Exercise Professional Education

02/24/2026

Gotta be careful about when to initiate active ROM post rotator cuff repair…

Healing After Surgical Repair? A Systematic Review and Meta-analysis

“Background:
The timing of passive range of motion (ROM) after surgical repair of the rotator cuff (RC) has been shown to affect healing. However, it is unknown if early or delayed active ROM affects healing.

Purpose:
To determine whether early versus delayed active ROM affects structural results of RC repair surgery.

Study Design: Systematic review and meta-analysis.

Methods:
A systematic review of articles published between January 2004 and April 2014 was conducted. Structural results were compared for early (\6 weeks after surgery) versus delayed (!6 weeks after surgery) active ROM using chi-square and Fisher exact tests, as well as relative risks (RRs) and 95% CIs. The analyses were stratified by tear size and repair method.

Results:
A total of 37 studies (2251 repairs) were included in the analysis, with 10 (649 repairs) in the early group and 27 (1602 repairs) in the delayed group. For tears "3 cm, the risk of a structural tendon defect was higher in the early versus delayed group for transosseous plus single-row suture anchor repairs (39.7% vs 24.3%; RR, 1.63 [95% CI, 1.28-2.08]). For tears .3 cm, the risk of a structural tendon defect was higher in the early versus delayed group for suture bridge repairs (48% vs 17.5%; RR, 2.74 [95% CI, 1.59-4.73]) and all repair methods combined (40.5% vs 26.7%; RR, 1.52 [95% CI, 1.17-1.97]). For tears .5 cm, the risk of structural tendon defect was higher in the early versus delayed group for suture bridge repairs (100% vs 16.7%; RR, 6.00 [95% CI, 1.69-21.26]). There were no statistically significant associations for tears measuring "1, 1-3, or 3-5 cm.

Conclusion:
Early active ROM was associated with increased risk of a structural defect for small and large RC tears, and thus might not be advisable after RC repair.”

Am J Sports Med published online May 5, 2015 Melissa A. Kluczynski, Maureen M. Isenburg, John M. Marzo and Leslie J. Bisson A Systematic Review and Meta-analysis Does Early Versus Delayed Active Range of Motion Affect Rotator Cuff Healing After Surgical Repair?

02/19/2026

Tough article for exercise professionals advocating for “stretching” …

Stretching not exactly a pillar of fitness, 20 experts agree.

20 stretching experts pooled their expertise for an ambitious consensus paper (Warneke et al. PMID 40513717).

This is not a “scientific review,” exactly: it formalizes expert opinion of existing reviews, which is more clinically useful, more PRACTICAL and broader in scope than a scientific review.

The clickbait headline for this would be “The Great Stretching Myth: 20 Scientists Reveal What Actually Works — and What Doesn’t.”

And it doesn’t work for much.

Speaking of consensus, this paper mostly has my back on everything I’ve ever written about stretching. It’s like a summary of my own work on the topic!

HERDING EXPERT CATS

A bunch of experts is a proverbial “herd of cats,” so how do you get them on the same page? You use a structured “Delphi” process — a formal, multi-round method for reaching expert agreement. The all met up to kick things off, and then after that it was all written opinions, iterative and anonymized (although I bet some opinions didn’t have to be signed to be recognizable). They settled on definitions for the three main types of stretching: static (holding a muscle at length), dynamic (controlled movement through range), and PNF (a combination of stretching and muscle contraction).

They were more divided on the definition of “dynamic stretching” than anything else they covered — just 80% agreement. Very on-brand for exercise science. 😏

After definitions, they reviewed the reviews on eight major stretching topics: range of motion (ROM), strength, muscle growth (hypertrophy), stiffness, injury prevention, recovery, posture, and cardiovascular health.

THE LEAST BAD NEWS: FLEXIBILITY

The clearest finding (95% panel agreement): stretching reliably improves flexibility. “It is known”: both short-term (acute) and long-term (chronic) stretching increase ROM. But curb your enthusiasm, because stretching is not the only way to unlock this achievement — other activities like resistance training or foam rolling can improve flexibility just as well, and arguably resistance training offers far better bang for your exercise buck.

And it’s also the only benefit of stretching the panel confirmed wholeheartedly. All other benefits were minimal and heavily disclaimed.

THE NEXT CLOSEST THING TO GOOD NEWS: FLEXIBLE BLOOD VESSELS

Warneke et al. give us a very cautious recommendation to stretch for … cardiovascular health? There’s some evidence that stretching reduces arterial stiffness and improves cardiovascular health. But the evidence isn’t good enough yet, and this benefit (like flexibility) can likely be had better with other kinds of exercise — leaving it only as a practical option “for those unable to engage in active (therapeutical) exercise.”

PLENTY OF MIXED AND BAD NEWS

They also acknowledge that stretching might reduce the stiffness of muscles or tendons, but with important caveats: it takes a huge dosage, it’s not a strong effect, and it’s not even clearly a good thing (tendon stiffness is probably a FEATURE, not a bug).

On strength and muscle size: a good dose of stretching (>60s) makes you temporarily weaker, acutely undermining explosive effort. Over weeks, high-volume static stretching can (weirdly) increase strength and muscle mass — but only slightly and requires a surprising time investment: do 15 minutes per muscle per day for six weeks, and you may not have time for much else, and all for what? “Slight” strength gains. The panel bluntly states stretching is not recommended as a primary strategy for building strength or muscle.

Injury prevention? Despite decades of hopeful practice and research, the thin evidence definitely does not support stretching as a general injury-prevention tool. Some data suggest static stretching might reduce muscle injuries, but maybe at the COST of more bone/joint injuries (plausible, but based only on scraps of evidence so far).

Soreness? Does it take the edge off? The panel agreed 100% on this one: no!

The other recommendation they were unanimous on: don’t bother stretching to improve posture. Not that posture generally needs much improving. But even if it did, stretch wouldn’t help.

“MORE STUDY NEEDED,” OF COURSE — BUT IT’S SURE NOT LOOKING GOOD FOR STRETCHING

Some limitations: the panel was overwhelmingly male, they focused on healthy populations, and they relied on existing systematic reviews — which rest on a foundation of trials that leaves much to be desired. As the authors note, “scientific research is an ever-evolving process,” and “a number of stretching applications have barely been explored in the literature.”

Stretching is nowhere close to being a pillar of fitness like so many people assume. It has only a couple known or half-known benefits, and even those aren't clean wins, because other kinds of exercise do the same and more. Stretching remains something to do almost entirely because it feels good; most common goals that people have in mind for it are faith-based at best, or actually contradicted by the science we have so far.

~ Paul Ingraham, PainScience.com publisher

02/17/2026

Assessing Agreement in Lower-Body Joint Interlimb Asymmetries in Isometric, Dynamic, and Loaded Conditions

"Abstract
Rosenblum, LJ, Lovalekar, M, Martin, BJ, Feigel, ED, Mroz, KH, McCarthy, AM, Koltun, KJ, Stefl, TJ, Forse, JN, Doyle, TLA, and Nindl, BC. Assessing agreement in lower body joint inter-limb asymmetries in isometric, dynamic, and loaded conditions. J Strength Cond Res XX(X): 000–000, 2025—Interlimb asymmetry (ILA) for static and dynamic movements can indicate aberrant musculoskeletal and neuromuscular function. The purpose of this analysis was to measure ILA agreement in different isometric, dynamic, and loaded conditions at the ankle, knee, and hip, for single-joint and lower-body ILA; to assess the effect of a load on kinetic and kinematic ILA during jumps; and to evaluate the effect of physiological fatigue on gait ILA. Twenty-two men (30.2 ± 5.0 years, 1.8 ± 0.08 m, 85.6 ± 10.0 kg, 16.9 ± 5.4% body fat) participated in ankle, knee, hip, and lower-body assessments of relative (N·kg−1) and peak isometric strength (N); dynamic peak range of motion (º) and dynamic peak forces (N) without and with load (9.7 kg); and tibial impact (g) during aerobic capacity tests (pre- and at-fatigue). Agreements between ILA (≥10% vs.

02/10/2026

Poor sleep can increase Allostatic Load, and relatively higher exercise (intensity/volume) in that state can cause trouble!

Exercise-mediated modulation of autonomic nervous system and inflammatory response in sleep-deprived individuals: A narrative reviews of implications for cardiovascular health

"Abstract

Sleep deprivation is a growing concern in cardiovascular risk, causing physiological disruptions like autonomic dysregulation and inflammation. Recent research indicates that sleep deprivation increases sympathetic nervous activity while decreasing parasympathetic activity, leading to increased blood pressure, impaired endothelial function, and heightened inflammation. Exercise has emerged as a non-pharmacological approach to increase cardiovascular health. However, the impact of exercise on sleep deprivation-induced changes in autonomic activity and inflammation remains unclear. To explore this, we reviewed studies investigating the effects of acute exercise on autonomic regulation and inflammatory markers following sleep deprivation. We conducted a narrative review of the literature. PubMed/MEDLINE, Google Scholar, and Web of Science (WOS) searched the articles between May 2022 and April 2023. The papers had to: [1] focus on recent studies between 2000 and 2023; [2] consist of sleep deprivation participants; [3] be published in English. Acute moderate- to high-intensity exercise after sleep deprivation may reduce parasympathetic activity, trigger pro-inflammatory cytokines, and delay recovery to normal levels. In contrast, regular exercise routines may mitigate the adverse effects of sleep deprivation on autonomic regulation and reduce systemic inflammation. Sleep deprivation can lead to autonomic imbalance, increased blood pressure, and increased inflammatory responses, which are further amplified by acute exercise, increasing the cardiovascular burden. When sleep deprivation occurs, exercise intensity and timing should be carefully chosen to avoid adverse cardiovascular health risks."

Saputro RE, Chou CC, Lin YY, Tarumi T, Liao YH. Exercise-mediated modulation of autonomic nervous system and inflammatory response in sleep-deprived individuals: A narrative reviews of implications for cardiovascular health. Auton Neurosci. 2025 Jun;259:103256. doi: 10.1016/j.autneu.2025.103256. Epub 2025 Mar 6. PMID: 40073691.

02/05/2026

Great visit with our colleagues Raphael Justo and Mike Robles in Tampa Florida!

02/03/2026

Getting older is a real pain!

"Abstract
Older adults compared with younger adults are characterized by greater endogenous pain facilitation and a reduced capacity to endogenously inhibit pain, potentially placing them at a greater risk for chronic pain. Previous research suggests that higher levels of self-reported physical activity are associated with more effective pain inhibition and less pain facilitation on quantitative sensory tests in healthy adults. However, no studies have directly tested the relationship between physical activity behavior and pain modulatory function in older adults. This study examined whether objective measures of physical activity behavior cross-sectionally predicted pain inhibitory function on the conditioned pain modulation (CPM) test and pain facilitation on the temporal summation (TS) test in healthy older adults. Fifty-one older adults wore an accelerometer on the hip for 7 days and completed the CPM and TS tests. Measures of sedentary time, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were obtained from the accelerometer. Hierarchical linear regressions were conducted to determine the relationship of TS and CPM with levels of physical activity, while controlling for demographic, psychological, and test variables. The results indicated that sedentary time and LPA significantly predicted pain inhibitory function on the CPM test, with less sedentary time and greater LPA per day associated with greater pain inhibitory capacity. Additionally, MVPA predicted pain facilitation on the TS test, with greater MVPA associated with less TS of pain. These results suggest that different types of physical activity behavior may differentially impact pain inhibitory and facilitatory processes in older adults."

Naugle KM, Ohlman T, Naugle KE, Riley ZA, Keith NR. Physical activity behavior predicts endogenous pain modulation in older adults. Pain. 2017 Mar;158(3):383-390. doi: 10.1097/j.pain.0000000000000769. PMID: 28187102.

01/27/2026

"The Real Rule of Exercise Biology

Exercise is not a behavior.

It is a dose-dependent biological instruction set.

High-intensity and sprint training prioritize mitochondrial expansion.

Endurance training prioritizes vascular remodeling and delivery efficiency.

Volume matters only in relation to intensity.

Duration determines how fully tissue reorganizes it infrastructre.

Intensity tells muscle how much capacity is needed

Duration tells muscle how permanently to build it

If you only train one way, you send only one message.

And muscle will adapt - faithfully - to exactly what you ask of it.

Not what you meant."

Traster D., Not all exercise sends the same message: your mitochondria know the difference, Neuroscience and Neuroplasticity, Jan. 19, 2026.

Here is another, more technical version:

“Fundamental mechanical stimuli decoded by skeletal muscle

Basically, muscles can adopt three strategies of quantitative or qualitative effect on muscular phenotype to adjust for altered functional demands (Goldspink 1985): (1) positive or negative longitudinal growth; (2) positive or negative radial growth and (3) contractile [myosin heavy chain (MyHC)] and metabolic tuning.

These adaptational strategies can be adopted concurrently or separately, depending on the specificity of the (patho-)physiological condition. Generally, exercise-induced physiological conditions can be viewed as the perturbations of the muscle cells’ tensional integrity. Perturbation of tensional integrity occurs by increasing or decreasing myocellular active and/or passive tension, as well as energy production or absorption. Additionally, these tensional and energetic alterations can be sustained for different duration. Thus, every exercise condition is coded by a specific combination of changes in constant or intermittent active and/or passive tension of different duration. These temporal changes in active and/or passive tension, together with the inferred structural insults, are then decoded at the molecular level and transduced into an appropriate response.”

Toigo, M., Boutellier, U., New fundamental resistance exercise determinants of molecular and cellular muscle adaptations, Eur J Appl Physiol (2006) 97: 643–663 DOI 10.1007/s00421-006- 0238-1.

01/20/2026

It is not all about strength: rethinking mechanistic assumptions in exercise- based rehabilitation for musculoskeletal pain relief.

"CONCLUSIONS
Exercise therapy is effective across a range of MSK conditions, but its effects are likely mediated by a constellation of biopsychosocial mechanisms. Both clinicians and researchers must continue to prescribe a range of exercises, including resisted exercises, geared towards maximizing strength gains. But we must move beyond simplistic assumptions about how it helps and accept the uncertainty related to exercise prescription and rigorously investigate how and why it makes a difference."

Powell J, Wood L, Cashin AG, Lewis JS. It is not all about strength: rethinking mechanistic assumptions in exercise-based rehabilitation for musculoskeletal pain relief. Br J Sports Med. 2025 Dec 31:bjsports-2025-110372. doi: 10.1136/bjsports-2025-110372. Epub ahead of print. PMID: 41475974.

01/19/2026

Exercise Professionals!!

If you are struggling to keep up with the mindless content our industry is overproducing, we have a solution for you!

Join our Exercise Professionals Club and channel your energy into something new and fresh that’ll elevate your mind and career. This club will help you with your thinking, analysis, and decision making 💡all while giving you access to intriguing video content, interviewing skills and so much more!

Try today with using the code “club100” and get your first month free!

01/13/2026

"Exercise therapy is effective across a range of MSK conditions, but its effects are likely mediated by a constellation of biopsychosocial mechanisms. Both clinicians and researchers must continue to prescribe a range of exercises, including resisted exercises, geared towards maximizing strength gains. But we must move beyond simplistic assumptions about how it helps and accept the uncertainty related to exercise prescription and rigorously investigate how and why it makes a difference."

Powell J, Wood L, Cashin AG, Lewis JS. It is not all about strength: rethinking mechanistic assumptions in exercise-based rehabilitation for musculoskeletal pain relief. Br J Sports Med. 2025 Dec 31:bjsports-2025-110372. doi: 10.1136/bjsports-2025-110372. Epub ahead of print. PMID: 41475974.

01/06/2026

Colleagues,

Why not start the New Year exploring NEW CONTENT to support your professional development?

The Exercise Professionals Club offers unique and engaging content that will challenge your current perspectives, build on what you already know, and support your competency as a high-level problem solver using exercise.

Free First Month with code CLUB100

https://www.exerciseproed.com/become-a-member/

Here is a link to a sample video, so check it out!

https://1drv.ms/v/c/2aa57b2c8dac4e3d/IQCDi-GSz7kdQqsrAy_BPPEtAUmQ8hSbg3kfGsMJjIYgUbI?e=fZGvFA

An Exercise Professionals Club membership connects you to a community of fitness experts. Enter a deep physiology and muscle resource library to keep learning long after the classes are over!