Guest Column

Matching goal to exercise intensity


It’s that time of year when we tend to reflect on the past and look to the future. We set goals for ourselves, and sometimes these goals are on fitness and health.

However, the outside weather around here in the winter may limit outdoor activities as a way to improve our fitness and activity level.

Some tend to look to their local gyms as a place to exercise. But how do we decide where to begin? What machines? How much weight? How many repetitions? How often? Of course, there are sometimes trusted fitness professionals at the gyms who can assist.

Others will look to the internet and exercise videos to help. These can be a bit more structured and informative. The issue with this option is the lack of interaction between instructor and participant. Are goals discussed? Is it tailored to meet the individual’s specific needs? Are past or current medical conditions taken into consideration?

One of my patients that I treat for lower back pain issues relies on online videos for her fitness and exercise but consistently comes in with issues related to some of the exercises she is trying to do. I frequently have her perform her routine with me correcting her form. I also have given her instruction on the purpose of different exercises and what the dosage should be based on the desired effect.

Exercise dosage is not something most folks consider. The general tendency is to use the old and true concept of three sets of 10. However, this is not the best strategy as, again, it is not specific for a purpose.

As a doctor of physical therapy, and someone who has achieved board certification in orthopedics and serves as an adjunct faculty member for the University of North Florida DPT program, exercise dosing has become a crucial area of knowledge for myself, not just for my patients but also my students.

Medical exercise therapy is a concept introduced in the 1950s by Norwegian physiotherapist Oddvar Holten, through which he created a model of exercise intensity based on a specific number of repetitions called the Holten Curve. The Holten Curve gives instruction on the number of repetitions of a given weight that produces fatigue and the functional quality targeted.

For instance, if one wants to work on power, five repetitions to fatigue, general strength would be 10-15 repetitions to fatigue (hence the three sets of 10). Endurance would be 25-30 repetitions to fatigue. Sometimes, the goal may not be a strength change necessarily; it could be a stimulus for tissue healing or reduce swelling and could even be for pain relief with the repetitions being greater than a 30 count and no fatigue is produced.

Knowing your exercise dosage is key to achieving the results you may be after. Proper exercise dosing is even more important if one has a current or past medical problem, particularly a musculoskeletal issue.  That is why the concept of medical exercise therapy and the Holten Curve was developed by a physiotherapist.

Physical therapists are movement specialists who have a keen understanding of anatomy, physiology, biomechanics and can examine individuals to identify specific impairments related to functional deficits. Their interventions should always be patient-centered and rely on quality research and the latest evidence. This allows for a much safer, efficient and specific plan of action. One would hope their physical therapist is also knowledgeable in medical exercise therapy as well for the reasons mentioned in this article. Consulting your physician is typically recommended when beginning an exercise routine; however, a licensed and experienced physical therapist also can be a good resource when looking to improve your health and wellness, particularly in the presence of an underlying physical issue.

Dr. Chris Kopp PT, DPT is a licensed doctor of physical therapy and is a board-certified orthopedic clinical specialist and owner of Premier Physical Therapy. He can be reached at or by calling 904-996-6922 or online at