a) RESISTANCE TRAINING COMPONENT
(1) Our client wanted to achieve both strength gains in the squat exercise and hypertrophy gains of their legs our client’s routine had to reflect both aspects of these different training techniques. Which is why we decided to break up the routine into two separate days with one focusing on strength and the other focusing on hypertrophy. Our program 1 was likely to achieve strength due to the number of sets, intensities and repetitions we prescribed. Rhea et al.1 and Marshall et al.2 concluded from a study that the optimal number of sets for trained individuals (those who had been regularly lifting weights for over a year) was 4 to help maximal gains in strength development. Rhea et al. also concluded that the best weights to elicit strength gain was around 80% of 1RM, with a repetition count of 4-6, which we prescribed at 5 repetitions. We allowed 3min rest intervals between sets and the beginning of new exercises to help recovery of the muscle and attain greater strength gains3.

(2) Program 2 was this time designed to focus on hypertrophy of the client’s legs, the programs number of repetitions, sets, intensity, exercise selection and rest intervals reflected this. A meta-analysis of hypertrophy by Scheonfeld4 concluded that maximal hypertrophy gains can be achieved using at least 60% of 1RM, for 8-12 repetitions for 4 sets helping to achieve the basic principle of hypertrophy of higher volume, multiple set protocols. Our clients program reflected this using 60% or 1RM weights, 10 repetitions per set for 4 sets. Scheonfeld4 also noted the importance of differing exercise selection to elicit stress to different muscles on different force planes causing different activation patterns. This is why our program includes squats, front squats, lunges and Romanian dead-lifts, all movements with different planes of movement which will help total lower limb hypertrophy. Rest intervals remained at 3 mins between sets and different exercises to let the muscle recover and be able to perform a greater volume3.
(3) The quality of our evidence that helped us design our training program combined both meta-analysis and published journal articles from an array of journals to help us conclude on what best to describe for our client. We had one meta-analysis by Rhea et al published fairly recently in 2003 in ASCM’s journal. It included 140 studies with a combined total of 1433 participants, an impressive effect size. Although it was noted that the study used both published and unpublished journals. The other meta-analysis was by Scheonfeld4 which was published by the Journal of Strength and Conditioning Research which looked at a total of 205 published studies.
The journal articles that were used were both very recently published, Marshall et al.2 in the European Journal of Applied Physiology and De Sallas et al.3 in the Journal of Science and Medicine in Sport. Marshall et al used 43 healthy male trained athletes who had been regularly lifting weights for at least over a year in a 12-week trial. Whilst De Sallas et al.3 used 36 recreationally trained men who also had been lifting weights regularly for over a year that participated in a 16-week trial. Both journals used a specific (trained) and fairly large effect size for their trials over a reasonably long period of time, both great attributes to help increase the validity of the studies.

b) NUTRIONAL COMPONENT
(1) In order to develop strength it is critical that there is adequate energy intake to meet the needs of training and that carbohydrate intake is sufficient to maintain glycogen stores. The consumption of the 140-330g of carbohydrates 3 to 5 hours before exercise has shown to increase muscle glycogen levels and improve exercise performance5. The ingestion of carbohydrates before exercise has three important effects on the body, there is a brief decline in plasma glucose with the onset of exercise, an increased carbohydrate oxidation causing an accelerated breakdown of glycogen and blunting of fatty acids. These metabolic changes do not have a negative effect to exercise performance because there is an increased carbohydrate availability, which compensates for greater carbohydrate utilisation. There are few studies that have studied the long-term effects of high and low carbohydrate intake during training and the adaptations of each. In a short term study conducted by Simonsen et al., carbohydrate intake and performance adaption was compared using a moderate carbohydrate intake of 5g.kg.b.w.-1 and a high intake of 10g.kg.b.w.-1. Upon completion of the 4-week trial period the study showed that there was a power increase of 1.6% for the moderate carbohydrate diet and 10.7% for the high intake diet. Branch chain amino acid (BCAA) supplementation increases the availability and utilisation of BCAA, which is theorised to decrease catabolism during heavy training. BCAA have been shown to reduce central fatigue whish during training may help improve training adaptations and strength6.
(2) In this nutrition plan protein intake is at 1.7g.kg.b.w.-1 this is based on the protein requirements for resistance exercise is greater because amino acids may be oxidised during exercise and the resistance exercise increases protein synthesis and additional protein is necessary to repair damage to muscles. As a result of resistance exercise muscle protein synthesis increases, as does protein degradation to a lesser extent. The balance between these two outcomes determines the net protein balance. In order to maximise strength and hypertrophy gains a positive protein balance is essential. In order to reduce muscle protein breakdown carbohydrate and protein ingestion with essential amino acids can reduce this muscle protein breakdown due to the increase of plasma insulin levels. Insulin I an anabolic hormone and has been shown to have the effect of reducing protein degradation post-exercise. Therefore, the ingestion of protein and carbohydrates along with supplementation of essential amino acids is critical in improving hypertrophy, as it will ensure that there is a positive protein balance where by protein synthesis rates are greater than degradation rates. The ingestion of carbohydrates after exercise is important for hypertrophy as it results in higher muscle glycogen as well as being synthesized at a higher rate. Carbohydrate intake immediately after exercise has shown higher rates of glycogen storage during the first 2 hours of recovery. A study conducted by Wojtaszewski7 concluded that if carbohydrates are not consumed post exercise there is a lower rate of glycogen restoration until the required nutrients are ingested. Therefore in terms of improving hypertrophy it is important to have carbohydrates immediately post exercise to allow the muscle cells to start effective recovery and take advantage of the enhanced glycogen synthesis. The consumption of creatine monohydrate is based on evidence shown by Olsen et al. (#) that there is direct biochemical and physiological effects of creatine. Several studies have shown an increase in the accumulation of fat free mass and even gains in strength in periods of resistance training. Tarnopolsky et al.8 studied the supplementation of creatine monohydrate and carbohydrate intake versus casein protein and carbohydrate intake and found there was a greater increase in fat-free and total mass in the creatine monohydrate group. Based on these findings creatine monohydrate was incorporated into this training program in order to aid in hypertrophy and increase the subjects fat free mass.
(3) The systematic review conducted by Hargreaves et al.5 is the highest level of evidence as it encompasses. The review focuses on high quality randomised control trials evaluating the data and drawing conclusions based on the available evidence. In the study design conducted by Simonsen et al. was a randomised control study involving highly trained individuals making it relevant to this six-week prescription. The random allocation of subjects reduces the risk of allocation bias and the researchers were blinded as to which group the participants were in. The blinding plays a major role in reducing bias among the researchers and allows for more reliable results. The randomised control trial conducted by Ratamess6 involved 17 participants with a history of resistance training over a 4 week training period. This trial is relevant to this six week training program as the participants have a simular training history to the subject in this six week trial. The design of the trial was aiming at increasing strength and hypertrophy using high volume resistance training. A limitation to this study was the short period of training however the results were able to show substantial changes in the participants during the program and a clear difference between the intervention and control group.
c) GENERAL COMPONENTS
(1) Our program did exceed ACSM for the initial 6-weeks, but only by 0.1, and our client was left with some serious fatigue and pain especially in their back and knees. A main strength this program had in regards to the ability to burn fat and increase our clients lean body mass was the combination of compound exercises in each session. The use of the variety of squats, deadlifts and lunges played a crucial role in our decrease in body fat and increase in lean body mass as they use up a large number of muscles and also require more of a whole body movement, increasing metabolism. Our client showed signs of hypertrophy after this 6-week training program and beat ACSM convincingly in this area. One factor leading to this result was the appropriate volumes used for each exercise. As identified by Schoenfeld4, the appropriate volumes required for hypertrophy are roughly 60%-70% 1RM, and our program placed the volumes within these brackets for the majority of the sets and exercises. Also for our hypertrophy gains, we used appropriate rest intervals of 90 seconds between sets. Schoenfeld4 also identified the appropriate rests for hypertrophic gains are between 60-90seconds to allow the body to recover enough to be able to lift the desired weights again for the required repetitions and sets.
Lastly our program design also lead to significant hypertrophy due to its appropriate repletion ranges set out. 6-12 repetitions are required in order to elicit hypertrophic gains within the worked muscle, and placing out client within these ranges for his exercises allowed for this positive result4. Carbohydrate (CHO) intake was adequate enough to result in no loss of muscle mass, and also didn’t lead to excess storage of CHO in the body, resulting in fat. It has been shown by Hargreaves5 that the intake of roughly 140-330g (relative to body mass) prior to training in order to have adequate supplies for energy in the session. Our nutritional plan provided the appropriate foods and timing of food leading up to the session to provide this source of energy and the prevention of the use of muscle proteins as a fuel source, leading to a decrease in muscle mass. Due to the serious overtraining experienced by our client during this program, even though CHO intake was adequate, there was serious fatigue that lead to a decrease in strength over the program. Directly after our training session, our client consumed a meal of protein and CHO to help replenish lost fuel sources, increased protein synthesis and in turn helps to aid recovery9. This allowed for an increase in performance ability and helped lead to gains in hypertrophy. Once again, due to the poor program design in regards to strength, the nutritional plan could not balance out the extreme fatigue experienced. Providing our client with a high protein diet and also a high protein meal directly after training helped for muscle protein resynthesis to help build up the muscle cells (Hypertrophy) and aid in recovery. Our nutritional plan provides 1.7g.kg.b.w.-1 of protein for resistance training as directed by Ivy & Ferguson9.
Another factor that has lead to our program beating ACSM in regards to hypertrophy was the inclusion of creatine monohydrate into the diet. Studies10,8 have show that the use of creatine monohydrate has lead to increases in fat free mass and also gains in strength. The increase in fat free mass and hypertrophy above ACSM in our client could have resulted from this extra intake of the supplement.
(2) Overtraining is defined as an excessive frequency, volume, or intensity of training, resulting in fatigue11. The first 6 weeks of our program demonstrated alarming signs of overtraining on our client’s body. We were forced to decrease our programs overall volume by first reducing the number of days per week our client exercised from 3 down to 2 and then reduce the overall volume of training (number of exercises). We did this because our initial program had excessive frequency and intensity that resulted in fatigue and knee pain.
We also split our new routines into both a strength focused and hypertrophy focused programs with differing numbers of repetitions and intensities so muscle adaptation could be specific for each type of training mode12, especially strength which decreased after our first 6 weeks primarily due to our high rep range.
We also increased our rest interval time because of De Sallas et al.3 study that concluded that 90 seconds was an inefficient amount of time when compared to 3 mins for the muscle to completely recover between sets and perform at a greater rate or volume. The main change made in the second six week program for the nutrition was to separate the ingestion carbohydrates post exercise making the meals more frequent and separated by 30 minutes. The ingestion for these meals was changed to 1.5g.kg-1. This change is based on the findings by Doyle13 who found that with these ingestion times and amounts synthesis rates are increased by 25-30%. This study is supported by Burke et al.14 who tested four large meals verses 16 hourly snacks. Eating more meals showed higher sustained insulin and glucose levels. Due to the fatigue and pain the client was experiencing after the first 6 weeks, we gave the client week 7 off from training, and assigned them stretches, light swimming and also a massage in order to let them rest and recover so they could continue on for the remainder of their program.
(3) As this program has been developed to focus mainly on the development of the squat strength, the program has been using the same 4 exercises for the last 6-week period. In order for the client to maintain motivation and not become bored of this program, there should be a variation of exercises, but keeping the squat exercise in the program so the goals can still be met. Other exercises can also help to focus on fat loss and the improvement in hypertrophy. Cardiovascular exercises can be incorporated into the sessions with some high intensity circuits involving large compound exercises such as the squat, deadlift, chin ups, push-ups and short bursts of exercises such as rowing or sprints. This will help maintain the goals of improving the squat strength, but will greatly help with the increase of fat free mass if the diet is sufficient, and also help to lower the clients body fat percentage15. With this increase in energy use from the circuits, there must be an increase and adaptation to the dietary plan in order to provide sufficient nutrients to maintain all the clients goals.

References

1. Rhea MR, Alvar BA, Burkett LN, Ball SD. A meta-analysis to determine the dose response for strength development. Medicine and science in sports and exercise. 2003;35:456-464.

2. Marshall PWM, McEwen M, Robbins DW. Strength and neuromuscular adaptation following one, four, and eight sets of high intensity resistance exercise in trained males. European Journal of Applied Physiology. 2011;111:3007-3016.

3. de Salles BF, Simão R, Miranda H, Bottaro M, Fontana F, Willardson JM. Strength increases in upper and lower body are larger with longer inter-set rest intervals in trained men. Journal of science and medicine in sport / Sports Medicine Australia. 2010;13:429-433.

4. Schoenfeld BJ. The mechanisms of muscle hypertrophy and their application to resistance training. Journal of strength and conditioning research / National Strength & Conditioning Association. 2010;24:2857-2872.

5. Hargreaves KM, Hawley JA, Jeukendrup AE. Pre-exercise carbohydrate and fat ingestion: effects on metabolism and performance. Journal of Sport Science. 2004; 22(1): 31-38.

6. Ratamess NA, Kraemer JS, Volek MR, Rubin AL, Gomez DN, French MJ, Sharman MM, Mcguigan T, Scheett K, Hakkinen DN, Newton RU. The effects of amino acid supplementation on muscular performance during resistance training overreaching. J. Strength Cond. Res. 2003; 17:250– 258..

7. Wojtaszewski, F, Nielson P, Kiens B, Richter E. Regulation of glycogen synthase kinase-3 in human skeletal muscle: effects of food intake and bicycle exercise. Diabetes, 2001;50: 265–269.

8. Tarnopolsky M, Parise G, Yardley J, Ballantyne S, Olatinji S, Phillips. Creatine-dextrose and protein-dextrose induce similar strength gains during training. Medicine and Science in Sports and Exercise, 2001;33; 2044-2052.

9. John L Ivy, Lisa M Ferguson. Optimizing Resistance Exercise Adaptations Through the Timing of Post-Exercise Carbohydrate-Protein Supplementation. Strength and Conditioning Journal. 2010;32:30-36.

10. Olsen S, Aagaard P, Kadi F, Tufekovic G, Verney J, Olesen L, et al. Creatine supplementation augments the increase in satellite cell and myonuclei number in human skeletal muscle induced by strength training. Journal of Physiology, 2006;573: 525-534.

11. Nick Sharp, Gerald Masterson. Monitoring Your Athletes vs Overtraining. Coach and Athletic Director. 2007;76:48
12. Campos GER, Staron RS, Luecke TJ, et al. Muscular adaptations in response to three different resistance-training regimens: specificity of repetition maximum training zones. European journal of applied physiology. 2002;88:50-60

13. Doyle JA, Sherman WM, and Strauss RL. Effects of eccentric and concentric exercise on muscle glycogen replenishment. Journal of Applied physiology. 1993. 74: 1848-1855.

14. Burke M, Collier R,Hargreaves M. Muscle glycogen storage after prolonged exercise: the effect of the glycemic index of carbohydrate feedings. Journal of Applied Physiology. 1993;75: 1019–1023.

15. Boutcher SH. High-intensity intermittent exercise and fat loss. Journal of obesity. 2011;2011:868305-10.