sets with short rest periods between sets).

If you want muscular hypertrophy, the weight lifting community says to aim for 6 – 12 reps and 3 – 5 sets with longer rest periods and heavier weights.

For strength and power (i.e. for most athletes), then you aim for 1 – 5 reps of the heaviest weight you can lift, pull, push, etc., with even longer rest intervals. This could be difficult in our canine population… but worth thinking about and knowing.

When it comes to SETS, I found the following reference from the National Strength and Conditioning Association:

•  2-3 will help build muscular endurance (12 to 20+ reps)

•  3-6 build muscular hypertrophy (6 to 12 reps)

•  3-5 build muscular power (3 to 5 reps)

•  2-6 build muscular strength (less than 6 reps)

How do you know where to start?  Pick something.  See how it goes.  Do more next time.

Complexity

Complexity, pertains to the process of selecting and implementing exercises, moving from general to specific motor patterns, from closed kinetic chain (CKC), slow controlled movement to open kinetic chain (OKC), fast action-reaction, from discrete to serial skills, from predictable to unpredictable environment in the effort to promote optimal motor development and carry over from training to competition.

Think about what an agility dog needs to do.  All of the different movements and skills that are necessary, the dynamic stability, the body awareness, the reaction times, and so on!  This is the end-stage rehab.  Here is where you need to understand the ‘job of the dog’ and the stresses place on the body to be successful in their sport or recreational activities.  Incorporate some of these into the late stages of rehab.  (Small rant:  You don’t targe complexity or strength in the Underwater Treadmill!  Get them out of there when you are in the later stages of rehab!)

Frequency

Frequency: refers to how often you exercise.  Here, we have no research to guide us when it comes to dog.  When it comes to humans, my review of multiple bits of research found the following in regards to CONDITIONING:

Cardio -20 – 30 min, 3 – 5 x / week

Strength or Power  -2 – 3 x / week

Flexibility - 2 – 3 x / week  (1 rep x 30 second holds)

Balance - 2 – 3 x / week x 10 - 15 minute session

HIIT (could replace cardio)-15% of workouts

Plus, we need to figure out where we fit in components of agility, tendon training, body awareness, sport specific needs and skill training.  Warm up and cool down needs to incorporated, and some rest time too!

From a REHAB perspective (and not a Conditioning perspective), we do want our patients to be doing some kind of exercise every day that targets our REHAB goals.

So, how do you progress exercises in your canine patient?  Choose from the above categories to create a progression.  Note that older dogs progress slower than younger dogs.  Typically, I try to only progress one or two components at time within an exercise session… however, each session should have a progression, even if just a small one!  Then watch for the response…

Was the dog sore after the exercise session?  Did that soreness last more than a day?  Could the dog ‘warm up’ out of stiffness? (If yes, that’s great, if no, then the exercise session was too much).  Was the soreness associated with an increase in joint pain / swelling?  (Again, that indicates too much exercise.)

All of this culminates in my thinking that the next blog needs to be about Exercise Outcome Measures!  Hmmm…

So, until next time,

Cheers!

Laurie