This is the 3rd part of 4 part series. Also checkout Part 2, and Part 1.
Tension. Time under tension. Duration of set.
The key concept behind my successful rehabilitation and the method I used to gain my muscle back following CABG (Coronary Artery Bypass Graft(s)) surgery was creating constructive muscular TIME UNDER TENSION.
More specifically, systematically exposing all my muscles to long duration sets with a large pool of exercises.
In strength training, a long duration for one set of a given number of repetitions is 70 seconds.
This is based on the energy systems (study) responsible for muscle contraction. When we talk about strength training (weight training), we are talking about events that last 0-70 seconds – anaerobic activity, aka, muscle contraction not limited by oxygen. When physical activity (muscle contraction) lasts longer than 70 seconds, it’s called “cardio”, aka activity limited by your ability to deliver oxygen to the working muscles (“aerobic”). By definition, all strength training (weight training) is anaerobic, “high-intensity” activity. All “cardio”, by definition is aerobic, “low-intensity” activity.
“Intensity” is not a measure of how much you sweat, or how difficult you perceive something to be.
“Intensity” is not a subjective, descriptive phenomenon, it is an objective, numerical phenomenon based on the load (weight expressed in pounds or kilos) of an event (exercise).
Intensity is quantitative, not qualitative.
Intensity is based on MATH, not OPINION. Intensity is a measure of how close you are to your 100% maximum exertion, your 1 Repetition Maximum. For example, if your absolute maximum (1RM) flat barbell press is 220 pounds (100 kg), then when you use 110 pounds (50 kg) on flat barbell press you are working at 50% intensity (50%RM). 
If your maximum front squat is 99 lbs (45 kg), then when you use 33 lbs (15 kg) on front squats you are performing reps at 33% intensity (33%RM). Intensity is mathematically related to the duration of the set (time under tension). As intensity rises, duration will fall. As duration rises, intensity will fall. Nobody lifts a heavy weight for a long time. Nobody sprints a marathon. In the strength coaching world, we say intensity and duration are inversely related. We also say, the longer the duration of the athletic “event”, the weaker the athlete. The shorter the duration of the athletic “event”, the stronger the athlete.
Effective strength training is performed primarily between 60% and 100% intensity
(33% intensity, as in the above example, would be considered warm-up weight). One hundred percent intensity describes the maximum load (weight) we can handle, an event that generally lasts just a few seconds. Sixty percent intensity describes a load (weight) that is 60% of your 1 RM (Repetition Maximum). Coincidentally, most trainees can perform (“rep out”) for approximately 60 seconds at 60% of their 1 Rep Max. 
For example, if your 1RM in the flat dumbbell press is a pair of 50 lb dumbbells, you can likely grab the 30’s (30 is 60% of 50) and perform reps continuously for about 60 seconds. This will usually be 8-15 reps, depending on your rep speed.
So, when we are talking about strength training, we are talking strictly about resistance training exercises that last 0-70 seconds. Anything over 70 seconds is called cardio (aerobic exercise), and, in the context of this article, we are not concerned about describing the optimal format for cardio.
Additionally, the human adaptation caused by strength training is defined categorically by the average duration of the set.
For example, if a set of 5 repetitions lasts less than 20 seconds, we say that the body will adapt to this stimulus with mostly neurological changes. At this duration of set, we are training the body to use, more efficiently, the muscle we already possess.
At the other end of the strength training scale, sets that last 40-70 seconds, we can expect a significantly different adaptation from this training stimulus. For example, if a set of 15 repetitions lasts 60 seconds, the body will adapt to this type of training with mostly muscular changes (body composition changes). At this duration of set, we are telling the body, “hey, it’s time for some remodeling around here“. 
Basically, the result is the body will stuff more sugar, salt, and water into the muscle cells and make the muscle fibers generally thicker and more durable (hypertrophy). Over the longer term, with chronic exposure to properly programmed strength training and the nutrition to support it, the body may actually add more muscle cells, building new muscle (hyperplasia).
Clearly, at 6’1″, 195 pounds, post-CABG, the message I need to express to my body was remodeling. Gaining 30 pounds of muscle back, drug-free, is no small task. I did not have time to waste. I needed to choose specifically the fastest way to increase muscle and lose bodyfat (or at least not gain fat).
From first hand experience, I knew the fastest and most efficient way to change my body was NOT burpees, TRX, Crossfit WODs, Synergy, boot camps, kettlebell workouts, machine-based cardio, Pure Barre, cardio kickboxing, group strength and conditioning classes, or any of the other numerous, trendy fitness options that I see so many people trying and eventually quitting due to lack of results.
If I have 4 hours per week for exercise time, and my primary goal is to gain as much muscle as possible while simultaneously losing body fat, then you can bet I will spend exactly 240 minutes each week lifting free weights in the appropriate format. I know, from 35 years of experience, that anything less than 100% of my training time lifting weights IS A WASTE OF MY TRAINING TIME. Lifting free weights is the fastest and most efficient way to change the body. And a proper understanding of what optimal strength training looks like is critical.
Fortunately, the optimal loading parameters and principles for muscle hypertrophy (growth) and physical rehabilitation are nearly identical.
When pursuing any goal, focus on the activities that maximize the return on your time and energy spent. Maximize your personal exercise ROI (Return On Investment) by performing precisely the tasks that give you the largest, most tangible return for your time and energy invested. Sometimes it is good to sweat and strain, but make sure you sweat and strain with purpose.
My rehab was complicated by a special twist, forcing me to adjust my strength training attack plan. Because the surgeons literally SAW your sternum in half to get at your heart, post-CABG patients are given a schedule of limit loads (study) for the arms in the first 6 months. Five pounds per arm limit for the first month, 10 pounds per arm limit after 6 weeks, 20 pounds per arm limit after 8 weeks, etc… by 12 weeks you are allowed to handle about 40 pounds per arm. Consequently, I was limited to 5 pound dumbbells, 10 pound dumbbells, etc… based on how many weeks post-op I was.
The risk to the sternum is real, and one mishap can really set you back. 
Fresh in my mind was the story my surgeon told me about a guy who followed the rules right to the 12th week mark, then, figuring he was all set, tried placing an air conditioner in his bedroom window by himself. The air conditioner slipped unexpectedly while placing it on the sill and he promptly snapped his sternum. The damage was so bad that you could literally take your finger and touch his heart.
Once I understood the general guidelines for my physical rehabilitation, I immediately jumped to the solution in my mind- reclaiming my body would mimic the phases of my development as a lifter. My first phase of my rehab would mirror my first experience with lifting weights. In my first exposure to weight training, when I was 12, I figured out how to grow my body with just a single, 20 lb dumbbell and my own body weight.
Given a defined limit load and confined mostly to my 8′ by 8′ foot bedroom, my younger self discovered how to achieve a seemingly impossible task. My current situation, and the solution, was disturbingly analogous – long duration of set with an emphasis on muscular tension, employing as many different free weight and body weight exercises as I could improvise.
Armed with this strategy, my workouts started with a lot of single limb dumbbell exercises and quickly evolved to something more sophisticated on paper, but just as simple in essence.
Here is a snapshot of one of my first workouts when I finally made it out of my house and back into the gym;
RECOVERY WORKOUTS:
-
- 3 Day Split Routine
Day 1: Legs Traps Core
Day 2: Chest Back
Day 3: Tris Bis Delts
REPEAT - Frequency: 6 on, 1 off
- 3 Day Split Routine
AM WORKOUT
Day 3 (Triceps, Biceps, Deltoids)
A1: seated cable row ss (semi-supinated / palms facing each other)
A2: flat db press ss
10 sets of 10 each, paired (each set lasts 60 seconds)
up to max of about 55-60lbs on rows, 22.5 dbs on presses
(Notes: perform a set of 10 reps on the rows, then a set of 10 on presses, then rows, then presses, etc, for at least 10 sets of 10 reps including warm-ups. The rest time between sets is only as long as the time it takes to move from one exercise to the other, approximately 10-20 seconds transition time)
B1: Behind The Neck (BTN) bilateral pulldowns
B2: standing db (dumbbell) press
5×12 each, paired (each set lasts 60 seconds)
(Notes: perform a set of 12 reps on the pulldowns, then a set of 12 on presses, then pulldowns, then presses, etc, for at least 5 sets of 12 reps including warm-ups. The rest time between sets is only as long as the time it takes to move from one exercise to the other, approximately 10-20 seconds transition time)
C: lying dumbbell triceps extensions (on floor), 5×15, 1 minute time under tension per set (1 min tut)
D: single arm overhead triceps extensions – 3×8, then 8/7/6/5/4/3/2/1 (each arm)
E: single arm reverse grip tricep pushdowns, 3×15, 1 min tut
F: straight bar curls, 3×15, 1 min tut
G: single arm hammer curls, 3×8, then 8/7/6/5/4/3/2/1 (each arm)
H: incline db curls, 3×8, 1 min tut
I: Arnold curls, 2×10-12, 1 min tut
This is a snapshot of an actual “Day 3: Triceps Biceps Deltoids” workout I performed in the morning, and an outline of the cardio I did in the afternoon of the same day:
PM WORKOUT
Cardio: Park Walk, 1.42 
miles, fastest time yet (logged in MapMyRun)
For the first couple months of my initial rehab phase, I used a 3 day split routine, meaning I split my strength training program into 3 distinct workout days, emphasizing specific muscles on each of the 3 days. This particular 3 day split features two thirds (67%) of my training time invested in upper body, one third (33%) invested in lower body. Although 100% of my training time was conducted in this general format maximizing blood flow, assigning 2 out of 3 days for upper body allows for concentrating on the general area I was most concerned about healing the quickest (the sternum).
Because the amount of weight I could use was limited by the strict guidelines set by my doctors, I needed to adapt this routine to something even more challenging, creating even more blood flow with light weights.
This is the 3rd part of 4 part series. Also checkout Part 2, and Part 1.
How could I possibly make this workout even more challenging and increase blood flow even more without significantly increasing the average amount of weight I was using? Find out how in the fourth and final part of this story, right here on The Perfect 105.
Paul Newt has a passion for learning in all its forms, and finds great enjoyment in conceptualizing, creating, and improving systems that lead to success. Paul spends his time training, coaching clients, being a great husband and father, consuming non-fiction books, tinkering with new technology, researching investments, and building on old, refining current, and discovering new successful methods to improve human health, performance, and appearance. Paul’s lifelong goal is to become the best version of himself, and add value to the world by assisting others in doing the same.