Resistance and Balance Training Program Design Guidelines

Introduction

Resistance and balance training are integral components of a well-rounded exercise program, essential for improving strength, enhancing functional performance, and reducing the risk of injury. Both forms rely on systematic, evidence-based approaches to ensure safety, effectiveness, and adherence.

A structured resistance training program develops muscular strength, endurance, and power, while balance training supports stability, coordination, and agility. Together, they provide a foundation for improved physical performance and overall quality of life.

This chapter will explore key principles and methodologies for resistance and balance training with a focus on assessment, program design, and progression. It introduces the concept of periodization as a critical framework for optimizing outcomes alongside practical strategies for addressing individual needs. By integrating resistance and balance training into a cohesive plan and beginning with the initial assessments, the goal of this chapter is to equip fitness professionals and individuals with the tools to build programs that are adaptable, progressive, and impactful.

Strength Assessment

Strength is defined as "the maximal force a muscle group can produce at a specified velocity" (Sands 2012). Strength is expressed as a one repetition maximum (1RM), the maximum load an individual can lift with proper form. An increase in 1RM indicates improved strength; otherwise no strength gains have occurred.

To evaluate strength effectively, the following tests are commonly recommended:

• Smith Machine squat
• Leg press
• Knee extension
• Bench press
• Overhead press

Strength tests are performed as "repetition maximum" (RM) tests whereby after an adequate warm-up the subject is expected to perform one to six repetitions with the maximum weight they are capable of lifting (1 to 6RM). This assumes that the subject can maintain proper form under maximum (1RM) or near maximal (2 to 6RM) loads.

RM tests should be reserved for select individuals as the untrained general population generally lacks the experience and self-efficacy needed to perform these tests safely. It is the fitness professional's responsibility to determine the risk versus the reward of asking the client to engage in maximum or near maximal testing (Riebe 2018).

FYI: A growing body of evidence supports using Rate of Perceived Exertion (RPE), Repetitions in Reserve (RIR), Face of Strain (or Effort), and Velocity of Movement as practical and reliable metrics for determining initial loads and guiding progression (Munoz-Lopez 2018; Uchida 2018).

Research demonstrates that lifting a load at or above 80% of an individual's 1RM, or within any maximal repetition range of 8 or fewer reps, can lead to significant increases in absolute strength (Riebe 2018). Given this, it is unnecessary to rely solely on 1RM testing as a dedicated assessment method within a single session, especially for beginners and novices.

Instead, strength can be effectively and safely evaluated within the Familiarization Phase of training using "The RPE Method" (a combination of RPE, RIR, Face of Strain, and observed slowing of movement velocity). This approach aligns with best practices, minimizes injury risk, and provides a more natural and integrated way to assess strength as part of a progressive program.

Strength-Endurance Assessment

Strength-endurance is defined as "the ability of a muscle group to execute repeated contractions over a period of time sufficient to cause muscular fatigue or to maintain a specific percentage of the maximum voluntary contraction (1RM) for a prolonged period of time." Strength-endurance is typically assessed and trained when repetitions reach 12 and above.

Examples of recommendations for strength-endurance, i.e., local muscle endurance, assessment include the following:

• Plank
• Push-up
• Abdominal curl-up (Riebe 2018)

Research also demonstrates that these tests are specific to the muscle groups being tested and are limited in their ability to assess whole-body local muscular endurance. Therefore, as with strength testing, the recommendation is that the fitness professional use The RPE Method.

The Purpose for Initial Assessments

The rationale for performing an initial assessment includes:

• Finding a baseline for future comparisons of improvement or to demonstrate the rate of progress
• Identifying current fitness levels to aid in exercise program design
• Aiding in exercise selection, frequency, volume, and intensity
• Developing realistic short, medium, and long-term fitness goals
• Having an opportunity to record decisions regarding appropriate scope of practice in case the client experiences an injury or an exacerbation of a current medical condition after the program begins (Jacobs 2018)

The most important benefit of performing repeated assessments is for the exerciser to observe positive improvements from their baseline levels of fitness and see progress towards achieving their goals. Assessments serve as a source of ongoing motivation.

All the above rationale can be obtained via The RPE Method and ongoing evaluation within the design of the program. The fitness professional can ultimately make a case-by-case decision whether maximal testing is warranted. However, the use of The RPE Method is safe and adequate in most cases and easier to implement.

To be clear, the recommendation is for the fitness professional or exerciser to choose between traditional strength and strength-endurance testing (e.g., 1RM bench press; abdominal curl-up) or The RPE Method. The primary purpose for testing within general and special populations is not to determine maximal strength or strength-endurance, but rather to establish fitness level and determine initial loading and appropriate exercise selection, frequency, volume, and intensity.

Since those characteristics can also be determined using The RPE Method, this method is frequently the better choice. Many individuals will lack the fitness, self-efficacy (confidence), and skill to perform exercises with maximal or near maximal loads right from the start. A learning curve may be necessary prior to increasing loads and overall intensity, which would negate the need for traditional strength and strength-endurance assessments.

Assessing strength and strength-endurance may be incorporated during the Familiarization Phase (initial program design or Transition Phase) as opposed to a session dedicated only to testing. In this case the fitness professional will place early emphasis on assessing movement during each exercise. This provides the opportunity to teach proper form using light to moderate loads, ensures safety, helps develop trust, and allows for assessment of strength based on loads lifted relative to established norms.

Flexible Linear Periodization

Introduction

Exercise and Periodization: A Synergistic Relationship

What is Exercise?

Exercise is a subcategory of physical activity that is intentional, planned, structured, and repetitive with the purpose of improving or maintaining physical fitness, performance, or health. Unlike general physical activity, exercise is more systematic and goal-oriented, designed to achieve specific outcomes.

What is Periodization?

Periodization refers to the systematic, planned, and structured manipulation of the variables that define an exercise program. By strategically adjusting factors such as intensity, volume, and frequency, periodization optimizes fitness and performance over time. For athletes it ensures peak performance aligns with key competitions, while for others it sustains progress and prevents plateaus.

The close alignment between the definitions of exercise and periodization underscores their interdependence. Exercise is inherently systematic and goal-driven, and periodization provides the framework to achieve those goals efficiently. Without periodization, an exercise program lacks the structure necessary for optimal results. Simply put, a non-periodized program is a suboptimal approach to exercise.

Periodization: A Deeper Dive

Periodization is a fundamental approach to program design that adjusts training variables in a planned, systematic way to enhance fitness and performance. Among the various periodization models, Linear and Non-Linear Periodization are the most commonly utilized.

• Linear Periodization involves progressively decreasing training volume while concurrently increasing intensity over a specific period. This model is straightforward and effective for gradual predictable progress (Turner 2011).
• Non-Linear Periodization takes an undulating approach with volume and intensity fluctuating throughout the training cycle. This model accommodates more frequent changes, making it adaptable to individual needs and preferences (Fleck 2011).

Flexible Periodization

In the early 2000s, Flexible Periodization gained attention for its emphasis on adjusting the program based on an individual's readiness to train (Kraemer 2007). Unlike traditional models, which often fix training variables in advance, flexible periodization allows for real-time modifications.

For example, if a scheduled heavy training session coincides with poor sleep, high stress, or feeling unwell, adjustments can be made to reduce volume, intensity, or even substitute exercises (e.g., swapping deadlifts for leg presses). The heavy session can then be rescheduled when the individual is better prepared.

This chapter focuses on the Flexible Linear and Non-Linear Periodization models, offering practical frameworks to optimize the resistance training variables outlined in Chapter 4.

Additional Background

Periodization originated in the 1950s and 1960s, developed by Russian and Eastern Bloc researchers based on Seyle's General Adaptation Syndrome (GAS). GAS identifies three stages of the body's response to a new stressor (Haff 2004):

1. 1.Shock: The initial response, lasting from weeks to months, where the body experiences muscle soreness and perceives the stress as a threat.
2. 2.Adaptation: The stage where the body adjusts to the stress, improving fitness and performance.
3. 3.Plateau: The final stage where adaptation has peaked and no further progress occurs unless the stressor changes.

The goal of periodization is simple: maximize the adaptation stage while avoiding the plateau. This is achieved by systematically manipulating training variables to maintain a productive level of stress.

Key principles to keep in mind when designing a program include:

• Plan: Develop a structured plan
• Log: Record progress to guide adjustments
• Periodize: Strategically manipulate training variables
• Adapt: Start with simpler models (e.g., flexible linear) and progress to more complex models (e.g., flexible non-linear)
• Auto-Regulate: Adjust plans based on individual readiness during sessions

While this book does not cover the conjugate model of periodization, it emphasizes the importance of applying the appropriate model for each individual, beginning with flexible linear periodization.

All periodization models share a common goal to enhance four key physiological adaptations: conditioning, strength, power, and hypertrophy by optimizing training variables over time. Strength in particular is foundational to improving the other three adaptations, making it essential to dedicate adequate time to lower repetition ranges (e.g., 4 to 8 reps per set).

Core Resistance Training Variables

As discussed in Chapter 4, resistance training program design involves manipulating several variables including:

1. 1.Frequency of training
2. 2.Intensity (objective and subjective)
3. 3.Sets per muscle group
4. 4.Repetitions per set
5. 5.Load selection for each exercise
6. 6.Exercise order
7. 7.Exercise selection
8. 8.Tempo of movement
9. 9.Rest periods between sets
10. 10.Recovery between sessions
11. 11.Active rest or deload phases
12. 12.Breathing techniques

The complexity of these variables highlights the value of periodization, which integrates them into cohesive adaptable programs. This is typically done through structured phases lasting two to four weeks.

General Description of the Scope of a Session, Week, Phase, and Cycle

Periodization models often refer to cycles such as micro-cycles, meso-cycles, and macro-cycles, which can be abstract terms. To simplify, this chapter will describe periodization in practical terms, addressing:

1. 1.The scope of an individual session
2. 2.How sessions fit into a week
3. 3.How weeks fit into a phase
4. 4.How phases fit into a cycle

By systematically addressing each level of scope, this approach ensures a clear, effective structure for resistance training programs.

Scope of a Session

Frequency determines the general setup of a session. For general and special populations, time and desire will commonly determine how frequently someone is going to train. Therefore, when designing a program, the first thing to decide is: how many days per week does the person have the time and desire to strength train?

Evidence-based guidelines suggest training each major muscle group in the body two to three times per week. Generally speaking:

• If a person only has the time or desire to resistance train twice per week, the sessions should be set up in a total-body format to ensure every major muscle group is trained twice per week (Garber 2011).
• If a person has the time and desire to resistance train three times per week, they have two options: perform one total body session and two split routines (e.g., one upper body session and one lower body session), or perform three total body sessions. In these scenarios, each major muscle group is trained two or three times per week.
• If a person has the time and desire to train four or more days per week, the sessions should be set up in a split routine format (e.g., upper body one session and lower body the next, or push exercises one session and pull exercises the next) (Stand 2009).

The setup of a session is explained in more detail in Chapter 8.

Scope of a Week

In a properly designed periodized program, the fitness professional must address the frequency, intensity, and volume of training and how to manipulate these variables to optimize long-term outcomes.

Frequency

As mentioned above, optimal training frequency for each major muscle group is two to three times per week (Schoenfeld 2015). Training a muscle group only once per week results in six days of rest, which, while sufficient for gains in the short term if intensity and volume are high, is not an ideal long-term approach.

Unfortunately, many people adopt suboptimal routines such as training one muscle group per session over five to six sessions weekly or combining two muscle groups in three sessions per week (e.g., chest and triceps on Monday, back and biceps on Wednesday, legs and shoulders on Friday). Conversely, training a muscle group more than three times per week, particularly larger muscle groups, can hinder recovery due to insufficient rest. This approach increases the likelihood of overtraining, which may lead to injury or pain.

Intensity

Apart from the Familiarization Phase, where intensity should initially be light-to-moderate and progress to hard (i.e., 7 RPE), weekly programming during the ongoing Flexible Linear Periodized program should include variation in intensity. Training sessions should not consistently be either light or heavy.

Instead, a balanced program alternates between varying levels of intensity over the course of the week. For those training with lower frequency (e.g., two to three sessions per week), the extended rest periods (four to five days) allow for one or two sessions to be heavy or hard, with the remaining session(s) at moderate intensity. This approach takes advantage of the increased recovery time to accommodate higher-intensity efforts.

In contrast, for individuals training four or more days per week, the reduced recovery time necessitates incorporating light-to-moderate sessions throughout the week. This minimizes central nervous system and joint stress, enabling long-term progression and reducing the risk of overtraining. Fitness professionals and individuals must evaluate readiness on a session-by-session basis, adjusting intensity levels according to physical and mental preparedness while monitoring progress in fitness and performance.

Volume

To achieve significant benefits from strength training, there is a minimum volume threshold to aim for. While any activity is better than none, evidence-based programs recommend targeting at least eight sets per large muscle group (legs, back, chest, and shoulders) per week to maximize results. For instance, an individual training three times per week, performing three working sets for each muscle group in each session, would meet the minimum threshold.

Periodizing weekly volume by varying between eight and twenty sets per large muscle group is an efficient, evidence-based strategy for sustained progression (Phillips 2019). This structured ebb and flow of workload ensures continued adaptation while minimizing the risk of overtraining.

Scope of a Phase

Phase lengths are defined as the number of weeks spent within a specific repetition range. In a Flexible Linear Periodization model, phase lengths typically range from two to four weeks. Referring to the General Adaptation Syndrome (GAS) outlined in Chapter 1, the body requires sufficient time to adapt to a stressor, in this case the repetition range and corresponding loads. However, extending a phase too long risks stagnation through over-adaptation and plateaus.

The goal is to identify the sweet spot where adaptation occurs without diminishing returns. Since a typical GAS stage can last as little as two weeks, this supports the two to four-week phase length as optimal for training progression. Below is a common example of how to manipulate phases within a Flexible Linear Periodization model beginning with the Familiarization Phase.

Initiating the Program and Assessing the Individual

The Familiarization Phase

The initial phase, known as the Familiarization Phase, typically spans two to four weeks. During this time both the individual and the coach navigate the natural learning curve. The focus is on starting at a low intensity, determining the individual's fitness capacity, progressing gradually, teaching fundamentals, building trust, and fostering self-confidence.

This phase provides both the body and mind time to adapt within their comfort zone before progressing to more challenging levels. It is an "ease into a progressive strength and conditioning program" period and it includes three sub-domains and associated attributes and goals:

Familiarization

• Learn the different names of exercises, flow of a session, and provide opportunities for the exerciser to ask questions. Be sure to assess for trigger points and teach (or learn) concepts such as the FITT principle for their trigger point release, flexibility, and aerobic program design.
• For individuals who suffer from joint pain, use this period as a time to determine their available pain-free range of motion.
• Begin at a low (safe) level and gradually progress by increasing volume and/or intensity. Training at or near 10 repetitions for all major muscle groups (except for core exercise) is a reasonable place to start.
• Begin with loads that are easily handled, which allows exercisers to experience success, as opposed to beginning with loads or exercises that are too challenging. This aids in the process of learning and the feel of how the body is responding to resistance training. It will help alleviate fears and build self-efficacy.
• Use The RPE Method, described in Chapter 4, to determine safe initial loads rather than performing repetition maximum testing, i.e., a 5RM bench press or 5RM Smith machine squat.
• Assess and correct, as needed, movement with all exercises such as squats, hip hinge, lunge, push, pull, press, and core exercises. During this time begin with conservative loads and place emphasis on correct form.
• Extensively use verbal, visual, e.g., mirrors and video feedback, and tactile, i.e., touching, cues to help develop mind-body connections. Also use feedback to instill confidence and self-efficacy.

Adaptation

• This phase allows the body to gradually respond to the new exercise stressors which minimizes the associated soreness and increases adherence.

Assessment

• Since it is impossible to create tests and assessments to locate movement dysfunction and imbalance for every exercise in a program, the Familiarization Phase should also be viewed as an Assessment Phase. During this period assessments are made in real time from session to session. Regular corrections occur via verbal, visual, and tactile cues to help establish familiarity and neuromuscular control.

Assessments also occur whenever it is appropriate to insert a new exercise into the program. Ideally, they also occur throughout the program with various loads, at different speeds, and under conditions of fatigue.

Note: Once this initial phase is completed, there is no need to return to it unless there is an extended layoff and the individual needs to readdress initial loads or reestablish proper form with specific exercises.

The end of the Familiarization phase and start of ongoing progression is determined by:

• The individual's proficiency at performing primary exercises
• An increase in intensity to an RPE of at least 7 on a 1 to 10 scale, i.e., the velocity of movement slows at the end of working sets
• Little to no delayed onset muscle soreness
• No joint pain

It is the fitness professional or individual's responsibility to determine the end of the Familiarization Phase.

Ongoing Progression, The Flexible Linear Periodized Program

Once that determination has been made, progression is defined by the start of a Flexible Linear Periodized program. A common example would be:

• Progress to 12 to 15 repetitions per set for each major muscle group (excluding core exercises) for a two to four-week phase. During this phase the primary goal is to increase the loads for each major muscle group so that they are slightly stronger in each exercise as compared with week one of this phase. This prepares the body to drop two repetitions per set and enter the next phase.
• Progress to 10 to 12 repetitions per set for each major muscle group (excluding core exercises) for a two to four-week phase. During this phase the primary goal is to increase the loads for each major muscle group so that they are slightly stronger in each exercise as compared with week one of this phase. This prepares the body to drop two repetitions per set and enter the next phase.
• Progress to 8 to 10 repetitions per set for each major muscle group (excluding core exercises) for a two to four-week phase. During this phase the primary goal is to increase the loads for each major muscle group so that they are slightly stronger in each exercise as compared with week one of this phase. This prepares the body to drop two repetitions per set and enter the next phase.
• Progress to 6 to 8 repetitions per set for each major muscle group (excluding core exercises) for a two to four-week phase. During this phase the primary goal is to increase the loads for each major muscle group so that they are slightly stronger in each exercise as compared with week one of this phase.
• Prior to moving back to 12 to 15 repetitions per set and repeating the cycle, insert one to two weeks of active rest or a one to two-week deload period. This time allows the exerciser to recover and recuperate from the cycle of four phases before beginning again.
• The fitness professional or exerciser also has the option to transition to a Flexible Non-Linear Periodization model described later in this chapter.

Scope of a Cycle

A cycle denotes the completion of the sum of two to four-week phases. The fitness professional or individual should progress across three or four phases following the Familiarization Phase, no more and no less. An example of four phases was given above, i.e., 12 to 15 repetitions per set, 10 to 12, 8 to 10, and 6 to 8.

A common example of a three-phase cycle is to:

• Begin at 15 repetitions per set for each major muscle group (excluding core exercises) for a two to four-week phase.
• Progress to 10 repetitions per set for each major muscle group (excluding core exercises) for a two to four-week phase.
• Progress to 5 repetitions per set for each major muscle group (excluding core exercises) for a two to three-week phase.
• Include an active rest or deload period of one to two weeks and then cycle through the phases again or move to a Flexible Non-Linear Periodization model.

The best results for improving conditioning, strength, power, and hypertrophy are obtained by spending most of the time training within the 4 to 15 repetition range and taking sets to "at or near" muscle failure. Therefore, with few exceptions, the phases should be set up so that the exerciser is training across that entire spectrum of repetitions over time.

Progressing to a Flexible Non-Linear Periodization Model

Understanding Undulating Repetition Ranges

Flexible Non-Linear Periodization (FNLP) involves alternating repetition ranges in a wave-like or undulating pattern across training sessions or weeks. Unlike linear periodization, which progresses through fixed phases of high to low repetitions over weeks or months, FNLP provides variability within a shorter time frame.

The primary theme across all periodization models, including FNLP, is to incorporate higher repetition ranges (e.g., 12 to 15 reps), moderate repetition ranges (e.g., 8 to 12 reps), and lower repetition ranges (e.g., 4 to 8 reps). This strategy optimizes physiological adaptations including:

1. 1.Conditioning (higher repetitions)
2. 2.Strength and Power (lower repetitions)
3. 3.Lean Muscle Tissue Development (all repetition ranges)

Common Methods of Non-Linear Periodization

There are two predominant ways to implement FNLP:

1. 1.Within-Week Variation: Different repetition ranges are used on separate training days within the same week (Table 6.3).
2. 2.Week-to-Week Variation: Each week emphasizes a different repetition range (Table 6.4).

Benefits of Flexible Non-Linear Periodization

FNLP retains the overarching goal of improving health and performance across the lifespan by:

• Providing more variety, which can increase motivation and adherence.
• Offering flexibility to adapt programs based on individual readiness and preferences.
• Serving as an ideal progression after beginning with a linear periodization model.

Example Training Programs

Practical Application

FNLP offers a flexible and effective framework for optimizing adaptations in conditioning, strength, and hypertrophy. Its variability allows exercisers to avoid monotony and better manage training fatigue. Additionally, FNLP's adaptability makes it suitable for individuals seeking a structured yet dynamic approach to resistance training, particularly those transitioning from a Familiarization Phase or recovering from an extended training layoff.

The inclusion of all repetition ranges ensures comprehensive physiological development and supports sustained progress over time. By incorporating FNLP, fitness professionals can design programs that are adaptable, engaging, and tailored to individual needs, fostering long-term adherence and success.

Using Objective Benchmarks to Guide Strength Progression

Progressing a resistance training program, much like an aerobic program (discussed in Chapter 5), should be deliberate, data-driven, and grounded in objective benchmarks. Table 6.5 presents normative strength standards for the general population, serving as a valuable reference for tracking performance and guiding purposeful progression.

Fitness professionals are encouraged to familiarize themselves with these standards, monitor client progress, and set goals to advance clients beyond the beginner category. With a well-designed, progressive, and periodized training program, achieving intermediate strength levels is attainable for everyone. This emphasis on measurable fitness aligns with a central theme of this book: using objective standards to accurately assess and enhance individual fitness.

The normative values above generally apply to individuals between the ages of 20 and 40. Subtract 5% from each value for the 5th decade of life (40 to 49), an additional 5% for the 6th decade of life (50 to 59), and 10% for each decade of life thereafter.

Case Study: Resistance Training Program Design for a 45-Year-Old Novice

Client Background

Jane Doe, a 45-year-old woman, is a novice exerciser with no prior structured resistance training experience. She works a sedentary desk job and reports mild lower back discomfort due to prolonged sitting. Jane's goals include improving overall strength, reducing back pain, and enhancing functional fitness for daily activities like lifting groceries and climbing stairs. She can commit to training three times per week and prefers a gym setting with access to standard equipment.

Step 1: Initial Assessment

• Screening: Completed PAR-Q+ and provided medical clearance. No contraindications noted. Exercise intake form and initial consultation provided additional background information.
• 3-Week Familiarization Phase (Assessment Phase): Used phase to determine initial loads for each major muscle group and progressed from a 5 RPE in Week 1 to a 7 RPE in Week 3. Frequency of training progressed from twice per week in Week 1 to three times per week in Weeks 2 and 3. Set volume progressed from two in Week 1 to three sets per muscle group in Weeks 2 and 3.
• Flexibility and Mobility following Joint Range of Motion Assessment: Tight hamstrings and hip flexors, moderate thoracic spine immobility.

Key Findings:

• Deconditioned with below-average strength and core stability.
• Needs to address imbalances and mobility limitations before progressing to heavier loads.

Step 2: Program Design Using the Familiarization Phase

• Frequency: 3 sessions per week.
• Intensity: Start with a 7 RPE for all exercises, gradually increasing to an 8 RPE by Weeks 3 and 4.
• Volume: Total body sessions, 3 sets per exercise during the first two weeks, progressing to 4 sets for the primary muscle groups (legs, back, chest, shoulders) in Week 4.
• Rest: 90 seconds to 2 minutes between sets for multi-joint exercises; 30 to 60 seconds for single-joint exercises.
• Focus: Emphasis on proper form, foundational movement patterns, increasing strength by the end of the phase, and building confidence.

Example Program (Weeks 1-4)

Step 3: Progression and Adjustments

• Weeks 5-8: Progress to 10 to 12 repetitions per set with heavier weights (RPE 7 to 8), maintain set volume (3 to 4 for major muscle groups), and introduce new exercises like deadlifts with a barbell or lunges.
• Monitor and Reflect: Evaluate Jane's feedback during sessions and track her strength improvements with a training log.
• Focus on Balance: Include dynamic balance exercises (e.g., side shuffle, backwards walk) once weekly to improve balance and proprioception.

Outcome After 8 Weeks

• Jane reports significant decrease in lower back discomfort and improved posture at work.
• Squat depth increased and she now performs goblet squats with a 20 lb dumbbell.
• Can hold a plank for 30 seconds with proper alignment.
• Increased confidence in her ability to progress to more advanced exercises.

This structured progressive approach ensures that Jane builds a strong foundation for long-term success while addressing her initial limitations.

Balance Assessment

Common balance testing protocols include static and transitional balance testing such as one-legged standing, forward reach, and Y-balance tests. It is critically important to understand that a growing body of evidence shows little transfer between static and dynamic balance (Kummel 2016; Rainer 2018). Dynamic balance is more important as it relates to decreasing the risk of falling. Static balance is important for creating isometric strength-endurance at the foot/ankle complex.

This type of training would be ideal for someone who is weak and hypermobile at the foot/ankle. After performing a joint range of motion assessment (described in more detail in Chapter 7), the fitness professional can determine if a static balance assessment is appropriate.

A recommended dynamic balance test is the Backwards Walk Test. The fitness professional should create a safe area and measure three meters (approximately 10 feet) with a visible start and end point. The client should be instructed to walk backwards across the three meters at the fastest pace they feel comfortable performing while the fitness professional walks with them as a spotter. On a "Go" command, the fitness professional, or preferably an assistant, will begin timing.

Completing the test in less than three seconds is considered "Excellent" and the client has a low risk of falling. Completing the test in 3.0 to 4.5 seconds is "Average" and the client is at moderate risk of falling. Completing the test in longer than 4.5 seconds is "Poor" and the client is at high risk of falling (Carter 2019).

While initial assessments provide baseline information and points of reference to refer to, they rarely change the approach for the design of the program. The corrective for nearly all weakness, imbalance, and dysfunction found as the result of any assessment is the consistent engagement in a safe, total body, progressive, flexible Periodized strength and conditioning program and a properly balanced mobility program as explained in this book.

Balance Training Program

Balance is defined as control of the center of mass over the base of support. Balance exercises fall into four general categories:

1. 1.Static: no movement and no change in the base of support; usually performed in an unstable environment (e.g., standing on one leg; standing on a bosu ball).
2. 2.Proactive: recovering from an unexpected perturbation (e.g., recovering from an unexpected push, pull, bump, or nudge).
3. 3.Reactive: anticipating a perturbation and reacting in advance. These also include transitional balance exercises where movement occurs but with no change in base of support (e.g., squat, lean, reach).
4. 4.Dynamic: movement which includes a change in the individual's base of support (e.g., lunge, step-down, backwards walk, grapevine walk).

Recent research studies and literature reviews have shown that strength is a primary component of balance (Abraham 2014); that balance is most likely task specific as opposed to a general ability; and that there is little transfer from static balance training to dynamic balance tasks (Rainer K 2018). This means that all types of balance should be included within the design of a program.

Referring to Seyle's General Adaptation Syndrome and the Principle of Specificity, it also means that a primary mechanism to improve balance is by improving general strength. Static balance exercises such as standing on one leg or standing on an unstable surface will primarily improve static postural sway and local muscle endurance (strength-endurance) at the foot-ankle complex (Saud 2019). This is particularly important for seniors and individuals with a hypermobile ankle who are at increased risk for ankle sprains. However, this type of training has little transfer in fall prevention during dynamic situations.

To improve overall balance a training program should include tasks that focus on improving:

1. 1.Strength
2. 2.Quickness / Reaction time
3. 3.The ability to change the base of support quickly to accommodate what is occurring in the moment
4. 4.Force absorption (e.g., step downs)

An example of a program that addresses these areas would be:

1. 1.Total body strengthening (2 to 5 days per week). Include single leg exercises such as multi-directional lunges, step ups, and single leg squats if possible.
2. 2.Explosive movements both bilaterally and unilaterally (e.g., Olympic lifts, jumps, hops, bounds).
3. 3.Three-dimensional awareness (e.g., backward walking/jogging, sideways and diagonal movements, shuffling, agility drills to improve quickness and reaction time). These attributes are optimally improved via recreational or competitive sports and activities such as tennis and basketball.
4. 4.Force absorption (e.g., step-downs, hops, jumps, bounds).

Unstable Surface Training

Fitness professionals and exercisers may consider the use of unstable surface training within a program such as stability balls, bosu balls, airex pads, and dyna discs. However, a large body of research shows that as the instability of a training environment increases, the load being used must decrease. Therefore, unstable surface training is not ideal for optimal strength adaptations (Behm 2015; Hubbard 2010; Kohler 2010).

Unstable surface training does increase muscle activation patterns, allowing the recruitment of smaller intrinsic muscles that aid in joint stabilization. This type of training can improve neuromuscular timing, improvement in the co-contractions around joints. An optimal approach to including unstable surface training into a program is by using these types of exercises as part of a dynamic warm-up (e.g., bodyweight squats on dyna discs or single leg balance on an airex pad) or as part of a separate therapeutic or recovery training session.

Revolving programs around unstable surface training is an inefficient approach which should be avoided.

Practical Application of Balance Training Variables

A comprehensive balance training program integrates static, reactive, proactive, and dynamic exercises to improve control, strength, and stability. Initial sessions may include static exercises such as single-leg stands to enhance postural control and foot-ankle stability. Progression involves dynamic tasks like multidirectional lunges or step-downs, focusing on force absorption and balance under movement.

Incorporating strength training, quickness drills, and agility exercises (e.g., backward walking, lateral shuffles) addresses the diverse components of balance. Explosive movements such as hops or jumps enhance neuromuscular coordination and reaction time. Unstable surface training can be used sparingly as part of warm-ups or recovery sessions to improve joint stabilization.

Programs should emphasize specificity, tailoring exercises to the individual's needs such as fall prevention for older adults or performance enhancement for athletes. Progression through task complexity ensures sustained improvement in balance, functional mobility, and overall physical competence.

Summary

This chapter emphasizes the integration of resistance and balance training as essential components of a comprehensive exercise program. It outlines key methodologies for assessing and enhancing muscular strength, endurance, and balance, highlighting the importance of systematic progression through flexible periodization models.

This chapter's emphasis on flexible linear periodization reinforces the universal algorithm's principle of adaptability, ensuring that progression aligns with individual readiness and capacity.

Key Points

1. 1.Strength and Endurance Assessment: Incorporates practical methods like The RPE Method to evaluate and guide program intensity while minimizing risk, especially for beginners.
2. 2.Flexible Linear and Non-Linear Periodization: Provides structured progression through repetition ranges, optimizing strength, endurance, and hypertrophy.
3. 3.Balance Training: Focuses on improving dynamic stability through targeted strength, reaction time, and force absorption exercises supplemented by specific tasks like agility drills and single-leg movements.
4. 4.Program Design: Advocates for tailoring exercise selection and intensity to individual needs, incorporating real-time assessments, and adapting to readiness levels for optimal results.

By systematically addressing strength and balance, this chapter provides a pathway to enhance physical resilience and performance. Through structured assessments and progressive training, clients achieve balanced development across all fitness domains.

Recognizing that The Medical Fitness Bible is part of a larger ecosystem which includes instructional videos developed to "bring the book to life," the reader is directed to www.MRFInstitute.org. It would be beneficial to view the videos as they provide greater clarity to the information presented in this chapter.