Downloaded from http://jramc.bmj.com/ on April 30, 2017 - Published by group.bmj.
com
1
Academic Department for
Military Rehabilitation, Defence
Medical Rehabilitation Centre
(DMRC), Headley Court, Surrey,
UK
2
Complex Trauma Unit, DMRC,
Surrey, UK
Correspondence to
Dr Jakob Kristensen, MPhil,
CSCS, Higher Scientific Officer
(HSO), Academic Department
for Military Rehabilitation,
Defence Medical Rehabilitation
Centre, Headley Court, Epsom,
Surrey KT18 6JW, UK;
jakob.kristensen711@mod.uk
To cite: Kristensen J,
Burgess S. J R Army Med
Corps 2013;159:35–39.
Kristensen J, et al. J R Army Med Corps 2013;159:35–39. doi:10.1136/jramc-2013-000008
A comparison of two 3-week resistance training
programmes commonly used in short-term
military rehabilitation
Jakob Kristensen,1 S Burgess2
ABSTRACT
Introduction Resistance training is an important com-
ponent of rehabilitation due to its ability to increase
muscular strength and enhance functional ability. The
aim of this study was to assess the effects of two differ-
ent resistance-training programmes currently used in mili-
tary rehabilitation.
Method 27 male rehabilitation patients, serving with the
Armed Forces and suffering from a range of lower limb mus-
culoskeletal injuries were divided into two matched groups.
Group 1 (n=14) performed the Daily Adjusted Progressive
Resistance Exercise (DAPRE), whereas Group 2 (n=13)
performed the Functional Strength Training (FST). An 8 repe-
tition maximum (8RM) deadlift and countermovement verti-
cal jump (CMVJ) test were used as Functional Assessment
Tests (FATs) and as measures of changes in strength and
power, respectively. Both were conducted on admission and
at discharge.
Results Lower limb strength and power increased signifi-
cantly in both the DAPRE (p≤0.001/p≤0.001) and the FST
(p≤0.001/0.001) groups. There was no significant differ-
ence between groups for either strength (p≥0.05) or power
(p≥0.05).
Conclusions Short-term resistance training during
rehabilitation can lead to gains in strength and power
despite differences in programme design. However we con-
clude that three weeks of resistance training is insufficient
duration to see significant differences between different
training protocols.
INTRODUCTION
Resistance training is an important component of
rehabilitation due to its ability to increase muscular
strength and enhance functional ability.1–4 The resist-
ance training component of the military rehabilitation
model has traditionally been administered using the
Daily Adjusted Progressive Resistance Exercise
(DAPRE) protocol. This system was first developed by
Knight in 19795 as an easy way of applying progres-
sive overload to a resistance training programme in a
rehabilitation setting (Table 1).
However, there are inherent concerns with the
use of the DAPRE protocol as a resistance training
method. Evidence shows that resistance training
induces neural adaptations, both within the central
nervous system (CNS) and peripheral nervous
system (PNS).6 7 These neural adaptations result in
increased maximal strength and rate of force devel-
opment (RFD) within the trained musculature. It is
widely accepted that loads above 70% of 1
Repetition Maximum (1RM) are needed to elicit
neural or morphological adaptations in skeletal
muscle in response to resistance exercise8–10 When
Original papers
extrapolating from repetition continuum tables it
is evident that a 10RM load, as utilised by the
DAPRE protocol, corresponds to approximately
70% of 1RM11–14 and therefore is of sufficient
intensity to induce improvements in maximal
strength. However, the two first sets of the DAPRE
loading protocol merely employ a percentage of
the 10RM and consequently do not fall within the
intensity bracket needed to improve maximal
strength. Thus, in effect the DAPRE system only
features two main work sets that fall within the
required intensity range. Whilst strength increases
have been observed with single and double set/low
volume resistance training programmes it is
widely accepted that a multiple set approach to
resistance training results in enhanced physiological
adaptations that is, increased strength and muscle
mass.14–18 Another possible issue with the use of
the DAPRE system is the fact that it is generally
used with resistance training machines rather than
free weights. Evidence suggests that performing
the same movement with free weights (FF) versus
fixed-form resistance machines (FX) leads to signifi-
cantly higher activation of stabiliser muscles19 20
Enhanced activation of these is generally consid-
ered to be beneficial in patients suffering from mus-
culoskeletal injuries.1 2
In an attempt to overcome these problems an
alternative resistance training programme, which
follows more recent guidelines for resistance pro-
gramme design1 9 14 has also been utilised at the
Defence Medical Rehabilitation Centre (DMRC).
This ‘functional strength training’ (FST) pro-
gramme (Table 2) is based on the three powerlifts
(squat, bench press, deadlift), while the remainder
of the training volume is made up of functional
exercises which are derivatives of the core lifts
(overhead squat, step-up, lunges, Romanian dead-
lifts, high-pulls). Patients typically perform 3–5
exercises with each exercise comprising four sets of
4–6 repetitions at 80–85% of 1RM. All four sets
for each exercise are completed before moving to
the next exercise. This programme is repeated three
times per week and the training load increased
weekly based on the ‘2 for 2’ rule described by
Baechle et al.14
The military currently only runs 3-week rehabili-
tation courses at the DMRC; however there are
no current studies investigating the magnitude of
improvements seen in such a short timeframe.
Furthermore, no previous studies have investigated
the effects of DAPRE versus functional resistance
training methods on measures of strength and
power within a rehabilitation context. Based on the
35
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Original papers

Table 1 DAPRE loading protocol as developed by Knight5 Table 3 Anthropometric characteristics of participants (mean
SET 1 2 3 4
values with standard deviation in brackets)
Group N Age (years) Height (cm) Weight (kg)
RESISTANCE 10 reps @ 50% of 6 reps @ Max Max reps @
10RM (established at 75% of reps @ adjusted weight DAPRE 14 30.7 (5.4) 177.2 (7.5) 82.6 (6.3)
baseline) 10RM 10RM (+2.5–5 kg)
FST 13 31 (6.5) 178.1 (4.8) 84.7 (6.5)
Rest between Sets: 3–5 mins.
Training frequency: Every day. RM, repetition maximum.

participants in the FST group only completed 7 resistance train-

current evidence in the literature we hypothesised that patients
in the FST group would exhibit significantly better improve-
ments in strength and power when compared to the DAPRE
group. The aim of this study was therefore to assess the effects
of two different resistance-training programmes currently used
in military rehabilitation.
METHOD
Patients
Twenty-seven participants were all admitted to the DMRC as
part of ongoing rehabilitation for a range of heterogenous lower
limb musculoskeletal injuries, including anterior compartment
syndrome, anterior knee pain (AKP) and patella/meniscus disor-
ders were divided into two groups. All patients were matched
for age, height, weight and gender.
Design
The overall design was considered a service evaluation in which
a matched-groups analysis of successive cohorts was utilised.
Group 1 performed the DAPRE protocol while Group 2 per-
formed the functional strength training programme (FST).
Lower body strength was assessed in both groups at admission
and discharge using the 8-RM deadlift. Evidence suggests that
the deadlift, due to its muscle recruitment pattern may be an
effective closed kinetic chain (CKC) exercise to employ in lower
limb rehabilitation.21 Due to the untrained nature of the
patients a trap-bar was used for ease of execution. Lower body
power was assessed in the same testing sessions using the
counter-movement vertical jump (CMVJ). This test has served
as the field test of choice in determining lower body power for
decades,1 9 14 and has been validated accordingly.22
Due to the increased training frequency advocated by the
DAPRE protocol, participants in this group completed 13 resist-
ance training sessions during their admission period, whereas
ing sessions.
Statistics
A one-way analysis of variance (ANOVA) was used to assess
changes in response to the two resistance training programmes.
Overall gains within groups was analysed with a paired t test.
The alpha level was at p≤0.05 for all analyses. All statistical ana-
lyses were carried out using SPSS V.16.0 (SPSS Inc. USA).
RESULTS
Anthropometric results for the 27 male rehabilitation patients
that participated in this study can be seen in Table 3. Values
given were those on admission, prior to commencement of the
exercise-based rehabilitation programme.
The within-groups results showed that lower limb power
(CMVJ score) increased significantly in both the DAPRE
( p≤0.01) and the FST ( p≤0.001) groups at discharge. The mag-
nitude of improvements in CMJ were higher in the FST group
and there was less dispersion in the overall data. Nevertheless,
no significant difference was observed between the two pro-
grammes in terms of improvements in lower-body power
( p≥0.05) (Figure 1).
Similarly, lower limb strength (DL score) increased signifi-
cantly in both the DAPRE ( p≤0.001) and the FST ( p≤0.001)
groups at discharge. The relative magnitude of improvement in
the two intervention groups is presented in Figure 2. No signifi-
cant difference was observed when comparing the effects of the
two different resistance training protocols on lower body
strength development.
DISCUSSION
The results of the present service evaluation indicate that during
a 3-week rehabilitation programme the DAPRE and FST resist-
ance training programmes are equally effective at improving
measures of lower limb strength and power in a group of
patients suffering from a range of lower limb musculoskeletal

Table 2 Example of a functional strength training session (X denotes as explosively as possible)

Exercise Loading Tempo Rest Progression Frequency

Back Squat 4 sets 40X 3–5 mins Add 2,5–5 kg 3× per week
4–6 reps 2 for 2 rule
8RM (85% 1RM)
Bench Press 4 sets 40X 3–5 mins Add 2,5–5 kg 3× per week
4–6 reps 2 for 2 rule
8RM (85% 1RM)
Trap Bar Deadlift 4 sets 40X 3–5 mins Add 2,5–5 kg 3× per week
4–6 reps 2 for 2 Rule
8RM (85% 1RM)
Dumbbell Lunge 4 sets 40X 3–5 mins Add 2,5–5 kg 3× per week
4–6 reps 2 for 2 rule
8RM (85% 1RM)
RM, repetition maximum.

36 Kristensen J, et al. J R Army Med Corps 2013;159:35–39. doi:10.1136/jramc-2013-000008

 Downloaded from http://jramc.bmj.com/ on April 30, 2017 - Published by group.bmj.com
Figure 1 Increases in Power (CMVJ)
in response to the two training
protocols. Error bars represent
standard error of mean (SEM).
injuries.. However, use of the FST programme appears to be
associated with a lower variability in the training outcome. The
DAPRE programme was characterised by a very large variation
in the results i.e. responders vs. non-responders, whereas all
subjects in the FST showed improvements in muscle strength
and power.
Although no significant differences were observed in the
present study between the DAPRE and FST resistance training
programmes the relative improvements were of a greater magni-
tude in the FST group. It is possible that these differences could
have reached statistical significance with a greater sample size or
if the resistance training programme would have been extended
beyond the 3-week mark, as evidence suggests that strength and
power continue to develop and reach higher magnitudes after
6–10 weeks of continued resistance training.1 9 10 Thus, the fact
that the DMRC currently only runs 3-week rehabilitation
courses, due to logistical constraints, may limit the benefits of
the resistance training programmes. However, the present study
Figure 2 Increases in deadlift
strength in response to the two
training protocols. Error bars represent
standard error of mean (SEM).
Kristensen J, et al. J R Army Med Corps 2013;159:35–39. doi:10.1136/jramc-2013-000008
Original papers
suggests that improvements in lower body strength and power
are achievable in as little as three weeks. A large body of evi-
dence suggests that the majority of these short-term improve-
ments are due to neural adaptations,1 6 7 9 10 however,
emerging evidence does suggest that significant increases in
muscle cross-sectional area (CSA) can be observed in as little as
3 weeks.23 Because we did not assess possible muscle hyper-
trophy through Magnetic Resonance Imaging (MRI) or ultra-
sound, we cannot rule out that morphological adaptations
contributed to the increased muscle strength observed in
response to either training programme.
Due to its reliance on compound multi-joint movements
coupled with a high-intensity loading protocol, the FST pro-
gramme was considered more stressful to the neuromuscular,
endocrine and immune system than the lower-intensity
weight-machine-centred DAPRE programme and thus, was only
performed 3 days a week. There is general agreement in
the literature that resistance training sessions which are
37
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Original papers
associated with a high overall body stress necessitate a reduced
training frequency1 9 10 14 18 It is therefore worth noting
that due to the increased frequency of the DAPRE programme
(13 vs 7 sessions), participants in the DAPRE programme com-
pleted a much higher training volume but failed to see a con-
comitant increase in strength and power when compared to the
FST group. It is plausible that the higher training intensity in
the FST group off-set the reduced training volume and led
to comparable results after a 3-week period. This finding
supports previous evidence in the literature which suggests that
resistance training with a higher intensity (>70% 1RM) is asso-
ciated with increased gains in strength and power, even in a
rehabilitation context.24–28 Furthermore, the total time spent
doing resistance training in the FST group was markedly less
than in the DAPRE group (90 min per week versus180 min per
week). This suggests that using the former approach to resist-
ance training in a busy rehabilitation programme, such as
Headley court, could free up more time for other rehabilitation
modalities while achieving at least the same beneficial effects on
muscle strength and power.
Although this service evaluation failed to demonstrate the
hypothesised superiority of the FST protocol it has been sug-
gested that FX movement patterns, as used in the DAPRE proto-
col, do not promote the neuromuscular coordination required
to enhance natural movement patterns.29–31 Thus, attempting to
strengthen the target musculature in isolation with various uni-
planar, Open-Kinetic-Chain movements has limited carryover
effect to the multi-planar compound movements, which patients
will encounter in a work or daily-living scenario.32 33
Conversely, correct execution of FF exercises may enhance the
development of functional strength and power in a patient
population due to significant improvements in neuromuscular
coordination.2 9 14 34–36 Thus, with regards to developing func-
tional strength, which will carry over into free-living activities,
evidence suggests that FST will be a superior training protocol.
Unfortunately, a clear limitation of this current service evalu-
ation was that the effects of the two separate training protocols
on functional ablity were not assessed. Although some research
indicates that there is a significant correlation between maximal
muscle strength and functional ability in certain types of
disease37 38 and aging,39 it is unclear whether this is also the
case in our study population with its heterogenous lower limb
injuries. Evidence indicates that muscle power may also be
strongly correlated with functional ability,40 however, based on
the literature we cannot say if this is also the case in our study
population. Thus, future research should strive to include tests
of functional ability as part of their outcome measures.
Although potentially less effective at improving functional
strength, the use of the DAPRE protocol in conjunction with
resistance training machines can possibly be useful in the most
deconditioned/de-trained subgroup of the rehabilitation patient
population.41 For these early-stage patients simply learning to
activate the target musculature again can prove challenging. In
this context, the DAPRE protocol in conjunction with resistance
machine exercises can function as an easy introduction to resist-
ance training before progression to FF or body-weight exercises.
However, based on the current literature it is likely that neither
the DAPRE protocol nor resistance machine exercises are
independently effective at maximally improving functional
strength in a patient population at the intermediate stage of
rehabilitation.
We conclude that 3 weeks of resistance training is insufficient
duration to see a significant difference between different resist-
ance training programmes. However, we recommend that the
38 Kristensen J, et al. J R Army Med Corps 2013;159:35–39. doi:10.1136/jramc-2013-000008
FST training programme is used in intermediate-stage rehabilita-
tion due to its time effectiveness and lower variability in training
outcome.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
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Kristensen J, et al. J R Army Med Corps 2013;159:35–39. doi:10.1136/jramc-2013-000008 39

 Downloaded from http://jramc.bmj.com/ on April 30, 2017 - Published by group.bmj.com

A comparison of two 3-week resistance

training programmes commonly used in
short-term military rehabilitation
Jakob Kristensen and S Burgess

J R Army Med Corps 2013 159: 35-39

doi: 10.1136/jramc-2013-000008

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