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4 Things You Should Never Exclude from your Exercise Program

I can’t speak to everyone on this, but the current selection of fitness options makes my head spin sometimes. The upside of this is that many of these fitness options are really fun, group based, and serve as a great way to make friends.

I’ve tried a number of different fitness avenues including group bike rides, run clubs, climbing gyms, and group fitness classes. However, the pandemic changed my routine a little bit by closing a lot of the gyms and in person options.

During this time I wanted to figure out how to design the optimal home program. In order to do so I needed to establish some kind of foundation or goal of what my workout needed to include.

My wife and I also had our first kid over this time so spending 2-3 hours on a given night at the climbing gym or a night bike ride around Atlanta was less feasible. That meant that the exercise plan had to be time efficient and include exercises that provide the most benefit for the given amount of time.

It turns out that there is a lot of research that goes into exercise and exercise dosage. Those researchers have developed four types of workouts to focus on. Those types are cardiovascular training, balance training, strength training, and flexibility training. An ideal workout program contains all of these aspects.

1. Cardiovascular Training

Everyone loves a good cardio workout. With that being said, what makes a good cardio workout and how do you measure its effectiveness? As I looked and researched this there were lots of opinions that included distance moved, time moving, and heart rate.

The two general variables to think about are time and intensity.. Time is easy to measure where intensity is a little more difficult. Intensity can be measured through heart rate as well as perceived exertion. This is a fancy way to say how difficult does this feel? The ability to hold a conversation during the exercise is an easy way to measure this.

Sustaining longer bouts of moderate cardiovascular exercise is good for endurance at a given level but doesn’t necessarily increase the ability of the cardiovascular system to handle activity that’s more difficult than moderate exercise. That’s why it’s good to include some version of high intensity exercise because it increases the capacity of the system and this training has also been shown to have other systemic benefits including improving mental health measures as well.

If you have a condition that limits your cardiovascular endurance, then it is wise to consult with a MD and/or a PT who can help create a plan that is safe and specific to your needs. Modifications that could help include specific programming or using different equipment (rowers, bike, etc) that helps you build up your tolerance to higher levels of activity.

The times below are the recommended guidelines for the volume or how much cardiovascular training one needs per week. These times are not recommended to be done all at once and can be broken down into smaller chunks of time throughout the week.

  • Cardiovascular Training

    • 150-300 min per week at moderate intensity (Hard enough to sweat but still hold conversation)

    • OR

    • 75-150 min per week at high intensity (Sweating, heavy breathing, difficult to hold conversation)

2. Balance Training

I’ve taken a couple courses on golf and running movement analysis. During these classes the participants are asked to test our balance through different movement tests. I noticed that even though I was faster or seemingly hitting the golf ball well my balance wasn’t what it was 10 years ago. It was my first experience of how our balance changes over time.

Balance can ultimately be seen as a conversation between nerves in your body that are constantly providing your brain with updates. Your brain considers all of this to tell muscles how to respond. As your muscles respond the nerves continue to update the brain and the process continues. Like any skill or movement, you need to keep practicing to keep these lines of communication open between our nerves, brain, and muscles.

Another way to think about it is that even if you were a high level baseball player in high school or college and haven’t played in 30 years, you would probably have a harder time hitting an 85 mph curveball now than in your prime when you played often. If we do not something as simple as standing on one leg on a consistent basis, we will have a really difficult time standing on one leg as we get older where it will be much more difficult to improve your balance quickly.

Maintaining good balance will benefit us as we get older. Improving your balance does not have to be standing on leg waiting for a timer to end as well. Balance training can be combined with strength training to maximize your time. Things like lunges, split squats, and other single leg exercises can help with your balance. A lot of core training can also be worked into balance training as well.

  • Balance

    • 2-3 days per week (20-30 min sessions) for balance, agility and coordination

      • Balance Level 1: single leg balance, tandem stance balance

      • Balance Level 2: Single leg deadlift, hip airplanes

      • Coordination: jump rope high cadence, step taps, ladder drills

3. Strength Training

I’ve always been more cardio or endurance focused in my workouts partly because I was always inherently better at this compared to strength training. However, I was looking into all the benefits of strength training in combination with long distance sports like running or cycling and it convinced me to focus more on it. It turns out that supplemental strength training doesn’t make you huge overnight and slow you down while running, it actually helps your muscles move more efficiently during the endurance sport.

Strength training is a key component to any exercise program. The benefits of strength training occur over longer periods of time. Initial muscle growth from exercise occurs after 6-8 weeks of continually challenging and progressing your strength workouts. This may seem like a lot of work, however, if you stick with it, habits will get formed and you will see the benefits over time.

  • Strength

    • 2-3 days per week with 2-4 sets including a combination of strength, power and endurance exercises

      • 8-12 reps per set = strength + power (weighted squats, deadlifts, pullups, kettlebell swings)

      • 10-20 reps per set = endurance (lightweight snatch, overhead dumbbell press or rows)

    • Allow 36-48 hours of recovery time between strength workouts

4. Flexibility

I don’t know about you, but the hardest part of the elementary school Presidential Fitness Test was the sit and reach test. As far as I was concerned, sitting and touching my toes with straight knees was about as feasible as my 3rd grade self dunking a basketball on a 10 foot goal while being 4 1/2 feet tall, uncoordinated, and weighing 70 lbs.

Flexibility is key for maintaining joint mobility. Allowing your joints to move and “flex” in a full range of motion helps protect against arthritis because that movement helps keep your joints lubricated. Stiffness and inflammation in your joint happens with prolonged immobility. Once certain joints are stiff, basic multi-joint functional movements like a squat can be painful or difficult because stiffness in one joint can lead to compensations in others.

Static stretching is one way to accomplish this and is helpful with pain relief and generally best done at the end of a workout. An active warmup is usually the best way to get the joints moving prior to a workout. See Lauren’s blog on the difference between stretching and warming up for more info.

  • Flexibility

    • 2-3 days per week (20-30 minute sessions)

    • Hold each stretch for 1-2 minutes at a time

    • No bouncing, just a static hold!. Static stretching is better after strenuous activity whereas an active warm up is better before activity.

Benefits of Skeletal Muscle Mass

I always associated a lot of skeletal muscle mass with Arnold Schwarzenegger telling a classroom of little kids in Kindergarten Cop that his muscle is not a tumor! However, I can assure you that getting to Arnold -in his prime- size (or even half of that) takes very specific and dedicated training and diet. You should not be hesitant to include strength training into your weekly routine out of fear of bulking up too much.

The goal in terms of how much percent skeletal muscle mass is 45% or higher for females and 50% or higher for males. The upside of building up to this number means that percent body fat will go down in the process. Body fat is not inherently bad, but excessive body fat can lead to increased inflammation. Increased inflammation can degrade tissues (ex cartilage, tendons) and ultimately decrease your pain tolerance.

Research is finding associations with more skeletal muscle mass and mortality and even brain mass. Increased strength has also been found to lessen the onset of arthritis. The general trend is that more muscle makes a person more resilient to injury, disease, and death as well as stronger ligaments and cartilage.

This seems like a lot!

As I was looking at these recommendations, I couldn’t help but think about how much less sleep this was going to lead to. Please remember that reaching these numbers often takes time to build up your body’s tolerance to activity. 50% muscle mass also does not happen overnight. These recommendations are based on research that shows long term health benefits are associated with maintaining this level of activity over time. We put a lot of time and investment into working to create wealth for our current and future lifestyles and adding that same investment for your health will lead to you feeling better now as well as in your future.

  • Plan out your week and break it into 3-4 workouts a week that includes all these types of exercise

  • Balance training can be fun. Think about going to the climbing gym or taking a yoga class!

  • Use interval training or sports for high intensity exercise.

  • Hire a coach! External motivation can go a long way with staying consistent with an exercise program. There’s plenty of great coaches and trainers in Atlanta and we’re happy to recommend you to a few if that would help.

  • Set a goal, find a friend, and/or join a class that includes all of these elements. Fitness is a lot more fun with friends.

5 Point Check Up

Lastly, measuring progress helps with motivation in the long term. At Functionize, our 5 Point Check Up is a great way to do that. It’s a comprehensive assessment of strength, function, endurance, movement, neurological screen, and body composition measurements of muscle mass and body fat percentages through an InBody scan. The 5 Point Check Up is similar to your bi-annual dentist visit. It identifies problem areas and gives you things to work on long before the pain sets in. This is also useful when you begin a new workout routine to determine if the exercises are actually helping you achieve your fitness goals. We recommend doing this once per year.


  • 5 Point Scan

    • InBody Scan to determine your actual body composition

    • Neurological testing

    • Joint range of motion testing

    • Endurance testing

    • Strength Testing

Thanks for reading!

Tyler Balfour, PT, DPT

Tyler and his family currently live in Decatur where he enjoys rock climbing, cycling, running, golf, and playing yard games in his free time. Being outside and moving energizes him and he seeks to use the highest quality of care to help his patients overcome physical impairments so they too can get outside and move.


  1. Martland et al. Can high-intensity interval training improve mental health outcomes in the general population and those with physical illnesses? A systematic review and meta-analysis. 2020

  2. Saeterbakken AH, Makrygiannis P, Stien N, et al. Dose-response of resistance training for neck-and shoulder pain relief: a workplace intervention study. BMC Sports Sci Med Rehabil. 2020;12:8.

  3. Blangsted AK, Søgaard K, Hansen EA, Hannerz H, Sjøgaard G. One-year randomized controlled trial with different physical-activity programs to reduce musculoskeletal symptoms in the neck and shoulders among office workers. Scandinavian Journal of Work, Environment & Health. 2008;34(1):55-65.

  4. Welch N, Moran K, Antony J, et al. The effects of a free-weight-based resistance training intervention on pain, squat biomechanics and MRI-defined lumbar fat infiltration and functional cross-sectional area in those with chronic low back. BMJ Open Sport Exerc Med. 2015;1(1):e000050.


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