Preparing for the Worst Part II

This past month, a few of us went to a wrestling tournament, and a couple of us older wrestlers decided to give it a go. Though I maintain a consistent training regimen that includes the strength/conditioning, cardiorespiratory and flexibility training that I’ve covered in these columns, I was physically challenged during this tournament. After my eighth and final match, I drug myself off the mat. I was gassed. “Man, I’m tired,” I said. Kahl Clark, a Butte, Mont., EMT-P/firefighter and mixed martial arts champion at 135 pounds, responded with “cardio, cardio, cardio, Johnny Boy!”

Now, Kahl knows I train cardio on a regular basis. But this time, I felt there was a deeper meaning to his words. What he really meant was this: To improve grappling endurance, cardio training needs to mimic the worst- case wrestling scenario. If you want your cardiovascular conditioning level to remain the same, then keep doing what you’re doing. But, like the advanced strength training programs I’ve discussed in my previous articles, if you want to improve cardiovascular efficiency, cardio conditioning needs to be intense.

The principle of overload states that when demands are made on body systems that the systems aren’t normally accustomed to the systems respond by becoming stronger or more efficient, given appropriate nutrition and recovery time, instead of “wearing out” or becoming weaker. This principle is usually associated with the musculoskeletal system, but it’s also true of cardiorespiratory training.

Similarly, it’s in those worst-case EMS scenarios, such as when we have to carry a patient for a prolonged period of time, that we get a real sense of whether our strength and cardio conditioning programs are doing the job. Most of us who train cardio do so at a comfortable pace that can be maintained for a prolonged period. This is fine if maintaining bodyweight is our only goal; however, it’s when the inevitable and extremely physically demanding call comes in that we realize that as EMS professionals, we must train cardio not only to maintain bodyweight for health purposes, but also to provide the best care we can to patients in need.

How Do You Rate?
Can you physically respond to the victim who’s half a mile off the road and needs help now? What if 12 inches of snow cover the ground, and there’s simply no way a motorized vehicle will get you to them?

If you said “no” to either question, you may need to give a little more attention to your cardiorespiratory conditioning program to prepare you for the inevitable, demanding call. So, what should Kahl have said to me instead as I came off the wrestling mat? “Interval training, interval training, interval training, Johnny Boy!”

Interval Training
Interval training combines higher intensity work segments with lower intensity active recovery/rest segments. For example, a 2:1 ratio may involve one minute of more intense exercise followed by 30 seconds at a slower pace. Developing your own interval training program allows you to be somewhat creative. The higher intensity segments of interval training mimic the metabolic environment of a physically demanding call, including an increase in heart rate, breathing rate and lactate levels, while the lower intensity segments allow for some recovery.

For example, if you can jog comfortably at a modest five mile per hour pace for 30 minutes or longer, then try this 11-minute interval training session:

“¢ 6 miles/hour for two minutes;
“¢ 5 miles/hour for one minute;
“¢ 6.5 miles/hour for two minutes;
“¢ 4.8 miles/hour for one minute;
“¢ 6.8 miles/hour for two minutes;
“¢ 4.8 miles/hour for one minute;
“¢ 7.0 miles/hour for one minute; and
“¢ 4.8 miles/hour for one minute.

Another interval training program I’ve found to be effective comes from Tabata and his associates, who found that seven to eight sets of interval training with a 2:1 work/rest ratio had a profound effect on aerobic and anaerobic capacities.(1) They used interval training for their national team of speed skaters, which involved 20 seconds of pedaling on a cycle ergometer at maximal levels followed by 10 seconds of sub-maximal work for seven to eight repetitions.

I’ve found this to be an efficient and effective training program. I recommend pedaling on the bike at a comfortable pace (around 80 rpms), and increase the resistance to as much as you can handle for 20 seconds at a time. As soon as you complete the 20-second interval, drop the resistance by about half for 10 seconds. This is only a four-minute interval training program. But it’s very intense (if you put effort into it), which is the major objective. So only add this if you’ve been exercising on a regular basis for at least six months. Also, the speeds involved in developing an interval training session would be experimental–it’s always advisable to be conservative. Don’t do too much too soon, but don’t be afraid to push yourself a little as you improve your physical fitness.

Be creative. As EMS professionals, we’re expected to respond to those in need regardless of how physically demanding the situation. Interval training can be implemented using any mode of exercise: cycling, stair stepping, swimming, rope-jumping or any other aerobic activity. So have fun with modifying your program, so you continue to see fitness and conditioning improvements.

1. Tabata I, Nishimura K, Kouzaki M, et al. Effects of Moderate-Intensity Endurance and High Intensity Intermittent Training on Anaerobic Capacity and VO2 Max. Med Sci Sports Exerc. 1996:28(10);1327—1330.

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